NUR 350 exam 3
A patient has a Pseudomonas aeruginosa infection that is sensitive to aminoglycosides, and the prescriber orders gentamicin. The patient tells the nurse that a friend received amikacin [Amikin] for a similar infection and wonders why amikacin was not ordered. What will the nurse tell the patient?
"Amikacin is given when infectious agents are resistant to other aminoglycosides."
A patient is admitted to the unit for treatment for an infection. The patient receives IV amikacin [Amikin] twice a day. When planning for obtaining a peak aminoglycoside level, when should the nurse see that the blood is drawn?
30 minutes after the IV infusion is complete
Besides the cost of administering a given drug, which are considerations when a provider selects a cephalosporin to treat an infection? (Select all that apply.)
Antimicrobial spectrum Adverse effects Pharmacokinetics
A first-time parent of a 6-week-old infant tells the nurse that she feels anxious and sad, cries a lot, and has difficulty sleeping. What will the nurse do?
Ask her to complete the Edinburgh Postnatal Depression Scale.
An agitated, extremely anxious patient is brought to the emergency department. The prescriber orders a benzodiazepine. The nurse understands that benzodiazepines are used in this clinical situation based on which principle?
Benzodiazepines have a rapid onset of action.
A patient who has been taking an SSRI tells the nurse that the drug has caused reduced sexual performance, weight gain, and sedation. The nurse will suggest that the patient ask the provider about using which drug?
Bupropion [Wellbutrin]
A patient is brought to the emergency department after taking a handful of TCA pills. The nurse will expect to provide what when caring for this patient? (Select all that apply.)
Cardiac monitoring Gastric lavage and activated charcoal Cholinesterase inhibitors
Which cephalosporin may be used to treat meningitis?
Cefotaxime
A patient has a skin infection and the culture reveals methicillin-resistant Staphylococcus aureus (MRSA). What is an appropriate treatment for this patient?
Ceftaroline
A nurse is teaching a nursing student what is meant by "generations" of cephalosporins. Which statement by the student indicates understanding of the teaching?
Cephalosporins have increased activity against gram-negative bacteria with each generation."
Which fluoroquinolone antibiotics may be administered to children? (Select all that apply.)
Levofloxacin; ciprofloxacin
A patient who travels frequently for business reports occasional instances of being unable to fall asleep. The patient tells the nurse that job demands requiring staying up late and then getting up early for meetings. The nurse expects that the provider will prescribe which medication for this patient?
Zaleplon (Sonata)
A child with an ear infection is not responding to treatment with amoxicillin [Amoxil]. The nurse will expect the provider to order:
amoxicillin-clavulanic acid (Augmentin).
Which side effect of clindamycin [Cleocin] causes the most concern and may warrant discontinuation of the drug?
diarrhea
A 6-week-old infant who has not yet received immunizations develops a severe cough. While awaiting nasopharyngeal culture results, the nurse will expect to administer which antibiotic?
erythromycin ethylsuccinate
A woman 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 healthcare provider to order:
fosfomycin [Monurol].
A patient who takes the loop diuretic ethacrynic acid is given intravenous gentamicin for an infection. After several days of treatment with gentamicin, the nurse reviews the patient's most recent laboratory results and notes a gentamicin trough of 2.1 mcg/mL and normal blood urea nitrogen (BUN) and serum creatinine levels. The nurse will question the patient about:
headache, dizziness, or vertigo.
A nurse is caring for an African American patient who has been admitted to the unit for long-term antibiotic therapy with sulfonamides. The patient develops fever, pallor, and jaundice. The nurse would be correct to suspect that the patient has developed:
hemolytic anemia
A young adult patient has been taking an antidepressant medication for several weeks and reports having increased thoughts of suicide. The nurse questions further and learns that the patient has attempted suicide more than once in the past. The patient identifies a concrete plan for committing suicide. The nurse will contact the provider to discuss:
hospitalizing the patient for closer monitoring.
A neonate is born to a patient who reports taking venlafaxine (Effexor XR). The nurse caring for the infant will observe the infant for:
irritability, tremor, and respiratory distress
uring an admission history, a patient reports a frequent need to return to a room multiple times to make sure an iron or other appliance is unplugged. What does the nurse understand about this patient's behavior?
it helps the patient reduce anxiety about causing a fire.
pregnant patient is treated with trimethoprim/sulfamethoxazole (TMP/SMZ) [Bactrim] for a urinary tract infection at 32 weeks' gestation. A week later, the woman delivers her infant prematurely. The nurse will expect to monitor the infant for:
kernicterus.
A pregnant female patient with bacteriuria, suprapubic pain, urinary urgency and frequency, and a low-grade fever is allergic to sulfa, ciprofloxacin, and amoxicillin. The nurse knows that the best alternative for treating this urinary tract infection is with:
methenamine (Hiprex).
A young, nonpregnant female patient with a history of a previous urinary tract infection is experiencing dysuria, urinary urgency and frequency, and suprapubic pain of 3 days' duration. She is afebrile. A urine culture is positive for more than 100,000/mL of urine. The nurse caring for this patient knows that which treatment is most effective?
A 3-day course of trimethoprim/sulfamethoxazole (Bactrim)
nurse is preparing to administer an antibiotic to a patient with methicillin-resistant Staphylococcus aureus (MRSA). The nurse would expect the healthcare provider to order which antibiotic?
Daptomycin (Cubicin)
A patient receiving a cephalosporin develops a secondary intestinal infection caused by Clostridium difficile. What is an appropriate treatment for this patient?
Discontinuing the cephalosporin and beginning metronidazole [Flagyl]
A hospitalized patient who is given one dose of flurazepam continues to show drowsiness the next day. A nursing student asks the nurse the reason for this, because the drug's half-life is only 2-3 hours. Which response by the nurse is correct?
When this drug is metabolized, the resulting compound has longer-lasting effects"
A patient is receiving an intraperitoneal aminoglycoside during surgery. To reverse a serious side effect of this drug, the nurse may expect to administer which agent?
calcium gluconate
A patient has a viral sinus infection, and the provider tells the patient that antibiotics will not be prescribed. The patient wants to take an antibiotic and asks the nurse what possible harm could occur by taking an antibiotic. Which response by the nurse is correct?
"Even normal flora can develop resistance and transfer this to pathogens."
A nurse is preparing a patient who will stop taking Lorazepam (Ativan) for anxiety and begin taking buspirone (Buspar). Which statement by the patient indicates a need for further teaching?
"I should stop taking the Ativan when I start taking the Buspar"
A patient is to begin taking doxycycline to treat a rickettsial infection. Which statement by the patient indicates a need for teaching about this drug?
"I should take this drug with food to ensure more complete absorption."
A patient will receive oral ciprofloxacin [Cipro] to treat a urinary tract infection. The nurse provides teaching for this patient. Which statement by the patient indicates a need for further teaching?
"I should take this medication with food or milk to improve absorption."
A nurse is discussing methicillin-resistant Staphylococcus aureus (MRSA) with a group of nursing students. Which statement by a student correctly identifies the basis for MRSA resistance?
"MRSA bacteria have developed PBPs with a low affinity for penicillins."
A patient who is taking immunosuppressant medications develops a urinary tract infection. The causative organism is sensitive to sulfonamides and to another, more expensive antibiotic. The prescriber orders the more expensive antibiotic. The nursing student assigned to this patient asks the nurse why the more expensive antibiotic is being used. Which response by the nurse is correct?
"Sulfonamides are bacteriostatic and depend on host immunity to work."
A pregnant adolescent patient asks the nurse whether she should continue to take her prescription for tetracycline [Sumycin] to clear up her acne. Which response by the nurse is correct?
"Tetracycline can be harmful to the baby's teeth and should be avoided."
A pregnant patient with fever, flank pain, and chills has a history of two previous bladder infections before getting pregnant. She is allergic to several antibiotics. She reports having taken methenamine successfully in the past. What will the nurse tell her?
"This agent is not effective against infections of the upper urinary tract."
A patient is diagnosed with an infection caused by Staphylococcus aureus, and the prescriber orders intravenous gentamicin and penicillin (PCN). Both drugs will be given twice daily. What will the nurse do?
Administer gentamicin, flush the line, and then give the penicillin.
A prescriber has ordered cefoxitin for a patient who has an infection caused by a gram-negative bacteria. The nurse taking the medication history learns that the patient experienced a maculopapular rash when taking amoxicillin [Amoxil] several years earlier. What will the nurse do?
Administer the cefoxitin and observe for any side effects.
A provider has ordered ceftriaxone 4 gm once daily for a patient with renal impairment. What will the nurse do
Administer the medication as prescribed.
A patient describes feelings of anxiety and fear when speaking in front of an audience and is having difficulty at work because of an inability to present information at meetings three or four times each year. The patient is reluctant to take long term medications. The nurse will expect the provider to order which treatment?
Alprazolam (Xanax) as needed
A patient is diagnosed with a lung infection caused by P. aeruginosa. The culture and sensitivity report shows sensitivity to all aminoglycosides. The nurse knows that the rate of resistance to gentamicin is common in this hospital. The nurse will expect the provider to order which medication?
Amikacin (Amikin)
Which patient with a urinary tract infection will require hospitalization and intravenous antibiotics?
An older adult man with a low-grade fever, flank pain, and an indwelling catheter
A patient is diagnosed with anxiety after describing symptoms of tension, poor concentration, and difficulty sleeping that have persisted for over 6 months. Which medication will the nurse expect the provider to order for this patient?
Buspirone [Buspar]
A provider has indicated that a serotonin/norepinephrine reuptake inhibitor (SNRI) will be prescribed for a patient who is experiencing major depression. When conducting a pretreatment health history, the nurse learns that the patient has a recent history of alcohol abuse. Which SNRI would be contraindicated for this patient?
Duloxetine (Cymbalta)
Which sedative-hypnotics are useful for both difficulty falling asleep and difficulty maintaining sleep?
Extended-release zolpidem (Ambien CR), Flurazepam (Dalmane), Eszopiclone (Lunesta)
A patient who has obsessive compulsive order has been undergoing behavioral therapy but continues to exhibit symptoms that interfere with daily life. Which intervention will the nurse expect the provider to order for this patient?
Fluoxetine (Paxil)
A nurse is performing an admission assessment on a patient. The patient reports taking alprazolam (Xanax) for "nerves." The nurse knows that this patient is most likely being treated for which condition?
Generalized anxiety disorder
A patient is receiving tobramycin three times daily. A tobramycin peak level is 4.5 and the trough is 1.2. What will the nurse do?
Give the next dose as ordered.
A nurse transcribes a new prescription for potassium penicillin G given intravenously (IV) every 8 hours and gentamicin given IV every 12 hours. Which is the best schedule for administering these drugs?
Give the penicillin at 0800, 1600, and 2400; give the gentamicin [Garamycin] at 1800 and 0600.
A patient with second-degree burns is treated with silver sulfadiazine [Silvadene]. A nursing student asks the nurse about the differences between silver sulfadiazine and mafenide [Sulfamylon], because the two are similar products, and both contain sulfonamides. What does the nurse tell the student about silver sulfadiazine?
It has antibacterial effects related to release of free silver.
A patient is diagnosed with periodontal disease, and the provider orders oral doxycycline [Periostat]. The patient asks the purpose of the drug. What is the nurse's response?
It inhibits collagenase to protect connective tissue in the gums."
A patient is brought to the emergency department by friends, who say that they were at a party where alcohol and a mix of barbiturates and benzodiazepines were all available. They tell the nurse that the patient was among the first to arrive at the party, which started several hours ago. The patient is nonresponsive and has pinpoint pupils and respirations of 6 breaths per minute. After oxygen has been administered, the nurse should prepare the patient for which intervention?
Maintain oxygen to brain
A patient whose spouse has died recently reports feeling down most of each day for the past two months. On further questioning, the nurse learns that the patient has quit participating in church and social activities, has difficulty falling asleep, and has lost 5 pounds. The patient reports feeling tired and confused all the time but does not have suicidal thoughts. What does the nurse suspect?
Major depression
A patient has an infection caused by Pseudomonas aeruginosa. The prescriber has ordered piperacillin and amikacin, both to be given intravenously. What will the nurse do?
Make sure to administer the drugs at different times using different IV tubing.
A patient with severe community-acquired pneumonia has been prescribed telithromycin [Ketek]. Which aspect of the patient's medical history is of concern to the nurse?
Myasthenia gravis
A patient shows signs and symptoms of conjunctivitis. Which aminoglycoside would the nurse expect to be ordered?
Neomycin [Neomycin]
The nurse is caring for a patient on a medical-surgical unit who has a fever of unknown origin. The prescriber has ordered a broad-spectrum antibiotic. Which intervention is the priority?
Obtaining all cultures before the antibiotic is administered
A patient with new-onset seizure disorder receives a prescription for phenobarbital. The patient reports being concerned about the sedative side effects of this drug. Which response by the nurse is correct?
Phenobarbital doses for seizures are nonsedating"
A nurse is caring for a patient who takes an ACE inhibitor and an ARB medication who will begin taking TMP/SMZ to treat a urinary tract infection. Which serum electrolyte will the nurse expect to monitor closely?
Potassium
A hospitalized patient who is taking demeclocycline [Declomycin] reports increased urination, fatigue, and thirst. What will the nurse do?
Provide extra fluids and reassure the patient that these are expected side effects.
A patient has an infection caused by Streptococcus pyogenes. The prescriber has ordered dicloxacillin PO. What will the nurse do?
Question the need for a penicillinase-resistant penicillin.
A nurse is reviewing the culture results of a patient receiving an aminoglycoside. The report reveals an anaerobic organism as the cause of infection. What will the nurse do?
Request an order for a different class of antibiotic.
A patient is receiving intravenous potassium penicillin G, 2 million units to be administered over 1 hour. At 1900, the nurse notes that the dose hung at 1830 has infused completely. What will the nurse do?
Request an order for serum electrolytes and cardiac monitoring.
Selective serotonin reuptake inhibitors are known to be effective for which disorders?
Social Anxiety Disorder, Obsessive Compulsive Disorder, Panic disorder, Generalized Anxiety Disorder
A nursing student asks a nurse to clarify the differences between the mechanisms of spontaneous mutation and conjugation in acquired resistance of microbes. What will the nurse say?
Spontaneous mutation leads to resistance to only one antimicrobial agent.
A child has been receiving chloramphenicol for a Neisseria meningitidis central nervous system (CNS) infection. The nurse administers the dose and subsequently notes that the child has vomited and appears dusky and gray in color. The child's abdomen is distended. What will the nurse do?
Stop the infusion immediately and notify the provider.
A nurse recognizes that the actions of benzodiazepines include which findings?
Suppression of seizures and/or seizure activity, relief of general anxiety
A patient has been taking high doses of clorazepate [Tranxene] for several months for an anxiety disorder. The nurse assessing the patient observes that the patient is agitated, euphoric, and anxious. What will the nurse do?
Suspect a possible paradoxical reaction to the clorazepate
A child with otitis media has had three ear infections in the past year. The child has just completed a 10-day course of amoxicillin [Amoxil] with no improvement. The parent asks the nurse why this drug is not working, because it has worked in the past. What will the nurse tell the patient?
The bacteria have synthesized penicillinase."
A patient develops CDAD. Which antibiotic is recommended for treating this infection?
Vancomycin
A hospitalized patient who is given one dose of flurazepam continues to show drowsiness the next day. A nursing student asks the nurse the reason for this, because the drug's half-life is only 2 to 3 hours. Which response by the nurse is correct?
When this drug is metabolized, the resulting compound has longer-lasting effects.
A nurse assisting a nursing student with medications asks the student to describe how penicillins (PCNs) work to treat bacterial infections. The student is correct in responding that penicillins:
disrupt bacterial cell wall synthesis.
An older adult patient who is to begin taking Imipramine (Tofranil) asks the nurse when the drug should be taken. The nurse will instruct the patient to:
divide the daily dose into two equal doses 12 hours apart
A nurse is obtaining a drug history from a patient about to receive sulfadiazine. The nurse learns that the patient takes warfarin, glipizide, and a thiazide diuretic. Based on this assessment, the nurse will expect the provider to:
monitor the patient's coagulation levels.
An older adult patient with chronic obstructive pulmonary disease (COPD) develops bronchitis. The patient has a temperature of 39.5°C. The nurse will expect the provider to:
order empiric antibiotics while waiting for sputum culture results.
A nurse is preparing to administer a dose of gentamicin to a patient who is receiving the drug 3 times daily. The nurse will monitor ____ levels.
peak and trough
A patient who is taking doxycycline for a serious infection contacts the nurse to report anal itching. The nurse will contact the provider to discuss:
prescribing an antifungal drug to treat a suprainfection.
A patient presents to the emergency department with complaints of chills, severe flank pain, dysuria, and urinary frequency. The patient has a temperature of 102.9°F, a pulse of 92 beats per minute, respirations of 24 breaths per minute, and a blood pressure of 119/58 mm Hg. The nurse would be correct to suspect that the patient shows signs and symptoms of:
pyelonephritis
The nurse is caring for a patient who is receiving vancomycin [Vancocin]. The nurse notes that the patient is experiencing flushing, rash, pruritus, and urticaria. The patient's heart rate is 120 beats per minute, and the blood pressure is 92/57 mm Hg. The nurse understands that these findings are consistent with:
red man
A patient who has fibromyalgia is diagnosed with major depression. The provider orders a TCA. The nurse will teach this patient to:
sit or lie down when feeling lightheaded
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. What describes the etiology of the thrush?
superinfection
A patient who is taking calcium supplements receives a prescription for ciprofloxacin [Cipro] for a urinary tract infection. The nurse will teach this patient to:
take the calcium either 6 hours before or 2 hours after taking the ciprofloxacin.
A patient who is experiencing alcohol withdrawal is given a benzodiazepine. The nurse understands that this drug is effective because:
the patient has a cross-dependence to the benzodiazepine
