Pharm exam3

A patient is admitted to the unit for treatment for an infection. The patient receives IV amikacin [Amikin] twice a day. When planning for obtaining a peak aminoglycoside level, when should the nurse see that the blood is drawn?

an hour after tranfusion

A nurse is teaching a nursing student about dalfopristin/quinupristin (Synercid). Which statement by the student indicates an understanding of the teaching?

Patients taking this drug should have blood tests performed frequently."

A child with an ear infection is not responding to treatment with amoxicillin (Amoxil). The nurse will expect the provider to order:

amoxicillin-clavulanic acid (Augmentin).

A nurse is explaining to nursing students why a cephalosporin is used in conjunction with an aminoglycoside for a patient with an infection. Which statement by a student indicates understanding of the teaching?

"Cephalosporins enhance the actions of aminoglycosides by weakening bacterial cell walls."

A young, nonpregnant female patient with a history of a previous urinary tract infection is experiencing dysuria, urinary urgency and frequency, and suprapubic pain of 3 days' duration. She is afebrile. A urine culture is positive for more than 100,000/mL of urine. The nurse caring for this patient knows that which treatment is most effective?

A 3-day course of trimethoprim/sulfamethoxazole (Bactrim)

A nurse provides teaching for a patient who is newly diagnosed with Parkinson's disease. Which statement by the patient indicates understanding of the drug therapy for this disease?

A levodopa/carbidopa combination is used to improve motor function.

Before giving methenamine (Hiprex) to a patient, it is important for the nurse to review the patient's history for evidence of which problem? A) Elevated blood urea nitrogen and creatinine B) History of reactions to antibiotic agents C) Possibility of pregnancy D) Previous resistance to antiseptic agents

A) Elevated blood urea nitrogen and creatinine

A patient who has a vancomycin-resistant enterococci (VRE) infection is receiving linezolid (Zyvox). Which laboratory result indicates that the patient is having an adverse effect? A. White blood cell (WBC) count of 1200 units/L B. Hemoglobin (Hgb) level of 18 g/dL C. Potassium level of 3.0 mEq/dL D. Glucose level of 200 mg/dL

A. White blood cell (WBC) count of 1200 units/L Linezolid can cause reversible myelosuppression, manifesting as anemia, leukopenia, or even pancytopenia. The potassium and blood glucose levels are not affected by linezolid.

A patient with multiple sclerosis is to begin treatment with interferon beta. The patient comes to the clinic to have pretreatment laboratory tests. Which statement by the patient indicates a need for further teaching about these tests?

After the first year of treatment, I will need once yearly blood work

A patient tells the nurse during the health history that the last time she received penicillin, she experienced anaphylaxis. Which of the following medications should the nurse advise the patient to avoid?

Cefoxitin (Mefoxin)

A patient who is receiving cefotetan (Cefotan) has all of these medications ordered. The nurse monitors the patient for an adverse effect related to an interaction with which medication? A. Regular insulin B. Ampicillin (Polycillin) C. Naproxen (Naprosyn) D. Bisacodyl (Dulcolax)

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

A 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.

An immunocompromised patient who is receiving piperacillin/tazobactam (Zosyn) develops oozing and bleeding from the gums. Which additional data should the nurse determine? A. Whether the patient has a fever above 100.5 °F B. Whether the patient reports any painful teeth C. The most recent platelet count D. The last time mouth care was given

C. The most recent platelet count Piperacillin/tazobactam (Zosyn) is an extended-spectrum penicillin used primarily for infections caused by Pseudomonas aeruginosa in immunocompromised hosts. It can cause bleeding secondary to disrupting platelet function; therefore, the platelet count may be altered. High fever, painful teeth, and mouth care do not address the patient's bleeding gums.

A patient with no known drug allergies is receiving amoxicillin (Amoxil) PO twice daily. Twenty minutes after being given a dose, the patient complains of shortness of breath. The patient's blood pressure is 100/58 mm Hg. What will the nurse do?

Contact the provider and prepare to administer epinephrine.

A patient is taking erythromycin ethylsuccinate for a chlamydial infection and develops vaginal candidiasis. The prescriber orders ketoconazole to treat the suprainfection. What will the nurse do?

Contact the provider to discuss changing to a different antifungal medication.

A patient with a urinary tract infection is given a prescription for TMP/SMZ. When reviewing the drug with the patient, the nurse learns that the patient has type 1 diabetes mellitus and consumes alcohol heavily. What will the nurse do?

Contact the provider to request a different antibiotic

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 patient who is receiving an aminoglycoside develops flaccid paralysis and impaired breathing. Which medication does the nurse anticipate administering? A. Magnesium sulfate (Epsom salt) B. Potassium chloride (K-Dur) C. Sodium bicarbonate (Citrocarbonate) D. Calcium gluconate (Kalcinate

D. Calcium gluconate (Kalcinate) Flaccid paralysis and impaired breathing are signs of impaired neuromuscular transmission, which may occur with aminoglycosides, especially if they are administered concurrently with a neuromuscular blocking agent. Impaired transmission can be reversed with intravenous infusion of a calcium salt (calcium gluconate). Magnesium sulfate, potassium chloride, and sodium bicarbonate do not reverse impaired neuromuscular transmission caused by aminoglycosides.

Which test is the most widely used method for assessing drug sensitivity? A. Minimum inhibitory concentration (MIC) B. Minimum bacterial concentration (MBC) C. Broth dilution D. Disk diffusion

D. Disk diffusion The most widely used method for assessing drug sensitivity is the disk diffusion test, also known as the Kirby-Bauer test. Through diffusion, an antibiotic-containing zone becomes established around each disk. As the bacteria proliferate, growth is inhibited around the disks that contain an antibiotic to which the bacteria are sensitive.

The nurse identifies what as the first step in the Campaign to Prevent Antimicrobial Resistance, established in 2002 by the CDC? A. Target the pathogen B. Access the experts C. Isolate the pathogen D. Vaccinate

D. Vaccinate Although all responses are components of the Campaign to Prevent Antimicrobial Resistance, step one is vaccination.

A nurse provides teaching for a patient with a newly diagnosed partial complex seizure disorder who is about to begin therapy with aniepileptic drugs (AEDs). Which statement by the patient indicates understanding of the teaching?

Even with an accurate diagnosis of my seizures, it may be difficult to find an effective drug.

A patient is receiving tobramycin three times daily. A tobramycin peak level is 4.5 and the trough is 1.2. What will the nurse do?

Give the next dose as ordered

A patient with second-degree burns is treated with silver sulfadiazine [Silvadene]. A nursing student asks the nurse about the differences between silver sulfadiazine and mafenide [Sulfamylon], because the two are similar products, and both contain sulfonamides. What does the nurse tell the student about silver sulfadiazine?

It has antibacterial effects related to release of free silver.

A nurse is reviewing the culture results of a patient receiving an aminoglycoside. The report reveals an anaerobic organism as the cause of infection. What will the nurse do?

Request an order for a different class of antibiotic.

A patient is about to receive penicillin G for an infection that is highly sensitive to this drug. While obtaining the patient's medication history, the nurse learns that the patient experienced a rash when given amoxicillin (Amoxil) as a child 20 years earlier. What will the nurse do?

Request an order for a skin test to assess the current risk.

A patient who has been taking a monoamine oxidase inhibitor (MAOI) for depression for several months tells the provider that the medication has not helped with symptoms. The provider plans to switch the patient to an SSRI. The nurse will teach this patient to:

Stop taking the MAOI 2 wks before starting the SSRI

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?

Suprainfection

A patient taking an MAOI is seen in the clinic with a blood pressureof 170/96 mm Hg. What will the nurse ask this patient?

To list all the foods eaten that day.

A patient develops CDAD. Which antibiotic is recommended for treating this infection?

Vancomycin

A patient who is receiving intravenous ciprofloxacin for pneumonia develops diarrhea. A stool culture is positive for Clostridium difficile. The nurse will expect the provider to:

add metronidazole

A patient has a positive urine culture 1 week after completion of a 3-day course of antibiotics. The nurse anticipates that the prescriber will:

begin a 2-week course of antibiotics.

A patient with a history of renal calculi has fever, flank pain, and bacteriuria. The nurse caring for this patient understands that it is important for the provider to:

begin anitbiotic therapy after urine culture and sensitivity are available

The nurse administers cefotetan (Cefotan) to a patient who also is taking warfarin (Coumadin). The nurse should monitor the patient carefully for

bruising or bleeding gums.

A patient is receiving an intraperitoneal aminoglycoside during surgery. To reverse a serious side effect of this drug, the nurse may expect to administer which agent?

calcium gluconate

An older male patient comes to the clinic with complaints of chills, malaise, myalgia, localized pain, dysuria, nocturia, and urinary retention. The nurse would most likely suspect that the patient has: a. acute cystitis b. UTI c.Pyelonephritis d.prostatitis

d.

A patient will be discharged from the hospital with a prescription for TMP/SMZ [Bactrim]. When providing teaching for this patient, the nurse will tell the patient that it will be important to:

drink 8 to 10 glasses of water each day

A patient complains of burning on urination and increased frequency. The patient has a history of frequent urinary tract infections (UTIs) and is going out of town in 2 days. To treat the infection quickly, the nurse would expect the health care provider to order

fosfomycin (Monurol).

A patient is diagnosed with an infection caused by Staphylococcus aureus, and the prescriber orders intravenous gentamicin and penicillin (PCN). Both drugs will be given twice daily. What will the nurse do?

give gentemicin flush the line then give penecillin

A patient who takes the loop diuretic ethacrynic acid is given intravenous gentamicin for an infection. After several days of treatment with gentamicin, the nurse reviews the patient's most recent laboratory results and notes a gentamicin trough of 2.1 mcg/mL and normal blood urea nitrogen (BUN) and serum creatinine levels. The nurse will question the patient about:

headache dizziness and vertigo

A patient who takes the loop diuretic ethacrynic acid is given intravenous gentamicin for an infection. After several days of treatment with gentamicin, the nurse reviews the patient's most recent laboratory results and notes a gentamicin trough of 2.1 mcg/mL and normal blood urea nitrogen (BUN) and serum creatinine levels. The nurse will question the patient about:

headache, dizziness, or vertigo

A nurse is caring for an African American patient who has been admitted to the unit for long-term antibiotic therapy with sulfonamides. The patient develops fever, pallor, and jaundice. The nurse would be correct to suspect that the patient has developed:

hemolytic anemia

A nurse preparing to administer intravenous gentamicin to a patient notes that the dose is half the usual dose for an adult. The nurse suspects that this is because this patient has a history of:

renal disease

A nurse is discussing microbial resistance among sulfonamides and trimethoprim with a nursing student. Which statement by the student indicates a need for further teaching?

resistance to sulfonamides is less than the resistance to trimethoprim

The parent of a 5-year-old child who has had four urinary tract infections in the past year asks the nurse why the provider doesn't just order an antibiotic for the child's current symptoms of low-grade fever, flank pain, and dysuria since these are similar symptoms as before. Which is the most important reason given by the nurse?

search for urinary abnormalities

The nurse is caring for a patient who will begin receiving intravenous ciprofloxacin [Cipro] to treat pyelonephritis. The nurse learns that the patient has a history of myasthenia gravis. Which action by the nurse is correct?

suggest the provider order a different antibiotic

A 65-year-old patient who receives glucocorticoids for arthritis is admitted to the hospital for treatment of a urinary tract infection. The prescriber has ordered intravenous ciprofloxacin [Cipro]. Before administering the third dose of this drug, the nurse reviews the bacterial culture report and notes that the causative organism is Escherichia coli. The bacterial sensitivity report is pending. The patient complains of right ankle pain. What will the nurse do?:

withold the dose of ciprofloxacin and notify provider of patient's symtoms

A 25 year old patient has been newly diagnosed with Parkinson's disease, and the prescriber is considering using pramipexole [Mirapex]. Before beginning therapy with this drug, the nurse will ask the patient about:

Any history of alcohol abuse or compulsive behaviors.

A patient who has been taking alprazolam [Xanax] to treat generalized anxiety disorder (GAD) reports recently stopping the medication after symptoms have improved but reports having feelings of panic and paranoia. Which initial action by the nurse is correct?

Ask the patient if the medication was stopped abruptly

A patient who is taking doxycycline for a serious infection contacts the nurse to report anal itching. The nurse will contact the provider to discuss:

prescribing an antifungal drug to treat a suprainfection.

A group of nursing students asks a nurse to explain the blood-brain barrier. The nurse would be correct to say that the blood-brain barrier:

prevents some potentially toxic substances from crossing into the central nervous system.

A patient describes feelings of anxiety and fear when speaking in front of an audience and is having difficulty at work because of an inability to present information at meetings three or four times each year. The patient is reluctant to take long-term medications. The nurse will expect the provider to order which treatment?

Alprazolam [Xanax] as needed

A nurse is providing education about tetracycline (Sumycin). Which statement by the patient best demonstrates understanding of the administration of this medication?

"I should not take this medication with milk or other dairy products."

A nurse teaches a patient about sulfonamides. Which statement by the patient indicates a need for further teaching?

"I should stop taking this drug when my symptoms are gone."

A 30-year-old male patient reports having two to four urinary tract infections a year. What will the nurse expect to teach this patient?

"You will need to take a low dose of medication for 6 months to prevent infections."

The nurse is caring for a patient taking vancomycin (Vancocin). Upon assessment of the patient, the nurse finds that he is experiencing flushing, rash, pruritus, and urticaria. His vital signs are: P-120/minute, BP-92/97 mm Hg, T-98.9° F, and R-20/minute. The nurse understands that these findings are consistent with

"red man" syndrome.

A patient is diagnosed with a lung infection caused by P. aeruginosa. The culture and sensitivity report shows sensitivity to all aminoglycosides. The nurse knows that the rate of resistance to gentamicin is common in this hospital. The nurse will expect the provider to order which medication?

Amikacin

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

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

A nurse should recognize that antibiotic prophylaxis is appropriate in patients with which medical conditions? (Select all that apply.) A. Aortic valve replacement B. Ruptured appendix C. Bronchitis D. Neutropenia E. Chickenpox

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

A patient is receiving penicillin G (Bicillin C-R). Which assessment should the nurse monitor as an indicator of an undesired effect? A. Cardiac rhythm B. Serum sodium level C. Lung sounds D. Red blood cell (RBC) count

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

The nurse is working with a patient who has a UTI. Because patient adherence to a medication regimen is a concern, the nurse anticipates use of which medication? A. Fosfomycin B. Amoxicillin C. Cephalexin D. Trimethoprim

A. Fosfomycin When adherence is a concern, fosfomycin, which requires just one dose, is an attractive choice. As a rule, amoxicillin and cephalexin are avoided, because they are less effective than the alternatives and are less well tolerated. Trimethoprim requires a longer course of therapy than fosfomycin.

Before administering an aminoglycoside, it is most important for the nurse to assess the patient for a history of what? A. Myasthenia gravis B. Asthma C. Hypertension D. Diabetes mellitus

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

A 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.

When ceftriaxone is administered intravenously, it is most important for the nurse to avoid mixing it with what? A. Ringer's lactate B. Normal saline C. Sterile water D. D5 0.45% NS

A. Ringer's lactate Mixing ceftriaxone with calcium causes precipitates to form. Ringer's lactate contains calcium; therefore it should not be mixed with ceftriaxone. It is safe to mix normal saline, sterile water, and D5 0.45% NS with ceftriaxone.

The parent of an infant with otitis media asks the nurse why the prescriber has ordered amoxicillin (Amoxil) and not ampicillin (Unasyn). What will the nurse tell the parent?

Ampicillin is not as acid stable as amoxicillin.

Which patient with a urinary tract infection will require hospitalization and intravenous antibiotics?

An older adult man with a low-grade fever, flank pain, and an indwelling catheter

A patient is being treated with interferon beta-1a [Avonex] for relapsing-remitting MS. The patients calls the clinic to report headache, fever, chills, and muscle aches after administering a dose. What will the nurse recommend?

Acetaminophen or ibuprofen

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

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

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

A nurse assesses the history of a patient who has had multiple complicated UTIs for which risk factors? (Select all that apply.) A. Female gender, child-bearing age B. Indwelling catheter C. Prostate hypertrophy D. Fair skin tone E. Urinary tract stones

B, C, E Complicated UTIs occur in both males and females and usually are associated with some predisposing factor, such as calculi, prostatic hypertrophy, or catheters. Uncomplicated UTIs occur primarily in women of child-bearing age and are not associated with any specific predisposing factor. Fair skin tone is unrelated to UTI occurrence.

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

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

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

The 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.

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 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.

A patient who is taking gentamicin and a cephalosporin for a postoperative infection requests medication for mild postsurgical pain. The nurse will expect to administer which of the following medications?

acetaminophen

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 other 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.

A patient has been taking fluoxetine [Prozac] for 2 years and reports feeling cured of depression. The nurse learns that the patient is sleeping well, participates in usual activities, and feels upbeat and energetic most of the time. The patient's weight has returned to normal. The patient reports last having symptoms of depression at least 9 months ago. What will the nurse tell this patient?

Discuss gradual withdrawal of the medication with the provider

A patient has been taking SSRI Antidepressant for major depression and reports having headaches and jaw pain. What will the nurse tell the patient?

Discuss these symptoms with a dentist.

The spouse of a patient with bipolar disorder (BPD) tells the nurse that the patient will not stay on the lithium ordered by the provider longer than 1 or 2 months at a time. The nurse understands that adherence to medication regimens in patients with BPD is problematic and will tell the spouse:

During manic episodes, many patients with BPD dont see the benefit of prophylactic medications

A 6-week-old infant who has not yet received immunizations develops a severe cough. While awaiting nasopharyngeal culture results, the nurse will expect to administer which antibiotic?

Erythromycin ethylsuccinate

A patient is receiving gentamicin once daily. A nursing student asks the nurse how the drug can be effective if given only once a day. The nurse explains drug dosing schedules for aminoglycosides. Which statement by the student indicates a need for further teaching?

Gentamicin has a longer half life than other aminoglycosides

A patient who is taking a first-generation antipsychotic (FGA) drug for schizophrenia comes to the clinic for evaluation. The nurse observes that the patient has a shuffling gait and mild tremors. The nurse will ask the patient's provider about which course of action?

Giving an anticholinergic medication

A child will begin taking methylphenidate [Ritalin} for attentio-deficit/hyperactivity disorder. Important baseline information about this patient will include:

Height and weight

A patient will receive oral ciprofloxacin [Cipro] to treat a urinary tract infection. The nurse provides teaching for this patient. Which statement by the patient indicates a need for further teaching?

I should take this with food or milk to improve absorption

A patient has been newly diagnosed with multiple sclerosis (MS), and the nurse provides teaching about the medications for the disease. Which statement by the patient indicates a need for further teaching?

If medication is begun early, permanent remission can be achieved.

A patient taken levodopa [Dopar] for Parkinson's disease for 2 weeks but reports no improvement in the symptoms. Which response by the nurse is correct?

It may take several months for a response to occur.

A patient asks a nurse about the effects of chronic alcohol use on the heart. The nurse's best response would be which statement?

Long-term alcohol use can damage the heart and cause heart failure

A patient has an infection caused by Pseudomonas aeruginosa. The prescriber has ordered piperacillin and amikacin, both to be given intravenously. What will the nurse do?

Make sure to administer the drugs at different times using different IV tubing.

Which monoamines act as neurotransmitters in the central nervous system

Norepinephrine, serotonin, dopamine, epinephrine

A nurse is preparing to administer a dose of gentamicin to a patient who is receiving the drug 3 times daily. The nurse will monitor ____ levels.

Peak and trough

A patient with new-onset seizure disorder receives a prescription for phenobarbital. The patient reports being concerned about the sedative side effects of this drug. Which response by the nurse is correct?

Phenobarbital doses for seizures are nonsedating

A nurse is teaching a group of nursing students about tricyclic antidepressants (TCAs). Which statement by a student indicates a need for further teaching?

TCAs have many side effects, but none of them are serious

A patient administers interferon beta1a SQ[Rebif] 22mcg/0.5 mL three times each week. The patient calls the nurse to report unrelieved itching and erythema at the injection site, despite the use of topical hydrocortisone for several weeks. What will the nurse tell this patient to do ?

Take oral diphenhydramine [Benadryl]

A patient newly diagnosed with Parkinson's disease has been taking levodopa/carbidopa [Sinemet] for several weeks and complains of nausea and vomiting. The nurse tells the patient to discuss what with the provider?

Taking a lower dose with a low-protein snack

A patient who has been taking linezolid (Zyvox) for 6 months develops vision problems. What will the nurse do?

Tell the patient that this symptom is reversible when the drug is discontinued.

An older patient has confusion, memory loss, and disorientation in familiar surroundings. The patient has been taking donepezil [Aricept] 10 mg once daily for 6 months. The patient's symptoms have begun to worsen, and the patient's spouse asks if the medication dose can be increased. What will the nurse tell the spouse?

The dose can be increased, because the patient has been taking the drug for longer than 3 months.

A nurse is caring for a patient who takes an ACE inhibitor and an ARB medication who will begin taking TMP/SMZ to treat a urinary tract infection. Which serum electrolyte will the nurse expect to monitor closely?

potassium

A patient has a Pseudomonas aeruginosa infection that is sensitive to aminoglycosides, and the prescriber orders gentamicin. The patient tells the nurse that a friend received amikacin [Amikin] for a similar infection and wonders why amikacin was not ordered. What will the nurse tell the patient?

amikacin is given when infectious agents are resistant to other aminoglycosides

Which fluoroquinolone antibiotics may be administered to children? (Select all that apply.)

ciproflaxacin and levofloxacin

A patient who has been using secobarbital for several months to treat insomnia tells the nurse that the prescriber has said the prescription will be changed to temazepam [Restoril], because it is safer. The patient asks why this agent is safer. The nurse is correct in telling the patient that temazepam:

potentiates endogenous gamma-aminobutyric acid (GABA) producing a finite CNS depression.

A pregnant patient is treated with trimethoprim/sulfamethoxazole (TMP/SMZ) [Bactrim] for a urinary tract infection at 32 weeks' gestation. A week later, the woman delivers her infant prematurely. The nurse will expect to monitor the infant for:

kernicterus

A patient who has been receiving intravenous gentamicin for several days reports having had a headache for 2 days. The nurse will request an order to:

obtain getamicn trough on next dose

A patient with an infection caused by Pseudomonas aeruginosa is being treated with piperacillin. The nurse providing care reviews the patient's laboratory reports and notes that the patient's blood urea nitrogen and serum creatinine levels are elevated. The nurse will contact the provider to discuss:

reducing the dose of piperacillin.

A patient who is receiving a final dose of intravenous (IV) cephalosporin begins to complain of pain and irritation at the infusion site. The nurse observes signs of redness at the IV insertion site and along the vein. The nurse's priority action is to

select an alternate intravenous site and administer the infusion more slowly.

A nurse counsels a patient who is to begin taking phenytoin [Dilantin] for epilepsy. Which statement by the patient indicates understanding of the teaching?

should brush and floss my teeth regularly.

A patient who has fibromyalgia is diagnosed with major depression. The provider orders a TCA. The nurse will teach this patient to:

sit or lie down when feeling lightheaded.

A patient who is experiencing alcohol withdrawal is given a benzodiazepine. The nurse understands that this drug is effective because:

the patient has a cross-dependence to the benzodiazepine.

A pregnant patient with fever, flank pain, and chills has a history of two previous bladder infections before getting pregnant. She is allergic to several antibiotics. She reports having taken methenamine successfully in the past. What will the nurse tell her?

this agent isn't effective against infections of the upper urinary tract