Pharm 1 A

B

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? A) Conjugation results in a gradual increase in resistance. B) Spontaneous mutation leads to resistance to only one antimicrobial agent. C) Spontaneous mutation can transfer DNA from one organism to another. D) Conjugation results in random changes in the microbe's DNA.

A

A child has received amoxicillin [Amoxil] for three previous ear infections, but a current otitis media episode is not responding to treatment. The nurse caring for this child suspects that resistance to the bacterial agent has occurred by which microbial mechanism? A) Drug Inactivation B) Reduction of drug concentration at the site of action C) Antagonist production D) Alteration of drug target molecules

D

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.

A (Rationale: Intravenous administration results in the fastest and most complete absorption of a drug.)

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 parent asks a nurse if the provider will prescribe an antibiotic for a child who attends school with several children who have strep throat. The child is complaining of a sore throat and has a fever. What will be the nurse's response? A) "Your child should come to the clinic to have a throat culture done today." B) "Your child probably has strep throat, so your provider will order an antibiotic." C) "With good hand washing, your child should not get strep throat" D) "Because strep throat is likely, your child should be treated empirically."

B

A patient has a localized skin infection, which is most likely caused by a gram-positive cocci. Until the culture and sensitivity results are available, the nurse will expect the provider to order a ____-spectrum ____ agent. A) narrow; systemic B) narrow; topical C) broad; topical D) broad; systemic

D

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? A) "Patients who overuse antibiotics are more likely to have nosocomial infections." B) "Host cells become resistant to antibiotics with repeated use." C) "Antibiotics are mutagenic and can produce changes that cause resistance." D) "Even normal flora can develop resistance and transfer this to pathogens."

C (Ciprofloxacin and other fluoroquinolones can exacerbate muscle weakness in patients with myasthenia gravis.)

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

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

B (Local application of mafenide is frequently painful)

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.

C (Patients taking sulfadiazine should be advised to avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin.)

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

An older adult patient with chronic obstructive pulmonary disease (COPD) develops bronchitis. The patient has a temperature of 103.1°F. The nurse will expect the provider to: A) Obtain a sputum culture and wait for the results before prescribing an antibiotic. B) Treat symptomatically, because antibiotics are usually ineffective against bronchitis. C) Order empiric antibiotics while waiting for sputum culture results. D) Treat the patient with more than one antibiotic without obtaining cultures.

D

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]

B

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

D (Rationale: The concept of the half-life tells us that, no matter what the amount of drug in the body may be, half (50%) will leave during a specified period of time (ie, the half-life). The actual amount of drug that is lost during one half-life depends on just how much drug is present: The more drug that is in the body, the larger the amount lost during one half-life. If a long dosing interval were used, drug levels would fall below the minimum effective concentration between doses, and therapeutic effects would be lost. Conversely, if a drug has a long half-life, a long time can separate doses without a loss of benefits.)

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

C (Fluoroquinolones can cause tendon rupture and should be discontinued if tendon pain or inflammation develops.)

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.

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

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 nonantibacterial soap and water. C) Use an alcohol-based handrub. D) Wash hands with chlorhexidine and water.

B

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

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. What describes the etiology of the thrush? A) Superinfection B) Nosocomial Infection C) Community Acquired Infection D) Antibiotic Resistance

C (Rationale: Drug metabolism, which is also known as biotransformation, is the enzymatic alteration of drug structure. Most drug metabolism takes place in the liver.)

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

B

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? A) Delaying administration of the antibiotic until the culture results are available. B) Obtaining all cultures before the antibiotic is administered. C) Administering the Antipyretics as soon as possible. D) Administering the antibiotic immediately.

D

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 (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.)

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.

B

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

B (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.)

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 (Metronidazole is a drug of choice for C. difficile infection.)

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

B (Commonly reported adverse reactions to oral acyclovir therapy include nausea, vomiting, diarrhea, headache, and vertigo.)

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

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."

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.)

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

B (Hypersensitivity reactions are common with cephalosporins. Patients should be instructed to report any signs of allergy, such as skin rash, itching, or hives.)

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

C

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.

D (The most severe hypersensitivity response to sulfonamides is Stevens-Johnson syndrome, a rare reaction with a mortality rate of about 25%.)

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

B (A few patients with penicillin allergy (about 1%) display cross-sensitivity to cephalosporins. If at all possible, patients with penicillin allergy should not be treated with any member of the penicillin family.)

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.

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.)

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

B

A recent campaign, initiated by the Centers for Disease Control (CDC), to delay the emergence of antibiotic resistance in hospitals, has what as one of its objectives? A) Allowing prescribers to develop their own prescribing guidelines B) Increased adherence to prescribed antibiotics C) Allowing patients to stop antibiotics when symptoms subside D) Increased use of antibiotics among parents of young children

B

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

D

The nurse is teaching a nursing student about the mechanism by which antimicrobial agents achieve selective toxicity. Which statement by the student indicates a need for further teaching? A) "Some agents act to block the conversion of para-aminobenzoic acid (PABA) to folic acid." B) "Some agents weaken the cell wall, causing cell wall lysis." C) "Some agents disrupt the bacterial cell wall." D) "Some agents cause phagocytosis of bacterial cells."

B, C, D

The nurse is teaching a pharmacology refresher course to a group of nurses. A student asks what host factors affect the choice of agents in antimicrobial therapy. The nurse will tell the students that such host factors include what? (Select all that apply.) A) Gender B) Immune system status C) Infection site D) Age E) Weight

A (Rarely, ciprofloxacin and other fluoroquinolones have caused tendon rupture, usually of the Achilles tendon.)

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 (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.)

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 (A capsule may cost more than a pill. Sustained-release formulations are capsules filled with tiny spheres that contain the actual drug; the individual spheres have coatings that dissolve at variable rates. Because some spheres dissolve more slowly than others, drug is released steadily throughout the day. These capsules should not be crushed. The primary advantage of sustained-release preparations is that they permit a reduction in the number of daily doses. These formulations have the additional advantage of producing relatively steady drug levels over an extended time (much like giving a drug by infusion). The major disadvantages of sustained-release formulations are their high cost and their potential for variable absorption.)

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 most 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.

C (Rationale: Antagonists produce their effects by preventing receptor activation by endogenous regulatory molecules and drugs. Antagonists have virtually no effects of their own on receptor function.)

When teaching a patient who has a gastric ulcer about cimetidine (a histamine H2 antagonist) therapy, the nurse should include which information 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.

A, D, E

Which are benefits of using a combination of two or more antibiotics? (Select all that apply.) A) Reduced toxicity B) Reduced cost C) Reduced risk of superinfection D) Reduced risk in severe infection E) Reduced resistance

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

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

C (If peripheral neuropathy develops, it can be reversed by administering pyridoxine (50 to 200 mg daily))

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.

D (Rifampin may be administered intravenously. Women taking oral contraceptives should consider a nonhormonal 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.)

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.

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

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

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 (Severe pyelonephritis requires intravenous antibiotic therapy.)

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

D, E

Which patients should be given antibiotics prophylactically? (Select all that apply.) A) Children undergoing chemotherapy who have mild neutropenia B) Postoperative patients who have undergone emergency cesarean sections C) Children who attend day care with other children who have strep throat D) Patients with compound fractures undergoing surgical repair E) Patients with certain congenital heart defects at risk for bacterial endocarditis

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.

B (Rationale: It is important to note that agonists do not necessarily make physiologic processes go faster; receptor activation by these compounds can also make a process go slower. Receptors are dynamic components of the cell. A partial agonist is an agonist that has moderate intrinsic activity.)

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

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.

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

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

A

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