Pharmacology II - Week 3 Infection Quiz
A nurse in a provider's office receives a call from a client who has been taking penicillin V three times daily and reports abdominal cramping with bloody diarrhea for several days. Which of the following instructions should the nurse give the client? "Bring in a stool sample for testing." "Take the drug only twice daily." "Use an over-the-counter anti-diarrheal medication." "Return to the clinic for blood work."
"Bring in a stool sample for testing." Abdominal cramping and bloody diarrhea can be caused by an overgrowth of the organism Clostridium difficile. The client should bring a stool sample in to be tested for the presence of this organism. The nurse should not make changes to the client's prescription. The provider will likely have the client stop the drug and prescribe a different antibiotic. Clients should not self-treat diarrhea with over-the-counter drugs until the cause of the abdominal distress and diarrhea has been determined. Blood work is not indicated for the client's reported symptoms.
A nurse is preparing to administer amphotericin B IV to a client who has a systemic fungal infection. Which of the following drugs should the nurse prepare to administer prior to the infusion to prevent or minimize adverse reactions? (Select all that apply.) Aspirin Hydrocortisone Acetaminophen Diphenhydramine Ibuprofen
Aspirin is incorrect. Infusion reactions to IV amphotericin B include fever, chills, nausea, and headache. Although aspirin, an NSAID, can help for these symptoms, it also increases the client's risk for renal injury because aspirin is nephrotoxic and is therefore not an appropriate drug to prevent or minimize adverse reactions. Hydrocortisone is incorrect. Although a hydrocortisone, a glucocorticoid, can reduce fever and chills, it can also decrease the client's resistance to infection and is therefore not an appropriate drug to prevent or minimize adverse reactions. Acetaminophen is correct. Infusion reactions to amphotericin B IV, such as fever, chills, nausea, and headache, start 1 to 2 hr after the infusion begins and subside within 4 hr. The nurse can help prevent these effects by administering acetaminophen prior to the infusion. Diphenhydramine is correct. The nurse can help prevent adverse reactions by administering diphenhydramine prior to the infusion. Ibuprofen is incorrect. Although ibuprofen, an NSAID, can help prevent adverse reactions, it also increases the client's risk for renal injury because ibuprofen is nephrotoxic and is therefore not an appropriate drug to prevent or minimize adverse reactions.
A nurse is caring for a client who has streptococcal pharyngitis and an allergy to penicillin. The nurse should recognize that which of the following drugs can be safely administered to this client? Nafcillin Azithromycin Cephalexin Amoxicillin/clavulanic acid
Azithromycin Azithromycin, a macrolide, is an acceptable alternative to penicillin for patients who have bacterial infections and are allergic to penicillin. The medication is effective against many gram-positive and gram-negative bacteria and is used for streptococcal pharyngitis. Nafcillin is a penicillin and is therefore contraindicated for clients who are allergic to penicillin. Vancomycin and clindamycin are safer alternatives. A small percentage of clients who are allergic to penicillin have a cross sensitivity to cephalosporins. Cephalexin is a cephalosporin and is an inappropriate choice for the client. Amoxicillin is a penicillin and is therefore contraindicated for clients who are allergic to penicillin. Vancomycin and clindamycin are safer alternatives.
A nurse is caring for a client who has a new prescription for acyclovir to treat a herpes simplex infection. Which of the following laboratory values should the nurse monitor for this client? Prothrombin time Hct BUN Aspartate aminotransferase
BUN Acyclovir, an antiviral drug, can cause renal toxicity due to drug accumulation in renal tubules. The nurse should monitor the client's urine output, BUN, and creatinine levels, and increase fluid intake to hydrate and flush the kidneys. Acyclovir, an antiviral drug, is unlikely to alter prothrombin times. Cefotetan, a second-generation cephalosporin, is an antimicrobial drug that can cause thrombocytopenia and prolonged bleeding times. Acyclovir, an antiviral drug, is unlikely to alter the client's hematocrit level. Amphotericin B is an antimicrobial drug that can cause anemia due to RBC suppression. Acyclovir, an antiviral drug, is excreted by the kidneys and is unlikely to alter liver function tests. Ketoconazole is an antimicrobial drug that can cause liver toxicity and requires monitoring of liver function.
A nurse is caring for a client who is taking warfarin and has a new prescription for trimethoprim/sulfamethoxazole to treat a urinary tract infection. The nurse should clarify the prescriptions with the provider because taking these two drugs concurrently can increase the client's risk for which of the following? Bleeding Thrombosis ECG changes Ototoxicity
Bleeding Trimethoprim/sulfamethoxazole, a sulfonamide combination, can increase the effects of warfarin and increase the client's risk for bleeding. The nurse should request another prescription to treat the infection, or, if the client decides to take the drug, ask the provider to prescribe a lower warfarin dose and monitor prothrombin time carefully. The client should report any sign of bleeding, such as easy or unexplained bruising. A drug interaction between warfarin and trimethoprim/sulfamethoxazole, a sulfonamide combination, is unlikely to increase the client's risk of thrombosis. Rifampin is an antimicrobial drug that decreases warfarin levels and increases the risk for thrombosis. A drug interaction between warfarin and trimethoprim/sulfamethoxazole, a sulfonamide combination, is unlikely to cause ECG changes. Erythromycin is an antimicrobial drug that can cause ECG changes, such as a prolonged QT interval. A drug interaction between warfarin and trimethoprim/sulfamethoxazole, a sulfonamide combination, is unlikely to cause ototoxicity. Several antimicrobial drugs can cause ototoxicity, including erythromycin and gentamicin.
A nurse in a provider's office receives a call from a client who is taking amoxicillin to treat a respiratory infection and reports a rash and wheezing. Which of the following instructions should the nurse give the client? Wait 1 hour and contact the provider if there is no improvement. Skip today's dose of amoxicillin and resume taking the drug tomorrow. Call emergency services immediately. Take an NSAID to reduce skin and airway inflammation.
Call emergency services immediately. Amoxicillin can cause a severe anaphylactic reaction. A client who has difficulty breathing should call emergency services and seek immediate care. The client will need to be treated with epinephrine and an antihistamine, such as diphenhydramine, to treat an anaphylactic reaction. The client might be experiencing respiratory difficulties due to an allergic reaction. It is unsafe to delay treatment. A drug allergy can cause rash, hives, and wheezing, and can get progressively worse. The client should not take the drug again. A drug allergy can cause rash, hives, and wheezing and can get progressively worse. An NSAID is unlikely to reverse that progression, although an antihistamine, such as diphenhydramine, can help.
When administering oral erythromycin to a client who has acute diphtheria, a nurse should monitor for which of the following adverse effects? Hypothermia Blurred vision Constipation Cardiac dysrhythmias
Cardiac dysrhythmias Erythromycin, a macrolide, can cause ECG changes, including a prolonged QT interval, and put the client at risk for a potentially fatal ventricular dysrhythmia. The nurse should monitor the client's ECG and tell the client to report palpitations, fainting, or dizziness. The drug is contraindicated for clients who have a history of QT prolongation. Erythromycin, a macrolide, is more likely to cause fever than hypothermia. Erythromycin, a macrolide, is more likely to cause hearing loss than vision changes. Erythromycin, a macrolide, is more likely to cause diarrhea than constipation.
A nurse in a provider's office receives a call from a client who is taking tetracycline orally to treat a chlamydia infection and reports severe blood-tinged diarrhea. The nurse should suspect the client is experiencing which of the following? Hemorrhoids Clostridium difficile-associated diarrhea Diverticular disease Small bowel obstruction
Clostridium difficile-associated diarrhea Severe diarrhea, often containing mucus and blood, can indicate Clostridium difficile-associated diarrhea. Treatment includes stopping drug therapy and replacing fluids and electrolytes. Clients should immediately report severe diarrhea and blood in the stools. Tetracycline, an antibiotic, is unlikely to cause hemorrhoids, although adverse effects include diarrhea, which can cause existing hemorrhoids to bleed. The nurse should assess the client for more serious causes of blood-tinged diarrhea if the client does have hemorrhoids. Tetracycline, an antibiotic, is unlikely to cause diverticular disease, a disorder that manifests as small pouches, or diverticula, that develop in the wall of the colon. Adverse effects of the drug include diarrhea, which can make existing diverticula bleed. Tetracycline, an antibiotic, is unlikely to cause small bowel obstruction, which manifests as nausea, vomiting, abdominal pain, and constipation. The drug causes diarrhea, not constipation.
A nurse is caring for a client who is about to begin taking nitrofurantoin to treat a urinary tract infection. The nurse should tell the client to report which of the following adverse effects of the drug? Constipation Dark brown urine Cough Tremors
Cough Nitrofurantoin, a urinary tract antiseptic, can cause cough, shortness of breath, chest pain, and fever. These adverse effects can indicate an acute allergic reaction and require immediate discontinuation of drug therapy. Nitrofurantoin, a urinary tract antiseptic, is more likely to cause diarrhea than constipation. Nitrofurantoin, a urinary tract antiseptic, can turn urine a dark brown color, but it is a harmless effect. The drug can also stain teeth, so clients should rinse their mouth after drinking the oral suspension. Nitrofurantoin, a urinary tract antiseptic, is unlikely to cause tremors, but it can cause peripheral neuropathy.
A nurse is caring for a client who is about to begin receiving acyclovir IV to treat a viral infection. The nurse should recognize that cautious use of the drug is essential if the client also has which of the following conditions? Heart failure Dehydration Asthma Tinnitus
Dehydration Acyclovir, an antiviral drug, can cause renal toxicity, especially in clients who are dehydrated. Hydration during and after IV infusion of the drug can help prevent crystalluria. Clients who have heart failure can take acyclovir, an antiviral drug. Metronidazole, an antiparasitic drug, is an antimicrobial drug that requires cautious use with clients who have heart failure. Clients who have asthma can take acyclovir, an antiviral drug. Amoxicillin, a penicillin, is an antimicrobial drug that requires cautious use with clients who have asthma. Clients who have tinnitus can take acyclovir, an antiviral drug. Vancomycin is an antimicrobial drug that requires cautious use with clients who have tinnitus.
A nurse is reviewing a client's prescriptions prior to administering gentamicin to the client to treat a systemic infection. The nurse should clarify the use of gentamicin with the provider if the client is taking which of the following drugs? Ethacrynic acid Diphenhydramine Acetaminophen Levothyroxine
Ethacrynic acid Gentamicin, an aminoglycoside, and ethacrynic acid, a loop diuretic, are ototoxic drugs. The nurse should identify that concurrent use increases the client's risk for hearing loss. Diphenhydramine does not specifically interact with gentamicin, an aminoglycoside. Amphotericin B is an antifungal drug that interacts adversely with gentamicin to increase the risk for nephrotoxicity. Acetaminophen does not interact with gentamicin, an aminoglycoside. NSAIDs, such as ibuprofen, interact adversely with gentamicin to increase the risk for nephrotoxicity. Levothyroxine does not interact with gentamicin, an aminoglycoside. Vancomycin is an antimicrobial drug that interacts adversely with gentamicin to increase the risk for ototoxicity.
A nurse is caring for a client who has a prescription for rifampin to treat tuberculosis. The nurse should expect the provider to prescribe which of the following drugs to the client to prevent possible resistance to rifampin? Gentamicin Vancomycin Isoniazid Metronidazole
Isoniazid Isoniazid is used to treat tuberculosis and reduces the possibility of resistance to rifampin when combined with the drug. Drug resistance can develop quickly if the client only takes rifampin. Gentamicin is not used to treat tuberculosis. It is prescribed to treat infective endocarditis and is used for management of enterococcal infections. Vancomycin is not used to treat tuberculosis. It is effective for treating osteomyelitis, pneumonia, and Clostridium difficile-associated diarrhea. Metronidazole is not used to treat tuberculosis. It is effective for treating septicemia or protozoal infections, such as giardiasis.
A nurse is caring for a client who is about to begin taking isoniazid to treat tuberculosis. The nurse should instruct the client to report which of the following adverse effects of the drug? (Select all that apply.) Jaundice Numbness of the hands Dizziness Hearing loss Oral ulcers
Jaundice is correct. Isoniazid, an antimycobacterial drug, can cause liver toxicity, especially in clients who abuse alcohol. The nurse should monitor liver enzymes during therapy and instruct the client to report indications of liver damage, such as jaundice, abdominal pain, and fatigue. Numbness of the hands is correct. Isoniazid can cause peripheral neuropathy. The nurse should instruct the client to report numbness, pain, or tingling in the hands or feet. Administering pyridoxine (vitamin B6) can help minimize these effects. Dizziness is correct. Isoniazid can cause dizziness, ataxia, and seizures. The nurse should instruct the client to report these CNS effects. Hearing loss is incorrect. Isoniazid is more likely to cause visual disturbances than hearing loss. Oral ulcers is incorrect. Isoniazid is unlikely to cause a superinfection and oral ulcers, but it can cause dry mouth.
A nurse is caring for a client who has a gynecologic infection and a history of alcohol use disorder. The nurse should identify that which of the following drugs can cause a reaction similar to disulfiram if the client drinks alcohol while taking it? (Select all that apply.) Nitrofurantoin Amoxicillin Aztreonam Cefotetan Metronidazole
Nitrofurantoin is incorrect. Nitrofurantoin, a urinary tract antiseptic, does not cause a reaction similar to disulfiram when clients consume alcohol. However, the drug can cause diarrhea, nausea, and vomiting. Amoxicillin is incorrect. Amoxicillin, a penicillin, does not cause a reaction similar to disulfiram when clients consume alcohol. However, the drug can cause diarrhea, nausea, and vomiting. Aztreonam is incorrect. Aztreonam, a monobactam, does not cause a reaction similar to disulfiram when clients consume alcohol. However, the drug can cause a superinfection with Candida albicans. Cefotetan is correct. Cefotetan, a second-generation cephalosporin, can cause a reaction similar to what disulfiram causes when clients consume alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension. Metronidazole is correct. Metronidazole, an antiparasitic drug, can cause a reaction similar to what disulfiram causes when clients consume alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension.
A nurse is caring for a client who has a new prescription for aztreonam to treat a respiratory tract infection. Which of the following findings in the client's medical record should the nurse recognize as requiring cautious use for this prescription and report to the provider? Glaucoma Closed-head injury Heart failure Renal impairment
Renal impairment Aztreonam, a monobactam, requires cautious use with clients who have renal dysfunction because it is excreted in the urine. Renal impairment could affect the excretion of aztreonam, allowing the level of the drug to accumulate. The nurse should report this finding to the provider, so the provider can prescribe a lower dose for the client or prescribe a different antimicrobial drug. Clients who have glaucoma can take aztreonam, a monobactam. Viral infection is a contraindication for the use of the drug. Clients who have a closed-head injury can take aztreonam, a monobactam. The drug requires cautious use with older adults. Clients who have heart failure can take aztreonam, a monobactam. Metronidazole is an antimicrobial drug that requires cautious use with clients who have heart failure.
A nurse is caring for a client who is about to begin taking metronidazole to treat an anaerobic intra-abdominal bacterial infection. The nurse should recognize that cautious use of the drug is indicated if the client also has which of the following conditions? Seizure disorder Hearing loss Asthma Anemia
Seizure disorder Metronidazole, an antiparasitic drug, can cause ataxia, vertigo, and seizures. It requires cautious use with clients who have a history of seizure activity, liver or renal failure, or heart failure. Clients who have hearing loss may take metronidazole, an antiparasitic drug. Vancomycin is an antimicrobial drug that requires cautious use with clients who have hearing loss. Clients who have asthma may take metronidazole, an antiparasitic drug. Amoxicillin, a penicillin, is an antimicrobial drug that requires cautious use with clients who have asthma. Clients who have anemia may take metronidazole, an antiparasitic drug. Amphotericin B, a polyene antibiotic, is an antimicrobial drug that requires cautious use with clients who have anemia.
A nurse is administering cefotetan IV to a client to treat an intra-abdominal infection. The nurse notes that the IV insertion site is warm, edematous, and painful to the touch. Which of the following actions should the nurse take? Decrease the rate of the cefotetan infusion. Administer diphenhydramine to the client. Request a prescription for another antibiotic. Stop the cefotetan infusion.
Stop the cefotetan infusion. The nurse should stop the infusion, remove the IV catheter, assess for tissue damage, and treat the client accordingly. The nurse should then initiate IV access via another site, continuing cefotetan therapy according to prescribed parameters. Because the client could have thrombophlebitis, slowing the infusion will not alleviate the potential tissue damage or risk of embolus, and the IV site should be changed. To prevent thrombophlebitis, the nurse should dilute cefotetan, a second-generation cephalosporin, and infuse it slowly over 20 to 30 min. The edematous, painful, and warm IV insertion site does not indicate an allergic reaction. The nurse should administer an antihistamine, such as diphenhydramine, if the client has hives, a rash, or other indications of an allergy to cephalosporins. Switching the client to another antibiotic is essential when the current drug is ineffective or the client has an intolerable reaction to it.
A nurse is caring for a client who has a new diagnosis of bacterial meningitis. The nurse should expect the provider to prescribe a drug from which of the following classifications of antibiotics? First generation cephalosporins Third generation cephalosporins Monobactams Macrolides
Third generation cephalosporins Later generation cephalosporins are used to treat infections that cross the blood-brain barrier, and third-generation are specifically prescribed to treat bacterial meningitis. First generation cephalosporins are primarily used to treat infections of the skin, bone, and joints. They are not effective in the treatment of meningitis. Monobactams are typically prescribed to treat infections of the abdomen, respiratory system, and female reproductive tract. Macrolides, such as erythromycin, are typically used to treat severe infections, such as whooping cough, diphtheria, and chlamydia.
A nurse in a provider's office receives a call from a client who was recently hospitalized and treated with imipenem IV for a bacterial infection and reports an inability to eat due to mouth pain. The nurse should identify that the client might be experiencing which of the following as an adverse effect of this drug? Malabsorption Superinfection Anorexia Dental caries
Superinfection Imipenem, a carbapenem, can cause the superinfection Candida albicans in the mouth, throat, or vagina. It can also cause glossitis, an inflammation or infection of the tongue. Clients taking the drug should report any mouth pain or vaginal discharge and itching because they might require treatment with an antifungal drug. Imipenem, a carbapenem, is unlikely to cause malabsorption, but it can cause gastroenteritis, abdominal pain, and vomiting. Imipenem, a carbapenem, is unlikely to cause anorexia, but it can cause gastroenteritis, abdominal pain, and vomiting. Imipenem, a carbapenem, is unlikely to cause dental caries, but dental caries are a possible cause of mouth pain. The drug can, however, cause glossitis, an inflammation or infection of the tongue, nausea, heartburn, and diarrhea.
A nurse is caring for a client who is about to begin taking itraconazole to treat a fungal infection. The nurse should instruct the client to report which of the following adverse effects of the drug? Tingling in the hands and feet Joint pain Swelling of hands or feet Excessive sweating
Swelling of hands or feet Itraconazole, an azole antifungal drug, can cause edema, which can also indicate heart dysfunction, and should be monitored closely. Itraconazole, an azole antifungal drug, is unlikely to cause paresthesia. Isoniazid is an antimicrobial drug that can cause tingling and numbness in the hands and feet. Itraconazole, an azole antifungal drug, is more likely to cause headaches than joint pain. Itraconazole, an azole antifungal drug, is unlikely to cause diaphoresis, but it can cause skin rashes, photosensitivity, and dry mouth.
A nurse in a provider's office receives a call from a client who is taking ciprofloxacin to treat a respiratory tract infection and reports dyspepsia. Which of the following instructions should the nurse give the client? Take an antacid at least 2 hr after taking the drug. Take the drug with a cup of coffee. Take an iron supplement with the drug. Take the drug with 240 mL (8 oz) of milk.
Take an antacid at least 2 hours after taking the drug. The nurse should recommend that the client take an antacid to relieve the dyspepsia at least 2 hr after taking ciprofloxacin, a fluoroquinolone. This is because antacids decrease the absorption of the drug. Clients who are taking ciprofloxacin, a fluoroquinolone, should avoid caffeine because it can increase the drug's CNS effects, including insomnia, restlessness, and anxiety. Clients who are taking ciprofloxacin, a fluoroquinolone, should avoid taking the drug with supplemental iron because iron decreases the absorption of the drug. Clients who are taking ciprofloxacin, a fluoroquinolone, should avoid taking the drug with milk or other dairy products because the calcium in these products decreases the absorption of the drug.
A nurse is caring for a client who is taking ciprofloxacin to treat a urinary tract infection. The client also takes prednisolone to treat rheumatoid arthritis. Recognizing the adverse effects of ciprofloxacin, the nurse should instruct the client to report which of the following adverse effects? Tachycardia Hair loss Insomnia Tendon pain
Tendon pain Ciprofloxacin, a fluoroquinolone, can cause tendon rupture, most often of the Achilles tendon. This adverse effect is especially common for older adults or clients who take glucocorticoids, such as prednisolone. The nurse should tell the client to report tendon pain and stop taking the drug. Ciprofloxacin, a fluoroquinolone, is unlikely to cause tachycardia. Amphotericin B is an antimicrobial drug that can cause this adverse effect. Ciprofloxacin, a fluoroquinolone, is unlikely to cause hair loss, but it can cause photosensitivity. Clients should wear sunscreen and protective clothing while outdoors to prevent severe sunburn. Ciprofloxacin, a fluoroquinolone, is unlikely to cause insomnia, but it can cause vertigo and malaise.
A nurse is caring for a client who is about to begin gentamicin therapy to treat an infection. The nurse should monitor the client for an alteration in which of the following? Bowel function Peripheral pulses Urine output Level of consciousness
Urine output Gentamicin, an aminoglycoside, can cause nephrotoxicity. The nurse should monitor the client's BUN and creatinine levels and for an increased output of diluted urine. It is also essential to monitor serum gentamicin levels and maintain a therapeutic range. Intravenous gentamicin, a sulfonamide combination, is unlikely to alter bowel function, but it can cause nausea and vomiting. Although monitoring peripheral pulses is a standard assessment for every client, gentamicin, a sulfonamide combination, is unlikely to affect the peripheral pulses. The drug can, however, cause either hypotension or hypertension. Although monitoring level of consciousness is a standard assessment for every client, gentamicin, a sulfonamide combination, is unlikely to affect the level of consciousness. The drug can, however, cause vertigo and skeletal muscle weakness.
A nurse is providing teaching for a client who takes an oral contraceptive and is about to begin rifampin therapy to treat tuberculosis. Which of the following instructions should the nurse include? Increase the rifampin dose. Increase the oral contraceptive dose. Allow 2 hours between taking the two drugs. Use a non-hormonal form of contraception.
Use a non-hormonal form of contraception. Rifampin, an antimycobacterial drug, can increase the metabolism of oral contraceptives, reducing their effectiveness. Clients who are taking oral contraceptives and rifampin should use additional, non-hormonal contraceptive methods to prevent an unwanted pregnancy. Oral contraceptives do not reduce the effects of rifampin, an antimycobacterial drug. They can, however, reduce the effects of warfarin and hypoglycemic drugs. Taking additional oral contraceptives would increase the risk of serious adverse effects from the oral contraceptives and is not recommended. Allowing 2 hr between taking the oral contraceptive and taking rifampin, an antimycobacterial drug, will not reduce the drug interaction.
A nurse is caring for a client whose sputum culture results indicate methicillin-resistant Staphylococcus aureus (MRSA). The nurse should recognize that which of the following medications will likely be administered to this client? Trimethoprim/sulfamethoxazole Tetracycline Cephalexin Vancomycin
Vancomycin Vancomycin, a potentially toxic antibiotic, is used primarily to treat serious infections in clients who are allergic to penicillin or whose infecting bacteria are resistant to penicillin, such as MRSA. The term methicillin-resistant refers generally to a lack of susceptibility to methicillin (no longer prescribed), all penicillins, cephalosporins, tetracyclines, beta-lactams, and many other antimicrobial drugs. MRSA is resistant to trimethoprim/sulfamethoxazole, a sulfonamide combination. MRSA is resistant to tetracycline, an antimicrobial drug. MRSA is resistant to cephalexin, a first-generation cephalosporin.
