3320 Exam #4
Which tetracycline may be administered with meals? A. Tetracycline B. Demeclocycline C. Doxycycline D. Minocycline
}Answer: D }Rationale: Tetracycline, demeclocycline, and doxycycline should be administered on an empty stomach. Minocycline can be administered with meals.
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."
Answer: Rationale: "Avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin." (Not safe in pregnancy, increase fluids, decrease dose of warfrin)
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: •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.
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 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 penicillins, 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 17-year-old male patient asks about treatment options for Chlamydia trachomatis infection. Which response by the nurse is appropriate? A. "Chlamydia is bacterial and is treated with azithromycin [Zithromax]." B. "This infection is treatable but is best prevented by vaccination." C. "The disease is viral and will be treated with valacyclovir [Valtrex]." D."The infection is fungal, and metronidazole [Flagyl] will be prescribed."
Answer: A Rationale: Chlamydia trachomatis infection is a bacterial infection that may be treated with a single 1 g oral dose of azithromycin or 100 mg of doxycycline orally twice daily for 7 days in nonpregnant adolescents and adults.
Which statement about syphilis does the nurse identify as true? A. Penicillin G is the drug of choice for all stages of syphilis. B. Early signs of congenital syphilis include purulent discharge from the urethra. C. The risk of neurosyphilis is decreased in individuals with HIV infection. D.Syphilis develops in one abrupt stage.
Answer: A Rationale: Early signs of congenital syphilis include sores, rhinitis, and severe tenderness over bones. The risk of neurosyphilis is increased in individuals with HIV infection. Syphilis develops in three stages, termed primary, secondary, and tertiary.
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.
Answer: B 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.
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 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 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 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.
Which is(are) the preferred drug(s) for the treatment of gonorrhea? A. Doxycycline and azithromycin B. Ceftriaxone C. Metronidazole D.Acyclovir [Zovirax]
Answer: B Rationale: Ceftriaxone is the preferred drug for treating gonorrhea. It should be given in combination with either azithromycin or doxycycline. Two drugs ‒ doxycycline and azithromycin ‒ are preferred agents for treating chlamydial infection in nonpregnant adolescents and adults. In nonpregnant women, bacterial vaginosis can be treated orally with metronidazole or intravaginally with metronidazole or clindamycin. Acyclovir is used for the treatment of herpes simplex infection.
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 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 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.
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
Answer: C Rationale: Amphotericin B causes renal injury in most patients. Kidney damage can be minimized by infusing 1 L of saline on the days amphotericin is infused.
A patient who takes warfarin is prescribed itraconazole [Sporanox] to treat a fungal infection. The nurse will teach the patient to do what? A. Take the medication with famotidine [Pepcid] to reduce gastric upset B. Prepare for long-term intravenous administration of itraconazole C. Avoid taking esomeprazole [Nexium] with itraconazole therapy D. Double the dose of warfarin
Answer: C Rationale: Drugs that reduce gastric acidity (for example, antacids, histamine2 [H2] antagonists, and proton pump inhibitors) can greatly reduce absorption of oral itraconazole. Accordingly, these agents should be administered at least 1 hour before itraconazole or 2 hours after. (Because proton pump inhibitors have a prolonged duration of action, patients using these drugs may have insufficient stomach acid for itraconazole absorption, regardless of when the proton pump inhibitor is given.) Itraconazole is administered by mouth. Patients who take warfarin and itraconazole are likely to have increased prothrombin times. Clotting studies should be performed, and warfarin doses should be adjusted accordingly.
A patient asks about home treatment for genital warts caused by human papillomaviruses. The nurse should recommend which treatment? A. 10% podophyllin [Podofin] B. 80% trichloroacetic acid (TCA) C. 0.5% podofilox [Condylox] D.Acyclovir [Zovirax]
Answer: C Rationale: Two preparations for the treatment of genital warts can be applied at home: 0.5% podofilox [Condylox] and 5% imiquimod [Aldara].
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 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.
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.
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.
The nurse is administering efavirenz [Sustiva] to a patient with AIDS. What will the nurse do? A. Offer St. John's wort with the medication to decrease depression B. Have the patient take the medication with ice cream or a milkshake C. Give the medication without regard to meals D.Administer the medication on an empty stomach at bedtime
Answer: D Rationale: Efavirenz should be administered on an empty stomach, preferably at bedtime. A high-fat meal may cause increases in plasma levels by 39%. St. John's wort may cause decreased levels of efavirenz.
Which statement by a new nurse about intravenous administration of amphotericin B indicates the nurse needs more education? A. Almost all patients receiving amphotericin B experience some degree of nephrotoxicity. B. Patients receiving amphotericin B should be under close supervision in a hospital. C. Heparin can be used in the infusion site to prevent phlebitis associated with amphotericin B therapy. D. Diphenhydramine plus acetaminophen can minimize rigors (shivering) associated with amphotericin B therapy.
Answer: D Rationale: Meperidine or dantrolene is used to treat rigors associated with amphotericin B therapy. Diphenhydramine plus acetaminophen can minimize fever, chills, rigors, nausea, and headache associated with amphotericin B therapy. The other statements are true.
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
Answer: D. Widespread skin lesions
The patient is ordered daily divided doses of gentamycin. The patient received an intravenous dose of gentamycin at 4:00 PM. When should the nurse obtain the peak level? A. 4:30 PM B. 5:00 PM C. 5:30 PM D. 6:00 PM
}Answer: A }Rationale: When using divided daily doses, draw blood samples for measuring peak levels 1 hour after IM injection and 30 minutes after completing an IV infusion. When a single daily dose is used, measuring peak levels is unnecessary. Draw samples for trough levels just before the next dose (when using divided daily doses) or 1 hour before the next dose (when using a single daily dose).
Before administering gentamycin, it is most important for the nurse to assess the patient for a history of what? A. Hypertension B. Myasthenia gravis C. Diabetes mellitus D. Asthma
}Answer: B }Rationale: Aminoglycosides must be used with caution in patients with renal impairment, pre-existing hearing impairment, and myasthenia gravis, and in patients receiving ototoxic drugs (especially ethacrynic acid), nephrotoxic drugs (for example, amphotericin B, cephalosporins, vancomycin, cyclosporine, nonsteroidal anti-inflammatory drugs [NSAIDs]), and neuromuscular blocking agents.
Iodoquinol [Yodoxin] is prescribed for a patient with intestinal amebiasis. Which statement by the patient indicates that medication teaching has been effective? A. "Common side effects include constipation and bloating." B. "I may experience a rash or acne while taking this medication." C. "I will need to take the medication for 10 days." D."I should take the medication once a day in the morning."
}Answer: B }Rationale: Common adverse effects of iodoquinol are rash, acne, slight thyroid enlargement, and gastrointestinal effects (nausea, vomiting, diarrhea, cramps, and pruritus ani). The medication is taken 3 times a day for 20 days to treat intestinal amebiasis.
A patient who was on a mission trip to Sub-Saharan Africa is admitted to the hospital with severe malaria. The nurse anticipates administration of which medication? A. Quinidine B. Quinidine gluconate C. Mefloquine D.Artesunate
}Answer: B }Rationale: IV quinidine gluconate is the treatment of choice for severe malaria in the United States.
A patient with scabies is prescribed permethrin [Elimite]. 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
}Answer: B }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.
A patient with head lice is prescribed malathion [Ovide] 5% lotion. Which direction should the nurse include in patient teaching? A. Apply the lotion to wet hair. B. Do not use a hair dryer or other source of heat until the alcohol has evaporated. C. Avoid using the lotion if it smells malodorous. D.Let the lotion remain on the hair for 1 hour, then thoroughly rinse it off.
}Answer: B }Rationale: The preparation is applied to dry hair, gently massaged in until the scalp is moist, and allowed to dry naturally. The lotion is flammable because of its 78% alcohol content; therefore, hair dryers and other sources of heat should be avoided until the alcohol has evaporated. Malathion is devoid of systemic adverse effects. The drug smells bad. Package labeling recommends waiting 8 to 12 hours before washing out the malathion with shampoo.
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
}Answer: B }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.
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
}Answer: C }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.
A patient is prescribed mefloquine [Lariam] to treat erythrocytic malaria. Which symptom should the nurse teach the patient to report that would indicate central nervous system toxicity? A. Amnesia B. Dizziness C. Hallucinations D.Fever
}Answer: C }Rationale: Psychiatric symptoms, such as hallucinations, depression, or suicidal ideation, should be reported immediately to the healthcare provider. These symptoms indicate central nervous system toxicity.
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
}Answer: C }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.
Which statement about ivermectin does the nurse identify as true? A.The drug kills parasites by suffocating them. B.Only one dose of the medication is necessary. C.Resistance to ivermectin is common. D.Ivermectin is taken by mouth.
}Answer: D }Rationale: Ivermectin is the only oral medication for ectoparasitic infestations. The drug kills parasites by disrupting nerve and muscle function. A single dose can be highly effective against both mites and lice. Because ivermectin does not kill ova, a second dose is usually needed. Resistance to ivermectin is uncommon.
A patient is prescribed atovaquone and proguanil hydrochloride [Malarone] for prophylaxis against malaria. The patient should take the medication in which way? A. For 7 days before exposure to an endemic area B. At bedtime to reduce possible food interactions C. With tetracycline to improve protection against infection D.With food or milk to enhance absorption
}Answer: D }Rationale: Malarone should be taken with food to enhance absorption. Tetracycline would reduce the levels of medication by up to 50% and should be avoided. For prophylaxis, Malarone should be taken 1 or 2 days before exposure and continued for 7 days after leaving an endemic area.
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 gentamycin therapy? A. Blurred vision B. Hand tremors C. Urinary frequency D. Tinnitus
}Answer: D }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.
Before administering erythromycin to a patient for an upper respiratory tract infection, it is most important for the nurse to determine if the patient is also prescribed which drug? A. Guaifenesin [Guiatuss] B. Hydrocodone [Vicodin] C. Nitroglycerin [Tridil] D. Verapamil [Calan]
}Answer: D }Rationale: QT prolongation and sudden cardiac death have occurred in patients taking CYP3A4 inhibitors, such as calcium channel blockers (verapamil), azole antifungal drugs, HIV protease inhibitors, and nefazodone.
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.
•Answer: A •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.
A patient is prescribed an antibiotic to treat a urinary tract infection. What statement by the patient indicates a need for further teaching? A. "I can stop the medication as soon as the symptoms have disappeared." B. "I will drink more fluids to help clear up the infection." C. "I will stop the medication and contact the doctor if I develop a rash." D."I should immediately report vaginal itching or discharge."
•Answer: A •Rationale: Patients should be taught not to discontinue antibiotics prematurely, but rather to complete the entire course of therapy, even if symptoms improve or resolve. The other responses are appropriate
The patient is being discharged with continued ciprofloxacin therapy. When providing discharge teaching, the nurse should advise the patient to call the healthcare provider immediately if what develops? A. Pain in the heel of the foot B. Nausea C. Diarrhea D. Headache
•Answer: A •Rationale: Rarely, ciprofloxacin and other fluoroquinolones have caused tendon rupture, usually of the Achilles tendon. The incidence is 1 in 10,000 or less. Because tendon injury is reversible if diagnosed early, fluoroquinolones should be discontinued at the first sign of tendon pain, swelling, or inflammation. In addition, patients should refrain from exercise until tendinitis has been ruled out.
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
•Answer: B •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.
Which statement about superinfections does the nurse identify as true? A. Superinfections are more common in patients treated with narrow-spectrum drugs. B. Superinfection is defined as a new infection that appears. during the course of treatment for a primary infection. C. Superinfections are caused by viruses. D.Superinfections are easy to treat.
•Answer: B •Rationale: Because broad-spectrum antibiotics kill off more normal flora than do narrow-spectrum drugs, superinfections are more likely in patients receiving broad-spectrum agents. Suprainfections are caused by drug-resistant microbes; these infections are often difficult to treat.
A patient is prescribed acyclovir [Zovirax] by mouth. The nurse should assess the patient for which adverse effects associated with oral acyclovir therapy? A. Stomatitis and gastritis B. Nausea, vomiting, and diarrhea C. Hives, difficulty breathing, and angioedema D.Tinnitus and decreased hearing
•Answer: B •Rationale: Commonly reported adverse reactions to oral acyclovir therapy include nausea, vomiting, diarrhea, headache, and vertigo.
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
•Answer: B •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.
A patient asks the nurse what he can do to prevent influenza. What should the nurse do? A. Teach the patient about antiviral medications B. Instruct the patient to obtain an influenza vaccination C. Tell the patient that frequent hand washing is effective D.Have the patient wear a mask when in public areas
•Answer: B •Rationale: Influenza is managed by vaccination with drugs. Vaccination is the primary management strategy to prevent influenza.
A patient is diagnosed with C. difficile infection. The nurse anticipates administering which medication? A. Daptomycin B. Metronidazole C. Rifampin D. Rifaximin
•Answer: B •Rationale: Metronidazole is a drug of choice for C. difficile infection. Daptomycin has a unique mechanism and can rapidly kill virtually all clinically relevant gram-positive bacteria, including MRSA. Rifampin [Rifadin] is a broad-spectrum antibacterial agent used primarily for tuberculosis. However, the drug is also used against several nontuberculous infections. Rifampin is useful for treating asymptomatic carriers of Neisseria meningitidis. Rifaximin [Xifaxan] is an oral, nonabsorbable analog of rifampin used to kill bacteria in the gut.
Which patient should receive prophylactic antibiotic therapy? A. A patient who is to have his teeth cleaned B. A patient who is scheduled for a hysterectomy C. A patient with a white blood cell count of 8000 cells/mm3 D.A patient with a high fever without an identifiable cause
•Answer: B •Rationale: Patients who undergo a hysterectomy (and other specific surgeries) may have a decreased incidence of infection if antibiotics are administered before or during surgery. Use of prophylactic antibiotics are not indicated for the other conditions.
Which patient would most likely need intravenous antibiotic therapy to treat a urinary tract infection? A. A patient with an uncomplicated urinary tract infection caused by Escherichia coli B. A patient with pyelonephritis with symptoms of high fever, chills, and severe flank pain C. A patient with acute cystitis who complains of dysuria, frequency, and urgency D.A patient with acute bacterial prostatitis with a mild fever, chills, and nocturia
•Answer: B •Rationale: Severe pyelonephritis requires intravenous antibiotic therapy.
A patient with HIV is prescribed saquinavir [Invirase]. It is most important for the nurse to monitor which laboratory value? A. Hemoglobin levels B. Platelet count C. Blood glucose levels D.Serum potassium levels
•Answer: C •Rationale: All protease inhibitors may cause hyperglycemia.
A patient has been prescribed ciprofloxacin for treatment of a urinary tract infection with Escherichia coli. Before administering the drug, it is most important for the nurse to assess the patient for a history of what? A. Hypertension B. Diabetes mellitus C. Myasthenia gravis D. Seasonal allergies
•Answer: C •Rationale: Ciprofloxacin and other fluoroquinolones can exacerbate muscle weakness in patients with myasthenia gravis. Accordingly, patients with a history of myasthenia gravis should not receive these drugs.
Which statement about oseltamivir [Tamiflu] does the nurse identify as true? A. Oseltamivir must be administered on an empty stomach. B. The drug is administered via an inhaler. C. Oseltamivir can be used to treat and prevent influenza. D.The drug is approved for use in infants 6 months of age or older.
•Answer: C •Rationale: Dosing of oseltamivir can be done with or without food, although dosing with food can reduce nausea. The drug is available in capsules (30, 45, and 75 mg) and as a powder (360 mg) to be reconstituted to a 6-mg/mL oral suspension. Oseltamivir [Tamiflu] is an oral drug approved for prevention and treatment of influenza in patients age 1 year or older.
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
•Answer: C •Rationale: Female patients with relapses of urinary tract infection may need long-term therapy up to 6 months with trimethoprim/sulfamethoxazole.
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.
•Answer: C •Rationale: Fluoroquinolones can cause tendon rupture and should be discontinued if tendon pain or inflammation develops.
hich 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.
•Answer: C •Rationale: If peripheral neuropathy develops, it can be reversed by administering pyridoxine (50 to 200 mg daily). 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.
Which statement about enfuvirtide does the nurse identify as true? A. The drug is administered intravenously. B. Enfuvirtide is one of the least expensive drugs used to treat HIV. C. Enfuvirtide is reserved for treating HIV-1 infection that has. become resistant to other antiretroviral agents. D.This drug is most effective when used alone.
•Answer: C •Rationale: Treatment with enfuvirtide requires twice-daily subQ injections and is very expensive (treatment costs about $20,000 a year). To delay the emergence of resistance, enfuvirtide should always be combined with other antiretroviral drugs.
Which drug does the nurse identify as a urinary tract antiseptic? A. Ciprofloxacin B. Ceftriaxone C. Nitrofurantoin D.Ceftazidime
•Answer: C •Rationale: Two urinary tract antiseptics currently are available: nitrofurantoin and methenamine. Ciprofloxacin, ceftriaxone, and ceftazidime are antimicrobials.
It is most important for the nurse to avoid administering oral ciprofloxacin to this patient with which food? A. Bananas B. Baked chicken C. Grapefruit juice D. Milk
•Answer: D •Rationale: Absorption of ciprofloxacin can be reduced by compounds that contain cations. Among these are (1) aluminum- or magnesium-containing antacids, (2) iron salts, (3) zinc salts, (4) sucralfate, (5) calcium supplements, and (6) milk and other dairy products, all of which contain calcium ions. These cationic agents should be administered at least 6 hours before ciprofloxacin or 2 hours after.
A patient has been prescribed docosanol [Abreva] cream for herpes labialis. Which statement will the nurse include in patient teaching? A. Apply the cream twice a day. B. Use of the cream will cut the duration of the herpes simplex lesion in half. C. Many serious adverse effects are associated with use of this medication. D.Apply the cream at the first sign of recurrence.
•Answer: D •Rationale: Application is done 5 times a day, beginning at the first sign of recurrence. Benefits are modest. In one trial, treatment reduced the time to healing from 4.8 days to 4.1 days, about the same response seen with penciclovir. Docosanol cream appears to be devoid of adverse effects.
Which statement about the BCG vaccine does the nurse identify as true? A. BCG is a live preparation of attenuated Mycobacterium bovis. B. BCG is routinely administered in the United States. C. BCG has no effect on tuberculin skin tests. D.BCG vaccine can be used to treat carcinoma of the bladder.
•Answer: D •Rationale: BCG vaccine is also used to treat carcinoma of the bladder. BCG vaccine is a freeze-dried preparation of attenuated Mycobacterium bovis (bacillus of Calmette and Guérin). In countries where TB is endemic, the World Health Organization recommends BCG vaccination in infancy. •Protection against TB can be conferred by inoculation, to protect children against severe, life-threatening TB infection (i.e., miliary TB and tuberculous meningitis). Routine vaccination is not done in the United States because the risk of infection with M. tuberculosis is low, and protection against pulmonary TB in adulthood is variable. Furthermore, vaccination with BCG can produce a false-positive result in the tuberculin skin test, which can't distinguish between antigens from M. bovis and antigens from M. tuberculosis.
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
•Answer: D •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.
Which information should the nurse include when teaching a patient about rifampin therapy? A. Oral contraceptives are safe to use with rifampin therapy. B. Contact your healthcare provider immediately if 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 be administered intravenously.
•Answer: D •Rationale: Rifampin may be administered intravenously. 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.
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
•Answer: D •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.
