Midterm Exam Review Questions
What are the side effects of vancomycin?
- The principal toxicity of vancomycin is renal failure. Risk is dose related and increased by concurrent use of other nephrotoxic drugs - Ototoxicity develops rarely, especially with use of other ototoxic drugs (aminoglycosides) - Thrombophlebitis: administer in dilute solution, change IV site - Rapid infusion of vancomycin causes "red man syndrome" - flushing, rash, pruritis particularly on neck, face, upper chest. Administer slowly (over at least 60 minutes) to avoid this syndrome.
You are working as a nurse in the intensive care unit (ICU). Your patient is a 45-year-old man who was being treated with several antibiotics and developed a C. difficile infection. The provider has prescribed vancomycin. The family asks, "Why is vancomycin used for this infection?" How should you respond?
- Vancomycin or metronidazole is the drug of choice for eliminating C. difficile from the bowel. - Vancomycin is an important but potentially toxic drug used primarily for (1) C. difficile infection, (2) methicillin-resistant Staphylococcus aureus (MRSA) infection, and (3) serious infections caused by susceptible organisms in patients allergic to penicillins.
What 2 methods can help penicillin combat destruction of its beta-lactam ring?
- use of a penicillinase-resistant penicillin such as Oxacillin, Nafcillin, or Doxicillin - addition of a beta-lactamase inhibitor such as clauvanic acid, TAZO, or Sulbactam (add to broad-spectrum or extended-spectrum antibiotics)
when do you check trough on a med?
30 mins before admin
The nurse should be particularly vigilant when monitoring intake and output and creatinine levels when a patient is receiving which antitubercular drugs? (Select all that apply.) A. Amikacin B. Gatifloxacin C. Kanamycin D. Isoniazid E. Streptomycin
A. Amikacin C. Kanamycin E. Streptomycin Rationale: Think more about the second-like TB meds, the aminoglycosides. Aminoglycosides are nephrotoxic. Isoniazid is a TB drug, but it is more hepatotoxic.
Which statement about allergic reactions to penicillin does the nurse identify as true? A. Anaphylactic reactions occur more frequently with penicillins than with any other drug. B. Allergy to penicillin always increases over time. C. Benadryl is the drug of choice for anaphylaxis due to penicillin allergy. D. Patients allergic to penicillin are also allergic to vancomycin.
A. Anaphylactic reactions occur more frequently with penicillins than with any other drug. Rationale: Anaphylactic reactions occur more frequently with penicillins than with any other drug. Allergy to penicillin can decrease over time. Epinephrine is the drug of choice for anaphylaxis. Vancomycin, erythromycin, and clindamycin are effective and safe alternatives for patients with penicillin allergy.
With treatment, Ann's symptoms begin to go away. Additionally, her bacteriology results have become available. Ann's specimen is culture positive and the drug susceptibility test shows that her TB is drug-susceptible to all of the drugs used in the standard treatment regimen. Why is it important to order drug susceptibility testing with the initial sputum culture? A. Early drug susceptibility test results help clinicians modify the drug treatment regimen if drug resistance is found. B. The patient will not have to return to the clinic for another test. C. Drug susceptibility results help to determine the infectiousness of the patient.
A. Early drug susceptibility test results help clinicians modify the drug treatment regimen if drug resistance is found. Rationale: Drug susceptibility testing helps clinicians choose appropriate drugs for treating patients. Treatment success depends upon using TB drugs that can kill the TB bacteria. If patients are given drugs to which their TB is resistant, they will still be sick with TB and potentially develop further drug resistance.
A nurse administered a PRN dose of Maalox to a pt at 07:30. The pt has a scheduled dose of PO tetracycline at 8:00 what should the RN do? A. Hold the tetracycline until 09:30 B. Contact HCP to get alternate antibiotic C. Administer the tetracycline as ordered D. Skip the 08:00 dose of tetracycline and resume treatment with the next scheduled dose
A. Hold the tetracycline until 09:30 Rationale: Hold until 09:30. You need to space tetracycline 2 hours apart from milk and antacids. Tetracycline forms an insoluble compound with calcium, iron, magnesium, aluminum, and zinc. The result is decreased absorption.
Ann is a 25-year old graduate student from Southeast Asia. She goes to the clinic complaining of a cough lasting 3 weeks, fever, and weight loss. The clinic evaluates her for TB. The results of her medical evaluation are: • Tuberculin skin test (TST): Positive • Chest x-ray: Cavity in lung • Sputum smear: Positive for acid-fast bacilli (AFB) • Nucleic acid amplification test (NAAT): Positive for M. tuberculosis • Culture: Pending • Drug susceptibility tests: Pending • HIV test: Negative Based on her medical evaluation results, Ann is presumed to have TB. She is started on the standard initial TB disease treatment regimen. Which of the following drugs should be included in Ann's initial treatment regimen? (Select all that apply.) A. Isoniazid (INH) B. Rifampin (RIF) C. Levofloxacin D. Pyrazinamide (PZA) E. Ethambutol (EMB) F. Linezolid
A. Isoniazid (INH) B. Rifampin (RIF) D. Pyrazinamide (PZA) E. Ethambutol (EMB)
Which information should the nurse include when teaching a patient about rifampin therapy? (Select all that apply.) A. Oral contraceptives are not effective when used with rifampin therapy. B. You may notice the color of your body fluids changes to reddish orange. C. Rifampin is safe to use in patients who have hepatic disease. D. Rifampin may only be taken orally.
A. Oral contraceptives are not effective when used with rifampin therapy. B. You may notice the color of your body fluids changes to reddish orange. Rationale: Women taking oral contraceptives should consider a nonhormonal form of birth control while taking rifampin. Rifampin frequently imparts a red-orange color to urine, sweat, saliva, and tears; patients should be informed of this harmless effect. Permanent staining of soft contact lenses occasionally has occurred, so the patient should consult an ophthalmologist about contact lens use. Rifampin is toxic to the liver, posing a risk of jaundice and even hepatitis. Asymptomatic elevation of liver enzymes occurs in about 14% of patients. However, the incidence of overt hepatitis is less than 1%. Hepatotoxicity is most likely in alcohol abusers and patients with pre-existing liver disease. These individuals should be monitored closely for signs of liver dysfunction. Rifampin may be administered intravenously.
Which of the following is defined as "inflammation of the kidney and its pelvis"? A. Pyelonephritis B. Prostatitis C. Cystitis D. Urethritis
A. Pyelonephritis
For a patient prescribed Bactrim, What s/s you would advise her to report? A. Rash B. edema C. hair loss D. constipation
A. Rash Rationale: Risk for SJS.
The principal cause underlying the emergence of resistance to tuberculosis therapy is inadequate drug therapy. A. True B. False
A. True Rationale: Active TB requires treatment with all four medications. Resistance may develop if the medication regimen is not followed exactly as ordered.
Amphotericin B can bind to cholesterol in human cell membranes causing toxicity. A. True B. False
A. True Rationale: Erika, my roommate who is an aerospace engineer, states, "That sounds about right."
Would a patient taking AZO for her UTI need a antibiotic or antiseptic? A. Yes B. No
A. Yes Rationale: AZO is a urinary analgesic, it does not have any antiseptic/antibiotic properties. This drug will help with pain and urinary burning/spasms.
One reason a provider may choose to use a PPI over a H2B is because of the adverse effects of H2RA which include CNS effects, pneumonia and the development of male breast tissue. A. true B. false
A. true Rationale: PPIs are more effective, but cause an irreversible inhibition of the enzyme it blocks.
A patient is to be started on TB therapy with rifampin. Which of these statements by the patient would indicate the patient needs further teaching? A. "I should contact my ophthalmologist regarding use of my contact lens." B. "I should contact my prescriber if I experience reddish-orange colored urine." C. "My oral contraceptive birth control may not work." D. "This drug can stain my contact lens."
B. "I should contact my prescriber if I experience reddish-orange colored urine."
A patient with scabies is prescribed permethrin [Nix]. The nurse will administer this medication in which way? A. As an oral solution in three divided doses B. As a topical cream applied to the entire body and rinsed after 8 hours C. By diluting in water and soaking the affected area for 15 minutes D. By spraying the mattress, bed linens, and clothing
B. As a topical cream applied to the entire body and rinsed after 8 hours Rationale: Permethrin for scabies is applied to the entire body and massaged into the skin; after a period of 8 to 14 hours, the topical cream is removed by washing the head and body.
The nurse is reviewing test results for a patient who is prescribed itraconazole. Which result would warrant immediate consultation with the prescriber? A. AST 35 B. BNP 745 C. Echo-EF 65% D. K+ 3.8
B. BNP 745 Rationale: The -azoles are associated with hepatotoxicity, sexual dysfunction, and cardiac dysfunction. BNP is an indicator of fluid overload, so this would be assessed in a patient taking this medication. Ejection fraction can be lowered as a result of this medication, but an EF of 65-70% is normal.
A patient with a history of a severe anaphylactic reaction to penicillin has an order to receive cephalosporin. What should the nurse do? A. Administer the cephalosporin as ordered. B. Contact the health care provider for a different antibiotic. C. Administer a test dose of cephalosporin to determine reactivity. D. Have an epinephrine dose available when administering the cephalosporin.
B. Contact the health care provider for a different antibiotic. Rationale: A few patients with penicillin allergy (about 1%) display cross-sensitivity to cephalosporins. If at all possible, patients with penicillin allergy should not be treated with any member of the penicillin family. Use of cephalosporins depends on the intensity of the allergic response to penicillin; if the penicillin allergy is mild, use of cephalosporins is probably safe. However, if the allergy is severe, cephalosporins should be avoided.
Which of these assessment findings, if identified in a patient who is receiving nitrofurantoin (Macrodantin), should the nurse report to the prescriber immediately? A. Brown colored urine B. Dyspnea C. Nausea D. Headache
B. Dyspnea Rationale: Nitrofurantoin can cause CNS effects, which can result in respiratory depression.
In the event of an anaphylaxis PCN allergy, Carbapenems can be used as an alternate A. True B. False
B. False Rationale: Carbapenems can be given if the allergic reaction is local. Other wise, PCNs, cephs, and carbapenems should be avoided due to the presence of the beta-lactam ring.
A NSPR, narrow spectrum penicillinase resistant, can be used to treat MRSA. A. True B. False
B. False Rationale: NSPRs (naficillin, oxacillin, dicillin) are used to treat Staph.
It would be a priority to report which symptoms in a patient who is prescribed the-azole antifungal drug fluconazole (Diflucan)? A. Abdominal pain/diarrhea B. Fever and blisters in mouth C. Headache and photophobia D. Nausea and vomiting
B. Fever and blisters in mouth Rationale: This medication has the risk for hypersensitivity reactions, such as Stevens-Johnson's syndrome.
This antibiotic drug class is avoid in patients taking meds that may also prolong QT. A. Serotonin Receptor Antagonist B. Macrolides C. Tetracyclines D. Sulfonamides
B. Macrolides Rationale: Serotonin receptor antagonists can prolong QT, but they are NOT antibiotics.
What is the priority reason why the nurse teaches a patient who is prescribed sulfamethoxazole to take this medication with a full glass of water? A. Decrease the risk of esophageal irritation B. Minimize crystal formation in the urine C. Prevent nausea D. Stimulate frequent voiding
B. Minimize crystal formation in the urine
Which of the following is defined as "inflammation of the gland surrounding the bladder neck in men"? A. Pyelonephritis B. Prostatitis C. Cystitis D. Reinfection E. Relapse F. Urethritis
B. Prostatitis
A patient is prescribed cefixime. The nurse should teach the patient to immediately report any signs of what? A. Milk intolerance B. Skin rash, hives or itching C. Constipation, nausea or vomiting D. Headache, contusions or seizures
B. Skin rash, hives or itching Rationale: Hypersensitivity reactions are common with cephalosporins. Patients should be instructed to report any signs of allergy, such as skin rash, itching, or hives. Cefditoren contains a milk protein and should not be prescribed for patients with a milk protein allergy. Ceftriaxone and cefotetan can promote bleeding. Diarrhea associated with antibiotic-associated pseudomembranous colitis (AAPMC) is a possible side effect with cephalosporins.
A patient is prescribed cefixime. The nurse should teach the patient to immediately report any signs of what? A. Milk intolerance B. Skin rash, hives, or itching C. Constipation, nausea, or vomiting D. Headache, contusions, or seizures
B. Skin rash, hives, or itching Rationale: Hypersensitivity reactions are common with cephalosporins. Patients should be instructed to report any signs of allergy, such as skin rash, itching, or hives. Cefditoren contains a milk protein and should not be prescribed for patients with a milk protein allergy. Cefoperazone and cefotetan can promote bleeding. Diarrhea associated with antibiotic-associated pseudomembranous colitis (AAPMC) is a possible side effect with cephalosporins.
Your patient has syphilis. He states he has a mild allergy to PCN, what medication would you anticipate being ordered for him? A. Amoxicillin B. Tetracycline C. Bactrim D. Cephalosporin
B. Tetracycline Rationale: Tetracycline is the alternative to PCN for syphilis.
The nurse is reviewing laboratory values from a patient who has been prescribed gentamicin. To prevent ototoxicity, it is most important for the nurse to monitor which value(s)? A. Serum creatinine and blood urea nitrogen levels B. Trough drug levels of gentamicin C. Peak drugs levels of gentamicin D. Serum alanine aminotransferase and aspartate aminotransferase levels
B. Trough drug levels of gentamicin Rationale: To minimize ototoxicity, trough levels must be sufficiently low to reduce exposure of sensitive sensory hearing cells. The risk of ototoxicity is related primarily to persistently elevated trough drug levels rather than to excessive peak levels. After collecting a peak or trough level, it is important to wait for the result prior to administering the medication.
A patient has been prescribed oral ciprofloxacin [Cipro] for a skin infection. When administering the medication, it is most important for the nurse to do what? A. Monitor for a decrease in the prothrombin time (PT) if the patient is also taking warfarin [Coumadin] B. Withhold antacids and milk products for 6 hours before or 2 hours afterward C. Inform the healthcare provider if the patient has a history of asthma D. Assess the skin for Stevens-Johnson syndrome
B. Withhold antacids and milk products for 6 hours before or 2 hours afterward Rationale: Absorption of ciprofloxacin can be reduced by ingestion of antacids and milk products. Ingestion of these products should occur at least 6 hours before ciprofloxacin or 2 hours afterward. Ciprofloxacin can increase the PT if the patient is also taking warfarin. Use of ciprofloxacin is contraindicated in patients with a history of myasthenia gravis. Patients taking ciprofloxacin are at risk for development of phototoxicity.
What is the main medication used to treat prostatitis/ A. rifampin B. ciprofloxacin C. penicillin G D. bactrim
B. ciprofloxacin Rationale: We want to use a stronger medication to treat prostatitis since it is higher up in the urethra.
Anticholinergic properties of scopolamine include A. increased secretions B. dry mouth C. diarrhea D. weight loss
B. dry mouth Rationale: Remember the anticholinergic properties with, "Can't see, can't pee, can't spit, can't shit."
The mechanism of action for carafate includes secreting mucous to help protect the GI mucosa from acid. A. true B. false
B. false Rationale: Carafate is a GI mucosal protectant, but it does not secrete anything. Rather, it creates a protective barrier that covers the ulcer.
Primaquine and quinine should not be administered to persons with G6PD deficiency because this deficiency: A. causes cinchonism B. increases hemolysis C. increases the risk of hypotension D. prevents the drug from working
B. increases hemolysis Rationale: These drugs cause hemolysis from deficiency of G6PD in red blood cells.
A patient who takes warfarin has been prescribed sulfadiazine. When teaching the patient about this drug, which statement will the nurse include? A. "If you become pregnant, it is safe to take sulfadiazine." B. "You should limit your fluid intake while taking sulfadiazine." C. "Avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin." D. "You will most likely need to have an increase in the dose of warfarin while taking sulfadiazine."
C. "Avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin." Rationale: Patients taking sulfadiazine should be advised to avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin. Sulfonamides can cause kernicterus in newborns. These drugs should not be administered to pregnant women near term, nursing mothers, or infants under 2 months old. Sulfadiazine causes deposition of sulfonamide crystals, which can injure the kidney. To minimize crystalluria, hydration should be sufficient to produce a daily urine flow of 1200 mL in adults; alkalinization of urine (for example, with sodium bicarbonate) can also help. Patients taking sulfadiazine should drink 8 to 10 glasses of water per day. Sulfonamides can intensify the effects of warfarin, phenytoin, and sulfonylurea-type oral hypoglycemics (for example, glipizide). When combined with sulfonamides, these drugs may require a reduction in dosage. TMP/SMZ is contraindicated for nursing mothers, pregnant women in the first semester or near term, infants under 2 months old, patients with folate deficiency (manifested as megaloblastic anemia), and patients with a history of hypersensitivity to sulfonamides and chemically related drugs, including thiazide diuretics, loop diuretics, and sulfonylurea-type oral hypoglycemics. Instruct patients to complete the prescribed course of treatment, even though symptoms may abate before the full course is over.
At what point is the patient most likely to experience fever, chills, rigors, nausea, and headache when receiving amphotericin B? A. Immediately after infusion begins B. 20-30 min after infusion begins C. 1-3 hours after infusion begins D. 3-6 hours after infusion begins
C. 1-3 hours after infusion begins
Which patient does the nurse identify as most likely to need treatment with trimethoprim/sulfamethoxazole [Bactrim] for a period of 6 months? A. A female patient with acute pyelonephritis B. A male patient with acute prostatitis C. A female patient with recurring acute urinary tract infections D. A male patient with acute cystitis
C. A female patient with recurring acute urinary tract infections Rationale: Female patients with relapses of urinary tract infection may need long-term therapy up to 6 months with trimethoprim/sulfamethoxazole.
A patient is receiving amphotericin B to treat a systemic fungal infection. To prevent renal damage, it is most important for the nurse to do what? A. Administer the medication through a central venous access device B. Administer potassium supplements C. Administer 1000 mL of 0.9% saline D. Administer the medication orally
C. Administer 1000 mL of 0.9% saline
A patient is prescribed metronidazole [Flagyl] to treat giardiasis. It is most important for the nurse to teach the patient that while taking this medication, which of the following should be avoided? A. Acetaminophen [Tylenol] B. Milk and dairy products C. Alcoholic beverages D. Sun exposure
C. Alcoholic beverages Rationale: Patients should be taught to avoid alcohol while taking metronidazole. Consumption of beverages or products containing alcohol while taking metronidazole may cause a disulfiram-like reaction.
Which information should the nurse include when teaching a patient about isoniazid (INH) therapy? A. Tubercle bacilli cannot develop resistance to isoniazid during treatment. B. Isoniazid is administered intravenously. C. An adverse effect of isoniazid therapy is peripheral neuropathy, which can be reversed with pyridoxine. D. The dose of isoniazid should be lowered if the patient is also taking phenytoin.
C. An adverse effect of isoniazid therapy is peripheral neuropathy, which can be reversed with pyridoxine. Rationale: If peripheral neuropathy develops, it can be reversed by administering pyridoxine (50 to 200 mg daily). Often pyridoxine is prescribed to take along with INH without waiting for neuropathy to develop. Tubercle bacilli can develop resistance to isoniazid during treatment. Isoniazid is administered orally and IM. Plasma levels of phenytoin should be monitored, and the phenytoin dosage should be reduced as appropriate; the dosage of isoniazid should not be changed. Isoniazid can raise levels of other drugs, including phenytoin.
A nurse is caring for a patient in an acute care setting who was admitted with a cerebral spinal fluid (CSF) infection caused by a highly gram-negative bacteria. Which of the following cephalosporin IV antibiotics should the nurse expect to be effective in treating this infection? A. Cefaclor (Ceclor)—2nd generation B. Cefazolin (Ancef)—1st generation C. Ceftazidime (Fortaz)—3rd generation D. Cephalexin (Keflex)—1st generation
C. Ceftazidime (Fortaz)—3rd generation Rationale: Ceftazidime, a 3rd generation cephalosporin is more likely to be effective against this infection than the other medications, which are from the 1st or 2nd generation. Medications from each progressive generation of cephalosporin are more effective against gram-negative bacteria, more resistant to being destroyed by beta-lactamase, and more able to penetrate the CSF.
This medication would be avoided in a patient with a connective tissue disorder such as Marfan's syndrome due to its risk of aortic dissection? A. Vancomycin B. Metronidazole C. Ciprofloxacin D. Azithromycin
C. Ciprofloxacin Rationale: Fluoroquinolones are associated with risk of aortic dissection.
Your patient has intermittent colitis. Which antibiotic is contraindicated for use in this patient? A. Erythromycin B. Doxycycline C. Clindamycin D. Azithromycin
C. Clindamycin Rationale: Clindamycin has an FDA block box warning against severe, life-threatening pseudomembranous colitis.
Which lab value would contraindicate the use of tetracycline to treat an infection? A. Potassium 3.4 mEq/L B. WBC 20,000 C. Creatinine 2.8 mg/dl D. Hemoglobin 10.5 g/dl
C. Creatinine 2.8 mg/dl Rationale: Elevated creatinine indicates renal impairment. Tetracycline is contraindicated in renal impairment.
Which of the following is defined as "inflammation of the urinary bladder"? A. Pyelonephritis B. Prostatitis C. Cystitis D. Reinfection E. Relapse F. Urethritis
C. Cystitis
A patient is prescribed doxycycline [Vibramycin]. If the patient complains of gastric irritation, what should the nurse do? A. Instruct the patient to take the medication with milk B. Tell the patient to take an antacid with the medication C. Give the patient food, such as crackers or toast, with the medication D. Have the patient stop the medication immediately and contact the health care provider
C. Give the patient food, such as crackers or toast, with the medication Rationale: Tetracyclines form insoluble chelates with calcium, iron, magnesium, aluminum, and zinc; absorption is decreased. Tetracyclines should not be administered together with milk or antacids. Long-acting tetracyclines, such as doxycycline, may be taken with food; food does not affect absorption.
Lab values that you would monitor on cephalosporins include A. BUN/creat B. creatinine kinase C. INR D. AST
C. INR Rationale: Cephalosporins interfere with vitamin K, therefore increasing the risk for bleeding since vitamin K clotting factors will affected.
What is a benefit of trimethoprim-sulfamethoxazole (TMP/SMZ) over using the two drugs components alone? A. Lack of interaction with drugs that have a narrow therapeutic range B. Fewer adverse effects C. Less resistance has developed D. Lower incidence of toxicity
C. Less resistance has developed
The nurse is assessing for adverse effects of IV gentamycin. Which change would be a priority to report to the prescriber? A. Dilute urine B. Headache C. Limp, weak muscles D. Ringing in the ears
C. Limp, weak muscles Rationale: Aminoglycosides can inhibit neuromuscular transmission, causing flaccid paralysis and potentially fatal respiratory depression. Most episode of NM blockade have occurred following intraperitoneal or intrapleural instillation (not common!!). However, NM blockade has also occurred with IV, IM ,and PO dosing.
Which medications are most appropriate to administer to a patient with a C.diff infection? (Select all that apply.) A. Ciprofloxacin (Cipro) B. Loperamide C. Metronidazole (Flagyl) D. Vancomycin E. Fidamoxicin (Dificid)
C. Metronidazole (Flagyl) D. Vancomycin E. Fidamoxicin (Dificid)
When administering drugs that are potentially nephrotoxic, the nurse should consult the prescriber before administering which OTC drugs? A. Antacids B. Acetaminophen C. NSAIDs D. Laxatives
C. NSAIDs
A patient with a history of PVD, T2DM, and latent TB is prescribed isoniazid and pyridoxine. What is the purpose of the pyridoxine? A. Improve arterial blood flow B. Prevent hypoglycemia C. Prevent peripheral neuropathy D. Treat resting mycobacteria within cells
C. Prevent peripheral neuropathy Rationale: Another name for pyridoxine is vitamin B6.
If you have a patient receiving IV Clindamycin and they develop hypotension and ECG changes, what would you do? A. Continue monitoring the patient closely B. Transfer Pt to ICU C. Stop the drug D. Slow the rate of administration
C. Stop the drug Rationale: Stop the drug!! Clindamycin can cause bradycardia and cardiac arrest.
Fluoroquinolones should be discontinued immediately if what happens? A. Nausea, vomiting, or diarrhea is experienced. B. Dizziness, headache, or confusion occurs. C. Tendon pain or inflammation develops. D. Theophylline is prescribed for asthma.
C. Tendon pain or inflammation develops. Rationale: Fluoroquinolones can cause tendon rupture and should be discontinued if tendon pain or inflammation develops. They are also not to be given to children under the age of 18, except in 2 conditions (pyelonephritis d/t E.coli and post exposure to anthrax). They can also cause QT prolongation.
Ann comes to the clinic each morning to take her medication by DOT. Because of a change in her class schedule, Ann is now unable to make it to the clinic for her scheduled DOT appointments. What can be done to ensure that Ann continues her TB treatment? A. Nothing. If Ann cannot make it to the clinic for her DOT appointments, then she will not be able to complete treatment. B. The health care worker should give Ann a bottle of all of the remaining drugs in her treatment plan and follow-up with Ann at the end of treatment. C. The health care worker should speak with Ann and find a time and location for the DOT visit that is convenient for Ann.
C. The health care worker should speak with Ann and find a time and location for the DOT visit that is convenient for Ann. Rationale: DOT is the most effective strategy for ensuring adherence to treatment. DOT appointments should be made at a time and location that are convenient for the patient. This can include the home, work setting, or a local hangout.
When can a health care worker determine that Ann has successfully completed treatment for active TB? A. When Ann successfully completes her initial treatment phase. B. When Ann leaves the United States after her classes are finished. C. When Ann takes all of the prescribed doses of her TB treatment. D. When Ann symptoms are gone and she feels better.
C. When Ann takes all of the prescribed doses of her TB treatment. Rationale: TB treatment completion is determined by the number of doses taken over a given period of time. This includes treatment given in both the initial and continuation treatment phase. It is important that patients take all of their prescribed doses of medication even if they feel better and their symptoms are gone to help ensure that the TB bacteria in their body is killed and that they do not develop drug resistance.
The administration of gentamicin, an aminoglycoside along with PCN may increase the patients risk of A. hepatotoxicity B. cardiac failure C. nephrotoxicity D. seizures
C. nephrotoxicity Rationale: Another nursing consideration is that these meds should not be given through the same line. The PCN will inactivate the aminoglycoside.
A patient is prescribed cefazolin. It is most important for the nurse to teach the patient to avoid which substance while taking cefazolin? A. Phenytoin B. Milk products C. Digitalis D. Alcohol
D. Alcohol Rationale: Cefazolin and cefotetan can cause alcohol intolerance. A serious disulfiram-like reaction may occur if alcohol is consumed. Inform patients about alcohol intolerance and warn them not to drink alcoholic beverages.
A patient is prescribed cefazolin. It is most important for the nurse to teach the patient to avoid which substance while taking cefazolin? A. Warfarin B. Milk products C. Digitalis D. Alcohol
D. Alcohol Rationale: Cefazolin and cefotetan can cause alcohol intolerance. A serious disulfiram-like reaction may occur if alcohol is consumed. Inform patients about alcohol intolerance and warn them not to drink alcoholic beverages.
Prior to administering a Macrolide antibiotic, the provider may order A. Blood glucose monitoring B. pulse ox C. weight D. EKG
D. EKG
Which INR result would be a reason to contact the prescriber in a patient with atrial fibrillation taking warfarin who has also been prescribed a sulfonamide? A. INR 2 B. INR 2.5 C. INR 3 D. INR 3.5
D. INR 3.5 Rationale: The therapeutic INR level for a patient on warfarin therapy is 2-3.
Your patient has an infected pressure ulcer. The wound culture reveals a vancomycin-resistant staph. Which medication would you expect to be ordered? A. Tetracycline B. Clindamycin C. Chloramphenicol D. Linezolid (Zyvox)
D. Linezolid (Zyvox) Rationale: Zyvox is specifically indicated for VRE or other vancomycin-resistant infections such as staph.
A patient is prescribed vancomycin orally for antibiotic-associated pseudomembranous colitis. The nurse will monitor the patient for what? A. Leukopenia B. "Red man" syndrome C. Liver impairment D. Ototoxicity
D. Ototoxicity Rationale: The most serious adverse effect of vancomycin is ototoxicity. "Red man" syndrome occurs only with rapid intravenous administration. Thrombocytopenia is an adverse effect of vancomycin.
A prescriber states that a patient will need to receive penicillin intravenously. The nurse anticipates administering which drug? A. Penicillin V B. Procaine penicillin G C. Benzathine penicillin G D. Potassium penicillin G
D. Potassium penicillin G Rationale: When high blood levels are needed rapidly, penicillin can be administered IV. However, only the potassium salt should be administered by this route. Owing to poor water solubility, procaine and benzathine salts must never be administered IV. Penicillin V is administered orally.
Which of the following is defined as "colonization with a new organism"? A. Pyelonephritis B. Prostatitis C. Cystitis D. Reinfection E. Relapse F. Urethritis
D. Reinfection
An HIV-infected patient who is receiving drug therapy, including delaviridine (Rescriptor) and saquinavir, is diagnosed with an active TB infection. Because of the drug interaction that decreases the effect of these drugs for HIV infection, this patient should not be prescribed which drug? A. Ethambutol B. Isoniazid C. Pyrazinamide D. Rifampin
D. Rifampin Rationale: Rifabutin may be given in place as it does not break down the HIV medications as much as Rifampin.
The nurse is caring for a patient receiving intravenous gentamicin for a severe bacterial infection. Which assessment finding by the nurse indicates the patient is experiencing an adverse effect of gentamicin therapy? A. Blurred vision B. Hand tremors C. Urinary frequency D. Tinnitus
D. Tinnitus Rationale: Ototoxicity can result from accumulation of the drug in the inner ear. Early signs that should be reported include tinnitus or headache. Other major adverse effects include nephrotoxicity and neuromuscular blockade.
Which of the following is defined as "inflammation of the tube that takes urine from the bladder to the urinary meatus"? A. Pyelonephritis B. Prostatitis C. Cystitis D. Urethritis
D. Urethritis
Which type of rash would most likely indicate the start of Stevens-Johnson syndrome when a patient is receiving sulfonamides? A. Amber-colored, crusty rash on the cheeks B. Papular rash on the shoulders C. Pruritic rash on the lower arms D. Vesicular rash in the mouth
D. Vesicular rash in the mouth
A patient who was taking sulfonamides develops Stevens-Johnson syndrome. Upon assessment, the nurse expects to find what? A. Hypotension B. Bronchospasm C. Temperature of 35.5º C D. Widespread skin lesions
D. Widespread skin lesions Rationale: The most severe hypersensitivity response to sulfonamides is Stevens-Johnson syndrome, a rare reaction with a mortality rate of about 25%. Symptoms include widespread lesions of the skin and mucous membranes, combined with fever, malaise, and toxemia. Bronchospasm and hypotension, as well as tachycardia, are manifestations of anaphylactic reactions.
Trimethoprim can lead to neural tube defects due to its MOA A. inhibit DNA synthesis B. inhibit RNA synthesis C. bind to 50s ribosomal subunit D. inhibit folic acid synthesis
D. inhibit folic acid synthesis Rationale: Folic acid deficiencies can lead to neural tube defects. Trimethoprim can exacerbate folic acid deficiencies.
Which of the following is defined as "recolonization with the same organism"? A. Pyelonephritis B. Prostatitis C. Cystitis D. Reinfection E. Relapse F. Urethritis
E. Relapse
What is considered first-line therapy for latent TB in high-risk patients?
INH (isoniazid). Isoniazid is the drug of choice for treatment and prophylaxis of TB because it is less toxic and less expensive than other agents, and it is easy to take and works better than other single agents
Why is multidrug therapy utilized for active TB disease?
Therapy for active infection is always initiated with at least two drugs to decrease the emergence of resistant organisms and to reduce the incidence of relapse
What is DOT (directly observed therapy)? Why is it used in TB therapy?
To ensure compliance with drug therapy, the nurse should communicate the reason for the need for multiple drugs, the reason for the need for long-term therapy, how to take the medication, protocols for directly observed therapy, when improvement may be expected, therapeutic goals, symptoms of adverse effects to report to the prescriber, the importance of reporting adverse effects, and interventions that may minimize adverse effects
Mr. Y is to receive the parenteral form of the drug penicillin G for the treatment of gonorrhea. He asks why he needs an injection. He would like the PO form because he does not want to have an injection. How should you respond?
You can tell Mr. Y that penicillin G cannot be taken by mouth. Penicillin G is broken down by acids in the stomach, making it ineffective. Other forms of penicillin, such as penicillin V, are stable in stomach acids.
what is the drug that discolors body fluids?
rifampin
T/F: Aminoglycosides are bactericidal
true
T/F: Aminoglycosides are primarily used to treat serious infections with aerobic gram-negative bacilli
true
T/F: Aminoglycosides are rapidly excreted by the kidneys
true
T/F: Sulfonamide antibiotics are chemically related to glipizide, glyburide, furosemide, and hydrochlorothiazide
true
T/F: Sulfonamides are currently used to treat UTIs
true
T/F: Sulfonamides are effective in treating an organism common in pneumonia occurring in patients with AIDS
true
T/F: Sulfonamides cross the placenta
true
T/F: Sulfonamides inhibit microbial synthesis of folic acid
true
drug interaction between -azoles and PPIs
can't be taken together; the -azole will increase the pH and make the PPI ineffective
What meds are used to treat C. diff?
vancomycin flagyl
T/F: Aminoglycosides are broad-spectrum antibiotics
false
T/F: Aminoglycosides can enter the CSF
false
T/F: Aminoglycosides readily kill anaerobes
false
T/F: Sulfonamides are narrow-spectrum antibiotics
false
T/F: Sulfonamides are widely used because of low toxicity
false
T/F: Sulfonamides do not cause toxicity when applied topically
false
rifantine
long acting TB med
what are the "NOs" for aminoglycosides?
neuromuscular blockade no during pregnancy no protein synthesis no gram-negatives
