Antibiotics/Antiviral/Antifunal Practice Questions

A patient is administered azithromycin to treat a community-acquired pneumonia. A change in what blood level may necessitate a reduction in the dosage? A. Creatinine B. AST and ALT C. CPK D. Differential

A) Creatinine For patients who have renal impairment, together with hepatic impairment, it is essential to reduce the dosage to 400 mg once daily. Alterations in CPK, white cell differential, and liver enzymes may not require a change in the dosage.

An adult patient has begun treatment with fluconazole. The nurse should recognize the need to likely discontinue the drug if the patient develops which of the following signs or symptoms? A) Jaundice B) Weight gain C) Iron deficiency anemia D) Hematuria

A) Jaundice The azoles may cause hepatotoxicity, and the development of jaundice usually accompanies liver damage, which may necessitate discontinuing the drug. Fluconazole is not associated with weight gain, anemia, or hematuria.

The client has been diagnosed with a serious infection caused by gram-negative aerobic bacilli. The client has been prescribed IV gentamicin. What statement by the client should the nurse follow up most promptly? A. "I feel like I'm having trouble hearing the last little while." B. "I definitely feel like my appetite has suffered since I started these antibiotics." C. "My IV site feels really itchy a lot of the time." D. "I've got this pounding headache that never seems to go away."

A. "I feel like I'm having trouble hearing the last little while."

Metronidazole is used cautiously in patients with which of the following? A. Blood dyscrasias B. Hypertension C. First trimester of pregnancy D. All of the above

A. Blood dyscrasias

A hospital patient has been prescribed ciprofloxacin IV for the treatment of cellulitis. After initiating the infusion of the patient's first scheduled dose, the patient develops a pronounced rash to her chest and arms. How should the nurse respond to this event? A. Discontinue the infusion and inform the care provider promptly B. Slow down the rate so that the infusion takes place over 2 hours C. Administer oral diphenhydramine to the patient during the infusion D. Administer a STAT dose of acetylcysteine

A. Discontinue the infusion and inform the care provider promptly

A client is receiving a cephalosporin and an aminoglycoside as combination therapy. What assessment should the nurse prioritize? A. Serum BUN and creatinine levels B. Coagulation studies C. Signs of disulfiram-like reaction D. Complete blood count

A. Serum BUN and creatinine levels

The nurse should advise the client to avoid taking which medication at the same time as a fluoroquinolone? A. antacids B. antihypertensives C. antidiabetic agents D. oral contraceptives

A. antacids

A nurse monitors a client closely for anaphylactic reactions secondary to penicillin therapy. The nurse understands that this occurs more commonly after which route of administration? A. parenteral B. oral C. topical D. transdermal

A. parenteral

An influenza outbreak has spread through a long-term care residence, affecting many of the residents with severe malaise, fever, and nausea and vomiting. In an effort to curb the outbreak, the nurse has liaised with a physician to see if residents may be candidates for treatment with what drug? A) Saquinavir mesylate B) Oseltamivir phosphate C) Lamivudine D) Ribavirin

B) Oseltamivir phosphate

A 43-year-old man has tested positive for systemic candidiasis, and the care team has decided on IV fluconazole as a first-line treatment. When administering this medication, the nurse should A) administer the drug with lactated Ringer's. B) infuse the drug no faster than 200 mg/h. C) avoid administering the drug through a peripheral IV. D. administer prophylactic heparin prior to the fluconazole.

B) infuse the drug no faster than 200 mg/h. Continuous infusion of fluconazole occurs at a maximum rate of 200 mg/h. The drug is not administered with lactated Ringer's or heparin. A peripheral IV may be used.

Beta-lactam antibacterial drugs, such as penicillins and cephalosporins, combat infection by binding to proteins in bacterial cell membranes. What does this binding produce? A. An impermeable cell wall B. A defective cell wall C. A cell with no wall D. A cell with no membrane

B. A defective cell wall

A patient is receiving cefazolin in combination with anticoagulants. To minimize the adverse effects during therapy, the nurse will A. monitor the site of injection. B. monitor the patient for bleeding gums. C. continue therapy until 2 days after symptoms have resolved. D. administer the medication with small amounts of food and fluids.

B. monitor the patient for bleeding gums.

Which antifungal drug can be given intravenously to treat severe yeast infections as well as a one-time oral dose to treat vaginal yeast infections? A. Voriconazole (Vfend) B. Nystatin (Mycostatin) C. Fluconazole (Diflucan) D. Caspofungin (Cancidas)

C. Fluconazole (Diflucan)

A patient is receiving oral nystatin suspension for a fungal infection of the mouth. Which of the following adverse effects is most likely to be experienced with this form of nystatin? A. Local irritation B. Burning C. Nausea D. Urinary urgency

C. Nausea Oral use of nystatin produces the following adverse effects: nausea, vomiting, and diarrhea. The vaginal application of nystatin produces the following adverse effects: local irritation and burning. Urinary urgency is not an adverse effect associated with nystatin.

A 7-year-old child has tonsillitis and is prescribed penicillin V, which is to be administered at home. The nurse will instruct the parents to administer the drug A. with a sip of water 1 hour before mealtime. B. immediately before or with a meal. C. with a glass of water 1 hour before or 2 hours after a meal. D. intravenously with the assistance of a home health nurse.

C. with a glass of water 1 hour before or 2 hours after a meal.

The nurse is preparing to administer trimethoprim-sulfamethoxazole (TMP-SMX) to a patient who is being treated for a urinary tract infection. The nurse learns that the patient has type 2 diabetes mellitus and takes a sulfonylurea oral antidiabetic drug. The nurse will monitor this patient closely for which effect? A.Headaches B.Hypertension C.Hypoglycemia D.Superinfection

C.Hypoglycemia

The nurse is providing medication instruction for a 75-year-old patient who has been prescribed ciprofloxacin (Cipro) for an acute sinus infection. The nurse instructs the patient and family to immediately report which of the following symptoms?

Confusion

A patient is prescribed azithromycin. The patient previously experienced nausea and vomiting when taking erythromycin and wants to know whether to expect the same effects with azithromycin. How will the nurse respond? A. "Take the drug with a hearty meal to reduce gastrointestinal side effects." B. "I need to call your health care provider and ask for a different antibiotic." C. "I will get a prescription for an antiemetic in case this drug causes vomiting." D. "This drug is like erythromycin but has less severe gastrointestinal side effects."

D. "This drug is like erythromycin but has less severe gastrointestinal side effects."

A group of nursing students are reviewing information about fluoroquinolones. The students demonstrate a need for additional review when they identify which as an example? A. Ciprofloxacin B. Levofloxacin C. Gemifloxacin D. Metronidazole

D. Metronidazole

A patient is being treated for oral candidiasis. Which medication will the nurse anticipate administering? A. Amantadine B. Griseofulvin C. Oseltamivir D. Nystatin

D. Nystatin

An outpatient has just received a prescription for ciprofloxacin 500 mg PO twice daily for acute bronchitis. The nurse should teach the patient A. not to take ciprofloxacin with a meal B. to restrict fluid intake to avoid fluid overload C. to take ciprofloxacin with an antacid (e.g., Tums) to decrease the chance of stomach upset D. to avoid prolonged exposure to sunlight

D. to avoid prolonged exposure to sunlight

The nurse is reviewing laboratory tests before preparing to administer a dose of amphotericin B. Before administering the drug, it is a priority to review which lab result? A. Creatinine levels. B. ECG. C. Liver function tests. D. WBC count.

A. Creatinine levels.

Which of the following classes of antibiotics is a direct inhibitor of DNA synthesis in bacteria? A. Fluoroquinolones B. Penicillins C. Macrolides D. Ketolides

A. Fluoroquinolones Fluoroquinolones directly affect DNA synthesis in bacteria. Macrolides and ketolides inhibit bacterial protein synthesis. Penicillins interfere with cell wall synthesis.

Penicillins are more effective when used on infections caused by what organism? A. Gram-positive bacteria B. Gram-negative viruses C. Gram-negative bacteria D. Fungi

A. Gram-positive bacteria

The nurse is administering penicillin to a client who has strep throat. Which of the following statements accurately describe the action of penicillin? A. It is effective against gram-positive organisms B. It is not effective against gram-negative organisms C. It has many side effects, especially in large doses D. It is metabolized in the liver

A. It is effective against gram-positive organisms

Azithromycin is the drug of choice for treating A. Legionnaire's disease B. Bacterial endocarditis C. Urinary tract infections D. Acne

A. Legionnaire's disease

A nurse should teach a patient to observe for which side effect when taking ampicillin (Polycillin)? A. Skin rash and loose stool B. Reddened tongue and gums C. Digit numbness and tingling D. Bruising and petechiae

A. Skin rash and loose stool

When teaching patients about treatment of viral infection with Acyclovir (Zovirax), which of the following statements will the nurse include? A. The drug is used mainly to suppress the replication of HSV-1, HSV-2, and VZV. B. Acyclovir (Zovirax) is only effective for initial viral infections. C. Acyclovir (Zovirax) is available in topical form only. D. Acyclovir (Zovirax) is taken once daily.

A. The drug is used mainly to suppress the replication of HSV-1, HSV-2, and VZV.

A patient was diagnosed with cryptococcal meningitis. Which of the following medications is administered to treat cryptococcal meningitis? A. amphotericin B B. Rocephin C. bleomycin D. mupirocin

A. amphotericin B Amphotericin B is administered for meningitis infections of cryptococcosis

A client being prepared for surgery has been prescribed prophylactic antibiotics. What medication would the nurse anticipate being prescribed? A. cefazolin B. penicillin G C. amoxicillin D. vibramycin

A. cefazolin

A nurse is preparing to administer a patient's first scheduled dose of tetracycline. The nurse should first ensure that the patient has not recently eaten A. dairy products. B. leafy green vegetables. C. any high-fat foods. D. acidic foods.

A. dairy products.

When administering a fluoroquinolone intravenously, the nurse should check the vital signs at which frequency? A. every 4 hours B. every 2 hours C. every 8 hours D. every 12 hours

A. every 4 hours The nurse should monitor the vital signs every 4 hours or as directed by the primary health care provider because infusing this type of medication can cause certain cardiac arrhythmias and pose the possibility of superinfection. Notify the primary health care provider if there are changes in the vital signs, such as a significant drop in blood pressure, an increase in the pulse or respiratory rate, or a sudden increase in temperature. Times longer than every 4 hours can cause severe harm if changes in vital signs are not detected earlier.

Gentamicin therapy is indicated in the treatment of what medical diagnosis? A. osteomyelitis B. acute renal failure C. multiple sclerosis D. myasthenia gravis

A. osteomyelitis The major clinical use of gentamicin (most commonly with other antibacterial agents) is empiric therapy for serious infections caused by susceptible aerobic gram-negative organisms. Treatment of infections such as septicemia, respiratory tract infections, urinary tract infections, intra-abdominal infections, and osteomyelitis often involves gentamicin. A black box warning alerts health care professionals that these drugs are nephrotoxic and ototoxic and must be used very cautiously in the presence of renal impairment. The drugs must also be used cautiously in clients with myasthenia gravis and other neuromuscular disorders because muscle weakness may be increased.

The nurse has administered the first dose of a client's newly-prescribed antibiotic. What assessment finding should the nurse interpret as adverse effect that suggests a more serious concern? A. rash to the face and trunk B. new onset of pain C. decrease in blood pressure from 128/77 mm HG preadministration to 119/70 postadministration D. drowsiness

A. rash to the face and trunk

A nurse is caring for a 52-year-old man with pyelonephritis. The health care provider has prescribed gentamicin. Which pair of symptoms would alert the nurse to a serious adverse reaction? A. tinnitus and decreased urinary output B. diarrhea and vomiting C. visual changes and hearing difficulty D. loss of sensation in the extremities and blood in the urine

A. tinnitus and decreased urinary output

What is the most common adverse reaction associated with metronidazole? A. Headache B. Nausea C. Thrombocytopenia D. Pseudomembranous colitis

B. Nausea

The nurse would teach a patient receiving metronidazole (Flagyl) to avoid ingestion of which drink? A. Milk B. Wine C. Coffee D. Orange juice

B. Wine

At what point is the patient most likely to experience fever, chills, rigors, nausea, and headache when receiving amphotericin B? A. Immediately after the infusion begins. B. 20-30 minutes after the infusion begins. C. 1-3 hours after the infusion beings. D. 3-6 hours after the infusion begins.

C. 1-3 hours after the infusion beings.

When considering known adverse reactions to gentamicin therapy, the nurse should focus assessment of what body structure? A. eyes B. oral cavity C. lymph nodes D. inner ears

D. inner ears

Penicillins may trigger an anaphylactic reaction in some clients. Within what period following injection of a penicillin is anaphylaxis most likely to occur? A. 30 minutes B. 15 minutes C. 45 minutes D. 10 minutes

A. 30 minutes

The nurse is assessing the urine output of a client who is receiving an aminoglycoside. The nurse should notify the health care provider if a client's output is less than how many mL/day? A. 750 mL/day B. 1000 mL/day C. 1500 mL/day D. 2000 mL/day

A. 750 mL/day The nurse should notify the health care provider if a client's output is less than 750 mL/day when taking an aminoglycoside. Any amount less than 30 mL/hr indicates kidney failure. The other values are within normal expectations.

When learning about the different classes of cephalosporins, the nurse correctly identifies which of the following statements? A. A first-generation cephalosporin is more useful than a third-generation cephalosporin against gram-positive microorganisms. B. Cephalosporins are completely different chemically from penicillin. C. Cephalosporins are divided into three different groups. D. Cephalosporins are limited in treating many types of bacteria.

A. A first-generation cephalosporin is more useful than a third-generation cephalosporin against gram-positive microorganisms.

The nurse is obtaining a medication history from a client diagnosed with genital herpes. Which drug would the nurse expect this client to be prescribed? A. Acyclovir (Zovirax) B. Ribavirin (Virazole) C. Amantadine (Symmetrel) D. Zidovudine (Retrovir)

A. Acyclovir (Zovirax)

A patient is taking nystatin (Mycostatin) in an oral lozenge form for oral candidiasis. Which instruction is correct? A. Allow the lozenge to dissolve slowly in the mouth. B. Swish the medication in the mouth and then swallow it. C. Chew the lozenge thoroughly to activate the medication. D. Swallow the lozenge whole without chewing.

A. Allow the lozenge to dissolve slowly in the mouth. Oral troche or lozenge forms of this medication should be allowed to dissolve slowly in the mouth without chewing.

A patient has been prescribed ciprofloxacin after being diagnosed with a sinus infection. Which of the following should the patient avoid taking concurrently with ciprofloxacin? A. Antacids B. Calcium channel blockers C. Beta-adrenergic blockers D, Diuretics

A. Antacids

The nurse is caring for a client who is taking ciprofloxacin for the treatment of acute cystitis. The nurse knows ciprofloxacin interacts with several other classes of medication and that it is important to assess the client's medication administration record for which classifications of medications? Select all that apply. A. Anticoagulants B. Antacids C. Xanthines D. Antibiotics E. Antivirals

A. Anticoagulants B. Antacids C. Xanthines Xantines - theophylline

A patient has been prescribed doxycycline (Vibramycin). Which of the following teaching instructions is a priority with this medication? A. Avoid sun exposure. B. Avoid unprotected sexual activity. C. Administer with an antacid. D Chew the tablets.

A. Avoid sun exposure.

A local bioterrorism medical team is responding to a possible anthrax attack. The team is instructed that a fluoroquinolone may be used to treat exposure to anthrax. The nurse should prepare to administer what antibiotic? A. Ciprofloxacin B. gemifloxacin C. amoxicillin D. finafloxacin

A. Ciprofloxacin Ciprofloxacin is used to treat exposure to anthrax. Gemifloxacin is most useful in treating acute episodes of chronic bronchitis and community-acquired pneumonia. Finafloxacin is used in treatment of acute otitis externa. Amoxicillin is a penicillin, not a fluoroquinolone.

The client has been taking levofloxacin IV since admission 12 hours ago for a urinary tract infection. The nurse assesses the client's temperature at 99.8ºF. What is the nurse's best response? A. Continue to monitor vital signs. B. Notify the health care provider. C. Administer an extra dose of levofloxacin. D. Administer an antipyretic.

A. Continue to monitor vital signs.

What are important for the nurse to monitor in a client receiving an antifungal medication? (Select all that apply.) A. Creatinine B. Daily weights C. Mental status D. Intake and output E. BUN

A. Creatinine B. Daily weights D. Intake and output E. BUN

Prior to administration of fluoroquinolones, which laboratory test should be obtained? A. Culture and sensitivity B. Hepatic function C. Renal function D. Complete blood counts

A. Culture and sensitivity It is most important that culture and sensitivity tests are obtained prior to the administration of the first dose of antibiotics, so that accurate information can be obtained. Complete blood counts and hepatic and renal function tests are important but may be obtained later.

Both IV ampicillin/sulbactam (Unasyn) and gentamicin (Garamycin) are ordered for a patient. When administering these medications, the nurse will do what? A. Ensure that separate IV solutions are used. B. Use two different peripheral IV sites. C. Administer the gentamicin first. D. There are no necessary precautions.

A. Ensure that separate IV solutions are used.

A patient is admitted to the emergency room with a diagnosis of Legionnaire's disease and is placed on isolation. Which of the following medications is the drug of choice for Legionnaire's disease? A. Erythromycin (Ery-Tab) B. Meclizine (Antivert) C. Pravastatin (Pravachol) D. Loxapine hydrochloride(Loxitane)

A. Erythromycin (Ery-Tab)

A patient who is being treated in the intensive care unit has been diagnosed with ventilator-associated pneumonia. Culture and sensitivity testing of the patient's sputum indicates that erythromycin is a treatment option. The nurse knows that this drug is likely contraindicated for what reason? A. Erythromycin inhibits normal liver function. B. Erythromycin is associated with gastrointestinal upset. C. Erythromycin is nephrotoxic. D. Erythromycin cannot be administered orally.

A. Erythromycin inhibits normal liver function. Erythromycin is seldom used in critical care settings, partly because broader spectrum bactericidal drugs are usually needed in critically ill patients and partly because it inhibits liver metabolism and slows elimination of several other drugs. Erythromycin is not nephrotoxic. The drug is administered orally, and GI upset does not contraindicate use.

Your client is currently taking aminoglycosides. You know that this type of medication is used in all of the following microorganisms, EXCEPT: A. Gram-positive cocci. B. Pseudomonas. C. Gram-negative Escherichia coli. D. Klebsiella.

A. Gram-positive cocci. Many hospital-acquired infections are caused by gram-positive cocci and gram-negative organisms. The major clinical use of parenteral aminoglycosides is to treat serious systemic infections caused by gram-negative microorganisms such as Pseudomonas and Proteus species, Escherichia coli, Klebsiella, Enterobacter, and Serratia species.

The nurse provides home care instructions for a patient who will take a high dose of azithromycin after discharge from the hospital. Which statement by the patient indicates understanding of the teaching? A. I may take antacids 2 hours before taking this drug. B. I should take acetaminophen for fever or mild pain. C. I should expect diarrhea to be a common, mild side effect. D. I should avoid dairy products while taking this drug.

A. I may take antacids 2 hours before taking this drug. Azithromycin peak levels may be reduced by antacids when taken at the same time so patients should be cautioned to take antacids 2 hours before or 2 hours after taking the drug. High-dose azithromycin carries a risk for hepatotoxicity when taken with other potentially hepatotoxic drugs such as acetaminophen. Diarrhea may indicate pseudomembranous colitis and should be reported. There is no restriction for dairy products when taking azithromycin.

A patient is prescribed both erythromycin and warfarin. It is important for the nurse to monitor which of the following laboratory tests? A. INR B. Hgb/Hct C. RBC D. BUN

A. INR Erythromycin can affect plasma levels of warfarin which will change the patient's ability to clot. Increased plasma levels would mean more warfarin in the bloodstream and a decreased ability to clot. The patient's ability to clot should be monitored with an INR

A patient is being treated with amphotericin B for a fungal infection of the urinary tract. What is the action of amphotericin B? A. It binds to ergosterol and forms holes in the membrane. B. It binds to an enzyme required for synthesis of ergosterol. C. It disrupts the fungal cell walls rather than the cell membrane. d. It inhibits glucan synthetase required for glucan synthesis.

A. It binds to ergosterol and forms holes in the membrane.

Which of the following are examples of fluoroquinolones? Select all that apply. A. Levofloxacin (Levaquin) B. Amoxicillin (Amoxil) C. Cephalexin (Keflex) D. Spectinomycin (Trobicin) E. Ciprofloxacin (Cipro)

A. Levofloxacin (Levaquin) E. Ciprofloxacin (Cipro)

While administering aminoglycosides to clients, the nurse must be aware of what toxicities that can result from their use? (Select all that apply.) A. Nephrotoxicity B. Cardiotoxicity C. Ototoxicity D. Hepatotoxicity E. Neurotoxicity

A. Nephrotoxicity C. Ototoxicity E. Neurotoxicity Serious adverse reactions of aminoglycosides include nephrotoxicity, ototoxicity, and neurotoxicity. A nurse recognizing these can greatly reduce permanent damage to the client's hearing, kidneys, and nerves.

The client is being started on oral ciprofloxacin (Cipro). The nurse identifies that the client is also taking corticosteroids. What is the most appropriate action of the nurse? A. Notify the health care provider B. Teach about adverse reactions C. Monitor for adverse reactions D. Decrease the dosage of Cipro

A. Notify the health care provider Clients taking fluoroquinolones and corticosteroids are at risk for tendonitis and tendon rupture. The nurse needs to make sure the provider is aware that the client is taking corticosteroids. It is outside the scope of nursing to adjust medication dosages.

A patient develops flushing, rash, and pruritus during an IV infusion of vancomycin (Vancocin). Which action should a nurse take? A. Reduce the infusion rate. B. Administer diphenhydramine (Benadryl). C. Change the IV tubing. D. Check the patency of the IV.

A. Reduce the infusion rate. When vancomycin is infused too rapidly, histamine release may cause the patient to develop hypotension accompanied by flushing and warmth of the neck and face; this phenomenon is called red man syndrome. Diphenhydramine is not necessary if the infusion is administered slowly over at least 60 minutes. Changing the IV tubing would not help the symptoms. The patency of the IV needs to be checked before the administration is started.

The nurse is preparing to administer a fluorquinolone medication to a client with a urinary tract infection. The nurse knows it is important to contact a health care provider immediately if which adverse effects occur? Select all that apply. A. Severe diarrhea containing mucous B. Decreased urine output C. Nausea D. Abdominal cramping E. Headache

A. Severe diarrhea containing mucous B. Decreased urine output

The nurse has been caring for a patient who has been taking antibiotics for 3 weeks. Upon assessing the patient, the nurse notices the individual has developed oral thrush. Which of the following describes the etiology of the thrush? A. Superinfection B. Antibiotic resistance C.. Nosocomial infection D. Community-acquired infection

A. Superinfection

A patient has been prescribed oral tetracycline for the treatment of acne. Which of the following must the nurse include in the patient teaching plan? A. Take the drug on an empty stomach. B. Take the drug along with a meal. C. Take the drug along with milk or fruit juice. D. Take the drug immediately after meals.

A. Take the drug on an empty stomach.

The nurse instructs a patient on the administration of clarithromycin. Which of the following patient teaching instructions is appropriate? A. Take the medication on an empty stomach. B. Take the medication with a calcium supplement. C. Take the medication with a class of milk. D. Take the medication with cheese.

A. Take the medication on an empty stomach.

A client with a complex medical history is showing signs and symptoms of sepsis. What aspect of this client's health history would rule out the safe and effective use of an aminoglycoside antibiotic? A. The client has chronic renal failure B. The client has a history of not adhering to treatment C. The client has type 2 diabetes, controlled with oral antihyperglycemics D. The client has a known latex allergy

A. The client has chronic renal failure

Fluoroquinolones are very effective against both gram-negative and gram-positive organisms. Several of the drugs in this class have been discontinued from use. What adverse effects have caused the removal of these drugs from the market?' A. The development of dysrhythmias after administration of fluoroquinolones B. The development of pathologic fractures after administration of fluoroquinolones C. The development of insomnia after administration of fluoroquinolones D. The development of severe phototoxicity after administration of fluoroquinolones

A. The development of dysrhythmias after administration of fluoroquinolones

A teenage boy receives a prescription for erythromycin for an upper respiratory tract infection. He complains that he cannot hear the teacher, who then sends him to the school nurse's office. After assessing the patient's hearing with a tuning fork, the nurse determines that his hearing is diminished. What is the most important nursing intervention? A. The nurse should notify the parents to call the physician; this is an adverse effect of erythromycin. B. The nurse should inform the parents of a physician who specializes in ear, nose, and throat surgery. C. The nurse should instruct the patient to stop taking the erythromycin and his hearing will improve. D. The nurse should call the physician and inform the patient of a change in antibiotics.

A. The nurse should notify the parents to call the physician; this is an adverse effect of erythromycin.

The nurse knows that pseudomembranous colitis is a superinfection of fluoroquinolones, especially when they are administered in high doses, because these medications have what effect in the body? A. They disrupt the normal flora of the body. B. They disrupt the existing bacterial infection. C. They increase the infectious bacterial process. D. They decrease the infectious bacterial process.

A. They disrupt the normal flora of the body.

The nurse is caring for a 23-year-old female client who uses oral contraceptives and has been prescribed ampicillin for treatment of a respiratory infection. What information is most important for the nurse to share with this client? A. Use a type of barrier birth control while you are taking this antibiotic. B. Do not take your oral contraceptives while you are taking this medication. C. Your menstrual cycle will have a heavier flow while on this medication. D. Taking this antibiotic with your oral contraceptives will cause an increased chance of bleeding.

A. Use a type of barrier birth control while you are taking this antibiotic.

A nurse is preparing to administer the antibiotic for a hospitalized patient who acquired a Methicillin-resistant Staph. aureus (MRSA) infection. Based on the nurses' knowledge of antibiotics for the treatment of MRSA, which medication may be ordered? Select all that apply. A. Vancomycin B. Neomycin C. Cefazolin D. Ceftaroline E. Metronidazole F. Piperacillin

A. Vancomycin D. Ceftaroline Methicillin-resistant Staph. aureus(MRSA), highly resistant bacteria, are resistant to all penicillins and all cephalosporins. Because most strains of MRSA are multidrug resistant, many other antibiotics are ineffective, including tetracyclines, clindamycin, trimethoprim/sulfamethoxazole, and beta-lactam agents (except ceftaroline). Preferred drugs are IV vancomycin, linezolid [Zyvox], daptomycin [Cubicin], telavancin [Vibativ], clindamycin, and ceftaroline.

The nurse is preparing a teaching plan for a client who is receiving cephalosporins. Which of the following would the nurse identify as the most commonly occurring adverse effects? A. Vomiting and diarrhea B. Headache and dizziness C. Superinfections D. Phlebitis

A. Vomiting and diarrhea

Aminoglycosides must be used cautiously in children as in adults. Dosage must be accurately calculated according to which factors? A. Weight and renal function B. Height and weight C. Age and weight D. Weight and leukocytosis

A. Weight and renal function Aminoglycosides must be used cautiously in children as in adults. Dosage must be accurately calculated according to weight and renal function.

A client is about to undergo treatment with amphotericin B. What preadministration intervention should the nurse implement to help manage some of the common adverse reactions to this drug therapy? Select all that apply. A. administer an antiemetic as prescribed B. administer acetylsalicylic acid (ASA) as prescribed C. administer an antihistamine as prescribed D. administer a corticosteroid as prescribed E. administer an antidiarrheal as prescribed

A. administer an antiemetic as prescribed B. administer acetylsalicylic acid (ASA) as prescribed C. administer an antihistamine as prescribed D. administer a corticosteroid as prescribed

Which laboratory value should the nurse assess in patients who are receiving demeclocycline? A. blood urea nitrogen B. aspartate aminotransferase C. alanine aminotransferase D. creatinine

A. blood urea nitrogen

The nurse is teaching the client about metronidazole, which has been prescribed for treating trichomoniasis. Which client comment indicates the need for additional education? A. "I may have a bad metallic taste in my mouth." B. "I'm glad I can still drink beer with these pills." C. "My urine may look a little darker than usual." D. "These pills may make me sick to my stomach."

B. "I'm glad I can still drink beer with these pills."

The client has been prescribed a fluoroquinolone. Which statement by the client indicates additional education is needed? A. "I will need to report severe diarrhea to my health care provider." B. "If I cover my head, I will be protected from the sun." C. "I will take my antibiotic four hours after I take my antacid." D. "I may experience a headache while taking this medication."

B. "If I cover my head, I will be protected from the sun." It is important that the client's skin is protected from a sunburn reaction while taking fluoroquinolones. The client needs to wear a wide-brimmed hat and protect the skin from sun exposure, even on a cloudy day. All other responses demonstrate understanding.

The health care provider has ordered amoxicillin for a client. What should the nurse instruct the client to take with the medication? A. A full glass of orange juice B. A full glass of water C. A full glass of milk D. A full glass of tea

B. A full glass of water

The nurse is obtaining a medication history from a client diagnosed with genital herpes. Which drug would the nurse expect this client to be prescribed? A. Ribavirin (Virazole) B. Acyclovir (Zovirax) C. Zidovudine (Retrovir) D. Amantadine (Symmetrel)

B. Acyclovir (Zovirax)

The nurse is developing the plan of care for the 55-year-old client who is taking metronidazole for C. difficile. Which measures should be included in the plan of care? Select all that apply. A. Assess cardiac status B. Assess for signs of infection C. Reinforce strict hand washing D. Give metronidazole with food E. Monitor results of stool samples

B. Assess for signs of infection C. Reinforce strict hand washing E. Monitor results of stool samples

Before administering intravenous (IV) penicillin, the nurse should do what? A. Flush the IV site with normal saline. B. Assess the patient for allergies. C. Review the patient's intake and output record. D. Determine the latest creatinine clearance result.

B. Assess the patient for allergies.

A client is to receive gentamicin for treatment of an infection. Which of the following would be most important for the nurse to assess to establish a baseline? A. Nutritional status B. Auditory function C. Gastrointestinal function D. Muscle strength

B. Auditory function

What renal effects may occur in clients treated with fluoroquinolones? (Select all that apply.) A. Glycosuria B. Azotemia C. Crystalluria D. Hematuria E. Pyuria

B. Azotemia C. Crystalluria D. Hematuria With fluoroquinolones, reported renal effects include azotemia, crystalluria, hematuria, interstitial nephritis, nephropathy, and renal failure. Pyuria (pus in the urine) is one of the reasons a fluoroquinolone is prescribed.

A male client is admitted to the unit with Pseudomonas aeruginosa sepsis. The health care provider orders aminoglycoside to be given concomitantly with penicillin intravenously. How would the nurse administer these drugs? A. By mixing both drugs in normal saline solution B. By administering the drug in separate IV bags C. By administering the drugs dextrose 5% and 0.9% normal saline D. By administering the drugs every other day

B. By administering the drug in separate IV bags

A public health nurse interacts with many members of the community who are at risk for sexually transmitted infections (STIs). The nurse should anticipate the use of tetracycline in a patient who is diagnosed with what STI? A. Vaginitis B. Chlamydia C. Human papillomavirus D. Trichomoniasis

B. Chlamydia

When prescribing metronidazole (Flagyl) to treat bacterial vaginosis, patient education would include: A. Metronidazole is safe in the first trimester of pregnancy. B. Consuming alcohol in any form may cause a severe reaction. C. Sexual partners need concurrent therapy. D. Headaches are a sign of a serious adverse reaction and need immediate evaluation.

B. Consuming alcohol in any form may cause a severe reaction.

A patient experiences sudden episodes of shaking chills after receiving a dose of amphotericin B. Which drug, ordered as-needed for this patient, should the nurse administer at this time? A. Acetaminophen (Tylenol). B. Dantrolene (Dantrium). C. Diphenhydramine (Benadryl). D. Lorazepam (Ativan).

B. Dantrolene (Dantrium).

The nurse is providing client teaching before discharging a client home. The client is taking ciprofloxacin. What action should the nurse encourage the client to prioritize? A. Eliminate red meat and seafood from the diet. B. Drink at least 2L of fluid per day. C. Avoid all caffeine and alcohol. D. Minimize sodium intake.

B. Drink at least 2L of fluid per day.

A patient is receiving intravenous amphotericin. Which of the following assessments warrants the discontinuation of the antifungal agent? A. Sodium of 138 mEq/L B. Hematocrit of 39% C. Blood urea nitrogen of 60 mg/dL D. AST 10Unit/L

B. Hematocrit of 39%

A new vaccination, Zostavax (Zoster Vaccine Live), has been approved to prevent the development of what condition in adults older than the age of 60 years? A. Influenza A B. Herpes zoster C. Avian influenza D. Herpes simplex

B. Herpes zoster

A 60-year-old male client with a diagnosis of bacteremia is being treated with intravenous gentamicin. After 4 days of treatment, the care team is pleased with the improvement in the client's condition and the effect of the drug treatment on his blood cultures. During morning care, the client has told the nurse that he is having ringing in his ears and woke up this morning with a pounding headache. How should the nurse respond to this client? A. Document the client's reports and integrate them into his plan of care. B. Hold the next scheduled dose of gentamicin until the health care provider has been consulted. C. Administer the next scheduled dose of gentamicin over 90 to 120 hours. D. Continue the gentamicin as ordered and monitor the client's symptoms closely.

B. Hold the next scheduled dose of gentamicin until the health care provider has been consulted. To avoid permanent ototoxic damage, gentamicin should be withdrawn at the first sign of tinnitus or persistent headache. This supersedes the modification of the client's care plan and slowing down the infusion of the drug does not mitigate the potential for ototoxic effects.

Why must a client who is receiving aminoglycosides be kept well hydrated? A. Hydration increases drug concentration in serum and body tissues. B. Hydration decreases drug concentration in serum and body tissues. C. Hydration stabilizes peak serum levels. D. Hydration stabilizes trough serum levels.

B. Hydration decreases drug concentration in serum and body tissues. Guidelines to decrease the incidence and severity of adverse effects when administering aminoglycosides include the following: Keep clients well hydrated to decrease drug concentration in serum and body tissues.

Which of the following is true regarding metronidazole? A. It must be taken on an empty stomach. B. It may cause an unpleasant metallic taste. C. It may be combined with alcohol in moderation. D. It has no drug interactions.

B. It may cause an unpleasant metallic taste.

The pharmacology instructor is discussing ways to decrease adverse effects on clients taking aminoglycosides. Which would the instructor include? A. Decreasing dietary potassium B. Keeping the client well hydrated C. Assessing liver function weekly D. Increasing dietary sodium

B. Keeping the client well hydrated Aminoglycosides are nephrotoxic. Keeping the client adequately hydrated (by increasing daily fluid intake to two to three liters) helps decrease the risk of adverse effects related to renal function. Renal function tests should be performed regularly during aminoglycoside therapy.

A child with a serious fungal infection is receiving amphotericin B parenterally. Which of the following minerals will the patient most likely be required to receive? A. Chloride B. Magnesium C. Glucose D. Sodium

B. Magnesium

An older adult is to receive a low dose of a cephalosporin for an infection. When realizing that this client has age-related diminished renal function, what intervention should the nurse implement? A. Hold the drug for lab work. B. Monitor blood creatinine levels. C. Notify the prescribing provider. D. Initiate monitoring of intake and output.

B. Monitor blood creatinine levels.

A 75-year-old patient with a history of renal impairment is admitted to the primary health care center with a UTI and has been prescribed a cephalosporin. Which of the following interventions is most important for the nurse to perform when caring for this patient? A. Monitoring fluid intake. B. Monitoring blood creatinine levels. C. Testing for occult blood. D. Testing for increased glucose levels.

B. Monitoring blood creatinine levels.

A client is being given a prescription for ciprofloxacin (Cipro) to treat a urinary tract infection. The nurse should warn the client about which of the following common adverse reactions? (Select all that apply.) A. Constipation B. Nausea C. Headache D. Dizziness E. Profuse sweating

B. Nausea C. Headache D. Dizziness Common adverse reactions to fluoroquinolones include nausea, vomiting, diarrhea, headache, abdominal pain or discomfort, dizziness, and photosensitivity, especially with lomefloxacin and sparfloxacin treatment.

A young adult has been receiving Cefalexin P.O. for the last 5 days to treat a respiratory infection. The nurse is concerned when the client reports urinating only once in the last 16 hours. What should the nurse consider as the cause? A. Steven-Johnson syndrome B. Nephrotoxicity C. Superinfection D. Systemic dehydration

B. Nephrotoxicity

A client is started on sulfamethoxazole-trimethoprim for a urinary infection. What adverse effect should the nurse assess with this client? A. Liver toxicity B. Renal damage C. Bone marrow depression D. Congestive heart failure

B. Renal damage

The nurse is administering amphotericin B (Albelcet). This medication: A. Should not be given with food. B. Should be given with plenty of fluids. C. Should be alternated with capsule and oral solution to increase effectiveness. D. Should be given with an antacid to decrease gastric upset.

B. Should be given with plenty of fluids.

The development of a new infection as a result of the elimination of normal flora by an antibiotic is referred to as what? A. Resistant infection B. Superinfection C. Nosocomial infection D. Allergic reaction

B. Superinfection

A client scheduled to undergo major abdominal surgery has been prescribed preoperative neomycin. Neomycin is used preoperatively for what reason? A. Enhance intestinal flora B. Suppress intestinal bacteria. C. Sterilize the incision site D. Produce ammonia.

B. Suppress intestinal bacteria. Neomycin and kanamycin may be given before bowel surgery to suppress intestinal bacteria. They may be given to treat hepatic coma. In hepatic coma, intestinal bacteria produce ammonia, which enters the bloodstream and causes encephalopathy. Drug therapy to suppress intestinal bacteria decreases ammonia production.

A patient is seen in the clinic after a bite from a tick. She has a rash over her arms and legs and arthritic pain in the joints. What is the drug of choice for Lyme's disease? A. Ibuprofen (Motrin) B. Tetracycline (Sumycin) C. Phenazopyridine (Pyridium) D. Nitrofurantoin (Macrodantin)

B. Tetracycline (Sumycin)

A 30-year-old woman who is in the first trimester of pregnancy has presented to her primary care provider with a 4-day history of a reddened, itchy left eye that is crusted with purulent exudate. The clinician suspects a bacterial, rather than viral, etiology. How will the client's pregnancy affect the potential use of ciprofloxacin to treat her conjunctivitis? A. Ciprofloxacin is safe to use in pregnancy and the client may use to same dose and route as a nonpregnant client. B. The use of ciprofloxacin is contraindicated in pregnancy. C. It is safe for the client to use topical ciprofloxacin but the oral route is potential teratogenic. D. The client will require a lower dose and longer course of ciprofloxacin than a nonpregnant, adult client.

B. The use of ciprofloxacin is contraindicated in pregnancy.

Prior to administering fluoroquinolones, it is most important for the nurse to assess for which finding or condition? A. vital signs. B. allergies C. hepatic function. D. respiratory function.

B. allergies Prior to administration of any medication, it is of highest priority to assess the client for allergies.

The nurse is reviewing the orders for a patient who has been admitted for treatment of pneumonia. The antibiotic orders include an order for doxycycline. however the patient is asked about his allergies, he lists doxycycline as one of them. What is the nurses priority action A. call the provider to clarify the order because of the patients allergy B. ask the patient to explain what happens when he has the allergic reaction C. ask the pharmacy to order a different antibiotic D. administer the drug with and antihistamine to reduce adverse effects

B. ask the patient to explain what happens when he has the allergic reaction

A client is scheduled for a bowel resection. During the perioperative period, which type of medication should the nurse anticipate the client will be given? A. penicillins B. cephalosporins C. sulfonamides D. antivirals

B. cephalosporins

A client with a diagnosis of rhinosinusitis has been prescribed ciprofloxacin 250 mg SQ b.i.d. When contacting the prescriber, the nurse should question the: A. dose. B. route C. frequency. D. choice of drug.

B. route Ciprofloxacin is given PO

A patient is being treated with amphotericin B. Which of the following statements indicates that the patient has understood the patient teaching? A. "The medication may cause diabetes." B. "The medication will cause liver necrosis." C. "The medication may cause kidney damage." D. "The medication will cause pancreatitis."

C. "The medication may cause kidney damage."

A client has been prescribed phenazopyridine for urinary tract symptoms related to an infection. The client asks why she is taking this medication. What is the most appropriate response by the nurse when the client asks why the medication has been prescribed? A. "This medicine is used to treat urinary retention." B. "This medicine will stop the blood in the urine." C. "This medicine will decrease the pain of your infection." D. "The medicine will prevent hesitancy when you're passing urine."

C. "This medicine will decrease the pain of your infection."

A patient is being treated for a severe fungal infection with amphotericin B. What is the expected length of treatment for this patient? A. 1 to 2 weeks B. 3 to 6 weeks C. 4 to 12 weeks D. 15 to 18 weeks

C. 4 to 12 weeks

It would be most important for a nurse to monitor which client for ototoxicity while on gentamicin therapy? A. A 43-year-old male with Parkinson disease B. A 32-year-old mother who is breast-feeding C. A 25-year-old male who has a hearing impairment D. A 22-year-old female who has just found out she is pregnant

C. A 25-year-old male who has a hearing impairment Clients with a history of hearing impairment and 8th cranial nerve impairment have an elevated risk of ototoxicity.

A prescriber has ordered oral fluconazole. Which of the following patient teaching guidelines is important to implement? A. Administer the medication on an empty stomach. B. Administer the medication 2 hours following breakfast. C. Administer the medication with meals. D. Administer the medication with a full glass of water

C. Administer the medication with meals.

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 mm Hg. 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.

C. Assess for other symptoms of this expected infusion-related reaction. 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.

You are writing a plan of care for a patient taking an oral fluoroquinolone. What would be an appropriate intervention to include in this plan? A. Teach the patient to increase intake of zinc and calcium with nutritional supplements. B. Restrict fluids. C. Avoid concomitant use of nephrotoxic drugs. D. Teach the patient to take the medication at mealtime.

C. Avoid concomitant use of nephrotoxic drugs. Since fluoroquinolones can impair renal function, concomitant use of other nephrotoxic drugs should be avoided when possible.

A female client is admitted to the critical care unit with sepsis related to a contaminated central line. The health care provider orders intravenous beta-lactam antimicrobials. The client's current laboratory report reflects renal impairment. What would the nurse expect the provider to do? A. Maintain the drug dose. B. Increase the drug dose. C. Decrease the drug dose. D. Administer the drug via an intramuscular route.

C. Decrease the drug dose.

A female patient who is allergic to penicillin will begin taking an antibiotic to treat a lower respiratory tract infection. The patient tells the nurse that she almost always develops a vaginal yeast infection when she takes antibiotics and that she will take fluconazole (Diflucan) with the antibiotic being prescribed. Which macrolide order would the nurse question for this patient? A. Azithromycin (Zithromax) B. Clarithromycin (Biaxin) C. Erythromycin (E-Mycin) D. Fidaxomicin (Dificid)

C. Erythromycin (E-Mycin) When erythromycin is given concurrently with fluconazole, erythromycin blood concentration and the risk of sudden cardiac death increase.

A patient is allergic to penicillin and has been diagnosed with a genitourinary infection caused by Chlamydia trachomatis. Which of the following medications will most likely be administered? A. Acamprosate calcium (Campral) B. Atazanavir (Reyataz) C. Erythromycin (Ery-Tab) D. Flumazenil (Mazicon)

C. Erythromycin (Ery-Tab) A patient who is diagnosed with a genitourinary infection that is caused by trachomatis and who is allergic to penicillin should be administered erythromycin (Ery-Tab).

The nurse is caring for several patients who are receiving antibiotics. Which order will the nurse question? A. Azithromycin (Zithromax) 500 mg IV in 500 mL fluid B. Azithromycin (Zithromax) 500 mg PO once daily C. Erythromycin 300 mg IM QID D. Erythromycin 300 mg PO QID

C. Erythromycin 300 mg IM QID Erythromycin and other macrolides should not be given intramuscularly because they cause painful tissue irritation.

Which of the following drugs would be classified as an aminoglycoside? A. Levofloxacin B. Clarithromycin C. Gentamicin D. Cefaclor

C. Gentamicin

A male client is prescribed aminoglycosides for a bladder infection secondary to benign prostatic hypertrophy. The nurse understands that these drugs reach higher concentrations in which areas of the body? (Select all that apply.) A. Pericardium B. Peritoneum C. Inner Ears D. Central nervous system E. Kidneys

C. Inner Ears E. Kidneys

What is the rationale for not administering tetracycline (Sumycin) to children under the age of 8 years? A. It will not treat the infection. B. It will increase the risk of heart failure. C. It will interfere with enamel development. D. It will increase the risk for future infections.

C. It will interfere with enamel development.

When discussing cephalosporins with the nursing class, the pharmacology instructor explains that this classification of drug is primarily excreted through which organ? A. Lung B. Liver C. Kidney D. Skin

C. Kidney

The nurse is caring for a patient who is receiving a high dose of intravenous azithromycin to treat an infection. The patient is also taking acetaminophen for pain. The nurse should expect to review which lab values when monitoring for this drugs side effects? A. Complete blood counts B. Electrolytes C. Liver enzymes D. Urinalysis

C. Liver enzymes High doses of macrolides, when taken with other, potentially hepatotoxic drugs such as acetaminophen may cause hepatotoxicity, so liver enzymes should be carefully monitored.

Numerous residents of a long-term care facility have developed Clostridium difficile-associated diarrhea over the past week. The nurses at this facility would anticipate that many residents would require which of the following drugs? A. linezolid B. daptomycin C. Metronidazole (Flagyl) D. chloramphenicol

C. Metronidazole (Flagyl)

A 40-year-old is being treated for an ear infection with a cephalosporin. Which adverse reactions should the nurse monitor for in the client? A. Hypotension B. Chest pain C. Nausea D. Excessive tearing

C. Nausea

A patient is receiving vancomycin (Vancocin). The nurse identifies what as the most common toxic effect of vancomycin therapy? A. Ototoxicity B. Hepatotoxicity C. Nephrotoxicity D. Cardiac toxicity

C. Nephrotoxicity The most common toxic effect of vancomycin (Vancocin) therapy is renal toxicity. Although ototoxicity may occur, it is rare. The liver and heart are not affected when vancomycin is used.

The nurse is caring for a patient on a medical-surgical unit who has been experiencing fever of unknown origin. The prescriber has ordered a broad-spectrum antibiotic. Which intervention is the priority? A. Administer the antibiotic immediately. B. Administer antipyretics as soon as possible. C. Obtain all cultures before the antibiotic is administered. D. Delay administration of the antibiotic until the culture results are available.

C. Obtain all cultures before the antibiotic is administered.

When providing health promotion teaching at a senior citizen center, the nurse would include information about which medication used to decrease the duration of influenza A and B? A. Indinavir (Crixivan) B. Enfuvirtide (Fuzeon) C. Oseltamivir (Tamiflu) D. Ganciclovir (Cytovene)

C. Oseltamivir (Tamiflu)

A female patient who is taking trimethoprim-sulfamethoxazole (TMP-SMZ) (Bactrim, Septra) to treat a urinary tract infection reports vaginal itching and discharge. The nurse will perform which action? A. Ask the patient if she might be pregnant. B. Reassure the patient that this is a normal side effect. C. Report a possible superinfection to the provider. D. Suspect that the patient is having a hematologic reaction.

C. Report a possible superinfection to the provider.

The nurse is preparing to administer clarithromycin to a patient. When performing a medication history, the nurse learns that the patient takes warfarin to treat atrial fibrillation. The nurse will perform which action? A. Ask the provider if azithromycin may be used instead of clarithromycin. B. Obtain an order for continuous cardiovascular monitoring. C. Request an order for periodic serum warfarin levels. D. Withhold the clarithromycin and notify the provider.

C. Request an order for periodic serum warfarin levels. Macrolides can increase serum levels of other drugs such as warfarin. If these drugs are used with macrolides, serum drug levels should be monitored. All macrolides have this drug interaction. Cardiovascular monitoring is not indicated. The drug may be given as long as serum drug levels are monitored.

A patient who is being treated for a seizure disorder with phenytoin receives a diagnosis of candidiasis. The prescriber orders fluconazole. What effect does fluconazole have on phenytoin? A. The dosage of phenytoin should be increased. B. The fluconazole will be ineffective with the phenytoin. C. The patient should be assessed for phenytoin toxicity. D. The fluconazole dosage will need to be increased

C. The patient should be assessed for phenytoin toxicity. The administration of fluconazole and phenytoin increases the serum levels of phenytoin, predisposing the client to phenytoin toxicity. This occurs because fluconazole interacts with cytochrome P450 enzymes to produce a significant interaction, decreasing phenytoin metabolism and increasing the risk of toxicity

A client is taking penicillin for an upper respiratory infection. The client calls the office after 2 days of therapy reporting nausea and abdominal pain. Which would be the best instruction for the nurse to give the client? A. Continue to take the medication as prescribed; these are expected side effects from the medication. B. Stop the medication immediately and go to the emergency room; these could be signs of a life-threatening reaction. C. These are normal side effects, but if they increase in severity or frequency, you need to contact the office again. D. Stop the medication and the health care provider will order you a different antibiotic.

C. These are normal side effects, but if they increase in severity or frequency, you need to contact the office again.

A client prescribed metronidazole to treat Clostridium difficile is also prescribed which medication orally to assist in restructuring the flora of the intestinal tract? A. Spectinomycin B. Rifaximin C. Vancomycin D. Quinupristin-dalfopristin

C. Vancomycin Oral vancomycin, active only against gram-positive microorganisms, is used to treat pseudomembranous colitis caused by C. difficile. Spectinomycin, rifaximin, and quinupristin-dalfopristin are not administered to treat pseudomembranous colitis caused by C. difficile.

A man had rheumatic fever as a child. He has an appointment for a tooth extraction. His dentist prescribes which of the following medications prior to the extraction? A. chloramphenicol B. vancomycin C. clarithromycin D. digoxin

C. clarithromycin

A patient who is receiving vancomycin (Vancocin) IV for a methicillin-resistant Staphylococcus aureus (MRSA) infection asks a nurse, "Why can't I take this medicine in a pill?" Which response should the nurse make? A. "The prescription could be changed, because vancomycin comes in two forms." B. "You're allergic to penicillin, and this is the only way this medication can be given." C. "It will cause too much loss of appetite and nausea if given in the oral form." D. "It is more effective by IV, because the pill form will stay in the digestive tract."

D. "It is more effective by IV, because the pill form will stay in the digestive tract." Because of its chemical size and weight, vancomycin is absorbed poorly in the gastrointestinal (GI) tract and is given parenterally for most infections. It is used for serious infections caused by organisms such as MRSA and in patients with susceptible organisms allergic to penicillins. Oral administration is used only for infections of the intestine. It is not associated with loss of appetite or nausea.

Your client receives IV vancomycin every 12 hours. You know that this infusion should run over: A. 3 to 4 hours. B. 2 to 4 hours. C. 30 minutes. D. 1 to 2 hours.

D. 1 to 2 hours. For systemic infections, vancomycin is given IV and reaches therapeutic plasma levels within 1 hour after infusion. It is very important to give IV infusions slowly, over 1 to 2 hours, to avoid an adverse reaction characterized by hypotension, flushing, and skin rash. This reaction, sometimes called "red man syndrome," is attributed to histamine release.

A nurse has been performing vigilant assessments of a patient who is receiving doses of intravenous gentamicin, each over 30 minutes. A blood sample for peak gentamicin levels should be drawn A. As soon as possible after the patient awakens in the morning. B. immediately after the third intravenous dose of the drug. C. at the midpoint between scheduled doses. D. 30 minutes after the drug has finished infusing.

D. 30 minutes after the drug has finished infusing. Blood for peak levels of gentamicin is drawn 30 minutes after the completion of a 30-minute intravenous (IV) administration or immediately after a 60-minute IV administration and 45 to 60 minutes after intramuscular (IM) administration. Blood for trough levels is drawn just before the next dose.

Thirty minutes after receiving an intramuscular (IM) injection of amoxicillin, a patient reports itching and redness at the injection site. Which action should the nurse take first? A. Elevate the lower legs. B. Place an ice pack on the site. C. Make sure the patient stays calm. D. Administer subcutaneous epinephrine.

D. Administer subcutaneous epinephrine.

The nurse needs to know that major adverse effects are MOST common by which drug? A. Fluconazole (Diflucan) B. Ketoconazole (Nizoral) C. Griseofulvin (Fulvicin P/G) D. Amphotericin B (Amphocin)

D. Amphotericin B (Amphocin)

A 9-year-old boy has been admitted to the pediatric unit after being diagnosed with pertussis. The pediatric nurse is processing the boy's admission orders and notes that IV demeclocycline (Declomycin) has been ordered. After beginning this treatment, the nurse should confirm the results of what laboratory test? A. Mean corpuscular volume (MCV) B. D-dimer C. Bilirubin D. BUN

D. BUN When administering demeclocycline, it is important to monitor the patient's BUN. Increases in the BUN are secondary to antianabolic effects.

Which of the following drugs is likely to be administered as a first-line treatment for anthrax exposure? A. Tobramycin B. Norfloxacin C. Gentamicin D. Ciprofloxacin

D. Ciprofloxacin

Unless hemodialysis is started within 48 hours, meropenum is contraindicated for clients with severe renal impairment. What laboratory measurement would indicate renal impairment? A. Hematocrit B. White blood count C. Serum albumin D. Creatinine clearance

D. Creatinine clearance

Before the selection of an aminoglycoside to treat a client's wound infection, what would the nurse expect the health care provider to order? A. White blood count B. Electrolyte panel C. Complete blood count D. Culture and sensitivity

D. Culture and sensitivity The choice of aminoglycoside depends on local susceptibility patterns and specific organisms causing an infection.

A woman is seen in the clinic for vaginal itching and discharge. Which of the following medications can be administered in a single dose to treat her discomfort and vaginal discharge? A. Caspofungin (Cancidas) B. Terbinafine (Lamisil) C. Ketoconazole (Nizoral) D. Fluconazole (Diflucan)

D. Fluconazole (Diflucan) Fluconazole (Diflucan) is used for vaginal candidiasis in a single oral dose of 150 mg. Caspofungin is not used for vaginal candidiasis, but for invasive aspergillosis. Terbinafine is used for interdigital tinea pedis. Ketoconazole is used for patients with organ transplants.

A client is prescribed ciprofloxacin for an acute sinus infection. The nurse knows that this anti-infective medication belongs to which drug category? A. Aminoglycosides B. Cephalosporins C. Tetracyclines D. Fluoroquinolones

D. Fluoroquinolones

A client is prescribed ciprofloxacin for an acute sinus infection. The nurse knows that this anti-infective medication belongs to which drug category? A. Penicillins B. Cephalosporins C. Tetracyclines D. Fluoroquinolones

D. Fluoroquinolones

A male client is placed on an IV regimen of aztreonam. The nurse would expect the health care provider to order which laboratory test? A. CBC B. Hematocrit C. Serum albumin D. Liver function

D. Liver function

A patient has developed Clostridium difficile associated with pseudomembranous colitis. Which of the following medications is effective in the treatment of Clostridium difficile? A. Linezolid B. Cladribine C. clarythromycin D. Metronidazole (Flagyl)

D. Metronidazole (Flagyl)

A patient has developed Clostridium difficile associated with pseudomembranous colitis. Which of the following medications is effective in the treatment of Clostridium difficile? A. Linezolid B. Cladribine C. Clarithromycin D. Metronidazole

D. Metronidazole (Flagyl)

A client has been admitted to the hospital with a urinary tract infection (UTI). The health care provider has prescribed ciprofloxacin (Cipro) IV to be administered every 12 hours. What is the nurse's priority responsibility to this client? A. Take a complete health history. B. Start the IV and begin the ciprofloxacin administration. C. Obtain vital signs. D. Obtain a urine specimen for culture and sensitivity.

D. Obtain a urine specimen for culture and sensitivity. The nurse must always obtain a culture and sensitivity before starting an antibacterial to be sure that the infecting organisms is sensitive to the antibacterial being used.

Which adverse effect can result if tetracycline is administered to children younger than 8 years of age? A. Drug-induced neurotoxicity B. Delayed growth development C. Gastrointestinal (GI) and rectal bleeding D. Permanent discoloration of the teeth

D. Permanent discoloration of the teeth

A young lifeguard has been prescribed moxifloxacin (Avelox). The nurse understands that the focus on education would be which adverse reaction? A. Weakness B. Fatigue C. Muscle cramping D. Photosensitivity

D. Photosensitivity

The nurse is teaching a client about his prescription for a macrolide antibiotic. What should the nurse teach the client to report? A. Lessening of symptoms of infection B. Missed doses C. Increased urinary output D. Recurring symptoms of infection

D. Recurring symptoms of infection

Which is a complication of vancomycin IV infusions? A. Angioedema B. Neurotoxicity C. Cardiomyopathy D. Red man syndrome

D. Red man syndrome

How does dantrolene receive rigors and fever associated with amphotericin B infusion? A. Blocking the action of amphotericin B. B. Counteracting an allergic reaction. C. Decreasing the set point of temperature in the hypothalamus. D. Relaxing muscles and preventing shivering.

D. Relaxing muscles and preventing shivering.

A client is receiving a cephalosporin and an aminoglycoside as combination therapy. What assessment should the nurse prioritize? A. Coagulation studies B. Signs of disulfiram-like reaction C. Complete blood count D. Serum BUN and creatinine levels

D. Serum BUN and creatinine levels

An 82-year-old woman is unable to take the influenza vaccine because of 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.

D. She should begin oral oseltamivir (Tamiflu) therapy as soon as possible.

A patient receiving tetracycline should receive the following instruction regarding the medication? A. Take tetracycline with food. B. Take tetracycline in combination with antacids. C. Take the first dose and then obtain a test known as culture and sensitivity. D. Take tetracycline with a full glass of water.

D. Take tetracycline with a full glass of water.

Which of the following should a nurse carefully monitor in a patient who has been administered cephalosporin as well as aminoglycosides for a wound infection? A. Nausea B. Nephrotoxicity C. Increased bleeding D. Respiratory difficulty

B. Nephrotoxicity

What is the MOST common drug used to treat oral candidiasis? A. Oseltamivir (Tamiflu) B. Nystatin (Mycostatin) C. Amantadine (Symmetrel) D. Griseofulvin (Fulvicin P/G)

B. Nystatin (Mycostatin)

When administering aminoglycosides, the nurse must be aware of which of the following adverse reactions? A. Liver necrosis, or hepatic failure B. Ototoxicity and nephrotoxicity C. Glaucoma and renal failure D. Hypoglycemia and hyperglycemia

B. Ototoxicity and nephrotoxicity

The nurse instructs the client who is taking oral ciprofloxacin to avoid which food while taking this medication? A. Hamburger B. Chicken C. Cheese D. Tuna

C. Cheese Clients taking oral ciprofloxacin should avoid calcium-containing foods while taking this medication.

A parent of a high school student calls the school nurse regarding her daughter's crying. The parent states that this behavior is unusual for her daughter. Which of the following medications contributes to changes in behavior? A. metronidazole B. naproxen sodium C. vitamin C D. erythromycin

D. erythromycin

After teaching a group of nursing students about the action of penicillins, the instructor determines that the teaching was effective when the students identify natural penicillins as exerting which type of effect on microorganisms? A. bactericidal B. bacteriostatic C. fungicidal D. fungistatic

A. bactericidal

A nurse is preparing to administer a client's first scheduled dose of tetracycline. The nurse should first ensure that the client has not recently eaten what type of foods? A. dairy products B. leafy green vegetables C. any high-fat foods D. acidic foods

A. dairy products

An older adult resident of a long-term care facility has been diagnosed with a fungal infection and has been prescribed fluconazole. What change in the client's laboratory values may necessitate a change in medication therapy? A. decreased creatinine clearance B. increased white blood cells C. decreased Hct and Hgb D. decreased ESR

A. decreased creatinine clearance

The nurse should include which instructions when teaching a patient about tigecycline therapy? (Select all that apply.) A. "Use sunscreen when you are outside." B. "If you have diarrhea more than five times a day, notify your healthcare provider." C. "Avoid using this drug if you are pregnant." D. "Stop taking the drug if you experience nausea." E. "Stop taking the drug if you experience vomiting."

A. "Use sunscreen when you are outside." B. "If you have diarrhea more than five times a day, notify your healthcare provider." C. "Avoid using this drug if you are pregnant."

The nurse must administer a tetracycline antibiotic to a patient who takes an oral calcium supplement with each meal. When should the nurse administer the tetracycline? A. 2 hours before meals B. 30 minutes before meals C. with meals D. 1 hour after meals

A. 2 hours before meals

The nurse is reviewing the medication order for a client who has been prescribed gentamicin. The nurse recognizes the inclusion of what administration instruction as a means to maximize the drug's efficacy? A. Administer once daily B. Administer after each meal C. Administer as a constant infusion D. Administer with intravenous calcium gluconate

A. Administer once daily Once-daily aminoglycoside dosing uses higher doses of gentamicin to produce high initial drug concentrations, with no repeat dosing until the serum concentration is quite low (typically 24 hours later). The rationale for this dosing approach is a potential increase in efficacy with a reduced incidence of nephrotoxicity. Gentamicin is not administered with calcium gluconate or as a constant infusion.

A patient who is undergoing hemodialysis has received a diagnosis of a systemic Candida infection. Which of the following interventions should be implemented when administering fluconazole? A. Administer the full dose of fluconazole after dialysis. B. Administer the full dose of fluconazole before dialysis. C. Administer one half of the dose of fluconazole after dialysis. D. Administer one half of the dose of fluconazole before dialysis.

A. Administer the full dose of fluconazole after dialysis.

A client who takes zinc daily is diagnosed with a severe infection and is ordered levofloxacin (Levaquin). The nurse is aware that taking these two drugs may have what affect on the antibiotic? A. Decreased absorption B. Increased absorption C. Increased elimination D. Decreased elimination

A. Decreased absorption

A client who takes zinc daily is diagnosed with a severe infection and is ordered levofloxacin (Levaquin). The nurse is aware that taking these two drugs may have what affect on the antibiotic? A. Decreased absorption B. Increased absorption C. Increased elimination D. Decreased elimination

A. Decreased absorption Antacids, iron salts and zinc can cause decreased absorption of the antibiotic. There is no affect on elimination of the antibiotic.

The nurse is to administer vancomycin to the client diagnosed with sepsis. The client is to have a peak and trough level completed on this dose of vancomycin. Which action should the nurse initiate first? A. Determine if the trough level has already been drawn on the client B. Check drug compatibilities before infusing into an existing IV line C. Evaluate the client's culture & sensitivity (C&S) report results D. Calculate the rate at which the vancomycin should be infused

A. Determine if the trough level has already been drawn on the client

What assessment finding would signal the nurse to the possibility that the client's infusion of vancomycin is running too quickly? A. The client is flushed and has a visible skin rash. B. The client's apical heart rate is irregular. C. The client is reporting nausea. D. The client reports pain at the intravenous access site.

A. The client is flushed and has a visible skin rash. It is very important to give IV infusions slowly, over 1 to 2 hours, to avoid an adverse reaction characterized by hypotension, flushing, and skin rash. This reaction, sometimes called red man syndrome, is attributed to histamine release. Irritation is likely the cause of pain at the IV access site. Neither cardiac arrhythmia nor nausea is associated with the rapid administration of this medication.

Which statements about vancomycin (Vancocin) does the nurse identify as true? (Select all that apply.) A. Vancomycin is the most widely used antibiotic in U.S. hospitals. B. Vancomycin is effective in the treatment of Clostridium difficile infection. C. Vancomycin is effective in the treatment of MRSA infections. D. Patients who are allergic to penicillin are also allergic to vancomycin. E. The major toxicity of vancomycin therapy is liver failure.

A. Vancomycin is the most widely used antibiotic in U.S. hospitals. B. Vancomycin is effective in the treatment of Clostridium difficile infection. C. Vancomycin is effective in the treatment of MRSA infections. Patients who are allergic to penicillin are able to take vancomycin. The major toxicity of vancomycin therapy is kidney failure. The other three statements are true.

A nurse is caring for a client who is receiving cephalosporin. Which histories will a nurse obtain as part of the preadministration assessment? Select all that apply. A. allergy history B. family history C. drug history D. surgical treatment history E. occupational history

A. allergy history C. drug history D. surgical treatment history

After teaching a group of nursing students about the action of penicillins, the instructor determines that the teaching was effective when the students identify natural penicillins as exerting which type of effect on microorganisms? A. bactericidal B. bacteriostatic C. fungicidal D. fungistatic

A. bactericidal

A client with an upper respiratory infection has been prescribed macrolides. Which changes during an ongoing assessment would lead the nurse to notify the health care provider? Select all that apply. A. drop in blood pressure B. increase in respiratory rate C. sudden increase in temperature D. regular urine output E. pulse rate within usual parameters

A. drop in blood pressure B. increase in respiratory rate C. sudden increase in temperature

Which medication is the drug of choice for Legionnaires disease? A. erythromycin B. loxapine hydrochloride C. meclizine D. pravastatin

A. erythromycin

A client reports having had a "bad reaction" the last time receiving penicillin. Prior to a scheduled dental procedure, the client is likely to be prescribed what drug? A. erythromycin B. clindamycin C. metronidazole D. vancomycin

A. erythromycin Prophylactically, erythromycin is administered to prevent alpha-hemolytic streptococcal endocarditis before dental or other procedures in clients who have valvular heart disease and are allergic to penicillin. Clindamycin may be useful as a penicillin substitute in clients who are allergic to penicillin and who have serious streptococcal, staphylococcal, or pneumococcal infections in which the causative organism is susceptible to clindamycin

When fluoroquinolones are administered intravenously, the nurse would check the needle site and area around the needle site for extravasation at which frequency? A. every hour B. every 2 hours C. every 4 hours D. every 6 hours

A. every hour When fluoroquinolones are administered intravenously, the nurse would check the needle site and area around the needle site for extravasation—escape of fluid from a blood vessel into surrounding tissue—every hour. Times longer than every hour can lead to necrosis of the tissue if extravasation occurs.

The nurse is justified in suspecting that a client who recently completed a course of ceftaroline may have been treated for what health problem? A. methicillin-resistant Staphylococcus aureus (MRSA) infection B. chlamydial infection C. endocarditis D. encephalitis

A. methicillin-resistant Staphylococcus aureus (MRSA) infection

What route of administration is most commonly used for the administration of ciprofloxacin when prescribed to an older adult client? A. oral (PO) B. intravenous (IV) C. subcutaneous (SQ) D. intramuscular (IM)

A. oral (PO) While ciprofloxacin is typically administered by the PO or IV route, in most cases, oral administration is used. The medication is not administered by either the SQ or IM routes.

Which of the following foods should not be taken with tetracycline? A. orange juice with calcium B. cranberry juice cocktail C. tomato juice D. lemonade

A. orange juice with calcium

A nurse monitors a client closely for anaphylactic reactions secondary to penicillin therapy. The nurse understands that this occurs more commonly after which route of administration? A. parenteral B. oral C. topical D. transdermal

A. parenteral Adverse effects mainly occur with parenteral administration, and penicillin is never administered topically or transdermally.

Tetracycline is often a viable treatment option when a client has an allergy to what antibiotics? A. penicillins B. aminoglycosides C. fluoroquinolones D. cephalosporins

A. penicillins

What event triggers the development of a superinfection? A. proliferation of antibiotic-resistant microorganisms B. bone marrow suppression triggered by antibiotic treatment C. complete establishment of the infection prior to initiation of antibiotic therapy D. unforeseen interactions between the antibiotic and other prescribed medications

A. proliferation of antibiotic-resistant microorganisms

The nurse knows that superinfections are a concern for clients who have been taking oral penicillins. Which is one of the more common superinfections? A. pseudomembranous colitis B. meningococcal meningitis C. septicemia D. syphilis

A. pseudomembranous colitis

A critical care nurse is caring for a client taking aminoglycosides. The dosage may need to be adjusted if the nurse finds monitored changes in what system? A. renal function B. lung function C. intestinal function D. cardiac function

A. renal function Aminoglycosides are nephrotoxic. Renal function should be monitored to determine whether dosage should be adjusted, particularly in clients with existing renal dysfunction.

The nurse has administered a client's first scheduled dose of amoxicillin. What subsequent client report should prompt the nurse to seek the discontinuation of this drug? A. shortness of breath B. nausea C. heartburn D. frontal lobe headache

A. shortness of breath

A patient is being treated for a fungal infection with IV amphotericin B. In order to prevent drug discomfort, the nurse should consistently monitor the patient's levels of A. sodium. B. hemoglobin. C. calcium. D. leukocytes.

A. sodium.

A 45-year-old female patient is prescribed ciprofloxacin to treat a bronchial infection. A nursing assessment revealed that she started taking daily vitamin supplements about 2 years ago. To maximize the therapeutic effects of the ciprofloxacin therapy, the nurse should advise the patient to A. take the vitamins at least 2 hours before or after taking ciprofloxacin. B. alternate the dosage of ciprofloxacin and vitamin supplements. C. reduce the dosage of vitamin supplements. D. reduce the dosage of vitamin supplements and double the dosage of ciprofloxacin.

A. take the vitamins at least 2 hours before or after taking ciprofloxacin.

When the nurse is teaching a patient who is taking acyclovir for genital herpes which statement by the nurse is most accurate A. this drug will help the lesion to dry and crust over B. acyclovir will eradicate the herpes virus C. this drug will prevent the spread of this virus to others D. be sure to give this drug to your partner too

A. this drug will help the lesion to dry and crust over

The nurse is caring for a client who is receiving amikacin for the treatment of a serious Staphylococcus aureus infection. What assessment should the nurse prioritize? A. urine output and creatinine clearance B. vision assessment C. cardiac monitoring D. skin assessment and monitoring of liver enzyme levels

A. urine output and creatinine clearance Aminoglycosides such as amikacin come with a black box warning alerting healthcare professionals to the serious risk of nephrotoxicity.

A nurse is providing education about tetracycline (Sumycin). Which statement by the patient best demonstrates understanding of the administration of this medication? A."I should not take this medication with milk or other dairy products." B. "I should not worry if I experience an acnelike rash with this medication." C. "I should take an antacid, such as Tums, if I experience gastrointestinal distress." D. "I should take this antibiotic with a calcium supplement to improve absorption."

A."I should not take this medication with milk or other dairy products."

A 22-year-old college student is allergic to penicillin. Consequently, her current chlamydial infection is being treated with oral erythromycin. What assessment should the nurse prioritize during this patient's course of treatment? A. Assessment of the patient's apical heart rate B. Assessment of the patient's hearing C. Assessment of the patient's peripheral pulses D. Assessment of the patient's renal function

B. Assessment of the patient's hearing With erythromycin, it is important to assess the patient's hearing. The loss of hearing is reversible with the discontinuation of the medication. Erythromycin does not typically affect renal function or circulation. The IV form has been associated with dysrhythmias, but this is not the case with the oral form.

A client has been on an antibiotic for two weeks for treatment of an infection. The client asks the nurse why a superinfection has been caused by this medication. What is the nurse's best response? A. "Antibiotics can disrupt the normal bacteria in your body and cause them to grow out of control." B. "Antibiotics can disrupt the normal bacteria in your body, causing another infection to occur." C. "The antibiotics are only effective in killing off some of the bacteria in the body." D. "The antibiotics are only effective against some types of bacteria."

B. "Antibiotics can disrupt the normal bacteria in your body, causing another infection to occur."

Which instructions should a nurse provide to a patient who is to start taking amoxicillin/clavulanate (Augmentin)? A. "Take Augmentin once per day and only at bedtime." B. "Augmentin may be taken with food or meals." C. "Avoid taking Augmentin with grapefruit juice." D. "Use a minimal amount of liquid to swallow the Augmentin."

B. "Augmentin may be taken with food or meals." Amoxicillin/clavulanate is a broad-spectrum aminopenicillin that may be taken with meals. Most other oral penicillins must be taken with a full glass of water 1 hour before or 2 hours after meals. Taking oral penicillins only at bedtime, avoiding grapefruit juice, and taking the drug with only minimal water are not necessary.

You are preparing to discharge a patient who is taking ciprofloxacin. What guidance would you offer this patient to prevent crystalluria? A. "Limit fluids to a couple of glasses per day." B. "Drink at least 2 liters of fluids per day." C. "Take the medication as prescribed." D. "Do not take antacids."

B. "Drink at least 2 liters of fluids per day."

Which statement indicates that the client understands the mechanism of action between itraconazole and a prescribed PPI? A. "the PPI will have little or no effec ton the effectiveness of the antifungal medication." B. "I know that I will need to take my PPI 2 hours after taking itraconazole." C. "I known that I will need to take itraconazole 1 hour after taking the PPI." D. "It's the combination of these drugs that increases my risk for heart failure."

B. "I know that I will need to take my PPI 2 hours after taking itraconazole." Drugs that increase the pH of gastric acid (e.g., antacids, histamine H2 blockers, proton pump inhibitors) decrease absorption of itraconazole and should be given at least 2 hours after itraconazole

After teaching a client who is prescribed oral erythromycin, the nurse determines that the teaching was successful when the client states which of the following? A. "I need to take the medicine with a meal so I don't get an upset stomach." B. "I should drink a full 8-oz glass of water when I take the medicine." C. "I might have some bloody diarrhea after using this medicine." D. "I only need to take one pill every day for this medicine to work."

B. "I should drink a full 8-oz glass of water when I take the medicine."

A man is receiving treatment with tetracyclines for a Mycoplasma pneumoniae infection. He says that drinking orange juice hurts his mouth. What priority assessment should the nurse make? A. Assess the patient's fecal output for signs and symptoms of diarrhea. B. Assess the patient's mouth for signs of candidal infection. C. Assess the patient's lung sounds for rales or rhonchi. D. Assess the patient's intake and output.

B. Assess the patient's mouth for signs of candidal infection.

A male client develops a wound infection, and the health care provider orders once-daily intravenous multiple-dose regimens of aminoglycosides. What kinds of monitoring does the nurse expect the provider to order? A. A complete blood count every 48 hours B. Peak and trough serum levels C. A serum albumin determination every 48 hours D. Measurement of electrolytes every 48 hours

B. Peak and trough serum levels Multiple-dose regimens (conventional dosing) of aminoglycosides must be carefully monitored with evaluation of peak and trough serum levels. Once-daily regimens are monitored with random level (12-hour) serum evaluation.

A client is prescribed ciprofloxacin for a urinary tract infection. The nurse is preparing to teach the client about the medication. What must the nurse include in the education plan? A. Take a missed dose, even if close to the next dose. B. Take precautions to prevent photosensitivity. C. Avoid foods high in sodium such as processed meats. D. Take the necessary vitamins along with the drug.

B. Take precautions to prevent photosensitivity.

An 80-year-old patient with chronic renal failure is admitted to the hospital with herpes simplex. The acyclovir (Zovirax) is to be administered parenterally. When preparing to administer this medication, what would the nurse expect in regard to the dose? A. The dose is smaller due to the herpes simplex. B. The dose is smaller based on the patient's kidney function. C. The dose is higher in treating genital herpes. D. The dose is higher if the creatinine is above 4.0mg/dL.

B. The dose is smaller based on the patient's kidney function. Oral and IV acyclovir are excreted in the urine, and the dose should be decreased in patients who are older or have renal impairment. The dose is not smaller due to herpes simplex. The dose is not higher in treating genital herpes. The dose should be lower if the creatinine level is above 4.0 mg/dL.

A patient is prescribed ciprofloxacin (Cipro). Which of the following nursing interventions will best prevent crystalluria? A. The nurse should limit oral fluids to 500 mL/day. B. The nurse should administer 2000 mL of oral fluids per day. C. The nurse should insert a urinary catheter. D. The nurse should administer phenazopyridine (Pyridium).

B. The nurse should administer 2000 mL of oral fluids per day.

A client has endocarditis and is taking gentamicin. The nurse will be sure to monitor the client's: A. potassium level. B. creatinine clearance. C. serum albumin level. D. prothrombin time.

B. creatinine clearance. Gentamicin is nephrotoxic and can result in acute tubular necrosis. The nurse will need to monitor for excessive urea level in the blood, decreased creatinine clearance, loss of the ability to concentrate urine, increased white blood cell count in the urine, and cells or casts in the urine.

A patient who will begin taking trimethoprim-sulfamethoxazole (TMP-SMX) asks the nurse why the combination drug is necessary. The nurse will explain that the combination is used to A. broaden the antibacterial spectrum. B. decrease bacterial resistance. C. improve the taste. D. minimize toxic effects.

B. decrease bacterial resistance.

Once-daily aminoglycoside (ODA) dosing, also called pulse dosing or extended-interval dosing, has replaced multiple daily dosing in many patients. What is the rationale behind ODA dosing? A. Lower cost B. decreased nephrotoxicity while maintaining therapeutic efficacy C. Higher efficacy with less hepatotoxicity D. Reduction in nursing effort

B. decreased nephrotoxicity while maintaining therapeutic efficacy

The nurse caring for a patient who will receive penicillin to treat an infection asks the patient about previous drug reactions. The patient reports having had a rash when taking amoxicillin (Amoxil). The nurse will contact the provider to A. discuss giving a smaller dose of penicillin. B. discuss using erythromycin (E-mycin) instead of penicillin. C. request an order for diphenhydramine (Benadryl). D. suggest that the patient receive cefuroxime (Ceftin).

B. discuss using erythromycin (E-mycin) instead of penicillin. Erythromycin is the drug of choice when penicillin is not an option. Giving smaller doses of penicillin does not prevent hypersensitivity reactions. Benadryl is useful when a hypersensitivity reaction has occurred. A small percentage of patients allergic to penicillins may be hypersensitive to cephalosporins.

When teaching a patient who is taking nystatin lozenges for oral candidiasis, which instruction by the nurse is correct? A. chew the lozenges carefully before swallowing B. dissolve the lozenge slowly and completely in your mouth C. dissolve the lozenges until it is half the original size and then swallow it D. theses lozenges need to be swallowed whole with a glass of water

B. dissolve the lozenge slowly and completely in your mouth

While reviewing a client's medication administration record, the nurse sees that the client is receiving streptomycin. Based on this, the nurse suspects that the client most likely has what health condition? A. acute renal failure. B. drug-resistant tuberculosis C. multiple sclerosis. D. myasthenia gravis.

B. drug-resistant tuberculosis Streptomycin is used in the treatment of multidrug-resistant tuberculosis. Like other aminoglycosides, it is nephrotoxic and ototoxic and must be used very cautiously in the presence of renal impairment. The drugs must also be used with extreme caution in clients with myasthenia gravis and other neuromuscular disorders because muscle weakness may be increased.

When administering the azoles in the home setting, the home health nurse should prioritize educational interventions that address what nursing diagnosis? A) Risk for injury related to antifungal therapy B) Risk for acute confusion related to antifungal therapy C) Risk for infection related to antifungal therapy D. Risk for falls related to antifungal therapy

C) Risk for infection related to antifungal therapy

While monitoring a patient who is receiving intravenous amphotericin B, the nurse expects to see which adverse effects A. Hypertension B. Bradycardia C Fever and chills D. Diarrhea and stomach cramps

C Fever and chills

A patient is prescribed acyclovir (Zovirax) for the treatment of genital herpes. What is the expected outcome of this medication? A) Decreased testosterone production B) Decreased libido C) Decreased viral shedding D) Decreased bacterial replication

C) Decreased viral shedding

A patient has sought care from her primary care provider after feeling "under the weather" for several days. The care provider suspects that the patient is suffering from a viral illness. What signs and symptoms typically accompany viral infections? Select all that apply. A) Increased white cell count B) Idiopathic bleeding C) Malaise D) Fever E) Headache

C) Malaise D) Fever E) Headache Symptoms usually associated with acute viral infections include fever, headache, cough, malaise, muscle pain, nausea and vomiting, diarrhea, insomnia, and photophobia. White blood cell counts usually remain normal, and bleeding is uncharacteristic.

A young adult patient's acne has responded well to treatment with tetracycline. However, the patient has now returned to the clinical with signs and symptoms of oral candidiasis. The nurse should recognize that this patient's current health problem is likely attributable to which of the following? A) A delayed (type IV) hypersensitivity reaction B) The fact that the patient may have chewed the capsules prior to swallowing them C) Superinfection following the eradication of normal oral flora D. A type I hypersensitivity reaction

C) Superinfection following the eradication of normal oral flora

Which information should the nurse include in discharge teaching for a client prescribed doxycycline (Vibramycin)? A. "Keep the remainder of the medication in case of recurrence." B. "Take the medication until you have no fever and feel better." C. "Apply sunscreen or wear protective clothing when outdoors." D "Take the medication with milk to minimize gastrointestinal upset."

C. "Apply sunscreen or wear protective clothing when outdoors."

Beta-lactam antibiotics, such as penicillins and cephalosporins, fight infection by inhibiting development of the causative bacteria. What specific component development do these drugs affect? A. DNA replication B. Cell division C. Cell wall synthesis D. Protein synthesis

C. Cell wall synthesis Beta-lactam antibacterial drugs inhibit synthesis of bacterial cell walls by binding to proteins in bacterial cell membranes. This binding produces a defective cell wall that allows intracellular contents to leak out. These do no affect DNA replication or cell division.

What is the MOST important action for the nurse to complete before administration of intravenous (IV) amphotericin B? A. Assess for nausea and vomiting. B. Monitor for cardiac dysrhythmias. C. Check for premedication prescriptions. D. Monitor IV site for signs of phlebitis.

C. Check for premedication prescriptions.

The nursing student correctly identifies the class of drugs that exerts their bactericidal effect by interfering with the synthesis of bacterial DNA, thus preventing cell reproduction and leading to death of the bacteria, as which of the following groups? A. Penicillins B. Cephalosporins C. Fluoroquinolones D. Sulfonamides

C. Fluoroquinolones The fluoroquinolones exert their bactericidal effect by interfering with the synthesis of bacterial DNA. This interference prevents cell reproduction, leading to death of the bacteria. Penicillins work by inhibiting the bacterial cell activities including cell wall synthesis, DNA or RNA synthesis, and protein synthesis. The sulfonamides are bacteriostatic and work by inhibiting the activity of folic acid in bacterial cell metabolism. Finally the cephalosporins have a beta-lactam ring and target the bacterial cell wall, making it defective and unstable

When administering drugs that are potentially nephrotoxic, the nurse should consult the prescriber before administering which over-the-counter (OTC) drug(s)? A. Antacids. B. Acetaminophen. C. NSAIDS. D. Laxatives.

C. NSAIDS.

The nurse is observing a graduate nurse administering medications. The other nurse would intervene if the graduate nurse attempted to give what medication intravenously? A. Ampicillin D. Oxacillin C. Penicillin G benzathine D. Ampicillin-sulbactam

C. Penicillin G benzathine Penicillin G benzathine is for IM use and may cause death in a client if it is given IV. Ampicillin, oxacillin, and ampicillin-sulbactam may all be given IV.

The health care provider orders an aminoglycoside for a ventilator-dependent client who is admitted to the critical care unit. The client's current diagnoses include respiratory arrest, type 2 diabetes, hepatitis C, and chronic obstructive pulmonary disease. Which statement indicates the risk of using this class of medication in this client? A. Risk for hepatic impairment is significant, because the drug is metabolized in the liver. B. Risk for hepatic impairment is significant because of a higher risk for toxicity. C. Risk for hepatic impairment is not significant, because the drug is excreted through the kidneys. D. Risk for hypertensive crisis is increased.

C. Risk for hepatic impairment is not significant, because the drug is excreted through the kidneys.

A patient from a nursing home arrives at the emergency department with acute pyelonephritis. The provider prescribes ciprofloxacin 500 mg PO twice daily. The patient has a history of seizures and bradycardia. The nurse should A. counsel the patient's caregiver to avoid administering the ciprofloxacin with the patient's anticonvulsant B. ask the provider to check blood levels of the patient's anticonvulsant(s) before giving the first dose of ciprofloxacin C. call the patient's seizure and dysrhythmia history to the provider's attention and inquire whether another type of antibiotic might be selected D. counsel the patient's caregiver to discontinue the ciprofloxacin after the patient's fever is gone

C. call the patient's seizure and dysrhythmia history to the provider's attention and inquire whether another type of antibiotic might be selected

A client with a gram-negative bacterial infection has been prescribed a fluoroquinolone. During the preadministration assessment, the nurse should ensure that which laboratory tests, if prescribed, are obtained before the first dose of fluoroquinolones is administered to the client? A. renal and hepatic function tests B. complete blood count C. culture and sensitivity test D. urinalysis

C. culture and sensitivity test

A 23-year-old man who works in construction calls the clinic to report that he has a rash all over his body, his skin is red, and it feels like it is burning. The nurse suspects that he is having a photosensitivity reaction from Moxifloxacin, which was prescribed the day before. The nurse will instruct the client to: A. continue to take the drug; the rash will eventually subside. B. decrease the dosage by half until being seen by the health care provider. C. discontinue the drug immediately and return to the clinic. D. stop the drug for 3 days and then continue with the prescribed schedule.

C. discontinue the drug immediately and return to the clinic.

A patient is admitted to the critical care unit with a diagnosis of Legionnaires disease. Based on your knowledge of pharmacology, which medication is the drug of choice to treat the infection? A. azithromycin B. clarithromycin C. erythromycin D. vancomycin

C. erythromycin

A patient is admitted to the critical care unti with a diagnosis of Legionnaire's disease. Based on your knowledge of pharmacology, which medication is the drug of choice to treat the infection? A. azithromycin B. clarithromycin C. erythromycin D. vancomycin

C. erythromycin

A 54-year-old woman with a history of osteoporosis has been prescribed ciprofloxacin for recurrent cystitis. Because of the patient's history, the nurse would be sure to discuss with the woman the use of A. alcohol. B. grapefruit juice. C. food containing iron or calcium. D. nicotine.

C. food containing iron or calcium.

During an infusion of amphotericin B, the nurse knows that which administration technique may be used to minimize infusion-related adverse effects A. forcing of fluids during the infusion B. infusing the med quickly C. infusing the med over a long period of time D. stopping the infusion of 2 hours after half of the bag has infused and then resuming 1 hour later

C. infusing the med over a long period of time

A 66-year-old woman with a history of recurrent urinary tract infections has been admitted to the hospital with a diagnosis of pyelonephritis. The client began treatment 36 hours ago with intravenous gentamicin and is being monitored closely. The nurse is aware that the therapeutic effect of the client's drug regimen is primarily a result of: A. alterations in the osmolarity of bacterial cytoplasm. B. lysis of the bacterial cell walls. C. interference with bacterial reproduction. D. enhancement of the client's immune function.

C. interference with bacterial reproduction.

How will a client's newly prescribed fluconazole be affected by long-term prescribed calcium channel blocker therapy? A. it will render the fluconazole ineffective B. it will increase the risk of blood dyscrasias C. it will increase the effect of the fluconazole D. it will increase the chance of fluconazole-related adverse effects

C. it will increase the effect of the fluconazole

The nurse recognizes that what drug classification increases the risk of ototoxicity and nephrotoxicity when prescribed with gentamicin? A. benzodiazepines B. proton pump inhibitors C. loop diuretics D. tricyclic antidepressants

C. loop diuretics Loop diuretics given simultaneously with gentamicin increase the risk of nephrotoxicity by decreasing fluid volume, thereby increasing drug concentrations in serum and tissues. Loop diuretics may also contribute to ototoxicity.

A patient who has been receiving tetracycline develops watery profuse diarrhea. A stool specimen identifies the causative agent as Clostridium difficile. The nurse anticipates that the tetracycline will be discontinued and the patient started on which medication? A. erythromycin B. gentamicin C. metronidazole (Flagyl) D. TMP/SMZ (Bactrim, Septra)

C. metronidazole (Flagyl)

The client is admitted to the acute care facility with acute septicemia and has orders to receive gentamicin and ampicillin IV. The nurse is performing an admission assessment that includes a complete nursing history. What information provided by the client would indicate the need to consult the healthcare provider before administering the ordered medication? A. history of hypothyroidism B. had prostate surgery 3 months ago C. takes high-dose furosemide daily D. allergy to peanuts and peanut products

C. takes high-dose furosemide daily

A teenage patient is taking a tetracycline drug as part of treatment for severe acne. when the nurse teaches this patient about drug related precautions, which is the most important info to cover A. when the acne clears up the medication may be discontinued B. this med needs to be taken with antacids to reduce GI upset C. the patient meeds to use sunscreen or avoid exposure to sunlight, because this drug may cause photosensitivity D. the teeth sound be observed closely for signs of mottling or other color changes

C. the patient meeds to use sunscreen or avoid exposure to sunlight, because this drug may cause photosensitivity

A client with a gram-negative infection is being treated with an aminoglycoside. What assessment should the nurse prioritize during treatment? A. breath sounds and oxygen saturation B. visual acuity C. urine output and BUN and creatinine levels D. muscle strength and coordination

C. urine output and BUN and creatinine levels

The client has been taking a fluoroquinolone and now reports that he has a white patch in his mouth. What is the best response of the nurse? A. "You are allergic to the medication. Stop taking it immediately." B. "That is the medication working. Continue to take as directed." C. "You are experiencing an adverse affect of the medication. Those symptoms will decrease over time." D. "You may be experiencing an additional infection. I will discuss this with your health care provider."

D. "You may be experiencing an additional infection. I will discuss this with your health care provider." A burning sensation of the mouth or throat may be an indication of a superinfection. It is important the nurse notify the provider. The nurse should not minimize the client's concerns or cause panic.

The nurse administers cefuroxime to a client at least one hour before meals, as prescribed. However, the client experiences a GI upset. Which is an appropriate nursing intervention in this case? A. Administer an antacid. B. Lower the dosage. C. Discontinue the drug. D. Administer the drug with food.

D. Administer the drug with food.

A male client is NPO as a consequence of a cerebrovascular accident sustained 3 years ago. His care is managed at home by his wife, and he receives all medications via gastrostomy tube. The health care provider orders a fluoroquinolone for the client to treat an infection. The nurse would instruct the client's wife to administer the medication in what way? A. With the enteral feeding B. On a full stomach C. With antacids D. On an empty stomach

D. On an empty stomach

A client seeking care for the treatment of a urinary tract infection (UTI) was prescribed nitrofurantoin. What change in the client's health status would prompt the use of an alternative medication? A. The client develops a fluid volume deficit. B. Urinalysis reveals the presence of ketones. C. The client develops leukocytosis. D. The client's UTI progresses to urosepsis.

D. The client's UTI progresses to urosepsis. Urinary antiseptics may be bactericidal for sensitive organisms in the urinary tract because these drugs are concentrated in renal tubules and reach high levels in urine. They are not used in urosepsis conditions (systemic infections in the blood) because they do not attain therapeutic plasma levels. Consequently, the development of urosepsis would necessitate a systemic antibiotic. Fluid deficit, ketones in the urine, and elevated white cells would not necessarily contraindicate the use of nitrofurantoin. These conditions would be treated separately.

A patient has been diagnosed with a fungal infection and is to be treated with itraconazole (Sporanox). Prior to administration, the nurse notes that the patient is taking carbamazepine (Tegretol) for a seizure disorder. Based on this medication regime, which of the following will be true regarding the medications? A) The serum level of carbamazepine will be increased. B) The patient's carbamazepine should be discontinued. C) The patient's antiseizure medication should be changed. D. The patient will require a higher dosage of itraconazole (Sporanox).

D. The patient will require a higher dosage of itraconazole (Sporanox). Drugs that induce drug-metabolizing enzymes (e.g., carbamazepine, phenytoin, rifampin) decrease serum concentrations of itraconazole. The serum level of carbamazepine will not need to be increased. The carbamazepine should not be discontinued or changed.

A microbe acquires antibiotic resistance by which means? A. Development of medication resistance in the host B. Over-riding of the minimum bactericidal concentration C. Incorrect dosing, which contributes to ribosome mutations D. Transfer of DNA coding to other bacteria

D. Transfer of DNA coding to other bacteria

When administering amphotericin B, what drug is administered to prevent the development of chilling, fever, malaise, and nausea? A. aminophylline B. ibuprofen C. penicillin G D. aspirin

D. aspirin Aspirin is administered with amphotericin B to decrease the symptoms of chilling, fever, nausea, malaise, and generalized discomfort.

The health care provider is selecting an antibiotic for a client with a known penicillin allergy. The provider knows that cephalosporins are a poor choice for this client because cephalosporins: A. are ineffective in clients who are allergic to penicillins. B. can cause kidney damage in clients who are allergic to penicillins. C. are derived from penicillin. D. can cause allergic reactions in clients who are allergic to penicillins.

D. can cause allergic reactions in clients who are allergic to penicillins.

The health care provider is selecting an antibiotic for a client with a known penicillin allergy. The provider knows that cephalosporins are a poor choice for this client because cephalosporins: A. are ineffective in clients who are allergic to penicillins. B. can cause kidney damage in clients who are allergic to penicillins. C. are derived from penicillin. D. can cause allergic reactions in clients who are allergic to penicillins.

D. can cause allergic reactions in clients who are allergic to penicillins.

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.

D. cause fewer adverse effects.

What information should the nurse provide a client prescribed warfarin and fluconazole concurrently? A. fluconazole decreases the effects of warfarin B. drink at least five 8-ounce glasses of water daily while taking this combination C. Warfarin has no effect on fluconazole therapy D. client will require regular assessment of the effects of the fluconazole toxicity

D. client will require regular assessment of the effects of the fluconazole toxicity

A recent nursing graduate is preparing to administer vancomycin to a man intravenously. The nurse states the patient reported that he experienced flushing with his last dose of vancomycin. The nurse should A. infuse the vancomycin over 30 min to decrease the chance of reaction B. hold the vancomycin dose until the physician's rounds the following morning C. dilute the vancomycin in 50 mL of normal saline solution and infuse over 60 minutes D. contact the physician, report the reaction, and request and order for diphenhydramine pretreatment

D. contact the physician, report the reaction, and request and order for diphenhydramine pretreatment

An adult patient has been diagnosed with bacterial sinusitis, and her care provider has prescribed oral erythromycin. The nurse has cautioned the patient against taking the drug together with antacids because this practice A. delays metabolism of the drug. B. can exacerbate nausea and reflux. C. causes a dangerous rise in gastric pH. D. decreases the absorption of the drug.

D. decreases the absorption of the drug.

After teaching a group of students about the indications for use for aminoglycosides, the instructor determines that the teaching was successful when the students identify which type of infection as a primary indication? A. gram-positive infections B. fungal infections C. viral infections D. gram-negative infections

D. gram-negative infections Aminoglycosides are used primarily in the treatment of infections caused by gram-negative microorganisms. Aminoglycosides are not effective on gram-positive bacteria. Since aminoglycosides are antibacterial, they are not effective on fungal or viral infections.

A client, admitted with a systemic mycoses, is being treated with fluconazole. The nurse will determine the success of the treatment by monitoring what client assessment data? A. cognitive status B. electrolyte levels C. basophil count D. temperature

D. temperature

During patient education regarding own oral macrolide such as erythromycin the nurse will include which information? A. If GI upsets occur the drug will have to be stopped B. the drug needs to be taken with an antacid to avoid GI problems C. the patient needs to take each dose with a sip of water D. the patient may take the drug with a small snack to reduce GI irritation

D. the patient may take the drug with a small snack to reduce GI irritation

A client asks why it is necessary to receive IV fluid hydration prior to initiation of amphotericin B infusion. The nurse's best response should be based on what information concerning amphotericin B infusions? A. Renal impairment occurs in most clients within the first 2 weeks of therapy B. The risk of liver failure is high among clients receiving amphotericin B infusion therapy. C. BUN should be monitored at least weekly to assess kidney function D. the risk of nephrotoxicity can be reduced by hydrating the client pre-infusion

D. the risk of nephrotoxicity can be reduced by hydrating the client pre-infusion