Chapter 09: Anti-Infectives: Antibacterial Drugs Nursing School Test Banks

Workman: Understanding Pharmacology

Chapter 09: Anti-Infectives: Antibacterial Drugs

Test Bank

MULTIPLE CHOICE

1. Why is it important to avoid killing off normal flora with antibacterial drugs?
a. Normal flora can help provide protection against the development of pathogenic infections.
b. Normal flora result in opportunistic infections while other bacteria result in pathogenic infections.
c. When normal flora are not present, the immune system is suppressed, increasing the risk for infection.
d. When normal flora are not present, the immune system is overactive, increasing the risk for autoimmune diseases.
ANS: A
Normal flora are the nonpathogenic bacteria that are always present on skin, mucous membranes, and in the digestive tract. They provide protection by crowding out pathogenic organisms and preventing them from entering the body.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: pp. 140, 142 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

2. Which type of bacteria cause infection when a patients immune system is impaired?
a. Pathogenic
b. Nonpathogenic
c. Gram negative
d. Opportunistic
ANS: D
Pathogenic bacteria cause disease or tissue damage while nonpathogenic bacteria do not. Opportunistic bacteria cause disease or tissue damage only when the immune system is not working well.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 139 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

3. How are bactericidal drugs different from bacteriostatic drugs?
a. Bacteriostatic drugs are more likely to cause an allergic response than bactericidal drugs.
b. Bacteriostatic drugs work only on bacteria, whereas bactericidal drugs are effective against other types of organisms.
c. Bactericidal drug actions result in killing the bacteria, whereas bacteriostatic drugs only slow bacterial growth.
d. Bactericidal drugs require assistance from the patients immune system to be effective, whereas bacteriostatic drugs are effective even when function is poor.
ANS: C
Bactericidal drugs directly kill bacteria; bacteriostatic drugs only stop bacteria from reproducing while the immune system kills the bacteria.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 141 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

4. A patient has a bacterial infection, but the causative organism is not known. Which type of antibacterial drug will most likely be prescribed?
a. Narrow-spectrum
b. Limited-spectrum
c. Extended-spectrum
d. Broad-spectrum
ANS: D
A broad-spectrum antibacterial drug is effective against a wide range of bacteria, both gram-positive and gram-negative. Narrow-spectrum drugs are effective against a few bacteria, while extended-spectrum drugs are effective against several types of bacteria.

PTS: 1 DIF: Cognitive Level: Comprehension (Understanding)
REF: p. 141 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

5. The nurse is teaching a patient in whom a wound infection developed after surgery about antibiotic therapy. Which statement made by the patient indicates a correct understanding of the therapy?
a. If my temperature is normal for 3 days in a row, the infection is gone and I can stop taking the drug.
b. If my temperature goes above 100 for 2 days, I should double the dose of the drug.
c. Even if I feel completely well, I should take the drug exactly as prescribed until it is gone.
d. I should notify my prescriber to change the medication if I develop diarrhea while taking this drug.
ANS: C
Antibiotic therapy is most effective when the patient takes the prescribed drug for the entire course and not just when symptoms are present. Most antibiotic therapy results in some degree of diarrhea. Although additional drugs may be needed to control this side effect, it is usually not necessary to stop the drug.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Health Promotion and Maintenance

6. A patient with a respiratory bacterial infection asks why a sputum sample is being collected before starting antibacterial drug therapy. What is the nurses best response?
a. Drug therapy for lung infections works better when less sputum is present.
b. A sputum sample will help us determine what drug will work best against your infection.
c. The lab will be able to determine which drug will treat your infection without harming your normal tissues.
d. The dosage of your antibacterial drug is determined by the organism that is causing your infection.
ANS: B
Identifying the type of bacteria causing an infection is important for selection of the appropriate drug to treat the infection. The most common way of identifying bacteria is culture and sensitivity. When a drug is effective against the bacteria, the bacteria do not grow.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

7. A patient receiving antibiotics for 3 days reports a skin rash over the chest, back, and arms. What is the nurses first action?
a. Ask the patient whether he or she has ever developed a rash while taking another drug.
b. Reassure the patient that many people have this expected reaction to antibiotic therapy.
c. Ask the patient whether the rash itches, burns, or causes other types of discomfort.
d. Document the report as the only action.
ANS: A
A rash is an indication that the patient is allergic to the drug; however, at this time it is not an emergency. The nurse will first explore the patients response further and hold the dose, then notify the prescriber of this problem.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Safe and Effective Care Environment

8. A patient who has been on antibiotic therapy for 3 weeks has a cottage cheeselike coating on the teeth, gums, and roof of the mouth. What is the nurses best action?
a. Take a specimen and send it to the laboratory for culture.
b. Hold the dose and notify the prescriber immediately.
c. Document this expected finding as the only response.
d. Assist the patient to perform frequent mouth care.
ANS: D
Prolonged antibacterial therapy can cause an oral yeast infection (thrush) by killing off the normal flora of the mouth. This infection causes a white, cottage cheeselike coating on the gums, roof of the mouth, or insides of the cheeks, which is not an allergic reaction nor is it a reason to stop the drug therapy. Help the patient use good oral hygiene with tooth-brushing and mouthwash at least every shift.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

9. What is the most important nursing action when a patient is first started on an intravenous (IV) antibacterial drug?
a. Check the IV site every 4 hours for redness around the site and the presence of cordlike veins.
b. Check the drip rate every hour to ensure that the proper blood drug level is maintained.
c. Assess the patients pulse, blood pressure, and respiratory effect every 15 minutes.
d. Assess the patients white blood cell count daily to determine drug effectiveness.
ANS: C
Anaphylaxis is a severe drug allergy that can quickly lead to death. Although drug-induced anaphylaxis can occur at any time, it is most likely to occur early during IV administration of the drug. Signs and symptoms are hives at the IV site, low blood pressure, rapid irregular pulse, swelling of the lips or lower face, and the patient feeling a lump in the throat. When the patient is receiving the first dose of an IV antibiotic, checking the patient at least every 15 minutes for symptoms of anaphylaxis is critical.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

10. A patient experiences facial angioedema after receiving a dose of a new antibacterial drug. Which assessment does the nurse perform first?
a. Airway adequacy
b. Peripheral lung sounds
c. Rate and depth of respirations
d. Symmetry of respiratory movement
ANS: A
Angioedema of the face includes the mouth and throat and can quickly lead to laryngeal edema. Edema in either place can obstruct the airway. Although assessing respirations is important, assess the airway first to determine patency.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

11. A patient with a bacterial infection has been placed on antibacterial therapy. Which assessment finding in the patient indicates to the nurse that the therapy is effective?
a. Red blood cell count is 4,500,000 cells/mm3
b. White blood cell (WBC) count is 8000 cells/mm3
c. Wound drainage is thick and yellow
d. Temperature is 102.4 Fahrenheit
ANS: B
Signs and symptoms of a resolving infection include reduced or absent fever; no chills; wound drainage that is no longer thick, foul-smelling, brown, green, or yellow; wound edges that are not red and raw-looking; and a WBC count that is in the normal range (5000 to 10,000 mm3).

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

12. A patient is having an anaphylactic reaction to an intravenous (IV) antibacterial drug. Which action does the nurse perform first?
a. Discontinue the IV therapy immediately and place the patient in shock position.
b. Hold the next dose and notify the prescriber immediately.
c. Discontinue the IV therapy and restart it at a different site.
d. Discontinue the drug and maintain the IV access.
ANS: D
When a patient is having an anaphylactic reaction to an IV drug, the first priority is to prevent any more drug from entering the patient. Stop the drug from infusing but keep the IV access open. If the drug is infusing high into the IV tubing, change the tubing after stopping the drug, and do not let any drug left in the tubing run into the patient. Starting a new IV line may be difficult or impossible during the hypotension that occurs during anaphylaxis.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

13. A patient who has been prescribed cephalexin (Keflex) reports having a severe allergic reaction to penicillin in the past. What is the nurses best response?
a. Reassure the patient that Keflex is not penicillin.
b. Place an allergy alert band on the patients wrist.
c. Notify the prescriber immediately before the first Keflex dose.
d. Highlight this important information in the patients medical record.
ANS: D
Cephalexin is a cephalosporin and has a chemical structure that is very similar to the structure of penicillin. Often a person who is allergic to penicillin also is allergic to cephalosporins. Even if the prescriber wishes to go ahead with cephalosporin therapy, he or she may first prescribe premedication to reduce the risk for an allergic response.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

14. A patient who has been prescribed amoxicillin (Amoxil) 250 mg orally every 8 hours asks the nurse if a higher dose of the drug just once a day can be taken instead. What is the nurses best response?
a. Taking this drug every 8 hours helps keep the blood level of the drug high enough to affect the bacteria.
b. Giving the drug at regular intervals over a 24-hour period helps prevent side effects.
c. Let me contact your prescriber and ask whether the drug can be given once a day.
d. When given once a day, the dose is higher so allergic reactions are more common.
ANS: A
For all antibacterial therapy, it is important to keep the blood level high enough to affect the bacteria causing the infection. For this reason it is best for a patient to take the drug evenly throughout a 24-hour period.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

15. A patient who has been prescribed oral cephalexin (Keflex) also takes aluminum hydroxide (Mylanta) 1 hour after each meal. What is the nurses best action?
a. Give the two drugs at the same time to prevent GI upset.
b. Give the cephalexin 1 hour before the aluminum hydroxide.
c. Give the aluminum hydroxide 1 hour before the cephalexin.
d. Give the aluminum hydroxide 4 hours after the cephalexin.
ANS: B
Cephalexin is a cephalosporin. These drugs are poorly absorbed with iron supplements or antacids. If a patient is receiving an antacid, the cephalosporin should be given 1 hour before or 4 hours after the antacid or iron supplement.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

16. A patient is to receive penicillin G benzathine (Bicillin LA) 2,400,000 units intramuscularly. The drug on hand is penicillin G benzathine 600,000 units/mL. How many milliliters does the nurse prepare?
a. 0.25
b. 0.5
c. 2
d. 4
ANS: D
Want 2,400,000 units/Have 600,000 units per mL. 2,400,000/600,000 = 24/6 = 4 mL.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

17. A patient prescribed vancomycin (Vancocin) has developed redness on the face, neck, chest, back, and arms. The family asks the nurse if the drug should be stopped because of this response. What is the nurses best answer?
a. Yes, these problems indicate an allergic reaction.
b. Yes, these side effects eventually lead to difficulty breathing.
c. No, these uncomfortable problems are an expected drug side effect.
d. No, the problems are caused by the presence of the infection and are not related to the drug.
ANS: C
Vancomycin is a powerful antibacterial drug that has many side effects, including red man syndrome. This problem is caused by a histamine release that dilates blood vessels, giving a red appearance to the face, neck, chest, back, and arms. Sometimes this reaction can be reduced by slowing the infusion rate; however, it is not an indication to stop the drug.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

18. A patient is prescribed intravenous ertapenem (Invanz). Which question is most important for the nurse to ask before giving the first dose of this drug?
a. Do you have a hearing problem or any trouble with your ears?
b. Do you take medications for seizures?
c. Are you allergic to sulfa drugs?
d. Have you ever had asthma?
ANS: B
Ertapenem belongs to the carbapenem antibacterial class. Drugs in this class can cause seizures in susceptible people. If a patient has a seizure disorder, the drug should be used with caution. The prescriber is notified of this problem because the dosage of anticonvulsive drug or drugs may need to be adjusted before the ertapenem is administered.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

19. A patient is receiving intravenous gentamicin. Which change in condition does the nurse report to the prescriber immediately?
a. Temperature increase from 38 C to 39 C.
b. Blood pressure decrease from 132/80 to 118/66.
c. Total 24-hour urine output decrease from 2100 mL to 1100 mL.
d. White blood cell (WBC) count decrease from 11,000/mm3 to 8500/mm3.
ANS: C
Gentamicin is an aminoglycoside antibacterial drug. These drugs are toxic to the kidneys (nephrotoxic). A decrease of urine output by 1000 mL in a 24-hour time period is cause for concern about kidney function. The drug may need to be stopped or the dosage decreased.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

20. A patient taking erythromycin reports experiencing nausea and upset stomach. What is the nurses best action?
a. Hold the drug and notify the prescriber immediately.
b. Ensure that the drug is given with or after food.
c. Ask if the patient has any drug allergies.
d. Document the report as the only action.
ANS: B
Side effects common to erythromycin include nausea, vomiting, and GI upset. This is not an indication of allergic reaction. Giving the drug with or after food will help prevent these side effects.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

21. An older adult patient is prescribed amikacin (Amikin). Which assessment technique is most important for the nurse to perform daily?
a. Asking about numbness in fingers and toes
b. Measuring calf circumference of both legs
c. Checking the mouth for open sores
d. Asking about ringing in the ears
ANS: D
Amikacin can be toxic to the ears (ototoxic), especially among older adults. One of the first signs of ototoxicity is ringing in the ears (tinnitus) which often occurs before actual hearing loss. The nurse must check the patient daily for tinnitus and changes in hearing.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

22. For which patient with a bacterial infection does the nurse question a prescription for tetracycline (Tetracon)?
a. 35-year-old patient with AIDS
b. 16-year-old patient with severe acne
c. 65-year-old patient with hypertension
d. 25-year-old patient taking oral contraceptives
ANS: A
The tetracyclines are broad-spectrum drugs that are bacteriostatic against most of the organisms that are sensitive to penicillins. Because they are only bacteriostatic, tetracyclines should be given only to patients with healthy immune systems. The person with AIDS has a severely compromised immune system that cannot fight the infection and needs a drug that is bactericidal rather than bacteriostatic. Although these drugs can interfere with tooth development and are not given to children, the 16-year-old patients teeth should be fully developed and therefore not susceptible to that effect of the drug.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

23. An older adult patient has been prescribed oral erythromycin tablets. Which precaution is most important for the nurse to teach?
a. Take this drug with food or right after eating to reduce intestinal side effects.
b. Avoid driving or operating dangerous equipment while taking this drug.
c. Take your pulse daily and notify your prescriber if it becomes irregular.
d. Wear a hat and sunscreen when outdoors.
ANS: C
All macrolide antibiotics, including erythromycin, have many side effects and interfere with other drugs. They can all cause GI side effects and increase sun sensitivity. The most dangerous side effect among older adults is the development of cardiac rhythm problems. The patient must be instructed to check his or her pulse at least once daily and report any new or worsening irregularities immediately.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

24. A patient is prescribed minocycline (Dynacin) 750 mg orally. What is the nurses best action before giving the first dose?
a. Check that the patient is not allergic to penicillin or sulfa drugs.
b. Use a new IV administration set to administer the drug.
c. Hold the dose and contact the prescriber.
d. Give the drug with milk or food.
ANS: C
The dosage of minocycline is smaller than most other tetracyclines. The average dose for an adult is 100 mg. It is likely that the prescriber intended to write 75 mg rather than 750 mg, which would be nearly 10 times the usual dosage.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

25. Why should tetracycline drugs be avoided during pregnancy and lactation?
a. Tetracycline crosses the placenta and causes brain hemorrhage in the fetus.
b. The fetal and newborn liver cannot metabolize the drug and anemia results.
c. The fetus and newborn are more likely to have allergic reactions to tetracycline.
d. The drug interferes with tooth enamel development causing permanently stained teeth.
ANS: D
Tetracyclines are pregnancy category D drugs. Their use during tooth development in the last half of pregnancy and in infancy can cause a permanent yellow-gray discoloration of the teeth and make the tooth enamel thinner. So, these drugs should not be used during pregnancy or when breastfeeding except for anthrax exposure or for another serious infection that is not likely to respond to other antibacterial drugs.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 156 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

26. The nurse is to administer doxycycline (Doxy) intravenously to a patient who is also receiving intravenous (IV) penicillin. Which action is most important for the nurse to implement?
a. Use IV tubing for doxycycline that has never come into contact with penicillin.
b. Use a glass container for the tetracycline and a plastic container for the penicillin.
c. Infuse the doxycycline only into a central line and the penicillin into a peripheral line.
d. Administer doxycycline with sterile saline and administer the penicillin with sterile water.
ANS: A
Doxycycline is a tetracycline drug. Tetracyclines interfere with the action of penicillin. It is important not to give these two drug types at the same time. They should not be mixed together in the same IV bag or run through the same IV tubing.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

27. An older adult patient is prescribed linezolid (Zyvox) 500 mg oral suspension. The drug on hand is 100 mg/5 mL. How many mL does the nurse prepare?
a. 2
b. 10
c. 25
d. 50
ANS: C
Want 500 mg in X mL/Have 100 mg in 5 mL. 500/100 = 5X 5 mL = 25 mL.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

28. Which laboratory blood test result for a patient taking clarithromycin (Biaxin) and warfarin (Coumadin) does the nurse report immediately to the prescriber?
a. Potassium 3.6 mEq/L
b. Sodium 134 mEq/L
c. Blood urea nitrogen (BUN) 21 mg/dL
d. International normalized ratio (INR) 4.6
ANS: D
Clarithromycin is a macrolide and can interfere with metabolism of many drugs. In particular, they increase the effects of warfarin. This patients INR of 4.6 indicates a dangerously long clotting time and a greatly increased risk for bleeding.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

29. The nurse is teaching a patient who has been prescribed azithromycin (Zithromax). Which statement made by the patient indicates that additional teaching is needed?
a. To avoid nausea, I will take my medicine along with food.
b. I will use another form of birth control along with my oral contraceptives.
c. Since I only have to take this drug once a day, it will be easy to remember.
d. To help get rid of the infection, I will spend 30 minutes each day out in the sun.
ANS: D
Although fresh air and sunshine are important, azithromycin is a macrolide and increases skin sensitivity to the sun (photosensitivity), greatly increasing the risk for sunburn, even among patients with dark skin. The nurse must teach patients to avoid direct sunlight and tanning beds while they are taking this drug and for at least 1 week after stopping the drug.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

30. Why must sulfonamide drugs be avoided during the last trimester of pregnancy and lactation?
a. The drug crosses the placenta and causes brain hemorrhage in the fetus.
b. The fetal and newborn liver cannot metabolize the drug and jaundice results.
c. The fetus and newborn are more likely to have allergic reactions to sulfonamides.
d. The drug interferes with tooth enamel development causing permanently stained teeth.
ANS: B
Sulfonamides are pregnancy category C drugs. Because these drugs can cause severe jaundice in the infant, they should be avoided during the last 2 months of pregnancy to reduce the chances that the baby will be born while the mother is still taking the drug. For the same reason, the breastfeeding mother should use alternate methods of infant feeding during the time she is taking the drug.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 159 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

31. Which laboratory blood test result for a patient taking trimethoprim/sulfamethoxazole (Septra) does the nurse report immediately to the prescriber?
a. Red blood cells (RBCs) 2.2 million/mm3
b. International normalized ratio (INR) 1.6
c. White blood cells (WBCs) 6,000/mm3
d. Sodium 134 mEq/L
ANS: A
Trimethoprim/sulfamethoxazole is a combination drug composed of two metabolism inhibitors. One of the most serious adverse effects of the metabolism inhibitors is suppression of bone marrow cell division, leading to fewer red blood cells and anemia. This patients RBC level is only about half of normal.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

32. Which precaution is most important for the nurse to teach a patient who has been prescribed sulfisoxizole (Gantrisin)?
a. Evenly space this drug throughout the 24-hour day.
b. Take the drug 1 hour before or 2 hours after a meal.
c. Drink at least 3 liters of liquids throughout the day.
d. Stop the drug immediately if diarrhea develops.
ANS: C
Sulfisoxizole is a sulfonamide, which is a type of chemical that can easily turn into crystals. Crystals that form and clump in the kidneys can cause kidney failure or kidney stones. Drinking at least 3 L of fluids daily while taking this drug can prevent crystallization in the kidneys.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

33. A patient is to receive trimethoprim/sulfamethoxazole (Septra) intravenously. The drug is mixed in 250 mL of D5W and is to be administered over 90 minutes. With a drop factor of 15 gtt/mL, how many drops per minute will the nurse set for the correct infusion rate?
a. 10
b. 20
c. 30
d. 40
ANS: D
At a rate of 250 mL in 90 minutes, the drug must infuse at 2.7 mL per minute (250 mL 90 minutes = 2.7 mL/min). With 15 drops equaling 1 mL, 2.7 mL 15 = 40.5 gtt/min, rounded down to 40 gtt/min.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

34. A patient taking ciprofloxacin (Cipro) reports pain and burning on urination. What is the nurses best action?
a. Notify the prescriber that the patients urinary tract infection is not responding to the drug.
b. Remind the patient that the pain is related to the body eliminating the infectious bacteria.
c. Instruct the patient to drink a full glass of water with each drug dose and increase fluids.
d. Ask the patient whether blood or pus also is present in the urine.
ANS: C
Ciprofloxacin is a fluoroquinolone drug that concentrates in the urine, making the urine irritating to surrounding tissues. The patient may experience pain or burning of the urethra and nearby tissues during urination. An incontinent patient may have skin irritation over the entire perineal area. To avoid this, teach the patient to drink a full glass of water with each dose and to drink more fluids throughout the day.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

35. A 75-year-old patient taking levofloxacin (Levaquin) reports all of the following new problems. For which problem does the nurse advise the patient to stop taking the drug immediately and notify the prescriber?
a. Having to get up at night to urinate
b. Swelling and pain in the right wrist
c. Feeling the heart pound after drinking coffee
d. Feeling light-headed when changing positions rapidly
ANS: B
A rare adverse effect of fluoroquinolones is the rupture of a tendon, most often in the shoulder, hand, wrist, or heel (Achilles tendon). This complication is most likely to happen in an older patient and in those who also take corticosteroids.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

36. Why must fluoroquinolone drugs be avoided during pregnancy, lactation, and childhood?
a. The drug damages muscles, tendons, and bones in the fetus and growing children.
b. The fetal and newborn liver cannot metabolize the drug, leading to anemia and jaundice.
c. The fetus and newborn are more likely to have allergic reactions to fluoroquinolones.
d. The drug interferes with tooth enamel development causing permanently stained teeth.
ANS: A
The fluoroquinolones are pregnancy category C drugs that increase the incidence for bone, joint, and tendon defects. These drugs should not be used during pregnancy, lactation, or children younger than 18 years of age unless the infection is life threatening and not sensitive to other drugs.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 161 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

MULTIPLE RESPONSE

1. Which are general surface protections that prevent bacteria from entering the body? (Select all that apply.)
a. Intact skin
b. pH of body secretions
c. Antibodies
d. Mucous membranes
e. White blood cells
ANS: A, B, D
Antibodies are involved in specific surface protections; they catch and trap bacteria. White blood cells provide general and specific internal protection against infection. Intact skin, mucous membranes, pH of body fluids, normal body flora, and products in saliva, perspiration, tears, and mucus all provide general surface protection and prevent bacteria from entering the body.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 140 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

2. A patient is being discharged home on antibacterial drug therapy. What instructions must the nurse teach the patient about allergic reactions? (Select all that apply.)
a. Notify your prescriber immediately if you vomit.
b. Stop taking the drug if you develop hives or a rash.
c. If you notice diarrhea be sure to stop taking the drug.
d. Continue taking the drug even if you feel well because it is fighting the infection.
e. Call 911 if you experience difficulty with breathing.
f. Avoid drinking caffeinated beverages with the drug.
ANS: B, E
GI upset, vomiting, and diarrhea are fairly common side effects of antibacterial drugs and are not signs of allergic reactions. When a patient experiences an allergic reaction, he or she should be taught to stop taking the drug if rash or hives develop and to call their prescriber immediately. A patient should also be taught to call 911 immediately for difficulty breathing or a feeling of a lump in the throat because these are signs of a serious allergic reaction.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 142 TOP: Nursing Process Step: Planning
MSC: Client Needs Category: Health Promotion and Maintenance

3. With which antibacterial drugs is teaching patients to wear protective clothing, hats, and sunscreen, and to avoid tanning beds most important? (Select all that apply.)
a. amoxicillin/clavulanic acid (Augmentin)
b. cefdinir (Omnicef)
c. clindamycin (Cleocin)
d. erythromycin (E-mycin)
e. lomefloxacin (Maxaquin)
f. tetracycline (Tetracon)
g. trimethoprim/sulfamethoxazole (Bactrim)
ANS: D, E, F, G
The macrolides, tetracyclines, sulfonamides, and fluoroquinolones all increase a persons skin sensitivity to sunlight. This can cause a severe sunburn even among people with dark skin who do not usually burn with sun exposure. Patients taking these drugs should avoid direct sunlight, tanning beds, and use protection when going outdoors in the sun (hats, long sleeves, sunscreen) during the time they are taking the drug and for at least 1 week after stopping the drug.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: pp. 155, 158, 161 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Health Promotion and Maintenance

4. Which actions are most likely to reduce the spread of community-acquired methicillin-resistant Staphylococcus aureas (CA-MRSA) in a family in which only one member is infected? (Select all that apply.)
a. Starting the noninfected family members on methicillin therapy.
b. Not sharing towels or bed linens with the infected person.
c. Washing the infected persons dishes separately from those of other family members.
d. Having the infected person wear a mask when in the same room with other family members.
e. Using good daily personal hygiene for all family members.
f. Washing hands with soap and water after any physical contact with an infected person.
ANS: B, E, F
MRSA is transmitted by direct contact from person-to-person and by skin contact with contaminated linens, sports equipment, clothing, and the sharing of cosmetics or personal care items (e.g., shavers, hairbrushes). Avoiding contact with these items prevents disease spread. Starting noninfected family members on methicillin therapy is not effective because drugs are not used for prophylaxis against S. aureas. Even if they were, the organism is resistant to methicillin. Washing dishes separately and the use of a mask are not effective measures because the disease is not spread by contact with GI fluids or by the airborne route.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 162 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Health Promotion and Maintenance

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