Pharmacology Exam 5 Questions and Answers,100% CORRECT

Pharmacology Exam 5 Questions and Answers Ch 38-44 PPT Questions 1. A patient is receiving Augmentin (amoxicillin and clavulanic acid) liquid solution through a PEG tube. What is the purpose of clavulanic acid? a. It works synergistically with the antibiotic to improve potency. b. It inhibits the action of the enzymes produced by beta-lactamase–producing bacteria. c. It protects the antibiotic from the harmful gastric acid secretions in the stomach. d. It enhances the absorption of the antibiotic in the small intestine. 2. When completing an admission assessment, the patient states that she is allergic to sulfa drugs. What will the nurse do next? a. Mark the allergy on her medical record. b. Place an “allergy” armband on the patient. c. Ask the patient for more information about the allergic reaction she had. d. Notify the physician about the patient’s allergy. 3. A patient has a prescription for a sulfa drug as treatment for a urinary tract infection. She is also taking an oral contraceptive, an oral sulfonylurea antidiabetic drug, and phenytoin for a history of seizures. Which drug may pose a potential serious interaction with the sulfa drug? a. The oral contraceptive b. The oral antidiabetic drug c. The phenytoin d. All of these 4. During intravenous quinolone therapy in an 88-year-old patient, which potential problem is of most concern when assessing for adverse effects? a. Hepatotoxicity b. Rhabdomyolysis c. Tendon rupture d. Nephrotoxicity 5. A patient is prescribed linezolid (Zyvox) to treat hospital-acquired pneumonia. It is most important for the nurse to determine if the patient is also taking which medication? a. A diuretic b. A selective serotonin reuptake inhibitor c. A cardiac glycoside d. A thyroid replacement drug 6. A 58-year-old man is receiving vancomycin as part of the treatment for a severe bone infection. After the infusion, he begins to experience some itching and flushing of the neck, face, and upper body. He reports no chills or difficulty breathing. The nurse should suspect: a. an allergic reaction has occurred. b. an anaphylactic reaction is about to occur. c. the medication will not be effective for the bone infection. d. the IV dose may have infused too quickly. 7. A group of office workers is concerned because a package was opened that contained a white powder substance. There is a concern that the white powder is anthrax. Which drug does the nurse anticipate being prescribed for the office workers? a. daptomycin (Cubicin) b. colistimethate (Coly-Mycin) c. ciprofloxacin (Cipro) d. quinupristin/dalfopristin (Synercid) 8. An 82-year-old woman is unable to take the influenza vaccine due to allergies, but she has been exposed to the virus through a family reunion. She does not yet have symptoms of the flu. Which option would be best for her? a. She should receive the flu vaccine as soon as possible. b. She should receive zanamivir (Relenza) in the inhalation form. c. She should begin oral oseltamivir (Tamiflu) therapy when symptoms begin. d. She should begin oral oseltamivir (Tamiflu) therapy as soon as possible. 9. A patient with HIV infection is seen in the clinic. The nurse notes that the patient is experiencing weight loss, chronic diarrhea, fever, and dropping CD4 counts. The nurse anticipates the patient is in which stage of HIV infection? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 10. A patient with active HIV has been taking zidovudine (Retrovir). Which potential adverse effect may limit the length of time this medication can be taken? a. Lactic acidosis b. Bone marrow suppression c. Hepatomegaly d. Fatigue 11. The nurse administers maraviroc (Selzentry) to a patient with HIV infection. It is most important for the nurse to monitor which of the following? a. CD4 count b. Bone marrow suppression c. Urinary output d. Liver function tests 12. A patient with tuberculosis has been taking antitubercular drugs. A sputum culture is ordered to test for acid-fast bacilli. When is the best time for the nurse to obtain the sputum culture? a. In the morning b. Noon c. Five o’clock in the evening d. Ten o’clock in the evening 13. A patient with a diagnosis of tuberculosis (TB) will be taking isoniazid (INH) as part of the anti-TB therapy. When reviewing the patient’s chart, the nurse finds documentation that the patient is a “slow acetylator.” This means that: a. the dosage of INH may need to be lower to prevent INH accumulation. b. the dosage of INH may need to be higher due to the slow acetylation process. c. he should not take INH. d. he will need to take a combination of anti-TB drugs for successful therapy. 14. A patient is receiving isoniazid (INH) for the treatment of tuberculosis. Which vitamin does the nurse anticipate administering with the INH to prevent isoniazid-precipitated peripheral neuropathies? a. Vitamin C b. Vitamin B12 c. Vitamin D d. Vitamin B6 15. Four weeks after beginning antitubercular drug therapy on an outpatient basis, the patient reports that he still experiences night sweats. What does the nurse identify as the main concern at this time? a. He is not taking his medication properly. b. More time is needed to see a therapeutic response. c. His infection may be resistant to the drug therapy ordered. d. He may have contracted a different strain of tuberculosis (TB). 16. A patient has an extremely severe infection with a Mycobacterium that is resistant to all but one antitubercular drug; however, the patient has had an allergic reaction to that drug in the past. What does the nurse anticipate as being ordered for this patient? a. A combination of antitubercular drugs will be chosen to fight the infection. b. The patient will receive the drug and supportive care to help him tolerate the antitubercular therapy. c. The patient will remain on isolation precautions until his cough clears. d. There is nothing that can be done with this patient. 17. A home care nurse is visiting a patient with a diagnosis of TB. The patient traveled abroad two months ago. He lives with his wife and 5-year-old son. The patient tells the nurse that he is concerned his son will also get TB so he wants to share his pills with his son. What is the best response by the nurse? a. “That is a good idea. Children should not be exposed to TB.” b. “You should give your son half of the dose you take.” c. “Do not share any of your medications with anyone. Contact your son’s health care provider to discuss your concerns.” d. “Children have an immune system that makes them immune to TB.” 18. The patient tells the nurse, “I had a shot after I returned from my trip overseas. I thought that was supposed to stop me from getting a tuberculosis infection.” What information regarding tuberculosis- related injections does the nurse identify as being true? a. BCG is used to prevent infection with tuberculosis for women of childbearing age. b. A positive result for a PPD test is indicated by redness at the site of injection. c. PPD is a diagnostic injection given intradermally to detect exposure to the TB organism. d. BCG is a vaccine injection derived from an activated strain of Mycobacterium bovis. 19. The patient’s wife is taking rifampin to prevent her from developing a tuberculosis infection. Which statement by the wife indicates that further teaching is needed? a. “Because my oral contraceptives will not work while I am taking rifampin, I will use another form of birth control.” b. “I will take the medication for one week and then stop.” c. “I will avoid prolonged exposure to the sun.” d. “My urine may turn a reddish color when taking rifampin.” 20. A patient has developed an aspergillosis infection. Which tissue does the aspergillosis affect? a. Skin b. Nails c. Blood d. Lungs 21. A patient is diagnosed with onychomycosis. The nurse anticipates use of which medication for the treatment of this condition? a. terbinafine (Lamisil) b. voriconazole (Vfend) c. fluconazole (Diflucan) d. amphotericin B (Amphocin, Fungizone) 22. A patient is receiving amphotericin B lipid complex. The nurse knows that an advantage of the lipid formulations of this drug is that they a. have a lower cost. b. can be administered quickly. c. take longer to be absorbed. d. cause fewer adverse effects. 23. Fifteen minutes after an infusion of amphotericin B was started, the patient begins to complain of fever, chills, muscle pain, and nausea. His heart rate has increased slightly, but his blood pressure is down to 100/68. What is the nurse’s priority? a. Notify the prescriber immediately. b. Recognize an impending anaphylactic reaction and stop the infusion. c. Assess for other symptoms of this expected infusion- related reaction. d. Slow the infusion to reduce these adverse effects. 24. A patient is taking nystatin (Mycostatin) in an oral troche form for oral candidiasis. Which instruction is correct? a. Allow the troche to dissolve slowly in the mouth. b. Swish the medication in the mouth and then swallow it. c. Chew the troche thoroughly to activate the medication. d. Swallow the troche whole without chewing. 25. When pyrimethamine is used to treat malaria, a sulfonamide antibiotic is often also used. The purpose of the antibiotic is to: a. treat the bacterial infections that often accompany malaria. b. allow the antimalarial drug to be effective in the exoerythrocytic phase. c. cause synergism, allowing for a stronger antimalarial effect. d. allow for reduced adverse effects because smaller doses of each drug are used. 26. Before administration of primaquine, it is most important for the nurse to assess the patient for a history of which condition? a. Asthma b. Diabetes mellitus c. Hypertension d. Rheumatoid arthritis 27. A male patient with an HIV infection has a severe case of P. jirovecii pneumonia (PJP) and needs to be treated with pentamidine. However, he is allergic to the inhaled form of this medication. Considering the seriousness of his condition, what does the nurse expect will be done in this situation? a. He will be given the inhaled form of pentamidine and be monitored closely. b. He will be given the pentamidine in an IM or IV injection and be monitored closely. c. Another drug, such as metronidazole (Flagyl), will be ordered. d. He will receive supportive care because he is unable to take the pentamidine. 28. A patient is taking metronidazole for amebiasis. What information should the nurse include in the patient teaching? a. How to check stool samples correctly and safely b. Metronidazole may precipitate hypertension c. Blurred vision is an expected effect of this medication, which will resolve with time d. To take the medication on an empty stomach 29. The nurse is administering medications. One patient has an order for aspirin 325 mg by mouth daily and another patient has an order for aspirin 650 mg 4 to 6 times daily (maximum 4 g/day). The nurse understands that the indication for the 325 mg of aspirin once daily is a. pain management. b. fever reduction. c. treatment of osteoarthritis. d. thromboprevention. 30. A hospitalized patient has an order for ketorolac (Toradol). The nurse notes that the order is only for 5 days. What is the reason for this? a. The patient’s pain should subside by that time. b. There are concerns about addiction to the drug. c. The drug can cause severe renal and gastrointestinal effects. d. The drug loses its effectiveness over time. 31. An 82-year-old woman is taking ibuprofen (Motrin) 3200 mg divided three times daily as treatment for arthritis. She has had no other health problems. What is the most important assessment for the nurse to monitor while the patient is on this therapy? a. Blood sugar b. Liver function studies c. Assessment of hearing d. Renal function studies 32. A patient is admitted with salicylate toxicity. When assessing the patient, the nurse anticipates which manifestation associated with salicylate toxicity? a. Bradycardia b. Hypoventilation c. Constipation d. Hyperglycemia 33. Which drug does the nurse associate with the development of potentially life-threatening skin adverse effects of exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis? a. probenecid b. colchicine c. febuxostat (Uloric) d. allopurinol (Zyloprim) 34. A patient is taking ibuprofen 800 mg three times a day by mouth as treatment for osteoarthritis. While taking a health history, the nurse finds out that the patient has few beers on weekends. What concerns would there be with the interaction of the alcohol and ibuprofen? a. Increased bleeding tendencies b. Increased chance for gastrointestinal bleeding c. Increased nephrotoxic effects d. Reduced antiinflammatory effects of the nonsteroidal antiinflammatory drug (NSAID) Ch 38-44 PPT Answers 1. Correct answer: B a. Rationale: The clavulanic acid works to inhibit the action of the enzymes produced by the bacteria, which would normally inactivate the antibiotic. 2. Correct answer: C a. Rationale: Some patients will say they are “allergic” to drugs when in fact what they experienced was a common and mild adverse effect. The nurse should clarify the patient’s statements with open-ended questions. 3. Correct answer: D a. Rationale: The combination of the sulfa drug with the oral contraceptive may reduce the effectiveness of the contraceptive. The combination with the oral antidiabetic drug may potentiate the hypoglycemic effect of the sulfonylurea drug, while the combination with phenytoin may potentiate the toxic effects of phenytoin. 4. Correct answer: C a. Rationale: A black box warning is required by the U.S. Food and Drug Administration for all quinolones because of the increased risk of tendonitis and tendon rupture with use of the drugs. This effect is more common in elderly patients, patients with renal failure, and those receiving concurrent glucocorticoid therapy (e.g., prednisone). 5. Correct answer: B a. Rationale: Linezolid has the potential to strengthen the vasopressor (prohypertensive) effects of various vasopressive drugs such as dopamine by an unclear mechanism. Also, there have been postmarketing case reports of this drug causing serotonin syndrome when used concurrently with serotonergic drugs such as the selective serotonin reuptake inhibitor (SSRI) antidepressants. It is recommended that the SSRI be stopped while the patient is receiving linezolid therapy if possible. 6. Correct answer: D a. Rationale: These symptoms are known as red man syndrome and may occur during or after an infusion of vancomycin. This syndrome is characterized by flushing and/or itching of the head, face, neck, and upper trunk area. Symptoms can usually be alleviated by slowing the rate of infusion to at least 1 hour. Red man syndrome is bothersome but usually not harmful. Rapid infusions may also cause hypotension. 7. Correct answer: C a. Rationale: Ciprofloxacin (Cipro) is the drug of choice for the treatment of anthrax (infection with Bacillus anthracis). 8. Correct answer: D a. Oseltamivir (Tamiflu) is the only one indicated for prophylaxis of influenza infection. Both oseltamivir and zanamivir can be used to treat active influenza illness. Treatment with oseltamivir and zanamivir ideally should begin within 2 days of symptom onset. 9. Correct answer: C a. Rationale: During stage 3, the infection progresses to a moderately symptomatic state. Weight loss, chronic diarrhea, and fever continues, and CD4 counts continue to drop. Opportunistic infections begin, including severe bacterial pneumonias and pulmonary tuberculosis (TB). Pulmonary TB is usually more severe in persons with AIDS and is currently the leading cause of death worldwide for HIV-infected patients. 10. Correct answer: B a. Rationale: The major dose-limiting adverse effect of zidovudine (Retrovir) is bone marrow suppression, and this is often the reason a patient with an HIV infection must be switched to another anti-HIV drug. 11. Correct answer: D a. Rationale: The antiretroviral drug maraviroc requires assessment of allergies and liver function as well as review of the list of medications the patient is taking because of the lengthy list of interacting drugs. 12. Correct answer: A a. Rationale: If the prescriber has ordered collection of a sputum specimen to test for acid-fast bacilli, it is best to obtain the sample early in the morning. The most common order is for three consecutive morning specimens, with a repeat specimen several weeks later. 13. Correct answer: A a. Rationale: When INH is taken by slow acetylators, the INH accumulates because there are not enough liver enzymes to break down the INH. Therefore, the dosages of INH may need to be adjusted downward to prevent toxicity. 14. Correct answer: D a. Rationale: Pyridoxine (vitamin B6) may be indicated to prevent isoniazid-precipitated peripheral neuropathies and numbness, tingling, or burning of the extremities. 15. Correct answer: C a. Rationale: The nurse should not jump to conclusions that the patient is not taking his medication properly. An improvement should start to occur within 2 weeks of starting drug therapy, but this may not occur if the patient’s TB is not sensitive to the prescribed drugs. An evaluation of the drug therapy will be needed. 16. Correct answer: B a. Rationale: It must be recognized that the urgency of treating a potentially fatal infection may have to be balanced against any prevailing contraindications. In extreme cases, patients are sometimes given a drug to which they have some degree of allergy with supportive care that enables them at least to tolerate the medication. Examples of such supportive care are treatment with antipyretics (e.g., acetaminophen), antihistamines (e.g., diphenhydramine), or even corticosteroids (e.g., prednisone, methylprednisolone). 17. Correct answer: C a. Rationale: Medications of any kind should never be shared with any other person. In particular, antitubercular drugs are age specific. Assessment of age is also important, because the likelihood of adverse reactions and toxicity is increased in elderly patients due to age-related liver and kidney dysfunction. Additionally, the safety of these drugs in children 13 years of age and younger has not been established. 18. Correct answer: C a. Rationale: PPD is a diagnostic injection given intradermally in doses of 5 tuberculin units (0.1 mL) to detect exposure to the TB organism. A positive result is indicated by induration (not erythema) at the site of injection and is known as the Mantoux reaction, named for the physician who described it. BCG is used in much of the world to vaccinate young children against tuberculosis. Although it does not prevent infection, evidence indicates that it reduces active tuberculosis by 60% to 80% and is even more effective at preventing more severe cases involving dissemination of infection throughout the body. 19. Correct answer: B a. Rationale: Antitubercular therapy is taken for long periods of time, often 24 months. Although this patient does not have an active infection at this time and is taking the rifampin to prevent an infection, the nurse should further investigate the length of time the medication is ordered. All other statements are true. 20. Correct answer: D a. Rationale: The primary tissue affected by aspergillosis is the lungs. 21. Correct answer: A a. Rationale: Terbinafine (Lamisil) is indicated for the treatment of onychomycosis (fungal infection of fingernail or toenail). Voriconazole (Vfend) is indicated for the treatment of invasive aspergillosis and other major fungal infections in patients who do not tolerate or respond to other antifungal drugs. Fluconazole (Diflucan) is indicated for the treatment of vaginal candidiasis, oropharyngeal and esophageal candidiasis, systemic candidiasis, and cryptococcal meningitis. Amphotericin B (Amphocin, Fungizone) is indicated for the treatment of systemic infections with broad spectrum of fungi. 22. Correct answer: D a. Rationale: Lipid formulations of amphotericin B have been developed in an attempt to decrease the incidence of its adverse effects and increase its efficacy. There are currently three lipid preparations of amphotericin B: amphotericin B lipid complex (Abelcet), amphotericin B cholesteryl complex (Amphotec), and liposomal amphotericin B (AmBisome). These lipid dosage forms have a much higher cost than conventional amphotericin B and for this reason are often used only when patients are intolerant of or have an infection refractory to nonlipid amphotericin B. 23. Correct answer: C a. Rationale: Almost all patients who receive amphotericin B experience fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache. For this reason, antihistamines, acetaminophen (an antipyretic), and antiemetics may be given as pretreatment to reduce these expected effects. 24. Correct answer: A a. Rationale: Oral troche or lozenge forms of this medication should be allowed to dissolve slowly in the mouth without chewing. 25. Correct answer: C a. Rationale: The combination of some antimalarial drugs with specific antibiotics results in synergistic effects, thus making the drugs more effective against the malarial infection. 26. Correct answer: D a. Rationale: Primaquine is contraindicated in patients with allergy or any disease states that may cause granulocytopenia (rheumatoid arthritis, systemic lupus erythematosus). Primaquine must be used with caution in patients with methemoglobinemia, porphyria, methemoglobin reductase deficiency, and glucose-6-phosphate dehydrogenase (G6PD) deficiency. 27. Correct answer: B a. Hypersensitivity is more common when the drug is administered by inhalation. An allergic reaction to the inhalational form does not preclude its administration by either the intramuscular or intravenous route, due to the seriousness of the Pneumocystis infection. 28. Correct answer: A a. When the patient is taking metronidazole for amebiasis, the nurse should include in the instructions how to check stool samples correctly and safely, and how to dispose of samples properly. Metronidazole may precipitate dizziness, so encourage the patient to be cautious in all activities until a response to the drug is noted and is consistent. Encourage the patient to contact the prescriber if there is any visual disturbance noted. The medication should be taken with food to decrease gastrointestinal upset. 29. Correct answer: D a. Rationa