Quizzam #1 (1/31/23)
A nurse is looking up information about the effects of a drug on different receptors. Characteristics of receptors include which of the following? 1. They are carbohydrates located in cell membranes or inside cells. 2. They are constantly synthesized and degraded in the body. 3. They bind with molecules of any drug circulating in the bloodstream. 4. They regulate the actions of all drugs.
2. Receptors are mainly proteins that are manufactured and eliminated like other proteins in the body. Their numbers and binding capacities can be increased or decreased in particular situations. Most receptors bind with relatively few drugs. Some drugs do not require receptor binding for their actions (e.g., antacids such as TUMS or Mylanta)
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 Rationale: Clients should space out ciprofloxacin administration 4 to 6 hours with any of the following: antacids, multivitamins, sucralfate, or other products containing calcium, iron, or zinc. Absorption of ciprofloxacin may be impaired when these substances are administered together with ciprofloxacin, resulting in a decreased antibiotic effect. None of the other options present a barrier to ciprofloxacin absorption. Question format: Multiple Choice Chapter 19: Drug Therapy With Aminoglycosides and Fluoroquinolones Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Objective: 4 Reference: p. 382, Preventing Interactions
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 Rationale: Clients treated with cephalosporins may be vulnerable to superinfections (infection after a previous infection, typically caused by microorganisms that are resistant to the antibiotics used earlier). Delayed hypersensitivity and renal involvement are highly unlikely. Antibiotics do not cause leukopenia.
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 Rationale: Probenecid can be given concurrently with penicillins to increase serum drug levels. Probenecid will not prevent an anaphylactic reaction. Probenecid will not break down the bacterial cell wall. Probenecid will not decrease the amount of penicillin needed for the treatment of infection.
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 Rationale: The once daily administration method uses higher doses to produce high initial drug concentrations, with no repeat dosing until the serum concentration is quite low (typically 24 hours later). The rationale for this dosing approach is a potential increase in efficacy with a reduced incidence of nephrotoxicity. Gentamicin is not administered orally. Question format: Multiple Choice Chapter 19: Drug Therapy With Aminoglycosides and Fluoroquinolones Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Objective: 3 Reference: p. 378, Table 19.2. DRUGS AT A GLANCE: Aminoglycosides
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 Rationale: When combined with a penicillin, the beta-lactamase inhibitor protects the penicillin from destruction by bacterial enzymes and extends the penicillin's spectrum of antimicrobial activity. The beta-lactamase inhibitor does not achieve any of the other effects described by the remaining options.
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 Rationale: With conventional dosing, it is necessary to take gentamicin peak levels 30 minutes after the end of a 30-minute IV infusion. Thus, 08:00 is the optimal peak time to assess the serum level of gentamicin. None of the other options would provide that assessment. Question format: Multiple Choice Chapter 19: Drug Therapy With Aminoglycosides and Fluoroquinolones Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Objective: 5 Reference: p. 376, Aminoglycosides
Error-reduction strategies during medication administration include which of the following? (Select all that apply.) 1. quiet zone signs at entrance to the medication room 2. protocols and checklist outlining medication administration 3. wearing of a sash or vest to signal others to avoid interruptions of the nurse during medication administration 4. carrying several patients' prescanned medications on a tray
A, B, and C. All of these strategies, except for carrying several clients' prescanned medications on a cart, potentially reduce the risk of medication error. The work-around of removing more than one client's medication from an automated medication dispensing system could lead to the administration of the wrong medication to a client.
A female patient with chronic lymphocytic leukemia is beginning to receive an oral cyclophosphamide. Which of the following instructions is most accurate? (Select all that apply.) A. Administer the drug with food only with gastric upset. B. Take the drug on an empty stomach. C. Take the drug at bedtime. D. Administer the drug 1 hour before a meal or 2 hours afterward.
A, B, and D. The nurse tells the client to take the oral cyclophosphamide on an empty stomach. If severe gastrointestinal upset occurs, she should take the drug with food. To take cyclophosphamide on an empty stomach, it should be taken 1 hour before a meal or 2 hours after a meal.
For a patient receiving a cytotoxic drug that will likely result in bone marrow depression, which of the following teaching considerations should be the priority for the nurse with the patient and family members or caregivers? A. Wash hands often, and avoid people with colds, flu, or other infections. B. Do not expect fatigue and weakness, which are uncommon. C. Expect gastrointestinal upset. More nausea and vomiting may occur when the blood cell counts are low. D. Take acetaminophen for fever.
A. Clients receiving a drug that depresses bone marrow function are at high risk of developing serious infections. Every effort should be made to prevent infections in the client. Although the client may be included in the vigilance necessary to make sure that those in proximity understand precautions, it is especially important that this be communicated to all others in the client's environment. Fatigue and weakness also often occur with bone marrow depression and require medical monitoring. There is no particular correlation between nausea and vomiting and blood cell counts. Any fever should be reported, and antibiotics are given rather than antipyretics.
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. First-generation cephalosporins are primarily effective against gram-positive bacteria. Second-generation cephalosporins are more active against gram-negative bacteria than first-generation drugs. Third-generation cephalosporins further extend the spectrum of activity against gram-negative organisms. Fourth-generation cephalosporins are the broadest of all in spectrum acting against some gram-positive and many gram-negative organisms, including greater stability against degradation by beta-lactamase enzymes.
Which of the following electrocardiographic changes warrant the discontinuation of saquinavir mesylate? A. prolongation of the QT interval B. inverted T wave C. elongated ST segment D. premature ventricular contraction
A. The development of a prolonged QT interval is indicative of an adverse effect of saquinavir and may warrant discontinuation of the drug.
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. When administering demeclocycline, it is important to monitor the client's blood urea nitrogen (BUN). Increases in the BUN are secondary to antianabolic effects.
For a patient receiving a cytotoxic drug that will likely result in bone marrow depression, which of the following teaching considerations should be the priority for the nurse with the patient and family members or caregivers? A. Wash hands often, and avoid people with colds, flu, or other infections. B. Do not expect fatigue and weakness, which are uncommon. C. Expect gastrointestinal upset. More nausea and vomiting may occur when the blood cell counts are low. D. Take acetaminophen for fever.
A. Clients receiving a drug that depresses bone marrow function are at high risk of developing serious infections. Every effort should be made to prevent infections in the client. Although the client may be included in the vigilance necessary to make sure that those in proximity understand precautions, it is especially important that this be communicated to all others in the client's environment. Fatigue and weakness also often occur with bone marrow depression and require medical monitoring. There is no particular correlation between nausea and vomiting and blood cell counts. Any fever should be reported, and antibiotics are given rather than antipyretics.
In explaining antineoplastic therapy to a family member of a patient who is to receive treatment with a cytotoxic drug, which of the following explanations is most accurate? A. Antineoplastic therapy damages both malignant and nonmalignant cells. B. It causes few adverse effects. C. It stimulates growth of cancer cells. D. It must be given daily
A. Cytotoxic drugs damage both normal and malignant cells and may cause severe adverse effects. They block or slow cancer cell growth rather than stimulating it. Administration of most of the drugs is cyclical, with cycles of a few days, then a few weeks without the drugs, then a repeat cycle as opposed to daily administration.
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. Penicillin allergy is the most common cause of drug-induced anaphylaxis. Piperacillin-tazobactam is a combination product containing an extended-spectrum antipseudomonal penicillin and a beta-lactamase inhibitor. Cross-allergenicity occurs among all the penicillins; therefore, asking the client about past reactions to penicillins is a necessary intervention before giving this medication. Drug administration is intravenous; thus, it is unlikely to cause stomach upset. After diluting the drug in intravenous fluid, administration occurs slowly through a small-bore needle in a large vein to prevent vein irritation and pain during infusion. It is important to monitor the site and ensure that it remains patent throughout the administration.
An HIV-positive man who takes etravirine (Intelence) develops a fungal infection following a trip to the Caribbean. He is admitted to the hospital, where he receives intravenous amphotericin B for the fungal infection. What effect will etravirine have on amphotericin B? A. The antifungal activity will be diminished when combined with etravirine. B. The serum amphotericin B level will become toxic. C. The patient will require a stronger antifungal agent to prevent resistance. D. The two drugs are synergistic and will work together to fight the fungal infection.
A. The administration of an antifungal agent, such as amphotericin B, with etravirine results in diminished anti-fungal activity because the etravirine occupies the substrates for metabolism.
A man infected with HIV is taking nevirapine (Viramune) and zidovudine (AZT). He develops a fever, malaise, and jaundice. He is at risk for which of the following conditions? A. hepatic failure B. heart failure C. pneumonia D. methicillin-resistant Staphylococcus aureus
A. The development of jaundice and flu-like symptoms when on a regimen of nevirapine can result in hepatic failure and encephalopathy.
A male patient is being treated for Hodgkin's lymphoma with vincristine. He also takes phenytoin daily in the morning for a seizure disorder. How will these two medications interact? A. Vincristine, when combined with phenytoin, will increase sedation. B. Phenytoin and vincristine are metabolized by CYP3A4, increasing vincristine toxicity. C. Phenytoin administered with vincristine will decrease cytotoxic drug effects. D. Vincristine will increase the patient's risk of having a seizure.
A. Vincristine causes fatigue. When combined with phenytoin the patient has an increase in central nervous system depression and fatigue.
In explaining antineoplastic therapy to a family member of a patient who is to receive treatment with a cytotoxic drug, which of the following explanations is most accurate? A. Antineoplastic therapy damages both malignant and nonmalignant cells. B. It causes few adverse effects. C. It stimulates growth of cancer cells. D. It must be given daily
A. Cytotoxic drugs damage both normal and malignant cells and may cause severe adverse effects. They block or slow cancer cell growth rather than stimulating it. Administration of most of the drugs is cyclical, with cycles of a few days, then a few weeks without the drugs, then a repeat cycle as opposed to daily administration.
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. It is important to assess if the woman is breast-feeding. If a fetus or young infant receives a sulfonamide by placental transfer, in breast milk, or by direct administration, the drug displaces bilirubin from binding sites on albumin. As a result, bilirubin may accumulate in the bloodstream (hyperbilirubinemia) and central nervous system (kernicterus), causing life-threatening toxicity.
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. Once-daily aminoglycoside dosing is contraindicated in clients with endocarditis, and only the conventional dosing regimen should be used. B is incorrect because gentamicin and ampicillin are recommended in endocarditis, and they increase the risk of treatment success, not failure. C is incorrect because the single daily dose of gentamicin is a maximum of 7 mg/kg, not 15 mg/kg, once daily. D is incorrect because streptomycin is not the recommended aminoglycoside for use in endocarditis.
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. Tetracycline is contraindicated with calcium or dairy products.
Differences in CYP-450 drug-metabolizing enzymes are known to cause genetic variation in the drug metabolism of certain drugs that increase the risk of adverse effects. These include which of the following? (Select all that apply.) 1. CYP2D6 metabolism of several antidepressant, antipsychotic, and betaadrenergic blocker drugs that increases the risk of drug accumulation and adverse effects. 2. CYP2D6 metabolism of codeine in individuals who are ultrarapid metabolizers. The conversion of codeine to morphine occurs quickly and poses a risk of serious adverse effects, such as respiratory depression. 3. CYP2C19 metabolism in some individuals of Asian descent. This may cause decreased drug metabolism of diazepam, omeprazole, and some antidepressants leading to adverse effects. 4. Individuals with a deficiency of glucose-6-phosphate dehydrogenase, who may have hemolytic anemia when given antimalarial drugs, sulfonamides, analgesics, antipyretics, and other drugs.
ALL
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.
Answer: A, C, D, E Rationale: The nurse should assess and report abnormal serum creatinine and blood urea nitrogen reflecting impaired renal clearance, a contraindication for the drug. Abnormal liver enzymes are a contraindication since the drug could lead to liver failure. A baseline complete blood count is needed to compare with future labs for anemia, an adverse effect, and to determine if the white blood count decreases, which is an indication that the drug is effective. The HCG is assessed because pregnancy is a contraindication for tetracycline since it can lead to fatal liver necrosis in the mother and cause bone and tooth development problems in the fetus. The drug needs to be taken on an empty stomach with 8 ounces (240 mL) of water. Calcium, iron, aluminum, or magnesium inhibits absorption of tetracycline. The drug decreases effectiveness of oral contraceptives, so the client needs to take another contraceptive until the drug is completed and, depending on the oral contraceptive, through the next menstrual cycle. The drug causes photosensitivity, so when the client must be in the sun, the client should use sunscreen and protective clothing to prevent sunburn. The client needs to report adverse reactions that indicate a need for the prescriber to change antibiotics.
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.
Answer: B, C Rationale: Nitrofurantoin is an anti-infective agent used to treat or prevent urinary tract infections. The medication may turn urine a harmless brown. The drug is absorbed better when administered with food, and there is a decrease in GI side effects when taken with food. Administering antacids with magnesium will decrease the absorption of the nitrofurantoin. The drug is contraindicated during pregnancy and during the first trimester because it increases the risk for birth defects. Near the end of pregnancy, the drug increases risk for hemolytic anemia. Phenazopyridine is a urinary analgesic to relieve pain related to urinary burning, urgency, frequency, and irritation of the urinary tract mucosa.
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 Rationale: Aminoglycosides accumulate in high concentrations in the inner ear, damaging sensory cells in the cochlea and vestibular apparatus. This accumulative effect increases the risk for the development of ototoxicity, causing in some cases irreversible damage to one's hearing. The medication should be held and alteration in hearing reported to the health care provider. The continued administration of the medication will only cause more damage to the cochlea and vestibular apparatus. Holding the medication and documenting the information in the nurses' notes will not allow for a new anti-infective to be administered and for the hearing to be assessed. Question format: Multiple Choice Chapter 19: Drug Therapy With Aminoglycosides and Fluoroquinolones Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Objective: 3 Reference: p. 377, Use in Patients With Critical Illness
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 Rationale: Ampicillin-sulbactam is a penicillin-beta-lactamase inhibitor combination consisting of ampicillin and sulbactam. Sulbactam helps reduce the development of resistance developing to the ampicillin. Ampicillin-sulbactam is not classified as an extended-spectrum antipseudomonal penicillin, cephalosporin, or aminopenicillin.
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 Rationale: Antibiotics like tetracyclines are useful in treating some animal bites and Lyme's disease through their ability to inhibit microbial protein synthesis. Ibuprofen is administered for the inflammation associated with the arthritic pain but not to treat the infection. Phenazopyridine, a urinary analgesic, is not administered for Lyme's disease. Nitrofurantoin is administered for urinary tract infections.
Which is the drug of choice for surgical prophylaxis associated with a vaginal hysterectomy? A. Cefadroxil B. Cefazolin sodium C. Cephalexin D. Cephradine
B Rationale: Cefazolin sodium is the drug of choice for surgical prophylaxis in most surgical procedures since it has demonstrated effective management of potential bacterial-related infections. While cefadroxil, cephalexin, and cephradine are all first-generation cephalosporins, they are not utilized as the drug of choice for surgical prophylaxis.
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 Rationale: Cephalosporins are broad-spectrum agents with activity against both gram-positive and gram-negative bacteria. But they are, in general, less active against gram-positive organisms and more active against gram-negative ones. Cephalosporins are not effective against fungi or viruses.
A client diagnosed with infective endocarditis would be most effectively treated with which medication? A. Dicloxacillin B. Ampicillin C. Nafcillin D. Oxacillin
B Rationale: Health care providers use ampicillin in the treatment or prophylaxis of infective endocarditis. Ampicillin is effective against bacterial infections. Dicloxacillin, nafcillin, and oxacillin are typically used to treat methicillin-resistant
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 Rationale: Newer fluoroquinolones have been developed with a broader spectrum of activity that provides improved coverage of gram-positive organisms and, in one case, anaerobes. Fluoroquinolones are often given orally. Like all drugs, they have adverse effects. Peak levels are not immediately achieved, and nor they do not have a broader spectrum than an aminoglycoside. Question format: Multiple Choice Chapter 19: Drug Therapy With Aminoglycosides and Fluoroquinolones Cognitive Level: Understand Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Objective: 7 Reference: p. 380, Fluoroquinolones
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 Rationale: The urine can be alkalinized by giving sodium bicarbonate to increase the rate of urinary excretion, raising the levels of sulfonamides in the urinary tract, and increasing effectiveness in the treatment of urinary tract infections. Sufficient water is important but will not increase alkalinity. Taking of tub baths is not recommended, because doing so increases the risk of urinary tract infection. The administration of orange juice increases acid, not alkalinity.
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, and D. Cefazolin, meropenem, and aztreonam all rely on renal clearance, and their dosages must be reduced in acute renal failure. The elimination of nafcillin does not entirely rely on renal clearance, because it is 60% metabolized by the liver.
A patient with an overdose of an oral drug usually receives which of the following? 1. specific antidote 2. activated charcoal 3. syrup of ipecac 4. strong laxative
B. Activated charcoal is considered the "universal antidote." Most therapeutic drugs do not have specific antidotes; syrup of ipecac to induce vomiting with overdoses of some drugs is no longer recommended (questionable effectiveness, danger of aspiration of vomitus), and strong laxatives are not indicated.
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. An adverse effect of imipenem is central nervous system toxicity including seizures, which is undesirable for this client with a head injury and seizure activity. Although imipenem may be given concomitantly with gentamicin, mixing these drugs together in the same IV fluid inactivates the gentamicin. Imipenem is a broad-spectrum antibiotic that should be infused over 40 to 60 minutes.
An infant is born to a mother infected with human immunodeficiency virus (HIV). When is it appropriate to administer zidovudine? A. following a positive HIV test B. within 6 to 12 hours after birth C. within the first 2 days of life D. only if the viral load is decreased
B. An infant born of a mother infected with HIV should be administered zidovudine within 6 to 12 hours after birth.
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. Research has demonstrated that antibiotics must be present in the client when the first skin incision to provide the most protection against infections acquired during surgery. That means that most antibiotics are ideally given no more than 1 hour before, not after, the first skin incision.
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. Amoxicillin-clavulanate is an orally administered combination product containing the antibiotic amoxicillin and the beta-lactamase inhibitor clavulanate. It is available in 250-, 500-, and 875-mg tablets; each of which contains 125 mg of clavulanate. Administering two 250-mg tablets of amoxicillin-clavulanate provides an overdosage (250 mg) of clavulanate.
The mother of an infant infected with human immunodeficiency virus (HIV) has a low viral load and gives birth to a healthy baby boy. What is the most appropriate medical intervention? A. Administer the adult dose of stavudine to the infant. B. Administer zidovudine and nevirapine. C. Assess the infant's viral load. D. Perform HIV testing on delivery
B. Infants born to mothers whose viral load (number of HIV RNA particles within the blood) is significantly below normal should receive zidovudine combined with nevirapine.
A vesicant antineoplastic drug does which of the following? A. It causes minor skin irritation. B. It causes extensive tissue damage. C. It requires administration with a corticosteroid. D. It requires deep intramuscular injection if diluted with normal saline.
B. Leakage of a vesicant drug into tissues surrounding the venipuncture site can cause severe tissue damage, which should be prevented if possible. Drug administration is often at a peripheral IV site, although it may occur via central line. Intramuscular administration is never appropriate.
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. Ciprofloxacin can chelate with cations, and iron, multivitamins, calcium, magnesium, aluminum salts, and sucralfate may significantly reduce the absorption of ciprofloxacin. Therefore, ciprofloxacin should be taken 2 hours before or 6 hours after administration of the other agents. A is incorrect because Maalox impairs the absorption of ciprofloxacin. C is incorrect because loop diuretics, not thiazide diuretics, potentiate the effects of nephrotoxicity. D is incorrect because of the interaction with Maalox and ciprofloxacin. Thiazide diuretics do not interact with ciprofloxacin like loop diuretics do.
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. Clients who are asymptomatic receive doxycycline or ciprofloxacin for 60 days following exposure to anthrax.
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. Gentamicin is excreted via the kidneys, and alterations in renal function may cause nephrotoxicity. Possible nephrotoxicity is a well-known adverse effect of gentamicin, and in this case, the nurse should notify the physician. A and C are incorrect because the client could be experiencing renal impairment, and giving more gentamicin, even half the dose, may still cause drug toxicity and nephrotoxicity. D is incorrect because gentamicin could be contributing to the renal impairment. Although obtaining a trough level might help evaluate the gentamicin regimen, the nurse should not administer the drug until he or she discusses it with the physician.
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. When a client reports mouth pain and difficulty swallowing when taking an anti-infective agent such as tetracycline, it is necessary to inspect the client's mouth for white patchy areas. These areas indicate Candida albicans, a superinfection of the mouth
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. When applying silver sulfadiazine to a burned area, it is important to wear sterile gloves.
What organ system is responsible for the excretion of cefotaxime sodium from the body? A. Respiratory B. Hepatic C. Renal D. Gastrointestinal
C Rationale: Cefotaxime sodium, like all cephalosporins, is excreted by the kidneys. Cefotaxime is not excreted by the lungs, liver, or GI tract.
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 Rationale: Neomycin can be given before bowel surgery to suppress intestinal bacterial growth. Neomycin when administered orally is poorly absorbed in the GI tract and so exerts local bactericide effect there. The administration of neomycin will not prevent renal damage or ototoxicity but can actually increase the risk. It will also not affect the risk of airborne contamination since is focused on local effects in the GI tract. Question format: Multiple Choice Chapter 19: Drug Therapy With Aminoglycosides and Fluoroquinolones Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Objective: 5 Reference: p. 380, Other Drugs in the Class
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 Rationale: Phenazopyridine, a urinary analgesic, is given to relieve pain associated with urinary tract infection. It is not administered for urinary retention, hematuria, or hesitancy since its function is to act directly on the urinary tract mucosa to help eliminate the sensations of burning, urgency, frequency, and irritation.
A nurse is caring for a man who has worsening liver disease. In monitoring his medication, it is important to know that a patient with liver disease may have impaired drug 1. absorption 2. distribution 3. metabolism 4. excretion
C. The liver is mainly involved in drug metabolism. The gastrointestinal tract is mainly involved in absorption of oral drugs, the cardiovascular system is concerned with distribution, and the kidneys are concerned with excretion.
A patient is asking what the difference is between a prescription for 800 mg of a medication that can be purchased on an OTC basis as a 200-mg tablet. To address this issue, it is important that the nurse knows that OTC drugs 1. are considered safe for any consumer to use 2. are not available for treatment of most commonly occurring symptoms 3. often differ in indications for use and recommended dosages from their prescription versions 4. are paid for by most insurance policies
C. Uses may be different, and recommended dosages of over-the-counter (OTC) drugs are usually lower than prescription versions. Labels of OTC drugs contain a listing of people who should not use the drugs, and the drugs are not safe for everyone. Many OTC drugs are available to treat cold symptoms, heartburn, constipation, and other common problems. Insurance companies do not pay for OTC drugs.
The nurse is caring for a woman who has strong beliefs about not putting anything unnatural into her body. It is most accurate to say that most modern medications are 1. natural products derived from plants 2. natural products derived from minerals 3. synthetic products manufactured in laboratories 4. synthetic modifications of natural products
C. Although most older drugs originated as plants, minerals, or other natural products, newer drugs are mainly synthetic. Synthetic drugs are standardized and therefore more consistent in their characteristics and effects than natural products.
A nurse is reading a research report about use of a medication that describes the pharmacokinetics of a particular medication that a patient is taking. Pharmacokinetics involves 1. drug effects on human cells 2. drug binding with receptors 3. drug absorption, distribution, metabolism, and elimination 4. drug stimulation of normal cell functions
C. Pharmacokinetics involves movement of a drug through the body and its elimination. Drug binding with receptors and drug effects on cells are pharmacodynamic processes. Drug stimulation of normal cell functions describes an agonist drug.
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. The addition of ciprofloxacin has led to documented drug interactions with anticonvulsants and antidysrhythmics, and the prescriber should choose an alternative if possible. A is incorrect because the client needs to take the anticonvulsant for seizures as well as an antibiotic for pyelonephritis. Altering the administration schedule may precipitate seizures. B is incorrect because even if levels are obtained, it is the concurrent administration of ciprofloxacin that can alter the levels of the anticonvulsant. In addition, an interaction with the antidysrhythmic agent may prolong the QT interval. D is incorrect because all antibiotics should be taken for the entire duration of therapy, even if the client feels better or the fever is gone.
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 Rationale: Beta-lactam antibacterial drugs inhibit synthesis of bacterial cell walls by binding to proteins in bacterial cell membranes. Penicillin V does not inhibit protein synthesis, cause mutations, or lower the pH of a bacterium's cellular contents.
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 Rationale: Both tetracyclines and sulfonamides are contraindicated in clients with renal failure because of the risk of increased injury since they are excreted via the kidneys. These medications are not contraindicated in clients with asthma, hypertension, or diabetes mellitus unless there is a preexisting renal issue.
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 Rationale: Cefadroxil is a first-generation cephalosporin. Administration of cephalosporins or carbapenems should be avoided in individuals with life-threatening allergic reactions to penicillin. Lactulose reduces blood ammonia by resident intestinal bacteria. It is not contraindicated in the event of penicillin anaphylaxis. Ketoconazole is an antifungal and does not possess cross-sensitivity to penicillin. Kanamycin is an aminoglycoside and does not possess cross-sensitivity to penicillin.
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 Rationale: Postantibiotic effect is the term used to identify that aminoglycosides continue killing microorganisms even at low serum concentrations. None of the remaining options accurately describe this effect. Question format: Multiple Choice Chapter 19: Drug Therapy With Aminoglycosides and Fluoroquinolones Cognitive Level: Understand Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Objective: 7 Reference: p. 379, Nursing Implications
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 Rationale: Tetracyclines interfere with the production of free fatty acids and decrease Propionibacterium acnes in sebum. Tetracycline will decrease redness and swelling, but this response is not the direct action of the medication. Tetracycline treats Chlamydia, but Chlamydia is not the cause of acne. Tetracycline is not used in combination with doxycycline.
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 Rationale: The nurse needs to clarify the statement that the client made that reddish-orange urine needs to be immediately reported to the prescriber because this is a normal effect of the azo dye and harmless. The client must report immediately if the skin turns yellow because the drug is accumulating in the body and not being metabolized by the liver properly. The other statements are correct. The drug is taken with food to decrease GI upset. The client should be instructed to report a sore throat to the prescriber.
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 Rationale: Urinary antiseptics may be bactericidal for sensitive organisms in the urinary tract because these drugs are concentrated in renal tubules and reach high levels in urine. They are not used in urosepsis conditions (systemic infections in the blood) because they do not attain therapeutic plasma levels. Consequently, the development of urosepsis would necessitate a systemic antibiotic. Fluid deficit, ketones in the urine, and elevated white cells would not necessarily contraindicate the use of nitrofurantoin. These conditions would be treated separately.
In understanding the use of controlled substances for patients, it is important that the nurse knows that controlled drugs are 1. categorized according to prescription or nonprescription status 2. regulated by state and local laws more than federal laws 3. those that must demonstrate high standards of safety 4. scheduled according to medical use and potential for abuse
D. Controlled or scheduled drugs are categorized by federal law according to use and abuse potential. These drugs have regulations that govern prescribing, dispensing, administering, and record-keeping. Almost all scheduled drugs require prescriptions (i.e., cannot legally be sold over the counter). Basic laws are federal, and states and local communities may enact additional laws.
A nurse practitioner (NP) has just changed a patient's medication from an oral form to a patch formulation to avoid the first-pass effect. The NP has explained it to the patient, but the patient still has questions and asks the nurse to explain again what is meant by the first-pass effect. The nurse would be most correct in explaining that this has to do with how 1. drugs initially bind to plasma proteins 2. initial renal function is involved in drug excretion 3. the way drugs first reach their target cells 4. initial metabolism of an oral drug occurs before it reaches the systemic circulation
D. The "first-pass effect" involves metabolism of an oral drug in the liver so that only a portion of a drug dose reaches the systemic circulation and becomes available to act on target tissues or to be eliminated from the body. Drug binding to plasma proteins affects drug distribution; an increased amount of drug has to be absorbed before effective therapeutic levels of unbound drug are reached.
A man is very upset with a drug recall of a medication he has been taking for a long time. He states that he feels like he can no longer trust anyone to protect him. In response to his questions about the process of drug development, it is important to know that with a new drug, the U.S. Food and Drug Administration (FDA) is responsible for 1. testing the drug with animals 2. testing the drug with healthy people 3. marketing the drug to health care providers 4. evaluating the drug for safety and effectiveness
D. The U.S. Food and Drug Administration reviews studies reported by others, mainly pharmaceutical companies, and determines whether a drug is sufficiently safe and effective to be marketed. The drug manufacturer is responsible for testing the drug (in animals and people) and marketing the drug.
A man is very upset with a drug recall of a medication he has been taking for a long time. He states that he feels like he can no longer trust anyone to protect him. In response to his questions about the process of drug development, it is important to know that with a new drug, the U.S. Food and Drug Administration (FDA) is responsible for 1. testing the drug with animals 2. testing the drug with healthy people 3. marketing the drug to health care providers 4. evaluating the drug for safety and effectiveness
D. The U.S. Food and Drug Administration reviews studies reported by others, mainly pharmaceutical companies, and determines whether a drug is sufficiently safe and effective to be marketed. The drug manufacturer is responsible for testing the drug (in animals and people) and marketing the drug.
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. Bundle-branch block and changes in the ST and T waves are cardiac-related adverse effects of nitrofurantoin.
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. Photosensitivity may occur with exposure to direct or indirect sunlight; therefore, the client should avoid prolonged exposure to the sun. Sunscreens do not prevent photosensitivity reactions. A is incorrect because clients may take ciprofloxacin with food to avoid gastrointestinal upset. B is incorrect because adequate fluid intake should accompany a ciprofloxacin dose to prevent drug crystals from forming in the urinary tract. C is incorrect because ciprofloxacin interacts with antacids, resulting in impaired ciprofloxacin absorption.
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. Tetracycline should be taken with a full glass of water.
The mother of a 14-month-old girl calls a nurse working in a pediatric clinic and reports that her daughter ingested an unknown number of sleeping pills about 4 hours ago and is now drowsy. The mother asks what she should do. The best response to give the mother is 1. "Administer a dose of syrup of ipecac to ensure vomiting" 2. "Call the Poison Control Center immediately" 3. "Administer a strong laxative and observe for a response" 4. "Call 911 to transport your daughter to the nearest emergency department"
D. The main goals of treatment are starting treatment as soon as possible after drug ingestion, supporting and stabilizing vital functions, preventing further damage from the toxic agent by reducing absorption or increasing elimination, and administering antidotes when available and indicated. Given the time since ingestion and the drowsiness of the girl, this is best accomplished by emergency medical personnel.
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. To prevent crystalluria, it is essential that clients receive 2000 mL of fluids in a 24-hour period.
DC: penicillins
P: amoxicillin TU: bacterial infection
DC: Aromatase Inhibitors
P: anastrazole TU: breast cancer
DC: monobactams
P: aztreonam TU: bacterial infection
DC: Nitrosourea
P: carmustine TU: cancer
DC: Cephalosporins
P: cephalexin TU: bacterial infection
Drug Class : Fluroquinolones
P: ciprofloxacin TU: bacterial infections
DC: Platinum
P: cisplatin TU: cancer
DC: Nitrogen Mustard
P: cyclophosphamide TU: cancer
DC: Pyrimidine
P: cytarabine TU: cancer
NNRTIs
P: delavirdine TU: HIV
DC: Anthracycline
P: doxorubicin TU: cancer
Fusion Inhibitors
P: enfuvirtide TU: (treatment experienced) HIV
DC: Androgen Blocker
P: flutamide TU: prostate cancer
Drug Class: Aminoglycosides
P: gentamicin TU: serious bacterial infections
DC: Targeted Antineoplastic
P: imatinib TU: cancer (specific)
DC: carbapenems
P: imipenem TU: bacterial infection
DC: Interferon
P: interferon TU: cancer, hepatitis
DC: Gonadotropin-Releasing
P: leuprolide TU: prostate cancer
DC: CCR5
P: maraviroc TU: (CCRV) HIV
DC: Purine
P: mercaptopurine TU: cancer
DC: Antifolate
P: methotrexate TU: cancer
Drug Class: Urinary tract antiseptic
P: nitrofurantoin TU: treatment and prevention of UTI
DC: Taxane
P: paclitaxel TU: cancer
Integrase Inhibitors
P: reltegravir TU: HIV
DC: Protease Inhibitors
P: ritonavir TU: HIV
DC: Estrogen Receptor Blocker
P: tamoxifen TU: breast cancer
Drug Class: Tetracyclines
P: tetracycline TU: bacterial infection
DC: Topoisomerase Inhibitor
P: topotecan TU: cancer
DC: Monoclonal Antibody
P: trastuzumab TU: cancer (specific)
Drug Class: Sulfonamides
P: trimethoprim TU: bacterial infection (UTI)
DC: Vinca Alkaloid
P: vincristine TU: cancer
DC: NRTIs
P: zidovudine TU: HIV