VN 16 study guide Test 3

Question 1

Rifampin: client education; uses; adverse effects

Answer 1

Client education: normal: red, orange, tears, Urine, sweat
Teach:Wear glasses instead of contacts due to discoloration of tears
Oral contraceptives ineffective
“Use non-hormonal back up birth control
Hepatotoxicity

Question 2

Ethambutol: adverse reactions

Answer 2

Report blurred vision or color changes
Teach baseline eye exams and routine eye exams
Optic neuritis (a decrease in visual acuity and changes in color perception

Question 3

Isoniazid: adverse reactions, contraindications.

Answer 3

I-interferes with absorption B6 (pyridoxine)
•	The vitamin B6 = peripheral neuropathy
•	Take vitamin B6 25–50 mg/day
Adverse reactions
N-Neuropathy
Report:
•	New numbness 
•	tingling extremities 
•	ataxia
H- Hepatotoxicity
REPORT immediately 
•	Jaundice (yellow) skin/sclera 
•	dark urine 
•	fatigue 
•	elevated liver enzymes (AST/ALT)
HOLD the Med 
•	Teach: NO ETOH (NO ALCOHOL )

Question 4

Drug interactions with antiretroviral medications

Answer 4

1. antifungalsEliminate or manage fungal infectionsIncreased serum level of the antiretroviral
2. clarithromycin=Treat bacterial infection=Increased serum level of both drugs
3. sildenafilTreat erectile dysfunctionIncreased adverse reactions of sildenafil
4. opioid analgesics=Pain relief=Risk of toxicity with ritonavir
5. anticoagulant, anticonvulsant, antiparasitic agentsPrevent blood clots, seizures, parasitic infections, respectivelyDecreased effectiveness when taking ritonavir
6. interleukins=Prevent severely low platelet counts usually related to chemotherapy=Risk of antiretroviral toxicity
7. fentanylAnalgesia, used typically with procedures requiring anesthesiaIncreased serum level of fentanyl
8. oral contraceptives=Birth control=Decreased effectiveness of the birth control agent
9. rifampinPulmonary tuberculosisWith efavirenz, nevirapine only; decreased serum levels of antivirals

Question 5

Ritonavir: adverse effects and drug interactions

Answer 5

Antiretrovirals

• Nausea, vomiting
• Diarrhea
• Altered taste
• Headache, fever, and chills
• Rash
• Numbness and tingling in the circumoral area (around the mouth) or peripherally, or both

Interacting Drug=Common Use=Effect of Interaction
opioid analgesicsPain reliefRisk of toxicity with ritonavir

Drug interaction
anticoagulant,
anticonvulsant,
antiparasitic agents

Common Use
Prevent blood clots, seizures, parasitic infections, respectively
Effect of Interaction
Decreased effectiveness when taking ritonavir

Question 6

Acyclovir: nursing considerations; uses

Answer 6

Antiviral
USE
• Herpes Simplex and Varicella
• Cytomegalovirus (CMV) such as retinitis
• CMV prevention in transplant recipients
• Hepatitis B and C
• Influenza A and B
• Respiratory syncytial virus (RSV)
NURSING CONSIDERATIONS
• Nephrotoxicity: slow over an 1hr infusion and increase fluids

Question 7

Nystatin: client education

Answer 7

Antifungal

shake well, swish and swallow, remove and soak dentures in medication.

Advise patient to maintain adequate fluid intake to ensure sufficient hydration for drug therapy and
increase urine output
Instruct patient with genital herpes to avoid spreading infection via abstinence of condom use. Teach
women with genital herpes to have a Pap test done as indicated by health care provider
Blood pressure :May cause orthostatic hypotension. Teach patient to rise slowly
Administer IV over 60 minutes
Monitor CBC, renal/liver function test, urine output
Assess for superinfection
Increase Fluid intake
Instruct Client to practice abstinence of use condoms
Perform oral hygiene
Watch for orthostatic hypotension
To treat herpes
Shingles and genital
Treats Varicella (chicken pox)

Question 8

Metronidazole: drug interactions

Answer 8

Antiprotozoal
Drinking alcohol while taking metronidazole causes a very uncomfortable disulfiram-like reaction
For clients taking disulfiram, also called Antabuse, as a part of their treatment for alcoholism, The addition of metronidazole may cause a psychotic reaction.

Question 9

Common adverse reactions of antifungals

Answer 9

Systemic Administration: 
•	Liver toxic and renal injury
•	Fluconazole=liver
•	Amphotericin B=renal injury (IV)
●Creatinine >1.3=bad kidney
●Less than 30ml/hr urine (oliguria)
●Topical Administration:
•	Site irritation
•	Burning
•	Crusting or drainage

Question 10

Amphotericin B: adverse reactions

Answer 10

Antifungal
Bone marrow suppression, thrombophlebitis, tachycardia, Hypotension, nephrotoxic,
Hypokalemia, Red blood cell suppression (anemia)

Question 11

Quinine: adverse reactions

Answer 11

Antiprotozoal

Nausea, vomiting, cinchonism, skin rash, visual disturbances

Question 12

Cinchonism: manifestations

Answer 12

Allergic reaction of quinine
Cinchonism= a group of symptoms associated with quinine administration, including tinnitus, dizziness, headache, GI disturbances, and visual disturbances. These symptoms usually disappear when the dosage is reduced

Question 13

Risk factors of TB

Answer 13

• Location of residence- Large Urban areas/place of birth
• High immigration rates
• Higher rates in foreign born than US born (Asia, Mexico)
• homeless (shelters)
• incarcerated
• HIV or immunocompromised
• alcoholism
• illicit drug use
• social behavior more than the aging itself

Question 14

Latent TB

Answer 14

Identifying the Individual With Latent TB Infection
• Does not feel sick or have symptoms of the disease
• PPD skin test or blood test is positive for TB infection
• Normal chest x-ray and negative sputum test
• Has alive TB bacteria, but it is inactive
• Cannot spread the TB bacteria to others
• Needs treatment for the disease to prevent active disease at a later time
Latent treatment is used for those infected with M. tuberculosis but do not have the active disease TB. These individuals have a positive skin/blood test yet are not infectious and cannot spread the disease to others.
High-Risk Individuals for LTB
• Positive IGRA (interferon-gamma release assay )TB blood test
• TST (tuberculin skin test) greater than 5 mm in clients who are:
o HIV positive
o Recent contact with active TB cases
o X-ray shows old TB
o Organ transplant clients
o Selected immunosuppressed clients
• TST greater than 10 mm in clients who are:
o Traveling from countries where TB is prevalent
o IV drug users
o Residents/employees of high-risk living settings, e.g., long-term care, hospitals
o Laboratory personnel working with Mycobacteria
o Children under 4 years up to adolescents exposed to high-risk adults

Question 15

MMR vaccine: nursing considerations

Answer 15

Measles
• also known as Rubeola
• Or the 10-day measles
• Spread by direct/indirect contact
• Caused by the Rubeola virus
• SX: high fever, malaise, photophobia, red skin rash, Koplik’s spots
MUMPS
• Acute contagious febrile disease
• Causes inflammation of the salivary glands
• Transmitted by droplet infection/direct contact
• SX: Chills, fever, pain below and in front of the ears
RUBELLA
• Known as German measles or three-day measles
• Viral disease, an acute upper respiratory infection
• Transmitted by droplet infection/direct contact
• SX: Slight fever, drowsiness, swollen glands and lymph nodes, fine red rash

Question 16

Vaccines: general contraindications

Answer 16

Moderate or severe illness, with or without fever.

during acute febrile illnesses, leukemia, lymphoma, immunosuppressive illness or drug therapy, and nonlocalized cancer.

Question 17

Gardasil: uses

Answer 17

Generic drug: human papillomavirus (HPV) active immunity vaccine
Brand name: Gardasil

• Prevention of disease is caused by HPV
• Genital warts
• Certain cancers

Question 18

Vaccines and pregnancy

Answer 18

Safe
•	Influenza vaccine (shot, inactived) safe in all stages of pregnancy 
•	Meningococcal, pneumococcal, TD
•	Hep A and Hep B
•	Flu TIV(IM)
•	TDAP
Not safe-any liVe virus 
•	HPV
•	Flu LAV (intranasal)
•	MMR
•	Varicella