NR413 Pharmacology Exam 5 - Regis University
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Free NR413 Pharmacology Exam 5 - Regis University Questions
A female client is prescribed a broad spectrum antibiotic. The client reports that she frequently develops a yeast infection when taking antibiotics. Which of the following instructions should the nurse include for the client?
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Educate the client that yeast infections are a form of severe allergic reaction, she should take an antihistamine
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It is best to take multiple antibiotics at the same time to prevent fungal overgrowth/infections
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Try to take in daily yogurt, buttermilk, or a probiotic agent to help prevent fungal overgrowth/infection
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There have been improvements in antibiotic treatment so fungal overgrowth/infections no longer occur
Explanation
Broad-spectrum antibiotics disrupt the normal, protective bacterial flora throughout the body, including in the vaginal area, which can allow for an overgrowth of Candida (yeast). Consuming foods containing live cultures (such as yogurt or buttermilk) or taking a probiotic supplement can help restore normal flora balance and reduce the risk of developing a secondary yeast infection during antibiotic therapy.
Why the other options are incorrect:
A. Educate the client that yeast infections are a form of severe allergic reaction, she should take an antihistamine. This is factually incorrect; a yeast infection is a fungal overgrowth, not an allergic reaction, and antihistamines would not be an appropriate treatment.
B. It is best to take multiple antibiotics at the same time to prevent fungal overgrowth/infections. Taking multiple antibiotics simultaneously would further disrupt normal flora and increase, not decrease, the risk of fungal overgrowth.
D. There have been improvements in antibiotic treatment so fungal overgrowth/infections no longer occur. This is factually inaccurate; fungal overgrowth remains a common and well-documented complication of antibiotic therapy.
A client with cancer has been admitted to the hospital for severe anemia due to chemotherapy. For religious reasons, the client is refusing blood transfusions. What order from the provider would the nurse anticipate?
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Tamoxifen
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Oprelvekin
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Erythropoietin
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Filgrastim
Explanation
Erythropoietin is a hematopoietic growth factor that stimulates the bone marrow to produce red blood cells. For a client who is refusing blood transfusions due to religious beliefs but requires treatment for chemotherapy-induced anemia, erythropoietin provides an alternative method to help increase red blood cell production without the need for a blood transfusion.
Why the other options are incorrect:
A. Tamoxifen. This is a hormone therapy medication used to treat estrogen receptor-positive breast cancer and has no role in treating anemia.
B. Oprelvekin. This medication stimulates platelet production and is used to treat thrombocytopenia, not anemia.
D. Filgrastim. This medication stimulates white blood cell (neutrophil) production and is used to treat neutropenia, not anemia.
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"Multiple agents are necessary because of the risk of the TB bacteria developing drug resistance"
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"Due to non-compliance, we prescribe many drugs so that even if you are 50% compliant we can still cure you"
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"You are very sick, we only use multiple drugs when the TB case is severe"
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"If we use more agents, then we can treat you for a shorter period of time"
Explanation
Tuberculosis treatment requires a multidrug regimen because using a single agent increases the risk of the bacteria developing resistance to that medication. Combining multiple antitubercular drugs with different mechanisms of action helps ensure more complete eradication of the bacteria and significantly reduces the likelihood of resistant strains developing.
Why the other options are incorrect:
B. "Due to non-compliance, we prescribe many drugs so that even if you are 50% compliant we can still cure you" This is inaccurate and could encourage poor medication adherence; the client must take the full regimen as prescribed for effective treatment.
C. "You are very sick, we only use multiple drugs when the TB case is severe" Multidrug therapy is the standard of care for all active TB cases, not reserved solely for severe presentations.
D. "If we use more agents, then we can treat you for a shorter period of time" This is misleading; TB treatment still requires a prolonged course (typically 6 months or more) regardless of using multiple agents, and the primary purpose is to prevent resistance, not shorten treatment duration.
Laboratory Data:
- WBC: 894 — Normal values: 4000-10000
- RBC: 4.2 — Normal values: M: 4.7-6.1, F: 4.2-5.4
- Hemoglobin: 11.5 — Normal values: M: 13.5-17.5, F: 11.5-15.5
- Hematocrit: 36% — Normal values: M: 40%-52%, F: 36%-48%
- Platelets: 149,800 — Normal values: 150,000-400,000
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Instruct the client to increase the caloric density of their diet
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Instruct the client to begin using a soft toothbrush for oral hygiene
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Instruct the client to plan for periods of rest to prevent fatigue
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Instruct the client to avoid crowds
Explanation
The client's WBC count of 894 is critically low compared to the normal range of 4,000–10,000, indicating severe leukopenia (a common effect of chemotherapy). This places the client at significant risk for developing a serious, potentially life-threatening infection. The highest priority nursing intervention is to instruct the client to avoid crowds and other sources of infection exposure to protect their compromised immune system.
Why the other options are incorrect:
A. Instruct the client to increase the caloric density of their diet. While nutrition is important during chemotherapy, this is not the priority concern given the client's critically low WBC count and associated infection risk.
B. Instruct the client to begin using a soft toothbrush for oral hygiene. This is appropriate and relevant to the client's slightly low platelet count (149,800, just below normal) to reduce bleeding risk, but it is not the highest priority compared to the severely low WBC count and infection risk.
C. Instruct the client to plan for periods of rest to prevent fatigue. The client's RBC, hemoglobin, and hematocrit are only mildly low/borderline within range, making fatigue management a lower priority compared to the critical infection risk posed by the severely low WBC count.
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Stop the current antibiotic infusion, and provide hand-off report of these results to the oncoming nurse
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Call the provider to see if a change in antibiotics should be made before the next administration
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Send a message to the provider about the results, but administer the current antibiotic
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Discontinue the antibiotic, and call the pharmacy to obtain a new order for an appropriate antibiotic
Explanation
When culture and sensitivity results reveal that the bacteria is resistant to the currently ordered antibiotic, the nurse's priority action is to promptly notify the provider so that an appropriate change in therapy can be ordered before the next dose is due. This ensures the client receives an effective treatment as soon as possible while working within the nurse's scope of practice, since only the provider can change the medication order.
Why the other options are incorrect:
A. Stop the current antibiotic infusion, and provide hand-off report of these results to the oncoming nurse. Passing this critical information along without taking direct action or notifying the provider delays necessary treatment changes and does not represent a proactive priority action.
C. Send a message to the provider about the results, but administer the current antibiotic. Continuing to administer an antibiotic known to be ineffective against the resistant organism does not benefit the client and delays appropriate treatment.
D. Discontinue the antibiotic, and call the pharmacy to obtain a new order for an appropriate antibiotic. This is outside the nurse's scope of practice; only the provider can order a change in antibiotic therapy, not the pharmacy or the nurse independently.
The provider has just prescribed Amphotericin B for a hospitalized client. Based on the medication prescribed, the nurse anticipates that the client has been diagnosed with which disorder?
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Severe viral infection
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Active tuberculosis
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Severe fungal infection
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Severe bacterial infection
Explanation
Amphotericin B is a potent systemic antifungal medication reserved for the treatment of serious, life-threatening fungal infections due to its significant side effect profile, including nephrotoxicity and infusion-related reactions. Its use indicates the client has been diagnosed with a severe systemic fungal infection requiring aggressive antifungal therapy.
Why the other options are incorrect:
A. Severe viral infection. Amphotericin B has no antiviral activity and would not be prescribed for a viral infection.
B. Active tuberculosis. Tuberculosis is treated with specific antitubercular agents (such as isoniazid, rifampin, ethambutol, and pyrazinamide), not antifungal medications like amphotericin B.
D. Severe bacterial infection. Amphotericin B has no antibacterial activity and is not used to treat bacterial infections.
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Teach the client how to administer intramuscular injections since they will need to do this independently
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Instruct the client to stay in the waiting room for the next 30 minutes to monitor for allergic reactions
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Place a bandage over the injection site before sending the patient home
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Document the date, time, dosage, and location of the injection in the client's medical record
Explanation
Penicillin carries a risk of severe allergic reactions, including anaphylaxis, which most commonly occur within the first 30 minutes after administration. The priority nursing intervention is to have the client remain in the clinic for observation during this critical window, allowing for prompt intervention if a reaction occurs.
Why the other options are incorrect:
A. Teach the client how to administer intramuscular injections since they will need to do this independently. This is not relevant to a single in-clinic IM injection and does not address the priority safety concern of monitoring for an allergic reaction.
C. Place a bandage over the injection site before sending the patient home. This is a minor, non-priority task compared to the critical need to monitor for a potentially life-threatening allergic reaction.
D. Document the date, time, dosage, and location of the injection in the client's medical record. While documentation is an important nursing responsibility, it is not the priority over ensuring client safety through monitoring for an immediate allergic reaction.
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If you have a negative pregnancy test prior to starting treatment, then you will not need another pregnancy test
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It will be okay to donate blood in-between dosages of isotretinoin
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You will need to avoid the use of oral contraceptives while taking this drug
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You will need to use two forms of contraception during treatment and for one month after treatment
Explanation
The iPledge program requires female clients of childbearing potential who are prescribed isotretinoin to use two effective forms of contraception simultaneously, starting one month before treatment, continuing throughout treatment, and for one month after discontinuing the medication, due to isotretinoin's significant risk of severe birth defects.
Why the other options are incorrect:
A. If you have a negative pregnancy test prior to starting treatment, then you will not need another pregnancy test. This is incorrect; the iPledge program requires monthly pregnancy testing throughout the course of treatment, not just a single test prior to starting.
B. It will be okay to donate blood in-between dosages of isotretinoin. Clients taking isotretinoin are instructed not to donate blood during treatment and for one month after, due to the risk of the medication being transmitted to a pregnant recipient through transfusion.
C. You will need to avoid the use of oral contraceptives while taking this drug. Oral contraceptives are an acceptable and often recommended form of one of the two required methods of contraception during isotretinoin treatment, not something to avoid.
Which one of the following chemotherapeutic agents can lead to a form of neurotoxicity of the peripheral nerves, also known as stocking-glove syndrome, that causes numbness and tingling in the fingers and toes?
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Vincristine
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Tamoxifen
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Methotrexate
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Dexamethasone
Explanation
Vincristine is a chemotherapeutic agent well known for causing peripheral neuropathy, presenting as a "stocking-glove" pattern of numbness and tingling in the hands and feet. This neurotoxic effect occurs due to the drug's impact on microtubules within peripheral nerve cells, disrupting normal nerve function.
Why the other options are incorrect:
B. Tamoxifen. This is a selective estrogen receptor modulator used for hormone-receptor-positive breast cancer and is not associated with peripheral neuropathy.
C. Methotrexate. This chemotherapeutic agent is primarily associated with side effects such as mucositis and myelosuppression, not the classic stocking-glove peripheral neuropathy pattern.
D. Dexamethasone. This is a corticosteroid used as an adjunct in cancer treatment and is not associated with causing peripheral neuropathy.
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Antibiotic drug resistance can develop when clients stop taking the drug when symptoms improve
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Antibiotic drug resistance can develop only for clients taking narrow spectrum antibiotics
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Antibiotic resistance can develop when the client takes the antibiotic as it is prescribed until it is gone
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Antibiotic resistance can develop when a client takes an antibiotic for a viral condition
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Antibiotic resistance can develop when nurses administer antibiotics prior to obtaining cultures
Explanation
Stopping antibiotics early allows surviving, partially resistant bacteria to multiply and develop further resistance. Using antibiotics for viral infections (which they have no effect on) provides an opportunity for bacteria in the body to be unnecessarily exposed to the drug, promoting resistance without any therapeutic benefit. Administering antibiotics before obtaining cultures can result in inappropriate or overly broad antibiotic use, since the specific causative organism and its sensitivities have not yet been identified, increasing the risk of resistance developing.
Why the other options are incorrect:
B. Antibiotic drug resistance can develop only for clients taking narrow spectrum antibiotics. This is inaccurate; antibiotic resistance can develop with both narrow and broad-spectrum antibiotics, not exclusively narrow-spectrum agents.
C. Antibiotic resistance can develop when the client takes the antibiotic as it is prescribed until it is gone. Completing the full prescribed course of antibiotics as directed is the correct practice and actually helps prevent resistance, rather than contribute to it.
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