Pharm NCLEX question E4
A nurse assisting a nursing student with medications asks the student to describe how penicillins (PCNs) work to treat bacterial infections. The student is correct in responding that penicillins: A. disinhibit transpeptidases. B. disrupt bacterial cell wall synthesis. C. inhibit autolysins. D. inhibit host cell wall function.
Answer: B Rationale: •PCNs weaken the cell wall, causing bacteria to take up excessive amounts of water and subsequently rupture. •PCNs inhibit transpeptidases and disinhibit autolysins. •PCNs do not affect the cell walls of the host.
A patient receiving a cephalosporin develops a secondary intestinal infection caused by Clostridium difficile. What is an appropriate treatment for this patient? A. Adding an antibiotic, such as vancomycin (Vancocin), to the patient's regimen B. Discontinuing the cephalosporin and beginning metronidazole (Flagyl) C. Discontinuing all antibiotics and providing fluid replacement D. Increasing the dose of the cephalosporin and providing isolation measures
Answer: B Rationale: •Patients who develop C. difficile infection (CDI) as a result of taking cephalosporins or other antibiotics need to stop taking the antibiotic in question and begin taking either metronidazole or vancomycin. •Adding one of these antibiotics without withdrawing the cephalosporin is not indicated. •CDI must be treated with an appropriate antibiotic, so stopping all antibiotics is incorrect. •Increasing the cephalosporin dose would only aggravate the CDI.
A pregnant adolescent patient asks the nurse whether she should continue to take her prescription for tetracycline (Sumycin) to clear up her acne. Which response by the nurse is correct? A. "Tetracycline is safe to take during pregnancy." B. "Tetracycline may cause allergic reactions in pregnant women." C. "Tetracycline can be harmful to the baby's teeth and should be avoided." D. "Tetracycline will prevent asymptomatic urinary tract infections."
Answer: C Rationale: •Tetracyclines can cause discoloration of deciduous and permanent teeth. Tooth discoloration can be prevented if the drugs are not taken by pregnant women or by children under 8 years of age. •Tetracycline is not appropriate for a pregnant patient. •Pregnancy does not precipitate an allergic response to tetracycline. •Tetracycline should not be used to prevent urinary tract infections (UTIs), especially in pregnant women.
The nurse is caring for a patient receiving intravenous acyclovir (Zovirax). To prevent nephrotoxicity associated with intravenous acyclovir, the nurse will: •A. increase the patient's intake of foods rich in vitamin C. •B. monitor urinary output every 30 minutes. •C. hydrate the patient during the infusion and for 2 hours after the infusion. •D. provide a low-protein diet for 1 day before and 2 days after the acyclovir infusion.
Answer: C Rationale: •The nurse should ensure that the patient is hydrated during the acyclovir infusion and for 2 hours after the infusion to prevent nephrotoxicity. •Increasing vitamin C would not help prevent nephrotoxicity. •Monitoring urine output is important but would not help prevent nephrotoxicity. •A low-protein diet is not indicated after an acyclovir infusion.
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. What is the nurse's priority action? A. Apply warm packs to the arm, and infuse the medication at a slower rate. B. Continue the infusion while elevating the arm. C. Select an alternate intravenous site and administer the infusion more slowly. D. Request central venous access.
Answer: C Rationale: •These signs indicate thrombophlebitis. The nurse should select an alternative IV site and administer the infusion more slowly. •The IV should not be continued in the same site, because necrosis may occur. •A central line would be indicated only for long-term administration of antibiotics.
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? A. 1 hour after the IV infusion is complete B. 1 hour before administration of the IV infusion C. 30 minutes after the IV infusion is complete D. A peak level is not indicated with twice-daily dosing.
Answer: C Rationale: •When divided daily doses are used, blood samples for measurement of peak levels are drawn 1 hour after IM injection and 30 minutes after completion of an IV infusion. This medication is administered IV, so blood draws must follow 30 minutes after infusion to obtain peak levels. •Measurement of peak levels is unnecessary only when a single daily dose is used.
The nurse is caring for a patient who is receiving vancomycin (Vancocin). The nurse notes that the patient is experiencing flushing, rash, pruritus, and urticaria. The patient's heart rate is 120 beats per minute, and the blood pressure is 92/57 mm Hg. The nurse understands that these findings are consistent with: A. allergic reaction. B. rhabdomyolysis. C. Stevens-Johnson syndrome. D. red man syndrome.
Answer: D Rationale: •Rapid infusion of vancomycin can cause flushing, rash, pruritus, urticaria, tachycardia, and hypotension, a collection of symptoms known as red man syndrome. •Rhabdomyolysis is not associated with the administration of vancomycin. •The patient's symptoms may seem to indicate an allergic reaction, but this is specifically red man syndrome. •The symptoms are not those of Stevens-Johnson syndrome, which manifests as blisters or sores (or both) on the lips and mucous membranes after exposure to the sun.
Which side effect of clindamycin (Cleocin) causes the most concern and may warrant discontinuation of the drug? A. Headache B. Nausea C. Vomiting D. Diarrhea
Answer: D Rationale: •CDAD is a serious, sometimes fatal superinfection associated with clindamycin. •Patients with diarrhea should notify their prescriber immediately and discontinue the drug until this condition has been ruled out. •Headache, nausea, and vomiting do not warrant discontinuation of the drug and are not associated with severe side effects.
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? A. "Cephalosporins enhance the actions of aminoglycosides by weakening bacterial cell walls." B. "Cephalosporins prevent neuromuscular blockade associated with aminoglycosides." C. "Cephalosporins prolong the post-antibiotic effects of the aminoglycosides so doses can be decreased." D. "Cephalosporins reduce bacterial resistance to aminoglycosides."
Answer: A Rationale: •Cephalosporins, penicillins, and vancomycin can be used in conjunction with aminoglycosides; these drugs weaken the bacterial cell wall and enhance the bactericidal actions of aminoglycosides. •Cephalosporins do not prevent neuromuscular blockade. •They do not prolong the post-antibiotic effects of aminoglycosides. •They do not affect bacterial resistance.
A patient comes to the clinic and receives valacyclovir (Valtrex) for a herpes-zoster virus. The nurse instructs the patient to take the medication: A. without regard to meals. B. without any dairy products. C. each morning. D. on an empty stomach.
Answer: A Rationale: •The patient may take the medication without regard to meals. •The patient does not need to avoid dairy products, take the pill only in the morning, or take it on an empty stomach.
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? A. Contact the provider and prepare to administer epinephrine. B. Notify the provider if the patient develops a rash. C. Request an order for a skin test to evaluate possible PCN allergy. D. Withhold the next dose until symptoms subside.
Answer: A Rationale: •This patient is showing signs of an immediate penicillin allergy, that is, one that occurs within 2 to 30 minutes after administration of the drug. The patient is showing signs of anaphylaxis, which include laryngeal edema, bronchoconstriction, and hypotension; these must be treated with epinephrine. •This is an emergency, and the provider must be notified immediately, not when other symptoms develop. •It is not necessary to order skin testing. •The patient must be treated immediately, and subsequent doses should not be given.
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? A. Make sure to administer the drugs at different times using different IV tubing. B. Make sure to administer the drugs at different times using different IV tubing. C. Suggest that a fixed-dose combination of piperacillin and tazobactam (Zosyn) be used. D. Watch the patient closely for allergic reactions, because this risk is increased with this combination.
Answer: A Rationale: •When penicillins are present in high concentrations, they interact with aminoglycosides and inactivate the aminoglycoside; therefore, these two drugs should never be mixed in the same IV solution. •The drugs should be given at different times. because PCN inactivates gentamicin; therefore, the nurse should give one first, flush the line, and then give the other. •In the treatment of Pseudomonas infections, extended-spectrum penicillin, such as piperacillin, usually are given in conjunction with an antipseudomonal aminoglycoside, such as amikacin; therefore, suggesting a larger dose of piperacillin and discontinuation of the amikacin is incorrect. •Zosyn is not recommended. •The risk of allergic reactions does not increase with this combination of drugs.
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? A. "I may have abdominal pain and nausea, but these are usually mild." B. "I should take this medication with food or milk to improve absorption." C. "I should stop taking the medication immediately if I experience heel pain." D. "I will need to use sunscreen every time I go outdoors."
Answer: B Rationale: •Dairy products inhibit the absorption of ciprofloxacin, so they should be avoided. •Abdominal pain and nausea and vomiting are common and usually mild. •Patients should stop taking the drug if heel pain occurs until tendonitis has been ruled out. •Photosensitivity can occur, so sunscreen should be used.
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. A. peak B. peak and trough C. serum drug D. trough
Answer: B Rationale: •When divided doses of aminoglycosides are given, it is important to measure both peak and trough levels of the drug, because it is more difficult to achieve therapeutic peaks in lower doses without causing toxicity. •Trough levels are drawn when single-dosing regimens are used, because high peak levels are guaranteed.
A nurse is providing education about tetracycline (Sumycin). Which statement by the patient best demonstrates understanding of the administration of this medication? A. "I should not worry if I experience an acne-like rash with this medication." B. "I should take an antacid, such as Tums, if I experience gastrointestinal distress." C. "I should not take this medication with milk or other dairy products." D. "I should take an antacid, such as Tums, if I experience gastrointestinal distress."
Answer: C Rationale: •The patient should avoid taking the medication with dairy products to help prevent chelation. •An acne-like reaction would indicate an allergic response. •Taking the medication with calcium-containing antacids or supplements should be avoided, because this also leads to chelation.
A child has been receiving chloramphenicol for a Neisseria meningitidis central nervous system (CNS) infection. The nurse administers the dose and subsequently notes that the child has vomited and appears dusky and gray in color. The child's abdomen is distended. What will the nurse do? A. Contact the provider for an order to obtain a chloramphenicol level. B. Notify the provider that the child's meningitis is worsening. C. Recognize this as initial signs of a C. difficile infection. D. Stop the infusion immediately and notify the provider.
Answer: D Rationale: •Gray syndrome is a potentially fatal toxicity associated with chloramphenicol use. When symptoms occur, the drug should be stopped immediately. •Lower chloramphenicol levels may prevent gray syndrome, but lowering the dose will not stop symptoms once they have appeared. •These are not signs of worsening meningitis or a C. difficile infection.
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: A. antibiotic resistance. B. interpatient variation. C. liver disease. D. renal disease
Answer: D Rationale: •The aminoglycosides are eliminated primarily by the kidneys, so in patients with renal disease, doses should be reduced or the dosing interval should be increased to prevent toxicity. •Patients with antibiotic resistance would be given amikacin. •Interpatient variation may occur but cannot be known without knowing current drug levels. •Aminoglycosides are not metabolized by the liver, so liver disease would not affect drug levels.
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? A. Tobramycin B. Paramomycin C. Gentamicin D. Amikacin
Answer: D Rationale: •When resistance to gentamicin and tobramycin is common, amikacin is the drug of choice for initial treatment of aminoglycoside-sensitive infections. •Gentamicin would not be indicated, because resistance is more likely to develop. •Paromomycin is used only for local effects within the intestine and is given orally. Tobramycin is not indicated, because organisms can more readily develop resistance.