Midterm Practice

A client is ordered to receive a cephalosporin to treat a bacterial infection. Regarding monitoring of the client, the highest priority action on the part of the nurse includes assessing the client for which side effects? a. Nausea, vomiting, and diarrhea b. Photophobia and phototoxicity c. Pain with urination and blood in the urine d. High fevers and sweating

a. Nausea, vomiting, and diarrhea

A client with otitis media is ordered to receive amoxicillin (Amoxil). The client discloses to the nurse that she is allergic to penicillin. What is the highest priority action on the part of the nurse? a. Notify the healthcare provider that the client is allergic to penicillin. b. Encourage the client to take the dose under close monitoring. c. Administer half of the amoxicillin dose under supervision. d. Report the amoxicillin order to the supervisor.

a. Notify the healthcare provider that the client is allergic to penicillin.

A young child is diagnosed with meningitis and is prescribed an aminoglycoside. Based on the potentially toxic effects of the medication, what is the highest priority nursing intervention? a. Schedule hearing tests and assess of urine output. b. Assess urine output and bone marrow function. c. Assess renal and hepatic function. d. Assess visual acuity and color discrimination.

a. Schedule hearing tests and assess of urine output.

The highest priority nursing intervention for the client receiving azithromycin (Zithromax) is to: a. assess liver enzymes on a regular basis. b. instruct the client to take the drug on an empty stomach. c. administer a laxative daily to prevent constipation. d. administer each dose of medication with antacids.

a. assess liver enzymes on a regular basis.

The client has been ordered to be treated with tetracycline. He is also being treated with digoxin. The nurse anticipates that, based on the interaction of the two drugs, the client will experience _____ effects of the _____. a. increased; digoxin b. increased; tetracycline c. decreased; digoxin d. decreased; tetracycline

a. increased; digoxin

A nurse is ordered to draw blood levels for a person receiving an antibiotic. The nurse is aware that peaks and troughs of serum antibiotic levels are monitored for drugs with a: a. narrow therapeutic index. b. large therapeutic index. c. long half-life. d. short half-life.

a. narrow therapeutic index.

The nurse is instructing the client on the proper way to self-administer nystatin. The client tells the nurse that he has been simply drinking a small amount of the medication from the bottle. The nurse explain to the client that the medication dosage should consist of 1 to 2: a. teaspoons, swished and then swallowed. b. teaspoons, swished and then expelled. c. ounces, swallowed twice daily. d. ounces, used to swab the oral cavity.

a. teaspoons, swished and then swallowed.

The nurse is providing teaching to a patient taking an oral tetracycline antibiotic. Which statement by the nurse is correct? a. "Avoid direct sunlight and tanning beds while on this medication." b. "Milk and cheese products result in increased levels of tetracycline." c. "Antacids taken with the medication help to reduce gastrointestinal distress." d. "Take the medication until you are feeling better."

a. "Avoid direct sunlight and tanning beds while on this medication."

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 nurse is discussing methicillin-resistant Staphylococcus 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 Staphylococcus aureus strains."

a. "MRSA bacteria have developed PBPs with a low affinity for penicillins."

A pregnant adolescent patient asks the nurse whether she should continue to take her prescription for tetracycline [Sumycin] to clear up her acne. Which response by the nurse is correct? a. "Tetracycline can be harmful to the baby's teeth and should be avoided." b. "Tetracycline is safe to take during pregnancy." c. "Tetracycline may cause allergic reactions in pregnant women." d. "Tetracycline will prevent asymptomatic urinary tract infections."

a. "Tetracycline can be harmful to the baby's teeth and should be avoided."

A prescriber has ordered cefoxitin for a patient who has an infection caused by a gram-negative bacteria. The nurse taking the medication history learns that the patient experienced a maculopapular rash when taking amoxicillin [Amoxil] several years earlier. What will the nurse do? a. Administer the cefoxitin and observe for any side effects. b. Give the cefoxitin and have epinephrine and respiratory support available. c. Request an order for a different, nonpenicillin, noncephalosporin antibiotic. d. Request an order to administer a skin test before giving the cefoxitin.

a. Administer the cefoxitin and observe for any side effects.

A patient with no known drug allergies is receiving amoxicillin [Amoxil] PO twice daily. Twenty minutes after being given a dose, the patient complains of shortness of breath. The patient's blood pressure is 100/58 mm Hg. What will the nurse do? a. Contact the provider and prepare to administer epinephrine. b. Notify the provider if the patient develops a rash. c. Request an order for a skin test to evaluate possible PCN allergy. d. Withhold the next dose until symptoms subside.

a. Contact the provider and prepare to administer epinephrine. This patient is showing signs of an immediate penicillin allergy, that is, one that occurs within 2 to 30 minutes after administration of the drug. The patient is showing signs of anaphylaxis, which include laryngeal edema, bronchoconstriction, and hypotension; these must be treated with epinephrine. This is an emergency, and the provider must be notified immediately, not when other symptoms develop. It is not necessary to order skin testing. The patient must be treated immediately, and subsequent doses should not be given.

The nurse is reviewing the sputum culture results of a patient with pneumonia and notes that the patient has a gram-positive infection. Which generation of cephalosporin is most appropriate for this type of infection? a. First generation b. Second generation c. Third generation d. Fourth generation

a. First generation

When reviewing the medication orders for a patient who is taking cephalosporin, the nurse notes that the patient is also taking the oral anticoagulant warfarin (Coumadin). What possible effect may occur as the result of an interaction between these drugs? a. The penicillin will cause an enhanced anticoagulant effect of the warfarin. b. The penicillin will cause the anticoagulant effect of the warfarin to decrease. c. The warfarin will reduce the anti-infective action of the penicillin. d. The warfarin will increase the effectiveness of the penicillin.

a. The penicillin will cause an enhanced anticoagulant effect of the warfarin.

When antibacterials are prescribed for the treatment of an infection and a culture is ordered, what should happen next? a. The initial dose of the antibiotic should be given before the culture is taken. b. The culture should be taken before the initial dose of the antibiotic is given. c. The culture should be taken any time after the antibiotic therapy begins. d. The culture may be taken at any time before or during antibiotic therapy.

b. The culture should be taken before the initial dose of the antibiotic is given.

A client who reports an allergy to penicillin is ordered to receive cephalexin (Keflex). The correct action for the nurse is to: a. administer the medication as ordered with additional fluids. b. administer the medication and carefully observe for allergic reaction. c. call the physician to change the order because of the allergy history. d. administer another antibiotic after consulting the pharmacist.

b. administer the medication and carefully observe for allergic reaction.

A client is ordered to receive tetracycline. The client reports that she is using oral contraceptives. The nurse's recommendations are based on the fact that when tetracycline is taken with an oral contraceptive, the desired action of the oral contraceptive is: a. increased. b. decreased. c. affected in an unpredictable way. d. nullified.

b. decreased.

A client with type 2 diabetes is treated with a sulfonylurea agent. The client is diagnosed with a urinary tract infection and is ordered to receive co-trimoxazole (Bactrim, Septra). The nurse should evaluate for a(n): a. increased hyperglycemic response. b. increased hypoglycemic response. c. decreased action of the sulfonamide drug. d. prolonged action of the sulfonamide drug.

b. increased hypoglycemic response.

A nurse is teaching a nursing student what is meant by "generations" of cephalosporins. Which statement by the student indicates understanding of the teaching? a. "Cephalosporins are assigned to generations based on their relative costs to administer." b. "Cephalosporins have increased activity against gram-negative bacteria 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 bacteria with each generation."

A patient has a viral sinus infection, and the provider tells the patient that antibiotics will not be prescribed. The patient wants to take an antibiotic and asks the nurse what possible harm could occur by taking an antibiotic. Which response by the nurse is correct? a. "Antibiotics are mutagenic and can produce changes that cause resistance." b. "Even normal flora can develop resistance and transfer this to pathogens." c. "Host cells become resistant to antibiotics with repeated use." d. "Patients who overuse antibiotics are more likely to have nosocomial infections."

b. "Even normal flora can develop resistance and transfer this to pathogens."

A patient receiving a cephalosporin develops a secondary intestinal infection caused by Clostridium difficile. What is an appropriate treatment for this patient? a. Adding an antibiotic, such as vancomycin [Vancocin], to the patient's regimen b. Discontinuing the cephalosporin and beginning metronidazole [Flagyl] c. Discontinuing all antibiotics and providing fluid replacement d. Increasing the dose of the cephalosporin and providing isolation measures

b. Discontinuing the cephalosporin and beginning metronidazole [Flagyl]

The client has been started on Streptomycin. She complains to the nurse of changes in her level of hearing. What is the highest priority nursing intervention on the part of the nurse? a. Restrict fluid intake. b. Assess for paralytic ileus. c. Hold the next dose of medication and notify the physician. d. Monitor urine for sugar.

c. Hold the next dose of medication and notify the physician.

A client has been receiving a cephalosporin for 20 days to treat a severe bacterial infection. The client complains of mouth pain, and the nurse assesses white patches in the client's mouth. What is the highest priority action on the part of the nurse? a. Provide mouth care with glycerin swabs. b. Encourage the client to drink more fluids. c. Notify the physician and describe symptoms. d. Administer analgesia for the mouth pain.

c. Notify the physician and describe symptoms

A client with a UTI is ordered to receive trimethoprim-sulfamethoxazole, also known as co-trimoxazole (Bactrim, Septra). The nurse is aware that Bactrim is a combination of two drugs. What is the purpose of this combination? a. It decreases the response against disease-producing organisms. b. The two drugs have an antagonistic drug effect. c. Trimethoprim prevents bacterial resistance to sulfamethoxazole. d. It prevents toxic drug effects.

c. Trimethoprim prevents bacterial resistance to sulfamethoxazole. Use of sulfonamides leads to bacterial resistance. The trimethoprim prevents this.

The client has a hypersensitivity to penicillin. The nurse anticipates that the drug of choice for this client will be: a. cefuroxime (Ceftin, Zinacef). b. clindamycin (Cleocin). c. erythromycin (E-mycin, Ilotycin). d. gentamicin SO4 (Garamycin).

c. erythromycin (E-mycin, Ilotycin).

The client has been ordered treatment with Amoxil. The client reports to the nurse that she has developed symptoms of vaginitis. The highest priority action on the part of the nurse is to recognize this as: a. an expected side effect of the medication. b. a life-threatening reaction to the drug. c. evidence of development of a superinfection. d. evidence of an anaphylactic reaction.

c. evidence of development of a superinfection.

With continuous use of antibiotics, antibiotic resistance result because: a. bacteria are producing fewer mutations. b. the immune system has enhanced ability to fight infection. c. mutant bacteria are surviving antibiotic use. d. fewer new antibiotics have been produced.

c. mutant bacteria are surviving antibiotic use.

The client will need a prophylactic agent for herpes simplex. The nurse anticipates that the client will be ordered: a. ciprofloxacin (Cipro). b. fluconazole (Diflucan). c. oral acyclovir (Zovirax). d. pentazocine (Talwin).

c. oral acyclovir (Zovirax). Oral acyclovir (Zovirax) is the drug of choice to prevent HSV1.

The highest priority nursing intervention while the client is being treated with polymyxin B (Aerosporin) is frequent monitoring of: a. blood glucose and fasting blood glucose levels. b. liver enzymes and liver function studies. c. serum creatinine levels and urinary output. d. hydration and serum albumin levels.

c. serum creatinine levels and urinary output.

A patient is to begin taking doxycycline to treat a rickettsial infection. Which statement by the patient indicates a need for teaching about this drug? a. "I should consult my provider before using laxatives or antacids while taking this drug." b. "I should not take a calcium supplement or consume dairy products with this drug." c. "I should take this drug with food to ensure more complete absorption." d. "If I get diarrhea, I should stop taking the drug and let my provider know immediately."

c. "I should take this drug with food to ensure more complete absorption."

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 agents 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."

c. "Some agents cause phagocytosis of bacterial cells."

The nurse is monitoring for therapeutic results of antibiotic therapy in a patient with an infection. Which laboratory value would indicate therapeutic effectiveness of this therapy? a. Increased red blood cell count b. Increased hemoglobin level c. Decreased white blood cell count d. Decreased platelet count

c. Decreased white blood cell count

A child has received amoxicillin [Amoxil] for three previous ear infections, but a current otitis media episode is not responding to treatment. The nurse caring for this child suspects that resistance to the bacterial agent has occurred by which microbial mechanism? a. Alteration of drug target molecules b. Antagonist production c. Drug inactivation d. Reduction of drug concentration at the site of action

c. Drug inactivation

A patient has an infection caused by Streptococcus pyogenes. The prescriber has ordered dicloxacillin PO. What will the nurse do? a. Administer the medication as ordered. b. Contact the provider to suggest giving the drug IV. c. Question the need for a penicillinase-resistant penicillin. d. Suggest ordering vancomycin to treat this infection.

c. Question the need for a penicillinase-resistant penicillin.

A patient who is receiving a final dose of intravenous (IV) cephalosporin begins to complain of pain and irritation at the infusion site. The nurse observes signs of redness at the IV insertion site and along the vein. What is the nurse's priority action? a. Apply warm packs to the arm, and infuse the medication at a slower rate. b. Continue the infusion while elevating the arm. c. Select an alternate intravenous site and administer the infusion more slowly. d. Request central venous access.

c. Select an alternate intravenous site and administer the infusion more slowly.

A patient is receiving his third intravenous dose of a penicillin drug. He calls the nurse to report that he is feeling "anxious" and is having trouble breathing. What will the nurse do first? a. Notify the prescriber. b. Take the patient's vital signs. c. Stop the antibiotic infusion. d. Check for allergies.

c. Stop the antibiotic infusion.

The nurse is monitoring a patient who has been on antibiotic therapy for 2 weeks. Today the patient tells the nurse that he has had watery diarrhea since the day before and is having abdominal cramps. His oral temperature is 101° F (38.3° C). Based on these findings, which conclusion will the nurse draw? a. The patient's original infection has not responded to the antibiotic therapy. b. The patient is showing typical adverse effects of antibiotic therapy. c. The patient needs to be tested for Clostridium difficile infection. d. The patient will need to take a different antibiotic.

c. The patient needs to be tested for Clostridium difficile infection.

A patient recently began receiving clindamycin [Cleocin] to treat an infection. After 8 days of treatment, the patient reports having 10 to 15 watery stools per day. What will the nurse tell this patient? a. The provider may increase the clindamycin dose to treat this infection. b. This is a known side effect of clindamycin, and the patient should consume extra fluids. c. The patient should stop taking the clindamycin now and contact the provider immediately. d. The patient should try taking Lomotil or a bulk laxative to minimize the diarrheal symptoms.

c. The patient should stop taking the clindamycin now and contact the provider immediately.

The nurse is teaching a patient who will be discharged home from the hospital to take amoxicillin (Amoxil) twice daily for 10 days. Which statement by the nurse is correct? a. "Discontinue the antibiotic when your temperature returns to normal and your symptoms have improved." b. "If diarrhea occurs, stop taking the drug immediately and contact your provider." c. "Stop taking the drug and notify your provider if you develop a rash while taking this drug." d. "You may save any unused antibiotic to use if your symptoms recur."

c. "Stop taking the drug and notify your provider if you develop a rash while taking this drug." Patients who develop signs of allergy, such as rash, should notify their provider before continuing medication therapy. Patients should be counseled to continue taking their antibiotics until completion of the prescribed regimen even when they feel well. Diarrhea is an adverse effect but does not warrant cessation of the drug. Before deciding to stop taking a medication due to a side effect, encourage the patient to contact the provider first. Patients should discard any unused antibiotic.

The nurse is providing discharge teaching for a patient who will receive oral levofloxacin (Levaquin) to treat pneumonia. The patient takes an oral hypoglycemic medication and uses over-the-counter (OTC) antacids to treat occasional heartburn. The patient reports frequent arthritis pain and takes acetaminophen when needed. Which statement by the nurse is correct when teaching this patient? a. "You may take antacids with levofloxacin to decrease gastrointestinal upset." b. "You may take nonsteroidal anti-inflammatory medications (NSAIDs) for arthritis pain." c. "You should monitor your serum glucose more closely while taking levofloxacin." d. "You should take levofloxacin on an empty stomach to improve absorption."

c. "You should monitor your serum glucose more closely while taking levofloxacin."

A nurse is monitoring for the side effects of acyclovir (Zovirax). The nurse anticipates that the client may experience what side effect? a. Hepatotoxicity b. High blood pressure c. Increased intracranial pressure d. Rash and pruritus

d. Rash and pruritus

A client has relayed instructions from a physician regarding an allergy to a type of antibiotic therapy. The nurse would question which instruction? a. Wear a Medic Alert bracelet that indicates the allergy. b. Avoid all penicillin-type drugs. c. Inform all healthcare providers of the allergy. d. Restrict fluids when taking the antibiotic

d. Restrict fluids when taking the antibiotic

The client has been ordered to be treated with amoxicillin. The highest priority instruction that the nurse should give the client related to diet while on the medication is to avoid: a. green leafy vegetables. b. beef and other red meat. c. coffee, tea, and colas. d. acidic fruits and juices.

d. acidic fruits and juices. Acidic fruits and juices should be avoided while the client is being treated with amoxicillin.

The client has been prescribed Streptomycin. The highest priority nursing intervention related to a life-threatening side effect of the medication is to monitor for: a. blood pressure changes. b. decrease in pulse rate. c. nausea and vomiting. d. decreased urinary output.

d. decreased urinary output.

The client is being treated with Metronidazole. She complains to the nurse of experiencing reddish brown urine. The nurse interprets this finding as a(n): a. potentially life-threatening reaction to the medication. b. symptom of an anaphylactic reaction to the medication. c. sign that the medication dosage needs to be increased. d. expected side effect of a high dose of the medication.

d. expected side effect of a high dose of the medication.

The client has been diagnosed with candidiasis (thrush). The nurse anticipates that the client will be treated with: a. co-trimoxazole. b. pyrimethamine. c. sulfamethoxazole. d. fluconazole.

d. fluconazole.

Nystatin (Mycostatin), a polyene antifungal drug, is frequently administered as an oral suspension for Candida infection in the mouth. Client instruction regarding the administration of nystatin is to: a. dilute the oral suspension with water and then swallow the solution. b. drink the oral suspension and follow with 4 ounces of water. c. drink the oral suspension but do not follow with fluid or food. d. swish the liquid in the mouth and then swallow or expel the suspension.

d. swish the liquid in the mouth and then swallow or expel the suspension.

During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and decreased appetite. Which statement is the nurse's best advice to the patient? a. "Take it with cheese and crackers or yogurt." b. "Take each dose with a glass of milk." c. "Take an antacid with each dose as needed." d. "Drink a full glass of water with each dose."

d. "Drink a full glass of water with each dose."

A child with otitis media has had three ear infections in the past year. The child has just completed a 10-day course of amoxicillin [Amoxil] with no improvement. The parent asks the nurse why this drug is not working, because it has worked in the past. What will the nurse tell the patient? a. "Amoxicillin is too narrow in spectrum." b. "The bacteria have developed a three-layer cell envelope." c. "The bacteria have developed penicillin-binding proteins (PBPs) that have a low affinity for penicillins." d. "The bacteria have synthesized penicillinase."

d. "The bacteria have synthesized penicillinase." Beta-lactamases are enzymes that cleave the beta-lactam ring and render the PCN inactive. This resistance is common with organisms that cause ear infections. Amoxicillin is a broad-spectrum antibiotic. A three-layer cell envelope occurs in gram-negative bacteria. Some bacterial strains, including methicillin-resistant Staphylococcus aureus (MRSA), develop PBPs with a low affinity for penicillins. MRSA is not a common cause of otitis media.

A parent asks a nurse if the provider will prescribe an antibiotic for a child who attends school with several children who have strep throat. The child is complaining of a sore throat and has a fever. What will be the nurse's response? a. "Because strep throat is likely, your child should be treated empirically." b. "With good hand washing, your child should not get strep throat." c. "Your child probably has strep throat, so your provider will order an antibiotic." d. "Your child should come to the clinic to have a throat culture done today."

d. "Your child should come to the clinic to have a throat culture done today."

A patient is admitted with a fever of 102.8° F (39.3° C), origin unknown. Assessment reveals cloudy, foul-smelling urine that is dark amber in color. Orders have just been written to obtain stat urine and blood cultures and to administer an antibiotic intravenously. The nurse will complete these orders in which sequence? a. Blood culture, antibiotic dose, urine culture b. Urine culture, antibiotic dose, blood culture c. Antibiotic dose, blood and urine cultures d. Blood and urine cultures, antibiotic dose

d. Blood and urine cultures, antibiotic dose

Which cephalosporin may be used to treat meningitis? a. Cefaclor b. Cefazolin c. Cefoxitin d. Cefotaxime

d. Cefotaxime

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 antibiotic until the culture results are available d. Obtaining all cultures before the antibiotic is administered

d. Obtaining all cultures before the antibiotic is administered

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 the etiology of the thrush? a. Antibiotic resistance b. Community-acquired infection c. Nosocomial infection d. Superinfection

d. Superinfection

A patient develops CDAD. Which antibiotic is recommended for treating this infection? a. Chloramphenicol b. Clindamycin [Cleocin] c. Linezolid [Zyvox] d. Vancomycin

d. Vancomycin

A patient has a localized skin infection, which is most likely caused by a gram-positive cocci. Until the culture and sensitivity results are available, the nurse will expect the provider to order a ____-spectrum ____ agent. a. broad; systemic b. broad; topical c. narrow; systemic d. narrow; topical

d. narrow; topical

It would be critical for a nurse to monitor which of the following patients 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

A patient is receiving long-term clindamycin therapy for a life-threatening infection. The nurse will begin by monitoring this drug therapy by obtaining: A) Blood glucose levels daily for 1 week B) Establishing the patient's auditory abilities C) A baseline complete blood count D) Liver enzymes weekly until the drug therapy is completed

C) A baseline complete blood count

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 an antibiotic that was prescribed the day before. The nurse will instruct the patient to: A) Continue to take the drug; the rash will eventually subside. B) Decrease the dosage by half until being seen by the doctor. 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 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

A nurse is instructing a diabetic patient, who has a severe respiratory infection caused byStreptococcus pneumoniae, how to monitor his glucose levels while taking cefazolin. The nurse will instruct the patient to use: A) Fehling solution for testing B) Benedict solution for testing C) Clinitest tablets for urine testing D) Blood testing for glucose level

D) Blood testing for glucose level

A patient is taking rifampin (Rifadin) for active TB. When discussing this drug with the patient, the nurse should stress that: A) The drug usually causes cardiac arrhythmias. B) The drug frequently causes seizure activity. C) Facial flushing may appear but will go away once therapy is concluded. D) Body fluids such as urine, saliva, tears, and sputum may become discolored.

D) Body fluids such as urine, saliva, tears, and sputum may become discolored.

A priority assessment of a patient who is to be started on cilastatin-imipenem (Primaxin) by the nurse would be to determine if the patient has a history of: A) Anemia B) Hypertension C) Diabetes mellitus D) Seizure disorder

D) Seizure disorder

Mild acne may be initially treated with: A. Topical combined antibiotic B. Minocycline C. Topical retinoid D. OTC benzoyl peroxide

D. OTC benzoyl peroxide

Josie has severe cystic acne and is requesting treatment with Accutane. The appropriate treatment for her would be: A. Order a pregnancy test and if it is negative prescribe the isotretinoin (Accutane) B. Order Accutane after educating her on the adverse effects C. Recommend she try oral antibiotics (minocycline) D. Refer her to a dermatologist for treatment

D. Refer her to a dermatologist for treatment

A man is prescribed ciprofloxacin to treat a sexually transmitted disease. The nurse will instruct the patient to: A) Complete the entire course of drug therapy. B) Reduce the dosage of ciprofloxacin gradually. C) Take the drug only in safe and secure home settings. D) Take the drug through subcutaneous injection if it tastes bad.

A) Complete the entire course of drug therapy.

A patient has been prescribed oral tetracycline. The nurse will instruct the patient to take the drug: A) On an empty stomach 1 hour before or 2 hours after taking any meals or other drugs B) With a meal C) With milk or fruit juice D) At bedtime only

A) On an empty stomach 1 hour before or 2 hours after taking any meals or other drugs

A 34-year-old woman has a urinary tract infection and has been prescribed SMZ-TMP. She has had chronic urethritis for the past 4 years. The nurse has instructed the patient to drink 1.5 L of water daily, and they have discussed the drug and its adverse effects. Further instruction to the patient should include: A) Performing periodic urine testing to check for crystals B) Performing random glucose testing while taking the medication C) The need to administer an aminoglycoside drug along with the SMZ-TMP to treat urosepsis D) Advising the patient to take bubble baths to ensure cleanliness

A) Performing periodic urine testing to check for crystals

A nurse is caring for a patient who has a serious respiratory infection. The patient is being treated with combination therapy of a cephalosporin and an aminoglycoside. The nurse will be sure to monitor which of the following? A) Serum BUN and creatinine levels B) Serum sodium and potassium levels C) Prothrombin time (PT) and partial thromboplastin time (PTT) D) Aspartate aminotransferase levels

A) Serum BUN and creatinine levels

A 45-year-old female patient is prescribed ciprofloxacin to treat a bronchial infection. A nursing assessment revealed 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.

The most cost-effective treatment for two or three impetigo lesions on the face is: A. Mupirocin ointment B. Retapamulin (Altabax) ointment C. Topical clindamycin solution D. Oral amoxicillin/clavulanate (Augmentin)

A. Mupirocin ointment

Initial drug therapy choices for rosecea should include a A. topical agent. C. isotrentinion B. oral antibiotics D. benzoyl peroxide

A. topical agent.

A 25-year-old woman is being treated with penicillin G as prophylaxis to prevent bacterial endocarditis prior to a dental procedure. The nurse should question the patient concerning her use of: A) Alcohol B) Oral contraceptives C) Fats in her diet D) Nicotine

B) Oral contraceptives

A 20-year-old female patient is receiving topical clindamycin for acne vulgaris. She develops a rash and urticaria along with severe itching where the medication is applied. The nurse will formulate which of the following nursing diagnoses for the patient? A) Diarrhea B) Risk for Injury related to allergic reactions C) Imbalanced Nutrition: Less than Body Requirements D) Risk of Injury related to blood dyscrasia

B) Risk for Injury related to allergic reactions

A patient calls the clinic to tell the nurse that she forgot to take a dose of penicillin G. The nurse will advise her to: A) Take the dose immediately, regardless of the timing of the next dose. B) Take the dose immediately, but not if it is time for the next scheduled dose. C) Forget about the missed dose and continue on the regular schedule. D) Take the missed dose along with the next dose.

B) Take the dose immediately, but not if it is time for the next scheduled dose.

Rosesa usually starts in this part of a person's lifespan A. Adolescant C. Teen B. Midlife D. Toddler

B. Midlife

A client is to receive erythromycin intravenously. What is the highest priority nursing intervention? a. Call the physician; the drug should not be given IV. b. Administer the solution slowly to avoid pain. c. Administer the solution quickly to prevent infection. d. Call the pharmacist to verify the correct route.

b. Administer the solution slowly to avoid pain.

A client is being treated with multidrug therapy for acute tuberculosis. The drug regimen includes streptomycin. What will be the highest priority nursing intervention while the client is being treated with streptomycin? a. Assess urine output and kidney function. b. Assess hearing acuity. c. Monitor hepatic function. d. Conduct an ECG to watch for changes.

b. Assess hearing acuity.

A client is ordered to take the anticoagulant warfarin (Coumadin) with co-trimoxazole (Bactrim, Septra). Based on the interaction of the drugs, the client's warfarin level should be monitored and the dose may need to be adjusted in which way? a. Increased b. Decreased c. Taken every other day d. Discontinued

b. Decreased

A client is taking a high dose of azithromycin (Zithromax). The client should be monitored for which adverse reaction? a. Nephrotoxicity b. Hepatotoxicity c. Neurotoxicity d. Blood dyscrasias

b. Hepatotoxicity This medication may be hepatotoxic, and liver enzymes must be monitored.

A client at an outpatient clinic is ordered to receive ampicillin (Omnipen) for an infection. Which nursing intervention related to penicillins would the nurse question? a. Verify that the client is not allergic to penicillin. b. Obtain culture before administering the first dose of medication. c. Instruct client to discontinue penicillin when temperature is normal. d. Encourage the client to increase fluid intake.

b. Obtain culture before administering the first dose of medication.

A client is ordered to receive isotretinoin. What is a priority diagnostic test for the nurse to complete before beginning therapy? a. Blood glucose level b. Pregnancy test c. Serum electrolytes d. Complete blood count

b. Pregnancy test

A 7-year-old client is being evaluated for treatment with tetracycline. Which knowledge is most important for the nurse to share with the client and parents about tetracycline? a. Tetracycline is safe if taken during pregnancy. b. Tetracycline may cause permanent discoloration to the teeth if taken before age 8 years. c. Tetracycline causes bone marrow suppression in clients of all ages. d. Tetracycline should be taken with milk or milk products and antacids to avoid gastrointestinal side effects.

b. Tetracycline may cause permanent discoloration to the teeth if taken before age 8 years.

A patient who has been taking gentamicin for 5 days reports a headache and dizziness. What will the nurse do? a. Request an order for a gentamicin peak level. b. Suspect ototoxicity and notify the prescriber. c. Tell the patient to ask for help with ambulation. d. Tell the patient to report any tinnitus.

b. Suspect ototoxicity and notify the prescriber.

A patient is using a high-concentration keratolytic agent containing 20% salicylic acid to remove warts. What will the nurse teach this patient? a. Peeling and drying are desired effects of this drug. b. Systemic effects may occur with this medication. c. Tinnitus is a common side effect of little concern. d. Tissue injury is unlikely at this dose.

b. Systemic effects may occur with this medication.

A nurse assisting a nursing student with medications asks the student to describe how penicillins (PCNs) work to treat bacterial infections. The student is correct in responding that penicillins: a. disinhibit transpeptidases. b. disrupt bacterial cell wall synthesis. c. inhibit autolysins. d. inhibit host cell wall function.

b. disrupt bacterial cell wall synthesis.

An older adult patient with chronic obstructive pulmonary disease (COPD) develops bronchitis. The patient has a temperature of 39.5°C. The nurse will expect the provider to: a. obtain a sputum culture and wait for the results before prescribing an antibiotic. b. order empiric antibiotics while waiting for sputum culture results. c. treat symptomatically, because antibiotics are usually ineffective against bronchitis. d. treat the patient with more than one antibiotic without obtaining cultures.

b. order empiric antibiotics while waiting for sputum culture results.

The nurse is caring for a patient who is receiving vancomycin [Vancocin]. The nurse notes that the patient is experiencing flushing, rash, pruritus, and urticaria. The patient's heart rate is 120 beats per minute, and the blood pressure is 92/57 mm Hg. The nurse understands that these findings are consistent with: a. allergic reaction. b. red man syndrome. c. rhabdomyolysis. d. Stevens-Johnson syndrome.

b. red man syndrome.

A client's medication warrants peak and trough levels to be drawn. The nurse is aware that if the peak level of the drug is too high, what could occur? a. Mild side effects b. Inadequate drug action c. Slow onset of drug action d. Drug toxicity

d. Drug toxicity

A client enters the healthcare provider's office with complaints of verruca vulgaris (warts). What is the most accurate instructional point to include in a client teaching session? a. Warts can become malignant after 1 to 2 years and thus must be monitored closely. b. The only effective means of wart removal is by surgical excision. c. Drug therapy to remove a common wart may include systemic side effects. d. Electrodesiccation can be used to eradicate the common warts.

d. Electrodesiccation can be used to eradicate the common warts.

A nurse teaches a patient about sulfonamides. Which statement by the patient indicates a need for further teaching? a. "I need to drink extra fluids while taking this medication." b. "I need to use sunscreen when taking this drug." c. "I should call my provider if I develop a rash while taking this drug." d. "I should stop taking this drug when my symptoms are gone."

d. "I should stop taking this drug when my symptoms are gone."

An adolescent patient with moderate acne has begun a regimen consisting of combination clindamycin/benzoyl peroxide [BenzaClin] and tretinoin [Retin-A]. Which statement by the patient indicates understanding of this medication regimen? a. "I should apply the Retin-A immediately after bathing." b. "I should apply the Retin-A twice daily." c. "I should augment this therapy with an abrasive soap." d. "I should use sunscreen every day."

d. "I should use sunscreen every day."

A nurse is discussing microbial resistance among sulfonamides and trimethoprim with a nursing student. Which statement by the student indicates a need for further teaching? a. "Bacterial resistance to trimethoprim is relatively uncommon." b. "Resistance among gonococci, streptococci, and meningococci to sulfonamides is high." c. "Resistance to both agents can occur by spontaneous mutation of organisms." d. "Resistance to sulfonamides is less than resistance to trimethoprim."

d. "Resistance to sulfonamides is less than resistance to trimethoprim."

A patient has endocarditis and is taking gentamicin. The nurse will be sure to monitor which of the following? A) Potassium level B) Creatinine clearance C) Serum albumin level D) Prothrombin time

B) Creatinine clearance

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 of the following would a nurse assess for in a patient who is taking polymyxin B systemically? A) Peripheral neuropathy B) Nephrotoxicity and hepatotoxicity C) Hyperkalemia and hyponatremia D) Endocarditis and hypertension

B) Nephrotoxicity and hepatotoxicity

patient has been prescribed penicillin G for pharyngitis. She is upset that she has to take the antibiotic around the clock. The nurse will base her response to the patient on the fact that penicillin G: A) Has an average peak drug effect of 4 hours B) Needs to bind to plasma protein C) Is rapidly cleared unchanged from the plasma by the kidneys D) Does not penetrate the blood-brain barrier

C) Is rapidly cleared unchanged from the plasma by the kidneys

A patient has been prescribed daptomycin for a complicated skin infection. Which of the following will the nurse advise the patient to report immediately? A) Nausea and vomiting B) Palpitations C) Muscle pain or tingling D) Abdominal pain

C) Muscle pain or tingling

A 15-year-old patient has meningitis caused by Haemophilus influenzae. She is being treated with chloramphenicol. The most important nursing action for this patient would be to monitor: A) Blood sugar levels daily B) Liver enzymes monthly C) Plasma concentrations weekly D) Urine output daily

C) Plasma concentrations weekly

A 48-year-old female patient has acute pyelonephritis. Her urine pH is below 5.5, which indicates that it is acidic. Which of the following medications would serve to decrease the acidity of her urine? A) A sulfonamide B) Dihydrofolic acid C) Sodium bicarbonate D) Gentamicin

C) Sodium bicarbonate

A 34-year-old female patient is taking oral cephradine, a first-generation cephalosporin, at regular intervals with a 2-hour gap before meals. The patient reports gastrointestinal distress. The nurse will encourage the patient to: A) Drink plenty of fluids. B) Change the drug dosage. C) Take the drug with food. D) Administer the drug intravenously.

C) Take the drug with food.

A 24-year-old woman has a severe sinus infection and is being treated with ciprofloxacin. The nurse will instruct the patient to: A) Take the drug every 10 hours on an empty stomach. B) Stop the drug 24 hours after she feels better. C) Use a backup form of contraception in addition to birth control pills. D) Take the drug only at night.

C) Use a backup form of contraception in addition to birth control pills.

A 7-year-old 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

Tobie presents to clinic with moderate acne. He has been using OTC benzoyl peroxide at home with minimal improvement. A topical antibiotic (clindamycin) and a topical retinoid adapalene (Differin) are prescribed. Education of Tobie would include: A. He should see an improvement in his acne within the first 2 weeks of treatment B. If there is no response in a week, double the daily application of adapalene (Differin) C. He may see an initial worsening of his acne that will improve in 6 to 8 weeks D. Adapalene may cause bleaching of clothing

C. He may see an initial worsening of his acne that will improve in 6 to 8 weeks

A nurse works in a community setting where she follows patients who have TB. Which of the following patients would require the most follow-up from rifampin therapy? A) A new mother who is nursing B) A 45-year-old man C) A cancer patient D) An HIV-positive patient

D) An HIV-positive patient

A patient is receiving vancomycin (Vancocin) intravenously. The nurse will administer the medication over a period of: A) 1 minute B) 10 minutes C) 30 minutes D) 60 minutes

D) 60 minutes

A 58-year-old man has a severe bone infection in his big toe. The physician has ordered ciprofloxacin. The nursing history indicates that the patient has a pre-existing anemia. The nurse will inform the patient that he will need to have which of the following? A) An electrocardiogram B) A skin examination C) A 24-hour diet analysis D) A complete blood count

D) A complete blood count

Which nursing instruction related to photosensitivity is highest priority for the client receiving a sulfonamide? a. "Use a high SPF sunblock when out in the sun." b. "Avoid driving during daylight hours." c. "Take vitamin D to prevent photosensitivity." d. "Apply a moisturizer before going outside."

a. "Use a high SPF sunblock when out in the sun."

The client has been ordered Cefazolin. The nurse anticipates an increase in the client's _____ from this medication? a. BUN and serum creatinine b. serum potassium c. serum calcium d. serum white blood cells

a. BUN and serum creatinine

Most beta-lactam antibiotics are excreted through the kidneys. The nurse should assess the client's renal function by monitoring which levels? a. Blood urea nitrogen and serum creatinine b. Creatinine phosphokinase and alkaline phosphatase c. White blood cell count and red blood cell count d. Hemoglobin and hematocrit

a. Blood urea nitrogen and serum creatinine

Photosensitivity is a major complication of tetracycline (Sumycin). In providing client teaching, the nurse should suggest that the client ________ while on the medication. a. avoid direct sunlight b. wear a hat and long sleeves in the sun c. use a tanning bed only with supervision d. use a suntan lotion with a high SPF

a. avoid direct sunlight

The client has been placed on tetracycline (Sumycin) for acne control. In planning a dosage schedule, the nurse anticipates that the client will be taking: a. low doses over a period of months. b. low doses for 3 to 4 weeks. c. high doses for 10 days to 2 weeks. d. high doses for at least 1 year.

a. low doses over a period of months.

A nurse is explaining to nursing students why a cephalosporin is used in conjunction with an aminoglycoside for a patient with an infection. Which statement by a student indicates understanding of the teaching? a. "Cephalosporins enhance the actions of aminoglycosides by weakening bacterial cell walls." b. "Cephalosporins prevent neuromuscular blockade associated with aminoglycosides." c. "Cephalosporins prolong the postantibiotic effects of the aminoglycosides so doses can be decreased." d. "Cephalosporins reduce bacterial resistance to aminoglycosides."

a. "Cephalosporins enhance the actions of aminoglycosides by weakening bacterial cell walls."

A female patient will be starting therapy with oral isotretinoin (Amnesteem) as part of treatment for severe acne, and the nurse is providing teaching. Which teaching point will the nurse include in her teaching plan about isotretinoin? a. "You will have to use two contraceptive methods while on this drug." b. "You must avoid sexual activity while on this drug." c. "You will have to avoid pregnancy for 2 weeks after taking this drug." d. "If you are taking an oral contraceptive, you may take this drug."

a. "You will have to use two contraceptive methods while on this drug."

A patient who is taking gentamicin and a cephalosporin for a postoperative infection requests medication for mild postsurgical pain. The nurse will expect to administer which of the following medications? a. Acetaminophen b. Aspirin c. Ibuprofen d. Morphine

a. Acetaminophen Gentamicin and cephalosporins are both nephrotoxic. This patient should avoid taking other potentially nephrotoxic drugs. Acetaminophen is not nephrotoxic and may be given for mild pain. Aspirin and ibuprofen are both nephrotoxic. Morphine is not nephrotoxic but is not indicated for mild pain.

An adolescent has recently been experiencing pimples. The nurse notes several closed comedones across the patient's forehead and on the nose. The nurse will expect to teach this patient about the use of which medication? a. Benzoyl peroxide b. Topical clindamycin c. Topical erythromycin d. Topical retinoids

a. Benzoyl peroxide

Which side effect of clindamycin [Cleocin] causes the most concern and may warrant discontinuation of the drug? a. Diarrhea b. Headache c. Nausea d. Vomiting

a. Diarrhea

A 55-year-old obese patient was diagnosed with candidiasis in the skin folds under her breasts. When the nurse sees her at a follow-up visit 2 months later, she complains that it has returned. She said she applied the medicine for 1 week and stopped because the itching stopped and the cream was messy. Which statement is true regarding fungal infections of the skin? a. Fungal infections often require prolonged therapy. b. The patient has a new infection now. c. The patient needs to apply a dressing if the cream is too messy. d. This infection will probably never be cured.

a. Fungal infections often require prolonged therapy.

A 65-year-old patient who receives glucocorticoids for arthritis is admitted to the hospital for treatment of a urinary tract infection. The prescriber has ordered intravenous ciprofloxacin [Cipro]. Before administering the third dose of this drug, the nurse reviews the bacterial culture report and notes that the causative organism is Escherichia coli. The bacterial sensitivity report is pending. The patient complains of right ankle pain. What will the nurse do? a. Withhold the dose of ciprofloxacin and notify the provider of the patient's symptoms. b. Instruct the patient to exercise the right foot and ankle to minimize the pain. c. Question the patient about the consumption of milk and any other dairy products. d. Request an order to increase this patient's dose of glucocorticoids.

a. Withhold the dose of ciprofloxacin and notify the provider of the patient's symptoms.

A patient who is receiving intravenous ciprofloxacin for pneumonia develops diarrhea. A stool culture is positive for Clostridium difficile. The nurse will expect the provider to: a. add metronidazole [Flagyl]. b. increase the dose of ciprofloxacin. c. restrict dairy products. d. switch to gemifloxacin.

a. add metronidazole [Flagyl].

A child with an ear infection is not responding to treatment with amoxicillin [Amoxil]. The nurse will expect the provider to order: a. amoxicillin-clavulanic acid [Augmentin]. b. ampicillin. c. nafcillin. d. penicillin G [Benzylpenicillin].

a. amoxicillin-clavulanic acid [Augmentin].

A patient with high-risk factors for tuberculosis will begin therapy for latent TB with isoniazid and rifampin. The nurse learns that this patient takes oral contraceptives. The nurse will counsel this patient to discuss ____ with her provider. a. another birth control method b. reducing the rifampin dose c. reducing the isoniazid dose d. increasing the oral contraceptive dose

a. another birth control method

A patient who has been receiving intravenous gentamicin for several days reports having had a headache for 2 days. The nurse will request an order to: a. discontinue the gentamicin. b. obtain a gentamicin trough before the next dose is given c. give an analgesic to control headache discomfort. d. obtain renal function tests to evaluate for potential nephrotoxicity.

a. discontinue the gentamicin. A persistent headache may be a sign of developing ototoxicity, and since ototoxicity is largely irreversible, gentamicin should be withdrawn at the first sign of developing ototoxicity. A gentamicin trough should be obtained before the next dose is given when high gentamicin levels are suspects. Analgesics are not indicated until a serious cause of the headache has been ruled out. A headache is an early sign of ototoxicity, not nephrotoxicity.

During drug therapy for pneumonia, a female patient develops a vaginal superinfection. The nurse explains that this infection is caused by: a. large doses of antibiotics that kill normal flora. b. the infection spreading from her lungs to the new site of infection. c. resistance of the pneumonia-causing bacteria to the drugs. d. an allergic reaction to the antibiotics.

a. large doses of antibiotics that kill normal flora.

The nurse is providing teaching to a patient who will begin taking a cephalosporin to treat an infection. Which statement by the patient indicates a need for further teaching? a. "I may stop taking the medication if my symptoms clear up." b. "I should eat yogurt while taking this medication." c. "I should stop taking the drug and call my provider if I develop a rash." d. "I will not consume alcohol while taking this medication."

a. "I may stop taking the medication if my symptoms clear up."

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.

The nurse is preparing to administer the first dose of intravenous ceftriaxone (Rocephin) to a patient. When reviewing the patient's chart, the nurse notes that the patient previously experienced a rash when taking amoxicillin. What is the nurse's next action? a. Administer the drug and observe closely for hypersensitivity reactions. b. Ask the provider whether a cephalosporin from a different generation may be used. c. Contact the provider to report drug hypersensitivity. d. Notify the provider and suggest an oral cephalosporin.

a. Administer the drug and observe closely for hypersensitivity reactions. A small percentage of patients who are allergic to penicillin could also be allergic to a cephalosporin product. Patients should be monitored closely after receiving a cephalosporin if they are allergic to penicillin. There is no difference in hypersensitivity potential between different generations or method of delivery of cephalosporins.

A patient is receiving high doses of a cephalosporin. Which laboratory values will this patient's nurse monitor closely? a. Blood urea nitrogen (BUN), serum creatinine, and liver function tests b. Complete blood count and electrolytes c. Serum calcium and magnesium d. Serum glucose and lipids

a. Blood urea nitrogen (BUN), serum creatinine, and liver function tests

The nurse is preparing to give trimethoprim-sulfamethoxazole (TMP-SMX) to a patient and notes a petechial rash on the patient's extremities. The nurse will perform which action? a. Hold the dose and notify the provider. b. Request an order for a blood glucose level. c. Request an order for a BUN and creatinine level. d. Request an order for diphenhydramine (Benadryl).

a. Hold the dose and notify the provider.

The nurse is caring for a patient who is receiving an intravenous antibiotic. The patient has a serum drug trough of 1.5 mcg/mL. The normal trough for this drug is 1.7 mcg/mL to 2.2 mcg/mL. What will the nurse expect the patient to experience? a. Inadequate drug effects b. Increased risk for superinfection c. Minimal adverse effects d. Slowed onset of action

a. Inadequate drug effects

A patient is admitted to the hospital for treatment of pneumonia after complaining of high fever and shortness of breath. The patient was not able to produce sputum for a culture. The nurse will expect the patient's provider to order a. a broad-spectrum antibiotic. b. a narrow-spectrum antibiotic. c. multiple antibiotics. d. the pneumococcal vaccine.

a. a broad-spectrum antibiotic.

The nurse is caring for a patient who has recurrent urinary tract infections. The patient's current infection is not responding to an antibiotic that has been used successfully several times in the past. The nurse understands that this is most likely due to a. acquired bacterial resistance. b. cross-resistance. c. inherent bacterial resistance. d. transferred resistance.

a. acquired bacterial resistance.

A female patient has been taking isotretinoin (Amnesteem) for 3 months. During a follow-up appointment, which statement by the patient would be of highest concern to the nurse? a. "I am using two forms of contraception while on this drug." b. "I have been feeling rather down and lonely lately." c. "I wish I didn't have to be on this medication." d. "It's scary to know that this drug can cause birth defects."

b. "I have been feeling rather down and lonely lately."

A patient will receive oral ciprofloxacin [Cipro] to treat a urinary tract infection. The nurse provides teaching for this patient. Which statement by the patient indicates a need for further teaching? a. "I may have abdominal pain and nausea, but these are usually mild." b. "I should take this medication with food or milk to improve absorption." c. "I should stop taking the medication immediately if I experience heel pain." d. "I will need to use sunscreen every time I go outdoors."

b. "I should take this medication with food or milk to improve absorption."

A teenage boy is taking tretinoin (Retin-A) for acne. Which statement will the nurse include in the teaching plan? a. "Avoid foods that are heavy in salt and oils." b. "This drug may cause increased redness of your skin." c. "Try using an abrasive cleanser to remove old skin layers." d. "Being out in the sunlight will help your skin heal."

b. "This drug may cause increased redness of your skin."

A teenaged female patient has begun to develop acne and asks a nurse how to minimize pimple formation. What will the nurse recommend? a. Asking the provider about oral contraceptives b. Cleansing the face gently 2 to 3 times daily c. Eliminating greasy foods from the diet d. Using an abrasive agent to scrub the face

b. Cleansing the face gently 2 to 3 times daily

A 14-year-old patient has moderate acne that has not responded to topical drugs. The nurse will suggest that the patient and her parents discuss which treatment with the provider? a. Combination oral contraceptive medication b. Doxycycline [Vibramycin] c. Isotretinoin [Accutane] d. Spironolactone

b. Doxycycline [Vibramycin]

A patient will begin initial treatment for severe acne. Which regimen will the nurse expect the provider to order? a. Clindamycin/benzoyl peroxide [BenzaClin] and tretinoin [Retin-A] b. Doxycycline [Vibramycin] and tretinoin [Retin-A] c. Erythromycin [Ery-Tab) and benzoyl peroxide d. Topical clindamycin and isotretinoin [Accutane]

b. Doxycycline [Vibramycin] and tretinoin [Retin-A] Oral antibiotics are used for moderate to severe acne and are usually combined with a topical retinoid. Combination clindamycin/benzoyl peroxide and tretinoin are used for mild to moderate acne. Erythromycin can be used as an oral antibiotic but would need to be combined with a topical retinoid. Isotretinoin is used for severe acne that has not responded to other treatments.

An adolescent has begun using benzoyl peroxide lotion twice daily to treat acne. The patient reports experiencing drying and burning of the skin. What will the nurse suggest? a. Applying lotion to the skin after applying the drug b. Reducing the frequency to one application a day c. Discontinuing the medication, because this is likely an allergic reaction d. Requesting a prescription for a gel formulation of the drug

b. Reducing the frequency to one application a day

The nurse assumes care for a patient who is currently receiving a dose of intravenous vancomycin (Vancocin) infusing at 20 mg/min. The nurse notes red blotches on the patient's face, neck, and chest and assesses a blood pressure of 80/55 mm Hg. Which action will the nurse take? a. Request an order for IV epinephrine to treat anaphylactic shock. b. Slow the infusion to 10 mg/min and observe the patient closely. c. Stop the infusion and obtain an order for a BUN and serum creatinine. d. Suspect Stevens-Johnson syndrome and notify the provider immediately.

b. Slow the infusion to 10 mg/min and observe the patient closely. When vancomycin is infused too rapidly, "red man" syndrome may occur; the rate should be 10 mg/min to prevent this. This is a toxic reaction, not an allergic one, so epinephrine is not indicated. Stevens-Johnson syndrome is characterized by a rash and fever. Red man syndrome is not related to renal function.

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.

The client is being treated with Bactrim. The nurse should anticipate seeing an increase in the client's serum: a. glucose. b. potassium. c. BUN and creatinine. d. calcium.

c. BUN and creatinine.

A client is diagnosed with acne. The client expresses concern to the nurse that he has not yet been placed on medication. The nurse explains to the client that the initial nonpharmacologic approach for treating acne vulgaris includes: a. application of large doses of vitamin A. b. application of large doses of vitamin C. c. cleansing of the skin gently several times a day. d. vigorously scrubbing skin in the morning and at bedtime.

c. cleansing of the skin gently several times a day.

The client will be prescribed a tetrocycline. The nurse anticipates that this medication will be given: a. with each meal. b. with extra water. c. on an empty stomach. d. one half-hour after meals.

c. on an empty stomach.

A patient who is taking immunosuppressant medications develops a urinary tract infection. The causative organism is sensitive to sulfonamides and to another, more expensive antibiotic. The prescriber orders the more expensive antibiotic. The nursing student assigned to this patient asks the nurse why the more expensive antibiotic is being used. Which response by the nurse is correct? a. "Immunosuppressed patients are folate deficient." b. "Patients who are immunosuppressed are more likely to develop resistance." c. "Sulfonamides are bacteriostatic and depend on host immunity to work." d. "Sulfonamides intensify the effects of immunosuppression."

c. "Sulfonamides are bacteriostatic and depend on host immunity to work."

A nurse preparing to administer intravenous gentamicin to a patient notes that the dose is half the usual dose for an adult. The nurse suspects that this is because this patient has a history of: a. antibiotic resistance. b. interpatient variation. c. liver disease. d. renal disease.

d. renal disease.

A patient has severe acne that has been refractory to treatment. The patient is taking tetracycline and using topical tretinoin [Retin-A] and has been applying benzoyl peroxide twice daily. The provider asks the nurse to teach this patient about isotretinoin [Accutane], which the patient will begin taking in a few weeks. The nurse will include which statement when teaching this patient about this drug? a. "Alcohol may be consumed in moderation when taking this drug." b. "Skin rash, headache, and hair loss are common with this drug." c. "Tetracycline must be discontinued before beginning the isotretinoin." d. "Two pregnancy tests are required before each monthly refill of your prescription."

c. "Tetracycline must be discontinued before beginning the isotretinoin."

When reviewing the allergy history of a patient, the nurse notes that the patient is allergic to penicillin. Based on this finding, the nurse would question an order for which class of antibiotics? a. Tetracyclines b. Sulfonamides c. Cephalosporins d. Quinolones

c. Cephalosporins

A nurse is caring for a patient who takes an ACE inhibitor and an ARB medication who will begin taking TMP/SMZ to treat a urinary tract infection. Which serum electrolyte will the nurse expect to monitor closely? a. Calcium b. Chloride c. Potassium d. Sodium

c. Potassium

A nurse is reviewing the culture results of a patient receiving an aminoglycoside. The report reveals an anaerobic organism as the cause of infection. What will the nurse do? a. Contact the provider to discuss an increased risk of aminoglycoside toxicity. b. Continue giving the aminoglycoside as ordered. c. Request an order for a different class of antibiotic. d. Suggest adding a penicillin to the patient's drug regimen.

c. Request an order for a different class of antibiotic.

A patient has a urinary tract infection. The nurse knows that which class of drugs is especially useful for such infections? a. Macrolides b. Carbapenems c. Sulfonamides d. Tetracyclines

c. Sulfonamides

A patient with type 2 diabetes mellitus takes glipizide. The patient develops a urinary tract infection, and the prescriber orders TMP/SMZ. What will the nurse tell the patient? a. Patients with diabetes have an increased risk of an allergic reaction. b. Patients taking TMP/SMZ may need increased doses of glipizide. c. The patient should check the blood glucose level more often while taking TMP/SMZ. d. The patient should stop taking the glipizide while taking the TMP/SMZ.

c. The patient should check the blood glucose level more often while taking TMP/SMZ.

patient who has been hospitalized for 2 weeks has developed a pressure ulcer that contains multidrug-resistant Staphylococcus aureus (MRSA). Which drug would the nurse expect to be chosen for therapy? a. Metronidazole (Flagyl) b. Ciprofloxacin (Cipro) c. Vancomycin (Vancocin) d. Tobramycin (Nebcin)

c. Vancomycin (Vancocin)

A patient with bronchitis is taking TMP/SMZ, 160/800 mg orally, twice daily. Before administering the third dose, the nurse notes that the patient has a widespread rash, a temperature of 103°F, and a heart rate of 100 beats per minute. The patient looks ill and reports not feeling well. What will the nurse do? a. Administer the dose and request an order for an antipyretic medication. b. Withhold the dose and request an order for an antihistamine to treat the rash. c. Withhold the dose and notify the provider of the symptoms. d. Request an order for intravenous TMP/SMZ, because the patient is getting worse.

c. Withhold the dose and notify the provider of the symptoms. The most severe hypersensitivity reaction with TMP/SMZ is Stevens-Johnson syndrome, which manifests with fever, malaise, and rash. The drug should be discontinued immediately if a rash occurs. Requesting an antipyretic while giving the drug is incorrect. Giving antihistamines is not indicated. Giving TMP/SMZ intravenously would make the reaction worse.

A patient who is taking doxycycline for a serious infection contacts the nurse to report anal itching. The nurse will contact the provider to discuss: a. adding an antihistamine to the patient's drug regimen. b. ordering liver function tests to test for hepatotoxicity. c. prescribing an antifungal drug to treat a superinfection. d. testing the patient for a C. difficile secondary infection.

c. prescribing an antifungal drug to treat a superinfection. A superinfection occurs secondary to suppression of drug-sensitive organisms. Overgrowth with fungi, especially Candida albicans, is common and may occur in the mouth, pharynx, vagina, and bowel. Anal itching is a sign of such an infection, not a sign of hepatotoxicity. Antihistamines will not treat the cause. C. difficile is characterized by profuse, watery diarrhea.

To prevent yellow or brown discoloration of teeth in children, tetracyclines should not be given: a. to children once the permanent teeth have developed. b. to patients taking calcium supplements. c. to pregnant patients after the fourth month of gestation. d. with dairy products or antacids.

c. to pregnant patients after the fourth month of gestation.

The nurse is teaching a nursing student about the minimal effective concentration (MEC) of antibiotics. Which statement by the nursing student indicates understanding of this concept? a. "A serum drug level greater than the MEC ensures that the drug is bacteriostatic." b. "A serum drug level greater than the MEC broadens the spectrum of the drug." c. "A serum drug level greater than the MEC helps eradicate bacterial infections." d. "A serum drug level greater than the MEC increases the therapeutic index."

c. "A serum drug level greater than the MEC helps eradicate bacterial infections."

The nurse is preparing to administer amoxicillin (Amoxil) to a patient and learns that the patient previously experienced a rash when taking penicillin. Which action will the nurse take? a. Administer the amoxicillin and have epinephrine available. b. Ask the provider to order an antihistamine. c. Contact the provider to discuss using a different antibiotic. d. Request an order for a beta-lactamase resistant drug.

c. Contact the provider to discuss using a different antibiotic.

A patient is diagnosed with mycoplasma pneumonia. Which antibiotic will the nurse expect the provider to order to treat this infection? a. Azithromycin (Zithromax) b. Clarithromycin (Biaxin) c. Erythromycin (E-Mycin) d. Fidaxomicin (Dificid)

c. Erythromycin (E-Mycin)

The nurse is preparing to give a dose of oral clindamycin (Cleocin) to a patient who is being treated for a skin infection caused by Staphylococcus aureus. The patient has had several doses of the medication and reports having nausea. Which action will the nurse take next? a. Administer the next dose when the patient has an empty stomach. b. Hold the next dose and contact the patient's provider. c. Instruct the patient to take the next dose with a full glass of water. d. Request an order for an antacid to give along with the next dose.

c. Instruct the patient to take the next dose with a full glass of water.

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 drug's 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.

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.

A patient who is taking trimethoprim-sulfamethoxazole (TMP-SMX) calls to report developing an all-over rash. The nurse will instruct the patient to perform which action? a. Increase fluid intake. b. Take diphenhydramine. c. Stop taking TMP-SMX immediately. d. Continue taking the medication.

c. Stop taking TMP-SMX immediately.

A child has been diagnosed with impetigo, a skin infection. The nurse anticipates that which drug will be used to treat this condition? a. Spinosad (Natroba) b. Nystatin (Mycostatin) c. Acyclovir (Zovirax) d. Bacitracin

d. Bacitracin

The nurse is reviewing the medication orders for a patient who will be receiving streptomycin therapy. Which other medication or medication class, if ordered, would be a potential interaction concern? a. Calcium channel blockers b. Phenytoin c. Proton pump inhibitors d. Loop diuretics

d. Loop diuretics

A nurse is performing a physical assessment on a patient with tuberculosis who takes rifampin [Rifadin]. What would be an expected finding? a. Crystalluria b. Myopathy c. Peripheral neuropathy d. Red-orange-tinged urine

d. Red-orange-tinged urine

A child has been receiving chloramphenicol for a Neisseria meningitidis central nervous system (CNS) infection. The nurse administers the dose and subsequently notes that the child has vomited and appears dusky and gray in color. The child's abdomen is distended. What will the nurse do? a. Contact the provider for an order to obtain a chloramphenicol level. b. Notify the provider that the child's meningitis is worsening. c. Recognize this as initial signs of a C. difficile infection. d. Stop the infusion immediately and notify the provider.

d. Stop the infusion immediately and notify the provider.

The nurse is caring for a patient who will begin receiving intravenous ciprofloxacin [Cipro] to treat pyelonephritis. The nurse learns that the patient has a history of myasthenia gravis. Which action by the nurse is correct? a. Administer the ciprofloxacin and monitor the patient for signs of muscle weakness. b. Ask the provider whether the ciprofloxacin can be given orally. c. Request an order for concurrent administration of metronidazole [Flagyl]. d. Suggest that the provider order a different antibiotic for this patient.

d. Suggest that the provider order a different antibiotic for this patient.

A 79-year-old patient is receiving a quinolone as treatment for a complicated incision infection. The nurse will monitor for which adverse effect that is associated with these drugs? a. Neuralgia b. Double vision c. Hypotension d. Tendonitis and tendon rupture

d. Tendonitis and tendon rupture

A nurse is preparing to administer oral ofloxacin to a patient. While taking the patient's medication history, the nurse learns that the patient takes warfarin and theophylline. The correct action by the nurse is to request an order to: a. reduce the dose of ofloxacin. b. increase the dose of ofloxacin. c. increase the dose of theophylline. d. monitor coagulation levels.

d. monitor coagulation levels.

A nurse is obtaining a drug history from a patient about to receive sulfadiazine. The nurse learns that the patient takes warfarin, glipizide, and a thiazide diuretic. Based on this assessment, the nurse will expect the provider to: a. change the antibiotic to TMP/SMZ. b. increase the dose of the glipizide. c. monitor the patient's electrolytes closely. d. monitor the patient's coagulation levels.

d. monitor the patient's coagulation levels.

The nurse is caring for a patient who is receiving an intravenous antibiotic. The nurse notes that the provider has ordered serum drug peak and trough levels. The nurse understands that these tests are necessary for which type of drugs? a. Drugs with a broad spectrum b. Drugs with a narrow spectrum c. Drugs with a broad therapeutic index d. Drugs with a narrow therapeutic index

d. Drugs with a narrow therapeutic index Medications with a narrow therapeutic index have a limited range between the therapeutic dose and a toxic dose. It is important to monitor these medications closely by evaluating regular serum peak and trough levels.

The nurse is preparing to give a dose of a cephalosporin medication to a patient who has been receiving the antibiotic for 2 weeks. The nurse notes ulcers on the patient's tongue and buccal mucosa. Which action will the nurse take? a. Hold the drug and notify the provider. b. Obtain an order to culture the oral lesions. c. Gather emergency equipment to prepare for anaphylaxis. d. Report a possible superinfection side effect of the cephalosporin.

d. Report a possible superinfection side effect of the cephalosporin.

The nurse is caring for a 7-year-old patient who will receive oral antibiotics. Which antibiotic order will the nurse question for this patient? a. Azithromycin (Zithromax) b. Clarithromycin (Biaxin) c. Clindamycin (Cleocin) d. Tetracycline (Sumycin)

d. Tetracycline (Sumycin) Tetracyclines should not be given to children younger than 8 years of age because they irreversibly discolor the permanent teeth.

A female patient will receive doxycycline to treat a sexually transmitted illness (STI). What information will the nurse include when teaching this patient about this medication? a. Nausea and vomiting are uncommon adverse effects. b. The drug may cause possible teratogenic effects. c. Increase intake of dairy products with each dose of this medication. d. Use a backup method of contraception if taking oral contraceptives.

d. Use a backup method of contraception if taking oral contraceptives.