Regis University (Pharmacology I, Exam 4) Anti-infective, Anti-inflammatory, Anti-rheumatic and pain management Questions and Answers

Beta-Lactam Antibiotic? - Answer- Penicillin Name 3 Macrolide Antibiotics. - Answer- Erythromycin, Azithromycin and Clarithromycin Nursing Implications of Antibiotics regarding cultures. - Answer- ALWAYS get a culture done BEFORE beginning antibiotic therapy! Allopurinol (Zyloprim) is used to: - Answer- Prevent uric acid production (usually to prevent recurrence of a gout attack) What is the goal for drug therapy for gout? - Answer- To decrease symptoms/ prevent recurrence. Colchicine is used to: - Answer- Reduces inflammatory response of joints (most common, used for acute attack) When should Colchicine be discontinued? - Answer- If GI symptoms develop A patient has been prescribed tetracycline. When providing information regarding this drug, the nurse would be correct in stating that tetracycline A. Is classified as a narrow-spectrum antibiotic and only treats a few infections B. Is used to treat a wide variety of disease processes C. Has been identified to be safe during pregnancy D. Is contraindicated in children younger than 8 years - Answer- D. Is contraindicated in children younger than 8 years Teaching for a patient redceiving a prescription for ciprofloxacin (Cipro) should include (Select all that apply): 1. Report unusual heel, lower leg or calf pain or difficulty walking. 2. Avoid taking the medicine with milk products and antacids. 3. Limit vitamin C, both dietary and oral vitamin forms. 4. Take her pill with an antihistamine to avoid side effects - Answer- 1. Report unusual heel, lower leg or calf pain or difficulty walking. 2. Avoid taking the medicine with milk products and antacids The nurse recognizes that opioid analgesics exert their action by interacting with a variety of opioid receptors. Drugs such as morphine act by activating: - Answer- Mu and kappa The client admitted with hepatitis B is prescribed Vicodin tabs 2 for treatment of pain. The appropriate nursing action is to: a.) Administer the drug as ordered. b.) Administer one tablet only. c.) Question the physician about the order. d.) Hold the drug until the physician arrives. - Answer- c.) Question the physician about the order. Vicodin is a combination drug of hydrocodone and acetaminophen. Acetaminophen can be hepatotoxic, and is contraindicated in liver disease Naloxone (Narcan) is administered to a client with severe respiratory depression and suspected drug overdose. After 20 minutes, the client remains unresponsive. The most likely explanation for this is: a.) The client did not use an opioid drug. b.) The dose of naloxone was inadequate. c.) The client is resistant to this drug. d.) The drug overdose is irreversible. - Answer- a.) The client did not use an opioid drug. If opioid antagonists (Naloxone) fail to reverse symptoms of respiratory depression quickly, the overdose was likely due to a non-opioid substance Celecoxib (Celebrex) is added to the treatment regimen of a client with arthritis. The nurse explains that the major advantage of this drug is: a.) The drug is less expensive. b.) The drug has no known side effects. c.) The drug has anti-inflammatory properties. d.) The drug's effectiveness is the same as opioids. - Answer- c.) The drug has anti-inflammatory properties. Celecoxib (Celebrex) has anti-inflammatory properties. It is not less expensive, has many side effects, and is less potent than opioids. Two days after surgery, an elderly client refuses a PRN dose of analgesic dose for fear of becoming "hooked." The nurse should respond by stating that: a. It is impossible to become hooked on PRN narcotics. b. Short-term use of narcotics is not likely to cause a person to become dependent on them. c. Side effects that occur in the elderly mean that medications will be discontinued as soon as possible. d. The elderly are least likely to become dependent on narcotics. - Answer- b. Short-term use of narcotics is not likely to cause a person to become dependent on them Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which of the following would indicate the presence of systemic toxicity from this medication? 1. Tinnitus 2. Diarrhea 3. Constipation 4. Decreased respirations - Answer- 1. Tinnitus Rationale: Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can result. Symptoms include tinnitus, dizziness, hyperpnea, and psychological disturbances. Constipation and diarrhea are not associated with salicylism A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is reinforcing teaching for the client about the medications prescribed, including clarithromycin (Biaxin), esomeprazole (Nexium), and amoxicillin (Amoxil). Which statement by the client indicates the best understanding of the medication regimen? 1. "My ulcer will heal because these medications will kill the bacteria." 2. "These medications are only taken when I have pain from my ulcer." 3. "The medications will kill the bacteria and stop the acid production." 4. "These medications will coat the ulcer and decrease the acid production in my stomach." - Answer- 3. "The medications will kill the bacteria and stop the acid production." Rationale: Triple therapy for Helicobacter pylori infection usually includes two antibacterial drugs and a proton pump inhibitor. Clarithromycin and amoxicillin are antibacterials. Esomeprazole is a proton pump inhibitor. These medications will kill the bacteria and decrease acid production A postoperative client has received a dose of naloxone hydrochloride for respiratory depression shortly after transfer to the nursing unit from the postanesthesia care unit. After administration of the medication, the nurse checks the client for: 1. Pupillary changes 2. Scattered lung wheezes 3. Sudden increase in pain 4. Sudden episodes of diarrhea - Answer- 3. Sudden increase in pain Rationale: Naloxone hydrochloride is an antidote to opioids and may also be given to the postoperative client to treat respiratory depression. When given to the postoperative client for respiratory depression, it may also reverse the effects of analgesics. Therefore, the nurse must check the client for a sudden increase in the level of pain experienced. Options 1, 2, and 4 are not associated with this medication A client has been taking isoniazid (INH) for 2 months. The client complains to a nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing: 1. Hypercalcemia 2. Peripheral neuritis 3. Small blood vessel spasm 4. Impaired peripheral circulation - Answer- 2. Peripheral neuritis Rationale: A common side effect of the TB drug INH is peripheral neuritis. This is manifested by numbness, tingling, and paresthesias in the extremities. This side effect can be minimized by pyridoxine (vitamin B6) intake. Options 1, 3, and 4 are incorrect. A nurse reinforces discharge instructions to a postoperative client who is taking warfarin sodium (Coumadin). Which statement, if made by the client, reflects the need for further teaching? 1. "I will take my pills every day at the same time." 2. "I will be certain to avoid alcohol consumption." 3. "I have already called my family to pick up a Medic-Alert bracelet." 4. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated." - Answer- 4. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated." Rationale: Ecotrin is an aspirin-containing product and should be avoided. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking prescribed medication at the same time each day increases client compliance. The Medic-Alert bracelet provides health care personnel emergency information. A nurse is reinforcing discharge instructions to a client receiving sulfisoxazole. Which of the following should be included in the list of instructions? 1. Restrict fluid intake. 2. Maintain a high fluid intake. 3. If the urine turns dark brown, call the health care provider (HCP) immediately. 4. Decrease the dosage when symptoms are improving to prevent an allergic response. - Answer- 2. Maintain a high fluid intake. Rationale: Each dose of sulfisoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Some forms of sulfisoxazole cause urine to turn dark brown or red. This does not indicate the need to notify the HCP. Phenazopyridine hydrochloride (Pyridium) is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. The nurse reinforces to the client: 1. To take the medication at bedtime 2. To take the medication before meals 3. To discontinue the medication if a headache occurs 4. That a reddish orange discoloration of the urine may occur - Answer- 4. That a reddish orange discoloration of the urine may occur Rationale: The nurse should instruct the client that a reddish-orange discoloration of urine may occur. The nurse also should instruct the client that this discoloration can stain fabric. The medication should be taken after meals to reduce the possibility of gastrointestinal upset. A headache is an occasional side effect of the medication and does not warrant discontinuation of the medication Ibuprofen (Advil) is prescribed for a client. The nurse tells the client to take the medication: 1. With 8 oz of milk 2. In the morning after arising 3. 60 minutes before breakfast 4. At bedtime on an empty stomach - Answer- 1. With 8 oz of milk Rationale: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs should be given with milk or food to prevent gastrointestinal irritation. Options 2, 3, and 4 are incorrect. In monitoring a client's response to disease-modifying antirheumatic drugs (DMARDs), which findings would the nurse interpret as acceptable responses? Select all that apply. 1. Symptom control during periods of emotional stress 2. Normal white blood cell counts, platelet, and neutrophil counts 3. Radiological findings that show nonprogression of joint degeneration 4. An increased range of motion in the affected joints 3 months into therapy 5. Inflammation and irritation at the injection site 3 days after injection is given 6. A low-grade temperature upon rising in the morning that remains throughout the day - Answer- 1. Symptom control during periods of emotional stress 2. Normal white blood cell counts, platelet, and neutrophil counts 3. Radiological findings that show nonprogression of joint degeneration 4. An increased range of motion in the affected joints 3 months into therapy Rationale: Because emotional stress frequently exacerbates the symptoms of rheumatoid arthritis, the absence of symptoms is a positive finding. DMARDs are given to slow progression of joint degeneration. In addition, the improvement in the range of motion after 3 months of therapy with normal blood work is a positive finding. Temperature elevation and inflammation and irritation at