Pharm - Question in PPT

A patient complains of painful urination. A physical examination reveals vesicles on her labia, vagina, and the foreskin of her clitoris. The nurse will expect to teach this patient about which medication? Hmmm...vesicles. Sounds like Herpes Simplex virus. Ok, so I'm looking for an antiviral. A. Acyclovir [Zovirax] (yes!) B. Azithromycin [Zithromax] (Azithromycin is a macrolide antibiotic.) C. Cephalexin [Keflex] (This is a cephalosporin antibiotic...prefix: ceph.) D. Tinidazole [Tindamax] (This is an antifungal...suffix: azole.)

A.

Which statement about syphilis does the nurse identify as true? A.Penicillin G is the drug of choice for all stages of syphilis. B.Syphilis is treated with an antiviral. C.Azithromycin [Zithromax] IV is used to treat syphilis. D.Syphilis develops in one abrupt stage.

A.

A patient is being discharged on PO penicillin G for treatment of syphilis. Which of the following statements indicates a need for further education? Ok, so I am looking for the WRONG statement here. Are these true or false as related to PCN? A.I will make sure to take this medication 2 hours after I eat a meal. (True! Empty belly.) B.I will need to use an alternative type of birth control while on this medication. (True!) C.I can stop this medication once I feel better. (False!!! For all abx!) D.If I notice that my urine is darker in color, I will call my doctor. (Ok, so this might be a little tricky....this COULD indicate some renal issues so this is probably true, but I KNOW C is false and therefore my correct answer.)

C.

Your patient is being treated for gonorrhea with antibiotics. It is the nurse's priority to assess for which of the following before beginning treatment? Ok...so we treat gonorrhea with a cephalosporin and azithromycin. Ok so a cephalosporin and a macrolide. A.Superinfections (sounds good, but is it priority?) B.Atrial fibrillation (sounds good, cardiac, ABCs, but it's not associated with either antibiotic.) C.Constipation (sure, but probably not a priority.) D.An allergy to penicillin (Hmm...cephalosporins have a cross sensitivity to pcns and I need to make sure my patient isn't allergic to pcn before giving a cephalosporin because their allergy could be anaphylaxis which is an emergency!)

D.

STI During a routine screening, an asymptomatic, pregnant patient at 37 weeks' gestation learns that she has an infection caused by Chlamydia trachomatis. The nurse will expect the provider to order which drug? Ok, so the patient is pregnant and she has a bacterial STD. A. Azithromycin (yes!) B. Doxycycline (yes...but wait, she's pregnant. Not this one.) C. Penicillin G (hmmm...not associated with chlamydia. Not this one.) D. Amphotericin B (wait, this is an antifungal, chlamydia is a bacteria! Not this one.)

•A) Azithromycin •We use azithromycin and doxycycline but! We don't use doxy with pregnant women as it can potentially damage baby's teeth

A 17-year-old male patient asks about treatment options for Chlamydia trachomatis infection. Which response by the nurse is appropriate? A."Chlamydia is bacterial and is treated with azithromycin [Zithromax]." B."This infection is treatable but is best prevented by vaccination." C."The disease is viral and will be treated with valacyclovir [Valtrex]." D."The infection is fungal and fluconazole [Diflucan] will be prescribed."

•Answer: A •Rationale: Chlamydia trachomatis infection is a bacterial infection that may be treated with a single 1 g oral dose of azithromycin or 100 mg of doxycycline orally twice daily for 7 days in nonpregnant adolescents and adults.

Before administering gentamycin, it is most important for the nurse to assess the patient for a history of what? • A.Hypertension B.Stage 2 chronic renal failure C.Diabetes mellitus D.Asthma

•Answer: 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.

Which is(are) the preferred drug(s) for the treatment of gonorrhea? A.Gentamicin [Garamycin] and azithromycin [Zithromax] B.Ceftriaxone [Rochephin] and azithromycin [Zithromax] C.Nystatin [Mycostatin] D.Acyclovir [Zovirax]

•Answer: B •Rationale: Ceftriaxone (a cephalosporin) is the preferred drug for treating gonorrhea. It should be given in combination with either azithromycin or doxycycline. •Two drugs—doxycycline and azithromycin—are preferred agents for treating chlamydial infection in nonpregnant adolescents and adults. Acyclovir is used for the treatment of herpes simplex infection.

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.

•Answer: B •Rationale: 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.

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

•Answer: B •Rationale: To minimize ototoxicity, 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.

Antifungals A patient is receiving amphotericin B to treat a systemic fungal infection. To prevent renal damage, it is most important for the nurse to do what? ´ A.Administer the medication through a central venous access device. B.Administer potassium supplements. C.Administer 1000 mL of 0.9% saline before the dose is due. D.Administer the medication orally.

•Answer: C •Rationale: Amphotericin B causes renal injury in most patients. Kidney damage can be minimized by infusing 1 L of saline on the days amphotericin is infused.

The patient is ordered for daily intravenous gentamycin. The patient is due for a dose of gentamycin at 4:00 pm. When should the nurse obtain the trough level? • A.2:30 pm B.5:00 pm C.5:30 pm D.3:45 pm

•Answer: D •Draw samples for trough levels just before the next dose

Which statement by a new nurse about intravenous administration of amphotericin B indicates the nurse needs more education? ´ A.Almost all patients receiving amphotericin B experience some degree of nephrotoxicity. B.Patients receiving amphotericin B should be under close supervision in a hospital. C.Heparin can be used in the infusion site to prevent phlebitis associated with amphotericin B therapy. D.Diphenhydramine plus acetaminophen can minimize rigors associated with amphotericin B therapy.

•Answer: D •Rationale: Meperidine or dantrolene is used to treat rigors associated with amphotericin B therapy. Diphenhydramine plus acetaminophen can minimize fever, chills, rigors, nausea, and headache associated with amphotericin B therapy. The other statements are true.

Aminoglycosides 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

•Answer: D •Rationale: Ototoxicity can result from accumulation of the drug in the inner ear. Early signs that should be reported include tinnitus or headache. Other major adverse effects include nephrotoxicity and neuromuscular blockade.

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

•Answer: D •Rationale: 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.

Sulfonamides/Trimopine Which adverse affects is the nurse preventing by doing the following? Maintaining adequate hydration Performing periodic blood tests Avoiding in patients with a history of hypersensitive reactions to drugs Discontinuing when rash appears

•Renal impairments, crystalluria •Thrombocytopenia, hemolysis •Stevens-Johnson syndrome