Test 4 Study Questions
a
A 68-year-old patient is receiving an aminoglycoside IV for a serious infection. The patient develops heart failure and needs a diuretic. Which medication order would cause the nurse the most concern? a. Ethacrynic acid (Edecrin) b. Hydrochlorothiazide (HCTZ) c. Furosemide (Lasix) d. Bumetanide (Bumex)
d
A burn patient is admitted to a medical-surgical unit and acquires a urinary tract infection (UTI). The prescriber orders mafenide (Sulfamylon) to prevent bacterial colonization. The nurse should monitor the laboratory test results for the development of a. anemia. b. uremia. c. hepatitis. d. acidosis.
c
A faculty member is presenting information about chloramphenicol. The faculty member would be correct to state that the use of chloramphenicol is limited because of the risk of a. acute renal failure. b. Stevens-Johnson syndrome. c. fatal aplastic anemia. d. acute respiratory distress syndrome.
c
A newly admitted patient is going to be started on a course of antibiotic therapy with penicillin. The nurse understands that, while taking the patient's health history, a priority assessment is questioning the patient about a. a history of seizure activity. b. the cardiac history. c. any previous allergy to penicillin. d. any recent urinary tract infections (UTIs).
b, e
A nurse is administering dalfopristin/quinupristin (Synercid) to a hospitalized patient. What are the most likely indications for these drugs? (Select all that apply.) a. Urinary tract infection (UTI) with E. coli b. Vancomycin-resistant E. faecium c. Pneumococcal infection in a patient with hepatic failure d. Peptic ulcer disease (PUD) e. Methicillin-resistant S. aureus or S. epidermidis
b
A nurse is caring for a patient with an infection that is being treated with an aminoglycoside. Which of the following findings would most concern the nurse? a. Decreased white blood cell count b. Proteinuria c. Decreased BUN d. Concentrated urine
d
A nurse manages the care of a patient who is taking rifampin (Rifadin) for leprosy. The patient telephones and reports, "My urine and saliva have looked orange-red for the past 2 days." Select the nurse's best response. a. "This is consistent with an allergic response, and the drug should be stopped." b. "Continue the drug for another week to see if the color returns to normal." c. "Stop the drug, because it is likely that hepatitis has developed." d. "This is a normal effect of the drug and is harmless."
a
A nurse reviews the culture report of a patient being treated with an aminoglycoside for a serious infection. Which organism identified in the report would prompt the nurse to contact the prescriber about changing the antibiotic? a. Staphylococcus aureus b. E. coli c. Proteus mirabilis d. Pseudomonas aeruginosa
a
A nurse transcribes a new prescription for potassium penicillin G given intravenously (IV) q 8 h and gentamicin IV q 12 h. Which plan is the best schedule for administering these drugs? a. Give the penicillin at 0800, 1600, and 2400; give the gentamicin (Garamycin) at 1800 and 0600. b. Give the penicillin at 0800, 1600, and 2400; give the gentamicin (Garamycin) at 1200 and 2400. c. Give the penicillin at 0600, 1400, and 2200; give the gentamicin (Garamycin) at 0600 and 1800. d. Give the penicillin every 8 hours; give the gentamicin (Garamycin) simultaneously with two of the penicillin doses.
b
A patient admitted to the unit for treatment of leprosy has been prescribed clofazimine (Lamprene). Which clinical finding would most concern the nurse? a. Reddish tint to the urine and feces b. Sluggish, hypoactive bowel sounds c. Hair loss d. Nausea and abdominal cramps
a
A patient admitted with an infected below-the-knee amputation (BKA) and heart failure (HF) is taking vancomycin (Vancocin) and furosemide (Lasix). Which of the following is the most important instruction the nurse should provide? a. Report any ringing in the ears or dizziness. b. Report frequent nocturia. c. Elevate the affected extremity. d. Keep the head of the bed at 30 degrees.
c
A patient being followed for latent tuberculosis has been on INH therapy for 2 months. While reviewing the laboratory test results, the nurse notes that the liver function test results have become grossly abnormal. The nurse should instruct the patient to a. continue the drug unless jaundice, nausea, or itching develops. b. continue the drug and have liver function tests repeated weekly. c. stop the medication immediately, and other drugs will be prescribed. d. stop the drug and restart it when liver function returns to normal.
a
A patient being treated with cefmetazole (Zefazone) complains of a headache. Which analgesic would be the best choice for this patient? a. Acetaminophen b. Aspirin c. Ibuprofen d. Excedrin
b
A patient complains of burning on urination and increased frequency. The patient has a history of frequent urinary tract infections (UTIs) and is going out of town in 2 days. To treat the infection quickly, the nurse would expect the health care provider to order a. vancomycin (Vancocin). b. fosfomycin (Monurol). c. aztreonam (Azactam). d. trimethoprim/sulfamethoxazole (Bactrim).
b
A patient has been taking nalidixic acid (NegGram) for recurrent urinary tract infections. While reviewing the patient's medications, that nurse notes that the patient also has been taking warfarin (Coumadin) and alerts the prescriber. What change to the medication regimen would the nurse anticipate? a. Increase in the warfarin b. Decrease in the warfarin c. Increase in the nalidixic acid d. Decrease in the nalidixic acid
a
A patient has just been prescribed nalidixic acid (NegGram) for treatment of a UTI. The nurse is providing patient education about nalidixic acid. Which statement by the patient demonstrates a need for further teaching? a. "I may experience diarrhea." b. "I should take all my medicine until it is gone." c. "I should wear sunscreen and protective clothing when out in the sun." d. "I may experience blurred vision."
c
A patient has just received a prescription for a 10-day course of penicillin for the treatment of strep throat. What patient education is essential for the nurse to provide? a. Family members who have the same symptoms should also receive treatment. b. The agent should be discontinued as soon as symptoms resolve to prevent allergic reactions. c. The entire course of the drug must be taken to prevent the recurrence of infection and potential resistance. d. The medication should be discontinued as soon as symptoms resolve to reduce the risk of resistance.
c
A patient is beginning therapy for active tuberculosis (TB). The patient asks, "Why do I have to take so many drugs?" What is the nurse's best response? a. "When a case is severe enough, multiple drugs are required." b. "The more agents used, the shorter the duration of the therapy." c. "Multiple agents prevent the emergence of resistant organisms." d. "It is assumed that patients take about 50% of the prescribed drug."
c
A patient is being treated with chloramphenicol (Chloromycetin) for an infection that has not responded to other antibacterial agents. A blood sample is drawn for determination of a serum trough level of the drug. The level is reported as 15 mcg/mL. The nurse's priority action is to a. administer the drug as scheduled. b. request that the laboratory perform a confirming test. c. withhold the drug and notify the prescriber. d. expect the prescriber to increase the dose for subsequent administrations.
a
A patient is being treated with trimethoprim-sulfamethoxazole (Bactrim) for bronchitis. The patient has been taking captopril (Capoten) and spironolactone (Aldactone). The nurse would expect which of the following findings? a. Potassium level of 5.5 mEq/L b. Potassium level of 3.5 mEq/L c. Sodium level of 139 mEq/L d. Chloride level of 104 mEq/L
b
A patient is prescribed azithromycin (Zithromax) as an alternative to penicillin. The patient tells the nurse that he experienced nausea and vomiting when he took erythromycin several months ago and asks if he should expect the same effects with azithromycin. Select the nurse's best response. a. "I need to call your health care provider and ask for a different antibiotic." b. "This drug is like erythromycin but has less severe gastrointestinal side effects." c. "Take the drug with a hearty meal to reduce gastrointestinal side effects." d. "I will get a prescription for an antiemetic in case this drug causes vomiting."
b
A patient is prescribed cycloserine (Seromycin pulvules) for resistant tuberculosis. What laboratory test results would the nurse monitor this patient? a. Urine sample 12 hours after administration b. Serum drug level 2 hours after administration c. Drug level through a 24-hour urine sample d. Serum level immediately before the next dose is due
c
A patient is receiving intravenous vancomycin (Vancocin). A unique complication of rapid IV infusion of vancomycin is a. pleural effusion. b. angioedema. c. red man syndrome. d. neurotoxicity.
b
A patient is receiving methenamine (Mandelamine) for the treatment of a chronic UTI. Which agent, when given concurrently with methenamine, can create a risk for crystalluria? a. Ciprofloxacin (Cipro) b. Sulfisoxazole c. Nalidixic acid (NegGram) d. Erythromycin (ERYC)
d
A patient is taking gentamicin (Garamycin) on once daily regimen. The prescriber orders a blood sample to be drawn for measurement of a trough level of the drug. When should the nurse draw the blood? a. 1 hour after the infusion is complete b. 8 hours after the infusion is complete c. 12 hours after the infusion is complete d. 1 hour prior to the next infusion
a
A patient is taking pyrazinamide as a component of a multidrug regimen for tuberculosis. Which co-morbid condition in the patient's health history would most concern the nurse? a. Cirrhosis b. Migraine headaches c. Diabetes d. Osteoarthritis
b
A patient is taking trimethoprim/sulfamethoxazole (TMP-SMZ). To help the patient avoid the side effects associated with this drug, the nurse should encourage the patient to a. take the medication with food. b. maintain adequate hydration. c. avoid the use of Tylenol. d. limit alcohol intake.
c
A patient presents to the emergency department with complaints of chills, severe flank pain, dysuria, and urinary frequency. Vital signs reveal: temperature 102.9° F, pulse 92, respirations 24, and blood pressure 119/58. The nurse would be correct to suspect that the patient shows signs and symptoms of a. acute cystitis. b. urinary tract infection. c. pyelonephritis. d. prostatitis.
b
A patient reports a severe urticarial reaction to benzathine penicillin G. The nurse would expect the prescriber to order which alternative antibiotic? a. Amphotericin B b. Erythromycin (E-Mycin) c. Ampicillin/sulbactam (Unasyn) d. Ceftazidime (Fortaz)
c
A patient returns to the clinic after taking antibiotics for a UTI. When a urinalysis is performed, it is determined that the patient still has a UTI. The nurse asks the patient if she took all her medication until it was gone. The patient replied that she hates taking pills two and three times a day and asks if there is something she can "take just once and get it over with." The nurse anticipates that the prescriber will order a. ciprofloxacin (Cipro). b. cephalexin (Keflex). c. fosfomycin (Monurol). d. amoxicillin (Amoxil).
c
A patient shows signs and symptoms of conjunctivitis. Which of the following aminoglycosides would the nurse expect to be ordered? a. Amikacin (Amikin) b. Kanamycin (Kantrex) c. Neomycin (Neomycin) d. Paromomycin (Humatin)
d
A patient tells the nurse during the health history that the last time she received penicillin, she experienced anaphylaxis. Which of the following medications should the nurse advise the patient to avoid? a. Ibuprofen (Motrin) b. Doxycycline (Vibramycin) c. Imipenem (Primaxin) d. Cefoxitin (Mefoxin)
a, c, e
A patient who had surgery 6 days earlier has developed a urinary tract infection, for which the prescriber has ordered nitrofurantoin (Macrodantin). The nurse is providing patient education about the medication. What should the nurse include in the teaching? (Select all that apply.) a. "We will need to monitor your creatinine clearance levels." b. "It would be best to take your meds on an empty stomach." c. "Your urine may have a brown tint." d. "You may experience constipation." e. "You may experience a headache."
a
A patient who has been diagnosed with multidrug-resistant tuberculosis asks how long the treatment regimen will last. Select the nurse's best response. a. "After the sputum is converted to negative for TB organisms, the therapy continues for 12 to 24 months." b. "The entire course of therapy lasts 3 to 6 months or until the chest radiograph is normal." c. "Therapy is indefinite, because there is no method of determining responsiveness." d. "No therapy is completely effective in multidrug-resistant tuberculosis, so treatment is needed for several years."
b
A patient who has been receiving clindamycin for 10 days develops profuse diarrhea and abdominal pain and has a temperature of 101.2° F. The nurse suspects that the patient has an infection caused by C. difficile. The nurse would expect the prescriber to order a. penicillin G. b. vancomycin (Vancocin). c. tetracycline (Sumycin). d. azithromycin (Zithromax).
d
A patient who has been taking nalidixic acid (NegGram) for a urinary tract infection is now diagnosed with a respiratory infection. The patient asks, "Will the nalidixic acid I'm taking cover both infections?" Select the nurse's best response. a. "The drug you are on will cover you for organisms in the respiratory tract as well. Continue taking it as prescribed." b. "To cover the respiratory tract infection, you will need two additional doses of this medication." c. "This drug can actually cause respiratory tract infections, so you should discontinue it immediately." d. "The drug you're taking has no action outside the urinary tract. You will need an additional antibiotic for the respiratory tract infection."
c
A patient who is receiving a final dose of intravenous (IV) cephalosporin begins to complain of pain and irritation at the infusion site. The nurse observes signs of redness at the IV insertion site and along the vein. The nurse's priority action is to a. apply warm packs to the arm and infuse the medication at a slower rate. b. continue the infusion while elevating the arm. c. select an alternate intravenous site and administer the infusion more slowly. d. request central venous access.
b
A patient who was unable to provide a medication history was admitted to the unit. The patient is receiving penicillin for treatment of an infection. The patient begins to wheeze. Upon assessing the patient, the nurse finds an edematous airway, bronchoconstriction, and a blood pressure of 88/47. The nurse's priority action should be to a. obtain suction and an oropharyngeal airway device. b. administer epinephrine (adrenalin). c. check the oxygen saturation and apply oxygen. d. administer IV fluids to increase the blood pressure.
b
A patient who works as a landscaper is preparing to be discharged home. He has been instructed to take tetracycline (Sumycin) as an outpatient. Which of the following should be included in the discharge teaching for this patient? a. "Take all the medication until symptoms subside." b. "Use sunscreen and protective clothing when outdoors." c. "Take the medication with Pepto-Bismol to avoid diarrhea." d. "Take the medication with food and milk to minimize GI upset."
b
A patient with a history of hypertension is taking linezolid (Zyvox) for an infection. The nurse should be concerned about which of the following foods on the patient's tray? a. Grapes b. Aged cheese c. Milk d. Coffee
b
A patient with a history of transient ischemic attacks (TIAs) is being treated with warfarin (Coumadin) and begins therapy with trimethoprim/sulfamethoxazole (Bactrim). Which of the following findings would most concern the nurse? a. Thrombophlebitis b. Increased bleeding c. Decreased effect of the antibiotic d. Decreased effect of warfarin
d
A patient with an abdominal infection has been prescribed oral clarithromycin (Cleocin). The nurse, who is providing patient education about the drug, should teach the patient to report a. headache. b. vomiting. c. muscle tenderness. d. diarrhea.
a
A patient with renal impairment who has been taking nitrofurantoin (Macrodantin) for a urinary tract infection telephones a nurse and describes the recent onset of "numbness and tingling" in the fingers and toes. The nurse should instruct the patient to a. discontinue the drug and come in for further evaluation. b. continue the drug and keep the hands and feet elevated when possible. c. check the color of the extremities and a pulse every 4 hours. d. collect a urine sample and bring it to the clinic.
c
A patient with type 2 diabetes is taking an oral hypoglycemic agent. She complains of feeling "poorly" since she started taking a sulfonamide for a urinary tract infection. The nurse should take which of the following actions? a. Have the patient come in immediately for re-evaluation. b. Have the patient check her blood glucose level to see whether it is high. c. Instruct the patient to check her blood glucose level to see whether it is low. d. Advise the patient to add an extra snack just prior to bedtime.
d
A pregnant adolescent asks the nurse whether it would be all right to continue to take her prescription for tetracycline (Sumycin) to clear up her acne. What response by the nurse provides the best information? a. "Tetracycline is effective in clearing up acne." b. "Tetracycline may cause allergic reactions in pregnant women." c. "Tetracycline will resolve an asymptomatic urinary tract infection." d. "A tetracycline drug could be harmful to the baby's teeth and should be avoided."
d
A public health nurse is conducting research to reduce the occurrence of UTIs among the public. Which of the following patients would have the highest risk for developing a urinary tract infection? a. A 68-year-old woman with stress incontinence b. A 16-year-old girl who just became sexually active c. A 56-year-old male with frequents complaints of lower abdominal pain d. An 82-year-old woman living in a skilled care nursing facility
a
An adult has active tuberculosis, as diagnosed by sputum examination and culture. In evaluating the patient's response to therapy, the nurse would want to see which finding? a. Improved x-ray report within 3 months b. Absence of symptoms by 8 weeks c. Return to a negative skin test by 4 weeks d. Negative computed tomography (CT) scan by 2 weeks
d
An older male patient comes to the clinic with complaints of chills, malaise, myalgia, localized pain, dysuria, nocturia, and urinary retention. The nurse would most likely suspect that the patient has a. acute cystitis. b. urinary tract infection. c. pyelonephritis. d. prostatitis.
c
During the physical assessment of a patient who has been taking antibiotics for several weeks, the nurse notes that the patient has developed white, patchy spots on the tongue and oral mucosa. The nurse correctly identifies the signs and symptoms of a. stomatitis. b. herpes simplex. c. Candida albicans infection. d. vulvovaginal candidiasis.
d
Eight hours after administering a sulfonamide, the nurse notes that a patient has a temperature of 104° F, pulse of 112, BP of 104/52, respirations of 20, malaise, and widespread lesions of the skin and mucous membranes. The nurse would be correct to suspect a. suprainfection. b. systemic mycoses. c. red man syndrome. d. Stevens-Johnson syndrome.
c
For which diagnosis would the nurse administer a sulfonamide? a. Prostatitis b. Pyelonephritis c. Urinary tract infection d. Conjunctivitis
d
For which of the following patients would nitrofurantoin (Macrodantin) be contraindicated? a. Patient with a urine phosphate of 0.9 gm/24 hr b. Patient with a urine specific gravity of 1.024 c. Patient with bacteria in the urine d. Patient with a creatinine clearance of 38 mL/min
b
If a patient is receiving divided doses of tobramycin, what time should a blood sample be obtained for determination of a trough level of the drug, which is to be administered at 1000? a. 1130 b. 0945 c. 1200 d. 1030
c, d
In which of the following scenarios would the nurse consider antibiotic therapy to be prophylactic? (Select all that apply.) a. Patient with neutropenia and cancer who experiences fever and cough b. Patient with a fever of unknown origin c. Patient undergoing an operation for a compound fracture d. Patient with an artificial heart valve who is scheduled for hernia repair e. Patient with a new diagnosis of endocarditis
a
Of the many adverse effects of tetracycline (Sumycin), one of the most serious is pseudomembranous colitis. This disorder most likely occurs because tetracycline is a(n) a. broad-spectrum antibiotic. b. narrow-spectrum antibiotic. c. highly protein bound medication. d. acid-labile drug.
a
The nurse administered ticarcillin (Ticar) to a patient with the morning medications. Later, when assessing the patient, the nurse notes a light red rash with pruritus. The prescriber is notified and orders a desensitization of the medication. The nurse correctly explains to the patient which of the following procedures? a. Desensitization involves a small initial dose, which is followed by increasing doses every 60 minutes. b. Desensitization involves infusing the same dose of medication but in a more dilute solution. c. Desensitization involves administration of a pretreatment of Tylenol and diphenhydramine (Benadryl). d. Desensitization involves administration of the medication continuously rather than every 8 hours.
c
The nurse administers cefotetan (Cefotan) to a patient who also is taking warfarin (Coumadin). The nurse should monitor the patient carefully for a. increased WBCs. b. significantly elevated levels of cefotetan. c. bruising or bleeding gums. d. hyperkalemia.
c
The nurse and a graduate nurse are reviewing an order for penicillin G (Benzylpenicillin). The nurse is discussing the pharmacokinetics of penicillin G with the graduate nurse. Which statement by the graduate nurse best demonstrates understanding of the pharmacokinetics of penicillin G? a. "Penicillin G is absorbed well when administered enterally and parenterally." b. "Excretion by the kidneys is subject to the first-pass effect and the cytochrome p-450 system." c. "Inflammation increases the distribution of penicillin G into the joints and cerebrospinal fluid." d. "Penicillins generally are bacteriostatic but seldom have bactericidal effects."
a
The nurse assesses a PPD on the forearm of a patient being screened for employment in an outpatient clinic. The induration is 4 mm. How should this finding be interpreted? a. Negative, insignificant b. Moderately significant, requiring chest radiograph c. Moderately significant, requiring sputum culture d. Significant, requiring treatment
a
The nurse correctly administers dirithromycin (Dynabac) a. with meals. b. on an empty stomach. c. with a carbonated soft drink. d. 2 hours before or after a meal.
d
The nurse describes a typical course of therapy to a patient newly diagnosed with active tuberculosis. Which description is the most accurate? a. "The course of therapy generally lasts 1 year. Four drugs are required during that period." b. "Most patients require 4 full months of therapy, followed by 1 year of weekly tuberculin skin tests." c. "The four-drug regimen should last for 4 weeks. If the radiograph is normal, the medications are discontinued." d. "The entire course should take 6 months; the first 2 months with four drugs, and the last 4 months with two drugs."
a
The nurse has been caring for a patient who has been taking antibiotics for 3 weeks. Upon assessing the patient, the nurse notices the individual has developed oral thrush. Which of the following describes the etiology of the thrush? a. Suprainfection b. Antibiotic resistance c. Nosocomial infection d. Community-acquired infection
b
The nurse has just received a patient from the recovery room who has been receiving amikacin (Amikin) for treatment of an infection. Upon assessment of the patient, the nurse finds that he cannot move his extremities, and he is having difficulty breathing. The nurse suspects neuromuscular blockage and should be prepared to administer a. epinephrine. b. calcium gluconate. c. Decadron. d. magnesium sulfate.
c
The nurse has received an order from the prescriber to administer spectinomycin (Trobicin) to a patient with gonorrhea. What route of administration will the nurse use? a. Oral (with a full glass of water) b. Intravenous (in a large vein) c. Intramuscular d. Subcutaneous
b
The nurse is admitting to the unit a patient who has just had a minor operation and received a general anesthetic. The nurse notices that gentamicin (Garamycin) is infusing IV. Which of the following clinical findings associated with these drug-drug interactions would most alarm the nurse? a. Diluted urine b. Decreased sensation in the lower extremities c. Hyperreflexia d. Persistent headache
c
The nurse is analyzing laboratory results for a patient who receives gentamicin (Garamycin) twice a day. The patient's peak gentamicin serum level is 3 mcg/mL. How would the nurse interpret this finding? a. The level would be considered a safe peak level. b. The level would be considered a toxic peak level. c. The level would be considered a subtherapeutic peak level. d. The level would be irrelevant, because a peak level is not indicated.
a
The nurse is caring for a patient admitted to the unit for an infection. The patient receives IV amikacin (Amikin) twice a day. The nurse is planning to obtain serum for measurement of a peak aminoglycoside level. When should the blood be drawn? a. 30 minutes after the infusion is complete. b. 1 hour after the infusion is complete. c. 1 hour prior to administration of the infusion. d. A peak level is not indicated.
c
The nurse is caring for a patient on a medical-surgical unit who has been experiencing fever of unknown origin. The prescriber has ordered a broad-spectrum antibiotic. Which intervention is the priority? a. Administer the antibiotic immediately. b. Administer antipyretics as soon as possible. c. Obtain all cultures before the antibiotic is administered. d. Delay administration of the antibiotic until the culture results are available.
d
The nurse is caring for a patient receiving gentamicin (Garamycin) intravenously (IV). What statement by the patient would most concern the nurse? "I am experiencing a. dizziness." b. ear pain." c. tone deafness." d. high-pitched tinnitus."
d
The nurse is caring for a patient starting INH for latent tuberculosis. Which clinical manifestations would most concern the nurse? a. Cramps in the back when walking up steps b. Headaches and lightheadedness on awakening c. Dry mouth and difficulty swallowing solids d. Difficulty buttoning shirts
a
The nurse is caring for a patient taking vancomycin (Vancocin). Upon assessment of the patient, the nurse finds that he is experiencing flushing, rash, pruritus, and urticaria. His vital signs are: P-120, BP-92/97, T-98.9° F, and R-20. The nurse understands that these findings are consistent with a. red man syndrome. b. rhabdomyolysis. c. an allergic reaction. d. Stevens-Johnson syndrome.
d
The nurse is caring for a patient who is being discharged home on rifampin (Rifadin) for the treatment of leprosy. What statement by the patient about the administration of this drug best indicates understanding? "I will take my medication a. twice daily." b. daily." c. twice weekly." d. monthly."
b
The nurse is caring for a patient who is taking rifabutin (Mycobutin). The patient begins to complain of a sudden onset of eye pain and blurred vision. The nurse suspects the patient is experiencing a. cataracts. b. uveitis. c. glaucoma-like syndrome. d. conjunctivitis.
b
The nurse is caring for a patient with TB who is being treated with capreomycin. During the assessment, the patient states that he has been a little dizzy lately, and he asks the nurse to repeat bits of the conversation multiple times. Why would this concern the nurse? a. Dizziness may indicate head congestion from the TB. b. Hearing loss is associated with capreomycin toxicity. c. The patient displays worsening symptoms of TB. d. This is an indication that the patient should be checked for urinary retention.
b
The nurse is caring for a patient with a Pseudomonas infection and has just administered amikacin (Amikin). What is the advantage of this aminoglycoside over the other aminoglycosides? a. It poses less risk of thrombophlebitis. b. It is the most resistant to bacteria. c. It is active against gram-positive bacteria. d. It is eliminated quicker than the others.
b
The nurse is caring for a patient with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) who has taken protease inhibitors for 18 months. The patient has been diagnosed with active tuberculosis. The nurse would not expect the addition of which drug to the patient's medication regimen? a. Isoniazid (INH) b. Rifampin (Rifadin) c. Pyrazinamide (PZA) d. Kanamycin (Kantrex)
d
The nurse is caring for an African American patient who has been admitted to the unit for long-term antibiotic therapy. The patient is taking a sulfonamide and begins to show a fever, pallor, and jaundice. The nurse would be correct to suspect that the patient has developed a. Stevens-Johnson syndrome. b. kernicterus. c. hepatotoxicity. d. hemolytic anemia.
d
The nurse is discussing upper and lower UTIs. She correctly states that most UTIs can be treated at home, except for a. acute cystitis. b. acute urethritis. c. complicated urinary tract infection. d. severe pyelonephritis.
b, e
The nurse is performing a physical assessment on a patient admitted to the hospital for an infection. The patient is taking gentamicin (Garamycin) for the infection. What areas should be the focus of the nurse's assessment? (Select all that apply.) a. Skin integrity b. Sense of hearing c. Blurred vision d. Fever e. Renal function
d
The nurse is performing a physical assessment on a patient with tuberculosis who takes rifampin (Rifadin). Which of the following would be an expected finding? a. Peripheral neuropathy b. Myopathy c. Crystalluria d. Red-orange-tinged urine
a, e
The nurse is performing an assessment on a patient receiving ticarcillin (Ticar) for treatment of a Pseudomonas infection. Which of the following clinical manifestations should most concern the nurse? (Select all that apply.) a. High sodium level and edema b. Transient headache c. Gastrointestinal (GI) discomfort d. Poor skin turgor e. Bleeding gums
a
The nurse is performing an assessment on a patient taking penicillin G (Benzylpenicillin). The patient shows confusion and hallucinations. The nurse would be correct to assume that a. blood levels of the drug are too high. b. the patient has a history of alcohol abuse. c. an intra-arterial injection has been administered inadvertently. d. an accidental injection into a peripheral nerve has been administered.
d
The nurse is planning to implement an order to desensitize a patient to an antibiotic to which the patient previously had experienced a severe reaction. Which of the following implementations would be most appropriate prior to administration of the drug? a. Stay with the patient for the duration of the medication administration. b. Have a heart monitor accessible in the patient's room. c. Clarify the order and recommend a different antibiotic. d. Have epinephrine readily accessible in the patient's room.
a
The nurse is preparing to discharge to home a patient who is a construction worker and who has been prescribed a sulfonamide. Which of the following instructions would be most important for this particular patient? a. "Make sure to use sunscreen." b. "Take the medication with food." c. "Report any muscle pain immediately." d. "Report any nausea or stomach upset."
c
The nurse is providing care to a patient with tuberculosis who is taking ethambutol (Myambutol). Which statement by the patient indicates a correct understanding of the effects of ethambutol? a. "Dizziness, drowsiness, and decreased urinary output are common with this drug, but they will subside over time." b. "Constipation will be a problem, so I will increase the fiber in my diet." c. "I will need to have my eyes checked periodically while I am taking this drug." d. "This medication may cause my bodily secretions to turn bluish green."
a
The nurse is providing discharge instructions to a patient about drug-drug and drug-food interactions. Which of the following statements by the patient indicates a lack of understanding about these medications? a. "I can take my cefotetan (Cefotan) with my warfarin (Coumadin)." b. "I can take ceftriaxone (Rocephin) and spironolactone (Aldactone)." c. "I can take yogurt with active cultures to counteract my vulvocandidiasis." d. "I can drink soda to enhance the effects of my fluconazole (Diflucan)."
a
The nurse is providing education about tetracycline (Sumycin). Which statement by the patient best demonstrates understanding of the administration of this medication? a. "I will avoid taking my medication with dairy products." b. "I will need to take my antibiotic with grapefruit juice." c. "I should take my antibiotic with a calcium-containing antacid to minimize gastrointestinal distress." d. "I should expect a slight, acne-like rash with this medication."
c
The nurse is providing patient education to a young adult patient who takes tetracycline (Sumycin). Which statement by the patient indicates a need for further teaching? a. "Tetracycline can be used for acne, too." b. "Tetracycline will help my H. pylori." c. "Tetracycline will stain my teeth." d. "I should not take this with my laxatives."
b
The nurse is reviewing laboratory test results for a patient who is about to begin taking piperacillin. An abnormal elevation in which laboratory values would cause the nurse to notify the prescriber immediately? a. PT and PTT b. BUN and creatinine c. Hematocrit and hemoglobin d. Serum glutamic-oxaloacetic transaminase (SGOT) and alanine transaminase (ALT)
a
The nurse is serving as a preceptor for a graduate nurse on a medical-surgical unit. The nurse, who is discussing the mechanisms of action of antibiotics, currently is talking about the mechanism of action of penicillins (PCNs). Which statement by the graduate nurse best demonstrates understanding? "Penicillin works by a. weakening the bacterial cell wall, which then ruptures and dies." b. inhibiting protein synthesis and suppressing bacterial growth." c. disrupting bacterial protein synthesis, destroying the bacterial wall." d. disrupting biochemical reactions, which results in cellular lysis."
c
The nurse is taking a health history on a patient who has come to the clinic for a follow-up appointment. The patient states that the only medication she is taking is trimethoprim/sulfamethoxazole (Bactrim). Which statement made by the patient would most concern the nurse? a. "I play softball on Thursdays." b. "I sometimes feel tired." c. "I am allergic to sulfa." d. "I am taking this medication for my urinary tract infection."
c
The nurse prepares to administer medications to a group of patients. For the patient with which condition would doxycycline (Atridox) most likely be indicated? a. Renal failure b. Lyme disease c. Periodontal disease d. Sexually acquired proctitis
c
The nurse understands that vancomycin (Vancocin) generally is given intravenously. In which patient would an oral route of administration be warranted? a. Patient with a central line infection b. Patient with bacterial endocarditis c. Patient with pseudomembranous colitis d. Patient with viral meningitis
a, b, e
The nurse, who is teaching a group of nursing students, asks, "How can nurses reduce the incidence of nosocomial infections?" Which responses by the students best demonstrate understanding? (Select all that apply.) a. "Nurses can break the chain of transmission of infections." b. "Nurses can remove invasive devices as soon as possible." c. "Nurses can use broad-spectrum antibiotics for colonization." d. "Nurses can reserve antibiotics for only life-threatening infections." e. "Nurses can encourage patients to get vaccinations."
b
The nurse, who is teaching a pharmacology refresher course to a group of nurses, is discussing selective toxicity, which refers to a drug's ability to a. harm a broad spectrum of organisms. b. kill or injure a target organism without injuring the host. c. disrupt the mammalian cell wall by causing engorgement and lysis. d. increase the production of folic acid used in the synthesis of nucleic acids.
b
The patient's prescriber has ordered antibiotic combination therapy. The patient asks the nurse why two antibiotics are required. Which response by the nurse best describes the rationale for combination therapy? a. "Additional coverage is provided in case one of the antibiotics is ineffective." b. "The first antibiotic potentiates the effect of the second antibiotic." c. "This is the only effective treatment for fever of unknown origin." d. "An allergic response is less likely if two antibiotics are administered."
d
The prescriber has just ordered neomycin for a patient with an infection. The nurse is aware that the most important reason neomycin is administered orally is that with parenteral administration is that it a. causes excessive gastric irritation. b. would kill beneficial intestinal flora. c. is inactivated by gastric enzymes after a first pass through the liver. d. is more ototoxic and nephrotoxic than other aminoglycosides.
c
Which of the following patients would be at the highest risk for aminoglycoside-induced nephrotoxicity? a. A 26-year-old woman with persistent headaches and tinnitus b. A 26-year-old female newlywed with chronic UTIs c. A 72-year-old patient also taking amphotericin B (Fungizone) d. A 30-year-old patient with pyelonephritis
a, d, e
Which statements about the differences between first- and fourth-generation cephalosporins are correct? (Select all that apply.) a. Fourth-generation agents have more activity against gram-negative organisms. b. First-generation agents are more active against anaerobes. c. First-generation agents have increased resistance to beta-lactamases. d. Fourth-generation agents have an increased ability to reach the cerebrospinal fluid. e. First-generation agents are more vulnerable to destruction by beta-lactamases.
a
With which class of drugs would the nurse be most likely to see Stevens-Johnson syndrome? a. Sulfonamides b. Tetracyclines c. Azoles d. Penicillins