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NSG 6011 PHARM FINALS REVIEW 1. The nurse provides teaching for a patient who will begin taking bosentan [Tracleer] for pulmonary arterial hypertension (PAH). Which statement by the patient indicates a need for further teaching about this medication? a. “I may take this medication with or without food.” b. “I may develop irreversible liver damage while taking this drug.” c. “I should not take cyclosporine while taking this medication.” d. “I will need to have lab tests every month while taking this drug.” ANS: B Liver injury may occur with bosentan but all cases to date have been reversible. The medication may be taken without regard to meals. Patients taking bosentan should not take cyclosporine concurrently. Patients will need to have liver enzymes measured monthly while taking the drug. 2. A patient with a history of heart disease develops pulmonary arterial hypertension (PAH), and the provider is considering prescribing sildenafil [Revatio]. The nurse caring for this patient will perform a careful drug history and not ify the provider if the patient is taking which medication? a. A beta blocker b. A calcium channel blocker c. Nitroglycerin d. Warfarin ANS: C Patients taking sildenafil should not take nitroglycerin, since the combination can produce a life - threatening drop in blood pressure. Beta blockers, calcium channel blockers, and warfarin are not contraindicated with sildenafil. 3. A pregnant patient begins active labor at 30 weeks’ gestation. The provider orders dexamethasone 6 mg intramuscularly to be given twice daily for 4 doses. The patient asks the nurse what effect this drug will have on the fetus. The nurse will tell her that the dexamethasone is given to: a. improve cognitive function in the fetus. b. improve fetal neuromotor development. c. increase fetal weight and length. d. increase lung development in the fetus. ANS: D When preterm delivery cannot be prevented, injecting the pregnant patient with glucocorticoids can accelerate fetal lung maturation. Glucocorticoids do not improve cognitive function, neuro motor development, or physical size in the fetus. 4. A nurse counsels a patient who is to begin taking gamma -hydroxybutyrate [Xyrem] for narcolepsy. It is important for the nurse to warn the patient that respiratory depression is a potential risk with concomitant use of: a. alcohol. b. beta blockers. c. caffeine. d. nicotine. ANS: A The nurse should advise the patient to avoid alcohol when taking gamma -hydroxybutyrate, because combining the two increases the risk of respiratory depression. Gamma -hydroxybutyrate has no drug -to-drug interactions with beta blockers, caffeine, or nicotine. 5. A provider has told a parent that a 3-year-old child has a minor ear infection and that an antibiotic would be prescribed in a couple of days if the child’s symptoms worsened. The parent asks the nurse why the child cannot get an antibiotic today. Which response by the nurse is correct? a. “If the eardrum ruptures, we can culture the fluid to determine which antibiotic is best.” b. “Most ear infections are caused by viruses, so antibiotic s are not effective.” c. “Most ear infections will resolve on their own without antibiotics.” d. “Your child will develop tolerance to antibiotics if they are prescribed too often.” ANS: C The vast majority of acute otitis media (AOM) episodes resolve without treatment, so unless the child is very ill, observation is the initial choice. Spontaneous rupture of the tympanic membrane can occur, but clinicians do not wait for it to happen to obtain a culture that will guide treatment. About 70% to 90% of AOM episod es are bacterial in origin. Patients do not develop tolerance to antibiotic effects; overuse of antibiotics can lead to resistant organisms. 6. A nurse is teaching a parent about the observation strategy for managing a 3-year-old child’s ear infection. Which statement by the parent indicates understanding of the teaching? a. “I should not give analgesics, because they may mask important symptoms.” b. “I will give ibuprofen or acetaminophen for pain or fever as needed.” c. “I will let my provider know if the symptoms are not better in 1 week.” d. “There is a slight risk of mastoiditis if antibiotic therapy is delayed.” ANS: B Observation is defined as management by symptomatic relief alone for 48 to 72 hours to allow time for AOM to resolve on its own. Parents should be taught to administer analgesics/antipyretics. Providing pain relief does not mask an important symptom. Parents should notify the provider if symptoms worsen or do not improve in 48 to 72 hours. There is no significant difference in the risk of developing mastoiditis. 7. An 18 -month -old child is seen in the clinic with a temperature of 40°C. The child’s parents tell the nurse that the child developed the fever the previous evening and was inconsolable during the night. The provider examines the child and notes a bulging, erythematous tympanic membrane. The nurse will expect to: a. ask the parent to return to the clinic in 2 days to see whether antibiotics need to be started. b. discuss a referral to an ear, nose, and throat specialist for follow -up treatment. c. teach the parent to give analgesics for 3 days while observing for worsening symptoms. d. tell the parent to administer amoxicillin at 45 mg/kg/dose twice daily. ANS: D Patients with severe symptoms of AOM should begin treatment with antibiotics upon diagnosis. For children 6 months to 2 years of age, treatment should begin when the diagnosis is certain, as evidenced by erythema of the tympanic membrane (TM) and distinct discomfort. Amoxicillin 45 mg/kg/dose twice daily is indicated. Observation for 2 days is not recommended for this child, because the diagnosis is certain; therefore, asking the parent to return in 2 days or to give only symptomatic treatment is incorrect. Referral to an ear, nose, and throat (ENT) specialist is not recommended un less the child has recurrent AOM or if treatments repeatedly fail 8. The nurse is administering ear drops to a patient with acute bacterial otitis externa. Which procedure would assist drug penetration into the ear canal? a. Administering refrigerated drops b. Inserting a sponge wick into the ear canal and then administering the drops c. Cleaning out the earwax with a cotton -tipped swab before giving the drops d. Inserting earplugs after administering the drops ANS: B Insertion of a sponge wick can aid delivery of the ear drops to the epithelium of the ear canal. Medication is absorbed into the wick, which delivers the drug to the epithelium. Ear drops should be warmed before administration to prevent dizziness, which may occur with instillation of cold drops. Cerumen should not be removed. Inserting cotton -tipped swabs may damage the epithelium. The use of earplugs may lead to further problems with bacterial otitis externa. 9. A teenaged female patient has begun to develop acne and asks a nurse how to minimize pimple formation. What will the nurse recommend? a. Asking the provider about oral contraceptives b. Cleansing the face gently 2 to 3 times daily c. Eliminating greasy foods from the diet d. Using an abrasive agent to scrub the face ANS: B Gentle cleansing 2 to 3 times a day can reduce surface oiliness and help minimize acne lesions. Oral contraceptives are not first -line treatment for acne. Eliminating greasy foods from the diet does not affect pimple formation. An abrasive agent is not indicated for mild a cne. 10. An adolescent patient with moderate acne has begun a regimen consisting of combination clindamycin/benzoyl peroxide [BenzaClin] and tretinoin [Retin -A]. Which statement by the patient indicates understanding of this medication regimen? a. “I should apply the Retin -A immediately after bathing.” b. “I should apply the Retin -A twice daily.” c. “I should augment this therapy with an abrasive soap.” d. “I should use sunscreen every day.” ANS: D Tretinoin increases susceptibility to sunburn, so patients should be warned to apply a sunscreen and wear protective clothing. Before applying Retin -A, the skin should be washed, toweled dry, and allowed to dry fully for 15 to 30 minutes. Retin -A is applied once daily. Abrasive soaps intensify localized reactions to Retin -A and s hould not be used. 11. 11. 8. A patient will begin initial treatment for severe acne. Which regimen will the nurse expect the provider to order? a. Clindamycin/benzoyl peroxide [BenzaClin] and tretinoin [Retin -A] b. Doxycycline [Vibramycin] and tretinoin [Retin -A] c. Erythromycin [Ery-Tab) and benzoyl peroxide d. Topical clindamycin and isotretinoin [Accutane] ANS: B Oral antibiotics are used for moderate to severe acne and are usually combined with a topical retinoid. Combination clindamycin/benzoyl peroxide and tretinoin are used for mild to moderate acne. Erythromycin can be used as an oral antibiotic but would need to be combined with a topical retinoid. Isotretinoin is used for severe acne that has not responded to other treatments. 12. A 50-year-old patient receives botulinum toxin type A [Botox] injections for the first time on her forehead and around her eyes. One week later, she calls the clinic to report that she is experiencing droopy eyelids. The nurse will tell the patient that this effect: a. is normal and will resolve in a few days. b. may persist for 3 to 6 months but will resolve. c. may progress to cause drooling and dysphagia. d. represents an adverse effect that may be permanent. ANS: B Botox is a neurotoxin that acts on cholinergic neurons to block the release of acetylcholine. Injection into the wrong site or diffusion from the correct site into surrounding tissues can weaken muscles not intended as targets. This patient’s droopy eyelids are an example of the wrong site being affected. Weakening of muscles can last 3 to 6 months but will resolve. It is incorrect to tell the patient that it is a normal effect or that it will resolve in a matter of days. Drooling and dysphagia are likely when injections are around the mouth. It is not a permanent effec t. 13. A patient begins using timolol [Timoptic] to treat primary open -angle glaucoma (POAG). The nurse gives a dose and notes that the patient develops shortness of breath. The nurse assesses the patient and auscultates wheezes in both lungs. The nurse will ask this patient about a history of which condition? a. Asthma b. Atrioventricular heart block c. Pulmonary hypertension d. Sinus bradycardia ANS: A Timolol is a beta blocker and can precipitate bronchoconstriction when absorbed systemically. Patients with asthma will develop shortness of breath and wheezing. These symptoms are not associated with AV block, pulmonary hypertension, or sinus bradycardia. 14. 14. A nursing student asks the nurse to discuss the differences between POAG and angle -closure glaucoma. Which statement by the nurse is correct? a. “Angle -closure glaucoma may be asymptomatic until irreversible damage has occurred.” b. “Both types are more common in African American patients.” c. “Drug therapy is the definitive treatment for angle -closure glaucoma.” d. “Early treatment with prostaglandin analogs can stop the progression of POAG.” ANS: D Prostaglandin analogs are first-line agents for treating POAG, and early treatment can stop the progression. Angle -closure glaucoma has a rapid onset of painful symptoms. POAG is more common in African Americans but angle -closure glaucoma is not. Surgery, not drugs, is the definitive treatment for angle -closure glaucoma. 15. 15. A nurse administers timolol [Timoptic] ophthalmic drops to a patient who has glaucoma. The patient reports stinging of the eyes shortly after the drops were administered. What will the nurse do? a. Monitor the patient’s heart rate, respiratory rate, and blood pressure. b. Notify the provider that the patient shows signs of angle -closure glaucoma. c. Reassure the patient that these are localized, reversible effects of the drug. d. Request an order for an antihistamine to treat this allergic response to the drug. ANS: C Local effects of timolol and other beta blockers are generally minimal, but transient ocular stinging can occur. There is no need to monitor vital signs, because this does not represent a systemic reaction. This is not a sign of angle -closure glaucoma. Antihistamines will not help. 16. A patient has been using latanoprost [Xalatan] ophthalmic drops. The patient tells the nurse, “My eyes used to be greenish -brown, but now they’re brown.” What will the nurse do? a. Reassure the patient that this is a harmless side effect. b. Report this toxic effect to the patient’s provider. c. Tell the patient that this indicates an increased risk of migraine headaches. d. Tell the patient that this effect will reverse when the medication is withdrawn. ANS: A Latanoprost can cause a harmless, heightened brown pigment of the iris that stops when the medication is discontinued but does not regress. It is not a sign of a toxic reaction. It does not indicate an increased risk of developing migraines. It will not reverse. 17. 17. A nurse is teaching a patient who will begin using a fixed -dose preparation of dorzolamide and timolol [Cosopt] for open -angle glaucoma. Which statement by the patient indicates a need for further teaching? a. “Blurred vision, tearing, or eye dryness may occur with this medication.” b. “I may experience a bitter taste in my mouth after instilling these eye drops.” c. “I will need to instill two eye drops 3 times daily in each eye.” d. “If I notice redness in my eyes or eyelids, I should stop using these drops.” ANS: C The fixed -dose preparation of dorzolamide and timolol is given as 1 drop twice daily. Blurred vision, tearing, eye dryness, and a bitter aftertaste are expected side effects. Redness in the eyes or eyelids indicates an allergic conjunctivitis and means that the drops should be discontinued. 18. A patient has had dilation of the eyes with an anticholinergic agent. What will the nurse say when preparing this patient to go home after the examination? a. “Systemic side effects will not occur with this agent.” b. “You may experience an increased heart rate, but this is a harmless side effect.” c. “You may need to wear dark glasses until this medication wears off.” d. “You will be able to read as soon as the exam is completed.” ANS: C Because the agent causes cycloplegia, which paralyzes the iris sphincter, the eyes are unable to respond to bright light, so patients should be advised to wear sunglasses until this effect wears off. Systemic side effects do occur with these agents. Tachycardia is a systemic effect and may indicate toxicity. Mydriasis is an effect of this drug, causing the eye to be unable to focus; patients will have blurred vision until this effect wears off. 19. A patient with severe allergic conjunctivitis who has been using cromolyn ophthalmic drops for 2 days calls the nurse to report persistence of the symptoms. When the nurse explains that it takes several weeks for maximum benefit to occur, the patient asks if there is something else to use in the meantime. The nurse will suggest that the patient discuss which drug with the provider? a. An ophthalmic demulcent b. H1-receptor antagonists c. Glucocorticoid drops d. Ocular decongestants ANS: B Histamine receptor antagonists can be used to provide immediate symptom relief, so until the cromolyn has provided relief, they may be useful for treating symptoms. Demulcents only add moisture to the eye and do not prevent chemical mediators from causing symptoms. Glucocorticoids are used for inflammatory disorders of the eye but are not first -line agents. Ocular decongestants are used to treat redness caused by minor irritants. 20. An older adult patient comes to an ophthalmology clinic complaining of increased difficulty reading in dim light. The provider examines the patient and notes three large yellow deposits under the patient’s cornea. The nurse will expect the provider to order which treatment for this patient? a. High doses of vitamins C and E, beta-carotene, and zinc b. Laser therapy c. Pegaptanib [Macugen] d. Photodynamic therapy ANS: A This patient has three large drusen with minor vision changes, signs of intermediate age -related macular degeneration (ARMD). Patients with intermediate ARMD can significantly reduce their risk of developing advanced ARMD by taking high doses of vitamins C and E, beta -carotene, and zinc. Laser therapy, pegaptanib, and photodynamic therapy are used to manage wet, or neovascular, ARMD. 21. A patient is about to undergo emergency surgery for acute angle -closure glaucoma. Before surgery, which agent(s) will the nurse expect to administer? (Select all that apply.) a. Acetazolamide b. Brimonidine [Alphagan] c. Mannitol d. Phenylephrine e. Timolol ANS: A, C, E Acetazolamide is used short term, in conjunction with other agents, to produce rapid lowering of IOP in patients with angle -closure glaucoma. Mannitol is an osmotic agent used in the emergency treatment of acute angle -closure glaucoma. Timolol help s reduce the production of aqueous humor and can be used in emergency treatment of angle -closure glaucoma. Brimonidine is used for long -term therapy for glaucoma. Phenylephrine is an adrenergic agonist used as a mydriatic agent 22. The nurse is reviewing personal knowledge of the medications used in the treatment of open -angle glaucoma. The nurse would be correct to identify which medication(s) as treatment? (Select all that apply.) a. Alpha 2 agonists b. Prostaglandin analogs c. Anticholinergics d. Carbonic anhydrase inhibitors e. Beta blockers ANS: A, B, D, Em The nurse is correct to identify alpha 2 agonists, prostaglandin analogs, carbonic anhydrase inhibitors, and beta blockers as the drugs used in the treatment of open -angle glaucoma. Anticholinergic agents are used to produce mydriasis and cycloplegia to facilitate intraocular examination and intraocular surgery 23. A patient has completed treatment with lindane shampoo for pediculosis, but the infestation has not been eradicated. The patient asks the nurse about repeating the treatment. What will the nurse tell the patient? a. A second treatment may be administered in 2 to 4 weeks. b. Lindane continues to have residual effects for several weeks after treatment. c. Repeat use of this drug may cause serious side effects. d. The patient should ask the prescriber to order lindane cream for a second treatment. ANS: C Repeated use of lindane carries a risk of seizures, so repeat dosing should be avoided. Patients should not use lindane if they have used it within the past few months, so 2 to 4 weeks is too soon. Lindane does not have residual therapeutic effects. The type of preparation does not change the recommendation about not repeating the treatments. 24. A parent has used permethrin [Nix] twice to treat head lice in a child. Two weeks after the last treatment, head lice are again found in the child’s hair. The parent asks the nurse what to do. The nurse will recommend asking the child’s provider about which therapy? a. Applying lindane 1% shampoo b. Cutting the child’s hair c. Ordering permethrin 5% [Elimite] d. Using benzyl alcohol [Ulesfia] ANS: D Permethrin 1% [Nix] is the drug of choice for lice, but it fails in about 5% of patients as the result of drug resistance. When drug resistance occurs, patients should be treated with malathion or benzyl alcohol. Lindane has serious central nervous system (CNS) side effects and should not be used unless other treatments fail. Cutting the child’s hair is not necessary. Permethrin 5% [Elimite] is used to treat scabies. 25. A patient is treated for Phthirus pubis with permethrin 1% lotion. Two days after using the lotion as directed, the patient calls to report increased itching, erythema, and edema of the pubic skin. What will the nurse tell the patient? a. This is an expected effect of the treatment and will subside. b. This represents an allergic reaction to the lotion. c. The patient should ask the provider about using malathion 0.5% lotion. d. The patient should repeat the permethrin now and contact the provider if no improvement is seen. ANS: A Permethrin may cause some exacerbation of the itching, erythema, and edema normally associated with pediculosis, so this is expected. It does not indicate an allergic reaction. There is no need to change to another product or to repeat the application. 26. A parent has been instructed to apply a combination product of pyrethrins with piperonyl butoxide [RID] to treat head lice in a child. The parent asks the nurse why it is necessary to repeat the application in 9 days. The nurse will respond by telling the parent that: a. a second treatment helps combat medication resistance. b. the dose needed to kill lice is too toxic to use all at once. c. the combination is active only against adult lice and not ova. d. the second dose helps rid the hair of nits and ova. ANS: C Pyrethrins plus piperonyl butoxide is given as two treatments, because the combination is active against adult lice. Ova are not affected, so a second dose is given when those hatch. A second dose does not affect medication resistance. The combination is not toxic in therapeutic doses. Nits and ova are not removed with a second treatment. 27. A patient who has scabies is treated with permethrin 5% cream. The patient calls the nurse 1 week after treatment to repo rt continued intense itching. What will the nurse tell this patient? a. “This is a hypersensitivity reaction to the permethrin.” b. “This is the body’s normal response to the scabies mites.” c. “You will need a second treatment of the permethrin.” d. “You will need to take ivermectin to clear up the infestation.” ANS: B Intense itching continues for a week or two following treatment with permethrin because the patient’s hypersensitivity reaction to the burrowed dead mites, feces, and eggs continues and itching will continue until the body recovers. It is not a hypersensitivity reaction to the medication. Permethrin is effective in just one application. Ivermectin is not indicated. 28. Which patient should not use lindane? (Select all that apply.) a. A child with a history of seizures b. A patient who has used lindane in the past 2 months c. A person who weighs 115 pounds d. A person with an autoimmune disorder e. A person with atopic dermatitis ANS: A, B, E Any patient with a history of seizures should not use lindane, because it is associated with seizures. Patients who have used lindane within the past 2 months are at increased risk for serious side effects with repeated use. Patients with psoriasis or atopic dermatitis should not use lindane. Lindane may be used in patients who weigh more than 110 pounds and in patients with autoimmune disorders. 29. A family has just returned from a camping trip, and all family members have diarrhea and colicky abdominal pain after eating. The parents report that they drank water from a well while on the camping trip. While awaiting stool cultures, the nurse will expect the provider to order which agent empirically? a. Iodoquinol [Yodoxin] b. Metronidazole [Flagyl] c. Miltefosine [Impavido] d. Sodium stibogluconate [Pentostam] ANS: B This family most likely has giardiasis, which can be acquired by drinking contaminated water. Metronidazole is the drug of choice for this infection. Iodoquinol is used for asymptomatic amebiasis. Miltefosine and sodium stibogluconate are used to treat leishmaniasis. 30. A child is diagnosed with cryptosporidiosis, and the prescriber orders nitazoxanide [Alinia]. While preparing the child’s parents to administer this drug, the nurse will: a. determine whether the child is taking immunosuppressant medications. b. instruct the family to have the child take the drug on an empty stomach. c. teach the parents that yellow discoloration of the sclerae represents a serious side effect. d. tell the parents that headache, dry mouth, and a metallic taste are common. ANS: A Nitazoxanide is approved for diarrhea caused by Cryptosporidium parvum in children only and is only effective in children who are immunocompetent. The nurse should assess whether the child is taking immunosuppressant medications. This drug should be given with food. Yellow discoloration of the sclerae may occur but resolves when the drug is discontinued. Headache, dry mouth, and a metallic taste are common side effects of metronidazole. 31. The nurse is monitoring a patient who is receiving an inhalation treatment with pentamidine [NebuPent]. The patient begins to cough and states that he is having trouble breathing. What is the best action by the nurse? a. Administer a PRN dose of a bronchodilator. b. Discontinue the inhalation treatment. c. Nothing, because these are expected adverse effects of pentamidine. d. Reduce the rate of the inhalation treatment. ANS b 32. The nurse is providing patient education to a 26-year-old college student who is being treated for Trichomonas vaginalis with metronidazole [Flagyl]. Which statement by the patient indicates understanding of the teaching? a. “I should not consume alcohol while taking this medication.” b. “If I have dark urine, I should stop taking the drug.” c. “The drug is safe throughout pregnancy.” d. “Vertigo and headaches may occur and are signs of toxicity.” ANS: A The patient should be advised to avoid drinking alcohol while taking this medication, because it may cause a disulfiram -like reaction. Darkening of the urine may occur but does not warrant discontinuing the drug. The drug is mutagenic for fetuses and should be avoided before and/or during pregnancy. Vertigo and headaches are side effects but are not signs of toxicity. 33. A patient from Africa is being treated for East African trypanosomiasis. The nurse is preparing to administer a first dose of suramin sodium [Germanin]. To prevent serious side effects, which action will the nurse take? a. Administer a small test dose before giving the drug. b. Ask the patient to lie flat while the drug is given. c. Give a high-fat snack with the drug to minimize gastric upset. d. Suggest to the provider that liver function tests (LFTs) be performed. ANS: A Suramin sodium can cause severe side effects, including a shock -like syndrome with IV dosing. A small test dose should be given initially to make sure this is not likely. Patients receiving pentamidine should be supine while receiving that drug. It is not necessary to provide a fatty snack with suramin or to obtain LFTs before administration. 34. A 20-kg pediatric patient is being treated for toxoplasmosis, and the provider orders pyrimethamine [Daraprim] 10 mg twice daily. The nurse caring for this patient will anticipate which additional order from the provider? a. Administer 10 to 15 mg of folinic acid with each dose of pyrimethamine. b. Give the medication intravenously over 30 to 45 minutes. c. Increase the dose to 20 mg twice daily after 2 to 4 days. d. Teach the family to monitor for muscle pain and joint stiffness. ANS: A Folinic acid is given with pyrimethamine to minimize adverse effects, and the dose is 10 to 15 mg twice daily, given with the pyrimethamine dose. The medication is given orally. The dose should be cut in half, not increased, after 2 to 4 days. Muscle pain and joint stiffness are adverse effects of sodium stibogluconate. 35. A nurse is teaching a group of nursing students about the two most common forms of malaria, Plasmodium vivax malaria and Plasmodium falciparum malaria. Which statement by a student indicates a need for further teaching? a. “Once erythrocyte forms of P. falciparum are eliminated, relapse will not occur.” b. “Patients with P. vivax malaria experience relapse with increased frequency over time.” c. “Patients with P. falciparum malaria experience symptoms at irregular intervals.” d. “Patients with P. vivax malaria rarely encounter drug resistance.” ANS: B Relapse is likely with P. vivax malaria, because dormant parasites remain in the liver. Over time, episodes of relapse become less frequent and eventually stop entirely. Relapse does not occur with P. falciparum malaria, because this type does not form hypnozoites that can become dormant. Symptoms of P. falciparum malaria occur at irregular intervals, unlike those of P. vivax malaria, which peak every 48 hours. Drug resistance by P. vivax is relatively uncommon. 36. A nurse is teaching a patient who is preparing to travel for a month -long missionary trip to Africa. The provider has ordered chloroquine [Aralen Phosphate] as suppressive therapy. Which statement by the patient indicates a need for further teaching? a. “I should continue taking the drug for 2 weeks after returning home.” b. “I should take 500 mg of this drug once each week.” c. “I should take the first dose 1 week before leaving for Africa.” d. “I should take this drug with meals.” ANS: A Patients taking chloroquine as suppressive therapy should take the medication for 4 weeks, not 2 weeks, after returning from an area where infection is likely. The patient is correct to state that 500 mg of the drug should be taken weekly, that the first dose should be taken 1 week before travel, and that the drug should be taken with meals. 37. 37. A patient has severe P. falciparum malaria and is unable to tolerate oral medications. Which regimen is the U.S. Food and Drug Administration (FDA) –approved treatment of choice for this patient? a. Intravenous quinidine gluconate plus intravenous doxycycline [Vibramycin] b. Intravenous artesunate followed by atovaquone/proguanil [Malarone] c. Intravenous quinine [Qualaquin] plus intravenou s clindamycin d. Intravenous mefloquine plus intravenous primaquine ANS: A For patients with severe malaria, IV quinidine gluconate is the only drug approved by the FDA for parenteral therapy of malaria; it should be accompanied by clindamycin, doxycycline, or tetracycline. Artesunate is considered the drug of choice for severe malaria, but it has not yet been approved by the FDA and must be used under the provisions of an Investigational New Drug protocol from the Centers for Disease Control and Prevention (CDC). Quinine is effective but has serious cardiotoxic side effects, so it is not a drug of first choice. Mefloquine and primaquine are not available as an IV medication. 38. A child has been diagnosed with enterobiasis, and the prescriber orders mebendazole [Vermox] to treat the infestation. When teaching this child’s parents about the treatment, the nurse will include which statement? a. “A single dose of mebendazole will eradicate the infestation.” b. “Everyone in the household should be treated with mebendazole.” c. “Serious complications of this type of infestation are common.” d. “Treatment should be limited to family members with symptoms.” ANS: B Everyone in the family should be treated simultaneously, because pinworms are easily spread. To treat pinworms, an initial dose of mebendazole 100 mg is given, and the dose is repeated in 2 weeks. The infestation rarely causes serious complications. Treatment is not limited to symptomatic infestations. 39. A child is seen in the clinic after complaining of intense perianal itching. The provider diagnoses the child with pinworms and orders mebendazole [Vermox]. The nurse will expect to teach the child’s parents to: a. administer the drug with a high-fat meal to improve absorption. b. avoid driving or other hazardous activities until the drug’s effects wear off. c. give each family member one dose of the drug now and another dose in 2 weeks. d. report serious adverse effects that can occur with death of the causative parasite. ANS: C Mebendazole is administered as a single dose once and then again in 2 weeks when given to treat pinworms. It should be given to all household members when one person is infested. Albendazole is given with a high -fat meal. Praziquantel can cause drowsiness. Ivermectin causes a Mazotti reaction, which occurs in patients treated for onchocerciasis with symptoms resulting from death of the parasite. 40. A patient tells the nurse that a close friend has ascariasis. The patient expresses worry about becoming infested. What will the nurse tell this patient? a. “Ascariasis usually resolves without treatment, so you should not worry.” b. “Avoid going barefoot and practice good hygiene and you won’t become infested.” c. “Treatment is always indicated if you are exposed, because ascariasis is contagious.” d. “You should be tested, because serious complications can occur without treatment.” ANS: D Because this patient is worried about possible infestation, testing should be done so that treatment can be initiated if necessary. Because ascariasis can have serious complications, treatment is always indicated. Ascariasis infestations do not result from poor hygiene or from going barefoot. Ascariasis is not contagious, so treatment should begin only if the diagnosis is certain. 41. A young female patient is seen in a rural clinic after complaining of abdominal pain. The patient is wearing dirty clothing and is barefoot. The provider orders a complete blood count, which shows that the patient is anemic. The nurse may suspect that this patient has which of the following infestations? a. Ancylostomiasis (hookworm) b. Ascariasis (giant roundworm) c. Enterobiasis (pinworm) d. Trichuriasis (whipworm) ANS: A Ancylostomiasis is most common when hygiene is poor and the patient habitually goes barefoot. Symptomatic anemia may occur in menstruating women or undernourished individuals. Ascariasis is usually asymptomatic. Enterobiasis is characterized by perianal itching. Trichuriasis is usually asymptomatic but may cause rectal prolapse if the worm burden is very large. 42. A patient is being treated for trichinosis. The patient asks the nurse why the provider has ordered prednisone in addition to the anthelmintic medication. The nurse will tell this patient that this is ordered to: a. prevent swelling of the legs caused by larval infestation of lymphatics. b. reduce the inflammation that occurs during larval migration. c. suppress the patient’s allergic response to the anthelmintic agent. d. suppress dermatologic symptoms that occur with heavy infestation. ANS: B Trichinosis is acquired by eating undercooked pork containing encysted larvae, which migrate from the intestine to the skeletal muscle. Prednisone is given to reduce the inflammation that results from larval migration. This parasite does not affect lymphat ics or cause elephantiasis. Prednisone is not given to counter allergic reactions to the drug. Dermatologic symptoms are not part of trichinosis infestations. 43. A patient is being treated with albendazole [Albenza] for neurocysticercosis caused by larval forms of the pork tapeworm. Which statement by the patient indicates a need for further teaching about the drug regimen? a. “I may need to take this medication for a month before the infestation is cleared.” b. “I should take this drug with a fatty meal to improve absorption.” c. “I will need to have liver function tests before and during treatment.” d. “I will take the drug in 3 consecutive cycles of 28 days, followed by 14 drug-free days.” ANS: D Albendazole is given in consecutive cycles when dosing i s done for cystic hydatid disease, not neurocysticercosis. For treatment of neurocysticercosis, patients generally take albendazole for 8 to 30 days. Albendazole can cause mild to moderate liver impairment, so patients should have liver function testing before and during treatment. The drug should be taken with a high-fat meal to improve absorption. 44. 44. A patient with strongyloidiasis is being treated with ivermectin [Stromectol]. What will the nurse expect to teach this patient? a. A Mazotti -type reaction is likely. b. Hypotension is a common side effect of the drug. c. The drug should be taken every 6 to 12 months until symptoms have cleared. d. The drug should be taken with water for 1 to 2 days. ANS: D Ivermectin is given for 1 to 2 days to treat strongyloidiasis. A Mazotti -type reaction occurs when ivermectin is used to treat onchocerciasis. Hypotension is not a common side effect. Ivermectin is given every 6 to 12 months when treating onchocerciasis. 45. A patient who is being treated for onchocerciasis with ivermectin [Stromectol] has a Mazotti reaction. Which assessment findings would the nurse expect? (Select all that apply.) a. Fever b. Nausea and vomiting c. Rash with pruritus d. Blurred vision e. Bone and joint pain ANS: A, C, E Signs and symptoms associated with a Mazotti reaction are fever, rash with pruritus, and bone and joint pain. Nausea and vomiting and blurred vision are not signs and symptoms associated with a Mazotti reaction. MULTIPLE CHOICE 1. A patient is using a metered -dose inhaler containing albuterol for asthma. The medication label instructs the patient to administer “2 puffs every 4 hours as needed for coughing or wheezing.” The patient reports feeling jittery sometimes when taking the medication, and she doesn’t feel that the medic ation is always effective. Which action is outside the nurse’s scope of practice? a. Asking the patient to demonstrate use of the inhaler b. Assessing the patient’s exposure to tobacco smoke c. Auscultating lung sounds and obtaining vital signs d. Suggesting that the patient use one puff to reduce side effects ANS: D