Pharmacology test 3

Over the course of treatment for chronic asthma, a client develops an allergy to the propellants in rapid-acting metered-dose inhalers (MDI). What option would the nurse expect to be used to address this problem after discharge?

A dry powder inhaler (DPI) Rationale: Dry powder inhalers contain no propellants.

The client receives Alendronate (Fossmsx) as treatment for osteoporosis. The nurse has completed medication education and evaluates learning has occurred when the client makes which statement?

" I commit lie down for at least 30 minutes after taking the medication." "I should call my doctor if I experience heart burn." "I must take this with full glass of water."

The nursing student asks the instructor how the concept from microbiology directly relates to client care. The nurse instructor best response is ?

" knowledge of bacteria and their classification assist the management of anti-infective therapy ?

A client who is experiencing no symptoms of a low calcium level asks why calcium is important. How should the nurse respond?

"Calcium is needed to keep the nervous system working properly." "Calcium is used by the body to make the muscles move." "Calcium is used in the blood to help with clotting." Rationale 1: In the nervous system, calcium ions influence the release of neurotransmitters and the excitability of all neurons. Rationale 2: Contraction is dependent on calcium ion movement in skeletal, smooth, and cardiac muscle cells. Rationale 3: Calcium is important for blood coagulation; it converts prothrombin into thrombin.

The mom of 4 years old calls the nurse to report her child has been having diarrhea since he began taking an antibiotic 48 hrs ago. The mom asked if she should give her child an over-the-counter medication for the diarrhea. What is the nurse best response?

"Don't treat the diarrhea and bring the child to the office. "

a client with osteoporosis has been prescribed raloxifene (Evista). Which question should the nurse ask to determine the client's risks for complications with this drug?

"Have you ever had or been treated for blood clots?" Raloxifene increases the risk of deep vein thrombosis and resulting pulmonary embolism. This history would contraindicate the use of raloxifene.

A client had hypertension and asks he nurse how this condition can lead to heart failure. Which is the best response by the nurse?

"Hypertension causes resistance in your blood vessels, or after-load; your heart works harder and weakens." ...the most common cause of increase after-load is an increase in peripheral resistance due to hypertension.

The nurse is teaching a client about taking risedronate (Actonel) for osteoporosis. Which statement by the client indicates a need for further teaching?

"I can return to bed while I wait for the medication to work." Rationale: Bisphosphonates can irritate the esophagus, so clients should remain upright for at least 30 minutes after administration to reduce this risk.

The client has gout and receives alloparinol (xylophon) the nurse had completed medication education and evaluated that more teaching is need it, when the client makes which statement?

"I should eat a lot of red meat including liver and sardines."

The nurse is educating a client with heart failure on monitoring for signs and symptoms. Which statement by the client indicates appropriate understanding of the teaching session?

"I should weigh myself every day." Rationale 1: Increased daily weight is a sign that a client could be decompensating. Daily weights are an effective means of monitoring for heart failure symptoms.

The nurse is instructing female client abt therapy with tetracycline (sumycin) which statement should be included ?

"If taking oral conception, an additional form of birth control is recommended."

The nursing student asks the instructor how concepts from microbiology directly relate to client care. The instructor's best response is:

"Knowledge of bacteria and their classification assists in the management of anti-infective therapy." Rationale: The knowledge of bacteria and their classification assists in the management of anti-infective therapy.

The nurse administers isosorbide dinitrate (Isordil). Which is the correct instruction to give the client?

"Take it with a glass of water." Rationale 3: Isosorbide dinitrate (Isordil) is given by mouth.

A client asks about the difference between the New York Heart Association (NYHA) and American Heart Association/American College of Cardiologists (AHA/ACC) heart failure classification models. Which response by the nurse is the most appropriate?

"The AHA/ACC classifications include clients who do not have, but are at risk for, heart failure." Rationale 4: The AHA/ACC model includes an additional classification for clients who do not have heart failure but are susceptible.

A client admitted with heart failure overhears the health care provider discussing plans to "digitalize" the client and asks the nurse what this means. Which response by the nurse is the most appropriate?

"The dose of digoxin gradually is increased until the heart tissue is saturated and symptoms of heart failure subside." Rationale 1: Digitalization is the process in which the dose of digoxin gradually is increased until the heart tissue is saturated and symptoms of heart failure subside.

The client asks the nurse why the health care provider did not prescribe the same antibiotic that the client always receives for an infection. The best response by the nurse would be:

"These bacteria have developed resistance and will respond better to this antibiotic." Rationale 4: Continuous use of the same type of antibiotic could lead to bacterial mutations that are insensitive to the effects of the antibiotic.

The client asks the nurse why the health care provider did not prescribe the same antibiotic that the client always receives for an infection. The best response by the nurse would be:

"These bacteria have developed resistance and will respond better to this antibiotic." Rationale: Continuous use of the same type of antibiotic could lead to bacterial mutations that are insensitive to the effects of the antibiotic.

A client with osteoarthritis does not want to use medication for pain control. What can the nurse suggest to improve the symptoms of this disorder?

. Begin a walking program. 2. Perform exercises to strengthen the quadriceps muscle. 3. Discuss the use of a brace with the health care provider. 4. Consider losing weight. Rationale 1: Walking helps maintain joint flexibility in the client with osteoarthritis. Rationale 2: Improving the strength of the quadriceps muscle will enhance the ability to perform activities of daily living. Rationale 3: Bracing may help keep joints positioned correctly and relieve pain. Rationale 4: Weight reduction helps if the weight-bearing joints such as the hip and knee are affected.

The priority assessment for a client receiving asthma medications to determine effectiveness of therapy should include:

. increased ease of breathing. 2. improved signs of peripheral oxygenation. 3. absence of adventitious sounds. Rationale 1: Increased ease of breathing would indicate less bronchospasm. Rationale 2: Improved peripheral oxygenation would indicate improved gas exchange. Rationale 3: Absence of adventitious sounds would indicate less mucus production.

A client has been prescribed allopurinol (Zyloprim) for gout. The purpose of this medication is to:

.reduce the formation of uric acid. rationale: Gout is a disorder caused by the accumulation of uric acid in the body. Allopurinol (Zyloprim) inhibits

The recommended dietary allowance for calcium in the normal healthy adult is:

1,000-1,200 mg per day. Rationale : The normal healthy adult should consume 1,000-1,200 mg of calcium per day.

The nurse determines that teaching about gout has been effective when the client makes which statements?

1. "I should increase my fluid intake to 2 to 4 liters every day." 2. "I should avoid eating salmon, sardines, organ meats, alcohol, mushrooms, legumes, and oatmeal." 3. "I should notify my health care provider if my pain gets worse."1 4. "I should weigh myself every day and notify my health care provider if I gain over 2 lbs in a day." Rationale 1: The client should be instructed to increase fluid intake to 2-4 L/day. Rationale 2: These are foods that contain purine and should be avoided in the client with gout. Rationale 3: Worsening pain could be an indication that the medication dosage needs to be adjusted and should be reported to the health care provider. Rationale 4: The client should conduct daily weights and notify the health care provider about any weight gain of 2.2 lbs or more in a day.

A client asks the nurse why the health care provider has ordered the asthma medication in inhalant rather than oral form. What is the nurse's best response?

1. "Inhaling an asthma medication offers a rapid and efficient way to get the medication directly into your lungs." 2. "Inhaling an asthma medication results in an almost instantaneous onset of action, which will relieve your symptoms much more quickly." 3. "Inhaling an asthma medication will control your symptoms with smaller doses, reducing the risk of systemic effects." Rationale 1: Inhalation offers a rapid and efficient mechanism for delivering drugs directly to the site of action—the lungs. Rationale 2: Delivering the medication directly into the lungs results in an almost instantaneous onset of action. Rationale 3: Delivering the drug directly to the site allows for smaller doses of the drug, which results in a lower risk of systemic effects.

The nurse is educating a client diagnosed with heart failure (HF). Which statements made by the client indicate the teaching was effective regarding compensatory mechanisms?

1. "My heart enlarged in order to compensate for the effects of heart failure." 2. "My nervous system kicks in to compensate for the effects of heart failure." 3. "My body will decrease blood flow to other organs in order to compensate for heart failure." Rationale 1: Ventricular hypertrophy occurs as a compensatory mechanism to heart failure. Rationale 2: One of the fastest homeostatic responses to diminished cardiac output is activation of the sympathetic nervous system (SNS). The increased heart rate resulting from sympathetic activation is a normal compensatory mechanism that serves to increase cardiac output. Rationale 3: When cardiac output in a client with HF is diminished, blood flow to the kidneys is reduced.

A pediatric nurse is educating a 6-year-old and the mother on the use of a metered-dose inhaler (MDI) with a spacer. The mother asks what the spacer is for. The nurse responds:

1. "Without the spacer, most of the medication does not get into the lungs because the heavier particles fall out into the throat." 2. "It can be difficult to properly coordinate pressing the canister and inhaling so the medication falls into the mouth instead of getting to the lungs." 3. "The spacer holds the medication during inhalation, so your child will not have to worry about coordination." Rationale 1: Even when MDIs are properly used, the majority of the aerosolized drug never reaches the lungs because the heavier particles fall out by gravity and are deposited in the throat. Rationale 2: Because the spacer holds the medication, the client does not have to precisely coordinate inhalation with activation. Rationale 3: The spacer holds drops that fall out of the aerosol so that less medication is deposited in the mouth and throat.

The nurse in a pulmonary clinic is evaluating several clients' theophylline levels. Which levels would take the highest priority?

1. 8 mcg/mL 2. 19 mcg/mL 3. 21 mcg/mL Theophylline has a very narrow therapeutic index. Therapeutic levels are 10 to 15 mcg/mL and the toxic level is anything above 20 mcg/mL.

Which clients would the nurse identify as needing 1,300 mg of calcium per day?

1. Client age 15 2. Pregnant client age 17 Rationale 1: The normal recommended intake of calcium for a 15-year-old client is 1,300 mg per day. Rationale 2: The normal recommended intake of calcium for a 17-year-old pregnant client is 1,300 mg per day.

The nurse is planning strategies for managing a new asthma client's symptoms. Which strategies will decrease the risk for bronchospasms?

1. Educating the client regarding the use of asthma medications 2. Educating the client regarding environmental control measures 3. Successfully managing comorbidities Rationale 1: The National Asthma Education and Prevention Program (NAEPP) recommends client education regarding the use of medication for symptoms. Rationale 2: The National Asthma Education and Prevention Program (NAEPP) recommends education regarding environmental triggers. Rationale 3: The National Asthma Education and Prevention Program (NAEPP) recommends managing comorbidities.

The nurse is caring for a client with heart failure. Which assessment findings indicate the client is currently experiencing stage 2 heart failure?

1. Fatigue with physical activity 2. Palpitations with physical activity 4. Dyspnea with physical activity Rationale 1: Clients experiencing stage 2 heart failure often experience fatigue. Rationale 2: Clients experiencing stage 2 heart failure often experience palpitations. Rationale 4: Clients experiencing stage 2 heart failure often experience dyspnea.

A client is prescribed zafirlukast (Accolate) for persistent, chronic asthma. Which nursing interventions take priority?

1. Instruct the client not to take aspirin while on a zafirlukast regimen. 2. Instruct the client to take zafirlukast on an empty stomach. 3. Discuss the possibility of headache. Rationale 1: Concurrent use with aspirin can significantly increase blood levels of zafirlukast, increasing the risk of adverse effects. Rationale 2: Taking zafirlukast with food can reduce its bioavailability. Rationale 3: Headache is the most common complaint from clients who take zafirlukast.

The nurse is discharging an asthma client with a new prescription for nedocromil (Tilade). What should the nurse instruct the client about this drug?

1. It may cause a bitter taste. 3. It may take up to a week of therapy before benefits are obtained. 4. It should be used on an as-needed basis for optimal benefits. 5. Headache is a common side effect. Correct Answer: 1,3 Rationale 1: Nedocromil (Tilade) may cause a bitter taste. Rationale 3: It may take up to a week of therapy before the benefits of Nedocromil (Tilade) are obtained.

While conducting a physical assessment, the nurse is concerned that the client, who is taking a bisphosphonate, is showing signs of osteonecrosis of the jaw. What did the nurse assess in this client?

1. Jaw pain and swelling 2. Several loose teeth Rationale 1: Symptoms of osteonecrosis of the jaw, which is a possible adverse effect of biphosphonate therapy, include jaw pain and swelling. Rationale 2: Symptoms of osteonecrosis of the jaw, which is a possible adverse effect of biphosphonate therapy, include loose teeth.

The client is prescribed an IV infusion of milrinone (Primacor) for the treatment acute heart failure. What is the priority plan of the nurse?

1. Monitor the ECG continuously. Rationale 1: The client's ECG is usually monitored continuously during the infusion of milrinone (Primacor).

The nurse is caring for a client being treated pharmacologically for heart failure. Which laboratory values is the nurse careful to monitor during treatment?

1. Potassium levels 2. BUN 3. Creatinine 5. Serum drug levels Rationale 1: It is important to monitor electrolyte levels, especially potassium, when a client is being treated pharmacologically for heart failure. Rationale : It is important to monitor renal function while a client is being treated pharmacologically for heart failure. Rationale : It is important to monitor serum drug levels while a client is being treated pharmacologically for heart failure.

The nurse is providing discharge instruction to a client newly diagnosed with asthma. The client has been prescribed albuterol (Proventil) for bronchospasm. Which side effects should the nurse explain to the client?

1. Restlessness 2. Tremor 3. Nervousness Rationale 1: Albuterol activates the sympathetic nervous system, which results in bronchodilation but can also cause restlessness. Rationale 2: Albuterol activates the sympathetic nervous system, which results in bronchodilation but can also cause tremors. Rationale 3: Albuterol activates the sympathetic nervous system, which results in bronchodilation but can also cause nervousness.

The admitting nurse suspects a client has moderate persistent asthma because:

1. Symptoms occur every day. 2. Symptoms occur more than one night a week. 3. Symptoms affect daily activity. Rationale 1: When symptoms occur every day, the asthma is considered moderate persistent. Rationale 2: When symptoms occur more than one night a week, the asthma is considered moderate persistent. Rationale 3: When symptoms affect daily activity, the asthma is considered moderate persistent.

The nurse is caring for a client who is being treated pharmacologically for the symptoms of heart failure. Which interventions would be included in the nurse's role of pharmacologic management of this client?

1. Teaching the client how to space medications to decrease adverse effects 2. Teaching the client the long-term benefits of beta blockers 3. Continually monitoring the client during IV infusions Rationale 1: One role of the nurse is client teaching. The nurse should teach the client how to space medications to decrease the hypotensive effects that can occur during treatment for heart failure. Rationale 2: Beta blockers can have many adverse effects that can affect adherence. The nurse should teach the client the long-term benefits in order to increase medication adherence. Rationale 3: Clients who are receiving medications used to treat heart failure by IV require continual monitoring by the nurse.

The nurse is caring for a client who is diagnosed with heart failure. The nurse knows that which conditions may have contributed to the development of heart failure in this client?

1. Uncontrolled hypertension 2. Coronary artery disease 3. Diabetes

The nurse is caring for a client who is diagnosed with heart failure. The nurse knows that which conditions may have contributed to the development of heart failure in this client?

1. Uncontrolled hypertension 2. Coronary artery disease 3. Diabetes 5. Mitral stenosis

The nurse in a pulmonary clinic knows that theophylline (Theo-Dur) should not be prescribed for:

1. a teenager taking erythromycin for acne. 2. a client taking lorazepam for anxiety. 3. a client taking ciprofloxacin for prostatitis. Rationale 1: Erythromycin is one of the common antibiotics that have a drug-drug interaction with theophylline. Rationale 2: Lorazepam is one of the antianxiety medications that have a drug-drug interaction with theophylline. Rationale 3: Ciprofloxacin is one of the antibiotics that have a drug-drug interaction with theophylline.

The nurse instructs a client with asthma that quick-relief medications that should be used for acute symptoms include:

1. albuterol (Proventil). 2. ipratropium (Atrovent). Rationale 1: Albuterol is a short-acting beta-adrenergic agonist and is the preferred drug for relief of acute symptoms because it relaxes bronchial smooth muscle. Rationale 2: Ipratropium is an anticholinergic, which can relax bronchial smooth muscle and is an alternate quick-relief drug for clients who cannot tolerate short-acting beta-adrenergic agonists.

The nurse has taught a group of clients with asthma the importance of knowing when to use quick-relief medications and when to use long-acting medications. The nurse knows the clients have understood the teaching when they identify which medications as long acting?

1. budesonide (Pulmicort) 2. nedocromil (Tilade) 3. zafirlukast (Accolate) Rationale 1: Budesonide is an inhaled corticosteroid. It is an anti-inflammatory medication used to decrease inflammation of the airways, resulting in long-term control of asthma symptoms. Rationale 2: Nedocromil is a mast cell stabilizer. It is an anti-inflammatory medication used to decrease inflammation of the airways, resulting in long-term control of asthma symptoms. Rationale 3: Zafirlukast is a leukotriene modifier. It is an anti-inflammatory medication used to decrease inflammation of the airways, resulting in long-term control of asthma symptoms.

The nurse, discharging a client recently diagnosed with asthma, explains that symptoms that should be reported immediately to the health care provider include:

1. difficulty breathing. 2. feeling breathless when speaking. 3. increased anxiety. Rationale 1: Difficulty breathing would indicate a deteriorating respiratory status and should be reported immediately. Rationale 2: Feeling breathless when speaking would indicate a deteriorating respiratory status and should be reported immediately. Rationale 3: Anxiety can indicate a deteriorating respiratory status and should be reported immediately.

A client has been prescribed beclomethasone (Beconase) for long-term management of persistent asthma. Prior to discharge, the nurse teaches the client about possible side effects, including:

1. hoarseness. 2. dry mouth. 3. changes in taste. Rationale 1: Hoarseness can occur as a local reaction to beclomethasone. Rationale 2: Dry mouth can occur as a local reaction to beclomethasone. Rationale 3: Changes in taste can occur as a local reaction to beclomethasone.

The nurse explains to a client that inhaled corticosteroid medications are used in the long-term management of asthma to decrease:

1. inflammation of the airways. 2. mucus production. 3. bronchial hyperresponsiveness to allergens. 5. edema. Rationale 1: Corticosteroids decrease inflammation. Rationale 2: Corticosteroids decrease inflammation, thereby reducing mucus production. Rationale 3: Corticosteroids decrease bronchial hyperresponsiveness to allergens that can cause inflammation, edema, and bronchospasm. muscle to be more responsive to beta agonist stimulation, which ultimately results in bronchodilation; but they do not directly decrease bronchial constriction. Rationale 5: Corticosteroids decrease inflammation, thereby reducing edema.

A client is diagnosed with a vitamin D deficiency. To aid in the correction of this deficiency, the nurse instructs the client to:

1. spend 15 minutes a day in the sun without sunscreen. 2. increase the intake of milk. 3. increase intake of vitamin-enriched foods. Rationale 1: In the skin, cholecalciferol, the inactive form of vitamin D, is synthesized from cholesterol. Exposing the skin to sunlight or ultraviolet light increases the level of cholecalciferol in the blood. Rationale 2: Cholecalciferol, the inactive form of vitamin D, can be obtained from dairy products such as milk. Rationale 3: Cholecalciferol, the inactive form of vitamin D, can be obtained from foods fortified with vitamin D.

When planning care for a client, the nurse will include interventions to address factors that predispose the client to developing gout, including:

1. taking a prescribed thiazide diuretic. 2. taking aspirin every day. 3. drinking four beers every night. 4. receiving treatment for polycythemia. Rationale 1: Gout can be caused by thiazide diuretics. Rationale 2: Gout can be caused by chronic aspirin use. Rationale 3: Gout can be caused by alcohol ingested on a chronic basis. Rationale 4: Polycythemia can cause secondary gout.

The nurse is caring for a client who is prescribed digoxin (Lanoxin) for a cardiac dysrhythmia. The nurse teaches the client about digoxin (Lanoxin) toxicity and determines that learning has occurred when the client makes which statements?

2. "I can drink orange juice every morning." 3. "If I have nausea I will notify my health care provider." 4. "I must check my pulse, and not take the medication if it is less than 60." Rationale 2: Orange juice is a source of potassium, which will minimize the risk for digoxin (Lanoxin) toxicity. Rationale 3: Nausea can be an expected side effect or it can indicate digoxin (Lanoxin) toxicity. The client should notify the health care provider for further investigation. Rationale 4: Sixty beats per minute is the generally accepted limit for withholding digoxin (Lanoxin).

The nurse teaches a client about lisinopril (Prinivil), and evaluates that additional teaching is required when the client makes which statement?

2. "I don't need to worry about having blood tests done." Rationale 2: The use of ACE inhibitors can lead to neutropenia, and the client should be monitored for this side effect by having the absolute neutrophil count (ANC) measured.

A client with heart failure asks how blood pressure and heart rate can be high if the heart is failing. Which response by the nurse is the most appropriate?

2. "The blood pressure and heart rate are trying to compensate because the heart cannot pump enough blood." Rationale 2: In response to decreased cardiac output, the body releases epinephrine and activates the renin-angiotensin-aldosterone system, leading to increased heart rate and blood pressure. While this would compensate for lower cardiac output in a normal client, it has a deleterious effect in heart failure, making it worse.

A client comes to the emergency department complaining of coughing and difficulty breathing. The diagnosis is heart failure. The client asks the nurse how difficulty breathing could be a heart problem. Which response by the nurse is the most appropriate?

2. "What you have is called congestive heart failure." 5. "The left side of your heart has weakened and blood has entered your lungs."

The client has a history of cardiac disease and receives furosemide (Lasix) and digoxin (Lanoxin). The nurse determines that education about dietary needs with these medications has been effective when the client makes which selection for lunch?

2. Baked fish, sweet potatoes, and banana pudding rational: Fish, sweet potatoes, and bananas are high in potassium, which will help prevent digoxin toxicity

Which physical assessment finding does the nurse would expect in a client with left-sided heart failure? 1. Enlarged liver 2. Lung congestion 3. Jugular vein distension 4. Peripheral edema

2. Lung congestion Rationale 2: Left-sided heart failure results in blood backing up into the lungs, causing pulmonary edema.

The nurse is reviewing the admission history of a client taking zileuton (Zyflo CR) in the emergency department. Which patient reports would take highest priority during the physical assessment?

2. Nausea 3. Yellow skin 4. Abdominal pain Rationale 2: Nausea can be a symptom of liver damage, which is a serious concern in clients taking zileuton. Rationale 3: Yellow skin implies jaundice, which is a serious concern in clients taking zileuton. Rationale 4: Abdominal pain can be a symptom of liver damage, which is a serious concern in clients taking zileuton.

A client is prescribed colchicine (Colcrys) for gout. The nurse discusses possible adverse effects of this therapy, including:

2. abdominal pain. 3. diarrhea. Rationale 1: Adverse effects of colchicine (Colcrys) include nausea and vomiting. Rationale 2: Adverse effects of colchicine (Colcrys) include abdominal pain.

A client diagnosed with heart failure reports shortness of breath only when climbing stairs or playing with grandchildren. According to the NYHA classification, the nurse documents which stage of heart failure for this client?

3. Stage 2 heart failure Rationale 3: Dyspnea with moderate-to-heavy exertion is classified as stage 2 heart failure.

A client with rheumatoid arthritis is prescribed hydroxychloroquine (Plaquenil). To encourage compliance, the nurse should advise the client to expect the effects of this drug to begin within:

4-6 weeks. Rationale: Hydroxychloroquine (Plaquenil) requires 4-6 weeks to achieve a therapeutic response.

A client who is diagnosed with heart failure is prescribed digoxin (Lanoxin). Prior to discharge, what will the best teaching plan of the nurse include?

4. "Report a weight gain of two or more pounds per day." Rationale 4: Weight gain could indicate fluid retention and a worsening of heart failure.

Which assessment finding would the nurse expect in a client with right-sided congestive heart failure (CHF) as opposed to left-sided failure?

4. Peripheral edema. Rationale 4: In right-sided HF, the blood backs up to the large veins, resulting in peripheral edema and engorgement of organs such as the liver.

A nurse is caring for several clients receiving bronchodilator therapy for asthma. The nurse has noted that some clients develop hyperglycemia during therapy. Which bronchodilator would the nurse consider problematic?

Albuterol (Proventil) Rationale 1: Beta agonists such as albuterol may cause hyperglycemia.

The client is prescribed digoxin (Lanoxin) for the treatment of heart failure. Which assessment findings would indicate adverse effects of this medication?

Anorexia and nausea Rationale 3: Anorexia and nausea are common adverse effects of digoxin (Lanoxin).

The nurse is caring for a client with systolic left-sided heart failure. The nurse knows that 60 to ___% of left-sided heart failure is systolic in nature.

Answer: 80 Rationale: Left-sided HF is further subdivided into two types. Systolic HF occurs when cardiac output (CO) is diminished due to decreased contractility of the myocardium. Approximately 60% to 80% of left-sided HF is the systolic type.

The client is prescribed enalapril (Vasotec) as treatment for heart failure. Which is the priority nursing assessment following the initial administration of this drug?

Assess the client's blood pressure. Rationale 2: Severe hypotension, known as first-dose phenomenon, can occur after the initial administration of enalapril (Vasotec).

A calcium supplement has been added to a client's drug regimen. The nurse should advise the client to:

Avoid taking calcium supplements with bran or whole-grain cereal. Rationale: Bran and whole-grain foods inhibit the absorption of calcium in the gastrointestinal tract.

A mother is struggling to manage her child's moderate persistent asthma at home. The mother asks the nurse if there are any nonpharmacologic measures she can use. Which strategies are most likely to be effective?

Avoiding stimuli such as secondhand smoke, pollutants, and cold air Rationale: Environmental controls call for limiting a child's contact with potential allergens, particularly at night, when the airway is most reactive. Stimuli such as secondhand smoke, pollutants, and cold air can trigger hyperresponsiveness in clients with asthma.

Fosamax® alendronate

Bone Resorption Inhibitor. It's bisphosphonate

The client takes bisphosphonate for osteoporosis: which assessment is best in determining the effectiveness of the medication ?

Bone density scan

The clients calories level is low. What will be the nurse primary concern?

Bone fractors

Bacterial protein synthesis is: 1. similar to human protein synthesis. 2. limited to cellular reproduction. 3. linked to the 80S ribosome. 4. controlled by metabolizing enzymes.

Correct Answer: Global Rationale: The basic steps in protein synthesis, or translation, are the same in bacteria as they are in humans. Bacterial protein synthesis, which is controlled by bacterial DNA, is required for cell function as well as cell reproduction. Bacterial protein synthesis is associated with 30S and 50S ribosomal subunits. The 80S subunit is associated with human cells.

Classes of antibiotics that exert their antibacterial effect by interfering with the synthesis of the bacterial cell wall include: 1. cephalosporins. 2. aminoglycosides. 3. sulfonamides. 4. erythromycins.

Correct Answer: Global Rationale: Cephalosporins have a beta-lactam ring that helps to disrupt bacterial cell walls. This beta-lactam ring resembles one of the chemical building blocks of peptidoglycan. When the PBP enzyme attempts to add the next "link" in the peptidoglycan chain, it binds to the beta-lactam ring, and construction of the cell wall is terminated.

Antibiotics classified as bacteriocidal protein synthesis inhibitors at normal doses include: 1. gentamicin (Garamycin). 2. tetracycline (Sumycin). 3. clindamycin (Cleocin). 4. erythromycin (E-mycin).

Correct Answer: 1 Global Rationale: Aminoglycosides such as gentamicin have a bacteriocidal effect; that is, they kill the bacteria. Tetracycline is usually considered bacteriostatic, although it can be bacteriocidal at high concentrations. Clindamycin acts on the 50S bacterial ribosomal subunit in a manner similar to that of the macrolides. It is usually bacteriostatic. Macrolides such as erythromycin are considered bacteriostatic but may be bacteriocidal in high doses.

Antibacterial protein synthesis inhibitors act by: 1. disrupting the growth of the polypeptide chain. 2. inhibiting synthesis of enzymes. 3. promoting lysis of the cell wall. 4. disrupting cell wall synthesis.

Correct Answer: 1 Global Rationale: Antibacterial protein synthesis inhibitors act by interrupting formation of the polypeptide chain. Sulfonamides act by inhibiting the synthesis of bacterial enzymes. Penicillins act by promoting lysis of the bacterial cell wall. Cephalosporins act by disrupting cell wall synthesis.

Which statement by a client who has received a prescription for ciprofloxacin (Cipro) indicates that further instruction by the nurse is needed? 1. "I will drink more coffee to make sure I get more fluids." 2. "I will make sure and wear sunscreen when I go outside to do my gardening." 3. "If my knees start hurting, I will call the doctor immediately." 4. "I won't take any antacids until I have finished this medication."

Correct Answer: 1 Global Rationale: Clients are advised to limit caffeine intake, not increase it, to decrease the chance of insomnia, nervousness, and anxiety. Clients are instructed to wear sunscreen while taking this drug because of the possibility of photosensitivity. Clients are instructed to report sudden, unexplained joint pain. Clients are told to avoid products containing aluminum or calcium (commonly found in antacids) while taking this drug.

A client is in her 16th week of pregnancy. A routine urinalysis has revealed bacteriuria, and the midwife has given the client a prescription for an antibacterial. The client asks why she must take this medication when she has no symptoms of an infection. What is the nurse's best response? 1. "Even though you don't have any symptoms, the infection could keep your baby from gaining enough weight before birth." 2. "I know you don't want to take this medication, but it is safe and will not harm you or your baby." 3. "You are denying your symptoms because you don't want to take the medication." 4. "Taking this medication will prevent your baby from developing kidney damage in the future."

Correct Answer: 1 Global Rationale: During pregnancy, the enlarging uterus creates pressure on the urinary bladder, which increases the size of the ureters and promotes urinary stasis and reflux. UTIs in pregnant women are a risk factor for prematurity and newborn low birth weight. The nurse should be prepared to answer the patient's questions and should not imply the patient is denying symptoms. There is no indication that treating bacteriuria in the mother will prevent kidney damage in the infant.

Fluoroquinolones are very effective against both gram-negative and gram-positive organisms. Several of the drugs in this class have been discontinued from use. What adverse effects have caused the removal of these drugs from the market? 1. The development of dysrhythmias after administration of fluoroquinolones 2. The development of pathologic fractures after administration of fluoroquinolones 3. The development of insomnia after administration of fluoroquinolones 4. The development of severe phototoxicity after administration of fluoroquinolones

Correct Answer: 1 Global Rationale: Some of the most serious adverse effects of drugs in this class are dysrhythmias (moxifloxacin). Several of the drugs in this class were removed from the market due to the potential for fatal dysrhythmias. Nearly all fluoroquinolones prolong the QT interval. Fluoroquinolones have caused joint toxicity, and rupture of tendons has been reported. However, this has not caused the removal of fluoroquinolones from the market. Fluoroquinolones cause dizziness, headache, and sleep disturbances in a small number of clients. However, this adverse effect has not caused the removal of fluoroquinolones from the market. Fluoroquinolones are indicated in the development of moderate-to-severe phototoxicity in clients exposed to direct or indirect sunlight. However, it has not caused the removal of fluoroquinolones from the market.

Which statement best describes the bacterial cell wall? 1. It is a rigid structure. 2. It is semipermeable. 3. It is composed of lipids. 4. It is single-layered.

Correct Answer: 1 Global Rationale: The cell wall is a structure that sets people apart from the bacterial world. Humans do not have them, but all bacteria do. The osmotic pressure is so high within a bacterial cell that the cell would rupture without the containment of this rigid structure. The cell wall also serves as a barrier to substances that try to enter the cell, including antibiotics. Simply, it protects the bacterial cell from a hostile environment.

A nursing instructor asks a group of students to explain the four-step process necessary for bacterial DNA replication. The student with the correct answer is the one who states that the four-step process is: 1. relax, unwind, replicate, and migrate. 2. migrate, replicate, unwind, and relax. 3. unwind, relax, migrate, and replicate. 4. replicate, unwind, relax, and migrate.

Correct Answer: 1 Global Rationale: The correct order of the four-step process is relax, unwind, replicate, and migrate.

A female client has had repeated bouts of acute uncomplicated cystitis. The health care practitioner has recommended that she change the form of birth control she is using and see if she has fewer infections. What change would be most beneficial for this client? 1. The client should stop using spermicidal foam and begin using birth control pills. 2. The client should stop using a cervical cap and begin using a diaphragm. 3. The client should stop using the "sponge" and begin using a diaphragm. 4. The client should stop using a female condom and begin using a cervical cap.

Correct Answer: 1 Global Rationale: Use of spermicides or diaphragms for contraception increases risk of UTI. Changing from birth control methods such as cervical caps which are much like diaphragms and condoms and sponges that require spermicide may reduce incidence of UTI.

Which instruction should take priority in client teaching for any antibiotic therapy? 1. The full course of prescribed drug therapy must be completed. 2. Maintain adequate food intake 3. Maintain an adequate fluid intake 4. Report symptoms of secondary infection, such as vaginal yeast infections

Correct Answer: 1 Global Rationale: While all of these points are important, the priority is teaching the patient to take the entire course of antibiotic. This helps ensure that the maximum amount of bacteria are killed and helps to prevent drug resistance.

A client's urine culture has come back showing that the infecting organism is resistant to ciprofloxacin (Cipro). The client is upset, saying that this medication has worked every other time. What explanation should the nurse give to the client concerning the development of resistance? 1. "There are a number of ways that an organism can become resistant to an antibacterial. Sometimes one of the enzymes involved in bacterial DNA replication mutates so that the medication is no longer effective." 2. "You must be infected with one of the new 'superbugs.' There aren't many antibacterials that will work against it." 3. "Don't worry; the doctor will give you levofloxacin (Levaquin) to take instead of ciprofloxacin (Cipro)." 4. "There are a number of ways that an organism can become resistant to an antibacterial. It probably happened because you didn't take your medication correctly the last time you took it."

Correct Answer: 1 Global Rationale: One of the ways that resistance occurs against fluoroquinolones is by a mutation to DNA gyrase, decreasing the effectiveness of the fluoroquinolone. There is nothing that indicates that this client is infected with an extremely resistant organism. Resistance to one fluoroquinolone usually confers resistance to other fluoroquinolones. Levofloxacin is also a fluoroquinolone. Although it is possible that improper use of a medication can increase the chance of resistance, it does not fully explain this resistance.

The nurse is managing care for a client prescribed tetracycline who is reporting frequent episodes of diarrhea. The nurse plans to monitor this client for: 1. pseudomembranous colitis. 2. paralytic ileus. 3. intestinal obstruction. 4. impaired biliary function.

Correct Answer: 1 Global Rationale: The presence of diarrhea must be monitored carefully due to the possibility of pseudomembranous colitis (PMC). Caused by Clostridium difficile, this is a rare though potentially severe disorder resulting from therapy with tetracyclines and other classes of antibiotics. Diarrhea is not associated with paralytic ileus. Bowel obstruction is not associated with tetracycline therapy. Clay-colored stool is associated with impaired biliary function.

For which client is the use of nitrofurantoin (Furadantin) contraindicated? 1. The client who needs a rescue inhaler for asthma three times a week 2. The client who has pernicious anemia 3. The client who developed nausea the last time she took the drug 4. The client who had hepatitis A 10 years ago

Correct Answer: 1 Global Rationale: This drug should be used with caution in patients with preexisting pulmonary disease, and pulmonary function should be closely monitored throughout therapy. Although rare, reports have cited diffuse interstitial pneumonitis or pulmonary fibrosis as causes of death in patients receiving nitrofurantoin. Clients with pernicious anemia are not affected by nitrofurantoin. Sulfonamides are contraindicated in clients with pernicious anemia. Nausea is a common side effect in clients who take nitrofurantoin, and would not contraindicate the use of this medication again. Nitrofurantoins are contraindicated in clients with liver dysfunction. A client who had hepatitis A 10 years also could have liver dysfunction, but most clients recover without liver dysfunction.

An advantage of using a broad-spectrum antibiotic is that: 1. it is effective against a large number of organisms. 2. it is effective against a small number of organisms. 3. it has a high potency. 4. it produces a large number of side effects.

Correct Answer: 1 Rationale 1: A broad-spectrum antibiotic is effective against a large number of organisms. Global Rationale: Broad-spectrum antibiotics are effective against a wide variety of different microbial species. These antibiotics may be started before results of culture and sensitivity are returned, especially if the infection is severe.

The nurse is assessing a client with heart failure. Which finding is of greatest concern? 1. Mitral murmur 2. Diffuse wheezes 3. Capillary refill of 2 seconds 4. Clubbed nails

Correct Answer: 1 Rationale 1: Mitral stenosis is a common cause of heart failure. A mitral murmur could be indicative of mitral stenosis. Rationale 2: Wheezes are associated with bronchial constriction, but not pulmonary edema. Rationale 3: Capillary refill of 2 seconds is normal. Rationale 4: Clubbed nails are a sign of impaired oxygenation, but are more commonly associated with respiratory problems, not heart failure.

The primary factor in the development of drug-resistant bacteria is the: 1. unwarranted use of antibiotics. 2. selection of the incorrect antibiotic. 3. lack of new antibiotics. 4. lack of client adherence.

Correct Answer: 1 Rationale 1: The widespread and sometimes unwarranted use of antibiotics has promoted the development of drug-resistant bacterial strains. Rationale 2: The selection of the incorrect antibiotic leads to exacerbation of an infection, not resistance. Rationale 3: New antibiotics are being released on at least an annual basis. Rationale 4: Client nonadherence can affect antibiotic effectiveness, but it is not the most important factor in the development of resistance.

A client has been prescribed nitrofurantoin (Furadantin) for the treatment of a UTI. The nurse explains that this medication is effective against which causative organisms? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. E. coli 2. S. saprophyticus 3. Pseudomonas 4. Proteus 5. Serratia

Correct Answer: 1,2 Global Rationale: Nitrofurantoin is active against the E. coli, S. saprophyticus, and many other strains of gram-positive and gram-negative aerobes. It is not effective against the Pseudomonas, Proteus, or Serratia species.

A pediatric nurse is caring for a child who has an infectious organism that produces beta lactamase. The nurse knows that which drugs should not be prescribed for this infection? 1. Penicillins 2. Cephalosporins 3. Macrolides 4. Fluoroquinolones 5. Sulfonamides

Correct Answer: 1,2 Global Rationale: Organisms that produce beta lactamase are resistant to many of the penicillin and cephalosporin antibiotics.

The nurse is preparing to administer a fluorquinolone medication to a client with a urinary tract infection. The nurse knows it is important to contact a health care provider immediately if which adverse effects occur? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Severe diarrhea containing mucous 2. Decreased urine output 3. Nausea 4. Abdominal cramping 5. Headache

Correct Answer: 1,2 Global Rationale: Severe diarrhea, especially containing mucous, blood, or pus, should be reported immediately. Decreased urine output should be reported immediately. Nausea is a common adverse effect that occurs with this classification of medication but does not require the nurse to immediately contact a health care provider. Abdominal cramping is a common adverse effect that occurs with this classification of medication but does not require the nurse to immediately contact a health care provider. Headache is a common adverse effect that occurs with this classification of medication but does not require the nurse to immediately contact a health care provider.

An infant has been diagnosed with a urinary tract infection. The nurse anticipates the health care provider may prescribe which medications as part of the treatment regimen? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Trimethoprim-sulfamethoxazole (TMP-SMZ) 2. Nitrofurantoin (Furadantin) 3. Fosfomycin (Monurol) 4. Norfloxacin (Noroxin) 5. Levofloxacin (Levaquin)

Correct Answer: 1,2 Global Rationale: TMP-SMZ and nitrofurantoin are effective in children. However, fluoroquinolones are contraindicated in children under age 18 because these drugs have been found to affect cartilage development. The safety and efficacy of fosfomycin has not been established in children younger than 12 years old.

Trimethoprim-sulfamethoxazole (Bactrim) has been prescribed for a client with a urinary tract infection. The nurse can administer this medication by which routes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. By mouth 2. By intravenous injection 3. By intramuscular injection 4. By subcutaneous injection 5. By the topical route

Correct Answer: 1,2 . Global Rationale: This medication is administered only by the oral and intravenous routes.

A clinic nurse is teaching a group of teens taking tetracycline for acne. Which teaching points should take priority? 1. Take tetracycline on an empty stomach to increase absorption. 2. Tetracycline may cause photosensitivity, making the skin susceptible to sunburn. 3. Tetracycline may cause vaginal yeast infection in women who are using oral contraceptives. 4. Tetracycline is one of the safest antibiotics to take during pregnancy. 5. Tetracycline commonly causes diarrhea. The client should start a clear liquid diet and slowly resume a normal diet.

Correct Answer: 1,2,3 Global Rationale: Adverse effects of tetracycline include photosensitivity and a higher incidence of vaginal yeast infections when taken concurrently with oral contraceptives. Food decreases absorption. Diarrhea is a common adverse effect, but should be assessed for the presence of pseudomembranous colitis. Tetracycline is contraindicated in pregnancy because it can cause brown stains on the baby's teeth.

A client asks why the health care provider ordered penicillin for the client's infection. How should the nurse respond? 1. "Your infection was caused by gram-positive bacteria." 2. "Penicillin is a narrow-spectrum antibiotic that can be used when the bacteria causing the infection is known." 3. "Penicillins are widely distributed to most body tissues." 4. "Penicillins are slowly excreted by the kidneys. This allows for less frequent dosing." 5. "If you're allergic to penicillin, we can give you a smaller dose to avoid a reaction."

Correct Answer: 1,2,3 Global Rationale: Although each drug in this class has certain unique properties, some generalizations may be made about the penicillins: most are more effective against gram-positive bacteria, although a few have activity against gram-negative bacteria; most have a narrow spectrum of antimicrobial activity; they are widely distributed to most body tissues, although only small amounts reach the cerebrospinal fluid (CSF); nearly all are rapidly excreted by the kidneys; most have short half-lives. Allergic reactions are the most common adverse effects of the penicillins and ones that require careful attention by nurses.

Which interventions would the nurse consider including in a plan of care for clients taking cephalosporins? 1. Monitor kidney function in older adults. 2. Monitor for persistent diarrhea in young children. 3. Discuss the concurrent use of alcohol. 4. Teach clients to report any fever that does not decrease within 12 hours of starting therapy. 5. Instruct clients to immediately go to the emergency department if any symptoms of red man syndrome occur during treatment.

Correct Answer: 1,2,3 Global Rationale: Because cephalosporins are cleared through the kidney, renal function should be monitored. These drugs may result in diarrhea which should be monitored to prevent dehydration. The patient should be advised that a disulfiram-like reaction may occur when some cephalosporins are taken concurrently with alcohol.

The nurse tells a client that the antibiotic the health care provider has prescribed is for Clostridium, the organism responsible for a number of diseases, including: 1. food poisoning. 2. gas gangrene. 3. tetanus. 4. pneumonia. 5. venereal disease.

Correct Answer: 1,2,3 Global Rationale: Clostridium is a gram-positive anaerobic bacilli that causes food poisoning, gas gangrene, and tetanus.

The health care provider asks the nurse to tell a client that tests confirm the client has a health care-associated infection (HAI). The nurse explains to the client that common sources of HAIs include: 1. the respiratory tract. 2. the urinary tract. 3. intravascular (IV) lines. 4. visitors with infectious illness. 5. drug-resistant bacteria.

Correct Answer: 1,2,3 Global Rationale: HAIs are generally from one of four sources: patient flora, invasive devices, medical personnel, or the medical environment. Invasive devices are often inserted into the respiratory system and the GU system.

A client is admitted with a severe gram-negative bacterial infection of the skin. Which diagnostic lab work should the nurse expect to see if ticarcillin-clavulanate (Timentin) is ordered in high doses? 1. Complete blood count (CBC) with platelets 2. Sodium level 3. Potassium level 4. Kidney function 5. Liver function

Correct Answer: 1,2,3 Global Rationale: High doses can lead to hypernatremia, platelet dysfunction, and hypokalemia. Electrolytes should be regularly monitored to prevent hypokalemia and hypernatremia.

The nurse has received an order to give imipenem-cilastatin (Primaxin) intravenously (IV) to a client. Which assessments should alert the nurse to contact the health care provider? 1. The client is allergic to penicillin. 2. The medication list includes antiseizure medications. 3. The client is an older adult with long-standing diabetes. 4. The urine culture and sensitivity reveals a urinary tract infection (UTI). 5. A wound culture is positive for methicillin-resistant Staphylococcus aureus (MRSA).

Correct Answer: 1,2,3 Global Rationale: Imipenem-cilastatin is contraindicated in patients who have experienced a severe allergic reaction to this drug, other carbapenems, cephalosporins, or penicillins. Because the kidneys excrete imipenem-cilastatin, patients with significant renal impairment must be carefully monitored and dosages lowered. This drug should be used cautiously in patients with brain lesions, head trauma, or a history of seizures due to an increased risk of seizures.

The community outreach nurse is teaching a group of older clients how bacterial organisms become resistant to antibiotics. Which statements by the clients demonstrate understanding of the instruction? 1. "I need to get the recommended immunizations so I don't get an infection and need an antibiotic." 2. "If possible, my doctor will need to culture any infections I have to make sure I am taking the correct antibiotics." 3. "I need to take antibiotics only when my health care provider thinks I have an infection." 4. "As soon as my infection is gone, I can stop the antibiotic. This way, I'll avoid becoming resistant to the antibiotic." 5. "I should never take an antibiotic for more than 10 days. This is what causes resistance."

Correct Answer: 1,2,3 Global Rationale: Methods of delaying the emergence of antibiotic resistance include preventing infections when possible, diagnosing and treating infections properly, using antimicrobials wisely, and preventing disease transmission.

The nurse is caring for a client who has developed an infection that is resistant to fluoroquinolone therapy. The nurse knows that this resistance is due to which reasons? 1. A mutation to the DNA gyrase. 2. The development of resistant pumps within the bacteria. 3. The bacterial cell wall structure has become impermeable. 4. Mutations to DNA helicase alter its ability to bind with fluoroquinolones. 5. The client administered the medication improperly.

Correct Answer: 1,2,3 Global Rationale: Mutations to DNA gyrase can alter its ability to bind fluoroquinolones, thus rendering the drug less effective. Some bacteria have developed resistance pumps that remove fluoroquinolones from inside their cells, thus rending the drug less effective. Some bacteria have developed a cell wall structure that is less permeable to the drugs, thus rendering the drug less effective. Mutations to DNA helicase have not rendered fluoroquinolones less effective. Improper administration of medication does not render the drug less effective.

The nurse tells a client with pneumonia that the physician has prescribed a macrolide antibiotic because: 1. newer macrolides have a longer half-life, which makes less frequent dosing attractive to clients. 2. newer macrolides cause fewer gastrointestinal symptoms. 3. macrolide antibiotics are considered one of the safest classes of antibiotics. 4. food does not interfere with the absorption of macrolide antibiotics as it does with other classes of antibiotics. 5. there are no strains of bacteria resistant to macrolide antibiotics.

Correct Answer: 1,2,3 Global Rationale: Newer macrolides can be dosed less frequently due to a longer half-life, cause fewer gastrointestinal symptoms, and are considered one of the safest classes of antibiotics. Food does decrease absorption and resistant strains of bacteria are becoming more common.

A client is admitted to the emergency department for an infection. The nurse recognizes that host factors that play a role in the selection of anti-infective therapy include: 1. status of immune system. 2. location of the infection. 3. history of allergic reactions. 4. previous infections. 5. results of culture and sensitivity (C&S).

Correct Answer: 1,2,3 Global Rationale: Patient factors such as host defenses, local tissue conditions, history of allergic reactions, age, pregnancy status, and genetics influence the choice of anti-infective.

To prevent the most serious adverse effects of aminoglycosides in a diabetic client, the nurse will monitor which diagnostic lab reports? 1. Serum drug concentration of aminoglycoside 2. Serum creatinine 3. Blood urea nitrogen (BUN) 4. Complete blood count (CBC) 5. Blood glucose

Correct Answer: 1,2,3 Global Rationale: Patients with diabetes are at risk for one of the most serious adverse effects of aminoglycosides. Aminoglycosides directly injure renal tubule cells, and this nephrotoxicity may be severe, affecting up to 26% of patients receiving these antibiotics. As expected, patients who are receiving higher doses for longer periods are most affected. Those with preexisting renal impairment or who are receiving concurrent therapy with other nephrotoxic drugs must be monitored carefully. Regular evaluation of urinalysis, blood urea nitrogen (BUN), and serum creatinine results is essential. Serum drug concentrations should be obtained regularly and doses adjusted accordingly to prevent permanent damage. Blood glucose and CBC do not monitor kidney function. Blood glucose is not affected by aminoglycoside use.

A client in the emergency department experienced a severe allergic response to penicillin. The client tells the nurse this is the first time she has ever taken this particular drug. Which questions can the nurse ask to determine the reason for the allergic response? 1. "Have you ever been exposed to mold?" 2. "Do you eat animal products that have been exposed to antibiotics such as penicillin?" 3. "Have you ever had another allergic reaction to a group of antibiotics called cephalosporins?" 4. "Do you have any seasonal allergies?" 5. "Do you have any diseases or are you taking any medications that suppress the immune system?"

Correct Answer: 1,2,3 Global Rationale: Prior exposure to penicillin is necessary for an allergic reaction, although this exposure may have occurred inadvertently through exposure to mold or by eating animal products that contain small amounts of penicillin. Allergy to one penicillin increases the risk of allergy to other drugs in this class. There is also a degree of cross-hypersensitivity between penicillins and cephalosporins.

The clinic nurse is calling back clients with various symptoms. Which symptoms would suggest a superinfection? 1. Diarrhea 2. Painful urination 3. Abnormal vaginal discharge 4. Cough 5. Joint pain

Correct Answer: 1,2,3 Global Rationale: Signs and symptoms of superinfection commonly include diarrhea, bladder pain, painful urination, or abnormal vaginal discharges.

A client is admitted to the emergency department with symptoms of meningitis. Reviewing the client's culture and sensitivity (C&S) report, the nurse would expect evidence of which organisms to confirm this diagnosis? 1. Streptococci 2. Escherichia coli 3. Haemophilus influenzae 4. Rickettsia rickettsii 5. Shigella

Correct Answer: 1,2,3 Global Rationale: Streptococci, Escherichia coli, and Haemophilus influenzae can cause meningitis in children.

A client is admitted to the emergency department with an infection of the skin on the upper right thigh. The nurse knows this infection could be caused by which organism? 1. Streptococci 2. Proteus mirabilis 3. Pseudomonas aeruginosa 4. Salmonella enteritides 5. Bacillus anthracis

Correct Answer: 1,2,3 Global Rationale: Streptococci, Proteus mirabilis, and Pseudomonas aeruginosa are all implicated in skin infections.

The nurse is planning care for a client with diabetes who has been prescribed an aminoglycoside antibiotic for a serious infection. Which nursing diagnoses would take priority? 1. Knowledge, Deficient related to drug therapy 2. Injury, Risk for related to adverse drug effects 3. Infection, Risk for 4. Fluid Volume: Deficient, Risk for related to diarrhea 5. Hyperthermia

Correct Answer: 1,2,3 Global Rationale: The client must be educated about the serious adverse effects of this therapy as the risk of nephrotoxicity and ototoxicity are high. Infection is the patient's current problem, so this is a priority diagnosis. Risk of fluid volume deficit and hyperthermia are not current priorities.

A client is unable to give a urine sample for a culture and sensitivity (C&S) and asks the nurse why the health care provider does not just prescribe a "really strong" antibiotic. The nurse responds that careful selection of the correct antibiotic is important because prescribing the wrong antibiotic: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. will delay effective treatment. 2. will give the bacteria more time to grow. 3. can contribute to the development of drug-resistant bacteria. 4. could result in a lawsuit. 5. could result in an allergic response.

Correct Answer: 1,2,3 Global Rationale: When the wrong antibiotic is prescribed correct treatment is delayed and bacteria have time to multiply. This action also contributes to the development of drug-resistant bacteria.

Which clients on erythromycin will the nurse monitor closely for drug-drug interactions? 1. Client wearing a fentanyl patch for chronic pain syndrome 2. Client taking theophylline for chronic obstructive pulmonary disease 3. Recovering heroin addict who takes methadone daily 4. Client using topical neomycin for wound infection 5. Client who is 4 months pregnant and taking prenatal vitamins

Correct Answer: 1,2,3 Global Rationale: When used concurrently with erythromycin, the serum levels and toxicities of alfentanil, carbamazepine, cyclosporine, fentanyl, theophylline, and methadone may increase. There is no drug-drug interaction with topical neomycin or prenatal vitamins.

A pregnant client has been prescribed azithromycin (Zithromax) for an upper respiratory infection. The client asks the nurse why this medication was prescribed instead of erythromycin. The nurse explains that azithromycin: 1. causes less nausea. 2. may be taken with or without food. 3. is safe to take during pregnancy. 4. does not cause diarrhea or abdominal pain. 5. is not associated with hypersensitivity.

Correct Answer: 1,2,3 . Global Rationale: Azithromycin causes less nausea, can be taken without regard to food ingestion, and is safe for pregnant clients. Diarrhea and abdominal pain are side effects. There are clients who are hypersensitive to macrolides and should not receive azithromycin.

The nurse is caring for a client who is taking ciprofloxacin for the treatment of acute cystitis. The nurse knows ciprofloxacin interacts with several other classes of medication and that it is important to assess the client's medication administration record for which classifications of medications? 1. Anticoagulants 2. Antacids 3. Xanthines 4. Antibiotics 5. Antivirals

Correct Answer: 1,2,3 . Global Rationale: Concurrent administration of ciprofloxacin with the anticoagulant warfarin may increase anticoagulant effects and result in bleeding due to the decreased metabolism of warfarin. Antacids may decrease the absorption of ciprofloxacin, thus causing decreased effectiveness of the antibiotic. Ciprofloxacin slows the hepatic metabolism of xanthines, including caffeine, theophylline, and theobromine. Theophylline levels may increase 15% to 30%. There is no known drug interaction between ciprofloxacin and other antibiotics. There is no known drug interaction between ciprofloxacin and antiviral medications.

Which clients taking penicillin G should the nurse plan to monitor closely? 1. A client with diabetes 2. A client with heart failure 3. A client taking spironolactone for hormonal acne 4. A client taking oral contraceptives 5. A client with pharyngitis

Correct Answer: 1,2,3 Global Rationale: Because 90% of a dose of penicillin G is excreted unchanged by the kidneys through tubular secretion, patients with significant renal impairment must be carefully monitored. Patients with heart failure should not receive the penicillin sodium salt. Hyperkalemia may result with high doses of the penicillin G potassium salt. Penicillin G may decrease the effectiveness of oral contraceptives.

An older adult has been prescribed an aminoglycoside antibiotic. The nurse would immediately contact the physician if the client exhibits which symptoms? . 1. High-pitched tinnitus 2. Vertigo 3. Nausea and vomiting 4. Diarrhea 5. Rash

Correct Answer: 1,2,3 Global Rationale: Because many older adults have some degree of preexisting hearing impairment, permanent deafness may occur in this group. Signs of impending inner ear damage include high-pitched tinnitus, headache, nausea, vomiting, and vertigo. Diarrhea may occur when taking aminoglycosides, but is not a reason to immediately collaborate with the prescriber. Rash is not associated with aminoglycosides.

The client asks the nurse why culture and sensitivity (C&S) testing has to be done prior to starting the antibiotic for a urinary tract infection (UTI). The nurse explains that several organisms can cause UTIs and a C&S is performed to identify the organism. Which organism could be isolated on this client's C&S? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Escherichia coli 2. Enterococci 3. Proteus mirabilis 4. Treponema 5. Borrelia burgdorferi

Correct Answer: 1,2,3 Global Rationale: E. coli, P. mirabilis, and enterococci are commonly associated with UTI.

The nurse has received an order to give imipenem-cilastatin (Primaxin) intravenously (IV) to a client. Which assessments should alert the nurse to contact the health care provider? 1. The client is allergic to penicillin. 2. The medication list includes antiseizure medications. 3. The client is an older adult with long-standing diabetes. 4. The urine culture and sensitivity reveals a urinary tract infection (UTI). 5. A wound culture is positive for methicillin-resistant Staphylococcus aureus (MRSA).

Correct Answer: 1,2,3 Global Rationale: Imipenem-cilastatin is contraindicated in patients who have experienced a severe allergic reaction to this drug, other carbapenems, cephalosporins, or penicillins. Because the kidneys excrete imipenem-cilastatin, patients with significant renal impairment must be carefully monitored and dosages lowered. This drug should be used cautiously in patients with brain lesions, head trauma, or a history of seizures due to an increased risk of seizures.

The emergency department nurse anticipates that which clients may be treated with ertapenem (Invanz)? 1. College student diagnosed with community-acquired pneumonia 2. Client diagnosed with complicated urinary tract infection (UTI) 3. Diabetic client with an infected toe 4. Young child diagnosed with H. influenzae otitis media 5. Older client diagnosed with community-acquired methicillin-resistant S. aureus (MRSA)

Correct Answer: 1,2,3 Global Rationale: Invanz is approved for the treatment of serious abdominopelvic and skin infections, community-acquired pneumonia, complicated UTIs, and diabetic foot infections without concomitant osteomyelitis.

The emergency department nurse anticipates that prophylactic antibiotics will likely be used to treat: 1. a client with a suppressed immune system. 2. a client who has been bitten by a dog. 3. a client whose spouse has been diagnosed with tuberculosis (TB). 4. a client who is being treated for a venereal disease. 5. a client who has just delivered a premature baby.

Correct Answer: 1,2,3 Global Rationale: Only in rare cases are anti-infectives given prophylactically for indefinite time periods. Examples include the prevention of infections in patients with suppressed immune systems such as those with HIV infection, or those receiving immunosuppressants following an organ transplant, patients with deep puncture wounds, or close exposure to persons with active tuberculosis.

A client is unable to give a urine sample for a culture and sensitivity (C&S) and asks the nurse why the health care provider does not just prescribe a "really strong" antibiotic. The nurse responds that careful selection of the correct antibiotic is important because prescribing the wrong antibiotic: 1. will delay effective treatment. 2. will give the bacteria more time to grow. 3. can contribute to the development of drug-resistant bacteria. 4. could result in a lawsuit. 5. could result in an allergic response.

Correct Answer: 1,2,3 Global Rationale: When the wrong antibiotic is prescribed correct treatment is delayed and bacteria have time to multiply. This action also contributes to the development of drug-resistant bacteria.

A client who has developed a resistance to levofloxacin (Levaquin) is concerned that getting rid of the infection will be impossible. What is the best response by the nurse to the client? 1. "The physician will admit you to the hospital and put you on an IV form of levofloxacin (Levaquin). You will not be resistant to that." 2. "The physician will take you off of the levofloxacin (Levaquin) for a few days and then have you start taking it again. Then it will be effective." 3. "The physician will switch you from levofloxacin (Levaquin) to ciprofloxacin (Cipro)." 4. "The physician will switch you to another type of antibacterial to which you haven't developed resistance."

Correct Answer: 1,2,3 Rationale 1: Mutations to DNA gyrase can alter its ability to bind fluoroquinolones, thus rendering the drug less effective. Rationale 2: Some bacteria have developed resistance pumps that remove fluoroquinolones from inside their cells, thus rending the drug less effective. Rationale 3: Some bacteria have developed a cell wall structure that is less permeable to the drugs, thus rendering the drug less effective. Rationale 4: Mutations to DNA helicase have not rendered fluoroquinolones less effective. Rationale 5: Improper administration of medication does not render the drug less effective. Global Rationale: Mutations to DNA gyrase can alter its ability to bind fluoroquinolones, thus rendering the drug less effective. Some bacteria have developed resistance pumps that remove fluoroquinolones from inside their cells, thus rending the drug less effective. Some bacteria have developed a cell wall structure that is less permeable to the drugs, thus rendering the drug less effective. Mutations to DNA helicase have not rendered fluoroquinolones less effective. Improper administration of medication does not render the drug less effective.

The nurse is discharging a client with a prescription for penicillin. The client asks the nurse how this antibiotic works. The nurse's response is based on the knowledge that the mechanism of action of this class of anti-infectives is: 1. inhibiting cell wall synthesis. 2. causing disruption of the cell wall, resulting in the cell absorbing water and lysing. 3. binding to specific proteins, resulting in the cell's inability to build a wall. 4. interfering with the transfer of ribonucleic acid (RNA). 5. changing the permeability of the cell membrane.

Correct Answer: 1,2,3 Rationale 1: Penicillin inhibits bacterial cell wall synthesis. Rationale 2: Penicillin inhibits cell wall synthesis, resulting in the cell absorbing water and lysing. Rationale 3: Binding to specific proteins disrupts the cell's ability to build a wall. Rationale 4: Interference of the transfer of RNA occurs during the inhibition of protein synthesis by the aminoglycosides, tetracyclines, macrolides, and oxazolidinones. Rationale 5: The disruption of the plasma membrane is the mechanism of action of azoles and polyenes.

The nurse is preparing to admit a client with a serious methicillin-resistant Staphylococcus aureus (MRSA) infection. The nurse knows MRSA will not respond to treatment with: 1. fluoroquinolones. 2. macrolides. 3. aminoglycosides. 4. tetracyclines. 5. linezolid.

Correct Answer: 1,2,3,4 Global Rationale: MRSA is a type of bacterium that is resistant to certain antibiotics such as methicillin, amoxicillin, and penicillin. At least 60% of S. aureus infections are now resistant to penicillin. The term "methicillin resistant" is still used for these infections despite the fact that methicillin was removed from the market many years ago. In recent years, MRSA strains have developed resistance to most classes of antimicrobials, including fluoroquinolones, macrolides, aminoglycosides, tetracyclines, and clindamycin.

The nurse caring for a client with cancer is teaching the client about chemotherapeutic medications that affect bacterial DNA replication. Which medications should the nurse include in the teaching plan for this client? 1. Cytarabine (Cytosar-U) 2. Fluorouracil (5-FU) 3. Daunorubicin (Cerubidine) 4. Bleomycin (Blenoxane) 5. Acyclovir (Zovirax)

Correct Answer: 1,2,3,4 Global Rationale: Cytarabine (Cytosar-U) and fluorouracil (5-FU) resemble nucleotides and are mistakenly incorporated into newly formed DNA strands. Daunorubicin (Cerubidine) and bleomycin (Blenoxane) are highly toxic antibiotics that interact with DNA to physically block replication. Although classified as antibiotics, these drugs are too toxic to be used for infections, but have therapeutic indications in the chemotherapy of specific types of cancer. Acyclovir is an antiviral agent, not a chemotherapeutic agent.

A client is being seen in the emergency department with a suspected urinary tract infection. The nurse believes the client has pyelonephritis based on which assessment findings? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Vomiting 2. Fever 3. Flank tenderness 4. Photophobia 5. Painful urination

Correct Answer: 1,2,3,5 Global Rationale: Assessment findings of pyelonephritis often include vomiting, fever, flank tenderness, and painful urination. Photophobia is not an expected finding.

Prior to discharge of a client on cephalosporin therapy, the nurse discusses potentially significant adverse effects, including: 1. Nausea. 2. Vomiting. 3. Abdominal pain. 4. Transient shortness of breath 5. Vaginal yeast infection.

Correct Answer: 1,2,3,5 Global Rationale: Rash and diarrhea are the most common adverse effects, and superinfections are likely when the antibiotic is used for prolonged periods. Nausea and vomiting are common effects of many antibiotics.

The nurse preparing to infuse vancomycin will monitor the client for: 1. loss of hearing and balance. 2. reddening upper body with dizziness. 3. confusion or hallucinations. 4. abnormal liver function. 5. fever and chills.

Correct Answer: 1,2,3,5 Global Rationale: Vancomycin may cause a syndrome of flushing, hypotension, tachycardia, and rash on the upper body, a condition called the red man syndrome. This syndrome can be minimized by infusing the drug over at least 60 minutes. Other common adverse effects include nausea, rash, fever, and chills. Serious adverse effects include confusion, seizures, and hallucinations. If extravasation occurs, it may lead to tissue necrosis. Ototoxicity is associated with serum concentrations of vancomycin above 60 to 80 mcg/mL. Tinnitus and high-tone hearing loss precede deafness and may progress even after this drug is discontinued. The most susceptible are older adults and those on high doses. Nephrotoxicity can occur in patients with therapeutic concentrations but is more common if trough serum concentrations are kept above 10 mcg/mL.

The nurse, administering an infusion of vancomycin, will observe the client for which symptoms of red man syndrome? 1. Reddening of the upper body 2. Hypotension 3. Reflex tachycardia 4. Headache 5. Seizure

Correct Answer: 1,2,3. Global Rationale: Vancomycin may cause a syndrome of flushing, hypotension, tachycardia, and rash on the upper body, a condition called the red man syndrome.

A client reports no improvement after 5 days of therapy with tetracycline. The nurse suspects drug resistance and knows that drug resistance can develop in which ways? . 1. A drug is prevented from concentrating inside the bacterial cell. 2. A broad-spectrum antibacterial drug is used instead of a narrow-spectrum drug. 3. A bacteriostatic agent is paired with a bacteriocidal agent. 4. Bacteria acquire the ability to degrade the antibiotic. 5. The shape of the bacteria mutates and prevents an antibiotic from binding to it.

Correct Answer: 1,2,4,5 Global Rationale: Resistance, the ability of an organism to degrade the antibiotic, can develop when a drug is prevented from concentrating within the bacterial cell. Broad-spectrum antibacterial agents are associated with bacterial drug resistance. Narrow-spectrum drugs should be used whenever the bacterial organism is known. Pairing bacteriostatic and bacteriocidal agents is a strategy used to reduce the development of resistant strains. Altering the shape of the bacterial ribosome can prevent an antibiotic from binding to the ribosome.

Guidelines for preventing antimicrobial resistance include: 1. using proper infection-control procedures. 2. shortening the duration of antibiotic administration. 3. using antimicrobials wisely. 4. preventing infections. 5. treating infections properly.

Correct Answer: 1,3,4,5 Methods of delaying the emergence of antibiotic resistance include: preventing infections when possible, diagnosing and treating infections properly, using antimicrobials wisely, and preventing disease transmission.

The nurse is administering ciprofloxacin to a client with acute cystitis. The nurse anticipates administering this drug to the client twice a day because the duration of action is ______ hours. Standard Text: Record your answer rounding to the nearest whole number.

Correct Answer: 12 Rationale: The duration of action for ciprofloxacin is 12 hours; therefore, the nurse anticipates the need to administer the medication twice a day.

The nurse is caring for a client diagnosed with a complicated urinary tract infection. The nurse anticipates that the client will require _____ days of antibiotic therapy. Standard Text: Record your answer rounding to the nearest whole number.

Correct Answer: 14 Global Rationale: Therapy for complicated urinary tract infections is often continued for 14 days to be certain that all uropathogens have been eliminated.

A client is admitted with a high fever accompanied by chills. The client complains of costovertebral pain but denies dysuria, urgency, or frequency. The diagnosis is pyelonephritis related to pathogens present in the blood. How would the nurse classify this urinary tract infection? 1. Ascending 2. Hematogenous 3. Retrograde 4. "Against the flow"

Correct Answer: 2 Global Rationale: A hematogenous infection is caused by pathogens traveling through the blood. Retrograde, or ascending, UTIs travel from the urethra to the bladder or the kidney. "Against the flow" refers to the difficulty that uropathogens have in reaching beyond the proximal portion of the urethra. It is a protection against UTIs.

The nurse caring for a group of clients recognizes that which client has a superinfection? 1. 47-year-old client with type 2 diabetes and pneumonia 2. 50-year-old AIDS client with candida 3. 46-year-old client with vascular disease and cellulitis of the leg 4. 52-year-old client with gastroesophageal reflux disease (GERD) and gastritis

Correct Answer: 2 Global Rationale: Antibiotics are unable to distinguish between host flora and pathogenic organisms. When an antibiotic kills the host's normal flora, additional nutrients and space are available for pathogenic microorganisms to grow unchecked. These new, secondary infections caused by antibiotic use are called superinfections, or suprainfections. The appearance of a new infection while receiving anti-infective therapy is highly suspicious of a superinfection. Signs and symptoms of superinfection commonly include diarrhea, bladder pain, painful urination, or abnormal vaginal discharges.

Bacterial enzymes participate in the construction of the bacterial cell wall. Penicillin targets these enzymes and interferes with: 1. bacterial DNA. 2. the addition of cross-links to the cell wall. 3. protein synthesis. 4. the channels in the cell's internal structure.

Correct Answer: 2 Global Rationale: Because of the critical importance of their cell walls, bacteria spend a lot of time and energy building them. At least 30 different bacterial enzymes participate in their construction. Some of these enzymes are targets for penicillins and related antibiotics and are called penicillin-binding proteins (PBPs). Most penicillins affect transpeptidase, which is the final PBP enzyme in the construction of the cell wall that adds the cross-links to the peptidoglycan layers. Without the cross-linking, the cell wall becomes weakened and bulges due to the high osmotic pressure inside the cell. The bacterial cell eventually lyses (disintegrates).

A client has been diagnosed with a complicated urinary tract infection (C-UTI). The nurse knows that C-UTIs are often treated differently than acute uncomplicated cystitis (AUC). What is a significant difference in the treatment of these infections? 1. Clients with AUC are rarely treated with antibacterials while those with C-UTIs almost always receive this therapy. 2. Clients with AUC receive a shorter course of antibacterials than do clients with C-UTIs. 3. Clients with AUC receive a longer course of antibacterials than do clients with C-UTIs. 4. Clients with AUC receive more toxic antibacterials than do clients with C-UTIs.

Correct Answer: 2 Global Rationale: C-UTIs may require aggressive pharmacotherapy, often involving more toxic drugs, higher doses, or prolonged therapy. Both types of infection are frequently treated with an antibacterial medication.

The health care provider has prescribed ciprofloxacin (Cipro) for four clients. For which client should the nurse contact the health care provider for further clarification? 1. A 67-year-old male who has just completed taking another antibacterial for chronic sinusitis 2. A 21-year-old female who gave birth 8 weeks ago and is still breast-feeding 3. A 49-year-old female who is experiencing "hot flashes" related to the onset of menopause 4. A 19-year-old male who plays soccer for his college team

Correct Answer: 2 Global Rationale: Ciprofloxacin is contraindicated in clients who are pregnant or breast-feeding because the drug is secreted in breast milk, and crosses the placenta. The use of ciprofloxacin after the use of another antibacterial is not contraindicated. Also, the client's age is not a contraindication unless the client also had liver or renal impairment. Symptoms of menopause are not contraindications for the use of ciprofloxacin. Fluoroquinolones are not administered to clients under age 18 unless the benefits outweigh the risks. This client is 19; therefore, the medication is not contraindicated due to age.

A client is prescribed gentamicin (Garamycin) concurrently with acyclovir (Zovirax). Which assessment would be the priority for the nurse? 1. Balance 2. Kidney function lab tests 3. Hearing 4. Visual acuity

Correct Answer: 2 Global Rationale: Concurrent use of gentamicin and acyclovir increases the risk of nephrotoxicity. A symptom of nephrotoxicity would be detected by monitoring kidney function tests. Gentamycin alone can cause vertigo and ototoxicity, but these findings are not complicated by the addition of acyclovir. Visual acuity is not affected.

A pregnant client has been diagnosed with a urinary tract infection. The nurse anticipates that the client will require a follow-up culture within _____ weeks after the conclusion of antibiotic therapy. Standard Text: Record your answer rounding to the nearest whole number.

Correct Answer: 2 Global Rationale: Discovery of high levels of bacteria in the urine is an indication for antimicrobial therapy, even if the patient is asymptomatic at the time of testing. A follow-up culture is performed 1 to 2 weeks after therapy is completed. Continued asymptomatic bacteriuria is predictive of symptomatic UTI later in pregnancy. Therapy for asymptomatic bacteriuria is continued until cultures are negative, or until delivery.

The nurse explains to a student nurse the mechanism by which resistance to fluoroquinolones occurs. The nurse knows the student requires further education when the student states: 1. "Bacterial cell walls become less permeable to the fluoroquinolones." 2. "Mutations to DNA helicase alter its ability to bind with fluoroquinolones." 3. "Mutations to DNA gyrase alter its ability to bind with fluoroquinolones." 4. "Certain bacteria have developed resistance pumps that remove fluoroquinolones from the cell."

Correct Answer: 2 Global Rationale: Fluoroquinolones do not bind with the enzyme DNA helicase. They bind with DNA gyrase, so resistance will occur from mutations to DNA gyrase. A change in bacterial cell wall permeability, the development of resistance pumps, and mutations to DNA gyrase contribute to resistance to fluoroquinolones.

A 22-year-old female client has acute uncomplicated cystitis. The nurse knows that which antibacterial would not be an appropriate choice to treat this infection? 1. Trimethoprim-sulfamethoxazole (TMP-SMZ) 2. Metronidazole (Flagyl) 3. Norfloxacin (Noroxin) 4. Fosfomycin (Monurol)

Correct Answer: 2 Global Rationale: Metronidazole is a miscellaneous antibacterial that is used to treat protozoal infections, and is often used in the treatment of pelvic infections. Trimethoprim-sulfamethoxazole is a fixed-dose combination sulfonamide, and is the traditional choice for AUC in most communities. Norfloxacin is a fluoroquinolone. Fluoroquinolones have become the drug of choice in many communities. Fosfomycin blocks cell wall synthesis. Its only indication for use is UTI

In which situation is it appropriate for the nurse to instruct the client to stop taking minocycline (Minocin) and promptly seek medical advice? 1. The client reports epigastric burning. 2. The client reports dizziness and vertigo. 3. The client reports vaginal discharge. 4. The client reports occasional nausea.

Correct Answer: 2 Global Rationale: Minocycline is the only tetracycline that can cause reversible vestibular toxicity. Symptoms include dizziness, vertigo, and weakness. Occasional nausea and epigastric burning are common side effects but do not require discontinuation of the drug. Vaginal discharge may be a symptom of a yeast infection and should be evaluated for treatment, but most likely does not require discontinuation of the drug.

Administering an aminoglycoside as monotherapy: 1. shortens the duration of therapy. 2. can lead to resistant bacterial strains. 3. reduces the incidence of adverse effects. 4. indicates that it is given intravenously.

Correct Answer: 2 Global Rationale: Resistance develops quickly when aminoglycosides are administered as monotherapy. Resistance occurs when a species acquires an ability to degrade the antibiotic. Monotherapy does not shorten length of therapy and is not a strategy to reduce incidence of adverse effects. Monotherapy is not related to route of administration.

The nurse knows that which antibiotic, when taken by a pregnant woman, can adversely affect the newborn's hearing? 1. Mycins 2. Aminoglycosides 3. Sulfonamides 4. Tetracyclines

Correct Answer: 2 Global Rationale: Some antibiotics are readily secreted in breast milk or cross the placenta. For example, tetracyclines taken by the mother can cause teeth discoloration in the newborn, and aminoglycosides can affect hearing. Some anti-infectives are pregnancy category D, such as minocycline, doxycycline, neomycin, and

A 3-year-old female is being seen in the clinic with symptoms of a urinary tract infection. Which medication would be appropriate for a child this age? 1. Levofloxacin (Levaquin) 2. Trimethoprim-sulfamethoxazole (TMP-SMZ) 3. Fosfomycin (Monurol) 4. Ciprofloxacin (Cipro)

Correct Answer: 2 Global Rationale: TMP-SMZ is the only drug listed that can be administered safely to a child. Fluoroquinolones are contraindicated in children under age 18 because of the possibility of cartilage damage. The safety and efficacy of fosfomycin have not been established in children younger than 12 years old.

A client has been on an antibiotic for 2 weeks for treatment of an ulcer caused by Helicobacter pylori. The client asks the nurse if the antibiotic could be causing diarrhea. What is the nurse's most accurate response? 1. "The infection has become severe." 2. "This might be a secondary infection due to the antibiotic therapy." 3. "The infection has a restricted group of microorganisms." 4. "The organisms that caused the infection have developed immunity to the drug."

Correct Answer: 2 Global Rationale: The appearance of a new infection while receiving anti-infective therapy is highly suspicious of a superinfection. Signs and symptoms of superinfection commonly include diarrhea, bladder pain, painful urination, or abnormal vaginal discharges. Broad-spectrum antibiotics are more likely to cause superinfections because they kill many microbial species, which sometimes includes host flora. Organisms that commonly cause superinfections are Clostridium albicans in the vagina, streptococci in the oral cavity, and Clostridium difficile in the colon.

The nurse would explain that Augmentin is a combination drug containing the antibiotic amoxicillin and clavulanate, which is a(n): 1. secondary antibiotic. 2. beta-lactamase inhibitor to prevent the excretion of penicillin. 3. anti-inflammatory to prevent allergic response. 4. antiviral to prevent superinfection.

Correct Answer: 2 Global Rationale: The fixed-dose combination of Augmentin combines amoxicillin with clavulanate, a beta-lactamase (penicillinase) inhibitor. By inhibiting penicillinase, these combined drugs allow a greater percentage of the aminopenicillin molecules to reach pathogens and affect cell wall synthesis. The beta-lactamase inhibitors are ineffective when used alone and therefore are always used in fixed combination formulations with other drugs.

The components required for bacterial protein synthesis are: 1. mRNA, tRNA, and 80S ribosomes. 2. mRNA, tRNA, and 70S ribosome. 3. DNA, mRNA, cell wall, and nucleoid. 4. mRNA, tRNA, plasma membrane, and pili.

Correct Answer: 2 Global Rationale: Three components are required for bacterial protein synthesis: messenger ribonucleic acid (mRNA), transfer ribonucleic acid (tRNA), and the 70S ribosome (subunits 30S and 50S). The 80S ribosome is located in human cells. DNA and nucleoids are not among the three components required for bacterial protein synthesis. Pili, hairlike projections on the surface of some bacteria, are not among the three components are required for bacterial protein synthesis.

A female client has been provided with a 3-day course of therapy as prophylaxis against another urinary tract infection. Which statement indicates that the client understands when to use this medication? 1. "I will take this medication on the first 3 days of the month." 2. "I will take this medication after my husband and I have sexual intercourse." 3. "When I first have symptoms, I will drink cranberry juice. If that is not effective, I will take the medication." 4. "If I develop symptoms of an infection, I will call the health care provider and make sure it is OK for me to go ahead and take the medication."

Correct Answer: 2 Global Rationale: With this type of treatment, the patient is provided with a single dose or 3-day course of therapy, which is initiated by the woman after each act of coitus, or when symptoms first develop. The medication is intended to be taken at the first sign of symptoms; the client should not delay treatment by trying something else.

How do fluoroquinolones block bacterial DNA replication? 1. Fluoroquinolones inhibit the synthesis of precursor bases. 2. Fluoroquinolones bind to enzymes of bacterial DNA replication, blocking the relaxation and migration processes. 3. Fluoroquinolones inhibit topoisomerase I so that DNA cannot be repaired. 4. Fluoroquinolones bind with the enzyme DNA polymerase, blocking the replication of the DNA process.

Correct Answer: 2 . Global Rationale: The fluoroquinolone antibiotics act on two enzymes in the DNA replication process. First, they bind to DNA gyrase, inhibiting its ability to relax the supercoiling of the bacterial DNA. When the replication enzymes reach an area still in a supercoiled state, replication terminates. A second mechanism is binding to topoisomerase IV. When this occurs, the two daughter DNA strands cannot migrate to opposite sides of the cell, and division cannot be completed. They do not inhibit synthesis of precursor bases, bind with the enzyme DNA polymerase or block repair as is the mechanism of action of some other classes of drugs.

The nurse is obtaining a client's drug history prior to initiating therapy with gentamicin (Garamycin). The client takes furosemide (Lasix). Based on this information, the nurse identifies the client is at increased risk for: 1. nephrotoxicity. 2. ototoxicity. 3. pseudomembranous colitis. 4. photosensitivity.

Correct Answer: 2 Global Rationale: Concurrent use of more than one ototoxic drug increases the risk of hearing impairment. The risk for nephrotoxicity is increased if nephrotoxic drugs are prescribed concurrently. Pseudomembranous colitis is a serious adverse effect associated with tetracycline. Photosensitivity is associated with protein synthesis inhibitors, but is not potentiated by addition of furosemide.

A client has been hospitalized for a severe urinary tract infection (UTI). Ciprofloxacin IV (Cipro) is prescribed. Two days later, the symptoms have abated, and the client is discharged with a prescription for oral ciprofloxacin (Cipro). What characteristics of fluoroquinolones allow for this quick discharge from the hospital? 1. Fluoroquinolones given as IV are very expensive, and must be switched to oral administration as soon as possible to save the client money. 2. Fluoroquinolones have equal serum drug levels with either IV or oral administration, which allows for a smooth transition from IV to oral therapy. 3. Fluoroquinolones given as an IV infusion eradicate infection quickly so that the client can be discharged. 4. Fluoroquinolones are less toxic when given orally.

Correct Answer: 2 Global Rationale: The serum levels of oral and IV administration of fluoroquinolones are the same, allowing for a smooth transition from IV to oral therapy. Many drugs are expensive, but this would not be a reason for early discharge from the hospital. Fluoroquinolones are effective against infection, but antibacterials must be given for a course of approximately 10 days. There is no difference in toxicity between IV and PO dosage.

The nurse caring for a client with an infection knows a contributing factor to the development of drug resistance is the presence of bacterial genetic errors called: 1. plasmids. 2. mutations. 3. conjugates. 4. duplications.

Correct Answer: 2 Rationale 1: Plasmids are small pieces of DNA. Rationale 2: Genetic errors are mutations. Rationale 3: Conjugation is a part of transcription. Rationale 4: Duplication is the repeating of the genetic code, and it is a normal process.

A 28-year-old female client presents to the emergency department with a temperature of 102.4°F. She states that she began experiencing frequency and burning upon urination yesterday and in the middle of the night woke up with the fever and chills. She also states that her back is hurting. These symptoms describe what type of infection? 1. Urethritis 2. Acute pyelonephritis 3. Acute renal failure 4. Cystitis

Correct Answer: 2 Rationale 1: The client with urethritis would have discomfort during voiding but would not have other symptoms of irritative voiding, or have fever or back pain. Rationale 2: Acute pyelonephritis is an inflammation of the kidney, pelvis, and other renal cells. The symptoms include irritative voiding symptoms, vomiting, fever, chills, and acute costovertebral angle and flank tenderness. Rationale 3: Acute renal failure (ARF)—or acute kidney injury (AKI), as it is now referred to in the literature—is defined as an abrupt or rapid decline in renal filtration function. ARF has few symptoms initially; in its second phase it is marked by fluid retention, azotemia, and metabolic acidosis. Rationale 4: Cystitis is a bladder infection. The client usually complains of symptoms such as dysuria and increased urgency and frequency. There is discomfort over the suprapubic area, not in the back or flank area. Temperature would be mildly elevated if at all.

The nurse is reviewing the lab values of a client receiving digoxin for the treatment of heart failure. The nurse plans to hold the next dose of digoxin as the serum blood level is greater than _____ ng/mL. Standard Text: Record your answer rounding to the nearest whole number.

Correct Answer: 2 Rationale: The health care provider should establish acceptable parameters for serum digoxin levels for each client, and the drug should be discontinued if the level rises above the maximum. Digoxin levels higher than 2.0 ng/mL are considered toxic.

A female client has been prescribed ampicillin (Principen). What should the nurse emphasize when instructing the client about the medication? 1. Do not become pregnant while on ampicillin. 2. If taking oral contraceptives, use an alternative form of birth control. 3. Ampicillin should be taken on an empty stomach. 4. Contact the health care provider immediately if persistent diarrhea with fever occurs. 5. Stop taking ampicillin if nausea occurs and report to the health care provider immediately. .

Correct Answer: 2,3,4 Global Rationale: Ampicillin may decrease the effectiveness of oral contraceptives. Because food decreases its absorption, ampicillin should be taken on an empty stomach. Diarrhea is a common occurrence when taking ampicillin, but if the diarrhea is persistent and fever continues the health care provider should be consulted

A pregnant client is seen in the emergency department for an infection. The nurse anticipates that antibiotics prescribed for this client would not include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. ampicillin. 2. minocycline. 3. neomycin. 4. streptomycin. 5. doxycycline.

Correct Answer: 2,3,4,5 Global Rationale: Some anti-infectives are pregnancy category D, such as minocycline, doxycycline, neomycin, and streptomycin.

The client on penicillin who is complaining of an abnormal vaginal discharge has a superinfection secondary to: 1. a nosocomial infection. 2. an overdose of penicillin. 3. the destruction by penicillin of normal flora in the vagina. 4. the development of an organism resistant to penicillin.

Correct Answer: 3 Global Rationale: Antibiotics are unable to distinguish between host flora and pathogenic organisms. When an antibiotic kills the host's normal flora, additional nutrients and space are available for pathogenic microorganisms to grow unchecked. These new, secondary infections caused by antibiotic use are called superinfections, or suprainfections. The appearance of a new infection while receiving anti-infective therapy is highly suspicious of a superinfection. Signs and symptoms of superinfection commonly include diarrhea, bladder pain, painful urination, or abnormal vaginal discharges.

The health care provider has ordered trimethoprim-sulfamethoxazole (Septra) to be administered IV to several hospitalized clients who have developed urinary tract infections. For which client should the nurse question the order? 1. The client with glaucoma 2. The client who has an indwelling urinary catheter inserted 3. The client who has AIDS 4. The client who had surgery yesterday

Correct Answer: 3 Global Rationale: Caution must be used when treating clients with acquired immunodeficiency syndrome (AIDS) because they experience a higher incidence of serious adverse effects than others. Glaucoma and presence of an indwelling urinary catheter are not contraindications for the use of Septra IV. It is not necessary to question the order solely due to the client's postoperative status.

A client who has been taking ciprofloxacin (Cipro) calls the health care provider to report that he has begun having loose stools. What instructions would be most helpful to this client? 1. Take a dose of antidiarrheal medication after every loose stool. 2. Do nothing until you have 8-10 loose stools per day. 3. Eat live-culture yogurt once or twice daily. 4. Limit the amount of water you drink to three glasses a day.

Correct Answer: 3 Global Rationale: Clients are often advised to consume live-culture dairy products to help maintain and restore normal intestinal flora. Antidiarrheal drugs should be used conservatively, which could cause retention of harmful bacteria. Clients should be given instructions to increase fluids, and should monitor for the presence of severe diarrhea.

Which generation of cephalosporin would be selected to treat complicated, drug-resistant meningitis? 1. Second 2. Third 3. Fourth 4. First

Correct Answer: 3 Global Rationale: First- and second-generation drugs do not cross the blood-brain barrier to any appreciable extent. Third-generation drugs are able to enter the CSF to treat CNS infections, but fourth generation cephalosporins are more effective against organisms that have developed resistance to earlier cephalosporins.

A 19-year-old client with symptoms of recurrent urinary tract infection states that she generally does not finish the prescription given to her for the infection. What medication is the health care practitioner most likely to prescribe for this client? 1. Nitrofurantoin (Furadantin) 2. Trimethoprim-sulfamethoxazole (TMP-SMZ) 3. Fosfomycin (Monurol) 4. Ciprofloxacin (Cipro)

Correct Answer: 3 Global Rationale: Fosfomycin would be the drug of choice for this client because it is given as a single dose, so compliance is not an issue. The other drugs are taken for a number of days and depend upon the client's compliance.

A nurse is conducting a class for preschool parents concerning ways to prevent illness in children. A parent asks why little girls are at greater risk for urinary tract infections than little boys. Which response by the nurse is most accurate? 1. "Little boys have short urethras, but they also have testicles that block bacteria from the rectum." 2. "Most little girls don't wipe themselves as well as little boys do after using the bathroom." 3. "Little girls have short urethras, which makes it easier for bacteria to move into the bladder." 4. "Testosterone in boys helps prevent urinary tract infections."

Correct Answer: 3 Global Rationale: Girls have more frequent UTIs because their urethras are shorter than boys', making it easier for bacteria to move into the bladder. Their rectums are also in closer proximity to the urethra than are boys'. Little boys do have testicles that help to block bacteria from traveling from the rectum to the urethra, but they have long urethras, not short ones. There is no evidence that boys wipe themselves better than do girls. Testosterone does not help prevent UTIs.

Bacterial protein synthesis inhibitors have selective toxicity because: 1. susceptible strains of bacteria are affected. 2. biochemical processes are the same. 3. human ribosomes are larger and denser than bacterial ribosomes. 4. antibacterial activity is broad-spectrum.

Correct Answer: 3 Global Rationale: Human ribosomes are larger and denser than bacterial ribosomes. As a result, human ribosomes are not targeted by the drug's antibacterial activity. Susceptible strains of bacteria are targeted by the drug's antibacterial activity. Biochemical processes that are the same would be targeted by the drug. The spectrum of an antibacterial drug describes the range of bacteria it is effective against.

The nurse is preparing to administer a broad-spectrum antibiotic medication to a client. An important nursing intervention prior to administration of the anti-infective is: 1. performing a culture within 24 hours after starting the medication. 2. obtaining the culture report, as when starting any medication. 3. performing a culture prior to administering the first dose of the anti-infective. 4. administering the medicine without performing cultures.

Correct Answer: 3 Global Rationale: Ideally, the pathogen should be identified before anti-infective therapy is begun.

A female client with acute uncomplicated cystitis (AUC) has been treated with antibacterials, and now reports that all symptoms have resolved. What further instructions should be given to this client at this time? 1. "Don't try to figure out for yourself if you have an infection; it might be dangerous." 2. "Come back to the clinic in 2 weeks for a urinalysis to check for signs of infection." 3. "Your health care practitioner would like to see you in 2 weeks to see how you are feeling." 4. "You don't need to come back to the clinic unless your symptoms return."

Correct Answer: 3 Global Rationale: In many cases, a diagnosis of AUC is made by the health care provider based on symptoms and history alone, without additional serologic or urinary testing. Women who have experienced a prior AUC are often able to self-diagnose. Rapid dipstick tests are available to examine for the presence of infection. Follow-up of AUC is usually by routine office visit; no additional testing or cultures are required if the symptoms promptly resolve.

Which location is the most difficult to reach with antibiotic therapy? 1. Gastrointestinal system 2. Integumentary system 3. Central nervous system 4. Lungs

Correct Answer: 3 Global Rationale: Infections of the central nervous system (CNS) are particularly difficult to treat because many medications are unable to cross the blood-brain barrier to reach the brain and associated tissues.

Fluoroquinolones are known to be effective against both gram-negative and gram-positive organisms. How is this possible? 1. Fluoroquinolones that are effective against gram-negative organisms block the enzyme topoisomerase IV, which stops the migration process of the two new strands to opposite sides of the cell. 2. Fluoroquinolones that are effective against gram-positive organisms block the enzyme DNA gyrase, which stops relaxation of the supercoil of the DNA. 3. Fluoroquinolones that are effective against gram-negative organisms block the enzyme DNA gyrase, and those effective against gram-positive organisms block topoisomerase IV. 4. All fluoroquinolones are effective against both gram-negative and gram-positive organisms. There is no difference in the way they block bacterial DNA replication.

Correct Answer: 3 Global Rationale: It is thought that fluoroquinolones inhibit DNA gyrase in gram-negative organisms, and inhibit topoisomerase IV in gram-positive organisms Specific fluoroquinolones are effective against either gram-negative or gram-positive organisms. Some of the newer fluoroquinolones are more effective against gram-positive organisms.

Which client would require the administration of prophylactic antibiotics? 1. A client with inflammation at the infection site 2. A client with a viral infection 3. A client with a suppressed immune system 4. A client with pus at the infection site

Correct Answer: 3 Global Rationale: Only in rare cases are anti-infectives given prophylactically for indefinite time periods. Examples include the prevention of infections in patients with suppressed immune systems such as those with HIV infection, or those receiving immunosuppressants following an organ transplant.

The nurse anticipates use of an extended-spectrum penicillins such as piperacillin when the patient is infected with which microbe? 1. Streptococcus 2. Herpes simplex 3. Pseudomonas 4. Staphylococcus

Correct Answer: 3 Global Rationale: Piperacillin and ticarcillin have broad spectrums of antimicrobial activity similar to those of the aminopenicillins. Their primary advantage is their additional activity against Pseudomonas aeruginosa; thus they are called extended-spectrum or antipseudomonal penicillins.

A 13-year-old client has been diagnosed with meningitis caused by Haemophilus influenzae type B. What drug is commonly prescribed to prevent this disease from occurring in individuals who had close contact with the client prior to the illness? 1. Metronidazole (Flagyl) 2. Daptomycin (Cubicin) 3. Rifampin (Rifadin) 4. Ciprofloxacin (Cipro)

Correct Answer: 3 Global Rationale: Rifampin is the drug of choice for prophylaxis of persons who have come in contact with clients with Haemophilus influenzae type B. Metronidazole is a miscellaneous antibacterial that is effective against both bacteria and multicellular parasites. It is the drug of choice for trichomoniasis, giardiasis, and amebiasis. Daptomycin is a miscellaneous antibacterial that is indicated for the treatment of complicated skin infections such as those caused by MRSA and VRSE. Ciprofloxacin is used for the treatment and prevention of inhalation B. anthracis spores. It is not indicated for the prophylaxis of H. influenzae type B.

A client who has been receiving therapy with tetracycline reports itching and yellowish discoloration of the skin. The nurse knows these symptoms could be associated with which adverse effect of tetracycline? 1. Cholestatic hepatitis 2. Acute pancreatitis 3. Fatty degeneration of the liver 4. Exfoliative dermatitis

Correct Answer: 3 Global Rationale: Serious adverse reactions of tetracycline include anaphylaxis; fatty degeneration of the liver, producing jaundice; and exfoliative dermatitis. Cholestatic hepatitis is an adverse effect associated with erythromycin estolate, a macrolide. Acute pancreatitis is not associated with tetracycline therapy. Exfoliative dermatitis is an adverse effect associated with tetracycline. However, it is associated with pruritus, not jaundice

A female client is prescribed tetracycline for acne. When providing information regarding this drug, the nurse explains that tetracycline: 1. is contraindicated in people over 20 years old. 2. is classified as a narrow-spectrum antibiotic. 3. has been identified to be unsafe during pregnancy. 4. is used to treat a wide variety of disease processes.

Correct Answer: 3 Global Rationale: Some antibiotics are readily secreted in breast milk or cross the placenta. For example, tetracyclines taken by the mother can cause teeth discoloration in the newborn, and aminoglycosides can affect hearing. Some anti-infectives are pregnancy category D, such as minocycline, doxycycline, neomycin, and streptomycin.

Which statement indicates that a client understands the reason for the need to drink approximately 3 liters of fluid while taking trimethoprim-sulfamethoxazole (TMP-SMZ)? 1. "I need to drink a lot of fluids to keep my bladder full." 2. "I need to drink a lot of fluids to flush the bacteria out of my bladder." 3. "I need to drink a lot of fluids to prevent crystals from forming in my urine." 4. "I need to drink a lot of fluids to prevent an allergy from developing."

Correct Answer: 3 Global Rationale: Sulfonamides have a low solubility, which may cause crystalluria, crystals that form in the urine and potentially obstruct the kidneys or ureters. The risk is higher in dehydrated patients and when urine pH is abnormally low. To decrease the possibility of crystalluria, fluids in amounts up to 3,000 mL per day should be encouraged to achieve a urinary output of 1,500 mL in 24 hours. It is not necessary to keep the bladder full and drinking fluids will not prevent a hypersensitivity reaction. Fluids do not flush the bacteria out of the system.

The nurse is instructing a female client about therapy with tetracycline (Sumycin). Which statement should be included in the instruction? 1. "Absorption of this drug is not affected by food." 2. "GI upset is a rare side effect." 3. "If taking oral contraceptives, an additional form of birth control is recommended." 4. "Take this drug immediately before bedtime." .

Correct Answer: 3 Global Rationale: Tetracyclines decrease the effectiveness of oral contraceptive therapy. Esophagitis and esophageal ulceration are associated with taking tetracycline before bed. The client should be instructed to avoid this practice. GI upset, nausea, vomiting, epigastric burning, and diarrhea are frequent side effects of tetracyclines. Dairy products decrease absorption

A client has received a prescription for a sulfonamide. Which statement by the client indicates a need for further instruction? 1. "If I develop a fever or severe diarrhea, I will call my health care provider." 2. "I will call the health care provider if my symptoms have not improved in the next few days. " 3. "I will limit my fluid intake to about three glasses per day." 4. "I will return for my scheduled appointment for lab work."

Correct Answer: 3 Global Rationale: The client should contact the health provider if symptoms do not improve in a few days or if fever or severe diarrhea develop. The client should know when to return for lab work or a follow-up appointment. The client should increase fluid intake to 2-3 liters per day rather than limit intake to approximately 24 ounces.

The nurse is discharging a client from the urgent care clinic who has been diagnosed with a urinary tract infection. The nurse knows the client has understood teaching when she states she will contact the health care provider if her fever persists for more than _____ days.

Correct Answer: 3 Global Rationale: The provider should be notified if fever and signs and symptoms of infection remain or increase after 3 days, or if the entire course of antibacterial has been taken and signs of infection are still present.

During pharmacology class, a nursing professor poses the following question: "We have learned that certain medications, such as fluoroquinolones, are effective because they inhibit bacterial DNA replication. Why don't these medications cause harm to the nonbacterial cells in the body?" Which student nurse answered the question correctly? 1. Student B: "Medications such as fluoroquinolones do not appear to affect human DNA because human DNA is very similar to bacterial cell DNA." 2. Student D: "Human DNA is inherently healthier than bacterial DNA, so medications such as fluoroquinolones do not affect their replication." 3. Student C: "Medications such as fluoroquinolones don't appear to affect human DNA replication because of the difference between the enzymes needed for bacterial and human DNA replication." 4. Student A: "These medications protect healthy human cells while they attempt to disrupt bacterial DNA replication."

Correct Answer: 3 Global Rationale: These drugs have no effect on human enzymes involved in DNA replication because of significant differences in the chemical structures of the human and bacterial enzymes. These differences account for their selective toxicity on bacteria, and their favorable safety profile. The statement regarding DNA health is inaccurate. These drugs offer no protection to human DNA.

DNA replication is necessary for bacterial cell replication. One of the ways that antibacterials are effective is by inhibiting the DNA replication. Antibacterials often accomplish this by: 1. encouraging the replication of the original DNA to form a new DNA strands. 2. encouraging migration of the DNA strands to opposite sides of the cell. 3. affecting the enzymes needed for DNA replication. 4. assisting the supercoil to relax and unwind.

Correct Answer: 3 Global Rationale: A large number of enzymes are needed for DNA replication, and some of these enzymes are targets for antibiotics. Replication of the original DNA to form new DNA is necessary for bacterial replication. Antibacterials would inhibit this replication. Migration of the DNA strands to opposite sides of the cell is necessary prior to DNA replication. Antibiotics would inhibit this migration. The supercoil must relax and unwind in preparation for DNA replication. Antibiotics would inhibit this process.

A client has been diagnosed with a gram-negative bacterial infection and has been prescribed a fluoroquinolone for treatment of this infection. What step of the bacterial DNA replication process is most likely being affected by the use of this medication? 1. It inhibits the enzyme DNA polymerase necessary for DNA replication. 2. It binds to the enzyme topoisomerase IV, preventing the new DNA strands from migrating to opposite sides of the cell, thus preventing bacterial cell replication. 3. It inhibits the relaxation of the supercoil prior to the unwinding process, which terminates replication. 4. It inhibits the unwinding of the two strands of the supercoil, thus terminating replication.

Correct Answer: 3 Global Rationale: The fluoroquinolone antibiotics act on two enzymes in the DNA replication process. First, they bind to DNA gyrase, inhibiting its ability to relax the supercoiling of the bacterial DNA. When the replication enzymes reach an area still in a supercoiled state, replication terminates. A second mechanism is binding to topoisomerase IV. When this occurs, the two daughter DNA strands cannot migrate to opposite sides of the cell, and division cannot be completed. They do not appear to affect the unwinding process itself or to prevent migration, and do not affect the enzyme DNA polymerase.

The nurse is caring for a female client with an uncomplicated UTI that is being treated with ciprofloxacin hydrochloride (Proquin XR). The client asks the nurse how long she will need to take this medication. The nurse tells the client she will have to take the medication for _______days. Standard Text: Record your answer rounding to the nearest whole number.

Correct Answer: 3 Rationale: Approved in 2005, Proquin XR contains only the hydrochloride salt and has been formulated to cause less nausea, vomiting, and diarrhea than other formulations. Proquin XR is administered for only 3 days and is only approved for uncomplicated UTI (acute cystitis).

The nurse is caring for a client who has been diagnosed with AUC. The client lives in a community where drug resistance is an issue. Which antibiotics may be prescribed for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Trimethoprim-sulfamethoxazole (TMP-SMZ) 2. Ciprofloxacin (Cipro) 3. Norfloxacin (Noroxin) 4. Nitrofurantoin (Furadantin) 5. Fosfomycin (Monurol)

Correct Answer: 3,4 Global Rationale: Norfloxacin (Noroxin), ofloxacin (Floxin), levofloxacin (Levaquin), and nitrofurantoin have become preferred drugs for AUC in communities with large numbers of drug-resistant conditions. Fosfomycin (Monurol) is used when compliance is an issue. Trimethoprim-sulfamethoxazole and ciprofloxacin are not the best drugs for use in communities with large numbers of drug-resistant conditions.

Which client should be most closely monitored for adverse effects directly related to receiving penicillin G? 1. A client who has osteomyelitis and will need IV medication for several months 2. A client who had a myocardial infarction 2 days ago and now has a fever of 102°F 3. A client who is postop from corneal transplant 4. A client who has diabetes and is on dialysis

Correct Answer: 4 Global Rationale: Because 90% of a dose of penicillin G is excreted unchanged by the kidneys through tubular secretion, patients with significant renal impairment must be carefully monitored. Patients with heart failure should not receive the penicillin sodium salt. Hyperkalemia may result with high doses of the penicillin G potassium salt.

A nursing student asks a nurse how antibacterials work. The nurse outlines the process, explaining that many antibacterials work by blocking bacterial DNA replication. The nurse knows further teaching is needed when the student states: 1. "Drugs inhibit the availability of precursor bases or nucleotides." 2. "Drugs can interact or bind with DNA, preventing the uncoiling or relaxation process." 3. "Drugs can bind to enzymes of DNA replication, halting the formation of new DNA strands." 4. "Drugs repair bacterial DNA damage."

Correct Answer: 4 Global Rationale: Drugs that block bacterial DNA replication would block the repair of the DNA, not allow it. Drugs block bacterial DNA replication by inhibiting synthesis of precursor bases or nucleotides, binding to bacterial DNA, and binding to the enzymes needed for replication.

A client has come to the health care provider's office with symptoms of a urinary tract infection (UTI). She states that she had no symptoms when she went to bed last night but woke this morning with severe burning with urination. A urine culture is completed and grows Escherichia coli. The client asks the nurse why these symptoms occurred so suddenly. The nurse's best response is: 1. "You probably had the symptoms for some time, but you didn't notice it until it became severe." 2. "The severity of your symptoms indicates a hygiene problem." 3. "Do you often have complaints of severe pain when you awaken?" 4. "The bacteria that caused your infection grow very rapidly, so it is possible you had no symptoms the night before."

Correct Answer: 4 Global Rationale: E. coli can replicate every 20 minutes, producing a billion cells in as little as 10 hours. The client usually won't complain of urinary tract discomfort until the bacterial level is sufficient to cause symptoms. Implying that the patient has poor hygiene is not therapeutic and does not answer the patient's question. Asking about pain in the morning does not address the patient's question.

First-generation cephalosporins are the most effective of this class of antibiotics against: 1. Protozoans. 2. Gram-negative bacteria. 3. Rickettsia. 4. Gram-positive bacteria.

Correct Answer: 4 Global Rationale: First-generation cephalosporins contain a beta-lactam ring; bacteria that produce beta lactamase are usually resistant to these drugs. They are the most effective cephalosporins against gram-positive bacteria, including staphylococci and streptococci and are sometimes the preferred drugs for these organisms. First-generation cephalosporins have only moderate activity against gram-negative bacteria.

The nurse is administering the first dose of ampicillin intramuscularly to a client with a severe infection. In addition to the six rights of medication administration, an important priority nursing action is to: 1. monitor bowel sounds. 2. teach the client about the side effects of the drug. 3. encourage the client to increase fluid intake. 4. monitor the client closely for hypersensitivity with the first dose.

Correct Answer: 4 Global Rationale: Hypersensitivity may occur even with the first dose of a medication. The nurse must monitor for that possibility.

The mother of a 4-year-old calls the nurse to report her child has been having diarrhea since he began taking an antibiotic 48 hours ago. The mother asks if she should give her child an over-the-counter medication for the diarrhea. What is the nurse's best response? 1. "Wait one more day and see if the diarrhea clears." 2. "Yes, give something over the counter, but only one dose." 3. "Yes, give something over the counter according to the dosage directions on the label." 4. "Do not treat the diarrhea, and bring the child to the office."

Correct Answer: 4 Global Rationale: Patients should be taught to consult the health care provider before taking any antidiarrheal drugs that slow gastric motility because these may cause the retention of harmful bacteria.

A client being discharged with a prescription for penicillin also takes probenecid. The nurse explains that probenecid: 1. prevents diarrhea often associated with penicillin. 2. will prevent an allergic response. 3. is a secondary antibiotic. 4. will allow the penicillin to stay in the body longer.

Correct Answer: 4 Global Rationale: Probenecid decreases excretion of penicillins and can lead to antibiotic toxicity. This is sometimes a desired effect but the patient will require monitoring.

Which statement by a nursing student about the mechanism of action of sulfonamides indicates the need for further instruction? 1. "Sulfonamides resemble the precursor molecule, PABA, so the enzymes needed for the synthesis of folic acid bind with sulfonamide instead of with PABA, stopping bacterial growth." 2. "Sulfonamides slow the growth of bacteria because they only inhibit folic acid that is synthesized by bacteria." 3. "Sulfonamides are effective against uropathogens by inhibiting the synthesis of bacterial folic acid." 4. "Sulfonamides are most effective in clients who eat large amounts of foods rich in folic acid."

Correct Answer: 4 Global Rationale: Sulfonamides resemble PABA, which allows the enzyme necessary for bacterial growth to mistakenly bind with the sulfonamide instead of with PABA. Sulfonamides only inhibit folic acid synthesized by bacteria. It is ineffective against "premade" folic acid needed by humans, thus level of ingestion of folic acid is not relevant.

A 19-year-old male client complains of burning while voiding. The health care practitioner diagnoses urethritis and explains that it is caused by a pathogen that infects the urethra. The client tells the nurse that his girlfriend had the same problem last week. The nurse knows that the most likely cause of the urethritis in this client is: 1. unrelated to his girlfriend's condition. 2. a descending bladder infection. 3. related to poor hygiene. 4. a sexually transmitted disease.

Correct Answer: 4 Global Rationale: The fact that the client reports that his girlfriend had similar symptoms last week is indicative of the possibility of a sexually transmitted disease. This client's symptoms appear to be confined to the urethra. Most UTIs ascend from the urethra to the bladder, and do not descend from the bladder to the urethra. There is nothing to indicate that poor hygiene is related to this client's condition.

A school nurse is conducting a health class for fifth-grade girls. The nurse instructs the girls that when toileting, they must remember to wipe from front to back. Which statement by a student indicates the need for further education? 1. "Girls need to wipe from front to back to avoid urinary tract infections." 2. "Girls must be careful about the way they wipe to prevent infection from bacteria present near the rectum." 3. "Girls must be careful how they wipe because the connection from the outside to the bladder is very short." 4. "Girls need to wipe front to back only after a bowel movement."

Correct Answer: 4 Global Rationale: The male and female urinary tracts are identical, with the exception of the urethra, which is shorter in the female and located closer to the anus. This anatomic difference results in the periurethral region of the female being populated by bacteria that are normally restricted to the gastrointestinal (GI) tract, and could cause UTIs. These anatomic differences result in a higher risk of UTI in females.

A 45-year-old male client comes to the health care practitioner with symptoms of cystitis. The client also has a fever, and states that it is very hard for him to "pass much urine." The health care practitioner performs a rectal examination and finds tenderness. What is possibly causing this client's set of problems? 1. Bladder infection 2. Urethritis 3. Acute pyelonephritis 4. Cystitis with prostatitis

Correct Answer: 4 Global Rationale: This client demonstrates symptoms of cystitis with prostatitis. The prostate becomes inflamed and can cause fever and urinary obstruction. A bladder infection is cystitis. This client does have cystitis, but also has symptoms of another condition. Symptoms of urethritis would include discomfort during voiding. There should not be fever or urinary obstruction. Symptoms of acute pyelonephritis include fever and flank pain. It would not cause urinary obstruction.

The health care practitioner is preparing to prescribe trimethoprim-sulfamethoxazole (Bactrim). For which client should the nurse question an order for this medication? 1. The client who has a Shigella infection of the bowel 2. The client with P. jiroveci pneumonia 3. The client with iron-deficiency anemia 4. The client with pernicious anemia

Correct Answer: 4 Global Rationale: Trimethoprim-sulfamethoxazole is contraindicated for clients with a folate-deficiency anemia because this drug is a folic acid inhibitor and would worsen the condition. There is no reason to question the order if the client has iron deficiency anemia. Trimethoprim-sulfamethoxazole is indicated for the treatment of Shigella infection of the small bowel and for treatment of P. jiroveci pneumonia.

Which type of antibiotic carries the highest risk of an allergic response? 1. Tetracyclines 2. Aminoglycosides 3. Cephalosporins 4. Penicillins

Correct Answer: 4 Global Rationale: Although not common, serious hypersensitivity reactions to antibiotics may be fatal. The penicillins are the class of antibacterials that have the highest incidence of allergic reactions: Between 0.7% and 10% of all patients who receive these drugs exhibit some degree of hypersensitivity.

A client has been diagnosed with a skin infection. The infective organism has been identified as MRSA, and daptomycin (Cubicin) IV has been prescribed. If this client complains of muscle pain, what will be the priority nursing intervention? 1. Place the affected extremity in a resting position. 2. Place a warm compress on the affected muscles. 3. Encourage the client to exercise the client and work out the soreness. 4. Obtain a blood specimen for a CPK.

Correct Answer: 4 Global Rationale: Because myopathy is a possibly adverse effect of daptomycin, the nurse should immediately obtain a CPK for evidence of muscle damage. Other actions such a rest or increased exercise or using a warm compress do not have priority in this patient's care.

The nurse sending a wound culture to the laboratory knows that the purpose of culture and sensitivity testing is to: 1. prevent an infection, a practice called chemoprophylaxis. 2. identify bacteria that have acquired resistance. 3. promote the development of drug-resistant bacterial strains by killing the bacteria sensitive to a drug. 4. determine which antibiotic is most effective against the infecting microorganism.

Correct Answer: 4 Global Rationale: Specimens such as urine, sputum, blood, or pus are examined in the laboratory for the purpose of isolating and identifying specific pathogens. After isolation, the microbe is exposed in the laboratory to different antibiotics to determine the most effective ones. This process of isolating the infectious organism and identifying the most effective antibiotic is called culture and sensitivity (C&S) testing.

A 16-year-old client has been prescribed metronidazole (Flagyl) for treatment of a sexually transmitted infection. This client has been seen in the clinic four times in the last 6 months for the same condition. The client just wants the nurse to give her the medication so that she can go home. What would be considered the priority nursing diagnosis for this client? 1. Noncompliance (antimicrobial therapy) related to therapeutic regimen 2. Diarrhea related to effects of drug therapy 3. Infection, Risk for 4. Knowledge, Deficient (infection) related to disease process, transmission, and drug therapy

Correct Answer: 4 Global Rationale: This client is exhibiting deficient knowledge about STIs because she has her fourth infection in the last 6 months. This client already has an infection, and is currently being treated for this infection, so there is no risk for infection. There is no data to indicate the client has diarrhea or has been noncompliant previously.

The ability of an organism to become unresponsive over time to an anti-infective is termed: 1. superinfection. 2. sensitivity. 3. mutation. 4. acquired resistance.

Correct Answer: 4 Rationale 1: A superinfection is a secondary infection that occurs when antibiotic therapy kills normal flora. Rationale 2: Sensitivity is the ability of an organism to be killed or of its growth to be halted by an antibiotic. Rationale 3: Mutation is the ability of an organism to adapt and change. This leads to antibiotic resistance. Rationale 4: Acquired resistance is the ability of an organism to become insensitive to the effects of an anti-infective.

The nurse caring for a client with an allergy to cephalosporins would be cautious in implementing an order for an anti-infective agent from which class? 1. Aminoglycosides 2. Fluoroquinolones 3. Sulfonamides 4. Penicillins

Correct Answer: 4 bit hypersensitivity to cephalosporins. Global Rationale: Although sometimes prescribed for patients who are allergic to penicillin, nurses must be aware that 5 percent to percent of the patients who are allergic to penicillin will also exhibit hypersensitivity to cephalosporins. Despite this small incidence of cross-allergy, the cephalosporins offer a reasonable alternative for patients who are unable to take penicillin. Cephalosporins are contraindicated, however, for patients who have experienced anaphylaxis following penicillin exposure.

The nurse is preparing to administer digoxin to a client with heart failure. The nurse assesses an apical pulse of less than _____ beats per minute and must hold the medication and notify the health care provider. Standard Text: Record your answer rounding to the nearest whole number.

Correct Answer: 60 Rationale: As a general rule, if the apical pulse falls below 60 beats per minute, the medication is withheld and the health care provider notified. Global Rationale: As a general rule, if the apical pulse falls below 60 beats per minute, the medication is withheld and the health care provider notified.

The nurse is planning care for a client with chronic obstructive pulmonary disease (COPD). The client's symptoms are wheezing, tachycardia, increased respiratory rate, coughing up yellow mucus, and a low oxygen level. The highest-priority nursing diagnosis is:

Gas Exchange, Impaired Rationale : The client has low oxygen levels. Increasing the level of oxygen in the client's bloodstream is the highest priority.

one thing about washing private area

Girls should always wash from front to back side, all the times. Not only after bowel movement !!

Classification of bacteria by their response to gram straining includes?

Gram negative and positive

A client is being treated for type 2 diabetes mellitus, tuberculosis, and rheumatoid arthritis. The nurse would be most concerned about this patient being treated with which medication?

Hydroxychloroquine (Plaquenil) Rationale: Etanercept is a tumor necrosis factor blocker. Because tumor necrosis factor is a cytokine that is important in cellular immunity, drugs that interfere with this cytokine increase the risk of infections and are contraindicated when a client has tuberculosis or a history of tuberculosis.

The nurse is assisting a client to master the use of a steroid inhaler. The client says, "I don't think I should be using steroids. I see steroids labeled as bad in the news at least once a week." The nurse's response is based on the fact that:

Inhaled steroids are very useful in managing reactive airways, with a fairly good safety profile. Rationale: Inhaled steroids are very useful in the management of chronic diseases like asthma and bronchitis. Because they are inhaled, their desired effect is local. The safety profile is good because the adverse effects are local as well.

What would the nurse identify as a priority diagnosis for a client with osteoporosis?

Injury, Risk for related to loss of bone calcium. Rationale 2: The client who has osteoporosis is at increased risk for injury from falls and resulting fractures.

The nurse is caring for a client with chronic bronchitis and a history of glaucoma. The nurse recognizes that which drug would not be an appropriate choice for the control of the client's bronchospasm?

Ipratropium (Atrovent) Rationale: Ipratropium is an anticholinergic that can elevate intraocular pressure. It is not a good choice for the client with glaucoma.

A client with persistent asthma has a history of multiple allergies, including peanuts and soy. The nurse knows that, given this history, which prophylactic medication should be avoided?

Ipratropium (Atrovent) Rationale: Ipratropium contains a substance derived from soya lecithin, so it is contraindicated in the presence of soy allergies.

New antibiotic classified as bactericidal agent. This means that the drug ?

Kills the infectious agent

The nurse is teaching a client about the use of an albuterol rescue inhaler. Which nursing diagnosis is most appropriate to avoid the adverse effects of albuterol?

Knowledge, Deficient related to proper use of albuterol inhaler Rationale 1: Correct inhaler use is essential to allow albuterol to penetrate deep enough into the airway to dilate the bronchioles.

An asthmatic client has been taking Accolate (zafirlukast) for a number of years. Coumadin is being added to the client's medications because of atrial fibrillation. What concern does the nurse have related to this addition?

Less warfarin (Coumadin) will be needed to achieve the desired prothrombin time (PT). Rationale: Warfarin (Coumadin) may significantly elevate the PT so that less warfarin (Coumadin) is needed.

The nurse administered the first dose of ampicillin intramuscular to a client with severe infection. In addition to the six-right of the medication administration, an important priority nursing action is to?

Monitor the client closely for hypersensitivity with the first dose.

As the nurse completes a medical history on a client admitted with heart failure, which disease should the nurse associate with heart failure?

Myocardial infarction. Rationale 4: The most common cause of heart failure in the United States is a progressive weakening of the heart muscle related to myocardial ischemia.

A client admitted with persistent asthma has a history of hypertension. Which class of asthma drugs must be used cautiously with clients who have hypertension?

Oral short-acting beta-adrenergic agonists Rationale : Oral beta-adrenergic agonists activate the sympathetic nervous system and must be used cautiously in clients with hypertension.

If client is allergic to cephalosporins the nurse will be cautious in implementing an order for an anti-infective agent from which class?

Penicillins

A client is prescribed a disease-modifying antirheumatic agent. What will the nurse explain as the mechanism of action for this medication?

Reduces damage and delays disease progression Rationale: Disease-modifying antirheumatic drugs reduce joint damage and delay disease progression.

The nurse is concerned that a client is at risk for the development of hypocalcemia because of which health problem?

Renal disease Rationale: Renal damage can result in excessive loss of calcium in the urine.

Plaquenil®

Rheumatoid Arthritis Agent. They are DMARD drugs

A child has Ticket, and is is being treated at the clinic. In addition to taking vitamin D as prescribed, what's is the best information the nurse can provide ?

Spend at least 20 minute or a day in the sunlight.

A client in acute respiratory distress on a medical unit is receiving a nebulizer albuterol treatment. The client is annoyed because he already has an albuterol metered-dose inhaler (MDI). The nurse's response to the client's concern is based on the knowledge that:

Suspension of the medication in liquid and delivery over a longer period increase the bronchodilator's effectiveness. Rationale : The client in acute distress benefits from the administration of a nebulizer treatment because the medication is delivered over a relatively longer period of time. Suspension in liquid particles with the use of a mouthpiece or mask and the assistance of a professional provider ensure that the medication will get to the lung's surfaces.

For which symptom is it critical for the nurse to monitor when caring for a client with hypoparathyroidism?

Tetany. Rationale 2: Tetany and its associated laryngospasm are manifestations of the severe hypocalcemia that is associated with hypoparathyroidism.

A client with limited strength in the hands is being prepared for discharge with a dry powder inhaler (DPI). The discharge nurse teaches the client that an advantage of this inhaler is that:

The client can activate the inhaler simply by inhaling. Rationale : Dry powder inhalers are activated by inhaling, which is an advantage to the client with decreased upper-body strength.

The nurse is collaboratively setting goals for the inpatient management of new-onset asthma in a child. The nurse prioritizes the client's nursing diagnoses and gives which goal the highest priority?

The client will report improved ease of breathing by discharge. Rationale: The goal with the highest priority is for the medication to be effective in a specific, measurable way.

The nurse is admitting a client with an exacerbation of asthma. The medication list includes albuterol, salmeterol, budesonide, cromolyn, and zafirlukast. The client takes these medicines every day, except for the albuterol. When planning the client's care, the nurse recognizes that:

The client's combination of medications is appropriate according to current practice guidelines. Rationale: Current practice guidelines recommend a long-acting bronchodilator and a steroid for long-term management. Mast cell stabilizer and leukotriene modifiers are also appropriate. Albuterol is appropriate as an as-needed short-acting inhaler.

Which instruction should take priority in client teaching for any antibiotics therapy ?

The full course of prescribed drug therapy must be completed.

Allipurinol

They are Utica acid inhibitors

Pathogenicity refer to an organs ability to ?

To cause disease

The nurse is caring for an orthopedic surgical client with mild intermittent asthma. During the second postoperative day, the client has an asthma attack while eating lunch. The nurse expects the health care provider to give an order for:

a short-acting selective beta-agonist inhaler. Rationale : Short-acting selective beta-agonist therapy via the inhaled route is the most appropriate therapy for mild intermittent asthma, used on an as-needed rescue basis.

The nurse should instruct a client with the initial stages of osteoarthritis to engage in low-impact exercise and take:

acetaminophen. Rationale: Acetaminophen is the drug of choice for osteoarthritis. It is effective and inexpensive.

When planning care for a client newly diagnosed with asthma, the nurse is aware that heavy caffeine intake could make the client intolerant of certain respiratory medications, including: .

albuterol. Rationale 2: Products containing caffeine such as coffee and tea may cause nervousness, tremor, or palpitations in clients taking albuterol

An adult is admitted to the emergency department with a respiratory rate of 32 breaths per minute and gasping. The nursing interview reveals the client witnessed a drive-by shooting. The nurse recognizes the client's rapid breathing is probably driven by:

brainstem activity. Rationale: The brainstem is highly influenced by emotions, particularly fear and anxiety. This client experienced both, which led to a sudden rise in respiratory rate.

A trauma client has experienced a ruptured diaphragm. The nurse would anticipate that this client will have difficulty:

carrying out the respiratory cycle. Rationale: Contraction and relaxation of the diaphragm are essential to the ventilation segment of the respiratory cycle.

A leading factor in the development of bacterial resistance is the ability of bacteria to undergo:

colonization. Rationale 3: Due to their rapid growth, bacteria make errors in duplicating their genetic code, thus forming a mutation.

A client with degenerative arthritis is provided with a spacer along with a corticosteroid metered-dose inhaler. The nurse recognizes that the spacer assists this client to:

compensate for decreased dexterity. Rationale 1: Spacers allow the client with decreased mobility or poor coordination to use a metered-dose inhaler more effectively.

A nurse in an intensive care unit is planning care for a client with severe bronchospasms triggered by a known allergy to peanuts. The nurse recognizes that constriction is related to inflammatory mediators that trigger:

constriction of the muscles in the walls of the large bronchiole tubes. Rationale: Allergic reactions can occur when a hypersensitive person is inadvertently exposed to an allergen, causing IgE antibodies to release histamine and other irritating substances. Bronchoconstriction quickly results.

A client is learning metered-dose inhaler technique. The client says, "I don't understand why I have to use this thing. Can't I just take pills?" The nurse responds that the inhalation route:

delivers the medication directly to the site, resulting in lower doses and fewer systemic side effects. Rationale: The inhaled route delivers the drug directly to the lungs, so lower doses are possible and there are fewer systemic side effects than are typically associated with pills.

Classification of bacteria by their response to Gram stain includes:

gram-positive and gram-negative. Rationale: Bacteria are classified as gram-positive or gram-negative by their ability or inability to respond to a violet color after staining.

A client with moderate and persistent asthma has obtained control with a formoterol inhaler qid for bronchospasm for several years. In the past couple of weeks, however, the client has been reporting more chest tightness and wheezing during the day. The nurse recognizes that the most likely problem is that the client:

has developed a tolerance to the medication. Rationale: Clients sometimes develop tolerance to the beta-adrenergic binding effects of inhaled bronchodilators.

A client with chronic obstructive pulmonary disease (COPD) is experiencing difficulty with copious amounts of tenacious sputum. A mucolytic drug is prescribed. The outcome the nurse would track is:

increase in clearance of sputum. Rationale: The intent of mucolytic therapy is to loosen the mucus so that it can be more easily expectorated.

Which question is most important for the nurse to ask the client who has been diagnosed with osteoporosis?

increasing the level of an inactive form of vitamin D in the blood. Rationale : Ultraviolet light increases the blood level of cholecalciferol synthesized from cholesterol in the skin.

The nurse helps a client establish goals to control asthma with medications. The nurse emphasizes that the preferred drugs for long-term control of asthma are:

inhaled corticosteroids. Rationale : Inhaled corticosteroids decrease inflammation, resulting in fewer asthma attacks.

The nurse is planning an educational program for a group of senior citizens on the importance of calcium intake. The nurse will explain that approximately 50% of the calcium in the body participates in intracellular functions and is:

ionized. Rationale : Ionized calcium is the only physiologically and clinically significant form of calcium.

A new antibiotic is classified as a bacteriocidal agent. This means that the drug:.

kills the infectious agent. Rationale: Bacteriocidal drugs kill bacteria.

The nurse is teaching an asthmatic client about the use of a corticosteroid inhaler prior to discharge. The expected outcome of this therapy is:

less swelling and mucus formation, and decreased hyperresponsiveness to allergens. Rationale : Corticosteroids decrease inflammation, mucus production, and edema and reduce bronchial hyperresponsiveness to allergens.

Anti-infectives are grouped into pharmacological classes by their:

mechanism of action. Rationale: Antibiotics are grouped into classes by their mechanism of action, susceptible organisms, and chemical structure.

A client has a serum calcium level of 12.0 mg/dL. The nurse suspects that the client is experiencing a pathophysiological process such as:

metastatic bone tumor. Global Rationale: The bone destruction that occurs with metastatic bone tumors releases calcium into the bloodstream and elevates the serum calcium level. Osteomalacia is a deficiency of vitamin D, and it would contribute to lower-than-normal serum calcium levels. Hypoparathyroidism would result in lower-than-normal serum calcium levels. Chronic renal disease is associated with lower-than-normal levels of calcium.

The nurse is admitting a client with a history of asthma attacks every other day and three episodes at night in the last month. The client reports activity is somewhat limited. The nurse anticipates that the health care provider will determine the client's level of asthma to be:

mild persistent. Rationale: This client fits the profile for mild persistent asthma with attacks that occur between three and six times

Invasiveness refers to a pathogen's ability to:

multiply more rapidly. Rationale: Invasiveness is the term for the ability of a pathogen to grow rapidly.

Hyaluronidase, an enzyme secreted by certain bacteria, allows the bacteria to:

penetrate anatomic barriers more easily. Rationale : Certain bacteria secrete hyaluronidase, which digests the matrix between human cells and allows the bacteria to penetrate anatomic barriers more easily.

Evista (raloxifene)

prevention and treatment of osteoporosis. It's selective estrogen receptor

Calcitrol (Calcijex, Rocaltrol)

promotes intestinal absorption of calcium. They're vitamin D therapy

The nurse explains to a client that drugs that activate beta 2-adrenergic receptors: relax bronchiolar smooth muscle. Rationale 1: Drugs that activate beta 2-adrenergic receptors cause bronchiolar smooth muscle to relax

relax bronchiolar smooth muscle. Rationale : Drugs that activate beta 2-adrenergic receptors cause bronchiolar smooth muscle to relax

A client with rheumatoid arthritis is prescribed hydroxychloroquine (Plaquenil). The nurse should caution the client to:

report blurred vision or decreased reading ability immediately. Rationale: Blindness can result from retinal damage and is the most serious adverse effect of this medication. Clients should report any indications of visual problems.

The client's culture report indicates the presence of gram-negative cocci in the urine. This means that the bacteria are:

round with thin cell walls. Rationale: Gram-negative cocci are round with thin cell walls.

The ability of an antibiotic to target pathogens without major effects on human cells is termed:

selective toxicity. Rationale: Antibiotic selective toxicity allows pathogens to be killed or their growth severely hampered without major effects on human cells.

Bisphosphonates, like Fosamax or Boniva

sit or stand for 30 minutes after taking -have enough vitamin D and calcium

The nurse, instructing a client on the prevention of osteoporosis, includes the importance of maintaining a normal serum calcium level because:

the support provided by bones is important for the structural integrity of the body. Rationale : Calcium is bound as a hard matrix known as hydroxyapatite crystals that provides support to the skeleton.