CS Exam 1 Questions

A nurse is preparing to administer epinephrine to a patient who is having a severe allergic reaction. Which route of administration should the nurse use to provide the fastest and most complete absorption of epinephrine? A. Intravenous B. Intramuscular C. Subcutaneous D. Oral

A

A patient is prescribed an antibiotic to treat a urinary tract infection. What statement by the patient indicates a need for further teaching? A. "I can stop the medication as soon as the symptoms have disappeared." B. "I will drink more fluids to help clear up the infection." C. "I will stop the medication and contact the doctor if I develop a rash." D. "I should immediately report vaginal itching or discharge."

A

When preparing to administer a sustained-release capsule to a patient, the nurse understands that which of the following is true for sustained-release capsules? A. They are usually more costly than pills. B. They are rapidly absorbed. C. They need to be crushed for appropriate absorption to take place. D. They need to be taken at regular intervals throughout the day.

A

Which virus undergoes yearly "antigenic drift," allowing for emergence of new strains? A. Influenza B. Streptococcus C. Staphylococcus D. Herpes simplex

A

Which statement about allergic reactions to penicillin does the nurse identify as true? A. Anaphylactic reactions occur more frequently with penicillins than with any other drug. B. Allergy to penicillin always increases over time. C. Benadryl is the drug of choice for anaphylaxis due to penicillin allergy. D. Patients allergic to penicillin are also allergic to vancomycin.

A (Anaphylactic reactions occur more frequently with penicillins than with any other drug. Allergy to penicillin can decrease over time. Epinephrine is the drug of choice for anaphylaxis. Vancomycin, erythromycin, and clindamycin are effective and safe alternatives for patients with penicillin allergy)

The patient is being discharged with continued ciprofloxacin therapy. When providing discharge teaching, the nurse should advise the patient to call the healthcare provider immediately if what develops? A. Pain in the heel of the foot B. Nausea C. Diarrhea D. Headache

A (Rarely, ciprofloxacin and other fluoroquinolones have caused tendon rupture, usually of the Achilles tendon. The incidence is 1 in 10,000 or less. Because tendon injury is reversible if diagnosed early, fluoroquinolones should be discontinued at the first sign of tendon pain, swelling, or inflammation. In addition, patients should refrain from exercise until tendinitis has been ruled out)

The patient is ordered daily divided doses of gentamycin. The patient received an intravenous dose of gentamycin at 4:00 pm. When should the nurse obtain the peak level? A. 4:30 pm B. 5:00 pm C. 5:30 pm D. 6:00 pm

A (Rationale: When using divided daily doses, draw blood samples for measuring peak levels 1 hour after IM injection and 30 minutes after completing an IV infusion. When a single daily dose is used, measuring peak levels is unnecessary. Draw samples for trough levels just before the next dose when using divided daily doses or 1 hour before the next dose when using a single daily dose)

The nurse delegates the cleaning of an automatic blood pressure machine to unlicensed assistive personnel (UAP). The nurse should instruct the UAP to use which agent to clean the equipment? A. Hexachlorophene B. A disinfectant, such as glutaraldehyde [Cidex Plus 28] C. An antiseptic, such as ethanol D. Povidone-iodine

B

Which patient should receive prophylactic antibiotic therapy? A. A patient who is to have his teeth cleaned B. A patient who is scheduled for a hysterectomy C. A patient with a white blood cell count of 8000 cells/mm3 D. A patient with a high fever without an identifiable cause

B

Which statement about superinfections does the nurse identify as true? A. Superinfections are more common in patients treated with narrow-spectrum drugs. B. Superinfection is defined as a new infection that appears during the course of treatment for a primary infection. C. Superinfections are caused by viruses D. Superinfections are easy to treat.

B

which statement about drug agonists does the nurse identify as being true? A. An agonist makes physiologic processes go faster. B. An agonist exerts effects by causing receptor activation. C. An agonist has moderate intrinsic activity. D. An agonist is a dynamic component.

B

A patient with a history of a severe anaphylactic reaction to penicillin has an order to receive cephalosporin. What should the nurse do? A. Administer the cephalosporin as ordered. B. Contact the healthcare provider for a different antibiotic. C. Administer a test dose of cephalosporin to determine reactivity. D. Have an epinephrine dose available when administering the cephalosporin.

B (1% display cross-sensitivity to cephalosporins if PCN allergy is severe)

A patient is prescribed cefixime. The nurse should teach the patient to immediately report any signs of what? A. Milk intolerance B. Skin rash, hives, or itching C. Constipation, nausea, or vomiting D. Headache, contusions, or seizures

B (Hypersensitivity reactions are common with cephalosporins, Patients should be instructed to report any signs of allergy, such as skin rash, itching, or hives. Cefditoren contains a milk protein and should not be prescribed for patients with a milk protein allergy. Cefoperazone and cefotetan can promote bleeding. Diarrhea associated with antibiotic-associated pseudomembranous colitis (AAPMC) is a possible side effect with cephalosporins)

A patient who sustained second- and third-degree burns has been prescribed mafenide. Which statement about mafenide does the nurse identify as true? A. Use of mafenide can cause alkalosis. B. Mafenide is painful upon application C. A blue-green to gray discoloration of the skin occurs with mafenide therapy. D. Mafenide exerts its therapeutic effect by the release of free silver.

B (Local application of mafenide is frequently painful. Mafenide is metabolized to a compound that can suppress renal excretion of acid, thereby causing acidosis. Silver sulfadiazine, another topical sulfonamide used for burn therapy, can cause a blue-green to gray skin discoloration, so facial application should be avoided. Mafenide does not cause this specific skin discoloration. Mafenide acts by the same mechanism as other sulfonamides. In contrast, the antibacterial effects of silver sulfadiazine are due primarily to the release of free silver, not to the sulfonamide portion of the molecule)

A patient is diagnosed with C. difficile infection. The nurse anticipates administering which medication? A. Daptomycin B. Metronidazole C. Rifampin D. Rifaximin

B (Metronidazole is a drug of choice for C. difficile infection. Daptomycin has a unique mechanism and can rapidly kill virtually all clinically relevant gram-positive bacteria, including MRSA. Rifampin [Rifadin] is a broad-spectrum antibacterial agent used primarily for tuberculosis. However, the drug is also used against several nontuberculous infections. Rifampin is useful for treating asymptomatic carriers of Neisseria meningitidis. Rifaximin [Xifaxan] is an oral, nonabsorbable analog of rifampin used to kill bacteria in the gut)

A patient has been prescribed oral ciprofloxacin [Cipro] for a skin infection. When administering the medication, it is most important for the nurse to do what? A. Monitor for a decrease in the prothrombin time (PT) if the patient is also taking warfarin [Coumadin]. B. Withhold antacids and milk products for 6 hours before or 2 hours afterward. C. Inform the healthcare provider if the patient has a history of asthma. D. Assess the skin for Stevens-Johnson syndrome.

B (Rationale: Absorption of ciprofloxacin can be reduced by ingestion of antacids and milk products. Ingestion of these products should occur at least 6 hours before ciprofloxacin or 2 hours afterward. Ciprofloxacin can increase the PT if the patient is also taking warfarin. Use of ciprofloxacin is contraindicated in patients with a history of myasthenia gravis. Patients taking ciprofloxacin are at risk for development of phototoxicity.)

Before administering gentamycin, it is most important for the nurse to assess the patient for a history of what? A. Hypertension B. Myasthenia gravis C. Diabetes mellitus D. Asthma

B (Rationale: Aminoglycosides must be used with caution in patients with renal impairment, pre-existing hearing impairment, and myasthenia gravis, and in patients receiving ototoxic drugs (especially ethacrynic acid), nephrotoxic drugs (eg, amphotericin B, cephalosporins, vancomycin, cyclosporine, nonsteroidal anti-inflammatory drugs [NSAIDs]), and neuromuscular blocking agents)

A patient is prescribed acyclovir [Zovirax] by mouth. The nurse should assess the patient for which adverse effects associated with oral acyclovir therapy? A. Stomatitis and gastritis B. Nausea, vomiting, and diarrhea C. Hives, difficulty breathing, and angioedema D. Tinnitus and decreased hearing

B (also headache and vertigo)

Which vaccine contains live viruses that are weakened or attenuated? A. Hepatitis B: recombinant viral protein B. Measles, mumps, rubella (MMR) C. Diphtheria, tetanus, pertussis (DTaP) D. Haemophilus influenzae type B (HIB): bacterial antigen

B (for C, Diphtheria and Tetanus are toxoids - purified toxins that have been detoxified without lost of immunogenicity. Pertussis is from killed whole-cell vaccine (acellular) that contains pertussis toxoid)

Which patient would most likely need intravenous antibiotic therapy to treat a urinary tract infection? A. A patient with an uncomplicated urinary tract infection caused by Escherichia coli B. A patient with pyelonephritis with symptoms of high fever, chills, and severe flank pain C. A patient with acute cystitis who complains of dysuria, frequency, and urgency D. A patient with acute bacterial prostatitis with a mild fever, chills, and nocturia

B (kidney infection if back is hurting)

The nurse is reviewing laboratory values from a patient who has been prescribed gentamicin. To prevent ototoxicity, it is most important for the nurse to monitor which value(s)? A. Serum creatinine and blood urea nitrogen levels B. Trough drug levels of gentamicin C. Peak drugs levels of gentamicin D. Serum alanine aminotransferase and aspartate aminotransferase levels

B (trough levels must be sufficiently low to reduce exposure of sensitive sensory hearing cells. The risk of ototoxicity is related primarily to persistently elevated trough drug levels rather than to excessive peak levels)

A patient is prescribed doxycycline [Vibramycin]. If the patient complains of gastric irritation, what should the nurse do? A. Instruct the patient to take the medication with milk. B. Tell the patient to take an antacid with the medication. C. Give the patient food, such as crackers or toast, with the medication. D. Have the patient stop the medication immediately and contact the healthcare provider.

C

Fluoroquinolones should be discontinued immediately if what happens? A. Nausea, vomiting, or diarrhea is experienced. B. Dizziness, headache, or confusion occurs. C. Tendon pain or inflammation develops. D. Theophylline is prescribed for asthma.

C

The CDC recommends that before entering a patient's room, the nurse should do what? A. Wash hands with an antibacterial soap and water. B. Wash hands with a non-antibacterial soap and water. C. Use an alcohol-based handrub. D. Wash hands with chlorhexidine and water.

C

Which of the following terms best describes a higher-than-normal white blood cell count? A. Neutrophilia B. Leukopenia C. Leukocytosis D. Granulocytosis

C

when teaching a pt who has a gastric ulcer about cimetidine (H2 antagonist) therapy, nurse should include which info about antagonists? A. An antagonist causes a chemical reaction in the stomach. B. An antagonist activates receptors in the stomach lining. C. An antagonist prevents receptor activation in the stomach. D. An antagonist improves receptor sensitivity in the stomach

C

A patient has been prescribed ciprofloxacin for treatment of a urinary tract infection with Escherichia coli. Before administering the drug, it is most important for the nurse to assess the patient for a history of what? A. Hypertension B. Diabetes mellitus C. Myasthenia gravis D. Seasonal allergies

C (Ciprofloxacin and other fluoroquinolones can exacerbate muscle weakness in patients with myasthenia gravis. Accordingly, patients with a history of myasthenia gravis should not receive these drugs)

Which patient does the nurse identify as most likely to need treatment with trimethoprim/sulfamethoxazole [Bactrim] for a period of 6 months? A. A female patient with acute pyelonephritis B. A male patient with acute prostatitis C. A female patient with recurring acute urinary tract infections D. A male patient with acute cystitis

C (Female patients with relapses of urinary tract infection may need long-term therapy up to 6 months with trimethoprim/sulfamethoxazole)

Which information should the nurse include when teaching a patient about isoniazid (INH) therapy? A. Tubercle bacilli cannot develop resistance to isoniazid during treatment. B. Isoniazid is administered intravenously. C. An adverse effect of isoniazid therapy is peripheral neuropathy, which can be reversed with pyridoxine. D. The dose of isoniazid should be lowered if the patient is also taking phenytoin.

C (If peripheral neuropathy develops, it can be reversed by administering pyridoxine (50 to 200 mg daily). Tubercle bacilli can develop resistance to isoniazid during treatment. Isoniazid is administered orally and IM. Plasma levels of phenytoin should be monitored, and the phenytoin dosage should be reduced as appropriate; the dosage of isoniazid should not be changed. Isoniazid can raise levels of other drugs, including phenytoin)

A patient who takes warfarin has been prescribed sulfadiazine. When teaching the patient about this drug, which statement will the nurse include? A. "If you become pregnant, it is safe to take sulfadiazine." B. "You should limit your fluid intake while taking sulfadiazine." C. "Avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin." D. "You will most likely need to have an increase in the dose of warfarin while taking sulfadiazine."

C (Patients taking sulfadiazine should be advised to avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin. Sulfonamides can cause kernicterus in newborns. These drugs should not be administered to pregnant women near term, nursing mothers, or infants under 2 months old. Sulfadiazine causes deposition of sulfonamide crystals, which can injure the kidney. To minimize crystalluria, hydration should be sufficient to produce a daily urine flow of 1200 mL in adults; alkalinization of urine (eg, with sodium bicarbonate) can also help. Patients taking sulfadiazine should drink 8 to 10 glasses of water per day. Sulfonamides can intensify the effects of warfarin, phenytoin, and sulfonylurea-type oral hypoglycemics (eg, glipizide). When combined with sulfonamides, these drugs may require a reduction in dosage. TMP/SMZ is contraindicated for nursing mothers, pregnant women in the first semester or near term, infants under 2 months old, patients with folate deficiency (manifested as megaloblastic anemia), and patients with a history of hypersensitivity to sulfonamides and chemically related drugs, including thiazide diuretics, loop diuretics, and sulfonylurea-type oral hypoglycemics. Instruct patients to complete the prescribed course of treatment, even though symptoms may abate before the full course is over.)

Which drug does the nurse identify as a urinary tract antiseptic? A. Ciprofloxacin B. Ceftriaxone C. Nitrofurantoin D. Ceftazidime

C (Two urinary tract antiseptics currently are available: nitrofurantoin and methenamine. Ciprofloxacin, ceftriaxone, and ceftazidime are antimicrobials)

A healthcare worker has been exposed to B. anthracis on the hand. What is the most appropriate action by the healthcare worker? A. Apply an alcohol-based handrub to the hands. B. Start a systemic-based anti-infective drug. C. Soak the hand in povidone-iodine. D. Wash both hands with soap and water.

D

Digoxin has a half-life of 36 to 48 hours. Because of the length of the half-life, the nurse expects dosing to occur how often? A. 4 times per day B. 3 times per day C. 2 times per day D. Once a day

D

The nurse identifies which patient as being at highest risk for slow drug metabolism? A. A 2-year-old boy who is prescribed an oral antibiotic B. A 14-year-old girl who takes four prescription drugs C. A 56-year-old man who has chronic hepatic disease D. A 76-year-old woman who has an elevated temperature

D

It is most important for the nurse to avoid administering oral ciprofloxacin to this patient with which food? A. Bananas B. Baked chicken C. Grapefruit juice D. Milk

D (Absorption of ciprofloxacin can be reduced by compounds that contain cations. Among these are (1) aluminum- or magnesium-containing antacids, (2) iron salts, (3) zinc salts, (4) sucralfate, (5) calcium supplements, and (6) milk and other dairy products, all of which contain calcium ions. These cationic agents should be administered at least 6 hours before ciprofloxacin or 2 hours after.)

Which statement about the BCG vaccine does the nurse identify as true? A. BCG is a live preparation of attenuated Mycobacterium bovis. B. BCG is routinely administered in the United States. C. BCG has no effect on tuberculin skin tests. D. BCG vaccine can be used to treat carcinoma of the bladder.

D (BCG vaccine is also used to treat carcinoma of the bladder. BCG vaccine is a freeze-dried preparation of attenuated M. bovis (bacillus of Calmette and Guérin). In countries where TB is endemic, the World Health Organization recommends BCG vaccination in infancy)

A patient is prescribed cefazolin. It is most important for the nurse to teach the patient to avoid which substance while taking cefazolin? A. Warfarin B. Milk products C. Digitalis D. Alcohol

D (Cefazolin and cefotetan can cause alcohol intolerance. A serious disulfiram-like reaction may occur if alcohol is consumed. Inform patients about alcohol intolerance and warn them not to drink alcoholic beverages)

Before administering erythromycin to a patient for an upper respiratory tract infection, it is most important for the nurse to determine if the patient is also prescribed which drug? A. Guaifenesin [Guiatuss] B. Hydrocodone [Vicodin] C. Nitroglycerin [Tridil] D. Verapamil [Calan]

D (Rationale: QT prolongation and sudden cardiac death have occurred in patients taking CYP3A4 inhibitors, such as calcium channel blockers (verapamil), azole antifungal drugs, HIV-protease inhibitors, and nefazodone)

Which tetracycline may be administered with meals? A. Tetracycline B. Demeclocycline C. Doxycycline D. Minocycline

D (Rationale: Tetracycline, demeclocycline, and doxycycline should be administered on an empty stomach. Minocycline can be administered with meals)

Which information should the nurse include when teaching a patient about rifampin therapy? A. Oral contraceptives are safe to use with rifampin therapy. B. Contact your healthcare provider immediately if the color of your body fluids changes to reddish orange. C. Rifampin is safe to use in patients who have hepatic disease. D. Rifampin may be administered intravenously.

D (Rifampin may be administered intravenously. Women taking oral contraceptives should consider a non hormonal form of birth control while taking rifampin. Rifampin frequently imparts a red-orange color to urine, sweat, saliva, and tears; patients should be informed of this harmless effect. Permanent staining of soft contact lenses occasionally has occurred, so the patient should consult an ophthalmologist about contact lens use. Rifampin is toxic to the liver, posing a risk of jaundice and even hepatitis. Asymptomatic elevation of liver enzymes occurs in about 14% of patients. However, the incidence of overt hepatitis is less than 1%. Hepatotoxicity is most likely in alcohol abusers and patients with pre-existing liver disease. These individuals should be monitored closely for signs of liver dysfunction)

A patient is prescribed vancomycin orally for antibiotic-associated pseudomembranous colitis (infection of large intestine). The nurse will monitor the patient for what? A. Leukopenia B. "Red man" syndrome C. Liver impairment D. Ototoxicity

D (The most serious adverse effect of vancomycin is ototoxicity. "Red man" syndrome occurs only with rapid intravenous administration. Thrombocytopenia is an adverse effect of vancomycin)

A patient who was taking sulfonamides develops Stevens-Johnson syndrome. Upon assessment, the nurse expects to find what? A. Hypotension B. Bronchospasm C. Temperature of 35.5°C D. Widespread skin lesions

D (The most severe hypersensitivity response to sulfonamides is Stevens-Johnson syndrome, a rare reaction with a mortality rate of about 25%. Symptoms include widespread lesions of the skin and mucous membranes, combined with fever, malaise, and toxemia. Bronchospasm and hypotension, as well as tachycardia, are manifestations of anaphylactic reactions)

A prescriber states that a patient will need to receive penicillin intravenously. The nurse anticipates administering which drug? A. Penicillin V B. Procaine penicillin G C. Benzathine penicillin G D. Potassium penicillin G

D (When high blood levels are needed rapidly, penicillin can be administered IV. However, only the potassium salt should be administered by this route. Owing to poor water solubility, procaine and benzathine salts must never be administered IV. Penicillin V is administered orally)

The nurse is caring for a patient receiving intravenous gentamicin for a severe bacterial infection. Which assessment finding by the nurse indicates the patient is experiencing an adverse effect of gentamycin therapy? A. Blurred vision B. Hand tremors C. Urinary frequency D. Tinnitus

D (others = nephrotoxicity, neuromuscular blockade)