week 12 sherpath Flashcards
1
Q
In which time frame would a nurse expect omeprazole to reach its peak concentration?
0.5 hour
1 hour
2 hours
4 hours
A
2 hours
2
Q
Which statement regarding the pharmacokinetic profile of esomeprazole is inaccurate?
“Esomeprazole is well absorbed after oral administration.”
“The drug is less than 50% protein bound.”
“Esomeprazole is extensively metabolized in the liver.”
“The drug undergoes excretion in the urine.”
A
“The drug is less than 50% protein bound.”
3
Q
Which statements are true about the pharmacokinetics of omeprazole and esomeprazole?
Select all that apply.
Omeprazole is more protein bound than esomeprazole.
Esomeprazole is metabolized more slowly than omeprazole.
Esomeprazole is excreted in the urine, while omeprazole is excreted in the feces.
Esomeprazole is metabolized in the liver, while omeprazole undergoes biliary -metabolism.
Esomeprazole achieves a higher blood level and has longer-lasting effects compared with omeprazole.
A
Esomeprazole is metabolized more slowly than omeprazole.
Esomeprazole achieves a higher blood level and has longer-lasting effects compared with omeprazole.
4
Q
Which dosage and administration protocol would a nurse follow with the administration of intravenous esomeprazole to Ms. Contreras?
If given as an injection, it will be given over 1 minute.
It may be given with other intravenous medications.
If given as an infusion, it will be administered over 10 to 30 minutes.
The freeze-dried powder will be reconstituted with 5 mL of dextrose 5% in water.
A
If given as an infusion, it will be administered over 10 to 30 minutes.
5
Q
Which drug interaction and outcome does the nurse anticipate will occur in Ms. Contreras with administration of esomeprazole?
Digoxin: Increased digoxin exposure
Digoxin: Decreased digoxin exposure
Ibuprofen: Increased ibuprofen exposure
Ibuprofen: Decreased ibuprofen exposure
A
Digoxin: Increased digoxin exposure
6
Q
Which patient parameters would a nurse ensure are assessed before a patient receives oral esomeprazole?
Select all that apply.
Medication history
Gastrointestinal (GI) history
Risk for and history of osteoporosis
Risk for and history of hypertension
Risk for and history of hypothyroidism
A
Medication history
Gastrointestinal (GI) history
Risk for and history of osteoporosis
7
Q
Which teaching points would a nurse share with a 33-year-old female patient who has been prescribed omeprazole delayed-release capsules for Zollinger-Ellison syndrome?
Select all that apply.
“Take omeprazole at least 1 hour before a meal.”
“Do not crush, chew, split, or open the omeprazole capsule.”
“You may experience headache and diarrhea with omeprazole.”
“Avoid alcohol while receiving omeprazole because it will decrease the absorption of the drug.”
“Use contraception and alert your health care provider if you suspect you are pregnant while taking omeprazole.”
A
“Do not crush, chew, split, or open the omeprazole capsule.”
“You may experience headache and diarrhea with omeprazole.”
“Use contraception and alert your health care provider if you suspect you are pregnant while taking omeprazole.”
8
Q
Which statement by the nursing student about the mechanism of action of proton pump inhibitors (PPIs) requires further intervention?
“PPIs inhibit active parietal cell acid secretion.”
“They inhibit ATPase that generates gastric acid.”
“They promote irreversible hydrogen or potassium ATPase inhibition.”
“PPIs work by blocking histamine2 receptors, which reduces gastric acid secretion.”
A
“PPIs work by blocking histamine2 receptors, which reduces gastric acid secretion.”
9
Q
In which time frame would a patient expect to experience effects from esomeprazole?
1 hour
2 hours
4 hours
6 hours
A
1 hour
10
Q
Which statement regarding the pharmacodynamic profile of omeprazole is accurate?
The onset of action of omeprazole is 2 hours.
Omeprazole’s duration of action is up to 24 hours.
The elimination half-life of omeprazole is 0.5 to 1 hour.
The elimination half-life of omeprazole is reduced in patients with liver dysfunction.
A
The elimination half-life of omeprazole is 0.5 to 1 hour.
11
Q
Which medical conditions would a nurse recognize that oral esomeprazole may be used to treat?
Select all that apply.
Gastroesophageal reflux disease (GERD)
Crohn disease
Duodenal ulcers
Nonsteroidal antiinflammatory drug (NSAID)-induced ulcers
Zollinger-Ellison syndrome
A
Gastroesophageal reflux disease (GERD)
Duodenal ulcers
Nonsteroidal antiinflammatory drug (NSAID)-induced ulcers
Zollinger-Ellison syndrome
12
Q
Which patients would a nurse determine require cautious use of or avoidance of esomeprazole?
Select all that apply.
A 70-year-old Asian patient with hypertension
A 73-year-old Caucasian patient with osteoporosis
A 29-year-old Hispanic patient who is breastfeeding
A 54-year-old Caucasian patient with alcoholic cirrhosis
A 38-year-old Hispanic patient with type 2 diabetes mellitus
A
A 70-year-old Asian patient with hypertension
A 73-year-old Caucasian patient with osteoporosis
A 29-year-old Hispanic patient who is breastfeeding
A 54-year-old Caucasian patient with alcoholic cirrhosis
13
Q
Which outcome would a nurse anticipate from the drug interaction that may occur in a patient who is receiving diazepam and has been newly prescribed omeprazole?
Increase in serum concentration of diazepam
Decrease in serum concentration of diazepam
Increase in serum concentration of omeprazole
Decrease in serum concentration of omeprazole
A
Increase in serum concentration of diazepam
14
Q
A patient who is receiving omeprazole has been prescribed clopidogrel following stent placement. Which outcome does a nurse alert the health care provider about resulting from the drug interaction?
Increase in activation of clopidogrel
Decrease in activation of clopidogrel
Increase in activation of omeprazole
Decrease in activation of omeprazole
A
Decrease in activation of clopidogrel
15
Q
A 93-year-old patient with gastroesophageal reflux disease (GERD) is prescribed esomeprazole. The patient is immobile in a skilled nursing facility, is frail, and experienced a stroke a year ago. Which adverse effects of esomeprazole will the nurse be concerned about in this patient?
Select all that apply.
Diabetes
Dementia
Pneumonia
Osteoporosis
Thyroid dysfunction
Hip or vertebral fracture
A
Dementia
Pneumonia
Osteoporosis
Hip or vertebral fracture
16
Q
Match the laxative with its associated drug class.
Osmotic
Stimulant
Selective Chloride Channel Activator
Emollient
Answer choices
Lubiprostone
Docusate sodium
Bisacodyl
Lactulose
Psyllium
A
Osmotic
Lactulose
Stimulant
Bisacodyl
Selective Chloride Channel Activator
Lactulose
Emollient
Bisacodyl
17
Q
Which statement by the nursing student regarding the pharmacokinetic parameters of lubiprostone requires further intervention?
“Lubiprostone has low systemic availability with oral administration.”
“The drug is 94% protein bound with minimal distribution outside of the gastrointestinal (GI) tract.”
“Lubiprostone is quickly metabolized in the stomach and jejunum by the cytochrome P450 (CYP450) system.”
“The drug is excreted mostly in urine and some in feces.”
A
“Lubiprostone is quickly metabolized in the stomach and jejunum by the cytochrome P450 (CYP450) system.”
18
Q
In which time frame would a nurse expect to note the effects of oral bisacodyl in a patient?
15 to 60 minutes
2 to 4 hours
6 to 12 hours
10 to 12 hours
A
6 to 12 hours
19
Q
To which classification of antidiarrheal drugs does bismuth subsalicylate belong?
Opiates
Probiotics
Adsorbents
Anticholinergics
A
Adsorbents
20
Q
Which statements regarding the pharmacodynamic parameters of loperamide are accurate?
Select all that apply.
The onset of action for loperamide is 1 hour.
The capsule formulation of loperamide has a time to peak concentration of 30 minutes.
The liquid formulation of loperamide has a time to peak concentration of 2.5 hours.
The duration of action of loperamide is 24 hours.
Loperamide’s elimination half-life ranges from 5 to 6 hours.
A
The onset of action for loperamide is 1 hour.
The liquid formulation of loperamide has a time to peak concentration of 2.5 hours.
The duration of action of loperamide is 24 hours.
21
Q
Which patient parameters would a nurse ensure are assessed before administering bisacodyl to a 17-year-old female patient?
Select all that apply.
Blood urea nitrogen (BUN)/Serum creatinine (SCr)
Bowel patterns
Blood pressure (BP)
Liver function tests
History of eating disorders
A
Blood urea nitrogen (BUN)/Serum creatinine (SCr)
Bowel patterns
Blood pressure (BP)
History of eating disorders
22
Q
A nurse determines that patients with which conditions can safely receive laxative therapy?
Select all that apply.
Dyslipidemia
Osteoarthritis
Hypothyroidism
Fecal impaction
Intestinal obstruction
A
Dyslipidemia
Osteoarthritis
Hypothyroidism
23
Q
Which outcome would a nurse anticipate will occur as a result of a drug interaction in a patient who is taking psyllium and has been prescribed tetracycline for an infection?
Increased effects of psyllium
Decreased effects of psyllium
Increased absorption of tetracycline
Decreased absorption of tetracycline
A
Decreased absorption of tetracycline
24
Q
Which patient statement about glycerin administration and effects requires further intervention?
“I can expect the laxative effect to occur in about 1 hour.”
“I should try to keep the suppository in for about 15 to 30 minutes.”
“The suppository does not need to melt for a bowel movement to occur.”
“I should insert one suppository into my rectum once or twice daily as needed for constipation.”
A
“I can expect the laxative effect to occur in about 1 hour.”
25
Which adverse effects would a nurse monitor for in a patient receiving lubiprostone for irritable bowel syndrome?
Select all that apply.
Hypertension
Severe diarrhea
Urinary tract infection (UTI)
Intestinal nerve damage
Upper respiratory tract infection
Severe diarrhea
Urinary tract infection (UTI)
Upper respiratory tract infection
26
Which side effects would the nurse alert Mr. Frank to be monitored for while receiving loperamide?
Select all that apply.
Tinnitus
Drowsiness
Dark stools
Urinary retention
Metallic taste and black tongue
Drowsiness
Urinary retention
27
Which patients would a nurse determine cannot safely receive treatment with loperamide without consultation with a health care provider?
Select all that apply.
A patient with gout
A patient with liver disease
A patient with ulcerative colitis
A patient who has misused opioids
A patient with type 2 diabetes mellitus
A patient with liver disease
A patient with ulcerative colitis
A patient who has misused opioids
28
Which outcome would a nurse anticipate would occur in a patient taking bismuth subsalicylate and aspirin as a result of a drug interaction?
Increased effect of bismuth subsalicylate
Decreased effect of bismuth subsalicylate
Increased risk for bleeding, bruising, and confusion
Decreased risk for bleeding, bruising, and confusion
Increased risk for bleeding, bruising, and confusion
29
Match the laxative with its associated mechanism of action.
Draws water into the intestine to relieve constipation
Softens and increases bulk of digested food
Increases water in stools to soften it so it is more comfortable to pass
Activates chloride channels to enhance intestinal fluid secretion
Answer choices
Psyllium
Lubiprostone
Mineral oil
Polyethylene glycol
Draws water into the intestine to relieve constipation
Polyethylene glycol
Softens and increases bulk of digested food
Psyllium
Increases water in stools to soften it so it is more comfortable to pass
Mineral oil
Activates chloride channels to enhance intestinal fluid secretion
Lubiprostone
30
Which statements regarding the pharmacodynamics of bismuth subsalicylate are accurate?
Select all that apply.
The onset of action for bismuth subsalicylate is 1 hour.
The duration of action of bismuth subsalicylate is 12 hours.
The time to peak concentration of bismuth subsalicylate is 2 hours.
The elimination half-life of bismuth is 24 hours.
The elimination half-life of salicylate is 2 to 5 hours.
The onset of action for bismuth subsalicylate is 1 hour.
The time to peak concentration of bismuth subsalicylate is 2 hours.
The elimination half-life of salicylate is 2 to 5 hours.
31
Which laxative absorbs fat-soluble vitamins, thereby reducing the body’s absorption of these vitamins from foods?
Psyllium
Bisacodyl
Mineral oil
Lubiprostone
Mineral oil
32
Which statement regarding the pharmacokinetic and pharmacodynamic parameters of psyllium is accurate?
Psyllium is excreted mostly in the urine.
Psyllium has an onset of action of 1 to 3 hours.
Psyllium reaches its peak concentration in 12 hours.
Psyllium is not absorbed after oral administration.
Psyllium is not absorbed after oral administration.
33
Which phrase describes how loperamide acts to exert antidiarrheal effects?
Destroys bacteria and toxins by lining the gastrointestinal (GI) tract
Replaces bacteria to promote normal bacterial flora in the GI tract
Slows GI motility, reduces electrolyte loss, and decreases fecal volume
Decreases GI contractions as well as reduces gastric secretions through drying effects
Slows GI motility, reduces electrolyte loss, and decreases fecal volume
34
Which statement regarding the pharmacokinetic parameters of bismuth subsalicylate is accurate?
Bismuth is extensively absorbed with oral administration.
Subsalicylate is minimally absorbed after oral administration.
Bismuth subsalicylate is metabolized in the liver to bismuth and salicylic acid.
The drug is excreted in the feces.
Bismuth subsalicylate is metabolized in the liver to bismuth and salicylic acid.
35
Which outcome does a nurse anticipate will occur as a result of a drug interaction in a patient who is taking the anticoagulant warfarin and bismuth subsalicylate?
Increased absorption of warfarin
Decreased absorption of warfarin
Increased absorption of bismuth subsalicylate
Decreased absorption of bismuth subsalicylate
Decreased absorption of warfarin
36
Which patient teaching points would the nurse share with a patient who is receiving psyllium powder?
Select all that apply.
Do not administer the powder without mixing it with water.
Drink the psyllium solution within 1 hour of mixing.
Drink one glass of water after administration of psyllium.
Mix the psyllium powder well with 8 to 10 oz of water.
Inhalation of the powder may cause runny nose, wheezing, and watery eyes.
Do not administer the powder without mixing it with water.
Drink one glass of water after administration of psyllium.
Mix the psyllium powder well with 8 to 10 oz of water.
Inhalation of the powder may cause runny nose, wheezing, and watery eyes.
37
Which statement by the patient in regard to bisacodyl plus senna administration requires further education?
“I can take this medication as long and as often as I need it.”
“I may experience diarrhea and cramping from taking this medication.”
“I should take the medication with plenty of water to help with absorption.”
“I should wait at least 1 hour after taking bisacodyl and senna to take my other medications.”
“I can take this medication as long and as often as I need it.”
38
A nurse is caring for a patient who appears to be dehydrated. It has been determined that the patient has been unintentionally overusing laxative therapy. Which patient parameters would be assessed in this patient?
Select all that apply.
Bowel sounds
Blood pressure
Thyroid function
Electrolytes
Fluid intake and output
Bowel sounds
Blood pressure
Electrolytes
Fluid intake and output
39
Which side effects would a nurse monitor for in a patient who is receiving lubiprostone?
Select all that apply.
Paralysis
Complete heart block
Severe diarrhea
Urinary tract infection (UTI)
Upper respiratory tract infection
Severe diarrhea
Urinary tract infection (UTI)
Upper respiratory tract infection
40
Which patient parameters would a nurse ensure are assessed before administering loperamide to a 71-year-old patient?
Select all that apply.
Glucose level
Blood pressure (BP)
Hydration status
Recent foods consumed
History of viral or bacterial infections, including Clostridium difficile
Hydration status
Recent foods consumed
History of viral or bacterial infections, including Clostridium difficile
41
Which effect would a nurse anticipate will occur if a patient takes hydrocodone, an opioid, while receiving loperamide?
Additive central nervous system (CNS) stimulant effects
Additive CNS depressant effects
Reduced efficacy of loperamide
Reduced efficacy of hydrocodone
Additive CNS depressant effects
42
Which patient teaching points would a nurse share with a patient who has been prescribed loperamide hydrochloride?
Select all that apply.
“Loperamide hydrochloride may increase your risk for bleeding.”
“Avoid alcohol while receiving loperamide hydrochloride because there is a risk for central nervous system (CNS) depression.”
“You can expect the tongue to turn black and the stools to darken while receiving loperamide hydrochloride.”
“Use caution when driving or performing tasks that require mental alertness while -receiving loperamide hydrochloride.”
“If diarrhea continues for more than 48 hours after initiation of loperamide hydrochloride, contact your health care provider.”
“Avoid alcohol while receiving loperamide hydrochloride because there is a risk for central nervous system (CNS) depression.”
“Use caution when driving or performing tasks that require mental alertness while -receiving loperamide hydrochloride.”
“If diarrhea continues for more than 48 hours after initiation of loperamide hydrochloride, contact your health care provider.”
43
Match the antiemetic with its drug class
Substance P/Neurokinin 1 Antagonists
Dopamine antagonists
Cannabinoids
Antihistamine
Answer choices
Dexamethasone
Dronabinol
Meclizine
Aprepitant
Ondansetron
Substance P/Neurokinin 1 Antagonists
Aprepitant
Dopamine antagonists
Ondansetron
Cannabinoids
Dronabinol
Antihistamine
Meclizine
44
In which time frame would a patient expect dronabinol to begin working?
5 to 15 minutes
30 to 60 minutes
2 to 3 hours
4 to 6 hours
30 to 60 minutes
45
Which statement regarding the pharmacokinetics of promethazine is accurate?
The drug is easily absorbed through the gastrointestinal (GI) tract.
Promethazine is minimally protein bound.
The drug does not undergo metabolism.
Promethazine undergoes biliary excretion.
The drug is easily absorbed through the gastrointestinal (GI) tract.
46
Which antiemetic exerts its effects by binding to acetylcholine receptors to block the nausea-inducing signal from communicating to the vomiting pathway?
Aprepitant
Scopolamine
Ondansetron
Promethazine
Scopolamine
47
Which length of time is the anticipated duration of action for meclizine’s effects?
1 hours
2 hours
6 hours
8 hours
6 hours
48
Which side effects would the nurse advise Ms. Smith to monitor for while receiving promethazine?
Select all that apply.
Shivering
Dizziness
Dry mouth
Blurry vision
Tachycardia
Dizziness
Dry mouth
Blurry vision
Tachycardia
49
Which patients would a nurse determine can safely receive treatment with scopolamine?
Select all that apply.
A patient with asthma
A patient with glaucoma
A patient with depression
A patient with breast cancer
A patient with myasthenia gravis
A patient with asthma
A patient with depression
A patient with breast cancer
50
A nurse is caring for a patient with breast cancer who is experiencing chemotherapy-induced nausea and vomiting. Which side effects and adverse effects would a nurse monitor for if the patient is receiving aprepitant?
Select all that apply.
Urticaria
Thrombocytopenia
Deep vein thrombosis
Extrapyramidal symptoms
Neuroleptic malignant syndrome
Urticaria
Thrombocytopenia
Deep vein thrombosis
51
Which patient parameters would a nurse evaluate in a patient receiving meclizine?
Select all that apply.
Heart rate
Gastric pH
Intake/Output
Bowel sounds
Blood pressure
Heart rate
Intake/Output
Bowel sounds
Blood pressure
52
Which antiemetic can a nurse anticipate having the longest duration of action?
Meclizine
Aprepitant
Dronabinol
Scopolamine
Scopolamine
53
Which antiemetic is excreted in urine, feces, and bile?
Meclizine
Dronabinol
Ondansetron
Promethazine
Dronabinol
54
Which statement regarding the pharmacodynamic parameters of intravenous (IV) ondansetron is accurate?
Its onset of action is 15 minutes.
It reaches its peak concentration in 30 minutes.
Its duration of action is 2 to 4 hours.
Its elimination half-life is 3 to 5 hours.
Its elimination half-life is 3 to 5 hours.
55
Which time frame can a nurse expect dexamethasone to reach its peak concentration?
5 to 10 minutes
15 to 30 minutes
45 to 60 minutes
1.5 to 2 hours
5 to 10 minutes
56
Which statement regarding the pharmacokinetic parameters of aprepitant is accurate?
The drug has an oral bioavailability of 25%.
Aprepitant is minimally protein bound (<5%).
The drug undergoes metabolism mostly by CYP3A4.
Excretion of aprepitant is predominantly in the feces.
The drug undergoes metabolism mostly by CYP3A4.
57
Which phrase describes how ondansetron works to treat nausea and vomiting?
Blocks dopamine2 receptors in the chemoreceptor trigger zone
Inhibits cholinergic stimulation of the vestibular and reticular systems
Blocks the serotonin receptors in the chemoreceptor trigger zone and vagal nerve terminals in the gastrointestinal (GI) tract
Binds to acetylcholine receptors deep within the brain to block the nausea-inducing signal from communicating to the vomiting pathway
Blocks the serotonin receptors in the chemoreceptor trigger zone and vagal nerve terminals in the gastrointestinal (GI) tract
58
Which patients would a nurse determine cannot safely receive therapy with promethazine?
Select all that apply.
A 50-year-old patient with osteoarthritis
A 27-year-old patient with hypothyroidism
A 1-year-old child with profuse vomiting
A 31-year-old patient who is breastfeeding
A 33-year-old patient with generalized anxiety disorder
A 1-year-old child with profuse vomiting
A 31-year-old patient who is breastfeeding
59
A nurse is caring for a patient who will be using a scopolamine patch for motion sickness. In addition to scopolamine, the patient is also taking diphenhydramine, an antihistamine, as needed for allergies. Which patient statement about scopolamine requires further intervention?
“I will apply the patch to my upper arm.”
“The patch should be applied 4 hours before travel.”
“I will apply the patch every 3 days as I am travelling.”
“If I use scopolamine with diphenhydramine, I may have significant dry mouth and dry eyes.”
“I will apply the patch to my upper arm.”
60
Which effect would a nurse anticipate might occur from the drug interaction between dronabinol and warfarin?
Increase in warfarin concentration
Decrease in warfarin concentration
Increase in dronabinol concentration
Decrease in dronabinol concentration
Increase in warfarin concentration
61
Which electrolyte abnormality would a nurse monitor for in a patient receiving dexamethasone as an antiemetic who is also receiving furosemide, a loop diuretic?
Hypokalemia
Hyperkalemia
Hyponatremia
Hypernatremia
Hypokalemia
62
Which frequency would a nurse anticipate seeing promethazine prescribed for a patient with nausea and vomiting?
Once daily
Every 4 to 6 hours
Every 8 to 12 hours
Every 3 days
Every 4 to 6 hours
63
Which explanation would a nurse provide a patient about the avoidance of alcohol while taking promethazine?
The combination may cause excessive central nervous system (CNS) effects such as sedation.
Tardive dyskinesia may occur when the combination of alcohol and promethazine is taken.
QT prolongation may occur if the patient consumes alcohol while taking promethazine.
If the patient consumes alcohol with promethazine, there is a risk for psychotic symptoms.
The combination may cause excessive central nervous system (CNS) effects such as sedation.
64
Which class of penicillin (PCN) affects bacteria with pseudomonal activity?
Broad-spectrum
Natural
Extended-spectrum
PCN resisters
Extended-spectrum
65
For which patient condition would piperacillin be most appropriate?
Pharyngitis with streptococcal species
Intraabdominal infection with Pseudomonas aeruginosa
Urinary tract infection (UTI) with Staphylococcal aureus
Skin infection with Escherichia coli
Intraabdominal infection with Pseudomonas aeruginosa
66
Through which route is cephalosporin eliminated?
Kidney
Liver
Intestine
Gallbladder
Kidney
67
For which bacterium is oral vancomycin indicated?
Staphylococcal aureus
Streptococcal faecalis
Pseudomonas aeruginosa
Clostridium difficile
Clostridium difficile
68
Which antibacterial is in the lincosamide class?
Sulfamethoxazole-trimethoprim (SMX-TMP)
Clindamycin
PCN G
Erythromycin
Clindamycin
69
Which antibacterial has low bioavailability following oral administration?
Erythromycin
Sulfamethoxazole-trimethoprim (SMX-TMP)
Cephalexin
Amoxicillin
Erythromycin
70
The nurse would anticipate administering clindamycin every 6 hours knowing that it has which half-life?
30 to 60 minutes
2 to 3 hours
5 to 9 hours
8 to 10 hours
2 to 3 hours
71
A patient asks the nurse why gentamicin is given intravenously. Which response would the nurse provide?
“Less drug is distributed to the tissues when it is given intravenously.”
“Bioavailability of gentamicin is higher when it is given orally, increasing the risk for adverse effects.”
“Gentamicin is given intravenously rather than orally due to its short half-life.”
“Gentamicin is not absorbed with oral administration.”
“Gentamicin is not absorbed with oral administration.”
72
Which pharmacokinetic activity of gentamicin explains why it is nephrotoxic?
Resorption in the renal cortex
Elimination in feces
High protein binding
Metabolism by the kidneys
Resorption in the renal cortex
73
Which antibacterials are effective against Pseudomonas aeruginosa?
Select all that apply.
Ciprofloxacin
Tetracycline
Vancomycin
Penicillin G (PCN G)
Gentamicin
Ciprofloxacin
Gentamicin
74
Ms. Wanly, who is complaining of flank pain, was prescribed ciprofloxacin. Before initiating the drug, which assessment would the nurse ensure was performed?
Vital signs, including temperature
Chemistry panel, including liver function tests
Urine sample for a culture and sensitivity test
Assessment of adequate fluid intake
Urine sample for a culture and sensitivity test
75
Because Ms. Wanly is also taking a beta blocker for hypertension, the nurse would closely monitor for which drug-drug interaction when administering ciprofloxacin?
Prolongation of QT intervals
Decreased bioavailability of ciprofloxacin
Hypersensitivity to the sun
Decreased therapeutic effects of beta blockers
Prolongation of QT intervals
76
For which patient would intravenous (IV) vancomycin be contraindicated?
A patient who has a corn allergy
A patient with inflammatory bowel disease (IBD)
A patient with heart failure
A patient taking other ototoxic drugs
A patient who has a corn allergy
77
A patient who is on an anticoagulant for a deep vein thrombosis to the lower extremity is to receive ceftriaxone for an infection. For which drug-drug interaction would the nurse monitor?
Worsening diarrhea
Increased intolerance to alcohol
Excessive ecchymosis
Increased swelling to the lower extremities
Excessive ecchymosis
78
A nurse is preparing to administer the third dose of gentamicin. Before administering the drug, which laboratory test results would be most important for the nurse to assess?
Gentamicin peak level
Metabolic panel, including renal function
Complete blood count (CBC), including differentials
Gentamicin trough level
Gentamicin trough level
79
Which antibacterials are effective against Pseudomonas aeruginosa?
Select all that apply.
Piperacillin
Ceftriaxone
Vancomycin
Cefepime
Penicillin G (PCN G)
Piperacillin
Ceftriaxone
Cefepime
80
The nurse is preparing antibacterials for several patients. For which type of infection would a patient receive oxacillin?
Cardiac infection with a staphylococcal species
Severe urinary infection with E. coli
C. difficile infection that is resistant to penicillin (PCN)
Severe tonsillitis with streptococcal species
Cardiac infection with a staphylococcal species
81
For which patient would the nurse seek clarification if amoxicillin was prescribed?
Patient who is pregnant and has a urinary infection
Patient who is a diabetic and has a skin infection
Patient who has asthma with a throat infection
A child with a respiratory infection
Patient who has asthma with a throat infection
82
A patient developed pseudomembranous colitis after being on oral antibiotics for 4 days. Which drug would the nurse anticipate administering?
Oral gentamicin
Oral vancomycin
Intravenous (IV) gentamicin
IV vancomycin
Oral vancomycin
83
Which cephalosporin would the nurse anticipate administering to a patient diagnosed with an infection that is resistant to methicillin (methicillin-resistant Staphylococcus aureus [MRSA])?
Cefepime
Ceftriaxone
Cefoxitin
Ceftaroline
Ceftaroline
84
For which reason is cilastatin administered with imipenem?
Cilastatin prevents the elimination of imipenem.
Cilastatin prevents renal metabolism of imipenem.
Cilastatin prevents hepatic metabolism of imipenem.
Cilastatin offers cardiac protection against imipenem.
Cilastatin prevents renal metabolism of imipenem.
85
For which patient condition would the nurse seek clarification before administering clindamycin?
Mild renal impairment
Skin infection
Irritable bowel syndrome (IBS)
Advanced liver disease
Advanced liver disease
86
Sulfamethoxazole-Trimethoprim (SMX-TMP) has a half-life of 8 to 10 hours. Which dosing schedule would be appropriate for SMX-TMP?
Every 6 hours
Every 8 hours
Every 12 hours
Every 24 hours
Every 12 hours
87
Which classes of antibacterials are effective against E. coli?
Select all that apply.
Lincosamide
Sulfonamide
Aminoglycoside
Tetracycline
Fluoroquinolone
Sulfonamide
Aminoglycoside
Fluoroquinolone
88
Which statement is an accurate description of the pharmacokinetic action of tetracycline?
Tetracycline is metabolized by the liver.
Tetracycline is absorbed in the lower intestine.
Tetracycline is primarily excreted in feces.
Tetracycline absorption decreases as the dose is increased.
Tetracycline absorption decreases as the dose is increased.
89
For which patient condition would tetracycline be indicated as a first-line therapy?
Urinary infection with E. coli
Gastric infection with H. pylori
Pulmonary infection with P. aeruginosa
Ear infection with H. Influenzae
Gastric infection with H. pylori
90
Which antibacterial drugs have protein binding of less than 40%?
Select all that apply.
Erythromycin
Gentamicin
SMX-TMP
Tetracycline
Ciprofloxacin
Gentamicin
Ciprofloxacin
91
For which prescription for ceftriaxone would the nurse seek clarification?
Ceftriaxone 1 g intravenous (IV) every 8 hours
Ceftriaxone 1 g IV every 12 hours
Ceftriaxone 1 g IV every 24 hours
Ceftriaxone 1 g intramuscular (IM) daily
Ceftriaxone 1 g intravenous (IV) every 8 hours
92
Which class of drugs can increase the risk for nephrotoxicity when coadministered with vancomycin?
Oral contraceptives
Nonsteroidal antiinflammatory drugs (NSAIDs)
Loop diuretics
Anesthetics
Nonsteroidal antiinflammatory drugs (NSAIDs)
93
Which antibacterial prescription would concern the nurse?
Vancomycin 1 g intravenous (IV) every 12 hours for C. difficile colitis
Amoxicillin 500 mg by mouth every 8 hours for urinary tract infection (UTI)
Cephalexin 500 mg by mouth every 12 hours for pharyngitis
Clindamycin 600 mg IV every 8 hours for skin infection
Vancomycin 1 g intravenous (IV) every 12 hours for C. difficile colitis
94
A patient who takes a diuretic was prescribed erythromycin for bronchitis. Which teaching information would the nurse provide to the patient?
Select all that apply.
“Be sure to take this drug every 12 hours with a full glass of water.”
“Erythromycin can cause ringing in the ears. Notify your health care provider if you notice ringing in the ears.”
“You may take the drug with food if the drug causes nausea.”
“You may have pain at the injection site because it is given in the muscle.”
“You may need to increase your potassium supplement.”
“Erythromycin can cause ringing in the ears. Notify your health care provider if you notice ringing in the ears.”
“You may take the drug with food if the drug causes nausea.”
“You may need to increase your potassium supplement.”
95
A patient was prescribed Sulfamethoxazole-Trimethoprim (SMX-TMP) for a skin infection. Which instructions would the nurse include in the discharge teaching?
Select all that apply.
“Use an alternate form of birth control.”
“Avoid all alcohol products.”
“Notify your health care provider of any nausea.”
“Be sure to apply sunscreen.”
“Be sure to take the medicine on an empty stomach.”
“Use an alternate form of birth control.”
“Avoid all alcohol products.”
“Be sure to apply sunscreen.”
96
Which statement is accurate with respect to the goal of antiviral treatment for viral hepatitis B (HBV)?
To reduce or suppress liver inflammation
To kill all HBV
To enhance the patient’s immune system
To sequester HBV for elimination
To reduce or suppress liver inflammation
97
For which medical condition would inhaled ribavirin be appropriate?
Influenza
Viral hepatitis C (HCV)
Respiratory syncytial virus (RSV)
Herpes zoster
Respiratory syncytial virus (RSV)
98
The nurse plans to administer oral acyclovir every 4 to 5 hours for herpes zoster because acyclovir has which half-life?
1 to 2 hours
2 to 4 hours
6 to 8 hours
10 to 12 hours
2 to 4 hours
99
Which antiviral drug would be prescribed to a patient who has genital herpes simplex?
Oseltamivir
Ribavirin
Lamivudine
Acyclovir
Acyclovir
100
To improve the effectiveness of antiretroviral protease inhibitors (PIs), which drug would the nurse anticipate administering?
Maraviroc
Efavirenz
Cobicistat
Darunavir
Cobicistat
101
Which statement by the patient indicates an accurate understanding on how to self-administer efavirenz?
“I will take the medicine on an empty stomach.”
“I will take the medicine with milk.”
“I will take the medicine as soon as I remember.”
“I have to sprinkle the capsule in food before taking.”
“I will take the medicine on an empty stomach.”
102
Which statement is accurate regarding the pharmacokinetics or pharmacodynamics of darunavir?
Food has no effect on the drug’s absorption rate.
The half-life of the drug is not altered with cobicistat.
The absorption rate of darunavir is extensive and rapid.
The majority of the drug is excreted in feces.
The majority of the drug is excreted in feces.
103
Which nursing action is appropriate when raltegravir is prescribed to a patient with renal impairment?
Notify the health care provider.
Administer the drug.
Administer the drug with food.
Hold the drug.
Administer the drug.
104
Which HIV antiretroviral drugs inhibit enzymes needed for viral replication?
Select all that apply.
Efavirenz
Maraviroc
Raltegravir
Abacavir
Enfuvirtide
Efavirenz
Raltegravir
Abacavir
105
Which condition would the nurse assess for as part of the medical history of a patient with suspected HIV infection?
Viral hepatitis
Influenza
Respiratory syncytial virus (RSV)
Rhinovirus
Viral hepatitis
106
For which reason is monotherapy not recommended for the treatment of HIV?
Genetic testing is not possible with monotherapy.
Hypersensitivity reactions are increased.
Monotherapy increases the risk for drug resistance HIV.
Monotherapy requires an increase in frequency and dose.
Monotherapy increases the risk for drug resistance HIV
107
For which reason do newer antiretroviral drugs have fewer drug-drug interactions?
Newer antiretroviral drugs are eliminated in urine.
Newer antiretroviral drugs are administered intravenously.
Newer antiretroviral drugs have minimal absorption after oral administration.
Newer antiretroviral drugs are metabolized by glucuronidation within the liver.
Newer antiretroviral drugs are metabolized by glucuronidation within the liver.
108
A patient diagnosed with HIV is prescribed efavirenz, abacavir, and lamivudine. Which statement describes how and when the patient would take efavirenz?
Efavirenz should be taken with milk upon rising from bed.
Efavirenz should be taken on an empty stomach at bedtime.
Efavirenz should be taken on an empty stomach just before lunch.
Efavirenz should be taken with a small snack at bedtime.
Efavirenz should be taken on an empty stomach at bedtime.
109
Which laboratory results are indicators that antiretroviral therapy (ART) has been successful?
Select all that apply.
Decrease in white blood cells
Decrease in HIV RNA
Decrease in red blood cells (RBCs)
Increase in platelets
Increase in CD4+ cells
Decrease in HIV RNA
Increase in CD4+ cells
110
For which patient would oseltamivir be appropriate in the treatment of influenza?
6-month-old patient who has been sick for 24 hours
12-month-old patient who has been sick for 4 days
6-year-old patient who has been sick for 36 hours
30-year-old patient who has been sick for 7 days
6-year-old patient who has been sick for 36 hours
111
Which statement is correct about the action of oseltamivir?
Prevents the replication of the virus
Kills the virus
Enhances the immune system
Encases the virus
Prevents the replication of the virus
112
A nurse is preparing to administer non-HIV antivirals for influenza. Which prescription would the nurse clarify before administering the antivirals?
Oseltamivir to a patient with influenza type B
Baloxavir marboxil to a patient with influenza type A
Oseltamivir to a patient with influenza type A
Amantadine to a patient with influenza type B
Amantadine to a patient with influenza type B
113
For which reason should patients increase their oral fluid intake while on antivirals?
Oral fluids will increase absorption.
Antivirals are excreted in urine.
Antivirals promote urination.
Fluids assist in the distribution of antivirals.
Antivirals are excreted in urine.
114
The nurse is preparing to administer antiretroviral drugs to a patient diagnosed with HIV. How many different types of antiretroviral drugs will the nurse anticipate in administering to the patient?
One
Three
Five
Seven
Three
115
For which reason should darunavir be taken with food?
Intestinal motility is increased to enhance drug excretion.
Darunavir causes severe gastrointestinal (GI) distress.
Food increases the half-life of darunavir.
Food increases the bioavailability of darunavir.
Food increases the bioavailability of darunavir.
116
Which drugs are indicated for patients with HIV?
Select all that apply.
Efavirenz
Abacavir
Oseltamivir
Maraviroc
Ribavirin
Efavirenz
Abacavir
Maraviroc
117
Which antiretrovirals have a protein binding of 80% or more?
Select all that apply.
Abacavir
Efavirenz
Raltegravir
Darunavir
Enfuvirtide
Maraviroc
Efavirenz
Raltegravir
Darunavir
Enfuvirtide
118
A patient with which condition cannot safely receive ribavirin?
Hepatitis C
Cardiac disease
Autoimmune hepatitis
Anemia
Autoimmune hepatitis
119
A child with respiratory syncytial virus (RSV) is receiving aerosolized ribavirin. Which action would the nurse take first when the child’s respiratory function declines during treatment?
Notify the health care provider.
Increase oxygen.
Engage the rapid response team.
Discontinue the treatment.
Discontinue the treatment.
120
A patient who is prescribed oseltamivir is to receive an influenza vaccine with live attenuated virus. Which instruction by the nurse is appropriate?
“Get the vaccine after you have stopped oseltamivir for at least 2 days.”
“Get the vaccine now because oseltamivir will help reduce pain at the injection site.”
“Stop oseltamivir 5 days after you get the vaccine.”
“Take plenty of vitamin C because the vaccine can make you sick.”
“Get the vaccine after you have stopped oseltamivir for at least 2 days.”
121
A patient, who has been on lamivudine for hepatitis B, was prescribed sulfamethoxazole-trimethoprim (SMX-TMP) for a urinary tract infection (UTI). The nurse notifies the health care provider because of which drug-drug interaction?
SMX-TMP can decrease the effects of lamivudine.
Lamivudine can increase the effects of trimethoprim.
SMX-TMP can increase lamivudine levels.
Lamivudine can negate the effects of SMX-TMP
SMX-TMP can increase lamivudine levels.
122
Acyclovir was prescribed to a patient with a history of seizures that have been controlled with phenytoin. Which action by the health care provider would the nurse anticipate because of the drug-drug interaction?
Increase the phenytoin dose.
Increase the acyclovir dose.
Decrease the phenytoin dose.
Decrease the acyclovir dose.
Increase the phenytoin dose.
123
Which statement by the patient indicates an accurate understanding of abacavir?
“I have to take the drug with food.”
“I will notify my health care provider if I have trouble swallowing to change it to a solution.”
“I need to avoid all alcohol, including over-the-counter liquid drug preparations.”
“I will notify my health care provider if I have flu-like symptoms.”
“I need to avoid all alcohol, including over-the-counter liquid drug preparations.”
124
A patient, who recently started antiretroviral therapy (ART) for HIV infection, asks the nurse why a strict routine for taking the drugs is important. Which reason would the nurse provide?
“Having a strict routine helps in noticing side effects.”
“Having a strict routine helps you plan your day better.”
“Strict drug adherence is important in preventing drug-resistant strains.”
“It reduces some of the side effects of the drugs if the drugs are taken at a certain time of day.”
“Strict drug adherence is important in preventing drug-resistant strains.”
125
A nurse preparing to administer abacavir notes the patient has mild renal impairment. Which action would the nurse anticipate taking?
Administer abacavir.
Notify the health care provider.
Administer intravenous (IV) fluids.
Hold the dose of abacavir.
Administer abacavir.
126
A patient who has difficulty swallowing solids is prescribed darunavir tablets. Which action by the nurse is correct?
Crush the pill and mix in a small amount of food or water.
Hold the dose until the patient can swallow pills.
Notify the health care provider for a gastrointestinal (GI) consult.
Notify the health care provider to change the prescription to an oral solution.
Notify the health care provider to change the prescription to an oral solution.
127
The nurse is educating a patient about the side and adverse effects of antiretroviral drugs. Which side effects will the nurse tell the patient are common?
Select all that apply.
Nausea
Lactic acidosis
Vomiting
Myalgia
Jaundice
Fatigue
Nausea
Vomiting
Myalgia
Fatigue
128
For which reason is amphotericin B administered intravenously?
Intravenous (IV) drugs are not metabolized by the liver.
It is poorly absorbed through the gastrointestinal (GI) tract.
The drug can be eliminated faster.
The intestines metabolize the drug.
It is poorly absorbed through the gastrointestinal (GI) tract.
129
Knowing that flucytosine is administered every 6 hours, which time frame describes the half-life of flucytosine?
3 to 8 hours
9 to 50 hours
20 to 50 hours
15 days
3 to 8 hours
130
Which antifungal inhibits the formation of ergosterol, a major sterol in the fungal cell membrane?
Flucytosine
Fluconazole
Griseofulvin
Amphotericin B
Fluconazole
131
Which of the antifungal drugs are classified as echinocandins?
Select all that apply.
Micafungin
Caspofungin
Amphotericin B
Griseofulvin
Ketoconazole
Micafungin
Caspofungin
132
Which priority assessment would the nurse conduct in Mr. Winter before administering fluconazole?
Obtain vital signs.
Determine immune status.
Check renal and hepatic function.
Ask about any previous treatment with antifungals.
Check renal and hepatic function.
133
Which statement by Mr. Winter indicates an accurate understanding about fluconazole?
“I will need to take the drug twice a day.”
“I must take the drug with high-fat food.”
“I will have to come for an injection of the drug on a weekly basis.”
“I can take the drug with food.”
“I can take the drug with food.”
134
The nurse is about to administer fluconazole to a young adult for vulvovaginal fungal infection. Which priority assessment is needed?
Past sexual history
Vital signs
Hemoglobin and hematocrit
Pregnancy test
Pregnancy test
135
Which patient condition would require the nurse to clarify a prescription for griseofulvin with the health care provider?
Systemic candida infection
Tinea capitis
Onychomycosis
Tinea corporis
Systemic candida infection
136
Flucytosine 37 mg/kg every 6 hours is prescribed to a patient with decreased urine output. Which action would the nurse anticipate?
Assess renal function.
Encourage fluid intake.
Administer the drug as prescribed.
Administer the drug intravenously over 1 hour.
Assess renal function.
137
The nurse is preparing to administer several antifungal drugs. Which antifungal drugs would the nurse anticipate administering orally?
Select all that apply.
Fluconazole
Caspofungin
Flucytosine
Griseofulvin
Amphotericin B
Fluconazole
Flucytosine
Griseofulvin
138
By which mechanisms does amphotericin B induce its therapeutic effects?
Select all that apply.
Binds to the fungal cell wall
Increases the cell membrane permeability
Inhibits cytochrome 450 (CYP450) enzyme
Converts amphotericin B to 5-fluorouracil
Causes fungal intracellular contents to leak out of the cell
Binds to the fungal cell wall
Increases the cell membrane permeability
Causes fungal intracellular contents to leak out of the cell
139
A young adult woman is prescribed an antifungal for vulvovaginal infection. Which statement made by the patient indicates a need for more teaching?
“I will abstain from sexual intercourse until the infection is resolved.”
“I will stop taking the drug while I am menstruating.”
“I will take the drug around lunchtime each day.”
“I will need to wear loose clothing to keep the area cool.”
“I will stop taking the drug while I am menstruating.”
140
As the nurse prepares to administer a dose of amphotericin, redness and pain at the intravenous (IV) site are noted. Which action would be appropriate for the nurse to take?
Place a cold pack to the IV site before administering the drug.
Administer the drug through the current site.
Flush the IV catheter with saline solution.
Administer amphotericin B through a different IV site.
Administer amphotericin B through a different IV site.
141
A patient receiving amphotericin B would be instructed to immediately report which adverse effect of the medication?
Muscular weakness
Ringing of the ears
Low grade fever
Nausea
Ringing of the ears
142
A patient on fluconazole should have which laboratory tests monitored frequently?
Select all that apply.
Glucose
Creatinine
Liver enzymes
International normalized ratio (INR)
Serum potassium
Creatinine
Liver enzymes
Serum potassium
