Pharm Exam 4 - Practice questions

Ototoxicity and aminoglycosides

- first sign of impending vestibular damage = headaches - ototoxicity is largely irreversible - use med for <10 days to avoid ototoxicity

Thirty minutes after receiving an intramuscular (IM) injection of penicillin G [Pfizerpen], a patient reports itching and redness at the injection site. Which action should the nurse take first?

Administer SubQ epinephrine

Which antibiotics inhibit protein syntehsis

Aminoglycosides Tetracyclines Macrolides

When providing patient teaching for oral sulfonamide therapy, the nurse should instruct the patient to take the sulfonamide in what way?

Between meals with a full cup of water

The nurse identifies appropriate use of antimicrobials to prevent infection in which situations? - cardiac surgery - recurrent UTI in women - anemia - tx of fever of unknown origin - hysterectomy

Cardiac surgery - reduce in surgeries Recurrent UTIs in women - can be helpful Hysterectomy - prophylaxis for hysterectomy or C-section

CDAD

Clostridium difficile-associated diarrhea

It is most important for the nurse to assess a patient receiving a cephalosporin for the development of which manifestation of antibiotic-associated pseudomembranous colitis (AAPMC)?

Diarrhea and abdominal cramping

Which laboratory result should a nurse monitor more frequently when a patient is receiving clarithromycin [Biaxin] and warfarin [Coumadin]?

INR

A patient who is receiving vancomycin [Vancocin] IV for a methicillin-resistant Staphylococcus aureus (MRSA) infection asks a nurse, "Why can't I take this medicine in a pill?" Which response should the nurse make?

It is more effective by IV, because the pill form will stay in the digestive tract Vanco is given parentally for post infections

A patient who is receiving ceftriaxone has all of these medications ordered. The nurse monitors the patient for an adverse effect related to an interaction with which medication? - Regular insulin - Ampicillin - Naproxen - Bisacodyl

Naproxen - cephalosporins cause bleeding tendencies and cation is needed with anticoagulant or NSAID use

A patient taking a sulfonamide is breast-feeding an infant. Which complication in the infant would the nurse associate with kernicterus?

Neurologic deficits

Are people who are allergic to penicillins always allergic to cephalosporins?

No, has 1% change of cross-sensitivity

What instructions should the nurse include when teaching pt about cephalosporin therapy?

Notify provider if develop diarrhea or rash

The nurse identifies which statements about Stevens-Johnson syndrome as true?

Patients with Stevens-Johnson syndrome have a mortality rate of about 25%. Toxemia is associated with Stevens-Johnson syndrome. Lesions of the mucous membranes are a characteristic of Stevens-Johnson syndrome.

A nurse observes a red streak and palpates the vein as hard and cordlike at the intravenous (IV) site of a patient receiving cefepime [Maxipime]. Which assessment should the nurse make about the IV site?

Phlebitis of the vein used for the antibiotic has developed Thrombophlebitis

Which statements about CDAD associated with clindamycin therapy does the nurse identify as true?

Potentially fatal Pts typically experienc abdominal pain Clindamycin therapy should be d/c and vancomycin therapy should be started

Which cardiovascular finding does the nurse identify as a possible adverse effect of erythromycin [Ery-Tab] therapy?

Prolonged QT interval - can cause dysrhythmia

A patient who is receiving an aminoglycoside (gentamicin) has a urinalysis result with all of these findings. Which finding should a nurse associate most clearly with an adverse effect of gentamicin? - WBC - Glucose - Protein - Ketones

Protein -

A nurse is assessing the effects of antimicrobial therapy in a patient with pneumonia. The nurse should establish which outcomes when planning care?

Reduction of fever Sterile sputum cultures O2 sat of 98%

A patient who has acquired immunodeficiency syndrome (AIDS) is receiving trimethoprim/sulfamethoxazole [Bactrim]. Which response should a nurse expect if the medication is achieving the desired effect?

Resolution of pneumonia Bactrim is drug of choice for treatment of PCP/PJP

When ceftriaxone is administered intravenously, it is most important for the nurse to avoid mixing it with what?

Ringer's lactate - this contains calcium which cannot be mixed with ceftriaxone

A patient is receiving an aminoglycoside (tobramycin) antibiotic. A nurse asks the patient to choose daily meal selections, to which the patient responds, "Oh, dear, I don't want another IV." The nurse makes which assessment about the patient's response?

Some hearing loss may have occurred - ototoxicity is side effect

What antibiotic inhibits folic acid synthesis

Sulfonamides

The nurse identifies tigecycline [Tygacil] as a derivative of what?

Tetracyclines

What is the minimum bactericidal concentration (MBC)

The lowest concentration of an antibiotic needed to reduce the number of bacterial colonies by 99.9%

A microbe acquires antibiotic resistance by which means?

Transfer of DNA coding to other bacteria Microbe, not the host, becomes medication resistant

What are examples of improper use of antibiotic therapy

Treating a viral infection Using dosing that results in a superinfection

The nurse knows that there is an increased risk of ototoxicity in a patient receiving an aminoglycoside if which level is high?

Trough level - high trough levels indicate aminoglycosides are unable to diffuse out of inner ear cells exposing to med for extended time and can lead to ototoxicity

Which instruction should a nurse include in the discharge teaching for a patient who is to start taking tetracycline?

Use sunscreen and protective clothing when outside

The nurse should include which instructions when teaching a patient about tigecycline therapy?

Use sunscreen when outside If have diarrhea more than 5 times per day notify provider Avoid using drug if pregannt

An antimicrobial medication that has selective toxicity has which characteristics

ability to avoid injuring host cells

Before administering trimethoprim, it is most important for the nurse to assess the patient for a history of what?

alcoholism, as folate deficiency is likely and bone marrow suppression can occur trimethoprim inhibits folic acid synthesis

Pt instruction for taking Augmentin

can be taken with food or meals

A nurse assessing a patient who is 12 years old should associate which complication with the patient's receiving tetracycline as a younger child?

discoloration of the teeth

A nurse monitors a patient who is receiving an aminoglycoside (gentamicin) for symptoms of vestibular damage. Which finding should the nurse expect the patient to have first?

headache - first sign of vestibular damage gentamicin causes ototoxicity which can cause impaired hearing and disruption of balance

A patient is admitted to the hospital with a medical diagnosis of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). When taking the patient's history, a nurse recognizes which information as the most important?

plays contact sport and is an athlete - MRSA is transmitted by skin-to-skin contact and by contact of contaminated objects

Most common side effects of ampicillin

skin rash and diarrhea

The nurse is assessing a patient who is receiving a sulfonamide for treatment of a urinary tract infection. To monitor the patient for the most severe response to sulfonamide therapy, the nurse will assess for what?

skin rash and lesions Stevens Johnson syndrome is the most serious response

A nurse is administering a daily dose of tobramycin at 1000. At which time should the nurse obtain the patient's blood sample to determine the trough level?

9 AM - drawn just before next dose w/ divided doses and 1 hr before next dose if daily dose

A nurse should recognize that antibiotic prophylaxis is appropriate in patients with which medical conditions? - Aortic valve replacement - Ruptured appendix - Bronchitis - Neutropenia - Chicken pox

Aortic valve replacement - prosthetic valves and are at risk for bacterial endocarditis Neutropenia - puts pt at risk for severe infections so want to treat prophylactically ruptured appendix is considered tx not prophylaxis

The nurse identifies which host factor as the most important when choosing an antimicrobial drug? - Age - Competent immune function - Genetic heritage - Previous medication reactions

Competent immune function site of infection is also unique to selection of abx

Which antibiotics inhibit cell wall synthesis

Penicillins Cephalosporins Vancomycin

Before administering a cephalosporin to a patient, it is most important for the nurse to assess the patient for an allergy history to what?

Penicillins - 1% cross-sensitivity

A nurse removes a central line access device once the patient no longer requires intravenous (IV) antibiotics. This action is an example of which strategy to prevent antimicrobial resistance established by the Centers for Disease Control and Prevention (CDC)?

Preventing infection

A patient develops flushing, rash, and pruritus during an IV infusion of vancomycin [Vancocin]. Which action should a nurse take?

Reduce the infusion rate When infused too rapidly, histamine release may cause hypotension, flushing, and warmth - red man syndrome

A patient is receiving vancomycin [Vancocin]. The nurse identifies what as the most common toxic effect of vancomycin therapy?

Renal toxicity

The development of a new infection as a result of the elimination of normal flora by an antibiotic is referred to as what?

Superinfection

What does the nurse identify as an adverse effect of clindamycin [Cleocin] therapy?

frequent loose, watery stools with mucous or blood C.diff associated diarrhea (CDAD) is most severe toxicity of clindamycin