EXAM 3 PRACTICE QUESTIONS
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.
Which statement will the nurse include when teaching a patient with HIV about management of the disease? A. HIV is considered a chronic disease. B. HIV infection can be cured with 1 year of therapy. C. Drug resistance does not occur in HIV treatment. D. Blood cultures and red blood cell counts are the principal laboratory tests to guide HIV treatment protocols.
Answer: A Rationale: Thanks to the drugs we have today, HIV infection has been transformed from a near-certain death sentence to a manageable chronic disease. However, despite these advances, treatment cannot cure HIV. In all cases, discontinuation of antiretroviral drugs has led to a rebound in plasma HIV. Among the drugs used for HIV, emergence of resistance is common. The principal laboratory tests used to guide therapy are CD4 T-cell counts and plasma HIV RNA (viral load) assays.
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).
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 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.
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.
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 who sustained second- and third-degree burns has been prescribed mafenide. Which statement about mafenide does the nurse identify as true? A.Use of mafenide can cause alkalosis. B.Mafenide is painful upon application. C.A blue-green to gray discoloration of the skin occurs with mafenide therapy. D.Mafenide exerts its therapeutic effect by the release of free silver.
Answer: B Rationale: Local application of mafenide is frequently painful. Mafenide is metabolized to a compound that can suppress renal excretion of acid, thereby causing acidosis. Silver sulfadiazine, another topical sulfonamide used for burn therapy, can cause a blue-green to gray skin discoloration, so facial application should be avoided. Mafenide does not cause this specific skin discoloration. Mafenide acts by the same mechanism as other sulfonamides. In contrast, the antibacterial effects of silver sulfadiazine are due primarily to the release of free silver, not to the sulfonamide portion of the molecule.
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.
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.
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.
Which statement about the BCG vaccine does the nurse identify as true? A.BCG is routinely given in U.S. B.Those given BCG should be screened for TB with the IGRA C.BCG has no effect on tuberculin skin tests D.BCG may cause active TB
Answer: B Rationale: Interferon Gamma Release Assay is not affected by BCG vaccine BCG is used primarily in countries with high rates of TB, NOT the U.S. BCG may cause false positive tuberculin skin test. BCG is a freeze-dried preparation of attenuate M. bovis, not the same bacteria that causes TB.
A patient with HIV is prescribed saquinavir [Invirase], a protease inhibitor (PI). 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 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 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.
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 an anti-acid medication 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.
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.
Which information should the nurse include when teaching a patient about isoniazid (INH) therapy? A.Tubercle bacilli cannot develop resistance to isoniazid during treatment. B.Isoniazid is administered intravenously. C.An adverse effect of isoniazid therapy is peripheral neuropathy, which can be reversed with pyridoxine. D.The dose of isoniazid should be lowered if the patient is also taking phenytoin.
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.
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.
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: C Rationale: Patients taking sulfadiazine should be advised to avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin. Sulfonamides can cause kernicterus in newborns. These drugs should not be administered to pregnant women near term, nursing mothers, or infants under 2 months old. Sulfadiazine causes deposition of sulfonamide crystals, which can injure the kidney. To minimize crystalluria, hydration should be sufficient to produce a daily urine flow of 1200 mL in adults; alkalinization of urine (eg, with sodium bicarbonate) can also help. Patients taking sulfadiazine should drink 8 to 10 glasses of water per day. Sulfonamides can intensify the effects of warfarin, phenytoin, and sulfonylurea-type oral hypoglycemics (eg, glipizide). When combined with sulfonamides, these drugs may require a reduction in dosage. TMP/SMZ is contraindicated for nursing mothers, pregnant women in the first semester or near term, infants under 2 months old, patients with folate deficiency (manifested as megaloblastic anemia), and patients with a history of hypersensitivity to sulfonamides and chemically related drugs, including thiazide diuretics, loop diuretics, and sulfonylurea-type oral hypoglycemics. ******Instruct patients to complete the prescribed course of treatment, even though symptoms may abate before the full course is over.*******
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 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 due to cost and dosing regimen. 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.
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 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 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.
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 should be taken on an empty stomach.
Answer: D Rationale: Rifampin should be given on an empty stomach - food may greatly reduce the absorption of Rifampin. 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.
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 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.
A prescriber states that a patient will need to receive penicillin intravenously. The nurse anticipates administering which drug? A. Penicillin V B. Procaine penicillin G C. Benzathine penicillin G D. Potassium penicillin G
Answer: D Rationale: When high blood levels are needed rapidly, penicillin can be administered IV. However, only the potassium salt should be administered by this route. Owing to poor water solubility, procaine and benzathine salts must never be administered IV. Penicillin V is administered orally.
