Pharm Exam 3

A client is allergic to penicillin and has been diagnosed with a genitourinary infection caused by Chlamydia trachomatis. Which medication will most likely be administered? A. erythromycin B. flumazenil C. acamprosate calcium D. atazanavir

A. A client who is diagnosed with a genitourinary infection that is caused by trachomatis and who is allergic to penicillin should be administered erythromycin since there is no known cross-reaction. Acamprosate calcium is administered as a substance abuse deterrent, not in place of penicillin. Atazanavir is an antiviral agent that is used to treat HIV infection, not Chlamydia trachomatis. Flumazenil is a benzodiazepine antagonist and not used for Chlamydia trachomatis.

For what client would a broad-spectrum antibiotic be most appropriate? A. A client who has symptoms of infection but whose culture and sensitivity results are not yet available B. A client who has an oral temperature of 100.2° F (37.9° C) but no other signs or symptoms of infection C. A client whose urinary tract infection has been attributed to Escherichia coli D. A client with a respiratory infection who is 84 years old

A. Broad-spectrum antibiotics are often used to treat infections while awaiting the results of culture and sensitivity testing. The presence of a fever with no other signs of infection would not be an indication for the use of broad-spectrum antibiotics. Narrow-spectrum antibiotics are generally preferred when the causative microorganism of an infection is known. Advanced age is not an indication for broad-spectrum antibiotic use.

The nurse is caring for a client who is taking tetracycline for Rocky Mountain spotted fever. The nurse notices that the client has developed painful mouth ulcers. The nurse knows that the client has developed what adverse reaction to the medication? A. Stomatitis B. Acne C. Hypersensitivity reaction D. Gastritis

A. Stomatitis is the development of ulcers in the mucous membranes of the oral cavity. It is an adverse reaction seen in clients taking tetracycline. Epigastric distress is another adverse reaction but is an inflammation of the stomach. A hypersensitivity reaction is usually seen as hives or wheals on the skin, and tetracycline is used in the treatment of acne.

A client has been prescribed ciprofloxacin IV for the treatment of cellulitis. After initiating the infusion of the client's first scheduled dose, the client develops a pronounced rash on the chest and arms. How should the nurse respond initially to this event? A. Slow down the rate so that the infusion takes place over 2 hours. B. Discontinue the infusion and inform the care provider promptly. C. Administer oral diphenhydramine to the client during the infusion. D. Administer an STAT dose of acetylcysteine.

B. Severe hypersensitivity reactions have occurred with the administration of fluoroquinolones. The nurse discontinues the antibiotic immediately if skin rash or other signs or symptoms occur. Administration of acetylcysteine or diphenhydramine is not indicated. Slowing down the rate of infusion would not address the problem as it relates to exposure to the medication. Neither the administration of acetylcysteine nor diphenhydramine is indicated initially. Acetylcysteine is prescribed to treat thick mucus lung secretions. Treatment with diphenhydramine would be ineffective if the ciprofloxacin were not first discontinued.

A client is receiving a cephalosporin and an aminoglycoside as combination therapy. What assessment should the nurse prioritize? A. Coagulation studies B. Signs of disulfiram-like reaction C. Serum BUN and creatinine levels D. Complete blood count

C. Explanation: The nurse would need to assess renal function indicated by serum BUN and creatinine levels because combining cephalosporins with aminoglycosides increases the client's risk for renal toxicity. Coagulation studies would be important if the client was receiving a cephalosporin with an oral anticoagulant because there is an increased risk for bleeding. Combining cephalosporins with alcohol could result in a disulfiram-like reaction. Assessing the client's complete blood count would not be directly indicated by the combination of cephalosporins and aminoglycosides.

A client diagnosed with Chlamydia is allergic to penicillin. What medication could be used as a substitute for penicillin in this situation? A. chloramphenicol B. tetracycline C. doxycycline D. erythromycin

D. Erythromycin is used as a penicillin substitute in clients who are allergic to penicillin and for prevention of rheumatic fever, gonorrhea, syphilis, pertussis, and chlamydial conjunctivitis in genitourinary infections caused by Chlamydia trachomatis and intestinal amebiasis caused by Entamoeba histolytica. None of the other options are typically used as a substitute to account for an allergy to penicillin when treating chlamydia.

Administration of what type of antibiotic by the nurse would be most likely to cause a superinfection? A. narrow spectrum B. bactericidal C. bacteriostatic D. broad spectrum

D. One offshoot of the use of anti-infectives, especially broad-spectrum anti-infectives, is destruction of the normal flora, allowing opportunistic pathogens to invade tissue and cause a superinfection. Narrow-spectrum anti-infectives are less likely to kill normal flora, although it is not impossible. A drug may be bactericidal, meaning it kills the pathogen; or bacteriostatic, meaning it prevents reproduction of the pathogen, but this is not related to superinfections.

Aminoglycosides toxicity

Ototoxicity and nephrotoxicity

Ciprofloxacin

Photosensitivity.

Aminoglycosides and potent diuretics

Should avoid being combined. It increases the incidence of ototoxicity, nephrotoxicity, and neurotoxicity

Disulfiram-like reaction are?

The client should avoid consuming alcoholic beverages for at least 72 hours after completing the drug course. s/s: Flushing, throbbing in the head and neck, respiratory difficulty, vomiting, sweating, chest pain, and hypotension are symptoms a nurse might observe in a client having this reaction.

Cephalosporins

Used to treat urinary tract infections, skin infections, and hospital-acquired pneumonias.

A nurse is preparing to give a patient an initial dose of a penicillin preparation. What is the first action the nurse should take? a) Ask the patient if he or she has ever had an allergic reaction to a penicillin. b) Ask the patient if he or she has ever had an episode of anaphylaxis. c) Ask the patient if he or she wears a medic alert bracelet. d) Ask the physician to order a skin test to assess the patient for hypersensitivity to penicillin.

a) Ask the patient if he or she has ever had an allergic reaction to a penicillin.Before giving the initial dose of any penicillin preparation, ask the patient if he or she has ever taken penicillin and, if so, whether an allergic reaction occurred. If the patient is believed to be hypersensitive and the penicillin is considered essential, a skin test can help assess the degree of hypersensitivity; the physician can use the results of the test to determine whether and how to administer a penicillin to the patient. Although penicillins are a common source of drug-induced anaphylaxis, not all anaphylaxis is caused by drugs.

When discussing cephalosporins with the nursing class, the pharmacology instructor explains that this classification of drug is primarily excreted through which organ? a) Kidney b) Liver c) Skin d) Lung

a) Kidney The cephalosporins are primarily metabolized in the liver and excreted in the urine. These drugs cross the placenta and enter breast milk. They are not excreted through the lungs, the liver, or the skin

An older adult is to receive a low dose of a cephalosporin for an infection. The nurse realizes that this client has age-related diminished renal function. What should the nurse do? a) Monitor blood creatinine levels. b) Substitute the drug with another type of anti-infective. c) Refuse to give the drug. d) Tell the patient not to take the drug.

a) Monitor blood creatinine levels. The older adult is more susceptible to the nephrotoxic effects of the cephalosporins, particularly if renal function is already diminished because of the aging process or a disease. With renal impairment, a lower dose can be given and monitoring creatinine levels is indicated. Refusing to give the drug is not necessary and substituting another drug is not in the scope of nursing practice. Telling the patient not to take the drug is also not therapeutic, because a low dose of the medication has been ordered.

A patient has been admitted to the critical care unit with a diagnosis of peritonitis that has necessitated treatment with gentamicin. As a result, the care team should be cautious when concurrently administering other medications that may cause a) ototoxicity or nephrotoxicity. b) neutropenia or autoimmune effects. c) increased intracranial pressure or changes in cognition. d) anemia or impaired erythropoiesis.

a) ototoxicity or nephrotoxicity. Because of the potential for nephrotoxicity and ototoxicity that is associated with gentamicin, other medications that may lead to these same adverse effects must be used with caution. Gentamicin does not typically affect immune function, ICP, or hematopoiesis.

The nurse is caring for a 62-year-old client who has been prescribed gentamicin. The patient reports difficulty hearing. What should the nurse do? a) Administer the dose and then notify the physician. b) Hold the dose and notify the physician immediately. c) Administer the dose and report this information to the oncoming nurse at shift change. d) Administer the dose and document the observation in the nursing notes.

b) Hold the dose and notify the physician immediately. Nurses should monitor clients for signs of aminoglycoside-induced ototoxicity. Since there is a possibility of reversing the condition (or at least arresting it) by discontinuing or reducing dosage of the drugs, the nurse should immediately contact the physician and hold the dose until receiving additional guidance.

When checking a patient's allergy history, the nurse should assume that if a patient is allergic to penicillins, he or she likely is also allergic to cephalosporins? a) False b) True

b) True Because of the close relationship of cephalosporins to penicillins, a patient allergic to penicillin may be allergic to cephalosporins. Approximately 10% of people allergic to a penicillin drug are also allergic to a cephalosporin.

The nurse is caring for a 23-year-old female client who uses oral contraceptives and has been prescribed ampicillin for treatment of a respiratory infection. What information is most important for the nurse to share with this client? a) Taking this antibiotic with your oral contraceptives will cause an increased chance of bleeding. b) Use a type of barrier birth control while you are taking this antibiotic. c) Do not take your oral contraceptives while you are taking this medication. d) You will need to double up on your oral contraceptive pills while taking this antibiotic.

b) Use a type of barrier birth control while you are taking this antibiotic. Clients taking oral contraceptives should be encouraged to use a barrier type of birth control during penicillin therapy; the penicillin will cause a decreased effectiveness of the contraceptive agent. The client should not be told to stop taking the oral contraceptive or to double the number of pills taken. The interaction between oral contraceptives and ampicillin will not cause an increased chance of bleeding, as that interaction is between large doses of penicillins and anticoagulants.

A client is prescribed cefazolin for a sinus infection. After administration of the first dose of the medication, the client reports itching. The nursing assessment reveals a rash over the client's torso; the client has a history of allergic reaction to penicillin. The client: a) is having an anaphylactic reaction and needs to be transferred to the ICU. b) is experiencing an allergic reaction caused by a cross-sensitivity reaction. c) should be watched carefully during the next dose of the medication to ensure the symptoms do not become more severe. d) is experiencing a side effect from the medication.

b) is experiencing an allergic reaction caused by a cross-sensitivity reaction. Cefazolin is contraindicated in anyone with a known allergy to cephalosporins. Caution must be used in clients with renal failure and in pregnant or lactating women. Because of the structural similarities between cephalosporins and penicillins, clients who are allergic to one type of drug may experience cross-sensitivity to the other. Cephalosporin hypersensitivity occurs in 5% to 10% of clients with penicillin allergy. Clients with a history of severe allergic reactions to penicillins should not receive cephalosporins because of their increased risk for cross-sensitivity reactions.

A patient with a longstanding diagnosis of chronic renal failure has experienced a significant decline in urine output in recent days, prompting him to seek care at a local clinic. A nurse at the clinic has suggested to a colleague that the administration of a diuretic such as hydrochlorothiazide may improve the patient's urine output. How should the colleague best respond to this suggestion? a) "That would probably help, but we'd have to do blood work first." b) "Actually, patients with renal failure usually can't take hydrochlorothiazide." c) "That would only work if he could come in twice a day to get it intravenously." d) "Maybe, but hydrochlorothiazide affects the bladder more than the kidneys."

b.)

What is the nurse's best response when the client asks why the nurse is obtaining a urine sample for culture and sensitivity, after the health care provider had diagnosed the client with a urinary tract infection? a) "The test is needed to know that you are adequately hydrated." b) "This test is done to make sure that you are not pregnant." c) "This test lets the health care provider know what medication will best treat the infection." d) "This test tells the health care provider if the infection has traveled to your kidneys."

c) "This test lets the health care provider know what medication will best treat the infection. "A urine for culture and sensitivity is performed to determine bacterial sensitivity to the drugs that will control the infection. It does not determine hydration or pregnancy status and will not reveal if the infection has traveled to the kidneys.

A nurse is caring for a patient who is being administered phenazopyridine. The patient is distressed on seeing that the urine is exhibiting a reddish-orange discoloration. Which is the most appropriate response by the nurse? a) "You will need to increase your fluid intake." b) "We will have to conduct a urinalysis." c) "You don't have to worry. This is normal with this medication." d) "I will have to notify the PHCP immediately."

c) "You don't have to worry. This is normal with this medication."The nurse should inform the patient that phenazopyridine may cause a reddish-orange discoloration of the urine, which is normal, so there is no cause to worry. Periodical urinalysis is conducted as a part of the ongoing assessment when caring for a patient with UTI. Since the orange-reddish discoloration of urine is normal, the nurse need not notify the primary health care provider immediately. The nurse also need not ask the patient to increase his intake of fluids.

Penicillins may trigger an anaphylactic reaction in some patients. During what period following injection of a penicillin is anaphylaxis most likely to occur? a) 12 hours b) 2 hours c) 30 minutes d) 8 hours

c) 30 minutes Anaphylaxis induced by injectable penicillins typically occurs within 30 minutes of administration.

A client is receiving ciprofloxacin for a urinary tract infection. This drug is administered IV. During an infusion, the nurse notes fluid leaking into the tissue around the IV site. What is the best response of the nurse? a) Increase the IV drip rate. b) Elevate the extremity. c) Discontinue the IV. d) Administer pain medication.

c) Discontinue the IV. Extravasation is occurring. Fluid is leaking into the surrounding tissue, and the IV infusion must be discontinued to prevent further tissue damage.

A nurse needs to administer a cephalosporin to a patient. The patient informs the nurse that he is allergic to penicillin. Which of the following actions is the nurse most likely to take in such a situation? a) Obtain patient's occupational history. b) Administer an antipyretic drug. c) Inform the primary health care provider. d) Suggest kidney function tests.

c) Inform the primary health care provider.Patients with a history of an allergy to penicillin may also be allergic to cephalosporin, so the nurse needs to inform the primary health care provider before the first dose of the drug is given. An antipyretic drug is administered when there is an increase in the body temperature of a patient receiving cephalosporin. Liver and kidney function tests may be ordered by the primary health care provider, not the nurse. Occupational history should be obtained before administration of any drug, irrespective of the patient's allergies.

A nurse is caring for a patient who has a serious infection. The patient is being treated with combination therapy of a cefazolin and an aminoglycoside. The nurse will be sure to monitor which of the following? a) Aspartate aminotransferase levels b) Serum sodium and potassium levels c) Prothrombin time (PT) and partial thromboplastin time (PTT) d) Serum BUN and creatinine levels

d) Serum BUN and creatinine levelsPatients receiving combination therapy of a cefazolin and an aminoglycoside will need to be monitored for nephrotoxicity and therefore would need serum BUN and creatinine levels done. Serum sodium and potassium levels as well as aspartate aminotransferase should be monitored when receiving sodium penicillin G. PT and PTT should be monitored when a patient is receiving aztreonam, a monobactam antibiotic.

A client is prescribed ciprofloxacin for a urinary tract infection. The nurse is preparing to teach the client about the medication. What must the nurse include in the education plan? a) Take a forgotten dose as soon as it is remembered, even if it is almost time for the next dose. b) Take the necessary vitamins along with the drug. c) Avoid dry areas to prevent the risk of asthma. d) Take precautions to prevent photosensitivity.

d) Take precautions to prevent photosensitivity. Caution the client about possible photosensitivity and encourage the client to take precautions to avoid sunlight or ultraviolet light. A forgotten dose may be taken as soon as it is remembered, but not if it is almost time for the next dose. Some vitamins also can decrease the absorption of ciprofloxacin; they should be taken at least 2 hours before or after the administration of ciprofloxacin, never along with the drug. The client need not avoid dry areas, as the drug is not known to increase the risk for asthma.

What symptom should the nurse expect to find if the client begins to exhibit signs of ototoxicity? a) Anorexia b) Rash c) Fatigue d) Tinnitus

d) Tinnitus One of the first symptoms to occur in a client who is developing ototoxicity is tinnitus or ringing in the ears. Fatigue, anorexia, and rash are other adverse effects but are not related to ototoxicity.