Revised - Pharm Final Ch 92-100
A 65-year-old patient who receives glucocorticoids for arthritis is admitted to the hospital for treatment of a urinary tract infection. The prescriber has ordered intravenous ciprofloxacin [Cipro]. Before administering the third dose of this drug, the nurse reviews the bacterial culture report and notes that the causative organism is Escherichia coli. The bacterial sensitivity report is pending. The patient complains of right ankle pain. What will the nurse do? a. Withhold the dose of ciprofloxacin and notify the provider of the patient's symptoms. b. Instruct the patient to exercise the right foot and ankle to minimize the pain. c. Question the patient about the consumption of milk and any other dairy products. d. Request an order to increase this patient's dose of glucocorticoids.
ANS: A A rare but serious adverse effect associated with fluoroquinolones is tendon rupture, and those at highest risk are children, patients older than 60 years, transplant patients, and any patients taking glucocorticoids. Any pain in either heel should be reported and the drug should be discontinued. Patients should be instructed not to exercise until tendonitis has been ruled out. Dairy products can reduce the absorption of ciprofloxacin, so this is not a concern with this patient. Because the pain may be caused by tendonitis associated with ciprofloxacin, it is not correct to request an increase in the glucocorticoid dosing.
A nurse is caring for a patient with an infection caused by Bacillus anthracis. Which action is most important for reducing the transmission of this disease? a. Disinfecting the bedpan with an antiseptic solution b. Using antibacterial hand soap when washing the hands c. Using an alcohol-based hand rub after each patient contact d. Wearing gloves while caring for the patient ANS: B
ANS: B All of these measures are appropriate for this patient; however, using an antibacterial hand soap is the most important, because only an antimicrobial soap is effective against a spore-forming bacterium, such as B. anthracis.
A patient has a positive test for hepatitis C and is admitted to the hospital. The admission laboratory tests reveal a normal ALT, and a liver biopsy is negative for hepatic fibrosis and inflammation. The nurse will prepare this patient for: a. dual therapy with pegylated interferon alfa and ribavirin. b. no medication therapy at this time. c. pegylated interferon alfa only until ALT levels are elevated. d. triple drug therapy with pegylated interferon alfa, ribavirin, and boceprevir.
ANS: B Current recommendations are that treatment is used only for patients with HCV viremia, persistent elevation of ALT, and evidence of hepatic fibrosis and inflammation upon liver biopsy. Dual therapy has been the regimen of choice for patients with the above symptoms, but the addition of a protease inhibitor has been shown to improve outcomes. It is not correct to give pegylated interferon alfa until ALT levels are elevated. Triple drug therapy is used for patients with the above symptoms.
The nurse is caring for a patient who is taking a protease inhibitor (PI). Upon review of the laboratory test results, the nurse notes that the patient has newly elevated plasma triglycerides and cholesterol. The nurse expects that the prescriber will manage these levels with: a. lovastatin [Mevacor]. b. simvastatin [Zocor]. c. modified diet and exercise. d. Pancrease.
ANS: C All PIs can elevate plasma levels of cholesterol and triglycerides. Potential interventions for hyperlipidemia include modified diet, exercise, and lipid-lowering agents. Lovastatin and simvastatin should be avoided, because they can accumulate to dangerous levels. Pancrease is not indicated to lower triglycerides and cholesterol.
For which patient would a topical antiseptic be most appropriate? a. A patient with a systemic infection b. A patient with a medium-sized abscess c. A patient who has a wound with moderate exudate d. A patient who needs to have wounds cleansed for prophylaxis
ANS: D Antiseptics are useful as prophylaxis; when applied properly, they can help cleanse wounds and reduce microbial contamination. A patient with a systemic infection is treated with a systemic anti-infective drug. An abscess must be incised and drained, and a topical agent cannot significantly penetrate the skin to be effective. A wound with moderate exudates requires antibiotic therapy.
A patient is beginning treatment for active tuberculosis (TB) in a region with little drug-resistant TB. Which treatment regimen will be used initially? a. Isoniazid and pyrazinamide b. Isoniazid, pyrazinamide, and ethambutol c. Rifampin, pyrazinamide, and ethambutol d. Isoniazid, rifampin, pyrazinamide, and ethambutol
ANS: D The induction phase of treatment for patients in a region without drug resistance is the same as for patients who are human immunodeficiency virus (HIV) negative or HIV positive and includes isoniazid, rifampin, pyrazinamide, and ethambutol. It is not correct to begin with two drugs. The three-drug regimen is used for inductions in areas with resistance to either isoniazid or rifampin.
A nurse is preparing to administer an antibiotic to a patient with methicillin-resistant Staphylococcus aureus (MRSA). The nurse would expect the healthcare provider to order which antibiotic? a. Daptomycin [Cubicin] b. Levofloxacin [Levaquin] c. Norfloxacin [Noroxin] d. Ciprofloxacin [Cipro]
ANS: A Daptomycin is active against MRSA. Levofloxacin and norfloxacin are not approved to treat MRSA. Ciprofloxacin is a poor choice for staphylococcal infections, including MRSA.
A patient complains of painful urination. A physical examination reveals vesicles on her labia, vagina, and the foreskin of her clitoris. The nurse will expect to teach this patient about which medication? a. Acyclovir [Zovirax] b. Azithromycin [Zithromax] c. Metronidazole [Flagyl] d. Tinidazole [Tindamax]
ANS: A Genital herpes can be treated with acyclovir, famciclovir, or valacyclovir, which are antiviral medications. Azithromycin, metronidazole, and tinidazole are antibiotics and do not have antiviral effects.
A patient arrives in the emergency department with multiple dirty abrasions after a bicycle- automobile accident . Which product might be used initially to cleanse this patient's wounds? a. Hydrogen peroxide b. Isopropanol (isopropyl alcohol) c. Povidone-iodine [Betadine] d. Soap and water
ANS: A Hydrogen peroxide does not have good antiseptic properties, because the antimicrobial component is destroyed by catalase in tissues. It is useful initially because the frothing that occurs when catalase liberates oxygen loosens debris and facilitates cleansing of a dirty wound. Isopropanol is irritating to the skin. Povidone-iodine is used on intact skin. Soap and water can be used, but hard scrubbing is necessary on a dirty abrasion and can be painful.
A pregnant patient with fever, flank pain, and chills has a history of two previous bladder infections before getting pregnant. She is allergic to several antibiotics. She reports having taken methenamine successfully in the past. What will the nurse tell her? a. "This agent is not effective against infections of the upper urinary tract." b. "This antiseptic agent is safe for use during pregnancy and has no drug resistance." c. "This drug is linked to many serious birth defects and is not recommended during pregnancy." d. "You will need to take this medication with meals to avoid gastric upset."
ANS: A Methenamine is safe for use during pregnancy and would be an excellent choice for this patient if she had a lower urinary tract infection. However, it is not an effective agent for upper urinary tract infection, because it is a prodrug that must break down into ammonia and formaldehyde to be effective. There is not enough time for formaldehyde to form in the kidneys, so it is not effective in the upper tract. Nitrofurantoin is linked to serious birth defects and also must be given with food to prevent gastrointestinal problems.
Before giving methenamine [Hiprex] to a patient, it is important for the nurse to review the patient's history for evidence of which problem? a. Elevated blood urea nitrogen and creatinine b. History of reactions to antibiotic agents c. Possibility of pregnancy d. Previous resistance to antiseptic agents
ANS: A Methenamine should not be given to patients with renal impairment, because crystalluria can occur. There is no cross-reactivity between methenamine and antibiotic agents. Methenamine is safe for use during pregnancy. There is no organism drug resistance to methenamine.
A patient is about to begin therapy with ethambutol. The nurse knows that, before initiating treatment with this drug, it is important to obtain which test(s)? a. Color vision and visual acuity b. Complete blood cell (CBC) count c. Hearing testing and a tympanogram d. Hepatic function tests
ANS: A Optic neuritis is a dose-related adverse effect of ethambutol. Patients receiving this drug should have color vision and visual acuity testing before therapy starts and periodically thereafter. A CBC, hearing evaluations, and hepatic function testing are not recommended.
The nurse is preparing to administer amphotericin B intravenously. The nurse will expect to pretreat the patient with which medications? a. Acetaminophen [Tylenol], diphenhydramine [Benadryl], and meperidine [Demerol] b. Aspirin, diphenhydramine [Benadryl], and meperidine [Demerol] c. Ibuprofen [Motrin], diphenhydramine [Benadryl], and meperidine [Demerol] d. Morphine sulfate [Morphine] and acetaminophen [Tylenol]
ANS: A Optimum pretreatment before the administration of amphotericin B comprises acetaminophen, diphenhydramine, and meperidine (for rigors). Motrin is not suggested as pretreatment. Aspirin is an option, but it may increase kidney damage. Morphine is not indicated in the pretreatment regimen.
The nurse is caring for a patient receiving intravenous acyclovir [Zovirax]. To prevent nephrotoxicity associated with intravenous acyclovir, the nurse will: a. hydrate the patient during the infusion and for 2 hours after the infusion. b. increase the patient's intake of foods rich in vitamin C. c. monitor urinary output every 30 minutes. d. provide a low-protein diet for 1 day before and 2 days after the acyclovir infusion.
ANS: A The nurse should ensure that the patient is hydrated during the acyclovir infusion and for 2 hours after the infusion to prevent nephrotoxicity. Increasing vitamin C would not help prevent nephrotoxicity. Monitoring urine output is important but would not help prevent nephrotoxicity. A low-protein diet is not indicated after an acyclovir infusion.
An adolescent patient comes to the clinic complaining of a burning sensation upon urination and a pus-like discharge from the penis. The nurse is correct to suspect that the patient has which disorder? a. Gonorrhea b. Herpes simplex c. Nongonococcal urethritis d. Syphilis
ANS: A This patient has signs and symptoms that are consistent with gonorrhea. Herpes simplex manifests as vesicles on the penis or testes (or both) with a watery discharge. Nongonococcal urethritis results in ulcers on the urethral site. Syphilis is characterized by chancres and skin lesions.
Which superficial mycosis is generally treated with oral antifungal agents? a. Tinea capitis b. Tinea corporis c. Tinea cruris d. Tinea pedis
ANS: A Tinea capitis must be treated with oral agents for 6 to 8 weeks. Tinea corporis, tinea cruris, and tinea pedis may be treated topically.
A patient will be discharged from the hospital with a prescription for TMP/SMZ [Bactrim]. When providing teaching for this patient, the nurse will tell the patient that it will be important to: a. drink 8 to 10 glasses of water each day. b. eat foods that are high in potassium. c. take the medication with food. d. take folic acid supplements.
ANS: A TMP/SMZ can injure the kidneys, because it causes deposition of sulfonamide crystals in the kidneys. Patients should be advised to drink 8 to 10 glasses of water a day to maintain a urine flow of 1200 mL in adults. Trimethoprim can cause hyperkalemia, so consuming extra potassium is unnecessary. The medication should be taken on an empty stomach. It is not necessary to consume extra folic acid, because mammalian cells use dietary folate and do not have to synthesize it; it is the process of folic acid synthesis that is altered by sulfonamides.
A patient has an abrasion, and the nurse is preparing to cleanse the area with iodine. Which preparation will the nurse use? a. Free elemental iodine b. Iodine solution c. Iodine tincture d. Povidone-iodine
ANS: B Iodine solution should be used for the treatment of wounds and abrasions, because it does not contain alcohol, which can irritate and damage the tissue. Free elemental iodine is released from iodine preparations after administration. Iodine tincture contains alcohol and is used on intact skin only. Povidone-iodine is used prophylactically to prevent postoperative infection.
A patient admitted to the hospital is using metronidazole [Flagyl] 0.75% gel. The nurse understands that this agent is used to treat which condition? a. Chlamydia trachomatis b. Gardnerella vaginalis c. Haemophilus ducreyi d. Trichomonas vaginalis
ANS: B Gardnerella vaginalis causes bacterial vaginosis and is treated with metronidazole gel. C. trachomatis is treated with systemic antibiotics. H. ducreyi, which causes chancroid, is treated with systemic antibiotics. T. vaginalis is treated with oral metronidazole.
A patient comes to a clinic for tuberculosis medications 2 weeks after beginning treatment with a four-drug induction phase. The patient's sputum culture remains positive, and no drug resistance is noted. At this point, the nurse will expect the provider to: a. change the regimen to a two-drug continuation phase. b. continue the four-drug regimen and recheck the sputum in 2 weeks. c. obtain a chest radiograph and consider adding another drug to the regimen. d. question the patient about adherence to the drug regimen.
ANS: B In patients with positive pretreatment sputum test results, sputum should be evaluated every 2 to 4 weeks until cultures are negative and then monthly thereafter. In the absence of drug resistance, treatment with the same regimen should continue. Sputum cultures should become negative in over 90% of patients in 3 or more months. The induction phase should last 2 months, so this patient should remain on a four-drug regimen. It is not necessary to order a chest radiograph or to add another drug at this stage of treatment. The patient is stable and has not developed symptoms that cause concern, so the patient does not need to be questioned about adherence.
A nurse is teaching a group of nursing students about influenza prevention. Which statement by a student indicates understanding of the teaching? a. "I may develop a mild case of influenza if I receive the vaccine by injection." b. "I should receive the vaccine every year in October or November." c. "If I have a cold I should postpone getting the vaccine." d. "The antiviral medications are as effective as the flu vaccine for preventing the flu."
ANS: B Influenza vaccine should be given every year in October or November. The vaccine will not cause influenza. Minor illnesses, such as a cold, are not a contraindication for receiving the vaccine. Antiviral medications are not as effective as the flu vaccine in preventing influenza.
A nurse is caring for a patient who is receiving amphotericin B [Abelcet] for a systemic fungal infection. In spite of receiving diphenhydramine and acetaminophen before initiation of treatment, the patient has fever and chills with rigors. The nurse will contact the provider to discuss the addition of which drug? a. Aspirin b. Dantrolene c. Hydrocortisone d. Omeprazole
ANS: B Patients receiving amphotericin frequently experience infusion reactions, with fever, chills, rigors, nausea, and headache. Pretreatment with diphenhydramine and acetaminophen can reduce mild reactions. If rigors occur, the patient should receive dantrolene or meperidine. Aspirin would be effective for pretreatment but can increase kidney damage. Hydrocortisone is also effective, but it causes immune suppression. Omeprazole is not indicated.
The nurse is preparing to discharge a patient with HIV who will continue to take enfuvirtide [Fuzeon] at home. The nurse is providing patient education about the medication. What information about the administration of enfuvirtide is most appropriate for the patient? a. The importance of injecting the drug into two alternating sites daily b. How to reconstitute and self-administer a subcutaneous injection c. The importance of taking the drug with high doses of vitamin E d. Likely drug interactions between enfuvirtide and other antiretroviral drugs
ANS: B The most appropriate information about the administration of enfuvirtide is how to reconstitute and self-administer a subcutaneous injection. The medication should never be injected into the same site or just between two sites. Vitamin E is not indicated for this medication. Enfuvirtide does not appear to cause significant drug interactions.
A patient with histoplasmosis is being treated with itraconazole [Sporanox]. The nurse will teach this patient to report which symptoms? a. Gynecomastia and decreased libido b. Headache and rash c. Nausea, vomiting, and anorexia d. Visual disturbances
ANS: C Itraconazole is associated with rare cases of liver failure, some of which were fatal. Patients should be instructed to reports signs of liver toxicity, including nausea, vomiting, and anorexia. Ketoconazole is associated with gynecomastia and libido changes. Headache and rash are associated with fluconazole. Visual disturbances may occur with voriconazole.
A pregnant female patient with bacteriuria, suprapubic pain, urinary urgency and frequency, and a low-grade fever is allergic to sulfa, ciprofloxacin, and amoxicillin. The nurse knows that the best alternative for treating this urinary tract infection is with: a. cephalexin [Keflex]. b. fosfomycin [Monurol]. c. methenamine [Hiprex]. d. nitrofurantoin [Macrodantin].
ANS: C Methenamine is an excellent second-line drug for this patient and is indicated because of the patient's multiple drug sensitivities. It is safe in pregnancy, and there is no drug resistance. Nitrofurantoin has potential harmful effects on the fetus and should not be used during pregnancy. Single-dose regimens are not recommended in pregnant women. Cephalexin can have cross-reactivity with amoxicillin.
A patient is admitted to the hospital with fever, headache, malaise, joint pain, and enlarged lymph nodes. Blood cultures are positive for Treponema pallidum. The nurse recognizes this as which type of syphilis? a. Congenital b. Primary c. Secondary d. Tertiary
ANS: C Secondary syphilis occurs when the organism spreads to the bloodstream, causing systemic symptoms such as fever, headache, reduced appetite, and general malaise, along with enlarged lymph nodes and joint pain. Congenital syphilis occurs when infants are exposed to T. pallidum in utero; early symptoms include sores, rhinitis, and point tenderness over bones. Primary syphilis is characterized by a primary lesion, called a chancre, at the point of entry, along with enlarged lymph nodes. Tertiary syphilis develops 5 to 40 years after the initial infection and can involve the brain, heart, and other sites.
A patient with second-degree burns is treated with silver sulfadiazine [Silvadene]. A nursing student asks the nurse about the differences between silver sulfadiazine and mafenide [Sulfamylon], because the two are similar products, and both contain sulfonamides. What does the nurse tell the student about silver sulfadiazine? a. It causes increased pain when the medication is applied. b. It has a broader spectrum of antimicrobial sensitivity. c. It has antibacterial effects related to release of free silver. d. It suppresses renal excretion of acid, causing acidosis.
ANS: C Silver sulfadiazine has antibacterial effects primarily related to the release of free silver and not to the sulfonamide portion of the molecule. Unlike mafenide, silver sulfadiazine reduces pain when applied. Silver sulfadiazine and mafenide have similar antibacterial effects. Because silver sulfadiazine does not suppress renal excretion of acid, it has fewer systemic effects.
A patient with type 2 diabetes mellitus takes glipizide. The patient develops a urinary tract infection, and the prescriber orders TMP/SMZ. What will the nurse tell the patient? a. Patients with diabetes have an increased risk of an allergic reaction. b. Patients taking TMP/SMZ may need increased doses of glipizide. c. The patient should check the blood glucose level more often while taking TMP/SMZ. d. The patient should stop taking the glipizide while taking the TMP/SMZ. ANS: C
ANS: C Sulfonamides can intensify the effects of some drugs, including glipizide, which is a sulfonylurea-type hypoglycemic medication. These drugs may require a reduction in dose to prevent toxicity. Patients should monitor their blood glucose more closely. There is no increase in allergic reactions to TMP/SMZ in patients who are diabetic. Patients taking TMP/SMZ may need reduced doses of glipizide but should not stop taking the drug.
A patient presents to the emergency department with complaints of chills, severe flank pain, dysuria, and urinary frequency. The patient has a temperature of 102.9°F, a pulse of 92 beats/min, respirations of 24 breaths per minute, and a blood pressure of 119/58 mm Hg. The nurse would be correct to suspect that the patient shows signs and symptoms of: a. acute cystitis. b. urinary tract infection. c. pyelonephritis. d. prostatitis.
ANS: C The nurse should suspect pyelonephritis. Pyelonephritis is characterized by fever, chills, severe flank pain, dysuria, urinary urgency and frequency, and pyuria and bacteriuria. Clinical manifestations of acute cystitis include dysuria, urinary urgency and frequency, suprapubic discomfort, pyuria, and bacteriuria. Urinary tract infections (UTIs) are very general and are classified by their location. These symptoms are specific to pyelonephritis. Prostatitis is manifested by high fever, chills, malaise, myalgia, localized pain, and various UTI symptoms but not by severe flank pain.
A child has ringworm on the scalp. A culture of the lesion reveals a dermatophytic infection. The nurse teaching the child's parents about how to treat this infection will include which statement? a. "Adverse effects of the medication include itching, burning, and erythema." b. "Apply the topical medication daily until at least 1 week after the rash is gone." c. "Your child will need to take this oral medication for 6 to 8 weeks." d. "You will use an antifungal shampoo to treat this infection."
ANS: C Tinea capitis is difficult to treat with topical medications; oral griseofulvin, taken for 6 to 8 weeks, is standard therapy. Itching, burning, and erythema are side effects of topical agents. Patients treating tinea corporis, tinea cruris, or tinea pedis are taught to apply medication until 7 days after the rash disappears. Antifungal shampoos are not effective for treating tinea capitis.
An immunocompromised child is exposed to chickenpox and the provider orders valacyclovir [Valtrex] to be given orally three times daily. The nurse will contact the provider to change this order for which reason? a. Valacyclovir is not used as varicella prophylaxis. b. The dosage is too high for this indication. c. The drug may cause serious adverse effects in immunocompromised patients. d. Valacyclovir is not approved for use in children.
ANS: C Valacyclovir is approved for use for varicella in immunocompetent children. In immunocompromised patients, it has produced a syndrome known as thrombotic thrombocytopenic purpura/hemolytic uremia syndrome (TTP/HUS). The dosage is fine for immunocompetent children.
A patient who is taking calcium supplements receives a prescription for ciprofloxacin [Cipro] for a urinary tract infection. The nurse will teach this patient to: a. consume extra fluids while taking the ciprofloxacin to prevent hypercalciuria. b. stop taking the calcium supplements while taking the ciprofloxacin. c. take the two medications together to increase the absorption of both. d. take the calcium either 6 hours before or 2 hours after taking the ciprofloxacin.
ANS: D Cationic compounds, including calcium supplements, can reduce the absorption of ciprofloxacin, so proper interval dosing is necessary. Consuming extra fluids is not indicated. With proper interval dosing, it is not necessary to discontinue the calcium while giving the ciprofloxacin. These two medications should not be given together.
A patient is about to begin treatment with isoniazid. The nurse learns that the patient also takes phenytoin [Dilantin] for seizures. The nurse will contact the provider to discuss: a. increasing the phenytoin dose. b. reducing the isoniazid dose. c. monitoring isoniazid levels. d. monitoring phenytoin levels.
ANS: D Isoniazid is a strong inhibitor of three cytochrome P450 enzymes, and inhibition of these enzymes can raise the levels of other drugs, including phenytoin. Patients taking phenytoin should have the levels of this drug monitored, and the dose should be reduced if appropriate. Reducing the dose of isoniazid is not indicated. It is not necessary to monitor isoniazid levels.
A pregnant patient is treated with trimethoprim/sulfamethoxazole (TMP/SMZ) [Bactrim] for aurinary tract infection at 32 weeks' gestation. A week later, the woman delivers her infant prematurely. The nurse will expect to monitor the infant for: a. birth defects. b. hypoglycemia. c. rash. d. kernicterus.
ANS: D Kernicterus is a disorder in newborns caused by deposition of bilirubin in the brain. Sulfonamides promote kernicterus by displacing bilirubin from plasma proteins. Sulfonamides should not be given to infants under 2 months of age or to pregnant women after 32 weeks' gestation. Sulfonamides do not cause birth defects or hypoglycemia. Serious rashes may occur but are not the primary concern in the newborn.
A nurse is preparing to administer oral ofloxacin to a patient. While taking the patient's medication history, the nurse learns that the patient takes warfarin and theophylline. The correct action by the nurse is to request an order to: a. reduce the dose of ofloxacin. b. increase the dose of ofloxacin. c. increase the dose of theophylline. d. monitor coagulation levels.
ANS: D Ofloxacin increases plasma levels of warfarin, so coagulation tests should be monitored. The ofloxacin dose should not be reduced or increased. Ofloxacin does not affect theophylline levels.
After starting an antiviral protease inhibitor, a patient with HIV telephones the nurse, complaining, "I'm so hungry and thirsty all the time! I'm urinating 10 or 12 times a day." The nurse recognizes these findings to be consistent with: a. pancreatic infiltration by HIV. b. allergic reaction. c. nonadherence to the antiviral regimen. d. hyperglycemia.
ANS: D Protease inhibitors have been associated with hyperglycemia, new-onset diabetes, abrupt exacerbation of existing diabetes, and diabetic ketoacidosis. These symptoms are not consistent with pancreatic infiltration or an allergic reaction. No evidence indicates that the patient is noncompliant.
A female patient who has hepatitis C is being treated with pegylated interferon alfa and ribavirin [Ribasphere]. It will be important for the nurse to teach this patient that: a. if she gets pregnant, she should use the inhaled form of ribavirin [Virazole]. b. if she is taking oral contraceptives, she should also take a protease inhibitor. c. she should use a hormonal contraceptive to avoid pregnancy. d. she will need a monthly pregnancy test during her treatment.
ANS: D Ribavirin causes severe fetal injury and is contraindicated during pregnancy. Women taking ribavirin must rule out pregnancy before starting the drug, monthly during treatment, and monthly for 6 months after stopping treatment. Inhaled ribavirin is also embryo lethal and teratogenic. Adding a protease inhibitor will reduce the efficacy of oral contraceptives. Women using ribavirin should use two reliable forms of birth control.
A young, nonpregnant female patient with a history of a previous urinary tract infection is experiencing dysuria, urinary urgency and frequency, and suprapubic pain of 3 days' duration. She is afebrile. A urine culture is positive for more than 100,000/mL of urine. The nurse caring for this patient knows that which treatment is most effective? a. A 14-day course of amoxicillin with clavulanic acid [Augmentin] b. A 7-day course of ciprofloxacin [Cipro] c. A single dose of fosfomycin [Monurol] d. A 3-day course of trimethoprim/sulfamethoxazole [Bactrim]
ANS: D Short-course therapy is recommended for uncomplicated, community-acquired lower urinary tract infections. The short course is more effective than a single dose, and compared with longer- course therapies, it is less costly, has fewer side effects, and is more likely to foster compliance. Amoxicillin with clavulanic acid is a second-line drug used for pyelonephritis. Fosfomycin is a second-line drug and can be useful in patients with drug allergies.
A nurse is caring for an African American patient who has been admitted to the unit for long- term antibiotic therapy with sulfonamides. The patient develops fever, pallor, and jaundice. The nurse would be correct to suspect that the patient has developed: a. Stevens-Johnson syndrome. b. kernicterus. c. hepatotoxicity. d. hemolytic anemia.
ANS: D Sulfonamides can cause hemolytic anemia in patients of African, American and Mediterranean origin, usually because of a genetic deficiency. Red cell lysis can produce fever, pallor, and jaundice, and patients should be observed for these signs. The patient's signs and symptoms are not characteristic of Stevens-Johnson syndrome or hepatotoxicity. The patient's signs and symptoms are not characteristic of kernicterus, which occurs in newborns.
A nurse is obtaining a drug history from a patient about to receive sulfadiazine. The nurse learns that the patient takes warfarin, glipizide, and a thiazide diuretic. Based on this assessment, the nurse will expect the provider to: a. change the antibiotic to TMP/SMZ. b. increase the dose of the glipizide. c. monitor the patient's electrolytes closely. d. monitor the patient's coagulation levels.
ANS: D Sulfonamides interact with several drugs and through metabolism-related interactions can intensify the effects of warfarin. Patients taking both should be monitored closely for bleeding tendencies. Changing to the combination product will not help, because sulfonamides are still present. Sulfonamides intensify glipizide levels, so this drug may actually need to be reduced. Trimethoprim, not sulfonamides, raises potassium levels.
A patient starting therapy with efavirenz [Sustiva] asks about the timing of the medication with regard to meals. Which patient education about the administration of this medication should the nurse provide? a. The drug must be taken within 30 minutes after a meal. b. The drug is best taken with a high-fat meal. c. The drug can be taken anytime without regard to meals. d. The drug should be taken once daily on an empty stomach.
ANS: D The nurse should advise the patient that the medication should be taken once daily on an empty stomach. Thirty minutes after a meal is too soon to take the medication. The medication is taken on an empty stomach, because high-fat meals increase plasma levels by 39% with capsules and by 79% with tablets. The medication must not be taken with high-fat meals
A patient has come to the clinic with tinea corporis, and the prescriber has ordered clotrimazole. When educating the patient about this medication, the nurse will include which statement? a. "Apply the medication over the entire body twice daily for 2 weeks." b. "Sun exposure will minimize the drug's effects." c. "This drug is effective after a single application." d. "Use the medication for at least 1 week after the symptoms have cleared."
ANS: D The nurse should advise the patient to continue therapy for at least 1 week after the symptoms have cleared up. The medication should be applied only to affected areas. Sun exposure will not delay the effects of clotrimazole. The drug must be applied twice daily for several weeks.
The nurse is caring for a patient who is HIV positive and is taking zidovudine [Retrovir]. Before administering the medication, the nurse should monitor which laboratory values? a. Ketones in the urine and blood b. Serum immunoglobulin levels c. Serum lactate dehydrogenase d. Complete blood count (CBC)
ANS: D The nurse should monitor the patient's CBC to determine whether the patient has anemia and neutropenia. Ketones are not an adverse effect of zidovudine. Nothing indicates a need to monitor the immunoglobulin levels or serum lactate dehydrogenase.
An older male patient comes to the clinic with complaints of chills, malaise, myalgia, localized pain, dysuria, nocturia, and urinary retention. The nurse would most likely suspect that the patient has: a. acute cystitis. b. urinary tract infection. c. pyelonephritis. d. prostatitis.
ANS: D The nurse should suspect prostatitis, which is manifested by high fever, chills, malaise, myalgia, and localized pain and may also be manifested by dysuria, nocturia, and urinary urgency, frequency, and retention. Clinical manifestations of acute cystitis include dysuria, urinary urgency and frequency, suprapubic discomfort, pyuria, and bacteriuria. Urinary tract infections are very general and are classified by their location. Pyelonephritis is characterized by fever, chills, severe flank pain, dysuria, and urinary frequency and urgency, as well as by pyuria and bacteriuria.
Which patient with a urinary tract infection will require hospitalization and intravenous antibiotics? a. A 5-year-old child with a fever of 100.5°F, dysuria, and bacteriuria b. A pregnant woman with bacteriuria, suprapubic pain, and fever c. A young man with dysuria, flank pain, and a previous urinary tract infection d. An older adult man with a low-grade fever, flank pain, and an indwelling catheter
ANS: D The patient with an indwelling catheter and signs of pyelonephritis shows signs of a complicated UTI, which is best treated with intravenous antibiotics. The other three patients show signs of uncomplicated urinary tract infections that are not severe and can be treated with oral antibiotics.
A nurse is performing a physical assessment on a patient with tuberculosis who takes rifampin [Rifadin]. What would be an expected finding? a. Crystalluria b. Myopathy c. Peripheral neuropathy d. Red-orange-tinged urine
ANS: D Urine tinged red-orange is a normal finding associated with rifampin's adverse effects. Peripheral neuropathy, myopathy, and crystalluria are not manifestations of adverse effects of rifampin.