Pharmacology Chapter 35

A patient has been diagnosed with tuberculosis and is prescribed Rifater (pyrazinamide with isoniazid and rifampin). While the patient is on this medication, what teaching is essential? (Select all that apply.) 1. "It is critical to continue therapy for at least 6 to 12 months." 2. "Two or more drugs are used to prevent tuberculosis bacterial resistance." 3. "These drugs may also be used to prevent tuberculosis." 4. "No special precautions are required." 5. "After 1 month of treatment, the medication will be discontinued

Ans: 1,2,3 Rationale: In order to effectively treat the TB bacterium, it is critical that the medicine be taken for 6 to 12 months and possibly as long as 24 months. Antitubercular drugs such as pyrazinamide, isoniazid (INH), and rifampin are also used for prevention and treatment of patients who convert from a negative TB test to a positive, although single drug use is most often prescribed in that situation. Multiple drug therapy is necessary because the Mycobacteria grow slowly, and resistance is common. Using multiple drugs in different combinations during the long treatment period lowers the potential for resistance and increases the chances for successful therapy. Options 4 and 5 are incorrect. Precautions to avoid adverse effects are required, and the drugs will be required much longer than 1 month.

A patient will be discharged after surgery with a prescription for penicillin. When planning at-home instructions, what will the nurse include? 1. Penicillin's can be taken while breast-feeding. 2. The entire prescription must be finished. 3. All penicillin's can be taken without regard to eating. 4. Some possible side effects include abdominal pain and constipation

Ans: 2 Rationale: Many people will discontinue medication after improvement is noted. All antibiotic regimens must be completed to prevent recurrence of infection unless allergy or significant adverse effects occur that warrant discontinuing or changing the drug used. Options 1, 3, and 4 are incorrect. Some penicillins (e.g., amoxicillin) should be taken with meals, whereas all others should be taken 1 hour before or 2 hours after meals. Penicillins should be used with caution during breast-feeding. Penicillins, along with other antibiotics, tend to cause diarrhea and not constipation.

A 32-year-old female has been started on amoxicillin (Amoxil, Trimox) for a severe UTI. Before sending her home with this prescription, the nurse will provide which instruction? 1. Teach her to wear sunscreen. 2. Ask her about oral contraceptive use and recommend an alternative method for the duration of the ampicillin course. 3. Assess for hearing loss. 4. Recommend taking the pill with some antacid to prevent gastrointestinal upset.

Ans: 2 Rationale: Penicillin antibiotics such as amoxicillin (Amoxil, Trimox) may significantly decrease the effectiveness of oral contraceptives and another method of birth control should be suggested during the time the drug is taken. Options 1, 3, and 4 are incorrect. Sun burning and hearing loss are not adverse effects commonly associated with penicillin.

What important information should be included in the patient's education regarding taking ciprofloxacin (Cipro)? 1. The drug can cause discoloration of the teeth. 2. Fluid intake should be decreased to prevent urine retention. 3. Any heel or lower leg pain should be reported immediately. 4. The drug should be taken with an antacid to reduce gastric effects.

Ans: 3 Fluoroquinolones such as ciprofloxacin (Cipro) have been associated with an increased risk of tendinitis and tendon rupture. Any heel or lower leg pain should be reported immediately for evaluation. Options 1, 2, and 4 are incorrect. Ciprofloxacin will not cause discoloration of the teeth, and fluids should be encouraged during use of the drug. Taking antacids concurrently with ciprofloxacin may significantly impair absorption of the drug.

What is the action of bactericidal drugs? 1. They disrupt normal cell function. 2. They will slow the growth of the bacteria. 3. They have a high potency. 4. They will kill the bacteria.

Ans: 4 Rationale 1: They do not disrupt normal cell function. Rationale 2: Bacteriostatic drugs slow the growth of bacteria. Rationale 3: Potency is related to the properties of resistance. Rationale 4: Bactericidal drugs kill the bacteria.

Superinfections are an adverse effect common to all antibiotic therapy. Which of the following best describes a superinfection? 1. An initial infection so overwhelming that it requires multiple antimicrobial drugs to treat successfully 2. Bacterial resistance that creates infections that are difficult to treat and are often resistant to multiple drugs 3. Infections requiring high-dose antimicrobial therapy with increased chance of organ toxicity 4. The overgrowth of normal body flora or of opportunistic organisms such as viruses and yeast no longer held in check by normal, beneficial flora

Ans: 4 Rationale: When normal host flora are de- creased or killed by antibacterial therapy, opportunistic organisms such as viral and fungal infections may occur. Options 1, 2, and 3 are incorrect. Bacterial resistance and organ toxicity may be adverse drug effects of anti- bacterial therapy but do not describe superinfections. The use of multiple antibiotics for severe infections is a therapeutic use of the drugs.

A patient has been prescribed tetracycline. When providing information regarding this drug, the nurse should include what information about tetracycline? 1. It is classifed as a narrow-spectrum antibiotic with minimal adverse effects. 2. It is used to treat a wide variety of disease processes. 3. It has been identifed to be safe during pregnancy. 4. It is contraindicated in children younger than 8 years.

Ans: 4 Tetracycline has the ability to cause permanent mottling and discoloration of teeth and there- fore is not advised for children younger than 8 years of age. Options 1, 2, and 3 are incorrect. Tetracyclines have one of the broadest spectrums of the antibiotics, and all antibiotics have significant adverse effects. Tetracycline is contraindicated in pregnancy.

The client receives gentamicin (Garamycin) intravenously (IV) in the clinical setting. What is a priority nursing action? 1. Monitor the client for hearing loss. 2. Draw daily blood chemistries. 3. Decrease the fluids for the client during therapy. 4. Place the client on isolation precautions.

Correct Answer: 1 Rationale 1: Aminoglycosides are ototoxic drugs, and the client should be monitored for hearing loss. Rationale 2: Serum levels of the drug are indicated, but not blood chemistries. Rationale 3: Decreasing fluids during therapy is not indicated. Rationale 4: Isolation is determined by the causative organism, not the drug used for treatment.

Which laboratory tests will be performed to determine whether a specific bacterium is resistant to a specific drug? 1. Culture and sensitivity test 2. Complete blood count 3. Blood urea nitrogen 4. Urinalysis

Correct Answer: 1 Rationale 1: Culture and sensitivity is the examination for a specific organism and can determine the correct medication. Rationale 2: Complete blood count would not determine the specific drug for the specific organism. Rationale 3: Blood urea nitrogen would not determine the specific drug for the specific organism. Rationale 4: Urinalysis would not determine the specific drug for the specific organism.

Following surgery, a client is placed on cefotaxime (Claforan). The assessment for possible adverse effects should include observing for 1. diarrhea. 2. headache. 3. constipation. 4. tachycardia.

Correct Answer: 1 Rationale 1: Diarrhea is a frequent adverse effect of cephalosporins. Rationale 2: Headache is not an adverse effect. Rationale 3: Diarrhea, not constipation, is a common problem. Rationale 4: Tachycardia is not an adverse effect.

The client is prescribed amoxicillin (Amoxil) for 10 days to treat strep throat. After 5 days, the client tells the nurse he plans to stop the medication because he feels better. What is the best response by the nurse? 1. "If you stop the medicine early, you have not effectively killed out the bacteria making you sick." 2. "You should get another throat culture if your symptoms return." 3. "If you stop the medicine early, this could result in resistance to the antibiotic." 4. "You should get another throat culture to see if the infection is gone."

Correct Answer: 1 Rationale 1: If all the medication is not taken, there is a strong possibility that not all bacteria have been eliminated. Rationale 2: Another throat culture is inappropriate; the client must finish the medication. Rationale 3: Stopping the medicine early can result in resistance to the antibiotic, but the client may not care about this unless he can see how it directly affects him. Rationale 4: Another throat culture is inappropriate; the client must finish the medication.

Treatment of tuberculosis usually involves 1. the use of two or more drugs at the same time. 2. surgical removal of tubercular lesions. 3. keeping the client hospitalized. 4. the use of a single drug.

Correct Answer: 1 Rationale 1: Multidrug therapy for 6-12 months is the usual pharmacotherapy for tuberculosis. Rationale 2: Surgery is not the treatment. Rationale 3: It is not necessary to keep the client in the hospital. Rationale 4: Use of a single drug is not usual.

The client tells the nurse that the doctor told him his antibiotic did not kill his infection but just slowed its growth. The client is anxious. What is the best response by the nurse to decrease the client's anxiety? 1. "This is okay because your body will help kill the infection too." 2. "This is okay because your doctor is an infectious disease specialist." 3. "This is okay because your blood work is being monitored daily." 4. "This is okay because your infection is not really that serious."

Correct Answer: 1 Rationale 1: Some drugs do not kill the bacteria but instead slow their growth and depend on the body's natural defenses to dispose of the microorganisms. These drugs, which slow the growth of bacteria, are called bacteriostatic. Rationale 2: Telling the client that the doctor is a specialist does not answer the question and will increase anxiety. Rationale 3: Telling the client that his blood work is being monitored does not answer the question and will increase anxiety. Rationale 4: Telling a client with an infection that the infection is not serious will increase anxiety because, to the client, all infections are serious.

Pathogenicity is different than virulence in that pathogenicity can 1. lead to the ability of organisms to cause infection. 2. kill pathogens. 3. cause a disease when pathogens are present. 4. disrupt cell lining.

Correct Answer: 1 Rationale 1: The ability of an organism to cause infection is its pathogenicity. Rationale 2: Medications that can kill bacteria are called bacteriocidal. Rationale 3: A highly virulent microbe is one that can produce disease when present in minute numbers. Rationale 4: Cell lining is not disrupted in this process.

The client has MRSA and receives vancomycin (Vancocin) intravenously (IV). The nurse assesses an upper body rash and decreased urine output. What is the nurse's priority action? 1. Hold the next dose of vancomycin (Vancocin) and notify the physician. 2. Obtain a stat X-ray and notify the physician. 3. Administer an antihistamine and notify the physician. 4. Obtain a sterile urine specimen and notify the physician.

Correct Answer: 1 Rationale 1: Upper body rash and decreased urine output are most likely symptoms of vancomycin (Vancocin) toxicity, so the medication should be held and the physician notified. Rationale 2: There is no reason to obtain a chest x-ray. Rationale 3: The nurse should collaborate with the physician regarding medications for treatment of this situation. Rationale 4: The client's symptoms are most likely not due to a urinary tract infection, so a sterile urine specimen is not indicated.

The nurse is providing community education regarding ways to reduce development of antibiotic resistance. Which information should be included? Select all that apply. 1. The best way to prevent antibiotic resistance is to prevent infections from occurring. 2. Do not expect to receive an antibiotic prescription for colds and influenza. 3. Take the full amount of any prescribed medication. 4. Go to the doctor as soon as you feel ill. 5. Use good infection control measures.

Correct Answer: 1,2,3,5 Rationale 1: It is much easier to prevent infection than it is to treat an infection. Rationale 2: It is not necessary to treat every respiratory illness with antibiotics. Most are viral and do not respond to antibiotics. Rationale 3: Stopping antibiotic therapy prematurely allows some pathogens to survive. The ones that survive are the strongest pathogens. Rationale 4: Not all illnesses require physician intervention. Rationale 5: Preventing transmission of illnesses is essential.

A patient has been prescribed ciprofloxacin (Cipro) for a severe sinus infection. The nurse evaluates that medication education has been effective when the patient makes which statements? Select all that apply. 1. "I should avoid milk while taking this medication." 2. "I should avoid coffee while taking this medication." 3. "If this medication upsets my stomach, I can take it with an antacid." 4. "I may have some diarrhea while taking this medication." 5. "If my stomach gets upset, I should take this medication with food."

Correct Answer: 1,2,4,5 Rationale 1: Dairy products can decrease the absorption of ciprofloxacin. Rationale 2: Ciprofloxacin can increase serum levels of caffeine. Rationale 3: Antacids can diminish drug absorption. Rationale 4: Diarrhea can occur while taking ciprofloxacin. Rationale 5: Ciprofloxacin may be administered with food to diminish adverse GI effects.

16-year-old patient is admitted to the emergency room after attempting to commit suicide by overdosing on the isoniazid (INH) prescribed for newly diagnosed tuberculosis. What information does the nurse provide to the family? Select all that apply. 1. INH overdose is very serious. 2. Large amounts of intravenous lipids will be administered. 3. Treatment will include infusion of vitamin B6. 4. Liver damage may occur. 5. Oral aspirin will be given as an antidote.

Correct Answer: 1,3,4 Rationale 1: INH is very serious and may be fatal. Rationale 2: There is no indication for large amounts of intravenous lipids. Rationale 3: Treatment includes infusion of vitamin B6. Rationale 4: INH may damage the liver, even in recommended dosages. Rationale 5: Oral aspirin is not the antidote for INH overdose.

Discharge planning for the client prescribed tetracycline will include which instruction? 1. Take the medication with antacids. 2. Take the medication with iron supplements. 3. Do not take the medication with milk. 4. Decrease the amount of vitamins.

Correct Answer: 3 Rationale 1: Antacids can decrease the effectiveness of tetracycline. Rationale 2: Iron can decrease the effectiveness of tetracycline. Rationale 3: Tetracycline effectiveness can be decreased by using milk products. Rationale 4: It is not necessary to decrease vitamins.

The nurse plans to teach the client with acquired immune deficiency syndrome (AIDS) about bacterial infections. Which information should the nurse include in this teaching? Select all that apply. 1. "If just a few bacteria make you sick, this is virulence." 2. "Most bacteria have developed antibiotic resistance." 3. "Pathogens are divided into two classes, bacteria and viruses." 4. "Pathogenicity means the bacteria can cause an infection." 5. "Actually, most bacteria will not harm us."

Correct Answer: 1,4,5 Rationale 1: A highly virulent microbe is one that can produce disease when present in minute numbers. Rationale 2: Antibiotic resistance is a problem; however, only a few, not most, bacteria have developed it. Rationale 3: Human pathogens include viruses, bacteria, fungi, unicellular organisms, and multicellular animals. Rationale 4: The ability of an organism to cause infection is called pathogenicity. Rationale 5: Only a few dozen pathogens commonly cause disease in humans; most are harmless.

The client receives multiple antibiotics to treat a serious infection. What will the priority assessment of the client by the nurse include? 1. Assessing blood cultures for the presence of bacteria 2. Assessing changes in stool, white patches in the mouth, and urogenital itching or rash 3. Assessing renal and liver function tests 4. Assessing whether or not the client has adequate food and fluid intake

Correct Answer: 2 Rationale 1: Assessing blood cultures is important, but not as important as assessing for superinfections. Rationale 2: A superinfection occurs when microorganisms normally present in the body, host flora, are destroyed by antibiotic therapy. A superinfection can be lethal and should be suspected if a new infection appears while the client is receiving antibiotics. Signs of superinfection commonly include diarrhea, white patches in the mouth, urogenital itching, and presence of a blistering itchy rash. Rationale 3: Assessing renal and liver function tests is very important but not as important as assessing for superinfections. Rationale 4: Assessing food and fluid intake is very important but not as important as assessing for superinfections.

The physician orders cefepime (Maxipime) for a client. What is a priority question for the nurse to ask the client prior to administration of this drug? 1. "Are you breastfeeding?" 2. "Are you pregnant?" 3. "Are you allergic to penicillin?" 4. "Are you allergic to tetracycline?"

Correct Answer: 3 Rationale 1: Cefepime (Maxipime) is a Pregnancy Category B drug and is safe to use while breastfeeding. Rationale 2: Cefepime (Maxipime) is a Pregnancy Category B drug and is safe for use during pregnancy. Rationale 3: Cephalosporins are contraindicated in clients who have experienced a severe allergic reaction to penicillin. Rationale 4: Cephalosporins are not contraindicated in clients who have experienced an allergic reaction to tetracycline.

The client receives multiple drugs for treatment of tuberculosis. The nurse teaches the client the rationale for multiple drug treatment and evaluates learning as effective when the client makes which statement? 1. "Current research indicates that the most effective way to treat tuberculosis is with multiple drugs." 2. "Multiple drugs are necessary because the bacteria are likely to develop resistance to just one drug." 3. "Treatment for tuberculosis is complex, and multiple drugs must be continued for as long as I am contagious." 4. "Multiple drug treatment is necessary for me to be able to develop immunity to tuberculosis."

Correct Answer: 2 Rationale 1: Current research does support multiple drug treatment, but this does not explain the rationale for this to the client. Rationale 2: Tuberculosis bacilli are likely to develop resistance to one drug, so multiple drugs must be used. Rationale 3: Treatment must be continued long after the client is no longer contagious. Rationale 4: Clients cannot develop immunity to bacterial infections.

The nurse works in infection control and teaches a class to staff nurses about the ways that resistance to antibiotics can occur. The nurse evaluates that learning has occurred when the nurses make which statement? 1. "Resistance to antibiotics most often occurs when physicians prescribe too many of them for elderly clients." 2. "Resistance to antibiotics can occur by the common use of them for nosocomial infections." 3. "Resistance to antibiotics most often occurs when physicians prescribe too many of them for children with ear infections." 4. "Resistance to antibiotics can occur by the prophylactic use of them for preoperative clients."

Correct Answer: 2 Rationale 1: The use of antibiotics by physicians with elderly clients is not the major cause of antibiotic resistance. Rationale 2: The organisms that cause nosocomial infections have most likely been treated with antibiotics and are the most likely organisms to develop resistance to antibiotics. Rationale 3: The use of antibiotics by physicians for children with ear infections is not the primary cause of antibiotic resistance. Rationale 4: The prophylactic use of antibiotics does not promote antibiotic resistance.

A client has been prescribed trimethoprim-sulfamethoxazole (Septra) for treatment of a urinary tract infection. Which comments, made by the client, would the nurse discuss with the prescriber before allowing the client to leave the clinic? Select all that apply. 1. "My husband and I plan to start a family as soon as possible." 2. "I forgot to take my potassium supplement today." 3. "Is it okay to take this with my warfarin?" 4. "It is so cloudy today." 5. "My 80-year-old mother is coming to visit today."

Correct Answer: 2,3 Rationale 1: Sulfa drugs are contraindicated for use by women at term. Rationale 2: Potassium supplements should not be taken during therapy unless directed by the health care provider. Rationale 3: Sulfa drugs may enhance the effects of oral anticoagulants. Rationale 4: Sulfa drugs can result in photosensitivity. Rationale 5: There is no reason this visit should be of concern regarding the medication prescribed.

The drug that would most likely be used in the treatment of tuberculosis is 1. Erythromycin (E-mycin). 2. Vancomycin (Vancocin). 3. Isoniazid (INH). 4. Gentamicin (Garamycin).

Correct Answer: 3 Rationale 1: Erythromycin is most effective against gram-positive bacteria. Rationale 2: Vancomycin is used for bactericidal reasons. Rationale 3: Isoniazid (INH) is the drug of choice for anti-tuberculosis therapy. Rationale 4: Gentamicin is used for bactericidal reasons.

A client who has diabetes mellitus is diagnosed with tuberculosis and has been prescribed multiple-drug therapy. What instruction should the nurse provide to this client? Select all that apply. 1. These medications can cause hypoglycemia, so you should always carry a sugar source. 2. Test your blood glucose more frequently while on these medications. 3. If your blood glucose levels elevate consistently, contact us. 4. Take your medication for diabetes at least 6 hours after taking these medications. 5. While on these medications, you will be more prone to infections in your feet.

Correct Answer: 2,3 Rationale 1: The medication regimen is more likely to cause hyperglycemia. Rationale 2: These medications may cause hyperglycemia. The client should monitor blood glucose levels more closely. Rationale 3: Constant elevation of blood glucose levels may warrant alteration in medication therapy for diabetes. Rationale 4: There is no reason to separate the administration of these medications by 6 hours. Rationale 5: There is no evidence that medications used to treat tuberculosis will increase the likelihood of infections in the feet.

The client is to receive an injection of penicillin G benzathine (Bicillin LA) in the outpatient clinic. What are the priority nursing actions prior to administering this injection? Select all that apply. 1. Have the client lie down and assess vital signs before she leaves. 2. Ask the client if she has ever had an allergy to penicillin before. 3. Inform the client that she will need to wait 30 minutes before leaving the clinic. 4. Inform the client that she must have someone drive her home. 5. Advise the client to rest for the remainder of the day.

Correct Answer: 2,3 Rationale 1: There is no reason to have the client lie down. It is not important to assess vital signs unless a problem has developed. Rationale 2: It is always important to ask about allergies. The nurse must be aware, however, that no history of allergy does not guarantee there will not be an allergic response with this administration. Rationale 3: It is important that the client be reassessed for development of allergic reaction before leaving the clinic. Rationale 4: There is no indication that the client will require someone else to drive her home. Rationale 5: There is no specific reason the client should rest related to administration of penicillin.

A patient has recurrent skin infections. The nurse anticipates administering an aminopenicillin such as which drug? Select all that apply. 1. Oxacillin 2. Ampicillin 3. Piperacillin 4. Amoxicillin 5. Dicloxacillin

Correct Answer: 2,4 Rationale 1: Oxacillin is a penicillinase-resistant penicillin. Rationale 2: Ampicillin is a broad-spectrum or aminopenicillin. Rationale 3: Piperacillin is an extended-spectrum penicillin. Rationale 4: Amoxicillin is a broad-spectrum or aminopenicillin. Rationale 5: Dicloxacillin is a penicillinase-resistant penicillin.

A client receiving chemotherapy has a very low white blood cell count. Antibiotic therapy is initiated. What rationales should the nurse provide for the addition of this drug? Select all that apply. 1. You have an infection. 2. We would like to prevent you from developing any infections. 3. Chemotherapy often causes infections. 4. This antibiotic will help your chemotherapy fight off your cancer. 5. If you are developing an infection, this medication will help kill it out early.

Correct Answer: 2,5 Rationale 1: There is no evidence of infection being present. Rationale 2: Antibiotics are given to those with low WBCs to help prevent or lessen infections. Rationale 3: The chemotherapy does not cause an infection, but does decrease immunity, allowing infection to occur. Rationale 4: This antibiotic is not being given to kill cancer cells. Rationale 5: Prophylactic antibiotics are given to kill bacteria while their numbers are small.

A client has been diagnosed with multidrug-resistant tuberculosis, and drug therapy has been initiated. The nurse evaluates that medication education has been effective when the patient says, "I can expect to take this medication for up to _____ months." Record your answer rounding to the nearest whole number

Correct Answer: 24 Rationale: Tuberculosis treatment requires long-term antibiotic therapy for up to 12 months. When the tuberculosis is multidrug-resistant, treatment may extend up to 24 months.

The student nurse asks the nursing instructor for help with her microbiology class. The student is studying bacteria. What does the best instruction by the nursing instructor include? Select all that apply. 1. Bacteria are either aerobic or anaerobic. 2. Bacteria are multicellular organisms. 3. E. coli are gram-negative bacteria. 4. Gram-staining is one way to identify bacteria. 5. Spherical-shaped bacteria are called cocci.

Correct Answer: 3,4,5 Rationale 1: Some organisms have the ability to change their metabolism and survive in either aerobic or anaerobic conditions. Rationale 2: Bacteria are single-celled organisms. Rationale 3: E. coli are gram-negative bacteria. Rationale 4: Gram-staining is one way to identify bacteria. Rationale 5: Spherical-shaped bacteria are called cocci.

The nurse is caring for a client receiving gentamicin IV. The nurse would observe for adverse effects of 1. diarrhea. 2. bleeding 3. increased urinary output. 4. ototoxicity.

Correct Answer: 4 Rationale 1: Diarrhea is not a common adverse effect of gentamicin. Rationale 2: Bleeding is not a common adverse effect. Rationale 3: Increased urinary output is not an adverse effect. Rationale 4: Ototoxicity is an adverse effect that could occur while receiving gentamicin. This could become permanent with continued use.

A client comes to the emergency department complaining of a sore throat. He has white patches on his tonsils, and he has swollen cervical lymph nodes. What will the best plan by the nurse include? 1. Plan to administer a narrow-spectrum antibiotic. 2. Plan to administer a broad-spectrum antibiotic. 3. Plan to obtain blood cultures. 4. Plan to obtain a throat culture

Correct Answer: 4 Rationale 1: Initial therapy with a narrow-spectrum antibiotic is too specific without knowing the causative organism. Rationale 2: A broad-spectrum antibiotic is commonly ordered, but a throat culture should be obtained first. Rationale 3: Blood cultures are not necessary at this point because the infection is in the throat; it is not systemic. Rationale 4: A throat culture is necessary to identify the causative organism and initiate the best antibiotic treatment.

A client comes to the emergency department with a fever of 104°F. The nurse anticipates which actions to help identify the correct antibiotic? 1. Obtaining liver and renal function tests. 2. Obtaining a complete blood count (CBC) test. 3. Obtaining a sterile urine specimen. 4. Obtaining blood for culture and sensitivity.

Correct Answer: 4 Rationale 1: Liver and renal function tests will not identify the causative organism. Rationale 2: The CBC will reveal the impact of infective agents on the immune system but will not identify the agent. Rationale 3: Obtaining a urine specimen is not the best method of determining this client's infective agent. Rationale 4: A high fever is usually indicative of a systemic infection. Blood cultures are the best way of identifying the causative organism.

The physician orders penicillin for a female client who has a sinus infection. What is a priority question to ask the client prior to administering the medication? 1. "Are you pregnant?" 2. "Do you plan to become pregnant?" 3. "Are you breastfeeding?" 4. "Are you taking birth control pills?"

Correct Answer: 4 Rationale 1: Penicillin is a Pregnancy Category B drug and is safe to take if a client is pregnant. Rationale 2: Penicillin is a Pregnancy Category B drug and is safe to take if a client plans to become pregnant. Rationale 3: Penicillin is a Pregnancy Category B drug and is safe to take if a client is breastfeeding. Rationale 4: Penicillin can cause birth control pills to lose their effectiveness.