NR-293 Pharmacology for Nursing Practice - Set 5 - Part 1

Correct Answer: The antibiotic killed protective flora allowing yeast overgrowth

Broad spectrum therapy destroys the lactobacilli that normally keep the vagina acidic, and Candida fills the gap. Repeated or prolonged courses make this superinfection more likely, and it should be reported for treatment. Option a is incorrect because drug hypersensitivity shows up as hives, generalised itching, or swelling rather than a localised discharge. No immune mechanism explains curd like material appearing only on mucous membranes. Option b is incorrect because more antibacterial coverage would deepen the very flora loss that started this. Yeast is a fungus, so antibacterial drugs have no effect on it and simply widen the opening further. Option d is incorrect because healthy secretions are clear or milky and cause no itching. Thick curd like discharge with irritation during antibiotic therapy is the hallmark picture of candidal overgrowth.

Correct Answer: Notify the provider about the rapid correction

Sodium should climb no faster than about eight to ten milliequivalents per liter in a day. A steeper rise risks osmotic demyelination, an irreversible injury, so the nurse reports the value before more is given. Option b is incorrect because speeding a correction that is already too fast compounds the danger. Hypertonic saline is titrated downward, not upward, once the neurologic symptoms ease and the laboratory trend turns steep. Option c is incorrect because swapping bags is a prescriber decision the nurse cannot make alone. Isotonic saline may well be the next step, yet it must be ordered after the provider learns how quickly the level moved. Option d is incorrect because a number moving toward normal is not automatically good news. Dysarthria, dysphagia and quadriparesis appear days after an overly brisk correction, long past the point where continuing the drip can be undone.

Correct Answer: Take the tablet with orange juice

Ascorbic acid in orange juice keeps iron in the ferrous form the intestine absorbs most readily, so pairing the tablet with a citrus source raises the fraction of each dose actually taken up. Option a is incorrect because milk delivers calcium, which binds iron in the gut and blocks uptake. Dairy belongs at least two hours away from the dose, not alongside it, or the anemia will keep improving slowly. Option b is incorrect because tannins in tea and coffee bind iron into complexes the small intestine cannot take up. Choosing a beverage like this with the tablet works directly against the goal the client asked about. Option d is incorrect because antacids raise gastric pH, and iron needs an acidic stomach to dissolve. Acid suppressing products belong well away from the supplement, ideally separated by a couple of hours in either direction.

Correct Answer: Give the dose deep into a muscle

This long acting suspension is licensed for deep intramuscular injection only. Accidental intravenous administration has caused cardiorespiratory arrest and death, which is why the product carries a boxed warning about the route. Option b is incorrect because no dilution makes this preparation safe for a vein. The particles are meant to sit in muscle and release drug over weeks, and a slower rate changes nothing. Option c is incorrect because using the running line delivers exactly the route the boxed warning forbids. Clients have arrested when this suspension entered the circulation, so convenience never justifies that shortcut. Option d is incorrect because cloudiness is normal for this formulation rather than a sign of contamination. Sending it back delays treatment of an infection that responds well to a single intramuscular dose.

Correct Answer: A sore throat with shaking chills today

Fever, chills and sore throat in a triple immunosuppressed client signal infection that can move to sepsis quickly, and steroids may blunt the usual signs. This report goes to the team the same day. Option a is incorrect because tremor is a familiar calcineurin inhibitor effect that is documented and monitored rather than treated as urgent. It becomes worrying only alongside confusion, seizures or visual change. Option b is incorrect because diarrhea is the dose limiting complaint with mycophenolate and two loose stools do not yet qualify as severe. Persistent or bloody stools would change that judgment entirely. Option d is incorrect because moon face and steroid weight gain are cosmetic and expected on prednisone. They warrant dietary counseling and reassurance at the next appointment, not a same day call to the surgeon.

Correct Answer: This class commonly irritates the gut

Stomach upset is the most common reason clients abandon macrolides, and erythromycin is the worst offender because it stimulates motilin receptors and speeds gastric emptying. Taking it with food often helps. Option a is incorrect because hypersensitivity announces itself with hives, wheezing, or swelling of the face and tongue. Digestive complaints alone sit in the intolerance column and do not require adding an allergy band. Option b is incorrect because macrolide liver injury does occur, yet it shows up as jaundice, dark urine, and right upper quadrant pain. Cramping on day two describes ordinary gastric irritation instead. Option c is incorrect because kidney injury does not belong to this class. Rising creatinine and shrinking urine output would signal renal damage, and neither appears anywhere in the client's telephone report.

Correct Answer: "I will use an electric razor and a soft toothbrush."

Soft bristles and an electric razor spare the gums and skin from the small cuts that will not stop bleeding once platelets drop. Both are standard precautions during myelosuppression. Option b is incorrect because flossing tears the gingival margin, and a client with few platelets may bleed steadily from those tiny wounds. Gentle brushing replaces flossing until counts recover. Option c is incorrect because nonsteroidal anti inflammatory drugs block platelet aggregation on top of an already low count. Acetaminophen is the analgesic of choice, and even that is cleared with the oncology team. Option d is incorrect because anything placed in the rectum can tear fragile mucosa and start bleeding that is hard to see and harder to stop. Oral or temporal routes are used instead.

Correct Answer: Stop the infusion and leave the catheter

Stopping halts further leakage, and leaving the catheter preserves the only route for aspirating residual drug and instilling antidote. Everything else follows, including provider notification, aspiration, marking the site and a cold compress. Option a is incorrect because flushing drives the vesicant deeper into subcutaneous tissue and widens the area that will blister and necrose. This is the single most damaging reflex at an extravasation site. Option b is incorrect because pulling the catheter discards the access needed to withdraw pooled drug and deliver dexrazoxane. Elevation matters later, after aspiration and notification have already happened. Option d is incorrect because warmth belongs to vinca alkaloid leaks, where it disperses the drug. An anthracycline needs cold, and no compress helps at all while the infusion is still running.

Correct Answer: A serum calcium of 12.4 milligrams per deciliter

Vitamin D drives intestinal calcium absorption, so toxicity shows up as hypercalcemia. Stones, bone pain, constipation and confusion follow a rising calcium, and polyuria develops because the kidney cannot concentrate urine at that level. Option a is incorrect because a high sodium produces thirst, dry sticky mucous membranes and restlessness, not constipation with polyuria. Vitamin D has no direct effect on sodium handling, so this value would need a separate cause. Option b is incorrect because low potassium brings muscle weakness, leg cramps, sluggish bowel sounds and characteristic flattened T waves. None of those appear here, and cholecalciferol supplements do not push potassium out of the serum. Option c is incorrect because a falling magnesium level causes tremor, hyperactive reflexes and torsades de pointes rather than lethargy and constipation. The presentation described points the other way, toward an excess of a divalent cation.

Correct Answer: Draw the cultures before the first dose

Even a single antibiotic dose suppresses bacterial growth enough to produce a false negative culture, leaving the team without an organism or a sensitivity report. Cultures are drawn first, then the drug follows promptly. Option b is incorrect because reversing that order lets the drug suppress the organism in the specimen bottle. The laboratory then reports no growth, and the prescriber keeps guessing at empiric coverage for days. Option c is incorrect because delaying antibiotics in sepsis costs survival with every hour that passes. Culture and sensitivity results take roughly two to three days, far too long to withhold treatment from an unstable client. Option d is incorrect because fever has already prompted the workup, so waiting for it to continue adds nothing. Suspected sepsis warrants specimens from two separate sites right away, not a conditional order tied to temperature.

Correct Answer: Ototoxicity involving the eighth cranial nerve

Aminoglycosides damage the eighth cranial nerve, and tinnitus is the earliest cochlear warning the client can report. The nurse holds the next dose and notifies the provider before hearing loss becomes permanent. Option a is incorrect because neuromuscular blockade shows up as muscle weakness and shallow respirations, not as ear noise. It appears with rapid infusion or in myasthenia gravis and threatens breathing rather than hearing. Option b is incorrect because a superinfection is a new organism overgrowing after normal flora die, producing thrush or watery diarrhea. Ringing in the ears comes from nerve injury, not from an opportunistic organism. Option d is incorrect because drug collecting in proximal tubular cells produces nephrotoxicity, which the nurse tracks through creatinine and urine output. That injury is silent in the ears and would not cause ringing.

Correct Answer: Give the scheduled vaccines at this visit

Mild illness with a low grade fever and current antibiotic therapy are both false contraindications. Deferring the doses only leaves the child unprotected and creates a missed opportunity that often never gets recovered. Option a is incorrect because antibiotics neither blunt the immune response nor interact with any vaccine antigen. Waiting for the course to end simply postpones protection for a reason that does not exist. Option c is incorrect because splitting the visit implies that live products are unsafe in mild illness, which they are not. Only moderate or severe acute illness is a precaution, and this child has neither. Option d is incorrect because waiting for a completely well toddler in daycare means waiting most of the winter. Every rescheduled visit raises the chance the series is never finished on time.

Correct Answer: Prolonged QT interval and torsades

Azithromycin prolongs the QT interval, sertraline adds to that effect, and low potassium makes torsades de pointes far more likely. The nurse checks the electrocardiogram and expects potassium replacement. Option a is incorrect because serotonin syndrome arises when sertraline meets another serotonergic agent such as tramadol or a triptan. Macrolides do not act on serotonin pathways, so agitation, clonus, and hyperthermia are not the concern. Option b is incorrect because macrolides are not among the nephrotoxic antibacterials. Their well known problems are stomach upset, liver injury, and cardiac conduction, and creatinine rarely changes on a short azithromycin course. Option c is incorrect because blood sugar swings belong to the fluoroquinolone profile, where hypoglycemia and hyperglycemia both appear. Nothing in this pairing disturbs glucose, and the potassium value points somewhere else entirely.

Correct Answer: Separate the antibiotic from dairy and calcium

Doxycycline chelates calcium and other divalent cations into an insoluble complex the gut cannot absorb. Taking the dose one hour before or two hours after dairy and supplements preserves the antibacterial effect. Option b is incorrect because pairing the drug with milk is exactly what destroys absorption. Calcium binds the antibiotic in the stomach, a diminished antibacterial effect follows, and the tick borne infection may persist. Option c is incorrect because stopping a prescribed supplement is unnecessary when spacing the doses solves the problem. Nothing about the interaction requires abandoning calcium, and the nurse cannot discontinue another provider's order. Option d is incorrect because burying the dose in milk multiplies the cation contact rather than avoiding it. Doxycycline also needs a full glass of water and an upright position to spare the esophagus.

Correct Answer: A serum potassium of 2.9 milliequivalents per liter

Amphotericin B wastes potassium and magnesium through the damaged tubule, and cramps with weakness fit hypokalemia. A potassium this low threatens cardiac rhythm, so it is replaced before the next dose runs. Option a is incorrect because a mildly low hemoglobin is common in prolonged infection and does not produce cramping muscles. It warrants tracking over time rather than a call during this shift. Option b is incorrect because a white count settling toward normal is evidence the antifungal is working. Reporting improvement as an alarm wastes the provider's attention and changes nothing about the cramps. Option c is incorrect because a glucose at the top of its range is unrelated to the electrolyte losses this drug causes. Cramping and weakness point to potassium, not to sugar.

Correct Answer: Take the dose with a small amount of food

Absorption is best without food, yet a dose the client refuses delivers nothing. Taking the tablet with a little food trades a smaller absorbed fraction for steady daily intake, which corrects the anemia. Option b is incorrect because withholding iron leaves the hemoglobin low and the fatigue unchanged. Gastrointestinal upset is common early and usually settles, so the nurse adjusts how the dose is taken rather than abandoning treatment. Option c is incorrect because chewing an iron tablet coats the teeth and does nothing for nausea. Only liquid preparations raise a staining concern normally, and even those go through a straw rather than being held in the mouth. Option d is incorrect because doubling up after a missed dose raises the amount of corrosive iron reaching the mucosa at once. That worsens the very nausea the client described and risks toxicity without speeding recovery.

Correct Answer: Confirm placement with the ordered abdominal radiograph

Radiographic confirmation is the standard after a blindly inserted tube and before the first use. Only an image reliably separates gastric placement from a tube that has slipped into the airway. Option a is incorrect because the sound of injected air travels through the chest as readily as the abdomen. This old whoosh test cannot tell a stomach from a bronchus and is no longer acceptable practice. Option c is incorrect because many clients speak and swallow normally with a tube resting in the lung, particularly when sedated or neurologically impaired. Bedside conversation offers reassurance without evidence of where the tip sits. Option d is incorrect because measuring residual assumes the tube already sits in the stomach. That check belongs to ongoing tolerance monitoring during established feeding, not to proving initial position on a newly placed tube.

Correct Answer: Notify the provider and review the sensitivity report

Failure to improve after roughly three days suggests the organism resists the drug chosen or the diagnosis is wrong. The nurse reports this and looks at the culture and sensitivity results with the provider. Option a is incorrect because comforting words leave an untreated infection to spread while everyone waits. Most clients feel better within two or three days, so continued worsening is a signal rather than normal variation. Option b is incorrect because supportive measures alone cannot overcome a resistant organism. Rest and fluids help a client feel better, yet neither changes which drug is fighting the bacteria in the leg. Option d is incorrect because skipping doses drops the blood level and gives surviving bacteria a chance to multiply. Interrupting therapy is one of the behaviours that manufactures resistance, and fever is not a reason to hold.

Correct Answer: Stop the infusion and prepare epinephrine

Throat tightness, wheezing, and hypotension during a first beta lactam dose signal anaphylaxis. Stopping the drug removes the antigen, and epinephrine is the only agent that reverses airway swelling and shock. Option b is incorrect because antihistamines are adjuncts that blunt itching and hives well after the crisis. They do nothing for laryngeal edema or collapsing blood pressure, so giving one alone wastes irreplaceable minutes. Option c is incorrect because slowing the rate keeps the triggering antigen entering the bloodstream. Dose related intolerance might ease with a slower drip, yet an immune mediated airway reaction only worsens while the bag hangs. Option d is incorrect because the pressure reading already documents shock and repeating it delays treatment. Assessment matters, yet an airway closing in front of the nurse calls for drug and equipment, not more numbers.

Correct Answer: Swish the dose in the mouth, then swallow

Nystatin works on contact with the mucosa, so the client swishes it around the mouth as long as possible and then swallows. Nothing should be eaten or drunk for about thirty minutes. Option a is incorrect because washing the suspension straight down with water carries it past the very patches it must coat. The drug is not absorbed, so contact time is the whole treatment. Option c is incorrect because diluting the dose in juice thins the film that should sit on the lesions and adds sugar that feeds yeast. Undiluted suspension holds against the mucosa better. Option d is incorrect because rinsing afterward washes the medication away within seconds of applying it. Clients are told the opposite, to keep food and fluids out of the mouth for half an hour.