NCLEX Questions
A nurse practitioner has prescribed nitrofurantoin for a woman with a urinary tract infection. Which of the following cardiovascular adverse effects is this patient at risk for developing? A. inverted T wave B. widened QRS C. premature ventricular contraction (PVC) D. bundle branch block
D
A parent of a high school student calls the school nurse regarding her daughter's crying. The parent states that this behavior is unusual for her daughter. Which of the following medications contributes to changes in behavior? A. metronidazole B. naproxen sodium C. vitamin C D. erythromycin
D
A patient receiving tetracycline should receive the following instruction regarding the medication? A. Take tetracycline with food. B. Take tetracycline in combination with antacids. C. Take the first dose and then obtain a test known as culture and sensitivity. D. Take tetracycline with a full glass of water.
D
Ampicillin is the drug of choice for the treatment of streptococcal pharyngitis
FALSE
Sulfonamides kill mature, fully formed bacteria.
FALSE
Urinary antiseptics may be used in systemic infections.
FALSE
Linezolid exhibits __________ activity against most staphylococci, enterococci, and streptococci.
BACTERICIDAL
For systemic infections, vancomycin is given IV and reaches therapeutic plasma levels within __________ hour(s) after infusion.
1
A nurse practitioner sees a 19-year-old college student in the student health center for severe diarrhea. The nurse diagnoses traveler's diarrhea based on the young woman's history; she had recently returned from Mexico. She receives a prescription for rifaximin 200 mg orally three times daily for 3 days. Four days later, she calls the office and reports to the nurse that she has a fever and that the diarrhea has not resolved. Which of the following is the most appropriate information to communicate to the student? A. Advise the student to return to the clinic for further tests and a different antibiotic. B. Call the pharmacy and authorize one refill of rifaximin. C. Advise the student that it takes up to 48 to 72 hours after the completion of treatment for the diarrhea to completely resolve. D. Tell the student to continue to drink plenty of fluids and report back in 24 hours.
A
Ofloxacin should be given for no longer than __________ days.
10
Sulfonamides should not be used to treat urinary tract infection in children less than __________ months of age.
2
A nurse is preparing to administer the first dose of piperacillin/tazobactam to a patient in an infusion clinic. The nurse should take which of the following precautions? A. Ask the patient about past allergic reactions to penicillins. B. Ask the patient about past allergic reactions to aminoglycosides. C. Mix the piperacillin/tazobactam with lidocaine to reduce pain of infusion. D. Instruct the patient to eat a snack to decrease stomach upset from piperacillin/tazobactam.
A
A client has been prescribed ciprofloxacin after being diagnosed with a sinus infection. What medication should the client avoid taking concurrently with ciprofloxacin? A. Antacids B. Calcium channel blockers C. Beta-adrenergic blockers D. Diuretics
A
A client is administered probenecid with a penicillin. The client asks why this drug is being administered. What is the best response the nurse can state to the client? A. "Probenecid will increase the serum level of penicillin." B. "Probenecid prevents an anaphylactic reaction." C. "Probenecid will break down the bacterial cell wall." D. "Probenecid decreases the amount of penicillin needed."
A
A client is prescribed daptomycin to treat a gram-negative infection caused by Staphylococcus aureus. Which symptom should be reported immediately to the health care provider based on the adverse effects of daptomycin? A. Weakness of the legs and arms B. Decreased wound drainage C. Hematuria D. Shortness of breath
A
A client is receiving gentamicin to treat meningitis. The health care provider has ordered a peak serum level be drawn in association with the 07:00 dose, which will finish infusing at 07:30. When should the peak serum level be drawn? A. 08:00 B. 09:00 C. 10:00 D. 12:00
A
A client with a diagnosis of osteomyelitis will soon begin treatment with gentamicin. Which schedule is most likely to maximize efficacy and minimize nephrotoxicity? A. Gentamicin 500 mg IV OD at 12:00 B. Gentamicin 250 mg PO BID at 07:30 and 19:30 C. Gentamicin 500 mg PO TID at 08:00, 12:00, and 19:00 D. Gentamicin 125 mg IV QID at 06:00, 12:00, 18:00, and 24:00
A
A physician writes an order for gentamicin 7 mg/kg intravenously every 24 hours and ampicillin 500 mg intravenously every 6 hours. The patient has a diagnosis of endocarditis. This is not an ideal antibiotic regimen for endocarditis because A. it is best to use multiple daily dosing of gentamicin for endocarditis B. the addition of gentamicin to ampicillin increases the risk of treatment failure in endocarditis C. the appropriate single daily dose of gentamicin is 15 mg/kg once daily D. streptomycin is the recommended aminoglycoside for use in endocarditis
A
A teenage boy receives a prescription for erythromycin for an upper respiratory tract infection. He complains that he cannot hear the teacher, who then sends him to the school nurse's office. After assessing the patient's hearing with a tuning fork, the nurse determines that his hearing is diminished. What is the most important nursing intervention? A. The nurse should notify the parents to call the physician; this is an adverse effect of erythromycin. B. The nurse should inform the parents of a physician who specializes in ear, nose, and throat surgery. C. The nurse should instruct the patient to stop taking the erythromycin and his hearing will improve. D. The nurse should call the physician and inform the patient of a change in antibiotics.
A
A woman develops a urinary tract infection following the delivery of an infant. The nurse practitioner is considering prescribing trimethoprim-sulfamethoxazole. What assessment is necessary to make? A. if the woman is breast-feeding B. if the woman has been treated with the medication in the past C. if anyone in her family has a known allergy to the drug D. if she is experiencing hematuria
A
An older adult client responded well to treatment with a third-generation cephalosporin. After being largely symptom free for 48 hours, the client has developed a fever of 38.6°C and an elevated white cell count. What phenomenon may account for this client's current clinical presentation? A. The client may be infected with microorganisms that were resistant to the cephalosporin. B. The client may be experiencing a delayed (type IV) hypersensitivity reaction to the cephalosporin. C. The client may be developing glomerulonephritis secondary to the nephrotoxic cephalosporin. D. The cephalosporin may have initially caused leukopenia and made the client susceptible to secondary infection.
A
How does adding a beta-lactamase inhibitor agent help achieve a therapeutic effect when prescribed for otitis media? A. It extends the spectrum of antibacterial activity of penicillin. B. It extends the spectrum of the beta-lactamase inhibitor. C. It decreases the side effects of high-dose penicillin. D. It increases the absorption of the penicillin.
A
The nurse instructs a patient on the administration of clarithromycin. Which of the following patient teaching instructions is appropriate? A. Take the medication on an empty stomach. B. Take the medication with a calcium supplement. C. Take the medication with a glass of milk. D. Take the medication with cheese.
A
The nurse is providing education to a client diagnosed with traveler's diarrhea caused by an E. coli infection. On what drug will the nurse provide teaching? A. Rifaximin B. Spectinomycin C. Chloramphenicol D. Erythromycin
A
What assessment finding would signal the nurse to the possibility that the client's infusion of vancomycin is running too quickly? A. The client is flushed and has a visible skin rash. B. The client's apical heart rate is irregular. C. The client is reporting nausea. D. The client reports pain at the intravenous access site.
A
Which laboratory value should the nurse assess in patients who are receiving demeclocycline? A. blood urea nitrogen B. aspartate aminotransferase C. alanine aminotransferase D. creatinine
A
Which of the following classes of cephalosporins have the best activity against gram-positive organisms? A. first-generation cephalosporins B. second-generation cephalosporins C. third-generation cephalosporins D. fourth-generation cephalosporins
A
Which of the following foods should not be taken with tetracycline? A. orange juice with calcium B. cranberry juice cocktail C. tomato juice D. lemonade
A
The nurse is preparing to administer gentamicin when the client suddenly mentions having experienced diminished hearing. What action should the nurse take based on this statement? A. Administer the dosage, and notify the health care provider of the alteration in hearing. B. Hold the dosage, and notify the health care provider of the alteration in hearing. C. Administer the dosage, and report the alteration in hearing to the audiologist. D. Hold the dosage, and document the finding in the nurses' notes.
B
The nurse prepares to administer tetracycline 500 mg PO every 6 hours to an adult client newly diagnosed with Lyme's disease. The client takes an oral contraceptive for birth control. Which measures would the nurse provide for safe and effective drug administration? Select all that apply. A. Assess baseline renal and hepatic profiles, complete blood count, and human chorionic gonadotropin (HCG). B. Administer the medication with milk or food to decrease gastrointestinal side effects. C. Instruct the client about the importance of using another form of contraceptive during the antibiotic usage. D. Educate importance of wearing sunscreen and protective clothing when in the sun while taking the drug. E. Report severe nausea and vomiting, diarrhea, rash, or perineal itching to the prescriber.
A, C, D, E
The nurse providing education to a client prescribed erythromycin recognizes a need for additional instruction when the client makes which suggestion? Select all that apply. A. Taking the medication with or without food B. Avoiding grapefruit juice while taking the medication C. Recognizing dark urine a normal side effect D. Identifying stomach cramping as an adverse effect E. Swallowing the medication with milk
A, C, E
Which is the drug of choice for surgical prophylaxis associated with a vaginal hysterectomy? A. Cefadroxil B. Cefazolin sodium C. Cephalexin D. Cephradine
B
A 22-year-old college student allergic to penicillin is being treated with oral erythromycin for a chlamydial infection. What assessment should the nurse prioritize during this client's course of treatment to monitor for adverse reactions? A. Assessment of the client's apical heart rate B. Assessment of the client's hearing C. Assessment of the client's peripheral pulses D. Assessment of the client's renal function
B
A cardiac surgeon orders cefazolin 1 g IV "on call" to the operating room for a patient scheduled for a heart valve replacement. The surgery is scheduled for 7:00 am the next morning. What is the rationale for giving the antibiotic at 6:30 am? The last dose was administered more than 8 hours ago. A. The cefazolin must be given 60 minutes before the procedure for legal reasons. B. The cefazolin must be given within 60 minutes before the first skin incision to reach therapeutic concentrations. C. The cefazolin trough level will be checked at 6:00 am, which would allow the level to come back before administration of the "on call" dose. D. The last dose was administered yesterday
B
A client diagnosed with a genitourinary infection is being treated with a fluoroquinolone. What is the advantage of a fluoroquinolone over an aminoglycoside? A. The fluoroquinolone does not have adverse effects. B. The fluoroquinolone can be given orally. C. The fluoroquinolone has a nearly immediate peak. D. The fluoroquinolone has a broader spectrum.
B
A client diagnosed with infective endocarditis would be most effectively treated with which medication? A. Dicloxacillin B. Ampicillin C. Nafcillin D. Oxacillin
B
A client is administered a sulfonamide for a urinary tract infection. Which intervention is most appropriate to increase alkalinity of the client's urine and, thus, the medication's effectiveness? A. Provide at least 2000 mL of water daily. B. Administer sodium bicarbonate. C. Recommend a tub bath every evening. D. Provide orange juice daily.
B
A client is administered a third-generation cephalosporin. The broad-spectrum agents like cephalosporins are most effective in treating which type of microorganism? A. Gram positive B. Gram negative C. Fungi D. Virus
B
A client is seen in the clinic after a bite from a tick. The client has a rash over the arms and legs and arthritic pain in the joints. What drug would the nurse expect the health care provider to prescribe? A. Ibuprofen B. Tetracycline C. Phenazopyridine D. Nitrofurantoin
B
A critically ill patient is receiving gentamicin 1.5 mg/kg intravenously every 8 hours. The patient has recently stopped making urine, and the most recent laboratory results indicate that the patient's creatinine level has risen from a normal value of 0.8 to 3.6 mg/dL. At the next scheduled time for administration of gentamicin, the nurse should A. administer half the prescribed dose B. hold the gentamicin and notify the provider C. administer gentamicin as prescribed D. draw a blood sample for testing the gentamicin trough level before the dose and then administer as prescribed
B
A man is receiving treatment for a Mycoplasma pneumoniae infection. He says that drinking orange juice hurts his mouth. What priority assessment should the nurse make? A. Assess the patient's fecal output for signs and symptoms of diarrhea. B. Assess the patient's mouth for signs of candidal infection. C. Assess the patient's lung sounds for rales or rhonchi. D. Assess the patient's intake and output.
B
A nurse is applying silver sulfadiazine (Silvadene) to a child's burns. Which of the following nursing interventions is most important when applying the medication? A. providing pain medication B. using sterile gloves C. giving the child a bath D. teaching the parent to apply the medication
B
A nurse reading a patient's chart notices that the patient is scheduled to receive ciprofloxacin 500 mg PO at 9:00 am. The medication administration record also indicates that Maalox 30 mL PO and hydrochlorothiazide 25 mg PO are due at 9:00 am. The nurse should A. administer all the medications as scheduled B. hold the Maalox until 11:00 am C. ask the provider to discontinue hydrochlorothiazide because of increased risk of ototoxicity D. administer the Maalox and ciprofloxacin but hold the hydrochlorothiazide
B
A nurse working in the neurointensive care unit is caring for a patient with a head injury who has been experiencing seizures and now has pneumonia caused by Pseudomonas aeruginosa. The physician has prescribed imipenem 1 g IV every 6 hours plus gentamicin for the pneumonia. Before administering the antibiotics, the nurse should do which of the following? A. Avoid mixing the imipenem and gentamicin in the same IV bag to prevent inactivation of the gentamicin. B. Remind the physician of the patient's seizures and inquire whether a different antibiotic might be safer. C. Suggest to the physician that imipenem is used to treat gram-positive infections and will not be effective in this patient. D. Set the infusion pump to deliver the imipenem over 15 minutes
B
A patient is admitted to the emergency department following opening an envelope containing a substance that experts have identified as anthrax. Which of the following medications is likely to be administered? A. tetracycline B. doxycycline C. amoxicillin-clavulanic acid combination D. neomycin
B
A woman is to receive amoxicillin-clavulanate 500 mg PO every 8 hours for bronchitis. The nurse retrieves two 250-mg tablets from the medication cart. This is incorrect for which of the following reasons? A. The amount of sulbactam in amoxicillin-clavulanate 250 mg is 62.5 mg per tablet, twice the intended amount. B. This provides twice the intended dose of clavulanate. C. The 250-mg tablets have less absorption than the 500-mg tablets. D. Administration of amoxicillin-clavulanate is only intravenous, so selecting tablets means that the wrong drug is being administered.
B
Ampicillin-sulbactam is administered to a client with Staphylococcus aureus. What type of anti-infective is ampicillin-sulbactam? A. Extended-spectrum antipseudomonal penicillin B. Penicillin-beta-lactamase inhibitor combination C. Cephalosporin D. Aminopenicillin
B
A physician has ordered trimethoprim-sulfamethoxazole (TMP-SMZ) for a woman with a urinary tract infection. The nurse has asked the patient about whether she takes any over- the-counter medications. The patient reports that she regularly takes St. John's wort as a mood elevator. Which of the following patient teaching interventions is most important? A. Taking St. John's wort and TMP-SMZ results in no known interactions. B. TMP-SMZ combined with St. John's wort leads to an increased therapeutic effect of the TMP-SMZ. C. TMP-SMZ has a decreased effect when given with St. John's wort. D. When given in combination, TMP-SMZ and St. John's wort result in manic tendencies.
B (BOOK) C (DR. CHANDLER)
The nurse prepares to administer nitrofurantoin 100 mg PO every 12 hours to an adult client newly diagnosed with a urinary tract infection. Which measures would the nurse provide for safe and effective drug administration? Select all that apply. A. Instruct the client that the drug is a urinary analgesic to provide pain relief of urinary tract infection symptoms. B. Inform the client that the medication may cause the urine to turn a harmless brown coloration. C. Administer the drug with a meal or snack because food helps with drug absorption and decreases onset of GI distress. D. Administer antacids with magnesium to increase the drug absorption of the nitrofurantoin. E. Educate the client that the drug is safe with pregnancy and has no adverse effects on fetal development.
B, C
In acute renal failure, doses of which of the following antibiotics must be reduced? (Select all that apply.) A. nafcillin B. cefazolin C. meropenem D. aztreonam
B, C, D
A client has been prescribed phenazopyridine for urinary tract symptoms related to an infection. What is the most appropriate response by the nurse when the client asks why the medication has been prescribed? A. "This medicine is used to treat urinary retention." B. "This medicine will stop the blood in the urine." C. "This medicine will decrease the pain of your infection." D. "The medicine will prevent hesitancy when you're passing urine."
C
A client scheduled for a bowel resection is to receive neomycin sulfate by mouth. The client asks the nurse the purpose of this medication. What is the most appropriate response the nurse can provide to the client? A. "It will prevent renal damage from occurring." B. "It will minimize the risk of ototoxicity." C. "It will decrease the growth of intestinal bacteria." D. "It decreases the risk of airborne contamination of the wound."
C
A man had rheumatic fever as a child. He has an appointment for a tooth extraction. His dentist prescribes which of the following medications prior to the extraction? A. chloramphenicol B. vancomycin C. clarithromycin D. digoxin
C
A patient from a nursing home arrives at the emergency department with acute pyelonephritis. The provider prescribes ciprofloxacin 500 mg PO twice daily. The patient has a history of seizures and bradycardia. The nurse should A. counsel the patient's caregiver to avoid administering the ciprofloxacin with the patient's anticonvulsant B. ask the provider to check blood levels of the patient's anticonvulsant(s) before giving the first dose of ciprofloxacin C. call the patient's seizure and dysrhythmia history to the provider's attention and inquire whether another type of antibiotic might be selected D. counsel the patient's caregiver to discontinue the ciprofloxacin after the patient's fever is gone
C
A patient is admitted to the critical care unit with a diagnosis of Legionnaires disease. Based on your knowledge of pharmacology, which medication is the drug of choice to treat the infection? A. azithromycin B. clarithromycin C. erythromycin D. vancomycin
C
What organ system is responsible for the excretion of cefotaxime sodium from the body? A. Respiratory B. Hepatic C. Renal D. Gastrointestinal
C
A nurse is caring for an adult client who has been diagnosed with bacterial sinusitis. The nurse has cautioned the client against taking prescribed oral erythromycin together with antacids. What is the basis of this instruction? A. Antacids delay metabolism of the drug. B. Antacids can exacerbate nausea and reflux. C. Antacids cause a dangerous rise in gastric pH. D. Antacids decrease the absorption of the drug.
D
A client has a history of a life-threatening anaphylactic reaction to penicillin G. Which medication should not be administered to this client? A. Lactulose B. Ketoconazole C. Kanamycin D. Cefadroxil
D
A client has developed Clostridium difficile associated with pseudomembranous colitis. Which medication is effective in the treatment of Clostridium difficile? A. Linezolid B. Cladribine C. Clarithromycin D. Metronidazole
D
A client is being treated for a urinary tract infection with trimethoprim-sulfamethoxazole. What assessment should the nurse make prior to the administration of the medication? A. Assessing for the presence of asthma B. Assessing for hypertension C. Assessing for diabetes mellitus D. Assessing for renal insufficiency
D
A client is prescribed penicillin V orally for a strep throat. What is the mechanism of action of this medication? A. It inhibits protein synthesis. B. It lowers the pH of cellular contents. C. It causes mutations. D. It inhibits cell wall synthesis.
D
A client seeking care for the treatment of a urinary tract infection (UTI) was prescribed nitrofurantoin. What change in the client's health status would prompt the use of an alternative medication? A. The client develops a fluid volume deficit. B. Urinalysis reveals the presence of ketones. C. The client develops leukocytosis. D. The client's UTI progresses to urosepsis.
D
A recent nursing graduate is preparing to administer vancomycin to a man intravenously. The nurse states the patient reported that he experienced flushing with his last dose of vancomycin. The nurse should A. infuse the vancomycin over 30 minutes to decrease the chance of a reaction B. hold the vancomycin dose until the physician's rounds the following morning C. dilute the vancomycin in 50 mL of normal saline solution and infuse over 60 minutes D. contact the physician, report the reaction, and request an order for diphenhydramine pretreatment
D
A teenager asks the nurse how tetracycline will improve acne. Which statement should the nurse provide to the client regarding the action of tetracycline? A. "Tetracycline decreases redness and swelling of the pustules." B. "Tetracycline treats the Chlamydia organism that causes acne." C. "Tetracycline is used in combination with doxycycline to treat acne." D. "Tetracycline interferes with the production of free fatty acids."
D
An outpatient has just received a prescription for ciprofloxacin 500 mg PO twice daily for acute bronchitis. The nurse should teach the patient A. not to take ciprofloxacin with a meal B. to restrict fluid intake to avoid fluid overload C. to take ciprofloxacin with an antacid (e.g., Tums) to decrease the chance of stomach upset D. to avoid prolonged exposure to sunlight
D
The nurse is educating a client newly diagnosed with a urinary tract infection about the prescribed phenazopyridine hydrochloride. Which statement made by the client establishes the need for further clarification? A. "The drug is an azo dye that acts directly on urinary tract mucosa to provide pain relief." B. "If I develop a sore throat, bleeding, or bruising, I will report the symptoms to my prescriber." C. "I will need to take the drug with food to decrease stomach upset." D. "I should report reddish-orange urine immediately to the prescriber."
D
What is the postantibiotic effect of gentamicin therapy? A. The tendency for clients to exhibit symptoms mimicking hypersensitivity after drug administration B. The tendency for adverse effects of a drug to be masked during administration C. The ability of microorganisms to proliferate between doses of antibiotics D. The ability of an antibiotic to kill bacteria even when serum concentrations are low
D
When administering a sulfonamide, which of the following interventions is most effective in decreasing crystalluria? A. administering 8 oz of cranberry juice B. providing a full liquid diet during the course of drug therapy C. inserting a Foley catheter for the measurement of an accurate intake and output D. providing a minimum of 1500 mL of fluid per day
D
Aminoglycosides are safe when administered to persons of advanced age.
FALSE
Pyrazinamide inhibits urate excretion that may cause acute attacks of __________ in some clients.
GOUT
Unexplained increases in serum CK levels associated with symptoms of __________ should prompt discontinuation of daptomycin.
MYOPATHY
Aminoglycosides are __________ and must be used very cautiously in clients with renal impairment.
NEPHROTOXIC
The major clinical use of parenteral aminoglycosides is to treat serious __________ infections caused by susceptible aerobic gram-negative organisms.
SYSTEMIC
Adequate drug therapy of clients with active tuberculosis usually produces improvement within 2 to 3 weeks.
TRUE
Aminoglycosides should not be mixed with penicillins in an IV solution or syringe.
TRUE
Azithromycin is used cautiously in clients with pseudomembranous colitis.
TRUE
Both tetracyclines (except doxycycline) and sulfonamides are contraindicated in clients with renal failure.
TRUE
Ciprofloxacin is currently recommended as the first-line treatment for suspected Bacillus anthracis infection (anthrax) until susceptibility results are available
TRUE
Clients receiving INH should be monitored monthly for signs and symptoms of hepatitis.
TRUE
Cross-allergenicity is allergy to a drug of another class with similar chemical structure.
TRUE
If nephrotoxicity occurs with aminoglycoside administration, it is usually reversible if the drug is stopped.
TRUE
Linezolid may cause the serious adverse effects of myelosuppression if taken over 2 weeks.
TRUE
Multidrug-resistant strains of tuberculosis are more common in populations with AIDS.
TRUE
Neomycin may be given to suppress intestinal bacteria prior to bowel surgery.
TRUE
Rifaximin is a medication prescribed for travelers' diarrhea due to Escherichia coli infection.
TRUE
Tetracyclines interfere with enamel development and may cause a permanent yellow, gray, or brown discoloration to the teeth.
TRUE
Therapeutic levels of chloramphenicol are 5 to 20 mg/mL.
TRUE
Tigecycline is effective in treating MRSA.
TRUE
With sulfonamide therapy, alkaline urine increases drug solubility and helps prevent crystalluria.
TRUE
penicillin was the first antibiotic developed.
TRUE
Linezolid is a weak monoamine oxidase (MAO) inhibitor; therefore, clients should avoid food high in __________ content while taking the drug.
TYRAMINE
Aminoglycoside dosage must be accurately calculated according to __________ and renal function.
WEIGHT
The __________ are drugs of choice for prevention of bacterial endocarditis.
aminopenicillins
Nafcillin IV is the __________ drug of choice.
antistaphylococcal
Clinical indications for use of penicillins include __________ infections caused by susceptible microorganisms.
bacterial
__________ antibiotics include penicillins and monobactams.
beta-lactam
__________ may be used to inhibit antidiuretic hormone in the treatment of chronic inappropriate antidiuretic hormone secretion
demeclocycline
Tetracyclines must be used cautiously in the presence of liver or __________ impairment.
renal
Sulfasalazine is contraindicated in people who are allergic to __________.
salicylates
Choice of route and dosage depends mainly on the __________ of the infection being treated.
severity
