Chapter 30: Macrolides, Tetracyclines, Aminoglycosides, and Fluoroquinolones Nursing School Test Banks

Chapter 30: Macrolides, Tetracyclines, Aminoglycosides, and Fluoroquinolones
Test Bank

MULTIPLE CHOICE

1. The nurse caring for a patient who will receive penicillin to treat an infection asks the patient about previous drug reactions. The patient reports having had a rash when taking amoxicillin (Amoxil). The nurse will contact the provider to
a. discuss giving a smaller dose of penicillin.
b. discuss using erythromycin (E-mycin) instead of penicillin.
c. request an order for diphenhydramine (Benadryl).
d. suggest that the patient receive cefuroxime (Ceftin).
ANS: B
Erythromycin is the drug of choice when penicillin is not an option. Giving smaller doses of penicillin does not prevent hypersensitivity reactions. Benadryl is useful when a hypersensitivity reaction has occurred. A small percentage of patients allergic to penicillins may be hypersensitive to cephalosporins.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 415
TOP: NURSING PROCESS: Assessment/Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A patient is diagnosed with mycoplasma pneumonia. Which antibiotic will the nurse expect the provider to order to treat this infection?
a. Azithromycin (Zithromax)
b. Clarithromycin (Biaxin)
c. Erythromycin (E-Mycin)
d. Fidaxomicin (Dificid)
ANS: C
Erythromycin is the drug of choice for treating mycoplasma pneumonia.

DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: Page 415
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. The nurse is caring for several patients who are receiving antibiotics. Which order will the nurse question?
a. Azithromycin (Zithromax) 500 mg IV in 500 mL fluid
b. Azithromycin (Zithromax) 500 mg PO once daily
c. Erythromycin 300 mg IM QID
d. Erythromycin 300 mg PO QID
ANS: C
Erythromycin and other macrolides should not be given intramuscularly because they cause painful tissue irritation.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 415
TOP: NURSING PROCESS: Planning/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. The nurse is caring for a patient who is receiving a high dose of intravenous azithromycin to treat an infection. The patient is also taking acetaminophen for pain. The nurse should expect to review which lab values when monitoring for this drugs side effects?
a. Complete blood counts
b. Electrolytes
c. Liver enzymes
d. Urinalysis
ANS: C
High doses of macrolides, when taken with other, potentially hepatotoxic drugs such as acetaminophen may cause hepatotoxicity, so liver enzymes should be carefully monitored.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 417
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. The nurse provides home care instructions for a patient who will take a high dose of azithromycin after discharge from the hospital. Which statement by the patient indicates understanding of the teaching?
a. I may take antacids 2 hours before taking this drug.
b. I should take acetaminophen for fever or mild pain.
c. I should expect diarrhea to be a common, mild side effect.
d. I should avoid dairy products while taking this drug.
ANS: A
Azithromycin peak levels may be reduced by antacids when taken at the same time so patients should be cautioned to take antacids 2 hours before or 2 hours after taking the drug. High-dose azithromycin carries a risk for hepatotoxicity when taken with other potentially hepatotoxic drugs such as acetaminophen. Diarrhea may indicate pseudomembranous colitis and should be reported. There is no restriction for dairy products when taking azithromycin.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 417
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. The nurse is preparing to administer clarithromycin to a patient. When performing a medication history, the nurse learns that the patient takes warfarin to treat atrial fibrillation. The nurse will perform which action?
a. Ask the provider if azithromycin may be used instead of clarithromycin.
b. Obtain an order for continuous cardiovascular monitoring.
c. Request an order for periodic serum warfarin levels.
d. Withhold the clarithromycin and notify the provider.
ANS: C
Macrolides can increase serum levels of other drugs such as warfarin. If these drugs are used with macrolides, serum drug levels should be monitored. All macrolides have this drug interaction. Cardiovascular monitoring is not indicated. The drug may be given as long as serum drug levels are monitored.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 415
TOP: NURSING PROCESS: Assessment/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. A female patient who is allergic to penicillin will begin taking an antibiotic to treat a lower respiratory tract infection. The patient tells the nurse that she almost always develops a vaginal yeast infection when she takes antibiotics and that she will take fluconazole (Diflucan) with the antibiotic being prescribed. Which macrolide order would the nurse question for this patient?
a. Azithromycin (Zithromax)
b. Clarithromycin (Biaxin)
c. Erythromycin (E-Mycin)
d. Fidaxomicin (Dificid)
ANS: C
When erythromycin is given concurrently with fluconazole, erythromycin blood concentration and the risk of sudden cardiac death increase.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 415
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. The nurse is preparing to give a dose of oral clindamycin (Cleocin) to a patient who is being treated for a skin infection caused by Staphylococcus aureus. The patient has had several doses of the medication and reports having nausea. Which action will the nurse take next?
a. Administer the next dose when the patient has an empty stomach.
b. Hold the next dose and contact the patients provider.
c. Instruct the patient to take the next dose with a full glass of water.
d. Request an order for an antacid to give along with the next dose.
ANS: C
Clindamycin should be taken with a full glass of water to minimize gastronintestinal (GI) irritation such as nausea, vomiting, and stomatitis. Giving the medication on an empty stomach will increase the likelihood of GI upset. It is not necessary to hold the next dose or to give an antacid.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 416
TOP: NURSING PROCESS: Nursing Intervention/Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. The nurse assumes care for a patient who is currently receiving a dose of intravenous vancomycin (Vancocin) infusing at 20 mg/min. The nurse notes red blotches on the patients face, neck, and chest and assesses a blood pressure of 80/55 mm Hg. Which action will the nurse take?
a. Request an order for IV epinephrine to treat anaphylactic shock.
b. Slow the infusion to 10 mg/min and observe the patient closely.
c. Stop the infusion and obtain an order for a BUN and serum creatinine.
d. Suspect Stevens-Johnson syndrome and notify the provider immediately.
ANS: B
When vancomycin is infused too rapidly, red man syndrome may occur; the rate should be 10 mg/min to prevent this. This is a toxic reaction, not an allergic one, so epinephrine is not indicated. Stevens-Johnson syndrome is characterized by a rash and fever. Red man syndrome is not related to renal function.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 418
TOP: NURSING PROCESS: Evaluation/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. The nurse is caring for a patient who will begin taking doxycycline to treat an infection. The nurse should plan to give this medication
a. 1 hour before or 2 hours after a meal.
b. with an antacid to minimize GI irritation.
c. with food to improve absorption.
d. with small sips of water.
ANS: C
Doxycycline is a lipid-soluble tetracycline and is better absorbed when taken with milk products and food. It should not be taken on an empty stomach. Antacids impair absorption of tetracyclines. Small sips of water are not necessarily indicated.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 419
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. The nurse is caring for a 7-year-old patient who will receive oral antibiotics. Which antibiotic order will the nurse question for this patient?
a. Azithromycin (Zithromax)
b. Clarithromycin (Biaxin)
c. Clindamycin (Cleocin)
d. Tetracycline (Sumycin)
ANS: D
Tetracyclines should not be given to children younger than 8 years of age because they irreversibly discolor the permanent teeth.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 419
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. The nurse is caring for a patient who is receiving a high dose of tetracycline (Sumycin). Which laboratory values will the nurse expect to monitor while caring for this patient?
a. Blood urea nitrogen (BUN) and creatinine levels
b. Complete blood counts
c. Electrolytes
d. Liver enzyme levels
ANS: A
High doses of tetracyclines can lead to nephrotoxicity, especially when given along with other nephrotoxic drugs. Renal function tests should be performed to monitor for nephrotoxicity.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 420
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

13. A female patient will receive doxycycline to treat a sexually transmitted illness (STI). What information will the nurse include when teaching this patient about this medication?
a. Nausea and vomiting are uncommon adverse effects.
b. The drug may cause possible teratogenic effects.
c. Increase intake of dairy products with each dose of this medication.
d. Use a backup method of contraception if taking oral contraceptives.
ANS: D
The desired action of oral contraceptives can be lessened when taken with tetracyclines, so patients taking oral contraceptives should be advised to use a backup contraception method while taking tetracyclines. Nausea and vomiting are common adverse effects. Doxycycline should not be taken with dairy products. Tetracycline may cause teratogenic effects.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 421
TOP: NURSING PROCESS: Planning/Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

14. The nurse is preparing to administer intravenous gentamicin to an infant through an intermittent needle. The nurse notes that the infant has not had a wet diaper for several hours. The nurse will perform which action?
a. Administer the medication and give the infant extra oral fluids.
b. Contact the provider to request adding intravenous fluids when giving the medication.
c. Give the medication and obtain a serum peak drug level 45 minutes after the dose.
d. Hold the dose and contact the provider to request a serum trough drug level.
ANS: D
Gentamicin can cause nephrotoxicity. When changes in urine output occur, the provider should be notified, and serum trough levels should be obtained to make sure the drug is not at a toxic level. If the drug level is determined to be safe, giving extra fluids either orally or intravenously may be indicated. Serum peak levels give information about therapeutic levels but are not a substitution for avoiding nephrotoxicity in the face of possible oliguria.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 422
TOP: NURSING PROCESS: Evaluation/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

15. The nurse is caring for a 70-kg patient who is receiving gentamicin (Garamycin) 85 mg 4 times daily. The patient reports experiencing ringing in the ears. The nurse will contact the provider to discuss
a. decreasing the dose to 50 mg QID.
b. giving the dose 3 times daily.
c. obtaining a serum drug level.
d. ordering a hearing test.
ANS: C
Aminoglycosides can cause ototoxicity. Any changes in hearing should be reported to the provider so that serum drug levels can be monitored. The dose is correct for this patients weight (5 mg/kg/day in 4 divided doses). A hearing test is not indicated unless changes in hearing persist.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 422
TOP: NURSING PROCESS: Evaluation/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

16. The nurse is preparing to begin a medication regimen for a patient who will receive intravenous ampicillin and gentamicin. Which is an important nursing action?
a. Administer each antibiotic to infuse over 15 to 20 minutes.
b. Order serum peak and trough levels of ampicillin.
c. Prepare the schedule so that the drugs are given at the same time.
d. Set up separate tubing sets for each drug labeled with the drug name and date.
ANS: D
Intravenous aminoglycosides can be given with penicillins and cephalosporins but should not be mixed in the same container. The IV line should be flushed between antibiotics, or separate tubing sets may be set up. Gentamicin must be infused over 30 to 60 minutes. It is not necessary to measure ampicillin peak and trough levels. Giving the drugs at the same time increases the risk of mixing them together.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 422
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

17. The nurse is reviewing a patients chart prior to administering gentamycin (Garamycin) and notes that the last serum peak drug level was 9 mcg/mL and the last trough level was 2 mcg/mL. What action will the nurse take?
a. Administer the next dose as ordered.
b. Obtain repeat peak and trough levels before giving the next dose.
c. Report possible drug toxicity to the patients provider.
d. Report a decreased drug therapeutic level to the patients provider.
ANS: C
Gentamycin peak values should be 5 to 8 mcg/mL, and trough levels should be 0.5 to 2 mcg/mL. Peak levels give information about whether or not a drug is at toxic levels, while trough levels indicate whether a therapeutic level is maintained. This drug is at a toxic level, and the next dose should not be given.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 423
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

18. The nurse is providing discharge teaching for a patient who will receive oral levofloxacin (Levaquin) to treat pneumonia. The patient takes an oral hypoglycemic medication and uses over-the-counter (OTC) antacids to treat occasional heartburn. The patient reports frequent arthritis pain and takes acetaminophen when needed. Which statement by the nurse is correct when teaching this patient?
a. You may take antacids with levofloxacin to decrease gastrointestinal upset.
b. You may take nonsteroidal anti-inflammatory medications (NSAIDs) for arthritis pain.
c. You should monitor your serum glucose more closely while taking levofloxacin.
d. You should take levofloxacin on an empty stomach to improve absorption.
ANS: C
Levofloxacin may increase the effects of oral hypoglycemic medications, so patients taking these should be advised to monitor their serum glucose levels closely. Antacids decrease the absorption of levofloxacin. NSAIDs taken with levofloxacin can cause central nervous system reactions, including seizures.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 425
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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