Pharmacology Chapter 52: Antidiabetics Nursing School Test Banks, PHARM Anti-inflammatories, PHARM Anti-tubercular Drugs, PHARM Chapter 26A - Penicillins and Cephalosporins, PHARM Dermatological Disorders, Pharmacology Chapter 30: Macrolides, Tetracy...

The nurse is reviewing a patient's chart prior to administering gentamycin (Garamycin) and notes that the last serum peak drug level was 9 mcg/mL and the last trough level was 2 mcg/mL. What action will the nurse take? a.Obtain repeat peak and trough levels before giving the next dose. b.Report a decreased drug therapeutic level to the patient's provider. c.Report possible drug toxicity to the patient's provider. d.Administer the next dose as ordered.

C

What are the drug-drug interactions for Amoxicillin?

-Increased effect with aspirin, allopurinol, probenecid -decreased effect with tetracycline, erythromycin -increased bleeding with oral anticoagulants -increased effect of methotrexate --Monitor labs for increased serum AST, ALT (both liver enzymes If the liver is injured or damaged, the liver cells spill these enzymes into the blood, raising the AST and ALT levels and signaling liver disease), BUN and creatinine; increased PT, INR

Patient Teaching - Anti-tubercular Drugs

-Tell patients who take INH to take drug 1 hours before meals or 2 hours after meals for better absorption -Direct to take as prescribed to prevent resistance. -Do not take antacids, will decrease absorption -Avoid alcohol d/t increased risk for hepatotoxicity -Sputum testing important for evaluating drug / tx regimen effectiveness -Warn patients contemplating pregnancy to first check with provider about taking TB drugs ethambutol and rifampin (both first line drugs, but adverse effects with pregnancy) -Report s/s of peripheral neuropathy -- happens with INH -- Vit. B6 will prevent/correct this. -Avoid sunlight to dec. risk for photosensitivity -Rifampin can make urine, feces, saliva, etc ORANGE - will dye contact lenses permenantly -When taking Ethambutol, advise patient to do 1 (single) daily dose and do not split it up, in order to prevent visual disturbances!! -Advise that family members in close contact get TB skin test and get prophylactic drug for 6months to a year. WHEN EVALUATING effectiveness of TB drugs, sputum specimens for acid-fast bacilli should be negative after taking anti tubercular drugs for SEVERAL WEEKS OR MONTHS. (3 months?)

A patient will begin taking streptomycin as part of the medication regimen to treat tuberculosis. Before administering this medication, the nurse will review which laboratory values in the patient's medical record? a.Complete blood count (CBC) with differential white cell count b.Potassium and magnesium levels c.Blood urea nitrogen (BUN) and creatinine d.Serum fasting glucose

C

A patient will take an anthelmintic medication and asks the nurse about side effects. The nurse will tell the patient that anthelmintic drugs a.have many serious adverse reactions. b.can cause hepatic toxicity. c.commonly have gastrointestinal (GI) side effects. d.cause orthostatic hypotension.

C

The nurse is caring for a hospitalized patient who has symptoms characteristic of pyelonephritis. Before administering the first dose of the intravenous antibiotic, the nurse will ensure that which action is performed? a.An antipyretic is administered. b.A dose of oral antibiotic is given. c.A urine culture is obtained. d.A urinary analgesic is given.

C

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.inherent bacterial resistance. b.transferred resistance. c.acquired bacterial resistance. d.cross-resistance.

C

The nurse is preparing to administer methenamine (Hiprex) to a patient who has pyelonephritis. Which action will the nurse perform? a.Monitor the patient's urine for dark brown color. b.Order alkaline foods 3 times daily. c.Increase fluid intake to 2000 mL per day. d.Request an order for a sulfonamide antibiotic

C

What is infliximab used to treat?

Infliximab can treat -rheumatoid arthritis, -psoriatic arthritis, -ankylosing spondylitis, -Crohn's disease, -plaque psoriasis, and -ulcerative colitis.

The nurse is caring for several patients who are receiving antibiotics. Which order will the nurse question?

a. Azithromycin (Zithromax) 500 mg IV in 500 mL fluid b. Azithromycin (Zithromax) 500 mg PO once daily c. Erythromycin 300 mg IM QID d. Erythromycin 300 mg PO QID THE ANSWER IS c. Erythromycin 300 mg IM QID

The nurse is caring for a patient who is receiving a high dose of tetracycline (Sumycin). Which laboratory values will the nurse expect to monitor while caring for this patient?

a. Blood urea nitrogen (BUN) and creatinine levels b. Complete blood counts c. Electrolytes d. Liver enzyme levels THE ANSWER IS a. Blood urea nitrogen (BUN) and creatinine levels

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 THE ANSWER IS c. Liver enzymes

A patient is diagnosed with influenza and will begin taking a neuraminidase inhibitor. The nurse knows that this drug is effective when taken within how many hours of onset of flu symptoms? a.24 hours b.12 hours c.48 hours d.72 hours

C

RN teaching patient about taking aspirin. What should they include in the teaching?

1. Avoid alcohol 2. Do NOT take on empty stomach (GI irritation) 3. Inform dentist of aspirin dosage before having dental work 4. Inform surgeon of aspirin dosage before having surgery (see book for more)

What are the three types of penicillins? What type of penicillin is piperacillin tazobactam?

1. Basic Penicillins (pen G procain, pen G benzathine, pen G sodium, pen VK) 2. Broad-Spectrum Penicillins (Amoxicillin, Ampicillin and derivatives) 3. Penicillinase-Resistant Penicillins (treats bacterial infections that are resistant to penicillins, include: Dicloxacilian sodium, Nafcillin, Oxacillin sodium) 4. Extended-Spectrum Penicillins (Piperacillin tazobactam)

What are the side effects for infliximab?

1. Fatigue 2. Headache 3. Chest Pain 4. Severe Infections

Problems related to Antibiotic Resistance

1. Mutant bacterial strain may have grown a thicker wall after replication. 2. Bacteria may transfer their genetic instructions to another bacterial species, making that species resistant to the same bacteria as well -- This means it can pass its high resistance on to a more virulent and aggressive bacterium as well. 3. Misuse and over-prescribing the drug (which is why patient education is so important -- take full dose, for full time, don't prescribe if it is a virus)

What are the three major ADVERSE REACTIONS to antibacterial drug administration? Example of one of these reactions?

1. allergic (hypersensitivity, anaphylaxis) reactions 2. superinfection (fungal infections frequently result in superinfections) 3. organ toxicity (liver and kidneys are involved in drug metabolism and excretion, and antibacterials may damage them. -- ahminoglycosides can be nephrotoxic and ototoxic)

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.Notify the provider and suggest an oral cephalosporin. c.Ask the provider whether a cephalosporin from a different generation may be used. d.Contact the provider to report drug hypersensitivity.

A

A patient who is taking acyclovir (Zovirax) to treat an oral HSV-1 infection asks the nurse why oral care is so important. The nurse will tell the patient that meticulous oral care helps to a.shorten the duration of drug therapy. b.reduce viral resistance to the drug. c.prevent gingival hyperplasia. d.minimize transmission of disease.

C

Ways to attack antimicrobial resistance (bacteria that has become resistant to antibacterial medications)... --To solve the issue related to antibiotic resistance, drug companies have been attempted. Oxazolidinones was one of the first, but was too toxic and was not able to be put on market. Another company was able to make the compound less toxic... The new drug is called _________1_________. It is effective against MRSA (methicillin-resistant S.aureus, VREF (vancomycin resistant Enterococcus faecium), and penicillin-resistant streptococci. There is also a drug called ________________2________________ (a combination drug with two streptogramin antibacterials in 30/70 combination), can be used intravenously for life-threatening infections caused by VREF and for treatment of bacteremia, S. aureus and Streptococcus. pyogenes. -- Develop drugs that disable the antibiotic-resistant mechanism in the ___________3___________. Patients would take the antibiotic-resistance disabler along with the antibiotic already on the market, making the drug effective again. --Developing a bacterial vaccine (another way to combat bacteria and lessen the need for abx). The bacterial vaccine against __________4_____________ has been effective in decreasing the occurrence of pneumonia and __________4___________ in various age groups. -Teach patients about proper abx use and when abx are actually needed / what causes resistance, etc. -Multi-antibiotic therapy, or daily use of several antibacterials, delays the development of microorganisms.

1. lizenolid 2. Quinupristin-dalfopristin 3. bacteria 4. pneumococcus 5. meningitis

For Antibacterials: Penicillins, Nursing Interventions include: -Sample and culture before abx started -Monitor for s/s of _____1_____ (stomatitis, genital discharge, or anal/genital itching - *Examine the patient for allergic rxn to the penicillin product, especially after their first and second doses. This may be a mild reaction, such as __2__, or a severe reactions such as ____3____ and ____4___. - *Have ___5_____ available to counteract a severe rxn. -Do NOT mix ____6_____ with high-dose or extended-spectrum penicillin G because the combination may inactivate the _______6_____. -Assess patient for bleeding if high doses of penicillin are being given (because a decreased in platelet aggregation may occur (decrease in clotting)). -Monitor body temperature and the infected area. -Dilute abx for IV use in an appropriate amount of solution as indicated.

1. superinfection 2. rash 3. respiratory distress 4. anaphylaxis 5. epinephrine 6. aminoglycosides

A child is being treated for pinworms, and the parent asks the nurse how to prevent spreading this to other family members. What will the nurse tell the parent? a."Your child should wash hands well after using the toilet." b."Obtain a daily stool specimen from your child." c."Give your child baths every day." d."Wash your child's clothing in hot water."

A

A child is diagnosed with pinworms. Which anthelmintic drug will the provider order for this child? a.Mebendazole (Vermox) b.Diethylcarbamazine (Hetrazan) c.Praziquantel (Biltricide) d.Bithionol (Bitin)

A

A patient who has completed the first phase of a three-drug regimen for tuberculosis has a positive sputum acid-bacilli test. The nurse will tell the patient that a.it may be another month before this test is negative. b.there may be a need to remain in the first phase of therapy for several weeks. c.the provider will change the pyrazinamide to ethambutol. d.drug resistance has probably occurred.

A

A patient will begin taking a urinary antimuscarinic medication. Which symptom should the patient report immediately? a.Urinary retention b.Fatigue c.Dry mouth d.Increased heart rate

A

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.Slow the infusion to 10 mg/min and observe the patient closely. b.Suspect Stevens-Johnson syndrome and notify the provider immediately. c.Request an order for IV epinephrine to treat anaphylactic shock. d.Stop the infusion and obtain an order for a BUN and serum creatinine.

A

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.Contact the provider to discuss using a different antibiotic. b.Administer the amoxicillin and have epinephrine available. c.Ask the provider to order an antihistamine. d.Request an order for a beta-lactamase resistant drug.

A

The nurse is preparing to administer an antibiotic to a patient who has been receiving the antibiotic for 2 days after a culture was obtained. The nurse notes increased erythema and swelling, and the patient has a persistent high fever of 39° C. What is the nurse's next action? a.Review the sensitivity results from the patient's culture. b.Discuss the need to add a second antibiotic with the provider. c.Administer the antibiotic as ordered. d.Contact the provider to request another culture.

A

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.Instruct the patient to take the next dose with a full glass of water. b.Hold the next dose and contact the patient's provider. c.Request an order for an antacid to give along with the next dose. d.Administer the next dose when the patient has an empty stomach

A

The nurse provides teaching for a patient who will begin taking nitrofurantoin (Macrodantin) to treat a urinary tract infection. Which statement by the patient indicates understanding of the teaching? a."I should take the drug with food and increase my fluid intake." b."If I experience gastrointestinal upset, I may take an antacid." c."I should notify my provider immediately if my urine is brown." d."Tingling of my fingers is a harmless side effect of this drug."

A

The patient has been ordered treatment with rimantadine (Flumadine). The patient has renal impairment. The nurse anticipates what change to the dose of medication? a.Decreased b.Unchanged c.Increased d.Held

A

A patient who is taking metronidazole (Flagyl) reports reddish-brown urine. Which action will the nurse take? a.Test her urine for occult blood. b.Request an order for a urinalysis. c.Reassure the patient that this is a harmless effect. d.Obtain an order for BUN and creatinine levels.

C

A patient who takes an oral sulfonylurea medication will begin taking fluconazole (Diflucan). The nurse will expect to monitor which lab values in this patient? a.Fluconazole levels b.Blood urea nitrogen (BUN) and creatinine c.Glucose d.Electrolytes

C

12.Silver sulfadiazine (Silvadene) is used for the treatment of second- and third-degree burns. The highest priority nursing intervention related to this drug is to monitor for: a. crystalluria. b. dehydration. c. headaches. d. hypertension.

ANS: A Extended use of silver sulfadiazine may lead to crystalluria.

9.The client is being treated with clobetasol propionate (Clobex). In scheduling the clients next appointment with the primary care provider, the nurse recognizes that the clients lesions need to be reassessed in _____ weeks. a.2 b.4 c.6 d.8

ANS: A The lesions should be reassessed after 2 weeks of treatment with the medication.

2.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.

ANS: A The most effective course of tetracycline dosage is low doses of the drug over a period of months.

3. 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

ANS: A To avoid photosensitivity, the client should avoid direct sunlight while she is taking the medication.

10. The nurse is preparing to administer the first dose of intravenous ceftriaxone (Rocephin) to a patient. When reviewing the patients chart, the nurse notes that the patient previously experienced a rash when taking amoxicillin. What is the nurses 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.

ANS: A 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.

4. The nurse is caring for a patient who has recurrent urinary tract infections. The patients 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.

ANS: A Acquired resistance occurs when an organism has been exposed to the antibacterial drug. Cross-resistance occurs when an organism that is resistant to one drug is also resistant to another. Inherent resistance occurs without previous exposure to the drug. Transferred resistance occurs when the resistant genes of one organism are passed to another organism.

8. 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 patients provider to order a. a broad-spectrum antibiotic. b. a narrow-spectrum antibiotic. c. multiple antibiotics. d. the pneumococcal vaccine.

ANS: A Broad-spectrum antibiotics are frequently used to treat infections when the offending organism has not been identified by culture and sensitivity (C&S). Narrow-spectrum antibiotics are usually effective against one type of organism and are used when the C&S indicates sensitivity to that antibiotic. The use of multiple antibiotics, unless indicated by C&S, can increase resistance. The pneumococcal vaccine is used to prevent, not treat, an infection.

14. A patient is receiving high doses of a cephalosporin. Which laboratory values will this patients 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

ANS: A Cefazolin will produce an increase in the patients BUN, creatinine, AST, ALT, ALP, LDH, and bilirubin.

12. A patient who has type 1 diabetes mellitus asks the nurse about using a combination insulin product such as Humalog 75/25. The nurse will tell the patient that use of this product a. depends on individual insulin needs. b. is useful for patient with insulin resistance. c. means less rotation of injection sites. d. requires refrigeration at all times.

ANS: A Combination products are convenient because the patient does not have to mix insulin, but the products depend on individual needs, since the doses are fixed. They are not used for patients with insulin resistance. Patients must continue to rotate injection sites. They do not require refrigeration after first use.

17. A patient who has type 2 diabetes mellitus asks the nurse why the provider has changed the oral antidiabetic agent from tolbutamide (Orinase) to glipizide (Glucotrol). The nurse will explain that glipizide a. has a longer duration of action. b. has fewer gastrointestinal side effects. c. may be taken on an as-needed basis. d. results in less hypoglycemic potential.

ANS: A Glipizide is a second-generation oral antidiabetic agent. It has a longer duration of action than the first-generation antidiabetic agents such as tolbutamide. It has many gastrointestinal side effects. It is taken once daily, not as needed. It has greater hypoglycemic activity than first-generation antidiabetics. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 768 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. The nurse is caring for a patient who is diagnosed with tuberculosis. The patient tells the nurse that the provider plans to order a prophylactic antitubercular drug for family members and asks which drug will be ordered. The nurse will expect the provider to order which drug? a. Isoniazid (INH) b. Pyrazinamide c. Rifampin (Rifadin) d. Streptomycin

ANS: A INH is the drug of choice for prophylactic treatment of patients who have had close contact with a patient who has tuberculosis.

9. A patient is ordered to receive insulin lispro at mealtimes. The nurse will instruct this patient to administer the medication at which time? a. 5 minutes before eating b. 15 minutes after eating c. 30 minutes before eating d. 10 minutes after eating

ANS: A Lispro acts faster than other insulins, and patients should be taught to give this medication not more than 5 minutes before eating.

2. 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

ANS: A Low peak levels may indicate that the medication is below the therapeutic level. They do not indicate altered risk for superinfection, a decrease in adverse effects, or a slowed onset of action.

12. 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.

ANS: A Patients should take all of an antibiotic regimen even after symptoms clear to ensure complete treatment of the infection. Patients are often advised to eat yogurt or drink buttermilk to prevent superinfection. A rash is a sign of hypersensitivity, and patients should be counseled to stop taking the drug and notify the provider if this occurs. Alcohol consumption may cause adverse effects and should be avoided by patients while they are taking cephalosporins.

8. The nurse is teaching a patient about rifampin. Which statement by the patient indicates understanding of the teaching? a. I should not wear soft contact lenses while taking rifampin. b. I will need regular eye examinations while taking this drug. c. I will report orange urine to my provider immediately. d. I understand that renal toxicity is a common adverse effect.

ANS: A Patients taking rifampin should be warned that urine, feces, saliva, sputum, sweat, and tears may turn a harmless red-orange color. Patients should not wear soft contact lenses to avoid permanent staining. Regular eye exams are necessary for patients who receive isoniazid and ethambutol. Orange urine is a harmless side effect and does not need to be reported. Renal toxicity is not common with rifampin.

13. The nurse is caring for a patient who takes low-dose erythromycin as a prophylactic medication. The patient will begin taking cefaclor for treatment of an acute infection. The nurse should discuss this with the provider because taking both of these medications simultaneously can cause which effect? a. Decreased effectiveness of cefaclor. b. Increased effectiveness of cefaclor. c. Decreased effectiveness of erythromycin. d. Increased effectiveness of erythromycin.

ANS: A The interaction of cefaclor and erythromycin will produce a decrease in the action of the cefaclor.

1. Which actions can contribute to bacterial resistance to antibiotics? (Select all that apply.) a. Frequent use of antibiotics b. Giving large doses of antibiotics c. Skipping doses d. Taking a full course of antibiotics e. Treating viral infections with antibiotics

ANS: A, C, E Frequent use of antibiotics increases the exposure of bacteria to an antibiotic and results in acquired resistance. Skipping doses of an antibiotic can lead to incomplete treatment of an infection, and the remaining bacteria may develop acquired resistance. Treating viral infections with antibiotics is unnecessary and may cause acquired resistance to develop from unneeded exposure to a drug. Infections adequately treated with an antibiotic do not result in resistance.

1. A client is being treated for tuberculosis. Which medications are used to treat this condition? (Select all that apply.) a. Streptomycin sulfate b. Amoxicillin (Amoxil) c. Ethambutol (Myambutol) d. Gentamicin (Garamycin) e. Rifabutin (Mycobutin) f. Ethionamide (Trecator-SC) g. Pyrazinamide

ANS: A, C, E, F, G Streptomycin sulfate, ethambutol (Myambutol), rifabutin (Mycobutin), ethionamide (Trecator-SC), and pyrazinamide are used to treat tuberculosis. The other medications are not used.

.Contact dermatitis may be caused by chemical or plant irritation. What nonpharmacologic measure may aid in alleviating the problem? a. Determining causative agent b. Cleansing the skin area immediately c. Wearing protective gloves or clothing d. Applying a sterile dressing over the involved area

ANS: B Cleansing is one of the chief methods to decrease the irritation that has been caused by contact dermatitis.

13.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

ANS: B Isotretinoin is highly teratogenic and includes strict guidelines related to ensuring safe use. Female clients who are sexually active will be asked to take a pregnancy test.

5.Upon assessment of the burned client, the nurse notes that the client is exhibiting mottled, blistered skin and is complaining of intense pain. These findings are congruent with which degree of burn injury? a. First b. Second c. Third d. Fourth

ANS: B Second-degree burns are characterized by mottled, blistered skin, and the client is typically in intense pain.

4. A patient is being treated with isoniazid (INH), rifampin, and pyrazinamide in phase I of treatment for tuberculosis. The organism develops resistance to isoniazid. Which drug will the nurse anticipate the provider will order to replace the isoniazid? a. Ciprofloxacin (Cipro) b. Ethambutol (Myambutol) c. Kanamycin d. Streptomycin sulfate

ANS: B If there is bacterial resistance to isoniazid, the first phase may be changed to ethambutol, rifampin, and pyrazinamide. Ciprofloxacin, kanamycin, and streptomycin are not generally first-line antitubercular drugs.

6. The nurse receives the following order for insulin: IV NPH (Humulin NPH) 10 units. The nurse will perform which action? a. Administer the dose as ordered. b. Clarify the insulin type and route. c. Give the drug subcutaneously. d. Question the insulin dose.

ANS: B Only regular insulin can be given intravenously. The nurse should clarify the order. It is not correct to give Humulin NPH insulin IV. The nurse should not administer the drug by a different route without first discussing with the provider.

2. A patient who has chronic liver disease reports contact with a person who has tuberculosis (TB). The nurse will counsel this patient to contact the provider to discuss a. a chest x-ray. b. a TB skin test. c. liver function tests (LFTs). d. prophylactic antitubercular drugs.

ANS: B Patients who have exposure to TB should have a TB skin test. A chest x-ray is performed if the skin test is positive. LFTs do not need to be done simply because of TB exposure. This patient is not a candidate for antitubercular drug prophylaxis.

12. A patient will begin taking streptomycin as part of the medication regimen to treat tuberculosis. Before administering this medication, the nurse will review which laboratory values in the patients medical record? a. Complete blood count (CBC) with differential white cell count b. Blood urea nitrogen (BUN) and creatinine c. Potassium and magnesium levels d. Serum fasting glucose

ANS: B Streptomycin can cause significant renal toxicity.

9. A patient who has completed the first phase of a three-drug regimen for tuberculosis has a positive sputum acid-bacilli test. The nurse will tell the patient that a. drug resistance has probably occurred. b. it may be another month before this test is negative. c. the provider will change the pyrazinamide to ethambutol. d. there may be a need to remain in the first phase of therapy for several weeks.

ANS: B The goal is for the patients sputum test to be negative 2 to 3 months after the therapy. The positive test does not indicate drug resistance. The provider will not change the drugs or keep the patient in the first phase longer than planned.

11. A patient has administered regular insulin 30 minutes prior but has not received a breakfast tray. The patient is experiencing nervousness and tremors. What is the nurses first action? a. Administer glucagon. b. Give the patient orange juice. c. Notify the kitchen to deliver the tray. d. Perform bedside glucose testing.

ANS: B The patient is symptomatic and has hypoglycemia. The nurse should give orange juice. Glucagon is given for patients unable to ingest carbohydrates. The kitchen should be notified, and bedside glucose testing should be performed, but only after the patient is given carbohydrates. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 765 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

16. A patient who is unconscious and has a pulse is brought to the emergency department. The patient is wearing a Medic-Alert bracelet indicating type 1 diabetes mellitus. The nurse will anticipate an order to administer a. cardiopulmonary resuscitation (CPR). b. glucagon. c. insulin. d. orange juice.

ANS: B This patient is most likely hypoglycemic and will need a carbohydrate. Glucagon is given parenterally if patients are unable to ingest a carbohydrate, such as orange juice. CPR is not indicated. Insulin will compound the hypoglycemia. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 765 TOP: NURSING PROCESS: Planning/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

1. The nurse is teaching a group of nursing students about diabetes. The nurse explains that which type of diabetes is the most common? a. Type 1 diabetes mellitus b. Type 2 diabetes mellitus c. Diabetes insipidus d. Secondary diabetes

ANS: B Type 2 diabetes mellitus is the most common type of diabetes. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: Page 759 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pathophysiology

4.The client is being treated extensively with silver nitrate cream. The nurse plans to closely monitor the clients level of: a. calcium. b. sodium. c. potassium. d. magnesium.

ANS: C Extensive use of silver nitrate can lead to hypokalemia.

1.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.

ANS: C Gentle cleansing is one of the chief nonpharmacologic treatments of acne.

6.Methoxsalen (Oxsoralen) is a drug used for the treatment of psoriasis. Clients using this agent should not be in direct sunlight for which reason? a. Skin could become lightened or blanched. b. Psoriasis would spread. c. Exposed skin would burn or blister. d. Skin would become sensitive to light.

ANS: C Methoxsalen (Oxsoralen) will produce burning or blistering of the skin if the area is exposed to direct sunlight.

5. The nurse is teaching a patient how to administer insulin. The patient is thin with very little body fat. The nurse will suggest injecting insulin a. by pinching up the skin and injecting straight down. b. in the abdomen only with the needle at a 90-degree angle. c. subcutaneously with the needle at a 45- to 60-degree angle. d. using the thigh and buttocks areas exclusively.

ANS: C In a thin person, with little fatty tissue, the needle is inserted at a 45- to 60-degree angle. In other patients, a 45- to 90-degree angle is acceptable. There is no recommendation for preferring one site over another. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 760 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. The nurse is teaching a patient who is newly diagnosed with type 1 diabetes mellitus about insulin administration. Which statement by the patient indicates a need for further teaching? a. I may use a chosen site daily for up to a week. b. I should give each injection a knuckle length away from a previous injection. c. I will not be concerned about a raised knot under my skin from injecting insulin. d. Insulin is absorbed better from subcutaneous sites on my abdomen.

ANS: C Lipohypertrophy is a raised lump or knot on the skin surface caused by repeated injections into the same site, and this can interfere with insulin absorption. Patients are encouraged to use the same site for a week, giving each injection a knuckle length away from the previous injection. Insulin absorption is greater when given in abdominal areas. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 760 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

18. A patient who has been taking a sulfonylurea antidiabetic medication will begin taking metformin (Glucophage). The nurse understands that this patient is at increased risk for which condition? a. Hypoglycemia b. Hyperglycemia c. Renal failure d. Respiratory distress

ANS: C Metformin can lead to renal failure. It does not produce hypoglycemia or hyperglycemia. It does not increase the risk of respiratory distress. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 769 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. The nurse is teaching a patient about home administration of insulin. The patient will receive regular (Humulin R) and NPH (Humulin NPH) insulin at 0700 every day. What is important to teach this patient? a. Draw up the medications in separate syringes. b. Draw up the NPH insulin first. c. Draw up the regular insulin first. d. Draw up the medications after mixing them in a vial.

ANS: C Patients should be instructed to draw up regular insulin first so that NPH is not mixed into the vial of regular insulin. It is not necessary to use separate syringes. Patients do not mix the medications in a vial.

9. 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.

ANS: C 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.

5. 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.

ANS: C Patients who have previously experienced manifestations of allergy to a penicillin should not use penicillins again unless necessary. The nurse should contact the provider to discuss using another antibiotic from a different class. Epinephrine and antihistamines are useful when patients are experiencing allergic reactions, depending on severity.

19. A 45-year-old patient who is overweight has had a diagnosis of type 2 diabetes for 2 years. The patient uses 20 units of insulin per day. The patients fasting blood glucose (FBG) is 190 mg/dL. The patient asks the nurse about using an oral antidiabetic agent. The nurse understands that oral antidiabetic agents a. cannot be used if the patient is overweight. b. cannot be used once a patient requires insulin. c. may be used since this patient meets criteria. d. may not be used since this patients fasting blood glucose is too high.

ANS: C Patients who require less than 40 units of insulin per day and who have a fasting blood glucose less than or equal to 200 mg/dL are candidates for oral antidiabetic agents. Being overweight is an indication, not a contraindication. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 770 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. 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.

ANS: C The MEC is the minimum amount of drug needed to halt the growth of a microorganism. A level greater than the MEC helps eradicate infections. Drugs at or above the MEC are usually bactericidal, not bacteriostatic. Raising the drug level does not usually broaden the spectrum or increase the therapeutic index of a drug.

6. The nurse caring for a patient who has tuberculosis and who is taking isoniazid, rifampin, and streptomycin reviews the medical record and notes the patients sputum cultures reveal resistance to streptomycin. The nurse will anticipate that the provider will take which action? a. Add ethambutol (Myambutol). b. Change the streptomycin to clarithromycin. c. Change the streptomycin to kanamycin. d. Order renal function tests.

ANS: C The patients current regimen is first-phase treatment. If resistance to streptomycin develops, the provider can change to kanamycin or to ciprofloxacin. Ethambutol is added if there is resistance to isoniazid. Clarithromycin is used during phase II. Renal function tests are not indicated.

2. A patient develops type 2 diabetes mellitus. The nurse will explain that this type of diabetes a. is generally triggered by medications. b. is not as common as type 1 diabetes. c. is often related to heredity and obesity. d. will not require insulin therapy.

ANS: C Type 2 diabetes is often caused by obesity and hereditary factors. Secondary diabetes is triggered by medications. Type 2 diabetes is the most common type of diabetes. Patients with type 2 diabetes may become insulin-dependent. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 759 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pathophysiology

3. A patient who has tuberculosis asks the nurse why three drugs are used to treat this disease. The nurse will explain that multi-drug therapy is used to reduce the likelihood of a. disease relapse. b. drug hypersensitivity reactions. c. drug resistance. d. drug adverse effects.

ANS: C Without multi-drug therapy, patients easily develop resistance to antitubercular drugs. Using more than one antitubercular drug does not prevent relapse, hypersensitivity reactions, or adverse effects.

11.The nurse plans to monitor a client with second-degree burns for which adverse reaction to mafenide acetate (Sulfamylon)? a. Increased intraocular pressure b. Urinary retention c. Fluid retention d. Superinfection

ANS: D Adverse reactions to mafenide acetate (Sulfamylon) include superinfection, respiratory alkalosis, blistering, and metabolic acidosis.

7.A client enters the healthcare providers 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.

ANS: D Electrodesiccation, along with freezing and surgical excision, can be used to treat the common wart.

10.The client is being treated with etretinate (Tegison, Soriatane). She has been using the medication for 6 weeks and is concerned because she has not seen an improvement in her symptoms. The most accurate response from the nurse is that it may be _____ months for the client to notice an improvement in her symptoms. a.2 b.8 c.4 d.6

ANS: D Treatment with etretinate may take up to 6 months to produce a change in the clients symptoms.

15. A patient will begin taking amoxicillin. The nurse should instruct the patient to avoid which foods? a. Green leafy vegetables b. Beef and other red meat c. Coffee, tea, and colas d. Acidic fruits and juices

ANS: D Acidic fruits and juices should be avoided while the client is being treated with amoxicillin because amoxicillin can be irritating to the stomach. Stomach irritation will be increased with the ingestion of citrus and acidic foods. Amoxicillin may also be less effective when taken with acidic fruit or juice.

14. A patient who has insulin-dependent diabetes mellitus must take a glucocorticoid medication for osteoarthritis. When teaching this patient, the nurse will explain that there may be a need to a. decrease the glucocorticoid dose. b. decrease the insulin dose. c. increase the glucocorticoid dose. d. increase the insulin dose.

ANS: D Glucocorticoids can cause hyperglycemia, so the insulin dose may need to be increased. Changing the glucocorticoid dose is not recommended. Decreasing the insulin dose will only compound the hyperglycemic effects. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 761 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. The nurse will administer parenteral insulin to a patient who will receive a mixture of NPH (Humulin NPH) and regular (Humulin R). The nurse will give this medication via which route? a. Intradermal b. Intramuscular c. Intravenous d. Subcutaneous

ANS: D Insulin is given by the subcutaneous route. Only regular insulin may be given IV. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 760 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

1. 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

ANS: D 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.

10. The parent of a junior high-school child who has type 1 diabetes asks the nurse if the child can participate in sports. The nurse will tell the parent a. that strenuous exercise is not recommended for children with diabetes. b. that the child must be monitored for hyperglycemia while exercising. c. to administer an extra dose of regular insulin prior to exercise. d. to send a snack with the child to eat just prior to exercise.

ANS: D Patients generally need less insulin with increased exercise, so the child should consume a snack to prevent hypoglycemia. Exercise is an integral part of diabetes management. Hypoglycemia is more likely to occur, and extra insulin is not indicated.

15. Which statement by a patient who will begin using an external insulin pump indicates understanding of this device? a. I will have an increased risk for hypoglycemia. b. I will leave this on when bathing or swimming. c. I will not need to count carbohydrates anymore. d. I will still need to monitor serum glucose.

ANS: D Patients using an insulin pump will still monitor serum glucose and count carbohydrates. The advantage of the pump is that it is programmed to deliver continuous rapid-acting insulin in varying amounts at different times throughout the day. Changes in food intake can alter the risk for hypoglycemia if the pump is not adjusted accordingly. They must be removed when bathing or swimming.

3. A patient who is overweight is being evaluated for diabetes. The patient has a blood glucose level of 160 mg/dL and a hemoglobin A1c of 5.8%. The nurse understands that this patient has which condition? a. Diabetes mellitus b. Hypoglycemia c. Normal blood levels d. Prediabetes

ANS: D Patients with a hemoglobin A1c between 5.7% and 6.4% are considered to have prediabetes. A level of 6.5% or more indicates diabetes. The patient is hyperglycemic. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 759 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pathophysiology

16. The patient will begin taking penicillin G procaine (Wycillin).The nurse notes that the solution is milky in color. What action will the nurse take? a. Call the pharmacist and report the milky color. b. Add normal saline to dilute the medication. c. Call the physician and report the milky appearance. d. Administer the medication as ordered by the physician.

ANS: D Penicillin G procaine (Wycillin) has a milky appearance; therefore, the appearance should not concern the nurse.

7. A patient who is taking isoniazid (INH) as part of a two-drug tuberculosis treatment regimen reports tingling of the fingers and toes. The nurse will recommend discussing which treatment with the provider? a. Adding pyrazinamide b. Changing to ethambutol c. Increasing oral fluid intake d. Taking pyridoxine (Vitamin B6)

ANS: D Peripheral neuropathy is an adverse reaction to INH, so pyridoxine is usually given to prevent this. It is not necessary to change medications. Increasing fluids will not help with this.

1. Which person should be treated with prophylactic antitubercular medication? a. A child who attends the same school with a child who has tuberculosis b. A nurse who is working in a hospital c. An individual who is HIV-positive with a negative TB skin test d. A patient who has close contact with someone who has tuberculosis

ANS: D Personal contact with a person having a diagnosis of tuberculosis is required to indicate prophylactic treatment with antitubercular therapy. Attending the same school does not necessarily mean close contact occurs. Health care professionals do not need prophylactic treatment. HIV-positive individuals with negative TB skin tests do not need prophylaxis.

13. The patient asks the nurse about storing insulin. Which response by the nurse is correct? a. All insulin vials must be refrigerated. b. Insulin will last longer if kept in the freezer. c. Opened vials of insulin must be discarded. d. Some combination pens do not require refrigeration.

ANS: D Some combination pens do not require refrigeration after first use. Storing insulin in the freezer is not recommended. Opened vials may either be kept at room temperature for a month or refrigerated for 3 months. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 761 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. 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 patients 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.

ANS: D The patients symptoms may indicate a superinfection and should be reported to the physician so it can be treated; however, the drug does not need to be held. It is not necessary to culture the lesions. The symptoms do not indicate impending anaphylaxis.

6. The nurse is preparing to administer an antibiotic to a patient who has been receiving the antibiotic for 2 days after a culture was obtained. The nurse notes increased erythema and swelling, and the patient has a persistent high fever of 39 C. What is the nurses next action? a. Administer the antibiotic as ordered. b. Contact the provider to request another culture. c. Discuss the need to add a second antibiotic with the provider. d. Review the sensitivity results from the patients culture.

ANS: D The sensitivity results from the patients culture will reveal whether the organism is sensitive or resistant to a particular antibiotic. The patient is not responding to the antibiotic being given, so the antibiotic should be held and the provider notified. Another culture is not indicated. Antibiotics should be added only when indicated by the sensitivity.

7. The nurse is preparing to administer the first dose of an antibiotic to a patient admitted for a urinary tract infection. Which action is most important prior to administering the antibiotic? a. Administering a small test dose to determine whether hypersensitivity exists b. Having epinephrine available in the event of a severe hypersensitivity reaction c. Monitoring baseline vital signs, including temperature and blood pressure d. Obtaining a specimen for culture and sensitivity

ANS: D To obtain the most accurate culture, the specimen should be obtained before antibiotic therapy begins. It is important to obtain cultures when possible in order to correctly identify the organism and help determine which antibiotic will be most effective. Administering test doses to determine hypersensitivity is sometimes done when there is a strong suspicion of allergy when a particular antibiotic is needed. Epinephrine is kept close at hand when there is a strong suspicion of allergy.

Eye exams important when taking ______________________.

Allopurinol (gout med)

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 nonsteroidal anti-inflammatory medications (NSAIDs) for arthritis pain." b."You should monitor your serum glucose more closely while taking levofloxacin." c."You should take levofloxacin on an empty stomach to improve absorption." d."You may take antacids with levofloxacin to decrease gastrointestinal upset."

B

A nurse whose last flu vaccine was 1 year prior is exposed to the influenza A virus. The occupational health nurse will administer which medication? a.Acyclovir (Zovirax) b.Amantadine HCl (Symmetrel) c.Oseltamivir phosphate (Tamiflu) d.Influenza vaccine

B

A patient calls the clinic in November to report a temperature of 103° F, headache, a nonproductive cough, and muscle aches. The patient reports feeling well earlier that day. The nurse will schedule the patient to see the provider and will expect the provider to order which medication? d a.Influenza vaccine b.Rimantadine HCl (Flumadine) c.An over-the-counter drug for symptomatic treatment d.Amantadine HCl (Symmetrel)

B

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.Erythromycin (E-Mycin) c.Fidaxomicin (Dificid) d.Clarithromycin (Biaxin)

B

A patient is preparing to travel to a country with prevalent malaria. To prevent contracting the disease, the provider has ordered chloroquine HCl (Aralen). The nurse will instruct the patient to take this drug according to which schedule? a.500 mg once followed by 500 mg per dose in 6 hours, 24 hours, and 48 hours b.500 mg weekly beginning 2 weeks prior to travel and continuing for 6 to 8 weeks after travel c.1000 mg once followed by 500 mg per dose in 6 hours, 24 hours, and 48 hours d.1000 mg weekly beginning 2 weeks prior to travel and continuing for 6 to 8 weeks after travel

B

A patient is taking chloroquine (Aralen) to treat acute malaria. Which statement by the patient indicates understanding of this medication? a."I should abstain from alcohol while taking this medication." b."I should report visual changes immediately." c."I should take this drug on an empty stomach." d."I should report urine output less than 1000 mL/day."

B

A patient who has chronic liver disease reports contact with a person who has tuberculosis (TB). The nurse will counsel this patient to contact the provider to discuss a.a chest x-ray. b.a TB skin test. c.liver function tests (LFTs). d.prophylactic antitubercular drugs.

B

A young adult female who is taking metronidazole (Flagyl) to treat trichomoniasis calls the nurse to report severe headache, flushing, palpitations, cramping, and nausea. What will the nurse do next? a.Tell her to go to the emergency department immediately. b.Ask about alcohol consumption. c.Reassure her that these are harmless side effects. d.Tell her that this signals a worsening of her infection.

B

The nurse is caring for a patient who is diagnosed with a urinary tract infection. The patient reports always having difficulty remembering to take medications. Which drug will the nurse expect the provider to select when treating this patient? a.Nalidixic acid (NegGram) b.Fosfomycin tromethamine (Monurol) c.Nitrofurantoin (Macrodantin) d.Trimethoprim-sulfamethoxazole (Bactrim)

B

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

B

The nurse is preparing to administer bethanechol chloride (Urecholine) to a patient. The nurse understands that this drug acts to a a.relax smooth muscles in the urinary tract. b.increase the tone of the urinary detrusor muscle. c.block parasympathetic nerve impulses. d.relieve urinary pain and burning.

B

The nurse is preparing to administer intravenous gentamicin to an infant through an intermittent needle. The nurse notes that the infant has not had a wet diaper for several hours. The nurse will perform which action? a.Give the medication and obtain a serum peak drug level 45 minutes after the dose. b.Hold the dose and contact the provider to request a serum trough drug level. c.Administer the medication and give the infant extra oral fluids. d.Contact the provider to request adding intravenous fluids when giving the medication.

B

A 25-year-old female patient reports urinary frequency with pain on urination, flank pain, fever, and chills. The nurse recognizes these symptoms as characteristic of which condition? a. Urethritis b.Cystitis c.Pyelonephritis d.Dysuria

C

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 should expect diarrhea to be a common, mild side effect." b."I may take antacids 2 hours before taking this drug." c."I should avoid dairy products while taking this drug." d."I should take acetaminophen for fever or mild pain."

B

Which person should be treated with prophylactic antitubercular medication? a.An individual who is HIV-positive with a negative TB skin test b.A patient who has close contact with someone who has tuberculosis c.A child who attends the same school with a child who has tuberculosis d.A nurse who is working in a hospital

B

Which nursing intervention has the highest priority for the patient who is taking cefepime? A. Wait until culture results are received before initiating antibiotic. B. Monitor the patient for signs and symptoms of a superinfection. C. Administer IV over 2 hours to prevent phlebitis. D. Instruct the patient to take the drug for 5 days only.

B. Monitor the patient for signs and symptoms of a superinfection.

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."If diarrhea occurs, stop taking the drug immediately and contact your provider." b."Discontinue the antibiotic when your temperature returns to normal and your symptoms have improved." 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

Acute gout attack medication?

Colchicine

Antibiotic combinations

Combination antibiotics should NOT be routinely prescribed or administered except for specific uncontrollable infections. Usually a SINGLE antibiotic will successfully treat an infection. Antibiotic Combinations can create various effects on the potency of each of the drugs: 1. Additive: the additive effect is equal to the SUM of the effects of the two antibiotics (1+1 = 2). 2. Potentiative: The potentiative effect occurs when one antibiotic potentiates the effects of the second antibiotic, INCREASING its EFFECTIVENESS. 3. Antagonistic: The antagonistic result is achieved with combination of a drug that is bactericidal (like penicillin), and a drug that is bacteriostatic (like tetracycline); when these two drugs are used together, the DESIRED EFFECT may be greatly REDUCED.

What is cross resistance? Examples?

Cross Resistance is: a bacteria's tolerance to an antibiotic that usually works in toxic effect to kill the bacteria, that is acquired not as a result of direct exposure but by exposure to a related substance. (You take an antibiotic for one bacterial infection and the bacteria develops a resistance to not only the drug you took, but also to another drug you have never used before) -There is complete cross-resistance between clindamycin and lincomycin. --Clinical isolates of streptococci and enterococci are commonly cross-resistant to erythromycin. -Drug-resistant strains of Mycobacterium tuberculosis present a great challenge to global tuberculosis (TB) control efforts. --Multidrug-resistant (MDR) strains of M. tuberculosis, defined as resistant to rifampin (RIF) and isoniazid (INH), are difficult to diagnose and are complicated and expensive to treat. --Furthermore, fewer treatment options are available for patients who contract or develop extensively drug-resistant (XDR) TB, which is MDR and has gained additional resistance to a fluoroquinolone and at least one of the second-line injectable antibiotics kanamycin (KAN), amikacin (AMK), or capreomycin (CAP)

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

D

A patient who is taking isoniazid (INH) as part of a two-drug tuberculosis treatment regimen reports tingling of the fingers and toes. The nurse will recommend discussing which treatment with the provider? a.Increasing oral fluid intake b.Changing to ethambutol c.Adding pyrazinamide d.Taking pyridoxine (B6)

D

An older woman has urgent urinary incontinence related to an overactive bladder. Which medication does the nurse expect the provider to order? d a.Flavoxate (Urispas) b.Dimethylsulfoxide (DMSO) c.Phenazopyridine HCl (Pyridium) d.Tolterodine tartrate (Detrol)

D

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 therapeutic index b.Drugs with a broad spectrum c.Drugs with a narrow spectrum d.Drugs with a narrow therapeutic index

D

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.Slowed onset of action b.Minimal adverse effects c.Increased risk for superinfection d.Inadequate drug effects

D

The nurse is caring for a patient who takes low-dose erythromycin as a prophylactic medication. The patient will begin taking cefaclor for treatment of an acute infection. The nurse should discuss this with the provider because taking both of these medications simultaneously can cause which effect? a.Decreased effectiveness of erythromycin. b.Increased effectiveness of cefaclor. c.Increased effectiveness of erythromycin. d.Decreased effectiveness of cefaclor.

D

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

D

The nurse is preparing to administer methenamine (Hiprex) to a patient who is diagnosed with a urinary tract infection. The nurse reviews the patient's chart and notes a urinary pH of 6.0. Which action will the nurse take? a.Restrict fluids to concentrate the patient's urine. b.Request an order for an increased dose. c.Administer the drug as ordered. d.Obtain an order for 8 ounces of cranberry juice 3 times daily.

D

The nurse is preparing to begin a medication regimen for a patient who will receive intravenous ampicillin and gentamicin. Which is an important nursing action? a.Prepare the schedule so that the drugs are given at the same time. b.Administer each antibiotic to infuse over 15 to 20 minutes. c.Order serum peak and trough levels of ampicillin. d.Set up separate tubing sets for each drug labeled with the drug name and date.

D

The nurse is teaching a nursing student about the antifungal drug amphotericin B. Which statement by the student indicates a need for further teaching? a."Patients who take this drug should have potassium and magnesium levels assessed." b."Patients with renal disease should not take amphotericin B." c."This drug is used for severe systemic infections." d."Amphotericin B may be given intravenously or by mouth."

D

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 increases the therapeutic index." b."A serum drug level greater than the MEC broadens the spectrum of the drug." c."A serum drug level greater than the MEC ensures that the drug is bacteriostatic." d."A serum drug level greater than the MEC helps eradicate bacterial infections."

D

The nurse is teaching a patient about rifampin. Which statement by the patient indicates understanding of the teaching? a."I understand that renal toxicity is a common adverse effect." b."I will report orange urine to my provider immediately." c."I will need regular eye examinations while taking this drug." d."I should not wear soft contact lenses while taking rifampin."

D

Which side effects are common to most urinary antiseptics? a.Peripheral neuritis b.Dyspnea and chest pain c.Visual disturbances d.Nausea and vomiting

D

A natural, or inherent resistance occurs without previous exposure to the antibacterial drug. For example, gram-negative bacterium pseudomonas aeruginosa is inherently resistant to __________________.

Penicillin G.

Ibuprofen is different than COX1 and 2 inhibitors, in that ibuprofen is more likely than celecoxib to cause _____________ ______________ _________________.

Peptic ulcer disease

An acquired resistance is caused by prior exposure to the antibacterial drug. Although S. aureus was once sensitive to ___________1____________, repeated exposures have caused this organism to evolve and become resistant tot that drug. _________2_________, an enzyme produced by the microorganism, is responsible for causing its penicillin resistance.

S. aureus once sensitive to (1) penicillin G. Penicillinase (2) metabolizes penicillin G, causing the drug to be ineffective. However, penicillinase-resistant penicillins that are effective against S. aureus are now available.

Cross Resistance of Anti-Tubercular Drugs (Six in total)

There is well-known cross-resistance between some of the antibacterial drugs used in treatment of TB. Resistance mutations to one anti-TB drug may confer resistance to some or all of the members of the drug family, and less commonly, to members of other families. For example, among aminoglycosides, resistance to kanamycin is associated with near complete cross-resistance to amikacin. In contrast, cross-resistance between kanamycin and streptomycin is generally low. Moreover, TB isolates that are resistant to kanamycin at high doses may be resistant to capreomycin (a polypeptide). Table 8.3 - Summary on cross-resistance between anti-TB agents 1-Rifamycins R and Rfb have high levels of cross-resistance. 2-Isoniazid Eto/Pto can have cross-resistance to H if the inhA mutation is present. 3-Aminoglycosides and polypeptides Amk and Km have very high cross-resistance. Km (or Amk) and Cm have low to moderate cross-resistance. S has low cross resistance with Amk and Km. 4-Fluoroquinolones FQs are believed to have variable cross-resistance between each other. Some in vitro data show that strains can be susceptible to some later-generation FQs when resistant to earlier-generation FQs (Ofx). In these cases, it is unknown if the later-generation FQs remain clinically effective. 5-Thioamides Eto and Pto have 100% cross-resistance. 6-Thioacetazone Thz cross-resistance to H, Eto/Pto, and PAS has been reported, but is generally considered low.

What are beta-lactamase inhibitors? What are the three meds?

When broad-spectrum abx (like amoxicillin) is combined with a beta-lactamase enzyme inhibitor such as clavulanic acid, the resulting antibiotic combination inhibits the bacterial lactamases, making the antibiotic effective and extending its antimicrobial effect. 1. clavulanic acid 2. sulbactam 3. tazobactam The combination drugs currently marketed include: - amoxicillin-clavulanic acid (oral) -ampicillin-sulbactam (parenteral) -piperacillin-tazobactam (parenteral)

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." THE ANSWER IS a. "I may take antacids 2 hours before taking this drug."

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

The nurse is caring for a patient who will begin taking doxycycline to treat an infection. The nurse should plan to give this medication

a. 1 hour before or 2 hours after a meal. b. with an antacid to minimize GI irritation. c. with food to improve absorption. d. with small sips of water. THE ANSWER IS c. with food to improve absorption.

The nurse is preparing to begin a medication regimen for a patient who will receive intravenous ampicillin and gentamicin. Which is an important nursing action?

a. Administer each antibiotic to infuse over 15 to 20 minutes. b. Order serum peak and trough levels of ampicillin. c. Prepare the schedule so that the drugs are given at the same time. d. Set up separate tubing sets for each drug labeled with the drug name and date. THE ANSWER IS d. Set up separate tubing sets for each drug labeled with the drug name and date.

The nurse is preparing to administer intravenous gentamicin to an infant through an intermittent needle. The nurse notes that the infant has not had a wet diaper for several hours. The nurse will perform which action?

a. Administer the medication and give the infant extra oral fluids. b. Contact the provider to request adding intravenous fluids when giving the medication. c. Give the medication and obtain a serum peak drug level 45 minutes after the dose. d. Hold the dose and contact the provider to request a serum trough drug level. THE ANSWER IS d. Hold the dose and contact the provider to request a serum trough drug level.

The nurse is reviewing a patient's chart prior to administering gentamycin (Garamycin) and notes that the last serum peak drug level was 9 mcg/mL and the last trough level was 2 mcg/mL. What action will the nurse take?

a. Administer the next dose as ordered. b. Obtain repeat peak and trough levels before giving the next dose. c. Report possible drug toxicity to the patient's provider. d. Report a decreased drug therapeutic level to the patient's provider. THE ANSWER IS c. Report possible drug toxicity to the patient's provider.

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

The nurse is preparing to administer clarithromycin to a patient. When performing a medication history, the nurse learns that the patient takes warfarin to treat atrial fibrillation. The nurse will perform which action?

a. Ask the provider if azithromycin may be used instead of clarithromycin. b. Obtain an order for continuous cardiovascular monitoring. c. Request an order for periodic serum warfarin levels. d. Withhold the clarithromycin and notify the provider. THE ANSWER IS c. Request an order for periodic serum warfarin levels.

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 THE ANSWER IS c. Erythromycin - E-Mycin

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) THE ANSWER IS d. Tetracycline (Sumycin)

A female patient who is allergic to penicillin will begin taking an antibiotic to treat a lower respiratory tract infection. The patient tells the nurse that she almost always develops a vaginal yeast infection when she takes antibiotics and that she will take fluconazole (Diflucan) with the antibiotic being prescribed. Which macrolide order would the nurse question for this patient?

a. Azithromycin (Zithromax) b. Clarithromycin (Biaxin) c. Erythromycin (E-Mycin) d. Fidaxomicin (Dificid) THE ANSWER IS c. Erythromycin (E-Mycin)

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

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. THE ANSWER IS b. Slow the infusion to 10 mg/min and observe the patient closely.

The nurse is caring for a 70-kg patient who is receiving gentamicin (Garamycin) 85 mg 4 times daily. The patient reports experiencing ringing in the ears. The nurse will contact the provider to discuss

a. decreasing the dose to 50 mg QID. b. giving the dose 3 times daily. c. obtaining a serum drug level. d. ordering a hearing test. THE ANSWER IS c. obtaining a serum drug level.

The nurse caring for a patient who will receive penicillin to treat an infection asks the patient about previous drug reactions. The patient reports having had a rash when taking amoxicillin (Amoxil). The nurse will contact the provider to

a. discuss giving a smaller dose of penicillin. b. discuss using erythromycin E-mycin instead of penicillin. c. request an order for diphenhydramine Benadryl. d. suggest that the patient receive cefuroxime Ceftin. THE ANSWER IS b. discuss using erythromycin E-mycin instead of penicillin.

When patient is taking aspirin, must notify MD if they experience which adverse reaction? a. tinnitus b. seizures c. sinusitis d. palpitations

a. tinnitus

Rifampin turns body fluids __________, and soft contact lenses may be permanently discolored.

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