Pathopharmacology I Quiz 12a

A patient is prescribed an antibiotic to treat a urinary tract infection. What statement by the patient indicates a need for further teaching? A. "I can stop the medication as soon as the symptoms have disappeared." B. "I will drink more fluids to help clear up the infection." C. "I will stop the medication and contat the doctor if I develop a rash." D. "I should immediately report vaginal itching or discharge."

A. "I can stop the medication as soon as the symptoms have disappeared." Patients should be taught not to discontinue antibiotics prematurely, but rather to complete the entire course of therapy, even if symptoms improve or resolve. The other responses are appropriate.

Which statement about allergic reactions to penicillin does the nurse identify as true? A. Anaphylactic reaction occur more frequently with penicillins than with any other drug. B. Allergy to penicillin always increases over time. C. Diphenhydramine [Benadryl] is the drug of choice for anaphylaxis due to penicillin allergy, D. Patient allergic to penicillin are also allergic to vancomyci.

A. Anaphylactic reaction occur more frequently with penicillins than with any other drug. Allergy to penicillin can decrease over time. Epinephrine is the drug of choice for anaphylaxis. Vancomycin, erythromycin, and clindamycin are effective and safe alternatives for patients with penicillin allergy.

Which patient should receive prophylactic antibiotic therapy? A. A patient who is to have their teeth cleaned. B. A patient who is scheduled for a hysterectomy. C. A patient with a white blood cell count of 8000 cells/mm3. D. A patient with a high fever without an identifiable cause.

B. A patient who is scheduled for a hysterectomy. may have a decreased incidence of infection if antibiotics are administered before or during surgery. Use of prophylactic antibiotics are not indicated for the other conditions.

A patient with a history of a severe anaphylactic reaction to penicillin has an order to receive cephalosporin. What should the nurse do? A. Administer the cephalosporin as ordered. B. Contact the health care provider for a different antibiotic. C. Administer a test dose of cephalosporin to determine reactivity. D. Have an epinephrine dose available when administering the cephalosporin.

B. Contact the health care provider for a different antibiotic. Patients with a history of severe anaphylactic reaction to penicillin will have the same reaction to cephalosporin as both antibiotics are from the beta-lactam family. Only patients with a history of a MILD reaction can be given cephalosporin.

Before administering gentamycin, it is most important for the nurse to assess the patient for a history of what? A. Hypertension B. Myasthenia gravis C. Diabetes mellitus D. Asthma

B. Myasthenia gravis Rationale: Aminoglycosides must be used with caution in patients with renal impairment, pre-existing hearing impairment, and myasthenia gravis, and in patients receiving ototoxic drugs (especially ethacrynic acid), nephrotoxic drugs (eg, amphotericin B, cephalosporins, vancomycin, cyclosporine, nonsteroidal anti-inflammatory drugs [NSAIDs]), and neuromuscular blocking agents.

Which statement about superinfections does the nurse identify as true? A. Superinfections are more common in patient treated with narrow-spectrum drugs. B. Superinfection is defined as a new infection that appears during the course of treatment for a primary infection. C. Superinfections are caused by viruses. D. Superinfections are easy to treat.

B. Superinfection is defined as a new infection that appears during the course of treatment for a primary infection. Because broad-spectrum antibiotics kill off more normal flora than do narrow-spectrum drugs, superinfections are more likely in patients receiving broad-spectrum agents. Suprainfections are caused by drug-resistant microbes. These infections are often difficult to treat.

A patient who takes warfarin has been prescribed sulfadiazine. When teaching the patient about this drug, which statement will the nurse include? A. "If you become pregnant, it is safe to take sulfadiazine." B. "You should limit your fluid intake while taking sulfadiazine." C. "Avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin." D. "You will most likely need to have an increase in the dose of warfarin while taking sulfadiazine."

C. "Avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin." Sulfonamides can cause photosensitivity

A patient is prescribed doxycycline [Vibramycin]. If the patient complains of gastric irritation, what should the nurse do? A. Instruct the patient to take the medication with milk B. Tell the patient to take an antacid with the medication. C. Give the patient food, such as crackers or toast, with the medication. D. Have the patient stop the medication immediately and contact the health care provider.

C. Give the patient food, such as crackers or toast, with the medication. Tetracyclines form insoluble chelates with calcium, iron, magnesium, aluminum, and zinc; absorption is decreased.

A patient is prescribed cefazolin. It is most important for the nurse to teach the patient to avoid which substance while taking cefazolin? A. Warfarin B. Milk products C. Digioxin D. Alcohol

D. Alcohol Rationale: Cefazolin and cefotetan can cause alcohol intolerance. A serious disulfiram-like reaction may occur if alcohol is consumed. Inform patients about alcohol intolerance and warn them not to drink alcoholic beverages.

The nurse is caring for a patient receiving intravenous gentamicin for a severe bacterial infection. Which assessment finding by the nurse indicates the patient is experiencing an adverse effect of gentamycin therapy? A. Blurred vision B. Hand tremors C. Urinary frequency D. Tinnitus

D. Tinnitus Rationale: Ototoxicity can result from the accumulation of the drug in the inner ear. Early signs that should be reported include tinnitus or headache. Other major adverse effects include nephrotoxicity and neuromuscular blockade.

A nurse is discussing methicillin-resistant S. aureus (MRSA) with a group of nursing students. Which statement by a student correctly identifies the basis for MRSA resistance? a) MRSA bacteria have developed PBPs with a low affinity for penicillins b) MRSA bacteria produce penicillinases that render penicillin ineffective c) MRSA occurs because of host resistance to penicillins d) MRSA strains replicate faster than other S. aureus strains

a) MRSA bacteria have developed PBPs with a low affinity for penicillins

A nurse is teaching a nursing student what is meant by "Generations" of cephalosporins. Which statement by the student indicates an understanding of the teaching? a) Cephalosporins and assigned to generations based on their relative costs to administer b) Cephalosporins have increased activity against gram-negative Bactria with each generation c) First-generation cephalosporins have better penetration of the cerebrospinal fluid d) Later generations of cephalosporins have lower resistance to destruction by beta-lactamases

b) Cephalosporins have increased activity against gram-negative Bactria with each generation With each progression from first-generation agents to fourth-generation agents, the cephalosporins show increased activity against gram-negative organisms, increased resistance to destruction by beta-lactamases, and increased ability to reach the CSF. Cost is not a definitive factor. First-generation drugs have less penetration of the CSF. Resistance to destruction by beta-lactamases increases with increasing generations.

A woman complains of burning on urination and increased frequency. The patient has a history of frequent urinary tract infections (UTIs) and is going out of town in 2 days. To treat the infection quickly, the nurse would expect the healthcare provider to prescribe a) Aztreonam [Azactam] b) Fosfomycin [Monurol] c) Trimethoprim/Sulfamethoxazole [Bactrim] d) Vancomycin [Vancocin]

b) Fosfomycin [Monurol]

The nurse is teaching a nursing student about the mechanism by which antimicrobial agents achieve selective toxicity. Which statement by the student indicates a need for further teaching? a) Some agents disrupt the bacterial cell wall b) Some agent act to block the conversion of para-aminobenzoic acid (PABA) to folic acid c) Some agents cause phagocytosis of bacterial cells d) Some agents weaken the cell wall causing cell wall lysis

b) Some agent act to block the conversion of para-aminobenzoic acid (PABA) to folic acid

The nurse is caring for a patient on a medical-surgical unit who has a fever of unknown origin. The prescriber has ordered a broad-spectrum antibiotic. Which intervention is the priority? a) Administering the antibiotic immediately b) Administering antipyretics as soon as possible c) Delaying administration of the antibiotics until the culture results are available d) Obtaining all cultures before the antibiotics is administered

d) Obtaining all cultures before the antibiotics are administered It is essential that samples of exudates and body fluids (in this case, blood cultures) be obtained for culture before initiation of treatment. Administration of the antibiotic is important but not more important than obtaining specimens for culture. Antipyretics may be indicated, but the priority is obtaining specimens for culture. Treatment may be initiated before the test results are available.

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. What describes oral thrush? a. Antibiotic resistance b. Community-acquired infection c. Nosocomial infection d. Superinfection

d. Superinfection Oral thrush is a manifestation of a superinfection. The development of thrush is not a symptom of antibiotic resistance. Oral thrush typically is not a community-acquired infection. The development of thrush is not a nosocomial infection.