Anti-Infectives NCLEX style Q's from Lehne CH 83-88

The nurse identifies which statements about Stevens-Johnson syndrome as true? (Select all that apply.) a. Patients with Stevens-Johnson syndrome have a mortality rate of about 25%. Correct b. Toxemia is associated with Stevens-Johnson syndrome. Correct c. Short-acting sulfonamides do not induce Stevens-Johnson syndrome. d. Patients with Stevens-Johnson syndrome usually are hypothermic. e. Lesions of the mucous membranes are a characteristic of Stevens-Johnson syndrome.

AND: A, B, E Short-acting sulfonamides do induce Stevens-Johnson syndrome on rare occasions, and patients with Stevens-Johnson syndrome usually are hyperthermic. The other three statements are true.

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

Ans: B The nurse's priority is to monitor for hypersensitivity reactions. 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. In rare cases, hematologic effects occur, requiring periodic blood studies.

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

Ans: B 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. Heart failure, diabetes, and emphysema are unrelated to adverse effects with trimethoprim.

When providing patient teaching for oral sulfonamide therapy, the nurse should instruct the patient to take the sulfonamide in what way? a. At mealtime, when food is available b. With soy or nonmilk products c. Between meals with a full cup of water d. On awakening before breakfast

Ans: D Oral sulfonamides should be taken on an empty stomach and with a full glass of water. To minimize the risk of renal damage, adults should maintain a daily urine output of 1200 mL. Sulfonamides should not be taken with soy or nonmilk products or food or before breakfast without liquids.

An antimicrobial medication that has selective toxicity has which characteristic? a. Ability to transfer DNA coding b. Ability to suppress bacterial resistance c. Ability to avoid injuring host cells d. Ability to act against a specific microbe

Answer C Selective toxicity refers to an antibiotic that has the ability to injure only invading microbes, not the host. Conjugation is the process through which DNA coding for drug resistance is transferred from one bacterium to another. Antibiotics do not suppress bacterial resistance, but rather promote the emergence of drug-resistant microbes. Antibiotics that are narrow spectrum are active against only a few microbes.

Before administering an aminoglycoside, it is most important for the nurse to assess the patient for a history of what? a. Myasthenia gravis b. Asthma c. Hypertension d. Diabetes mellitus

Answer: A Aminoglycosides can inhibit neuromuscular transmission, causing flaccid paralysis and potentially fatal respiratory depression. These drugs should be used with extreme caution in patients with myasthenia gravis.

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

Answer: A Ampicillin's most common side effects are rash and diarrhea; both reactions occur more frequently with ampicillin than with any other penicillin. Reddened tongue and gums, digit numbness and tingling, and bruising and petechiae are not associated side effects of ampicillin.

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.

Answer: A 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. Rather, these drugs should be administered separately. Two different peripheral IV sites are not necessary. Administering the gentamicin first does not ensure separation of the two medications.

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.

Answer: A 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. Diphenhydramine is not necessary if the infusion is administered slowly over at least 60 minutes. Changing the IV tubing would not help the symptoms. The patency of the IV needs to be checked before the administration is started.

The nurse identifies appropriate use of antimicrobials to prevent infection in which situations? (Select all that apply.) a. Cardiac surgery b. Recurrent urinary tract infections in women c. Anemia d. Treatment of fever of unknown origin e. Hysterectomy

Answer: A, B, E Prophylactic use of antibiotics can reduce the incidence of infection in certain kinds of surgery. Procedures in which prophylactic efficacy has been documented include cardiac surgery, peripheral vascular surgery, orthopedic surgery, and surgery on the gastrointestinal (GI) tract (stomach, duodenum, colon, rectum, and appendix). Prophylaxis is also beneficial for women undergoing a hysterectomy or an emergency cesarean section. Severe neutropenia, not anemia, puts individuals at high risk of infection. In young women with recurrent urinary tract infection, prophylaxis with trimethoprim/sulfamethoxazole may be helpful. Unless the cause of a fever is a proven infection, antibiotics should not be used. Fever by itself constitutes a legitimate indication for antibiotic use only when the fever occurs in a severely immunocompromised person. Because fever may indicate infection and because infection can be lethal to immunocompromised individuals, these patients should be given antibiotics when fever occurs, even if fever is the only indication that an infection may be present.

A nurse should recognize that antibiotic prophylaxis is appropriate in patients with which medical conditions? (Select all that apply.) a. Aortic valve replacement b. Ruptured appendix c. Bronchitis d. Neutropenia e. Chickenpox

Answer: A, D Antibiotic prophylaxis is appropriate and effective in certain situations. These include patients who have prosthetic valves and are at risk for bacterial endocarditis. The use of antibiotics in "dirty" surgeries, such as those for ruptured organs, is considered treatment, not prophylaxis. Severe neutropenia can put patients at risk for severe infection, and antibiotics can reduce infections but may encourage fungal invasion. Antibiotics are not prescribed preventively for bronchitis or chickenpox.

When administering an aminoglycoside to a patient with myasthenia gravis, it is most important for the nurse to assess what? a. Deep tendon reflexes b. Breath sounds c. Eyelid movement d. Muscle strength

Answer: B Aminoglycosides can inhibit neuromuscular transmission, causing potentially fatal respiratory depression. Patients with myasthenia gravis (MG) are at an increased risk. Deep tendon reflexes, eyelid movement, and muscle strength are important assessments for a patient who has MG, but they are not as important as airway and breathing ability.

The development of a new infection as a result of the elimination of normal flora by an antibiotic is referred to as what? a. Resistant infection b. Superinfection c. Nosocomial infection d. Allergic reaction

Answer: B Antibiotic therapy can destroy the normal flora of the body, which normally would inhibit the overgrowth of fungi and yeast. When the normal flora is decreased, these organisms can overgrow and cause a new infection, or superinfection.

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

Answer: B Clostridium difficile-associated diarrhea (CDAD) is the most severe toxicity associated with clindamycin and is characterized by profuse, watery stools. The cause is superinfection of the bowel with Clostridium difficile, an anaerobic gram-positive bacillus. Gray syndrome, which usually occurs in infants and those with aplastic anemia, is an adverse effect of chloramphenicol [Chloromycetin]. Hepatotoxicity is associated most closely with telithromycin [Ketek].

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."

Answer: B Tetracyclines are bacteriostatic antibiotics; photosensitivity and severe sunburn are common adverse effects. A full course of antibiotics must always be taken. Blood studies are not necessary for therapeutic levels. Absorption decreases after ingestion of chelates, such as calcium and magnesium, so doses should be given 2 hours before or 2 hours after ingestion of milk products

What is the minimum bactericidal concentration (MBC)? a. The lowest concentration of an antibiotic needed to suppress bacterial growth completely b. The lowest concentration of an antibiotic needed to reduce the number of bacterial colonies by 99.9% Correct c. The lowest concentration of an antibiotic needed to produce effects d. The lowest dose of an antibiotic needed to eradicate bacteria

Answer: B The MBC is the lowest concentration of drug that produces a 99.9% decline in the number of bacterial colonies (indicating bacterial kill). The lowest antibiotic concentration needed to suppress bacterial growth or to produce effects and the lowest antibiotic dose needed to eradicate bacteria are incorrect descriptions of MBC.

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

Answer: B Trough levels determine the lowest level between doses. Blood is drawn just before the next dose is administered when a divided dose is used or 1 hour before the next dose if a single daily dose is used.

The nurse identifies which host factor as the most important when choosing an antimicrobial drug? a. Age b. Competent immune function c. Genetic heritage d. Previous medication reactions

Answer: B Two factors—host defenses and the site of infection—are unique to the selection of antibiotics. It is critical for success that antibiotics act synergistically with the immune system to subdue infection. Other host factors, such as age, genetic heritage, and previous drug reactions, are the same factors that must be considered when choosing any other medication.

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 Correct c. Jugular vein distention d. Grade III diastolic murmur

Answer: B When present in high levels, erythromycin can prolong the QT interval, causing a potentially fatal ventricular dysrhythmia. It should be avoided by patients taking class IA or class III antidysrhythmic medications or others that inhibit metabolism.

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. Correct c. Patients usually experience abdominal pain. Correct d. Anticholinergics are effective in treating the diarrhea. e. Clindamycin therapy should be discontinued and vancomycin started. Correct

Answer: B, C, E CDAD is a potentially fatal condition in which patients experience abdominal pain. If CDAD develops, clindamycin therapy should be stopped and vancomycin or metronidazole therapy started. Leukocytosis, not leukopenia, develops. Anticholinergics can make the diarrhea worse and therefore should be avoided.

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]

Answer: C Three cephalosporins—cefmetazole [Zefazone], cefoperazone [Cefobid], and cefotetan [Cefotan]—cause bleeding tendencies. Caution should be used during concurrent use of anticoagulants and other nonsteroidal medications. Regular insulin, ampicillin, and bisacodyl are unrelated to adverse effects with cefotetan.

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

Answer: C Gentamicin causes irreversible ototoxicity, which results in both impaired hearing and disruption of balance. Headache is the first sign of impending vestibular damage (balance) and may last 1 to 2 days. Unsteadiness, vertigo, and dizziness appear after headache.

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.

Answer: C 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.

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

Answer: C The cephalosporins are beta-lactam antibiotics similar in structure and actions to the penicillins. They are contraindicated in patients with a history of severe allergic reactions to penicillins. The use of soy products, peanuts, and opioids is unrelated to cephalosporins.

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

Answer: C The most common toxic effect of vancomycin [Vancocin] therapy is renal toxicity. Although ototoxicity may occur, it is rare. The liver and heart are not affected when vancomycin is used.

Which statements about ototoxicity and aminoglycosides does the nurse identify as true? (Select all that apply.) a. The risk of ototoxicity is related primarily to excessive peak levels. b. The first sign of impending cochlear damage is headache. c. The first sign of impending vestibular damage is headache. Correct d. Ototoxicity is largely irreversible. Correct e. Use of aminoglycosides for less than 10 days is recommended to avoid ototoxicity. Correct

Answer: C, D, E The risk of ototoxicity with aminoglycoside use is related primarily to excessive trough levels. The first sign of impending vestibular damage is headache. The first sign of cochlear damage is tinnitus. The other two statements are true.

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."

Answer: D Because of its chemical size and weight, vancomycin is absorbed poorly in the gastrointestinal (GI) tract and is given parenterally for most infections. It is used for serious infections caused by organisms such as MRSA and in patients with susceptible organisms allergic to penicillins. Oral administration is used only for infections of the intestine. It is not associated with loss of appetite or nausea.

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)

Answer: D Clarithromycin is a macrolide similar to erythromycin and can inhibit hepatic metabolism of medications such as warfarin and theophylline. The INR is the blood test used to evaluate warfarin ranges. The aPTT is the blood test used in monitoring heparin. The platelet count and ESR are not affected by clarithromycin

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

Answer: D 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. Delay in long bone growth, early onset of puberty, and severe face and body acne are not adverse effects associated with tetracyclines.

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

Answer: a Penicillin G in high IV doses may cause hyperkalemia, which can result in dysrhythmias or cardiac arrest. Hypernatremia occurs with high IV doses of ticarcillin. Lung sounds and the RBC count are unrelated to the administration of penicillin G.

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.

Answer: d Itching and redness at the IM injection site indicate an allergy to penicillin. The primary treatment is epinephrine (subcutaneous, IM, or IV) plus respiratory support. Elevation, ice packs, and calming the patient are done once epinephrine has been administered.

Which instructions will the nurse include when teaching a patient about cephalosporin therapy? (Select all that apply.) a. "Notify your healthcare provider if you develop diarrhea." b. "Take aspirin if you develop a headache." c. "Notify your healthcare provider if you develop a rash." d. "Cephalosporins may not be taken with food." e. "Do not take cephalosporins if you have lactose intolerance."

Answers: A, C Cephalosporins may enhance bleeding tendencies, so drugs such as aspirin that may promote bleeding should be avoided. Cephalosporins may be taken with food, and they are safe to take if a patient has lactose intolerance. Severe diarrhea should be reported, because it may indicate the development of C. difficile infection. Any indication of an allergic reaction, including a rash, should be reported to the healthcare provider.

The nurse identifies which statements about penicillins as true? (Select all that apply.) a. Penicillins are the safest antibiotics available. b. The principal adverse effect of penicillins is allergic reaction. c. A patient who is allergic to penicillin always has a cross-allergy to cephalosporins. d. A patient who is allergic to penicillin is also allergic to vancomycin, erythromycin, and clindamycin. e. Penicillins are normally eliminated rapidly by the kidneys but can accumulate to harmful levels if renal function is severely impaired.

Answers: A,B,E A patient who is allergic to penicillin has a 1% chance of also being allergic to cephalosporins. Patients who are allergic to penicillin are safely able to take vancomycin, erythromycin, and clindamycin. The other three statements are true.

Which are examples of the improper use of antibiotic therapy? (Select all that apply.) a. Using surgical drainage as an adjunct to antibiotic therapy b. Treating a viral infection c. Basing treatment on sensitivity reports d. Treating fever in an immunodeficient patient e. Using dosing that results in a superinfection

Answers: B, E Common misuses of antibiotics include (1) treatment of a viral infection, which results in exposure of the patient to the risks of the medication without providing any benefits; and (2) improper dosing (dosing that is too high results in superinfection). The other answers are examples of the proper use of antimicrobial therapy.

Which statements about vancomycin [Vancocin] does the nurse identify as true? (Select all that apply.) a. Vancomycin is the most widely used antibiotic in U.S. hospitals. b. Vancomycin is effective in the treatment of Clostridium difficile infection. c. Vancomycin is effective in the treatment of MRSA infections. d. Patients who are allergic to penicillin are also allergic to vancomycin. e. The major toxicity of vancomycin therapy is liver failure.

Answers: a,b,c Patients who are allergic to penicillin are able to take vancomycin. The major toxicity of vancomycin therapy is kidney failure. The other three statements are true.

A nurse is assessing the effects of antimicrobial therapy in a patient with pneumonia. The nurse should establish which outcomes when planning care? (Select all that apply.) a. Potassium level of 4 mEq/dL b. Reduction of fever Correct c. Sterile sputum cultures Correct d. Oxygen saturation of 98% Correct e. Elastic skin turgor

Antimicrobial therapy is assessed by monitoring clinical and laboratory responses. Clinical indicators of success in a patient with pneumonia may include afebrile status and resolution of an infectious infiltrate, resulting in an oxygen saturation above 95%. The disappearance of infectious organisms from post-treatment cultures also indicates resolution of infection. Potassium levels and elastic skin turgor are not assessment parameters for clinical infections, including pneumonia.