Pharmacology Exam 4 Questions: Antibiotics
Which statement should the nurse include when teaching a patient about rifampin [Rifadin]? A. "A harmless side effect will be a red-orange discoloration of body fluids." B. "Oral contraception is the preferred method of birth control when using rifampin." C. "Take vitamin B6 to relieve numbness and tingling in the fingers and toes." D. "Treatment length for the medication is 3 times per day for an 8-week period."
"A harmless side effect will be a red-orange discoloration of body fluids."
A patient who is receiving vancomycin [Vancocin] IV for a methicillin-resistant Staphylococcus aureus (MRSA) infection asks a nurse, "Why can't I take this medicine in a pill?" Which response should the nurse make? A. "The prescription could be changed, because vancomycin comes in two forms." B. "You're allergic to penicillin, and this is the only way this medication can be given." C. "It will cause too much loss of appetite and nausea if given in the oral form." D. "It is more effective by IV, because the pill form will stay in the digestive tract."
"It is more effective by IV, because the pill form will stay in the digestive tract."
Which instruction should a nurse include in the discharge teaching for a patient who is to start taking tetracycline? A. "You may stop taking the pills when you begin to feel better." B. "Use sunscreen and protective clothing when outdoors." C. "You'll have to come back to the clinic for weekly blood work." D. "Take the medication with yogurt or milk so you won't have nausea."
"Use sunscreen and protective clothing when outdoors."
A nurse is administering a daily dose of tobramycin at 1000. At which time should the nurse obtain the patient's blood sample to determine the trough level? A. 0800 B. 0900 C. 1130 D. 1200
0900
The CDC's campaign to prevent the development of antimicrobial resistance in hospitals focuses on what four approaches?
1. Prevent Infection 2. Diagnose and Treat Infection Effectively 3. Use Antimicrobials Wisely 4. Prevent Transmission
What statements are true regarding ototoxicity and aminoglycosides?
1. The risk of ototoxicity with aminoglycoside use is related primarily to excessive trough levels 2. The first sign of impending vestibular damage is headache 3. The first sign of cochlear damage is tinnitus 4. Ototoxicity is largely irreversible 5. Use of aminoglycosides for less than 10 days is recommended to avoid ototoxicity
The nurse identifies which medication as the drug of choice for most infections caused by herpes simplex viruses and varicella-zoster virus? A. Ganiciclovir B. Amantadine C. Acyclovir D. Oseltamivir
Acyclovir
Thirty minutes after receiving an intramuscular (IM) injection of penicillin G [Pfizerpen], a patient reports itching and redness at the injection site. Which action should the nurse take first? A. Elevate the lower legs. B. Place an ice pack on the site. C. Make sure the patient stays calm. D. Administer subcutaneous epinephrine.
Administer subcutaneous epinephrine
The nurse notices tan lines around the arms of a female patient who is taking levofloxacin [Levaquin]. Which action should the nurse take? A. No action is needed, because this is a temporary but expected side effect. B. Continue the antibiotic with an anti-inflammatory medication. C. Advise the patient to avoid sun exposure and wear sun screen when outside. D. Discontinue the medication.
Advise the patient to avoid sun exposure and wear sun screen when outside
Before administering trimethoprim, it is most important for the nurse to assess the patient for a history of what? A. Heart failure B. Alcoholism C. Diabetes D. Emphysema
Alcoholism Trimethoprim inhibits bacterial synthesis of folic acid. It is avoided in patients when folate deficiency is likely, such as in alcoholism, because bone marrow suppression may occur.
Before administering intravenous (IV) penicillin, the nurse should do what? A. Flush the IV site with normal saline. B. Assess the patient for allergies. C. Review the patient's intake and output record. D. Determine the latest creatinine clearance result.
Assess the patient for allergies
A nurse should recognize that which laboratory result is used as a major factor in deciding when antiretroviral therapy is indicated for a patient infected with HIV? A. Plasma HIV RNA assay B. CD4 T-lymphocyte count C. Western blot assay D. OralQuick Rapid HIV-1 Antibody Test
CD4 T-lymphocyte count The CD4 T-cell count is the principal indicator of how much immunocompetence remains when a patient is infected with HIV. It is used as a guide in the initiation, discontinuation, and resumption of medications for opportunistic infections.
A patient is receiving penicillin G [Bicillin C-R]. Which assessment should the nurse monitor as an indicator of an undesired effect? A. Cardiac rhythm B. Serum sodium level C. Lung sounds D. Red blood cell (RBC) count
Cardiac rhythm Penicillin G in high IV doses may cause hyperkalemia, which can result in dysrhythmias or cardiac arrest
The nurse identifies which medication as posing a significant risk of causing confusion, somnolence, psychosis, and visual disturbances in elderly patients? A. Metronidazole [Flagyl] B. Rifampin [Rifadin] C. Ciprofloxacin [Cipro] D. Daptomycin [Cubicin]
Ciprofloxacin
It is most important for the nurse to assess a patient receiving a cephalosporin for the development of which manifestation of antibiotic-associated pseudomembranous colitis (AAPMC)? A. Rigidity B. Ileus C. Ascites D. Diarrhea
Diarrhea AAPMC, which is manifested initially by diarrhea and abdominal cramping, especially may develop with the use of broad-spectrum cephalosporins.
A nurse assessing a patient who is 12 years old should associate which complication with the patient's receiving tetracycline as a younger child? A. Delay in long bone growth B. Early onset of puberty C. Severe face and body acne D. Discoloration of the teeth
Discoloration of the teeth Tetracycline is contraindicated in children younger than 8 years of age, because it binds to calcium in developing teeth, resulting in permanent discoloration of the teeth
A patient who takes ciprofloxacin [Cipro] and runs 6 miles daily tells a nurse about heel and calf tenderness. The nurse anticipates the healthcare provider to take which action? A. No action is needed, because this is a temporary but expected side effect. B. Continue the antibiotic with an anti-inflammatory medication. C. Slow the running pace and walk more. D. Discontinue the medication, because severe damage can result.
Discontinue the medication, because severe damage can result Fluoroquinolones may result in tendinitis and rupture by disrupting the extracellular matrix of cartilage. Because tendon injury is reversible if diagnosed early, fluoroquinolones should be discontinued at the first sign of tendon pain or inflammation.
Most cases (more than 80%) of uncomplicated, community-acquired urinary tract infection (UTI) are caused by which bacteria? A. Klebsiella pneumoniae B. Escherichia coli C. Enterobacter spp. D. Pseudomonas spp.
E. coli
Both IV ampicillin/sulbactam [Unasyn] and gentamicin are ordered for a patient. When administering these medications, the nurse will do what? A. Ensure that separate IV solutions are used. B. Use two different peripheral IV sites. C. Administer the gentamicin first. D. There are no necessary precautions.
Ensure that separate IV solutions are used When penicillins are present in high concentrations, they interact chemically with aminoglycosides, causing inactivation of the aminoglycosides. Therefore, penicillins and aminoglycosides should not be mixed in the same IV solution
Which manifestations does the nurse associate with the development of hemolytic anemia? (Select all that apply.) A. Urticaria B. Fever C. Pallor D. Jaundice D. Diarrhea
Fever Pallor Jaundice
Which antifungal agent is used as a one-time oral dose to treat vaginal yeast infections? A. Nystatin [Mycostatin] B. Caspofungin [Cancidas] C. Voriconazole [Vfend] D. Fluconazole [Diflucan]
Fluconazole Fluconazole [Diflucan] has almost 100% bioavailability and therefore is often sufficient as a single dose to treat vaginal yeast infections.
What does the nurse identify as an adverse effect of clindamycin [Cleocin] therapy? A. Cyanosis and gray discoloration of the skin B. Frequent loose, watery stools with mucus and blood C. Reduction in all blood cells produced in the bone marrow D. Elevated bilirubin, with dark urine and jaundice
Frequent loose, watery stools with mucus and blood
A nurse monitors a patient who is receiving an aminoglycoside (gentamicin) for symptoms of vestibular damage. Which finding should the nurse expect the patient to have first? A. Unsteadiness B. Vertigo C. Headache D. Dizziness
Headache Headache is the first sign of impending vestibular damage (balance) and may last 1 to 2 days. Unsteadiness, vertigo, and dizziness appear after headache.
What considerations are needed when selecting an antibiotic?
Infecting Organism Organism's Sensitivity and Resistance Host Defenses (competent immune function) Site of Infection
Which approach should a nurse take to administer intravenous (IV) acyclovir [Zovirax] to an immunocompromised patient? A. Infuse IV fluids during administration of the dose and for 2 hours afterward. B. Administer IV acyclovir diluted in 20 mL normal saline (NS) over 10 minutes. C. Only infuse the drug if the white blood cell (WBC) count is above 2500/mm3. D. Ask the provider to change the route to subcutaneous (subQ) injection.
Infuse IV fluids during administration of the dose and for 2 hours afterward
The human immunodeficiency virus (HIV) uses which enzymes to replicate and infect a host cell? (Select all that apply.) A. Integrase B. Dihydrofolate reductase C. Reverse transcriptase D. Carbonic anhydrase E. Protease
Integrase Reverse Transcriptase Protease
Which laboratory result should a nurse monitor more frequently when a patient is receiving clarithromycin [Biaxin] and warfarin [Coumadin]? A. Activated partial thromboplastin time (aPTT) B. Platelet count C. Erythrocyte sedimentation rate (ESR) D. International normalized ratio (INR)
International normalized ratio (INR)
Which statements about CDAD associated with clindamycin therapy does the nurse identify as true? (Select all that apply.) A. Leukopenia commonly occurs. B. It is a potentially fatal condition. C. Patients usually experience abdominal pain. D. Anticholinergics are effective in treating the diarrhea. E. Clindamycin therapy should be discontinued and vancomycin started.
It is a potentially fatal condition Patients usually experience abdominal pain Clindamycin therapy should be discontinued and vancomycin started
A nurse should recognize that a patient who is infected with HIV is at the highest risk to develop opportunistic infections during which clinical phase of HIV? A. Late B. Intermediate C. Initial D. Prodromal
Late
A nurse develops a plan of care for a patient who has an outbreak of recurrent genital herpes and is taking oral acyclovir [Zovirax]. Which outcome should be included? A. Minimal scarring from lesions B. Less frequent eruption of lesions C. Prevention of transmission to contacts D. Complete eradication of the virus
Less frequent eruption of lesions
A patient who is receiving ceftriaxone has all of these medications ordered. The nurse monitors the patient for an adverse effect related to an interaction with which medication? A. Regular insulin B. Ampicillin [Polycillin] C. Naproxen [Naprosyn] D. Bisacodyl [Dulcolax]
Naproxen Three cephalosporins—cefmetazole [Zefazone], cefoperazone [Cefobid], and cefotetan [Cefotan]—cause bleeding tendencies. Caution should be used during concurrent use of anticoagulants and other NSAID medications.
A patient has acquired an infection while in the hospital. The nurse identifies this type of infection as what?
Nosocomial infection
A patient who has tuberculosis is treated with isoniazid. The nurse should monitor for which symptoms, which could indicate a vitamin B6 deficiency caused by the medication? A. Numbness and tingling in the fingers and toes B. Alopecia and flaking scalp C. Dry skin and brittle nails D. Oral ulcers and tongue fissures
Numbness and tingling in the fingers and toes
Before administering a cephalosporin to a patient, it is most important for the nurse to assess the patient for an allergy history to what? A. Soy products B. Peanuts C. Penicillins D. Opioids
Penicillins
A nurse observes a red streak and palpates the vein as hard and cordlike at the intravenous (IV) site of a patient receiving cefepime [Maxipime]. Which assessment should the nurse make about the IV site? A. An allergic reaction has developed to the drug solution. B. The drug has infiltrated the extravascular tissues. C. Phlebitis of the vein used for the antibiotic has developed. D. Local infection from bacterial contamination has occurred.
Phlebitis of the vein used for the antibiotic has developed IV cephalosporins may cause thrombophlebitis. To minimize this, the injection site should be rotated and a dilute solution should be administered slowly. An allergic response would be shown as itching, redness, and swelling. Infiltration would show as a pale, cool, and puffy IV site. Infection would show as pus, tenderness, and redness.
A patient is admitted to the hospital with a medical diagnosis of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). When taking the patient's history, a nurse recognizes which information as the most important? A. Plays a contact sport and is an athlete B. Currently resides in a long-term care facility C. Did not complete the last course of antibiotics D. Had gallbladder surgery in the previous month
Plays a contact sport and is an athlete CA-MRSA is transmitted by skin-to-skin contact and by contact with contaminated objects, such as sports equipment and personal items. It is seen in young, healthy people without recent exposure to healthcare facilities, which is one of the biggest risk factors for CA-MRSA.
Which cardiovascular finding does the nurse identify as a possible adverse effect of erythromycin [Ery-Tab] therapy? A. Heart rate of 52 beats per minute B. Prolonged QT interval C. Jugular vein distention D. Grade III diastolic murmur
Prolonged QT interval
Patients with frequent urinary tract reinfections should be put on what type of therapy?
Prophylactic therapy for at least 6 months
A patient who is receiving an aminoglycoside (gentamicin) has a urinalysis result with all of these findings. Which finding should a nurse associate most clearly with an adverse effect of gentamicin? A. White blood cells (WBCs) B. Glucose C. Ketones D. Protein
Protein Symptoms of concern are protein in the urine, dilute urine, and elevation of the serum creatinine and blood urea nitrogen (BUN) levels.
A patient develops flushing, rash, and pruritus during an IV infusion of vancomycin [Vancocin]. Which action should a nurse take? A. Reduce the infusion rate. B. Administer diphenhydramine [Benadryl]. C. Change the IV tubing. D. Check the patency of the IV.
Reduce the infusion rate When vancomycin is infused too rapidly, histamine release may cause the patient to develop hypotension accompanied by flushing and warmth of the neck and face; this phenomenon is called red man syndrome.
A patient is receiving vancomycin [Vancocin]. The nurse identifies what as the most common toxic effect of vancomycin therapy? A. Ototoxicity B. Hepatotoxicity C. Renal toxicity D. Cardiac toxicity
Renal toxicity
A patient who has acquired immunodeficiency syndrome (AIDS) is receiving trimethoprim/sulfamethoxazole [Bactrim]. Which response should a nurse expect if the medication is achieving the desired effect? A. Increase in CD4 T cells B. Increased appetite and weight gain C. Resolution of pneumonia D. Decrease in joint pain
Resolution of pneumonia Trimethoprim/sulfamethoxazole is the treatment of choice for Pneumocystis pneumonia (PCP), an infection caused by Pneumocystis jiroveci (formerly thought to be Pneumocystis carinii). PCP is an opportunistic pneumonia caused by a fungus that thrives in immunocompromised hosts.
When ceftriaxone is administered intravenously, it is most important for the nurse to avoid mixing it with what? A. Ringer's lactate B. Normal saline C. Sterile water D. D5 0.45% NS
Ringer's lactate Mixing ceftriaxone with calcium causes precipitates to form. Ringer's lactate contains calcium; therefore it should not be mixed with ceftriaxone.
The nurse is assessing a patient who is receiving a sulfonamide for treatment of a urinary tract infection. To monitor the patient for the most severe response to sulfonamide therapy, the nurse will assess for what? A. Diarrhea B. Skin rash and lesions C. Hypertension D. Bleeding
Skin rash and lesions The most serious response to sulfonamide therapy is Stevens-Johnson syndrome, which manifests as symptoms of the skin and mucous membranes, lesions, fever, and malaise.
A nurse should teach a patient to observe for which side effects when taking ampicillin? A. Skin rash and loose stools B. Reddened tongue and gums C. Digit numbness and tingling D. Bruising and petechiae
Skin rash and loose stools
The development of a new infection as a result of the elimination of normal flora by an antibiotic is referred to as what?
Suprainfection
An immunocompromised patient who is receiving piperacillin/tazobactam [Zosyn] develops oozing and bleeding from the gums. Which additional data should the nurse determine? A. Whether the patient has a fever above 100.5°F B. Whether the patient reports any painful teeth C. The most recent platelet count D. The last time mouth care was given
The most recent platelet count It can cause bleeding secondary to disrupting platelet function; therefore, the platelet count may be altered
After completing a course of ciprofloxacin [Cipro] for a skin infection, the patient says, "I took the whole bottle of pills, but my infection hasn't gotten any better." Which additional information should the nurse recognize as most significant? A. The patient takes antacids on a daily basis. B. The medication was stored in a cool, dry area. C. The patient did not use sunscreen while taking the ciprofloxacin [Cipro]. D. The patient took two doses of diphenhydramine [Benadryl] while on ciprofloxacin [Cipro] therapy.
The patient takes antacids on a daily basis
A microbe acquires antibiotic resistance by which means?
Transfer of DNA coding to other bacteria
Which are examples of the improper use of antibiotic therapy?
Treating a viral infection Improper dosing
A nurse should teach a patient who has Pneumocystis pneumonia (PCP) about the dosing and therapeutic effects of which medication? A. Trimethoprim/sulfamethoxazole [Bactrim] B. Azithromycin [Zithromax] C. Acyclovir [Zovirax] D. Ganciclovir [Cytovene]
Trimethoprim/sulfamethoxazole [Bactrim] - TMP/SMX
The nurse knows that there is an increased risk of ototoxicity in a patient receiving an aminoglycoside if which level is high? A. Concentration B. Trough C. Peak D. Dose
Trough
A nurse should recognize that for maximum therapeutic effects against the influenza virus, oseltamivir [Tamiflu] should be taken when? A. Two days or more after symptom onset B. When lung crackles are present C. Within 12 hours of symptom onset D. Only when fever is above 102°F
Within 12 hours of symptom onset Dosing must begin early—no later than 2 days after symptom onset. If treatment is started within 12 hours of symptom onset, symptom duration is reduced by more than 3 days.
A nurse administering flu vaccines at an annual clinic should recognize that which individuals should be vaccinated, as recommended by the Advisory Committee on Immunization Practices (ACIP)? (Select all that apply.) A. Women who will be pregnant during flu season B. All children 6 months and older and older adults C. Those who report severe allergy to chicken eggs D. Those who have a history of Guillain-Barré syndrome E. Those 6 months to 18 years old receiving aspirin therapy
Women who will be pregnant during flu season All children 6 months and older and older adults Those 6 months to 18 years old receiving aspirin therapy
