Pharm Unit 4

A patient being treated for TB asks to have a medication change to cycloserine because a family member read about the drug online. How should the nurse respond? -"Cycloserine is not as effective and can be more toxic." -"Cycloserine is more effective and less toxic." -"Cycloserine has more side effects than other medications." -"Cycloserine has less side effects than other medications."

"Cycloserine is not as effective and can be more toxic."

The nurse teaches Anna about amoxicillin. Which statement made by Anna indicates that further teaching is required? -"I should take this medication by mouth." -"It is okay for me to stop taking my medicine as soon as I feel better." -"I should not take this medicine if I have an allergy to penicillin or cephalosporin." -"I should use another form of birth control in addition to my birth control pills when taking this medication."

"It is okay for me to stop taking my medicine as soon as I feel better."

A student nurse is assisting a registered nurse with the admission of Ms. Houghton, and questions the registered nurse regarding the health care provider's order for pyridoxine. How should the registered nurse respond? -"Pyridoxine is necessary to prevent peripheral neuropathy." -"Pyridoxine should not be ordered at this time. I will call the health care provider." -"Pyridoxine is essential to prevent hepatotoxicity." -"Pyridoxine is necessary to prevent the patient from experiencing delirium tremens (DTs)."

"Pyridoxine is necessary to prevent peripheral neuropathy."

A nurse is doing discharge teaching with a patient receiving isoniazid and rifampin for a TB diagnosis, and the patient asks why two medications have to be taken. How does the nurse respond to this patient? -"It is the health care provider's preference regarding how many medications are prescribed." -"Combinations decrease resistance and treatment time." -"Combinations decrease resistance, but increase treatment time." -"Combination increase resistance, but decrease treatment time."

-"Combinations decrease resistance and treatment time."

A patient on IV vancomycin is tired of the long infusion times and would like to have his medication administered by IV push. What education should the nurse provide regarding this request? -"IV vancomycin is more effective when given slowly." -"IV vancomycin cannot be given by IV push because that type of administration can cause phlebitis." -"The IV Vancomycin cannot be given by IV push because that is not how it has been ordered by the health care provider." -"IV push is contradicted with vancomycin because fast administration can have a toxic effect known as Red Man Syndrome."

-"IV push is contradicted with vancomycin because fast administration can have a toxic effect known as Red Man Syndrome."

A hospitalized patient is prescribed multiple antibiotics for an infection. The patient asks why she is taking so many different types of antibiotics. What is the best response for the nurse to give? -"Multi-antibiotic therapy helps delay the development of microorganism resistance." -"Multi-antibiotic therapy uses fewer doses to treat an infection than single-antibiotic therapy." -"Multi-antibiotic therapy helps the health care provider determine if a patient is allergic to any of the medications." -"Multi-antibiotic therapy is used when the health care provider does not know what microorganism is causing the infection."

-"Multi-antibiotic therapy helps delay the development of microorganism resistance."

What response does the nurse give after the patient receiving multidrug therapy for TB asks about the length of time for treatment? -"Therapy will have to stop if your liver enzymes get too high." -"Therapy will end once your symptoms go away and you feel better." -"Multidrug therapy is 3 medications taken for 2 years." -"Multidrug therapy is split into two phases, about 9 months total."

-"Multidrug therapy is split into two phases, about 9 months total."

A patient states she is feeling better after completing half of her antibiotic therapy with no complications. What education should the nurse provide? -"Save the remainder of the antibiotics for use with a future infection." -"The prescription should be taken until completed even if you are feeling better." -"It is advisable to discontinue use of antibiotics if all of the symptoms have resolved." -"You can increase the frequency of dosing to complete the antibiotic therapy more quickly."

-"The prescription should be taken until completed even if you are feeling better."

A 30-year-old female patient is prescribed amoxicillin. Which education should the nurse provide? -"If you develop diarrhea, take amoxicillin with food." -"Make sure to take amoxicillin on an empty stomach." -"Avoid taking amoxicillin at the same time as an oral contraceptives." -"Use an additional form of birth control while taking this medication."

-"Use an additional form of birth control while taking this medication."

The nurse is preparing home instructions for a patient who has been diagnosed with a vaginal candidiasis infection. Which instruction should the nurse include when teaching the patient about taking antifungal medications? -"The infection should clear in 24 hours." -"You do not need medication to treat this infection." -"Once medication is started you can resume sexual intercourse." -"You must abstain from sexual intercourse until the treatment is finished and the infection is resolved."

-"You must abstain from sexual intercourse until the treatment is finished and the infection is resolved."

A nurse is completing the admission assessment for a patient being treated with active tuberculosis. The patient states that he lives with his wife and son. Which patient teaching statement is appropriate? -"Your wife and son will need to have a purified protein delivery (PPD) test and may require prophylactic treatment." -"Encourage your wife and son to stay inside and not leave the house for 3 days." -"If your wife or son start to have symptoms, you can share your medication with them." -"Your wife and son should eat a healthy diet to prevent coming down with symptoms of TB."

-"Your wife and son will need to have a purified protein delivery (PPD) test and may require prophylactic treatment."

At which time does the nurse tell the patient to take isoniazid in regard to food? -Immediately prior to eating -1 hour before or 2 hours after eating -Immediately after eating - hour after eating only

-1 hour before or 2 hours after eating

Which patient should receive prophylactic tubercular therapy? -A child whose sister has been recently diagnosed with active TB. -A woman who works in a hospital and has a negative TB test. -A man who is HIV positive with a negative TB test. -A man on a liver transplant list with a negative TB test.

-A child whose sister has been recently diagnosed with active TB.

A patient who has been prescribed acyclovir comes to the clinic complaining of dizziness when changing positions. What is the nurse's best action? -Advise the patient to change positions slowly. -Advise the patient not to stand for 1 hour after taking the medication. -Advise the patient to sit in a chair for 30 minutes after administration. -Advise the patient to remain lying down for 1 hour after taking the medication.

-Advise the patient to change positions slowly.

A dialysis patient is prescribed amoxicillin. When should the nurse administer the medication? -After dialysis -Before dialysis -During dialysis -Timing of administration does not matter

-After dialysis

How is the frequency of antibiotic dosing altered if a patient has renal impairment? -Antibiotic dosing is less frequent. -Antibiotic dosing is more frequent. -Frequency of antibiotic dosing is not altered. -Patients with renal impairment should not take antibiotics.

-Antibiotic dosing is less frequent.

A patient receiving isoniazid is discussing a beach trip that is planned later in the month. What teaching does the nurse need to do with the patient prior to discharge? -Apply sunscreen. -Avoid use of sunscreen. -Salt water may cause a skin sensitivity. -Sand may cause a skin sensitivity.

-Apply sunscreen.

A 50-year old patient with a history of asthma and consuming 1-2 alcoholic drinks a day is being started on isoniazid therapy for active TB. What education regarding isoniazid therapy should the nurse include when discharging the patient? -Avoid supplements containing vitamin B12. -Avoid drinking alcohol. -Take the medication with food. -Low blood sugar is a side effect.

-Avoid drinking alcohol.

When should a culture and sensitivity test be collected? -When the patient has a fever -Before antibiotics are initiated -After the first dose of an antibiotic -After antibiotic therapy is complete

-Before antibiotics are initiated

Amphotericin B treats fungal infections through which mechanism of action? -Destroys fungal cells by interrupting the cell wall -Increases cell death through the immune process -Causes cell death by increasing levels of T-lymphocytes -Binds to the fungal cell membrane and creates channels that increase cell permeability

-Binds to the fungal cell membrane and creates channels that increase cell permeability

Which hygiene practice is a priority in teaching a patient with TB? -Hand washing prior to eating. -Showering at least once a day. -Gentle brushing due to tooth sensitivity. -Discarding tissues and napkins that contain sputum.

-Discarding tissues and napkins that contain sputum.

The nurse is reviewing provider orders for a newly admitted patient. Which lab value would alert the nurse that administration of an antifungal would be contraindicated? -Nausea and vomiting -Elevated creatinine and BUN -Elevated liver enzyme values -Increased amylase and lipase

-Elevated liver enzyme values

Which examination should the patient receive while receiving streptomycin for TB? -Hearing screening -ECG -Dental Exam -Echocardiography

-Hearing Screen

How does isoniazid act on tubercle bacteria? -Inhibits cell wall synthesis -Inhibits bacterial deoxyribonucleic acid (DNA) replication -Engulfs and destroys bacteria -Enhances action of pyridoxine

-Inhibits cell wall synthesis

What additional effect can occur if food is taken with an antibiotic to prevent GI upset? -It can lead to increased thirst. -It can speed up the onset of action. -It can delay absorption of the antibiotic. -It can cause the antibiotic to become inactive.

-It can delay absorption of the antibiotic.

Why is a continuous antibiotic infusion effective in the treatment of a severe infection? -It is easier to administer than intermittent doses. -It has a decreased risk of severe adverse reactions. -It decreases symptoms of the infection more quickly. -It provides constant drug concentration and time exposure.

-It provides constant drug concentration and time exposure.

What effect does a bactericidal antibiotic have on a pathogen? -Kills the pathogen -Inhibits the pathogen's growth -Strengthens the pathogen's cell walls -Assists the pathogen with replication

-Kills the pathogen

Which disease in the patient's health history is a contraindication to prophylactic treatment for tuberculosis? -Liver disease -Diabetes -HTN -Gallstones

-Liver disease

What priority teaching needs to done with a patient who states he has not taken isoniazid treatment for the past two days because he has been feeling better? -Medication compliance -Signs and symptoms of reactions -Timing of administration -Exercise regimen during treatment

-Medication compliance

The nurse is treating a patient who has been prescribed amphotericin B while in the hospital. Which electrolyte does the nurse need to assess while caring for this patient? -Sodium -Calcium -Creatinine -Potassium

-Potassium

Why is it important to record a baseline neurologic assessment before administering antibiotics? -Some antibiotics have the potential for adverse CNS effects. -A patient with a baseline neurologic deficit should not take antibiotics. -It is part of a routine nursing assessment and should always be recorded. -It is part of a routine nursing assessment and should always be recorded.

-Some antibiotics have the potential for adverse CNS effects.

If a patient on amoxicillin reports a rash, what is the first step the nurse should take? -Decrease the frequency of dosing -Stop administrating the medication -Report the rash to the health care provider -Give the medication with a full glass of water

-Stop administrating the medication

A pregnant patient in her third trimester says that she would like to take tetracycline as an acne treatment because it has always worked for her in the past. What teaching should the nurse provide for this patient? -Tetracycline is contraindicated for pregnant women. -Tetracycline needs to be given in larger doses when a patient is pregnant. -The patient should avoid dairy products within 3 hours of taking tetracycline. -The patient should avoid ultraviolet light exposure when taking tetracycline due to the potential for a severe photosensitivity reaction.

-Tetracycline is contraindicated for pregnant women.

Effectiveness of an antibiotic is dependent on which factor? -The type of bacterial cell wall -The morphology of the bacteria -The Gram status of the bacteria -The length of time that it remains at the bacterial cell-binding site.

-The length of time that it remains at the bacterial cell-binding site.

How do bacteriostatic antibiotics, which only inhibit bacterial growth, contribute to the elimination of infection? -They decrease the symptoms of the infection. -They achieve the minimum effective concentration. -They are used in combination with bactericidal medications. -They work in conjunction with the body's natural defense mechanisms.

-They work in conjunction with the body's natural defense mechanisms.

Which are therapeutic uses of zidovudine? -Treating infection with HIV -Treating infection with herpes -Preventing influenza transmission -Treating infection with varicella zoster -Preventing mother-to-infant HIV transmission

-Treating infection with HIV -Preventing mother-to-infant HIV transmission

When treating a patient with antiviral medication, the nurse must monitor for signs of adverse effects. Which assessments should the nurse obtain to monitor whether the patient is having an adverse reaction to the medication? Select all that apply -AST/ALT -Urinary output -Amylase/Lipase -Serum Creatinine -Serum electrolytes -BUN

-Urinary output -Serum Creatinine -BUN

When teaching a patient about taking ketoconazole, what should the nurse tell the patient not to consume? -soda -alcohol -fruit juices -food within 2 hours

-alcohol

What is the half-life for isoniazid? - 3-5 minutes - 30 minutes -1-4 hrs -6-10 hrs

1-4 hrs

The nurse is administering acyclovir to a patient with normal renal function. How long will it take for half the drug to be absorbed? -2-3 hours -6-8 hours -12-14 hours -1-2 days

2-3 hours

The nurse is preparing to administer PO acyclovir to a patient. What is the half-life of the medication, assuming the patient has normal renal function? -2.5-3 hrs -6-8.5 hrs -12-14 hrs 1-2 days

2.5-3 hours

What is the total time of treatment for tuberculosis (TB) multidrug therapy? -2-3 months -4-5 months -6-9 months -12-15 months

6-9 months

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. "I can stop the medication as soon as the symptoms have disappeared." Rationale: Patients should be taught not to discontinue antibiotics prematurely, but rather to complete the entire course of therapy, even if symptoms improve or resolve. The other responses are appropriate

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. 4:30 PM 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).

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. Rationale: 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. Pain in the heel of the foot Rationale: 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.

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. A patient who is scheduled for a hysterectomy Rationale: Patients who undergo a hysterectomy (and other specific surgeries) may have a decreased incidence of infection if antibiotics are administered before or during surgery. Use of prophylactic antibiotics are not indicated for the other conditions.

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. A patient with pyelonephritis with symptoms of high fever, chills, and severe flank pain Rationale: Severe pyelonephritis requires intravenous antibiotic therapy.

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 health care 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. Contact the health care provider for a different antibiotic. Rationale: 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. Use of cephalosporins depends on the intensity of the allergic response to penicillin; if the penicillin allergy is mild, use of cephalosporins is probably safe. However, if the allergy is severe, cephalosporins should be avoided.

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. Mafenide is painful upon application. 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.

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

B. Metronidazole Rationale: 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.

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. Myasthenia gravis 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 (for example, amphotericin B, cephalosporins, vancomycin, cyclosporine, nonsteroidal anti-inflammatory drugs [NSAIDs]), and neuromuscular blocking agents.

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. Skin rash, hives, or itching Rationale: 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.

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. Superinfection is defined as a new infection that appears. during the course of treatment for a primary infection. Rationale: Because broad-spectrum antibiotics kill off more normal flora than do narrow-spectrum drugs, superinfections are more likely in patients receiving broad-spectrum agents. Suprainfections are caused by drug-resistant microbes; these infections are often difficult to treat.

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 drug levels of gentamicin 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.

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. Withhold antacids and milk products for 6 hours before or 2 hours afterward 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.

Which instruction or warning would a nurse teach a patient who is taking rifampin? -Body fluids will turn orange. -Body fluids will turn pink. -Avoid eating carrots. -Avoid eating spinach.

Body fluids will turn orange

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. "Avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin." Rationale: 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 (for example, 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 (for example, 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 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. A female patient with recurring acute urinary tract infections Rationale: 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. An adverse effect of isoniazid therapy is peripheral neuropathy, which can be reversed with pyridoxine. Rationale: 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 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 health care provider

C. Give the patient food, such as crackers or toast, with the medication Rationale: Tetracyclines form insoluble chelates with calcium, iron, magnesium, aluminum, and zinc; absorption is decreased. Tetracyclines should not be administered together with milk or antacids. Long-acting tetracyclines, such as doxycycline, may be taken with food; food does not affect absorption.

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

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

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. Tendon pain or inflammation develops. Rationale: Fluoroquinolones can cause tendon rupture and should be discontinued if tendon pain or inflammation develops.

When taking zidovudine, the patient should have which lab value especially monitored? -AST, ALT -Serum electrolytes -Sedimentation rate -Complete blood count

Complete blood count The patient's complete blood count needs to be monitored due to the risk of anemia with zidovudine.

What should patients avoid within 3 hours of taking tetracycline? -Driving -Lying flat -Drinking grapefruit juice -Consuming dairy products

Consuming dairy products

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. Alcohol Rationale: 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.

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 can be used to treat carcinoma of the bladder.

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

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

How are most antibiotic medications eliminated from the body? -Through bile -Through feces -Through urine -Through perspiration

Through Urine

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

D. Ototoxicity 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 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. Potassium penicillin G Rationale: 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.

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. Rationale: 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. 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.

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. Tinnitus 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.

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. Verapamil [Calan] 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.

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 35.5º C D. Widespread skin lesions

D. Widespread skin lesions 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.

The nurse is reviewing a patient's home medication list. The nurse notes that the provider has prescribed amphotericin B. Which home medication would have potential for interaction? -Digoxin -Acyclovir -Amoxicillin -Fluconazole

Digoxin

A patient has a follow-up appointment and is required to bring in a sputum specimen. The patient states, "I coughed this sputum up last night and saved it." What does the nurse need to do with the specimen? -Discard the specimen. -Send it to the laboratory. -Place it in the freezer. -Place it in the refrigerator.

Discard the specimen.

When teaching a patient about antifungal medications, which teaching point should the nurse include? -It may take multiple regimens to cure the infection. -Discontinuing the drug abruptly can cause a relapse. -The patient should only have to take one dose of the medication. -If the patient misses a dose of the medication, the patient can just continue the medication without taking that dose.

Discontinuing the drug abruptly can cause a relapse.

Where is zidovudine completely absorbed? -Lungs -Mouth -GI tract -Lymphatic System

GI tract

What laboratory test has a significant impact on the health care provider's choice of antibiotic regimen? -Gram stain -Lipid panel -Chest x-ray -Complete blood count (CBC)

Gram Stain

Which statements are true regarding the peak concentration times of oral and IM isoniazid? -IM peak concentration time is faster than oral. -Oral peak concentration time is faster than IM. -IM and oral peak concentration time are the same. -IM peak concentration time is slower than oral.

IM and oral peak concentration time are the same.

What should a patient do to assist with drug excretion while taking antibiotics? -Increase fluid intake -Avoid dairy products -Follow dosing instructions -Wash the hands frequently

Increase fluid intake

How does acyclovir work against the herpes virus? -Decreasing the viral load in the cells. -Disrupts viral replication by destroying viral cells. -Destroys the virus through destruction of the cell wall. -Interferes with the virus' DNA synthesis and disrupts the replication process.

Interferes with the virus' DNA synthesis and disrupts the replication process.

Which drug was the first oral drug preparation effective in treating tubercle bacillus? -Isoniazid (INH) -Rifampin -Kanamycin -Pyridoxine

Isoniazid (INH)

Which statement about amoxicillin is true? -It is bactericidal. -It is bacteriostatic. -It is 50% protein bound. -It has a half-life of 6 hours.

It is Bactericidal

What benefit is seen with antibiotics that have longer half-lives? -Less frequent dosing -Quicker onset of action -Less gastrointestinal (GI) upset -Slower elimination from the body

Less frequent dosing

Isoniazid is metabolized by which organ? -Kidneys -Liver -Pancreas -Stomach

Liver

The nurse is administering zidovudine to a patient by mouth. Through which organ is this medication metabolized? -Liver -GI Tract -Kidneys -Pancreas

Liver

What does the abbreviation MEC stand for in discussions of antibiotics?

Minimum Effective Concentration

What teaching point is important for the nurse to share with Mr. Franklin? -Genital herpes is associated with testicular cancer. -Genital herpes cannot be spread by sexual intercourse. -Mr. Franklin may stop taking the medication when herpetic symptoms are decreased. -Mr. Franklin should use condoms or practice sexual abstinence to avoid spreading herpes.

Mr. Franklin should use condoms or practice sexual abstinence to avoid spreading herpes.

Acyclovir is in which class of antivirals? -topical antivirals -Purine nucleosides -Non classified antivirals -Neuraminidase inhibitors

Purine Nucleosides

Why are microorganisms that cause health care-associated infections so difficult to treat? -The microorganisms that cause health care-associated infections have changed over time. -Health care associated infections are one of the top ten leading causes of death in the United States. -The patient acquires the microorganism while receiving treatment for another condition in a health care facility. -The microorganisms have been exposed to strong antibiotics in the past, which has made them more drug resistant and virulent.

The microorganisms have been exposed to strong antibiotics in the past, which has made them more drug resistant and virulent.

A patient with TB is not understanding why pyridoxine is being prescribed in addition to the isoniazid. How should the nurse respond? -The production of vitamin B6 is blocked, so pyridoxine can prevent peripheral neuropathy. -The production of vitamin B6 is increased, so pyridoxine can prevent peripheral neuropathy. -Pyridoxine helps with absorption of the isoniazid. -Pyridoxine helps with the excretion of the isoniazid.

The production of vitamin B6 is blocked, so pyridoxine can prevent peripheral neuropathy.

Which laboratory tests would the nurse draw prior to initiating antitubercular medications? Select all that apply. -liver enzymes -cbc -bun -serum creatinine -C reactive Protein

liver enzymes bun serum creatinine

A nurse would encourage a patient to participate in which kind of testing to evaluate the effectiveness of an antitubercular drug regimen? -lung fucntion testing -sputum testing -liver tests -kidney tests

sputum testing