Antibiotics Multiple Choice

The nurse presents a seminar on HIV testing to a group of seniors and their caregivers in an assisted living facility. Which responses fit the Centers for Disease Control and Prevention's (CDC's) recommendations for HIV testing? (Select all that apply.) A) ''I am 78 years old and I was treated and cured of syphilis many years ago.'' B) ''In 1986, I received a transfusion of platelets.'' C) ''Seven years ago, I was released from a penitentiary.'' D) ''I used to smoke marijuana 30 years ago, but I have not done any drugs since.'' E) ''I had sex with a man with a disreputable past from New York back in the late 1960s, but I have been happily married since 1971.'' F) ''At 68, I am going to get married for the fourth time.'' G) ''Downtown was where I picked up the best hookers back in the 1950s.'

-(A, C, F) A) ''I am 78 years old and I was treated and cured of syphilis many years ago.'' Rationale: People who have had sexually transmitted diseases should be tested for HIV. C) ''Seven years ago, I was released from a penitentiary.'' Rationale: HIV testing is recommended for people who are or have been in jails or prisons. F) ''At 68, I am going to get married for the fourth time.'' Rationale: People who are planning to get married should be tested for HIV. Incorrect: B) ''In 1986, I received a transfusion of platelets.'' Rationale: People who received blood transfusions between 1978 and 1985 should be tested for HIV. D) ''I used to smoke marijuana 30 years ago, but I have not done any drugs since.'' Rationale: HIV testing is recommended only for injection drug users. E) ''I had sex with a man with a disreputable past from New York back in the late 1960s, but I have been happily married since 1971.'' Rationale: AIDS cases were extremely rare prior to the 1970s. G) ''Downtown was where I picked up the best hookers back in the 1950s.'' Rationale: The current AIDS pandemic started in the mid to late 1970s.

The nurse is assessing a patient with a diagnosis of upper urinary tract infection (UTI). Which symptoms should the nurse expect to find? Select all that apply. 1 Chills 2 Fever 3 afebrile 4 Flank pain 5 Clear, yellow urine

1 . Chills 2 . Fever 4. Flank pain

Nurses have a major role in prevention of urinary tract infections (UTIs). Which guidelines can help prevent hospital-acquired UTIs? Select all that apply. 1. Avoid unnecessary catheterization. 2. Perform intermittent catheterization every 4 hours. 3. Wash hands before and after contact with each patient. 4. Wash around catheter insertion site with betadine daily. 5. Perform routine and thorough perineal hygiene for all hospitalized patients.

1. Avoid unnecessary catheterization. 3. Wash hands before and after contact with each patient. 5. Perform routine and thorough perineal hygiene for all hospitalized patients.

When teaching a female patient about measures to prevent recurrent urinary tract infection (UTI), what instructions should the nurse include? Select all that apply. 1 Urinate every six hours. 2 Wipe from front to back after urinating. 3 Empty the bladder before and after sexual intercourse. 4 Use vaginal douches or sprays to clean the perineal area. 5 Cleanse with warm soapy water after each bowel movement.

2 . Wipe from front to back after urinating. 3. Empty the bladder before and after sexual intercourse. 5. Cleanse with warm soapy water after each bowel movement.

What is the most effective means of reducing catheter-associated urinary tract infections (CAUTI)? 1 Emptying the catheter's collection reservoir every hour. 2 Administering topical and oral antibiotics prophylactically. 3 Cleaning the sample port of a Foley catheter with alcohol prior to accessing. 4 Avoiding unnecessary catheterization and aiming for early removal of catheters.

4. Avoiding unnecessary catheterization and aiming for early removal of catheters.

A client who was tested for human immunodeficiency virus (HIV) after a recent exposure had a negative result. During the post-test counseling session, the nurse tells the client which of the following? a) the test should be repeated in 6 months b) this ensures that the client is not infected with the HIV virus c) the client no longer needs to protect himself from sexual partners d) the client probably has immunity to the acquired immunodeficiency virus

A - A negative test result indicates that no HIV antibodies were detected in the blood sample. A repeated test in 6 months is recommended because false-negative test results have occurred early in the infection. Options B, C, and D are incorrect.

a newly admitted patient reports a penicillin allergy. The prescriber has ordered a second generation cephalosporin as part of the therapy. which nursing action is appropriate A. call the prescriber to clarify the order because of the patients allergy B. give the medication and monitor for adverse effects C. ask the pharmacy to change the order to a first generation cephalosporin D. administer the drug with a NAID drug to reduce adverse effect

A call the prescriber to clarify he order because of patients allergy

when administering vancomycin the nurse knows that which of theses is most important to assess before giving the medication A. renal function B. WBC count C. liver function D platelet count

A renal function

When providing instructions to clients on use of antibiotics, which instructions would the nurse include in the teaching? (Select all that apply.) A. Complete the entire course of therapy. B. Increase fluid intake up to 3000 mL/day. C. Wash your hands before and after preparing food. D. Notify the provider of any possible reactions that occur. E. Save unused medication in a cool dry place for later use

A, B, C, D There should not be any leftover medication, but if there is, it needs to be discarded in the appropriate method. The health care provider typically only writes a prescription for the exact amount of medication needed by the client.

Bacterial resistance to antibiotics can occur with which situations? (Select all that apply.) A. Clients stop taking an antibiotic when they feel better. B. Antibiotics that are prescribed to treat a viral infection C. Taking an antibiotic and an antiviral medication at the same time D. Microorganisms arriving from foreign countries and overseas ports D. Antibiotics that are prescribed according to culture and sensitivity reports

A, B. Not completing a full course of antibiotic therapy can allow bacteria that are not killed but have been exposed to the antibiotic to adapt their physiology to become resistant to that antibiotic. Administering antibiotics to treat viral infections is not effective and may expose small amounts of bacteria that may be present to the antibiotic and therefore risk the development of resistance.

What is the priority assessment data for a client prescribed antibiotic therapy? A. Allergies B. Immunizations C. History of seizures D. Cardiac dysrhythmias

A. Antibiotic allergy is one of the most common drug allergies. An allergic reaction that occurs after administration of an antibiotic has the potential to cause severe anaphylaxis and possible death

The client's culture has grown gram-positive cocci, and the health care provider prescribes two different antibiotics, one of which is gentamicin (Garamycin). To treat this type of infection, which type of antibiotic is typically prescribed together with gentamicin (Garamycin)? A. Penicillin B. Cephalosporin C. Fluoroquinolone D. Aminoglycoside

A. In gram-positive cocci, gentamicin is usually given in combination with a penicillin antibiotic. The other antibiotics are not typically prescribed with gentamicin for this culture result.

When planning care for a client receiving a sulfonamide antibiotic, it is important for the nurse to perform which intervention? A. Encourage fluid intake of 2000 to 3000 mL/day. B. Avoid direct sun exposure and tanning beds. C. Take the medication with dairy products such as milk or yogurt. D. Advise the client to report any tinnitus to the health care provider.

A. Clients should be encouraged to drink plenty of fluids (2000 to 3000 mL/24 hours) to prevent drug-related crystalluria associated with sulfonamide antibiotics.

A nurse is providing education about tetracycline (Sumycin). Which statement by the patient best demonstrates understanding of the administration of this medication? A."I should not take this medication with milk or other dairy products." B. "I should not worry if I experience an acnelike rash with this medication." C. "I should take an antacid, such as Tums, if I experience gastrointestinal distress." D. "I should take this antibiotic with a calcium supplement to improve absorption."

A. "I should not take this medication with milk or other dairy products." The patient should avoid taking the medication with dairy products to help prevent chelation. An acnelike reaction would indicate an allergic response. Taking the medication with calcium-containing antacids or supplements should be avoided, because this also leads to chelation

When teaching a patient infected with HIV regarding transmission of the virus to others, which statement made by the patient would indicate a need for further teaching? A. "I will need to isolate any tissues I use so as not to infect my family." B. "I will notify all of my sexual partners so they can get tested for HIV." C. "Unprotected sexual contact is the most common mode of transmission." D. "I do not need to worry about spreading this virus to others by sweating at the gym."

A. "I will need to isolate any tissues I use so as not to infect my family." HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or attending school with an HIV-infected person. It is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat.

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."

A. "Notify your healthcare provider if you develop diarrhea." C. "Notify your healthcare provider if you develop a rash." 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.

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

A. Aortic valve replacement D. Neutropenia 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.

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

A. Cardiac surgery B. Recurrent urinary tract infections in women E. Hysterectomy 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.

The HIV-infected patient is taught health promotion activities including good nutrition; avoiding alcohol, tobacco, drug use, and exposure to infectious agents; keeping up to date with vaccines; getting adequate rest; and stress management. What is the rationale behind these interventions that the nurse knows? A. Delaying disease progression B. Preventing disease transmission C. Helping to cure the HIV infection D. Enabling an increase in self-care activities

A. Delaying disease progression These health promotion activities along with mental health counseling, support groups, and a therapeutic relationship with health care providers will promote a healthy immune system, which may delay disease progression. These measures will not cure HIV infection, prevent disease transmission, or increase self-care activities

When planning care for a client receiving a sulfonamide antibiotic, it is important for the nurse to perform which intervention? A. Encourage fluid intake of 2000 to 3000 mL/day. B. Avoid direct sun exposure and tanning beds. C. Take the medication with dairy products such as milk or yogurt. D. Advise the client to report any tinnitus to the health care provider.

A. Encourage fluid intake of 2000 to 3000 mL/day.

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.

A. Penicillins are the safest antibiotics available. B. The principal adverse effect of penicillins is allergic reaction. E. Penicillins are normally eliminated rapidly by the kidneys but can accumulate to harmful levels if renal function is severely impaired. 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.

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

A. 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. Not completing an antibiotic course is unrelated.

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.

A. 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. 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.

A nurse should teach a patient to observe for which side effect when taking ampicillin (Polycillin)? A. Skin rash and loose stool B. Reddened tongue and gums C. Digit numbness and tingling D. Bruising and petechiae

A. Skin rash and loose stool 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.

A patient is receiving an aminoglycoside (tobramycin) antibiotic. A nurse asks the patient to choose daily meal selections, to which the patient responds, "Oh, dear, I don't want another IV." The nurse makes which assessment about the patient's response? A. Some hearing loss may have occurred. B. The confusion is due to the hospital stay. C. A nutrition consult most likely is needed. D. The patient has a family history of dementia.

A. Some hearing loss may have occurred. The patient's comment suggests that the person did not hear the instructions. Aminoglycoside antibiotics can cause ototoxicity. The first sign may be tinnitus (ringing in the ears), progressing to loss of high-frequency sounds. Audiometric testing is needed to detect it. Nutrition, confusion, and a family history of dementia do not address the problem of possible hearing loss associated with aminoglycosides.

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.

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. 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.

Which patient exposure by the nurse is most likely to require postexposure prophylaxis when the patient's human immunodeficiency virus (HIV) status is unknown? a. Needle stick with a needle and syringe used to draw blood b. Splash into the eyes when emptying a bedpan containing stool c. Contamination of open skin lesions with patient vaginal secretions d. Needle stick injury with a suture needle during a surgical procedure

ANS: A Puncture wounds are the most common means for workplace transmission of blood-borne diseases, and a needle with a hollow bore that had been contaminated with the patient's blood would be a high-risk situation. The other situations described would be much less likely to result in transmission of the virus.

A pregnant woman with a history of asymptomatic chronic human immunodeficiency virus (HIV) infection is seen at the clinic. The patient states, "I am very nervous about making my baby sick." Which information will the nurse include when teaching the patient? a. The antiretroviral medications used to treat HIV infection are teratogenic. b. Most infants born to HIV-positive mothers are not infected with the virus. c. Because she is at an early stage of HIV infection, the infant will not contract HIV. d. It is likely that her newborn will become infected with HIV unless she uses antiretroviral therapy (ART)

ANS: B Only 25% of infants born to HIV-positive mothers develop HIV infection, even when the mother does not use ART during pregnancy. The percentage drops to 2% when ART is used. Perinatal transmission can occur at any stage of HIV infection (although it is less likely to occur when the viral load is lower). ART can safely be used in pregnancy, although some ART drugs should be avoided.

A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ T-cell count of less than 200 cells/L. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct? a. "The patient meets the criteria for a diagnosis of an acute HIV infection." b. "The patient will be diagnosed with asymptomatic chronic HIV infection." c. "The patient has developed acquired immunodeficiency syndrome (AIDS)." d. "The patient will develop symptomatic chronic HIV infection in less than a year."

ANS: C Development of PCP meets the diagnostic criterion for AIDS. The other responses indicate earlier stages of HIV infection than is indicated by the PCP infection.

Human Immunodeficiency virus belongs to which classifications? a. Rhabdovirus b. Rhinovirus c. Retrovirus d. Rotavirus

Answer C. Rationale: HIV is a retrovirus that has a ribonucleic acid dependent reverse transcriptase.

Ms. X is diagnosed with acquired immunodeficiency syndrome (AIDS). The nurse caring for this patient is aware that for a patient to be diagnosed with HIV she should have which condition? a. Infection of HIV, have a CD4+ T-cell count of 500 cells/microliter, history of acute HIV infection b. Infection with Tuberculosis, HIV and cytomegalovirus c. Infection of HIV, have a CD4+ T-cell count of >200 cells/microliter, history of acute HIV infection d. Infection with HIV, history of HIV infection and T-cell count below 200 cells/microliter

Answer C. The three criteria for a client to be diagnosed with AIDS are the following: • HIV positive • CD4+ T-cell count below 200 cells/microliter • Have one or more specific conditions that include acute infection of HIV

The nurse observes precaution in caring for Mr. X as HIV is most easily transmitted in: a. Vaginal secretions and urine b. Breast milk and tears c. Feces and saliva d. Blood and semen

Answer D. Keyword: MOST EASILY. Rationale: HIV is MOST EASILY transmitted in blood, semen and vaginal secretions. However, it has been noted to be found in fecal materials, urine, saliva, tears and breast milk.

2. Trimethoprim and sulfamethoxazole (Bactrim) BID for 7 days is ordered for a patient who has a recurrent relapse of an Escherichia coli UTI. The nurse instructs the patient to a. take the antibiotic for the full 7 days, even if symptoms improve in a few days. b. return to the clinic in 3 days so that a urine culture can be done to evaluate the effectiveness of the drug. c. increase the effectiveness of the drug by taking it with cranberry juice to acidify the urine. d. take two of the pills a day for 5 days, and reserve the rest of the pills to take if the symptoms reappear.

Answer: A Rationale: Although an initial infection may be treated with a shorter course of antibiotics, the patient with a recurrent infection should take the antibiotic for 7 days. Success of treatment is evaluated by resolution of symptoms rather than by a repeat culture. Acidifying the urine when a patient is taking sulfa antibiotics may lead to stone formation. The patient is instructed to take all the antibiotics. Cognitive Level: Application Text Reference: p. 1157 Nursing Process: Implementation NCLEX: Physiological Integrity

3. The nurse determines that instruction regarding prevention of future UTIs for a patient with cystitis has been effective when the patient states, a. "I will empty my bladder every 3 to 4 hours during the day." b. "I can use vaginal sprays to reduce bacteria." c. "I will wash with soap and water before sexual intercourse." d. "I will drink a quart of water or other fluids every day."

Answer: A Rationale: Voiding every 3 to 4 hours is recommended to prevent UTIs. Use of vaginal sprays is discouraged. The bladder should be emptied before and after intercourse, but cleaning with soap and water is not necessary. A quart of fluids is insufficient to provide adequate urine output to decrease risk for UTI. Cognitive Level: Application Text Reference: p. 1161 Nursing Process: Evaluation NCLEX: Health Promotion and Maintenance

1. When assessing the patient who has a lower urinary tract infection (UTI), the nurse will initially ask about a. flank pain. b. pain with urination. c. poor urine output. d. nausea.

Answer: B Rationale: Pain with urination is a common symptom of a lower UTI. Urine output does not decrease, but frequency may be experienced. Flank pain and nausea are associated with an upper UTI. Cognitive Level: Application Text Reference: p. 1157 Nursing Process: Assessment NCLEX: Physiological Integrity

10. A patient with nephrotic syndrome develops flank pain. The nurse will anticipate treatment with a. antibiotics. b. antihypertensives. c. anticoagulants. d. corticosteroids.

Answer: C Rationale: Flank pain in a patient with nephrosis suggests a renal vein thrombosis, and anticoagulation is needed. Antibiotics are used to treat a patient with flank pain caused by pyelonephritis. Antihypertensives are used if the patient has high blood pressure. Corticosteroids may be used to treat nephrotic syndrome but will not resolve a thrombosis. Cognitive Level: Application Text Reference: p. 1175 Nursing Process: Planning NCLEX: Physiological Integrity

24. A 78-year-old patient is admitted to the hospital with dehydration and electrolyte imbalance. The patient is confused and incontinent of urine on admission. In developing a plan of care for the patient, an appropriate nursing intervention for the patient's incontinence is to a. insert an indwelling catheter. b. apply absorbent incontinent pads. c. assist the patient to the bathroom q2hr. d. restrict fluids after the evening meal.

Answer: C Rationale: In older or confused patients, incontinence may be avoided by using scheduled toileting times. Indwelling catheters increase the risk for UTI. Incontinent pads increase the risk for skin breakdown. Restricting fluids is not appropriate in a patient with dehydration. Cognitive Level: Application Text Reference: pp. 1183-1185 Nursing Process: Planning NCLEX: Physiological Integrity

9. The nurse establishes a nursing diagnosis of excess fluid volume related to inflammation at the glomerular basement membrane in a patient with acute glomerulonephritis. To best evaluate whether the problem identified in the nursing diagnosis has resolved, the nurse will monitor for a. proteinuria. b. elevated creatinine. c. periorbital edema. d. hematuria.

Answer: C Rationale: Resolution of the excess fluid volume is best evaluated by changes in edema. The other data may indicate whether the glomerulonephritis is resolving but do not provide data about fluid volume. Cognitive Level: Application Text Reference: p. 1165 Nursing Process: Evaluation NCLEX: Physiological Integrity

the patient is schedules for colorectal surgery tomorrow. He does not have sepsis, his white blood count is normal, he has no fever and he is otherwise in good health. However there is an order to administer an antibiotic on call before he goes to surgery. The nurse knows that the rationale for this antibiotic order is to A. provide empiric therapy B. provide prophylactic therapy C. treat for superinfection D. reduce the number of resistant organism

B provide prophylactic therapy

The nurse would teach a client prescribed metronidazole (Flagyl) to avoid ingestion of which drink? A. Milk B. Wine C. Coffee D. Orange juice

B. A disulfiram-like (Antabuse) reaction may occur with concurrent ingestion of metronidazole and alcohol, leading to facial flushing, tachycardia, palpitations, nausea, and vomiting.

For a client receiving an intravenous (IV) infusion of gentamicin (Garamycin), the nurse would monitor which laboratory values? A. Hematocrit and hemoglobin B. Blood urea nitrogen (BUN) and creatinine C. Prothrombin time and partial thromboplastin time D. Serum glutamic-oxaloacetic transaminase and alanine transaminase

B. Gentamicin has a high potential for nephrotoxicity. Nephrotoxicity typically occurs in 5% to 25% of clients. Thus, the client's renal function test results for BUN and creatinine must be monitored closely throughout therapy.

During antibiotic therapy, the nurse will assess the client for a condition that may occur because of the disruption of normal flora. The nurse knows this as what condition? A. Organ toxicity B. Superinfection C. Hypersensitivity D. Allergic reaction

B. Superinfections can occur when antibiotic therapy reduces or completely eliminates the normal bacterial flora of the body, which normally would inhibit the overgrowth of fungi and yeast. When the normal bacterial are flora and are reduced or completely eliminated, these organisms can overgrow and cause infections.

Which instruction should a nurse include in the discharge teaching for a patient who is to start taking tetracycline (Sumycin)? 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."

B. "Use sunscreen and protective clothing when outdoors." 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.

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.

B. Assess the patient for allergies The principal adverse effect of penicillins is allergic reaction. Penicillins are contraindicated in patients with a history of severe allergic reactions to penicillins, cephalosporins, or carbapenems. IV patency is important, as is monitoring renal function, because impairment can cause penicillins to reach toxic levels; however, these are not as important as determining allergy status.

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

B. Competent immune function 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.

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

B. Disrupt cell wall synthesis PCNs weaken the cell wall, causing bacteria to take up excessive amounts of water and subsequently rupture. PCNs inhibit transpeptidases and disinhibit autolysins. PCNs do not affect the cell walls of the host.

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

B. Frequent loose, watery stools with mucus and blood 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).

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

B. Headache 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.

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.

B. It is a potentially fatal condition. C. Patients usually experience abdominal pain. E. Clindamycin therapy should be discontinued and vancomycin started. 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 taking a sulfonamide is breast-feeding an infant. Which complication in the infant would the nurse associate with kernicterus? A. Hemolytic anemia B. Neurologic deficits C. Hepatocellular failure D. Ophthalmic infection

B. Neurologic deficits Kernicterus is a disorder in newborns caused by deposition of bilirubin in the brain, which leads to severe neurologic deficits and death. Sulfonamides promote kernicterus by displacing protein-bound bilirubin from the proteins, leaving newly freed bilirubin access to brain sites. Sulfonamides are not administered to infants under 2 years old, nor are they given to pregnant patients near term or nursing mothers. Hemolytic anemia, hepatocellular failure, and ophthalmic infection are not associated sulfonamide effects in infants.

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

B. Prolonged QT interval 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.

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

B. Skin rash and lesions 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.

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

B. Superinfection 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 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% C. The lowest concentration of an antibiotic needed to produce effects D. The lowest dose of an antibiotic needed to eradicate bacteria

B. The lowest concentration of an antibiotic needed to reduce the number of bacterial colonies by 99.9% 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.

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

B. Treating a viral infection E. Using dosing that results in a superinfection 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.

A 25-year-old male patient has been diagnosed with HIV. The patient does not want to take more than one antiretroviral drug. What reasons can the nurse tell the patient about for taking more than one drug? A. Together they will cure HIV. B. Viral replication will be inhibited. C. They will decrease CD4+ T cell counts. D. It will prevent interaction with other drugs

B. Viral replication will be inhibited. The major advantage of using several classes of antiretroviral drugs is that viral replication can be inhibited in several ways, making it more difficult for the virus to recover and decreasing the likelihood of drug resistance that is a major problem with monotherapy. Combination therapy also delays disease progression and decreases HIV symptoms and opportunistic diseases. HIV cannot be cured. CD4+ T cell counts increase with therapy. There are dangerous interactions with many antiretroviral drugs and other commonly used drugs.

A woman who had been taking an antibiotic for a UTI calls the nurse practitioner to complain of severe vaginal itching. she also had noticed a thick, white vaginal discharge. the nurse practitioner suspects that A. this is an expected response to antibiotic therapy B. the UTO had become worse instead of better C. a superinfection has developed D. the UTI is resistant to the antibiotic

C a super infection has developed

a teenage patient is taking a tetracycline drug as part of treatment for severe acne. when the nurse teaches this patient about drug related precautions, which is the most important info to cover A when the acne clears up the medication may be discontinued B. this med needs to be taken with antacids to reduce GI upset C. the patient meeds to use sunscreen or avoid exposure to sunlight, because this drug may cause photosensitivity D. the teeth sound be observed closely for signs of mottling or other color changes

C the patient meeds to use sunscreen or avoid exposure to sunlight, because this drug may cause photosensitivity

The nurse should assess a client for nephrotoxicity and ototoxicity when administering which antimicrobial? A. Cefazolin (Ancef) B. Clindamycin (Cleocin) C. Gentamicin (Garamycin) D. Erythromycin

C. Aminoglycoside antibiotics, including gentamicin, have a high risk for nephrotoxicity and ototoxicity.

A client who is allergic to penicillin is at increased risk for an allergy to which drug? A. Erythromycin (E-mycin) B. Gentamicin (Garamycin) C. Cefazolin sodium (Ancef) D. Demeclocycline (Declomycin)

C. Clients who are allergic to penicillins have an increased risk of allergy to other beta-lactam antibiotics. The incidence of cross-reactivity between cephalosporins and penicillins is reported to be between 1% and 4%.

Which information should the nurse include in discharge teaching for a client prescribed doxycycline (Vibramycin)? A. "Keep the remainder of the medication in case of recurrence." B. "Take the medication until you have no fever and feel better." C. "Apply sunscreen or wear protective clothing when outdoors." D. "Take the medication with milk to minimize gastrointestinal upset."

C. Photosensitivity is a common adverse effect of doxycycline, a tetracycline antibiotic. The client should avoid direct sun exposure and tanning bed use while taking this medication. Exposure to the sun can cause severe burns.

Which statement best describes health care-associated infections? A. They develop in more than 15% of hospitalized clients. B. The infection develops in response to various antibiotics. C. The infection was not incubating at the time of admission. D. Clients are admitted to the hospital with an infectious disease.

C. A health care-associated infection is an infection that is acquired during the course of receiving treatment for another condition in a health care facility. The infection is not present or incubating at the time of admission; also known as a nosocomial infection.

Which information should the nurse include in discharge teaching for a client prescribed doxycycline (Vibramycin)? A. "Keep the remainder of the medication in case of recurrence." B. "Take the medication until you have no fever and feel better." C. "Apply sunscreen or wear protective clothing when outdoors." D "Take the medication with milk to minimize gastrointestinal upset."

C. "Apply sunscreen or wear protective clothing when outdoors."

A pregnant woman who was tested and diagnosed with HIV infection is very upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection? A. "The baby will probably be infected with HIV." B. "Only an abortion will keep your baby from having HIV." C. "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." D. "The duration and frequency of contact with the organism will determine if the baby gets HIV infection."

C. "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." On average, 25% of infants born to women with untreated HIV will be born with HIV. The risk of transmission is reduced to less than 2% if the infected pregnant woman is treated with antiretroviral therapy. Duration and frequency of contact with the HIV organism is one variable that influences whether transmission of HIV occurs. Volume, virulence, and concentration of the organism as well as host immune status are variables related to transmission via blood, semen, vaginal secretions, or breast milk.

The nurse is providing care for a patient who has been living with HIV for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease? A. A new onset of polycythemia B. Presence of mononucleosis-like symptoms C. A sharp decrease in the patient's CD4+ count D. A sudden increase in the patient's WBC count

C. A sharp decrease in the patient's CD4+ count A decrease in CD4+ count signals an exacerbation of the severity of HIV. Polycythemia is not characteristic of the course of HIV. A patient's WBC count is very unlikely to suddenly increase, with decreases being typical. Mononucleosis-like symptoms such as malaise, headache, and fatigue are typical of early HIV infection and seroconversion.

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

C. Ability to avoid injuring host cells 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.

The nurse should assess a client for nephrotoxicity and ototoxicity when administering which antimicrobial? A. Cefazolin (Ancef) B. Clindamycin (Cleocin) C. Gentamicin (Garamycin) D. Erythromycin

C. Gentamicin (Garamycin)

A patient has acquired an infection while in the hospital. The nurse identifies this type of infection as what? A. Superinfection B. Suprainfection C. Nosocomial infection D. Resistant infection

C. Nosocomial infection Nosocomial infections are acquired by patients while in the hospital. Superinfection and suprainfection are terms used to describe the emergence of drug resistance.

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

C. Penicillins 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 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.

C. 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 nurse removes a central line access device once the patient no longer requires intravenous (IV) antibiotics. This action is an example of which strategy to prevent antimicrobial resistance established by the Centers for Disease Control and Prevention (CDC)? A. Preventing transmission B. Proper diagnosis C. Preventing infection D. Prudent antibiotic use

C. Preventing infection The CDC's campaign to prevent the development of antimicrobial resistance in hospitals focuses on four approaches: (1) prevent infection, (2) diagnose and treat infection effectively, (3) use antimicrobials wisely, and (4) prevent transmission. Expeditious removal of invasive devices, such as IV catheters, and restricting these devices to essential use are examples of the CDC's strategy to prevent infection.

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

C. Renal toxicity 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.

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

C. 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. It does not increase the number of CD4 T cells, the targeted cells of the human immunodeficiency virus (HIV), nor does it affect joint pain. Increased appetite and weight gain are not therapeutic actions of trimethoprim/sulfamethoxazole.

the patient is administering an intravenous aminoglycoside to a patient who had had gastrointestinal surgery. which nursing measures are appropriate A. report a trough drug level of .08 msg/mL and hold the drug B. enforce strict fluid restriction C. monitor serum creatine levels D. Warn the patient that the ruin may turn darker in color

C. monitor serum creatine levels

A diagnosis of AIDS is made when an HIV-infected patient has a. a CD4+ T cell count below 200/µL. b. a high level of HIV in the blood and saliva. c. lipodystrophy with metabolic abnormalities. d. oral hairy leukoplakia, an infection caused by Epstein-Barr virus.

Correct answer: a Rationale: AIDS is diagnosed when an individual with HIV infection meets one of several criteria; one criterion is a CD4+ T cell count below 200 cells/L. Other criteria are listed in Table 15-9.

Which strategy can the nurse teach the patient to eliminate the risk of HIV transmission? a. Using sterile equipment to inject drugs b. Cleaning equipment used to inject drugs c. Taking zidovudine (AZT, ZDV, Retrovir) during pregnancy d. Using latex or polyurethane barriers to cover genitalia during sexual contact

Correct answer: a Rationale: Access to sterile equipment is an important risk-elimination tactic. Some communities have needle and syringe exchange programs (NSEPs) that provide sterile equipment to users in exchange for used equipment. Cleaning equipment before use is a risk-reducing activity. It decreases the risk when equipment is shared, but it takes time, and a person in drug withdrawal may have difficulty cleaning equipment.

Transmission of HIV from an infected individual to another most commonly occurs as a result of a. unprotected anal or vaginal sexual intercourse. b. low levels of virus in the blood and high levels of CD4+ T cells. c. transmission from mother to infant during labor and delivery and breastfeeding. d. sharing of drug-using equipment, including needles, syringes, pipes, and straws

Correct answer: a Rationale: Unprotected sexual contact (semen, vaginal secretions, or blood) with a partner

Antiretroviral drugs are used to a. cure acute HIV infection. b. decrease viral RNA levels. c. treat opportunistic diseases. d. decrease pain and symptoms in terminal disease.

Correct answer: b Rationale: The goals of drug therapy in HIV infection are to (1) decrease the viral load, (2) maintain or raise CD4+ T cell counts, and (3) delay onset of HIV infection-related symptoms and opportunistic diseases.

Opportunistic diseases in HIV infection a. are usually benign. b. are generally slow to develop and progress. c. occur in the presence of immunosuppression. d. are curable with appropriate drug interventions.

Correct answer: c Rationale: Management of HIV infection is complicated by the many opportunistic diseases that can develop as the immune system deteriorates (see Table 15-10).

What is the most appropriate nursing intervention to help an HIV-infected patient adhere to a treatment regimen? a. "Set up" a drug pillbox for the patient every week. b. Give the patient a video and a brochure to view and read at home. c. Tell the patient that the side effects of the drugs are bad but that they go away after a while. d. Assess the patient's routines and find adherence cues that fit into the patient's life circumstances.

Correct answer: d Rationale: The best approach to improve adherence to a treatment regimen is to learn about the patient's life and assist with problem solving within the confines of that life.

The decision to begin antiretroviral therapy is based on: A. The CD4 cell count B. The plasma viral load C. The intensity of the patient's clinical symptoms D. All of the above

D A person's CD4 count is an important factor in the decision to start ART. A low or falling CD4 count indicates that HIV is advancing and damaging the immune system. A rapidly decreasing CD4 count increases the urgency to start ART. Regardless of CD4 count, there is greater urgency to start ART when a person has a high viral load or any of the following conditions: pregnancy, AIDS, and certain HIV-related illnesses and co infections.

As a knowledgeable nurse, you know that the primary goals of antiretroviral therapy (ART) include all, EXCEPT: A. Reduce HIV-associated morbidity and prolong the duration and quality of survival B. Restore and preserve immunologic function C. Maximally and durably suppress plasma HIV viral load D. Elimination of HIV entirely from the body

D Eradication of HIV infection cannot be achieved with available antiretroviral (ARV) regimens even when new, potent drugs are added to a regimen that is already suppressing plasma viral load below the limits of detection of commercially available assays.

A client with a known heart condition is prescribed an antibiotic before a dental procedure. What type of antibiotic therapy is this considered? A. Empiric B. Definitive C. Supportive D. Prophylactic

D. Prophylactic antibiotic therapy is used to prevent infections in individuals who are at high risk of development of an infection during or after a procedure. The antibiotics are given before the procedure for prophylactic treatment.

Which adverse effect can result if tetracycline is administered to children younger than 8 years of age? A. Drug-induced neurotoxicity B. Delayed growth development C. Gastrointestinal (GI) and rectal bleeding D. Permanent discoloration of the teeth

D. Tetracycline is contraindicated in children younger than 8 years of age because it can cause permanent discoloration of the adult teeth and tooth enamel, which are still forming in the child.

Which is a complication of vancomycin IV infusions? A. Angioedema B. Neurotoxicity C. Cardiomyopathy D. Red man syndrome

D. When infused too rapidly, clients receiving vancomycin may develop hypotension accompanied by flushing or itching of the head, face, neck, and upper trunk area. This phenomenon is called red man syndrome.

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

D. "I should stop taking this drug when my symptoms are gone." Patients should always be advised to complete the prescribed course of the antibiotic even when symptoms subside. Patients should also understand the need to drink 8 to 10 glasses of water a day, to use sunscreen, and to notify the provider if they develop a rash.

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."

D. "It is more effective by IV, because the pill form will stay in the digestive tract." 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.

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.

D. Administer subcutaneous epinephrine 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.

A nurse assessing a patient who is 12 years old should associate which complication with the patient's receiving tetracycline (Sumycin) 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

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

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)

D. International normalized ratio (INR) 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.

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 tinnitus . D. Ototoxicity is largely irreversible. E. Use of aminoglycosides for less than 10 days is recommended to avoid ototoxicity.

D. Ototoxicity is largely irreversible. E. Use of aminoglycosides for less than 10 days is recommended to avoid ototoxicity. 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.

Which adverse effect can result if tetracycline is administered to children younger than 8 years of age? A. Drug-induced neurotoxicity B. Delayed growth development C. Gastrointestinal (GI) and rectal bleeding D. Permanent discoloration of the teeth

D. Permanent discoloration of the teeth

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

D. Protein Aminoglycoside-induced nephrotoxicity usually presents as acute tubular necrosis. Symptoms of concern are protein in the urine, dilute urine, and elevation of the serum creatinine and blood urea nitrogen (BUN) levels. WBCs, glucose, and ketones are not specifically related to gentamicin use.

Which is a complication of vancomycin IV infusions? A. Angioedema B. Neurotoxicity C. Cardiomyopathy D. Red man syndrome

D. Red man syndrome

during therapy with a intravenous aminoglycoside, the patient calls the nurse and says I'm hearing some odd sounds, like ringing in my ear,." what is the nurses priority action at this time A. reassure the patient that these are expected adverse effects B. reduce the rate of intravenous infusion C. increase the rate of the intravenous infusion D. stop the infusion immediately

D. Stop the infusion immediately

The nurse has been caring for a patient who has been taking antibiotics for 3 weeks. Upon assessing the patient, the nurse notices the individual has developed oral thrush. What describes the etiology of the thrush? A. Antibiotic resistance B. Community-acquired infection C. Nosocomial infection D. Suprainfection

D. Suprainfection Oral thrush is a manifestation of a suprainfection. The development of thrush is not a symptom of antibiotic resistance. Oral thrush typically is not a community-acquired infection. The development of thrush is not a nosocomial infection.

A microbe acquires antibiotic resistance by which means? A. Development of medication resistance in the host B. Over-riding of the minimum bactericidal concentration C. Incorrect dosing, which contributes to ribosome mutations D. Transfer of DNA coding to other bacteria

D. Transfer of DNA coding to another bacteria All alterations in structure and function result from changes in the microbial genome. The microbe, not the host, becomes medication resistant. Genetic changes in a microbe result either from spontaneous mutation or from acquisition of DNA from conjugation with other bacteria. The minimum bacterial concentration (MBC) is used in testing for drug sensitivity. Incorrect dosing does not lead to microbe mutations.

during patient education regarding own oral macrolide such as erythromycin the nurse will include which information? A. If GI upsets occur the drug will have to be stopped B. the drug needs to be taken with an antacid to avoid GI problems C. the patient needs to take each dose with a sip of water D. the patient may take the drug with a small snack to reduce GI irritation

D. the patient may take the drug with a small snack to reduce GI irritation

A patient who has tested positive for the human immunodeficiency virus (HIV) arrives at the clinic with a report of fever, nonproductive cough, and fatigue. The patient's CD4 count is 184 cells/mcL. How should the healthcare provider interpret these findings? Please choose from one of the following options. A. The patient is diagnosed with acquired immunodeficiency syndrome (AIDS). B.The patient is now in the latent stages of HIV infection C.These findings provide evidence that the patient has seroconverted. D. This is an expected finding because the patient has tested positive for HIV.

The patient is diagnosed with acquired immunodeficiency syndrome (AIDS).

An older adult who takes medications for coronary artery disease has just been diagnosed with asymptomatic chronic human immunodeficiency virus (HIV) infection. Which information will the nurse include in patient teaching? a. Many medications have interactions with antiretroviral drugs. b. Less frequent CD4+ level monitoring is needed in older adults. c. Hospice care is available for patients with terminal HIV infection. d. Progression of HIV infection occurs more rapidly in older patients.

a

To evaluate the effectiveness of antiretroviral therapy (ART), which laboratory test result will the nurse review? a. Viral load testing b. Enzyme immunoassay c. Rapid HIV antibody testing d. Immunofluorescence assay

a

Which patient exposure by the nurse is most likely to require postexposure prophylaxis when the patient's human immunodeficiency virus (HIV) status is unknown? a. Needle stick with a needle and syringe used to draw blood b. Splash into the eyes when emptying a bedpan containing stool c. Contamination of open skin lesions with patient vaginal secretions d. Needle stick injury with a suture needle during a surgical procedure

a

The nurse plans a presentation for community members about how to decrease the risk for antibiotic-resistant infections. Which information will the nurse include in the teaching plan (select all that apply)? a. Continue taking antibiotics until all the medication is gone. b. Antibiotics may sometimes be prescribed to prevent infection. c. Unused antibiotics that are more than a year old should be discarded. d. Antibiotics are effective in treating influenza associated with high fevers. e. Hand washing is effective in preventing many viral and bacterial infections.

a,b,e

A 62-year-old patient has acquired immunodeficiency syndrome (AIDS), and the viral load is reported as undetectable. What patient teaching should be provided by the nurse related to this laboratory study result? a. The patient has the virus present and can transmit the infection to others. b. The patient is not able to transmit the virus to others through sexual contact. c. The patient will be prescribed lower doses of antiretroviral medications for 2 months. d. The syndrome has been cured, and the patient will be able to discontinue all medications.

a. The patient has the virus present and can transmit the infection to others. In human immunodeficiency virus (HIV) infections, viral loads are reported as real numbers of copies/μL or as undetectable. "Undetectable" indicates that the viral load is lower than the test is able to report. "Undetectable" does not mean that the virus has been eliminated from the body or that the indivi

A patient who uses injectable illegal drugs asks the nurse about preventing acquired immunodeficiency syndrome (AIDS). Which response by the nurse is best? a. "Avoid sexual intercourse when using injectable drugs." b. "It is important to participate in a needle-exchange program." c. "You should ask those who share equipment to be tested for HIV." d. "I recommend cleaning drug injection equipment before each use."

b

A pregnant woman with a history of asymptomatic chronic human immunodeficiency virus (HIV) infection is seen at the clinic. The patient states, "I am very nervous about making my baby sick." Which information will the nurse include when teaching the patient? a. The antiretroviral medications used to treat HIV infection are teratogenic. b. Most infants born to HIV-positive mothers are not infected with the virus. c. Because she is at an early stage of HIV infection, the infant will not contract HIV. d. It is likely that her newborn will become infected with HIV unless she uses antiretroviral therapy (ART).

b

Eight years after seroconversion, a human immunodeficiency virus (HIV)-infected patient has a CD4+ cell count of 800/µL and an undetectable viral load. What is the priority nursing intervention at this time? a. Teach about the effects of antiretroviral agents. b. Encourage adequate nutrition, exercise, and sleep. c. Discuss likelihood of increased opportunistic infections. d. Monitor for symptoms of acquired immunodeficiency syndrome (AIDS).

b

The registered nurse (RN) caring for an HIV-positive patient admitted with tuberculosis can delegate which action to unlicensed assistive personnel (UAP)? a. Teach the patient about how to use tissues to dispose of respiratory secretions. b. Stock the patient's room with all the necessary personal protective equipment. c. Interview the patient to obtain the names of family members and close contacts. d. Tell the patient's family members the reason for the use of airborne precautions.

b

A patient treated for human immunodeficiency virus (HIV) infection for 6 years has developed fat redistribution to the trunk, with wasting of the arms, legs, and face. What instructions will the nurse give to the patient? a. Review foods that are higher in protein. b. Teach about the benefits of daily exercise. c. Discuss a change in antiretroviral therapy. d. Talk about treatment with antifungal agents.

c

A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ T-cell count of less than 200 cells/uL. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct? a. "The patient meets the criteria for a diagnosis of an acute HIV infection." b. "The patient will be diagnosed with asymptomatic chronic HIV infection." c. "The patient has developed acquired immunodeficiency syndrome (AIDS)." d. "The patient will develop symptomatic chronic HIV infection in less than a year."

c

A patient with a positive rapid antibody test result for human immunodeficiency virus (HIV) is anxious and does not appear to hear what the nurse is saying. What action by the nurse is most important at this time? a. Teach the patient about the medications available for treatment. b. Inform the patient how to protect sexual and needle-sharing partners. c. Remind the patient about the need to return for retesting to verify the results. d. Ask the patient to notify individuals who have had risky contact with the patient.

c

The nurse designs a program to decrease the incidence of human immunodeficiency virus (HIV) infection in the adolescent and young adult populations. Which information should the nurse assign as the highest priority? a. Methods to prevent perinatal HIV transmission b. Ways to sterilize needles used by injectable drug users c. Prevention of HIV transmission between sexual partners d. Means to prevent transmission through blood transfusions

c

Which of these patients being seen at the human immunodeficiency virus (HIV) clinic should the nurse assess first? a. Patient whose latest CD4+ count is 250/µL b. Patient whose rapid HIV-antibody test is positive c. Patient who has had 10 liquid stools in the last 24 hours d. Patient who has nausea from prescribed antiretroviral drugs

c

The nurse is monitoring the effectiveness of antiretroviral therapy (ART) for a 56-year-old man with acquired immunodeficiency syndrome (AIDS). What laboratory study result indicates the medications have been effective? a. Increased viral load b. Decreased neutrophil count c. Increased CD4+ T cell count d. Decreased white blood cell count

c. Increased CD4+ T cell count Antiretroviral therapy is effective if there are decreased viral loads and increased CD4+ T cell counts.

A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse, "I feel obsessed with thoughts about dying. Do you think I am just being morbid?" Which response by the nurse is best? a. "Thinking about dying will not improve the course of AIDS." b. "It is important to focus on the good things about your life now." c. "Do you think that taking an antidepressant might be helpful to you?" d. "Can you tell me more about the kind of thoughts that you are having?"

d

A patient who is human immunodeficiency virus (HIV)-infected has a CD4+ cell count of 400/µL. Which factor is most important for the nurse to determine before the initiation of antiretroviral therapy (ART) for this patient? a. HIV genotype and phenotype b. Patient's social support system c. Potential medication side effects d. Patient's ability to comply with ART schedule

d

The nurse cares for a patient who is human immunodeficiency virus (HIV) positive and taking antiretroviral therapy (ART). Which information is most important for the nurse to address when planning care? a. The patient's blood glucose level is 142 mg/dL. b. The patient complains of feeling "constantly tired." c. The patient is unable to state the side effects of the medications. d. The patient states, "Sometimes I miss a dose of zidovudine (AZT)."

d

Which nursing action will be most useful in assisting a college student to adhere to a newly prescribed antiretroviral therapy (ART) regimen? a. Give the patient detailed information about possible medication side effects. b. Remind the patient of the importance of taking the medications as scheduled. c. Encourage the patient to join a support group for students who are HIV positive. d. Check the patient's class schedule to help decide when the drugs should be taken.

d

A 52-year-old female patient was exposed to human immunodeficiency virus (HIV) 2 weeks ago through sharing needles with other substance users. What symptoms will the nurse teach the patient to report that would indicate the patient has developed an acute HIV infection? a. Cough, diarrhea, headaches, blurred vision, muscle fatigue d. Night sweats, fatigue, fever, and persistent generalized lymphadenopathy c. Oropharyngeal candidiasis or thrush, vaginal candidal infection, or oral or genital herpes d. Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea

d. Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea Clinical manifestations of an acute infection with HIV include flu-like symptoms between 2 to 4 weeks after exposure. Early chronic HIV infection clinical manifestations are either asymptomatic or include fatigue, headache, low-grade fever, night sweats, and persistent generalized lympadenopathy. Intermediate chronic HIV infection clinical manifestations include candidal infections, shingles, oral or genital herpes, bacterial infections, Kaposi sarcoma, or oral hairy leukoplakia. Late chronic HIV infection or acquired immunodeficiency syndrome (AIDS) includes opportunistic diseases (infections and cancer).