ANTI INFECTIVE 15 q

Question 1

When reviewing the allergy history of a patient, the nurse notes that the patient is allergic to penicillin. Based on this finding, the nurse would question an order for which class of antibiotics?

a. Tetracyclines
b. Sulfonamides
c. Cephalosporins
d. Quinolones

Answer 1

c. Cephalosporins

Allergy to penicillin may also result in hypersensitivity to cephalosporins

Question 2

The nurse is providing teaching to a patient taking an oral tetracycline antibiotic. Which statement by the nurse is correct?

a. “Avoid direct sunlight and tanning beds while on this medication.”
b. “Milk and cheese products result in increased levels of tetracycline.”
c. “Antacids taken with the medication help to reduce gastrointestinal distress.”
d. “Take the medication until you are feeling better.”

Answer 2

a. “Avoid direct sunlight and tanning beds while on this medication.”

Drug-related photosensitivity occurs when patients take tetracyclines, and it may continue for several days after therapy. Milk and cheese products result in decreased levels of tetracycline when the two are taken together. A

Question 3

When reviewing the medication orders for a patient who is taking penicillin, the nurse notes that the patient is also taking the oral anticoagulant warfarin (Coumadin). What possible effect may occur as the result of an interaction between these drugs?

a. The penicillin will cause an enhanced anticoagulant effect of the warfarin.
b. The penicillin will cause the anticoagulant effect of the warfarin to decrease.
c. The warfarin will reduce the anti-infective action of the penicillin.
d. The warfarin will increase the effectiveness of the penicillin.

Answer 3

a. The penicillin will cause an enhanced anticoagulant effect of the warfarin.

Administering penicillin reduces the vitamin K in the gut (intestines); therefore, enhanced anticoagulant effect of warfarin may occur.

Question 4

A patient is receiving his third intravenous dose of a penicillin drug. He calls the nurse to report that he is feeling “anxious” and is having trouble breathing. What will the nurse do first?

a. Notify the prescriber.
b. Take the patient’s vital signs.
c. Stop the antibiotic infusion.
d. Check for allergies.

Answer 4

c. Stop the antibiotic infusion.

Hypersensitivity reactions are characterized by wheezing; shortness of breath; swelling of the face, tongue, or hands; itching; or rash. The nurse should immediately stop the antibiotic infusion, have someone notify the prescriber, and stay with the patient to monitor the patient’s vital signs and condition. Checking for allergies should have been done before the infusion.

Question 5

A patient is admitted with a fever of 102.8° F (39.3° C), origin unknown. Assessment reveals cloudy, foul-smelling urine that is dark amber in color. Orders have just been written to obtain stat urine and blood cultures and to administer an antibiotic intravenously. The nurse will complete these orders in which sequence?

a. Blood culture, antibiotic dose, urine culture
b. Urine culture, antibiotic dose, blood culture
c. Antibiotic dose, blood and urine cultures
d. Blood and urine cultures, antibiotic dose

Answer 5

d. Blood and urine cultures, antibiotic dose

All culture specimens should be obtained before initiating antibiotic drug therapy; otherwise, the presence of antibiotics in the tissues may result in misleading culture and sensitivity results.

Question 6

A patient tells the nurse that he is having nausea and decreased appetite during drug therapy with a tetracycline antibiotic. Which statement is the nurse’s best advice to the patient?

a. “Take it with cheese and crackers or yogurt.”
b. “Take each dose with a glass of milk.”
c. “Take an antacid with each dose as needed.”
d. “Drink a full glass of water with each dose.”

Answer 6

d. “Drink a full glass of water with each dose.”

Oral doses should be given with at least 8 ounces of fluids and food to minimize gastrointestinal upset.

Question 7

The nurse is monitoring a patient who has been on antibiotic therapy for 2 weeks. Today the patient tells the nurse that he has had watery diarrhea since the day before and is having abdominal cramps. His oral temperature is 101° F (38.3° C). Based on these findings, which conclusion will the nurse draw?

a. The patient’s original infection has not responded to the antibiotic therapy.
b. The patient is showing typical adverse effects of antibiotic therapy.
c. The patient needs to be tested for Clostridium difficile infection.
d. The patient will need to take a different antibiotic.

Answer 7

c. The patient needs to be tested for Clostridium difficile infection.

Antibiotic-associated diarrhea is a common adverse effect of antibiotics. However, it becomes a serious superinfection when it causes antibiotic-associated colitis, also known as pseudomembranous colitis or simply C. difficile infection. This happens because antibiotics disrupt the normal gut flora and can cause an overgrowth of Clostridium difficile. The most common symptoms of C. difficile colitis are watery diarrhea, abdominal pain, and fever. Whenever a patient who was previously treated with antibiotics develops watery diarrhea, the patient needs to be tested for C. difficile infection. If the results are positive, the patient will need to be treated for this serious superinfection.

Question 8

The nurse is monitoring for therapeutic results of antibiotic therapy in a patient with an infection. Which laboratory value would indicate therapeutic effectiveness of this therapy?

a. Increased red blood cell count

b. Increased hemoglobin level

c. Decreased white blood cell count

d. Decreased platelet count

Answer 8

c. Decreased white blood cell count

Decreased white blood cell counts are an indication of reduction of infection and are a therapeutic effect of antibiotic therapy

Question 9

The nurse is reviewing the culture results of a patient with an infection, and notes that the culture indicates a gram-positive organism. Which generation of cephalosporin is most appropriate for this type of infection?
a. First-generation
b. Second-generation
c. Third-generation d. Fourth-generation

Answer 9

a

Question 10

A patient will be having oral surgery and has received an antibiotic to take for 1 week before the surgery. The nurse knows that this is an example of which type of therapy?
a. Empiric
b. Prophylactic
c. Definitive
d. Resistance

Answer 10

b. Prophylactic

Prophylactic antibiotic therapy is used to prevent infection.

Question 11

A patient has a urinary tract infection. The nurse knows that which class of drugs is especially useful for such infections?

a. Macrolides
b. Carbapenems
c. Sulfonamides
d. Tetracyclines

Answer 11

c. Sulfonamides

Sulfonamides achieve very high concentrations in the kidneys, through which they are eliminated. Therefore, they are often used in the treatment of urinary tract infections.

Question 12

During drug therapy for pneumonia, a female patient develops a vaginal superinfection. The nurse explains that this infection is caused by which of these?

a. Large doses of antibiotics that kill normal flora.
b. The infection spreading from the lungs to the new site of infection.
c. Resistance of the pneumonia-causing bacteria to the drugs.
d. An allergic reaction to the antibiotics.

Answer 12

a. Large doses of antibiotics that kill normal flora.

Normally occurring bacteria are killed during antibiotic therapy, allowing other flora to take over and resulting in superinfections. The other options are incorrect.

Question 13

During antibiotic therapy, the nurse will monitor closely for signs and symptoms of a hypersensitivity reaction. Which of these assessment findings may be an indication of a hypersensitivity reaction? (Select all that apply.)
a. Wheezing
b. Diarrhea
c. Shortness of breath
d. Swelling of the tongue
e. Itching
f. Black, hairy tongue

Answer 13

A, C, D, E
Hypersensitivity reactions may be manifested by wheezing; shortness of breath; swelling of the face, tongue, or hands; itching; or rash

Question 14

When a patient is on aminoglycoside therapy, the nurse will monitor the patient for which indicators of potential toxicity?

a. Fever
b. White blood cell count of 8000 cells/mm3
c. Tinnitus and dizziness
d. Decreased blood urea nitrogen (BUN) levels

Answer 14

c. Tinnitus and dizziness

Dizziness, tinnitus, hearing loss, or a sense of fullness in the ears could indicate ototoxicity, a potentially serious toxicity in a patient.

Question 15

The nurse is administering a vancomycin (Vancocin) infusion. Which measure is appropriate for the nurse to implement in order to reduce complications that may occur with this drug’s administration?

a. Monitoring blood pressure for hypertension during the infusion
b. Discontinuing the drug immediately if red man syndrome occurs
c. Restricting fluids during vancomycin therapy
d. Infusing the drug over at least 1 hour

Answer 15

d. Infusing the drug over at least 1 hour

Infuse the medication over at least 1 hour to reduce the occurrence of red man syndrome. Adequate hydration (at least 2 L of fluid in 24 hours) during vancomycin therapy is important for the prevention of nephrotoxicity. Hypotension may occur during the infusion, especially if it is given too rapidly.

Question 16

Which problem may occur in a patient who has started aminoglycoside therapy?

a. Constipation
b. Renal damage
c. Gynecomastia
d. Leukocytosis

Answer 16

b. Renal damage

Patients on aminoglycoside therapy have an increased risk for nephrotoxicity.

Question 17

A patient who has been hospitalized for 2 weeks has developed a pressure ulcer that contains multidrug-resistant Staphylococcus aureus (MRSA). Which drug would the nurse expect to be chosen for therapy?

a. Metronidazole (Flagyl)
b. Ciprofloxacin (Cipro)
c. Vancomycin (Vancocin)
d. Tobramycin (Nebcin)

Answer 17

c. Vancomycin (Vancocin)

Vancomycin is the antibiotic of choice for the treatment of MRSA

Question 18

The nurse is reviewing the medication orders for a patient who will be receiving aminoglycoside therapy. Which other medication or medication class, if ordered, would be a potential interaction concern?

a. Calcium channel blockers
b. Phenytoin
c. Proton pump inhibitors
d. Loop diuretics

Answer 18

d. Loop diuretics

Concurrent use of aminoglycosides with loop diuretics increases the risk for ototoxicity.

Question 19

The nurse checks the patient’s laboratory work prior to administering a dose of vancomycin (Vancocin) and finds that the trough vancomycin level is 24 mcg/mL. What will the nurse do next?

a. Administer the vancomycin as ordered.
b. Hold the drug, and administer 4 hours later.
c. Hold the drug, and notify the prescriber.
d. Repeat the test to verify results.

Answer 19

c. Hold the drug, and notify the prescriber.

Optimal blood levels of vancomycin are a trough level of 10 to 20 mcg/mL. Measurement of peak levels is no longer routinely recommended, and only trough levels are commonly monitored. Blood samples for measurement of trough levels are drawn immediately before administration of the next dose. Because of the increase in resistant organisms, many clinicians use a trough level of 15 to 20 mcg/mL as their goal. These trough levels mean that even just before the next dose is due, when drug levels should be low, the drug levels are actually too high.

Question 20

A 79-year-old patient is receiving a quinolone as treatment for a complicated incision infection. The nurse will monitor for which adverse effect that is associated with these drugs?

a. Neuralgia
b. Double vision
c. Hypotension
d. Tendonitis and tendon rupture

Answer 20

d. Tendonitis and tendon rupture

A black box warning is required by the U.S. Food and Drug Administration for all quinolones because of the increased risk for tendonitis and tendon rupture with use of the drugs. This effect is more common in elderly patients, patients with renal failure, and those receiving concurrent glucocorticoid therapy (e.g., prednisone).

Question 21

The nurse is administering intravenous vancomycin (Vancocin) to a patient who has had gastrointestinal surgery. Which nursing measures are appropriate? (Select all that apply.)
a. Monitoring serum creatinine levels
b. Restricting fluids while the patient is on this medication
c. Warning the patient that a flushed feeling or facial itching may occur
d. Instructing the patient to report dizziness or a feeling of fullness in the ears
e. Reporting a trough drug level of 11 mcg/mL and holding the drug
f. Reporting a trough drug level of 24 mcg/mL and holding the drug
ANS: A, C, D, F

Answer 21

ANS: A, C, D, F
Constant monitoring for drug-related neurotoxicity, nephrotoxicity, ototoxicity, and superinfection remains critical to patient safety. Monitor for nephrotoxicity by monitoring serum creatinine levels. Ototoxicity may be indicated if the patient experiences dizziness or a feeling of fullness in the ears, and these symptoms must be reported immediately. Vancomycin infusions may cause red man syndrome, which is characterized by flushing of the neck and face and a decrease in blood pressure. In addition, adequate hydration (at least 2 L of fluids every 24 hours unless contraindicated) is most important to prevent nephrotoxicity. Optimal trough blood levels of vancomycin are 10 to 20 mcg/mL; therefore, the drug should not be administered when there is a trough level of 24 mcg/mL.

Question 22

A patient who is diagnosed with genital herpes is taking topical acyclovir, and the nurse is providing instructions about adverse effects. The nurse will discuss which adverse effects of topical acyclovir therapy?

a. Insomnia and nervousness
b. Temporary swelling and rash
c. Burning when applied
d. This medication has no adverse effects.

Answer 22

c. Burning when applied

Transient burning may occur with topical application of acyclovir.

Question 23

A patient who is HIV-positive has been receiving medication therapy that includes zidovudine (Retrovir). However, the prescriber has decided to stop the zidovudine because of its dose-limiting adverse effect. Which of these conditions is the dose-limiting adverse effect of zidovudine therapy?

a. Retinitis
b. Renal toxicity
c. Hepatotoxicity
d. Bone marrow suppression

Answer 23

d. Bone marrow suppression

Question 24

The nurse is administering intravenous acyclovir (Zovirax) to a patient with a viral infection. Which administration technique is correct?

a. Infuse intravenous acyclovir slowly, over at least 1 hour.
b. Infuse intravenous acyclovir by rapid bolus.
c. Refrigerate intravenous acyclovir.
d. Restrict oral fluids during intravenous acyclovir therapy.

Answer 24

a. Infuse intravenous acyclovir slowly, over at least 1 hour.

Intravenous infusions must be diluted as recommended (e.g., with 5% dextrose in water or normal saline) and infused with caution. Infusion over longer than 1 hour is suggested to avoid the renal tubular damage seen with more rapid infusions. Adequate hydration should be encouraged (unless contraindicated) during the infusion and for several hours afterward to prevent drug-related crystalluria.

Question 25

A patient is taking a combination of antiviral drugs as treatment for early stages of a viral infection. While discussing the drug therapy, the patient asks the nurse if the drugs will kill the virus. When answering, the nurse keeps in mind which fact about antiviral drugs?
a. They are given for palliative reasons only.
b. They will be effective as long as the patient is not exposed to the virus again.
c. They can be given in large enough doses to eradicate the virus without harming
the body’s healthy cells.
d. They may also kill healthy cells while killing viruses.

Answer 25

d. They may also kill healthy cells while killing viruses.

Because viruses reproduce in human cells, selective killing is difficult; consequently, many healthy human cells, in addition to virally infected cells, may be killed in the process, and this results in the serious toxicities that are involved with these drugs.

Question 26

A young adult calls the clinic to ask for a prescription for “that new flu drug.” He says he has had the flu for almost 4 days and just heard about a drug that can reduce the symptoms. What is the nurse’s best response to his request?

a. “Now that you’ve had the flu, you will need a booster vaccination, not the
antiviral drug.”

b. “We will need to do a blood test to verify that you actually have the flu.”

c. “Drug therapy should be started within 2 days of symptom onset, not 4 days.”

d. “We’ll get you a prescription. As long as you start treatment within the next 24
hours, the drug should be effective.”

Answer 26

c. “Drug therapy should be started within 2 days of symptom onset, not 4 days.”

Question 27

A patient who is diagnosed with genital herpes is taking topical acyclovir. The nurse will provide which teaching for this patient? (Select all that apply.)

a. “Be sure to wash your hands thoroughly before and after applying this medicine.”

b. “Apply this ointment until the lesion stops hurting.”

c. “Use a clean glove when applying this ointment.”

d. “If your partner develops these lesions, then your partner can also use the
medication.”

e. “You will need to avoid touching the area around your eyes.”

f. “You will have to practice abstinence when these lesions are active.”

Answer 27

A, C, E, F
This medication needs to be applied as long as prescribed, and the medication needs to be applied with clean gloves. Prescriptions should not be shared; if the partner develops these lesions, the partner will have to be evaluated before medication is prescribed, if needed. Eye contact should be avoided. The presence of active genital herpes lesions requires sexual abstinence.

Question 28

The nurse is discussing adverse effects of antitubercular drugs with a patient who has active tuberculosis. Which potential adverse effect of antitubercular drug therapy should the patient report to the prescriber?
a. Gastrointestinal upset
b. Headache and nervousness
c. Reddish-orange urine and stool
d. Numbness and tingling of extremities

Answer 28

d. Numbness and tingling of extremities

Question 29

The nurse will assess the patient for which potential contraindication to antitubercular therapy?
a. Glaucoma
b. Anemia
c. Heart failure
d. Hepatic impairment

Answer 29

d. Hepatic impairment

Results of liver function studies (e.g., bilirubin level, liver enzyme levels) need to be assessed because isoniazid and rifampin may cause hepatic impairment; severe liver dysfunction is a contraindication to these drugs. In addition, the patient’s history of alcohol use needs to be assessed.

Question 30

A patient has been taking antitubercular therapy for 3 months. The nurse will assess for what findings that indicate a therapeutic response to the drug therapy?

a. The chronic cough is gone.

b. There are two consecutive negative purified protein derivative (PPD) results over
2 months.

c. There is increased tolerance to the medication therapy, and there are fewer reports of adverse effects.

d. There is a decrease in symptoms of tuberculosis along with improved chest
radiographs and sputum cultures.

Answer 30

d. There is a decrease in symptoms of tuberculosis along with improved chest
radiographs and sputum cultures.

Question 31

A patient who has started drug therapy for tuberculosis wants to know how long he will be on the medications. Which response by the nurse is correct?
a. “Drug therapy will last until the symptoms have stopped.”
b. “Drug therapy will continue until the tuberculosis develops resistance.”
c. “You should expect to take these drugs for as long as 24 months.”
d. “You will be on this drug therapy for the rest of your life.”

Answer 31

c. “You should expect to take these drugs for as long as 24 months.”

Question 32

The nurse is preparing to administer morning medications to a patient who has been newly diagnosed with tuberculosis. The patient asks, “Why do I have to take so many different drugs?” Which response by the nurse is correct?
a. “Your prescriber hopes that at least one of these drugs will work to fight the
tuberculosis.”
b. “Taking multiple drugs is recommended because of the increasing presence of
resistance to TB drug therapy.
c. “Using more than one drug can help to reduce side effects.”
d. “Using multiple drugs enhances the effect of each drug.”

Answer 32

b. “Taking multiple drugs is recommended because of the increasing presence of

Question 33

A patient newly diagnosed with tuberculosis (TB) has been taking antitubercular drugs for 1 week calls the clinic and is very upset. He says, “My urine is dark orange! What’s wrong with me?” Which response by the nurse is correct?
a. “You will need to stop the medication, and it will go away.”
b. “It’s possible that the TB is worse. Please come in to the clinic to be checked.”
c. “This is not what we usually see with these drugs. Please come in to the clinic to be checked.”
d. “This is an expected side effect of the medicine. Let’s review what to expect.”

Answer 33

d. “This is an expected side effect of the medicine. Let’s review what to expect.”

Rifampin, one of the first-line drugs for TB, causes a red-orange-brown discoloration of urine, tears, sweat, and sputum. Patients need to be warned about this side effect.

Question 34

If a patient is taking fluconazole (Diflucan) with an oral anticoagulant, the nurse will monitor for which possible interaction?

a. Reduced action of oral anticoagulants
b. Increased effects of oral anticoagulants
c. Hypokalemia
d. Decreased effectiveness of the antifungal drug

Answer 34

b. Increased effects of oral anticoagulants

Azole antifungal drugs increase the effects of oral anticoagulants. As a result, increased bleeding may occur.

Question 35

A patient has received a prescription for a 2-week course of antifungal suppositories for a vaginal yeast infection. She asks the nurse if there is an alternative to this medication, saying, “I don’t want to do this for 2 weeks!” Which is a possibility in this situation?

a. A single dose of a vaginal antifungal cream.
b. A one-time infusion of amphotericin B.
c. A single dose of a fluconazole (Diflucan) oral tablet.
d. There is no better alternative to the suppositories.

Answer 35

c. A single dose of a fluconazole (Diflucan) oral tablet.

A single oral dose of fluconazole may be used to treat vaginal candidiasis

Question 36

A patient is taking nystatin (Mycostatin) oral lozenges to treat an oral candidiasis infection resulting from inhaled corticosteroid therapy for asthma. Which instruction by the nurse is appropriate?
a. “Chew the lozenges until they are completely dissolved.”
b. “Let the lozenge dissolve slowly and completely in your mouth without chewing
it.”
c. “Rinse your mouth with water before taking the inhaler.”
d. “Rinse your mouth with mouthwash after taking the inhaler.”

Answer 36

b. “Let the lozenge dissolve slowly and completely in your mouth without chewing
it.”

Nystatin may be given orally in the form of lozenges, or troches, which need to be slowly and completely dissolved in the mouth for optimal effects; tablets are not to be chewed or swallowed whole

Question 37

A patient who is being treated for malaria has started therapy with quinine and tetracycline. He asks the nurse why he is on an antibiotic when malaria is caused by a parasite. Which response by the nurse is correct?
a. “The tetracycline prevents reinfection by the malarial parasite.”
b. “The antibiotic is combined with quinine to reduce the side effects of the
quinine.”
c. “An antibacterial drug prevents the occurrence of superinfection during
antimalarial therapy.”
d. “The two drugs are more effective against malaria when given together.”

Answer 37

d. “The two drugs are more effective against malaria when given together.”

Question 38

A woman is traveling to a country where she will be at high risk for malarial infection. What will the nurse teach her regarding prophylactic therapy with hydroxychloroquine (Plaquenil)?
a. Hydroxychloroquine is better absorbed and has fewer adverse effects if taken on
an empty stomach.
b. The drug is started 3 weeks before exposure but can be discontinued once she
leaves the area.
c. The medication is taken only when she observes mosquito bites because it can
have toxic effects if taken unnecessarily.
d. The drug is usually started 1 to 2 weeks before traveling to endemic areas and is
continued for 4 weeks after leaving the area.

Answer 38

d. The drug is usually started 1 to 2 weeks before traveling to endemic areas and is
continued for 4 weeks after leaving the area.

Prophylaxis of malaria with hydroxychloroquine is usually started 1 to 2 weeks before exposure and continued for 4 weeks after the person has left the area. The medication should be taken with food to decrease gastrointestinal u

Question 39

A patient with an intestinal infection that is positive for the Giardia lamblia organism will be taking an antiprotozoal drug. The nurse will include which information in the teaching plan for this patient?

a. The urine may become dilute and pale during therapy.
b. Taking the medications with food reduces gastrointestinal upset.
c. The medications should be taken on an empty stomach.
d. The drugs may be discontinued once the diarrhea subsides.

Answer 39

b. Taking the medications with food reduces gastrointestinal upset.