Chap 35 Pharm_Exam#3

What important information should be included in the client's education regarding taking ciprofloxacin (Cipro)? 1. The drug can cause discoloration of the teeth. 2. Fluid intake should be decreased to prevent urine retention. 3. Any heel or lower leg pain should be reported immediately. 4. The drug should be taken with an antacid to reduce gastric effects.

Answer #3 Rationale: Fluoroquinolones such as ciprofloxacin (Cipro) have been associated with an increased risk of tendonitis and tendon rupture. Any heel or lower leg pain should be reported immediately for evaluation. Options 1, 2, and 4 are incorrect. Ciprofloxacin will not cause discoloration of the teeth and fluids should be encouraged during use of the drug. Taking antacids concurrently with ciprofloxacin may significantly impair absorption of the drug

A client has been diagnosed with tuberculosis and is prescribed Rifater (combination of pyrazinamide with isoniazid and rifampin). While the client is on this medication, what teaching is essential? (Select all that apply.) 1. "It is critical to continue therapy for at least 6 to 12 months." 2. "Two or more drugs are used to prevent tuberculosis bacterial resistance." 3. "These drugs may also be used to prevent tuberculosis." 4. "No special precautions are required." 5. "After 1 month of treatment, the medication will be discontinued."

Answer: 1,2,3, Rationale: For the medication to effectively treat the tuberculosis bacterium, it is critical that the medicine be taken for 6 to 12 months, and possibly as long as 24 months. Antitubercular drugs such as pyrazinamide, isoniazid (INH), and rifampin are also used for prevention and treatment of clients who convert from a negative TB test to a positive, although single drug use is most often prescribed in that situation. Rationale: Multiple drug therapy is necessary because the Mycobacteria grow slowly, and resistance is common. Using multiple drugs in different combinations during the long treatment period lowers the potential for resistance and increases the chances for successful therapy. Options 4 and 5 are incorrect. Precautions to avoid adverse effects are required and the drugs will be required much longer than 1 month.

A 32-year-old female has been started on amoxicillin (Amoxil, Trimox) for a severe UTI. Before sending her home with this prescription, the nurse will provide which instruction? 1. Teach her to wear sunscreens. 2. Ask her about oral contraceptive use and recommend an alternative method for the duration of the ampicillin course. 3. Assess for hearing loss. 4. Recommend taking the pill with some antacid to prevent GI upset.

Answer: 2 Rationale: Penicillin antibiotics such as amoxicillin (Amoxil, Trimox) may significantly decrease the effectiveness of oral contraceptives and another method of birth control should be suggested during the time the drug is taken. Options 1, 3, and 4 are incorrect. Sunburning and hearing loss are not adverse effects commonly associated with penicillin.

A client has been prescribed tetracycline. When providing information regarding this drug, the nurse should include what information about tetracycline? 1. It is classified as a narrow-spectrum antibiotic with minimal adverse effects. 2. It is used to treat a wide variety of disease processes. 3. It has been identified to be safe during pregnancy. 4. It is contraindicated in children younger than 8 years.

Answer: 4 Rationale: This drug has the ability to cause permanent mottling and discoloration of teeth and therefore is not advised for children younger than 8 years of age. Options 1, 2, and 3 are incorrect. Tetracyclines have one of the broadest spectrums of the antibiotics and all antibiotics have significant adverse effects. Tetracycline is contraindicated in pregnancy.

Use of this antibiotic may be associated with the presence of a benign crystalluria A. Ciprofloxacin B. TMP-SMX C. Gentamicin D. Carbapenem

B. TMP-SMX

This antibiotic can cause marked flushing of the head, neck, face and upper trunk if infused too quickly A. Cefepime B. Amoxicillin C. Vancomycin D. Metronidazole

C. Vancomycin Should be infused over 90 minutes. Rapid infusion will cause hypotension

The client receives gentamicin (Garamycin) intravenously (IV) in the clinical setting. What is a priority nursing action? 1. Monitor the client for hearing loss. 2. Draw daily blood chemistries. 3. Decrease the fluids for the client during therapy. 4. Place the client on isolation precautions.

Correct Answer: 1 Rationale 1: Aminoglycocides are ototoxic drugs, and the client should be monitored for hearing loss. Rationale 2: Serum levels of the drug are indicated, but not blood chemistries. Rationale 3: Decreasing fluids during therapy is not indicated. Rationale 4: Isolation is determined by the causative organism, not the drug used for treatment.

Which of the following laboratory tests will be performed to determine whether a specific bacterium is resistant to a specific drug? 1. Culture and sensitivity test 2. Complete blood count 3. Blood urea nitrogen 4. Urinalysis

Correct Answer: 1 Rationale 1: Culture and sensitivity is the examination for a specific organism, and can determine the correct medication. Rationale 2: Complete blood count would not determine the specific drug for the specific organism. Rationale 3: Blood urea nitrogen would not determine the specific drug for the specific organism. Rationale 4: Urinalysis would not determine the specific drug for the specific organism.

Following surgery, a client is placed on cefotaxine (Claforan). The assessment for possible adverse effects should include observing for 1. diarrhea. 2. headache. 3. constipation. 4. tachycardia.

Correct Answer: 1 Rationale 1: Diarrhea is a frequent adverse effect of cephalosporins. Rationale 2: Headache is not an adverse effect. Rationale 3: Diarrhea, not constipation, is a common problem. Rationale 4: Tachycardia is not an adverse effect.

The client is prescribed amoxicillin (Amoxil) for 10 days to treat strep throat. After 5 days, the client tells the nurse he plans to stop the medication because he feels better. What is the best response by the nurse? 1. "If you stop the medicine early you have not effectively killed out the bacteria making you sick." 2. "You should get another throat culture if your symptoms return." 3. "If you stop the medicine early, this could result in resistance to the antibiotic." 4. "You should get another throat culture to see if the infection is gone."

Correct Answer: 1 Rationale 1: If all the medication is not taken, there is a strong possibility that not all bacteria have been eliminated. Rationale 2: Another throat culture is inappropriate; the client must finish the medication. Rationale 3: Stopping the medicine early can result in resistance to the antibiotic, but the client may not care about this unless he can see how it directly affects him. Rationale 4: Another throat culture is inappropriate; the client must finish the medication.

Treatment of tuberculosis usually involves 1. the use of two or more drugs at the same time. 2. surgical removal of tubercular lesions. 3. keeping the client hospitalized. 4. the use of a single drug.

Correct Answer: 1 Rationale 1: Multi-drug therapy for 6-12 months is the usual pharmacotherapy for tuberculosis. Rationale 2: Surgery is not the treatment. Rationale 3: It is not necessary to keep the client in the hospital. Rationale 4: Multi-drug therapy is usually the treatment, so use of a single drug is not usual.

The client has MRSA and receives vancomycin (Vancocin) intravenously (IV). The nurse assesses an upper body rash and decreased urine output. What is the nurse's priority action? 1. Hold the next dose of vancomycin (Vancocin), and notify the physician. 2. Obtain a stat X-ray, and notify the physician. 3. Administer an antihistamine, and notify the physician. 4. Obtain a sterile urine specimen, and notify the physician.

Correct Answer: 1 Rationale 1: Upper body rash and decreased urine output are most likely symptoms of vancomycin (Vancocin) toxicity, so the medication should be held and the physician notified. Rationale 2: There is no reason to obtain a chest x-ray. Rationale 3: The nurse should collaborate with the physician regarding medications for treatment of this situation. Rationale 4: The client's symptoms are most likely not due to a urinary tract infection, so a sterile urine specimen is not indicated.

Pathogenicity is different than virulence in that pathogenicity can 1. lead to the ability of organisms to cause infection. 2. kill pathogens. 3. cause a disease when pathogens are present. 4. disrupt cell lining.

Correct Answer: 1 Rationale 1: Pathogenicity can lead to an organism's causing an infection. Rationale 2: Bactericidal ability leads to killing pathogens. Rationale 3: Virulence can cause a disease to be present, even in small numbers. Rationale 4: Cell lining is not disrupted in this process.

The client tells the nurse that the doctor told him his antibiotic did not kill his infection, but just slowed its growth. The client is anxious. What is the best response by the nurse to decrease the client's anxiety? 1. "This is okay because your body will help kill the infection too." 2. "This is okay because your doctor is an infectious disease specialist." 3. "This is okay because your blood work is being monitored daily." 4. "This is okay because your infection is not really that serious."

Correct Answer: 1 Rationale 1: Some drugs do not kill the bacteria, but instead slow their growth and depend on the body's natural defenses to dispose of the microorganisms. These drugs which slow the growth of bacteria are called bacteriostatic. Rationale 2: Telling the client that the doctor is a specialist does not answer the question and will increase anxiety. Rationale 3: Telling the client that his blood work is being monitored does not answer the question and will increase anxiety. Rationale 4: Telling a client with an infection that the infection is not serious will increase anxiety because to the client, all infections are serious.

The nurse plans to teach the client with acquired immune deficiency syndrome (AIDS) about bacterial infections. Which information should the nurse include in this teaching? Select all that apply. 1. "If just a few bacteria make you sick, this is virulence." 2. "Most bacteria have developed antibiotic resistance." 3. "Pathogens are divided into two classes, bacteria and viruses." 4. "Pathogenicity means the bacteria can cause an infection." 5. "Actually, most bacteria will not harm us."

Correct Answer: 1,4,5 Rationale 1: A highly virulent microbe is one that can produce disease when present in minute numbers. Rationale 2: Antibiotic resistance is a problem; however only a few, not most, bacteria have developed it. Rationale 3: Human pathogens include viruses, bacteria, fungi, unicellular organisms, and multicellular animals. Rationale 4: The ability of an organism to cause infection is called pathogenicity. Rationale 5: Only a few dozen pathogens commonly cause disease in humans; most are harmless.

The client receives multiple antibiotics to treat a serious infection. What will the priority assessment of the client by the nurse include? 1. Assessing blood cultures for the presence of bacteria 2. Assessing changes in stool, white patches in the mouth, and urogenital itching or rash 3. Assessing renal and liver function tests 4. Assessing whether or not the client has adequate food and fluid intake

Correct Answer: 2 Rationale 1: Assessing blood cultures is important, but not as important as assessing for superinfections. Rationale 2: A superinfection occurs when microorganisms normally present in the body, host flora, are destroyed by antibiotic therapy. A superinfection can be lethal and should be suspected if a new infection appears while the client is receiving antibiotics. Signs of superinfection commonly include diarrhea, white patches in the mouth, urogenital itching, and presence of a blistering itchy rash. Rationale 3: Assessing renal and liver function tests is very important, but not as important as assessing for superinfections. Rationale 4: Assessing food and fluid intake is very important, but not as important as assessing for superinfections.

The client receives multiple drugs for treatment of tuberculosis. The nurse teaches the client the rationale for multiple drug treatment, and evaluates learning as effective when the client makes which statement? 1. "Current research indicates that the most effective way to treat tuberculosis is with multiple drugs." 2. "Multiple drugs are necessary because the bacteria are likely to develop resistance to just one drug." 3. "Treatment for tuberculosis is complex, and multiple drugs must be continued for as long as I am contagious." 4. "Multiple drug treatment is necessary for me to be able to develop immunity to tuberculosis."

Correct Answer: 2 Rationale 1: Current research does support multiple drug treatment, but this does not explain the rationale for this to the client. Rationale 2: Tuberculosis bacilli are likely to develop resistance to one drug, so multiple drugs must be used. Rationale 3: Treatment must be continued long after the client is no longer contagious. Rationale 4: Clients cannot develop immunity to bacterial infections.

The nurse works in infection control and teaches a class to staff nurses about the ways that resistance to antibiotics can occur. The nurse evaluates that learning has occurred when the nurses make which statement? 1. "Resistance to antibiotics most often occurs when physicians prescribe too many of them for elderly clients." 2. "Resistance to antibiotics can occur by the common use of them for nosocomial infections." 3. "Resistance to antibiotics most often occurs when physicians prescribe too many of them for children with ear infections." 4. "Resistance to antibiotics can occur by the prophylactic use of them for pre-operative clients."

Correct Answer: 2 Rationale 1: The use of antibiotics by physicians with elderly clients is not the major cause of antibiotic resistance. Rationale 2: The organisms that cause nosocomial infections have most likely been treated with antibiotics, and are the most likely organisms to develop resistance to antibiotics. Rationale 3: The use of antibiotics by physicians for children with ear infections is not the primary cause of antibiotic resistance. Rationale 4: The prophylactic use of antibiotics does not promote antibiotic resistance.

A client has been prescribed trimethoprim-sulfamethoxazole (Septra) for treatment of a urinary tract infection. Which comments, made by the client, would the nurse discuss with the prescriber before allowing the client to leave the clinic? Select all that apply. 1. "My husband and I plan to start a family as soon as possible." 2. "I forgot to take my potassium supplement today." 3. "Is it okay to take this with my warfarin?" 4. "It is so cloudy today." 5. "My 80-year-old mother is coming to visit today."

Correct Answer: 2,3 Rationale 1: Sulfa drugs are contraindicated for use by women at term. Rationale 2: Potassium supplements should not be taken during therapy unless directed by the health care provider. Rationale 3: Sulfa drugs may enhance the effects of oral anticoagulants. Rationale 4: Sulfa drugs can result in photosensitivity. Rationale 5: There is no reason this visit should be of concern regarding the medication prescribed.

A client who has diabetes mellitus is diagnosed with tuberculosis and has been prescribed multiple-drug therapy. What instruction should the nurse provide to this client? Select all that apply. 1. These medications can cause hypoglycemia, so you should always carry a sugar source. 2. Test your blood glucose more frequently while on these medications. 3. If your blood glucose levels elevate consistently, contact us. 4. Take your medication for diabetes at least 6 hours after taking these medications. 5. While on these medications you will be more prone to infections in your feet.

Correct Answer: 2,3 Rationale 1: The medication regimen is more likely to cause hyperglycemia. Rationale 2: These medications may cause hyperglycemia. The client should monitor blood glucose levels more closely. Rationale 3: Constant elevation of blood glucose levels may warrant alteration in medication therapy for diabetes. Rationale 4: There is no reason to separate the administration of these medications by 6 hours. Rationale 5: There is no evidence that medications used to treat tuberculosis will increase the likelihood of infections in the feet

The client is to receive an injection of penicillin G benzathine (Bicillin LA) in the outpatient clinic. What is a priority nursing action by the nurse prior to administering this injection? Select all that apply. 1. Have the client lie down and assess vital signs before she leaves. 2. Ask the client if she has ever had an allergy to penicillin before. 3. Inform the client that she will need to wait 30 minutes before leaving the clinic. 4. Inform the client that she must have someone drive her home. 5. Advise the client to rest for the remainder of the day.

Correct Answer: 2,3 Rationale 1: There is no reason to have the client lie down. It is not important to assess vital signs unless a problem has developed. Rationale 2: It is always important to ask about allergies. The nurse must be aware, however, that no history of allergy does not guarantee there will not be an allergic response with this administration. Rationale 3: It is important that the client be reassessed for development of allergic reaction before leaving the clinic. Rationale 4: There is no indication that the client will require someone else to drive her home. Rationale 5: There is no specific reason the client should rest related to administration of penicillin.

A client receiving chemotherapy has a very low white blood cell count. Antibiotic therapy is initiated. What rationales should the nurse provide for the addition of this drug? Select all that apply. 1. You have an infection. 2. We would like to prevent you from developing any infections. 3. Chemotherapy often causes infections. 4. This antibiotic will help your chemotherapy fight off your cancer. 5. If you are developing an infection, this medication will help kill it out early.

Correct Answer: 2,5 Rationale 1: There is no evidence of infection being present. Rationale 2: Antibiotics are given to those with low WBCs to help prevent or lessen infections. Rationale 3: The chemotherapy does not cause an infection, but does decrease immunity, allowing infection to occur. Rationale 4: This antibiotic is not being given to kill cancer cells. Rationale 5: Prophylactic antibiotics are given to kill bacteria while their numbers are small.

Discharge planning for the client prescribed tetracycline will include which of the following? 1. Take the medication with antacids. 2. Take the medication with iron supplements. 3. Do not take the medication with milk. 4. Decrease the amount of vitamins.

Correct Answer: 3 Rationale 1: Antacids can decrease the effectiveness of tetracycline. Rationale 2: Iron can decrease the effectiveness of tetracycline. Rationale 3: Tetracycline effectiveness can be decreased by using milk products. Rationale 4: It is not necessary to decrease vitamins.

The physician orders cefepime (Maxipime) for a client. What is a priority question for the nurse to ask the client prior to administration of this drug? 1. "Are you breastfeeding?" 2. "Are you pregnant?" 3. "Are you allergic to penicillin?" 4. "Are you allergic to tetracycline?"

Correct Answer: 3 Rationale 1: Cefepime (Maxipime) is a Pregnancy Category B drug, and is safe to use while breastfeeding. Rationale 2: Cefepime (Maxipime) is a Pregnancy Category B drug, and is safe for use during pregnancy. Rationale 3: Cephalosporins are contraindicated in clients who have experienced a severe allergic reaction to penicillin. Rationale 4: Cephalosporins are contraindicated in clients who have experienced a severe allergic reaction to penicillin, not tetracycline.

The drug that would most likely be used in the treatment of tuberculosis is 1. erythromycin (E-mycin). 2. Vancomycin (Vancocin). 3. Isoniazid (INH). 4. Gentamicin (Garamycin).

Correct Answer: 3 Rationale 1: Erythromycin is most effective against gram-positive bacteria. Rationale 2: Vancomycin is used for bactericidal reasons. Rationale 3: Isoniazid (INH) is the drug of choice for anti-tuberculosis therapy. Rationale 4: Gentamicin is used for bactericidal reasons.

The student nurse asks the nursing instructor for help with her microbiology class. The student is studying bacteria. What does the best plan by the nursing instructor include? Select all that apply. 1. Bacteria are either aerobic or anaerobic. 2. Bacteria are multicellular organisms. 3. E-coli are gram-negative bacteria. 4. Gram-staining is one way to identify bacteria. 5. Spherical-shaped bacteria are called cocci.

Correct Answer: 3,4,5 Rationale 1: Some organisms have the ability to change their metabolism and survive in either aerobic or anaerobic conditions. Rationale 2: Bacteria are single cell organisms. Rationale 3: Gram-staining is one way to identify bacteria. E-coli are gram-negative bacteria. Rationale 4: Gram-staining is one way to identify bacteria. Rationale 5: Spherical-shaped bacteria are called cocci.

The nurse is caring for a client receiving gentamicin IV. The nurse would observe for adverse effects of 1. diarrhea. 2. nausea. 3. increased urinary output. 4. ototoxicity.

Correct Answer: 4 Rationale 1: Diarrhea is not a common adverse effect of gentamicin. Rationale 2: Nausea is not a common adverse effect. Rationale 3: Increased urinary output is not an adverse effect. Rationale 4: Ototoxicity is an adverse effect that could occur while receiving gentamicin. This could become permanent with continued use.

A client comes to the emergency department complaining of a sore throat. He has white patches on his tonsils, and he has swollen cervical lymph nodes. What will the best plan by the nurse include? 1. Plan to administer a narrow-spectrum antibiotic. 2. Plan to administer a broad-spectrum antibiotic. 3. Plan to obtain blood cultures. 4. Plan to obtain a throat culture.

Correct Answer: 4 Rationale 1: Initial therapy with a narrow-spectrum antibiotic is too specific without knowing the causative organism. Rationale 2: A broad-spectrum antibiotic is commonly ordered, but a throat culture should be obtained first. Rationale 3: Blood cultures are not necessary at this point because the infection is in the throat; it is not systemic. Rationale 4: A throat culture is necessary to identify the causative organism and initiate the best antibiotic treatment.

A client comes to the emergency department with a fever of 104° F. What will the best plan by the nurse include? 1. Plan to obtain liver and renal function tests. 2. Plan to obtain a complete blood count (CBC) test. 3. Plan to obtain a sterile urine specimen. 4. Plan to obtain blood for culture and sensitivity.

Correct Answer: 4 Rationale 1: Liver and renal function tests will not identify the causative organism. Rationale 2: The CBC will reveal the impact of infective agents on the immune system, but will not identify the agent. Rationale 3: Obtaining a urine specimen is not the best method of determining this client's infective agent. Rationale 4: A high fever is usually indicative of a systemic infection. Blood cultures are the best way of identifying the causative organism.

The physician orders penicillin for a female client who has a sinus infection. What is a priority question to ask the client prior to administering the medication? 1. "Are you pregnant?" 2. "Do you plan to become pregnant?" 3. "Are you breastfeeding?" 4. "Are you taking birth control pills?"

Correct Answer: 4 Rationale 1: Penicillin is a Pregnancy Category B drug, and is safe to take if a client is pregnant. Rationale 2: Penicillin is a Pregnancy Category B drug, and is safe to take if a client plans to become pregnant. Rationale 3: Penicillin is a Pregnancy Category B drug, and is safe to take if a client is breastfeeding. Rationale 4: Penicillin can cause birth control pills to lose their effectiveness.

What is the action of bactericidal drugs? 1. They disrupt normal cell function. 2. They will slow the growth of the bacteria. 3. They have a high potency. 4. They will kill the bacteria.

Correct Answer: 4 Rationale 1: They do not disrupt normal cell function. Rationale 2: Bacteriostatic drugs slow the growth of bacteria. Rationale 3: Potency is related to the properties of resistance. Rationale 4: Bactericidal drugs kill the bacteria

A client will be discharged after surgery with a prescription for penicillin. When planning at-home instructions, what will the nurse include? 1. Penicillins can be taken while breast-feeding. 2. The entire prescription must be finished. 3. All penicillins can be taken without regard to eating. 4. Some possible side effects include abdominal pain and constipation.

answer:2 Rationale: Many people will discontinue medication after improvement is noted. All antibiotic regimens must be completed to prevent recurrence of infection unless allergy or significant adverse effects occur that warrant discontinuing or changing the drug used. Options 1, 3, and 4 are incorrect. Some penicillins (e.g., amoxicillin) should be taken with meals, whereas all others should be taken 1 hour before or 2 hours after meals. Rationale: Penicillins should be used with caution during breast-feeding. Penicillins, along with other antibiotics, tend to cause diarrhea and not constipation.

Superinfections are an adverse effect common to all antibiotic therapy. Which of the following best describes a superinfection? 1. An initial infection so overwhelming that it requires multiple antimicrobial drugs to treat successfully 2. Bacterial resistance that creates infections that are difficult to treat and that are often resistant to multiple drugs 3. Infections requiring high-dose antimicrobial therapy with increased chance of organ toxicity 4. The overgrowth of normal body flora or of opportunistic organisms such as viruses and yeast no longer held in check by normal, beneficial flora

anwer:4 Rationale: When normal host flora are decreased or killed by antibacterial therapy, opportunistic organisms such as viral and fungal infections may occur. Options 1, 2, and 3 are incorrect. Bacterial resistance and organ toxicity may be adverse drug effects of antibacterial therapy but do not describe superinfections. The use of multiple antibiotics for severe infections is a therapeutic use of the drugs.