Exam 3 Practice Test Flashcards
A patient is about to receive PCN G for an infection that is highly sensitive to this drug. While obtaining the patient’s medication history, the nurse learns the patient experienced a rash when given amoxicillin (Amoxil) 20 years earlier. What will the nurse do?
a) Order a cephalosporin instead
b) Reassure the patient that allergic reactions diminish over time
c) Order a skin test to assess current risk
d) Use a desensitization schedule to administer the drug
Answer: C. - Order a skin test to assess current risk
Allergy to PCN can decrease over time; therefore, in patients with previous allergic reaction who need to take PCN, skin tests can be performed to assess the current risk. Until the risk is known, changing to a cephalosporin is not necessary. Reassuring the patient, the allergic reaction has diminished is not correct because this is not always the case. Desensitizing schedules are only used in a confirmed allergy, but the drug is needed nevertheless. Pg 666
A child with an ear infection is not responding to amoxicillin (Amoxil). The nurse will expect the provider to order:
a) Amoxicillin- clavulanic acid (Augmentin)
b) Ampicillin
c) Nafcillin
d) PCN G (Benzylpenicillin)
Answer: A -Amoxicillin- clavulanic acid (Augmentin)
Beta- lactamase inhibitors are drugs given in combination with penicillinase- sensitive PCN. Augmentin contains PCN and clavulanic acid and is often used in patients that do not respond to Amoxicillin alone. Ampicillin is similar to Amoxicillin, but amoxicillin is preferred; and if drug resistance occurs then ampicillin is usually equally ineffective. Nafcillin is only used in streptococci. PCN G would be ineffective like amoxicillin if beta-lactamase is present. Chapter 71 audioclip
A nurse assisting a nursing student with medications asks the student to describe how PCNs work to treat bacterial infections. The student is correct in stating:
a) Disinhibit transpeptidases
b) Disrupt bacterial cell wall synthesis
c) Inhibit autolysins
d) Inhibit host cell wall function
Answer: B - Disrupt bacterial cell wall synthesis
PCNs weaken the cell wall, causing bacteria to take up excessive amount of water and rupture. PCNs inhibit transpeptidases and disinhibit autolysins. PCNs do not affect cell walls of the host. Pg 662
A parent of an infant with otitis media asks the provider why Amoxicillin (Amoxil) instead of Ampicillin (Unasyn). What does the provider say?
a) Amoxicillin is a broader spectrum antibiotic than ampicillin
b) Amoxicillin is not inactivated by beta- lactamases
c) Ampicillin is associated with more allergic reaction
d) Ampicillin is not as acid stable as amoxicillin
Answer: D- Ampicillin is not as acid stable as amoxicillin
These medications are similar in structure and function but differ primarily and acid stability. Amoxicillin is more acid stable when administered orally and results in higher blood levels than can be obtained with equivalent doses of ampicillin. The two drugs have the same spectrum, are inactivated by beta-lactamases and cause allergic reactions. Chapter 71 audioclip
A child with otitis media has had 3 ear infections in the last year. The child has just completed a 10- day course of amoxicillin (Amoxil) with no improvement. The parent asks why this drug is not working as it has worked in the past. What will the APRN tell the patient?
a) Amoxicillin is too narrow in spectrum
b) The bacteria have developed a three- layer cell envelope
c) The bacteria have developed penicillin- binding
proteins (PBPs) that have low affinity for PCNs
d) The bacteria have synthesized penicillinase
Answer: D - The bacteria have synthesized penicillinase
Beta-lactamases are enzymes that cleave to the beat-lactam ring and render the PCN inactive. This resistance is common in organisms that cause ear infections. Amoxicillin is a broad-spectrum antibiotic. A three-layer envelope occurs in all gram-negative bacteria. Some bacterial strains including MRSA, develop PBPs with low affinity for PCN but MRSA is not a cause of otitis media. Pg 664
A patient with a Staphylococcus aureus infection is being treated with Nafcillin. The nurse providing care reviews the patient’s laboratory reports and notes the BUN and serum creatinine are elevated. The provider will:
a) Add an aminoglycoside
b) Order PCN G
c) Reduce the dose of Nafcillin
d) Order Amoxicillin
Answer: C - Reduce the dose of Nafcillin
Patients with renal impairment should received reduced dosages of PCNs to prevent toxicity. Aminoglycosides are nephrotoxic. PCN G and amoxicillin do not treat Staph aureus. Pg 665
A nurse is discussing MRSA with a group of nursing students; which statement by a student correctly identifies the basis for MRSA resistance?
a) MRSA bacteria have developed PBPs with a low affinity for PCNs
b) MRSA bacteria produce penicillinases that that render PCN ineffective
c) MRSA occurs because of host resistance to PCNs
d) MRSA strains replicate faster than other Staph aureus strains
Answer: A - MRSA bacteria have developed PBPs with a low affinity for PCNs
MRSA strains have a unique mechanism of resistance, which is the production of PBPs with a low affinity for PCNs and all other beta-lactam antibiotics. MRSA resistance is not related to beta-lactamase production. MRSA resistance refers to bacterial and not host resistance. The resistance of MRSA strains is not related to speed of replication. Pg 663-664
True/ False: Healthcare associated MRSA is typically more severe than community acquired MRSA and first line treatment is IV Vancomycin.
Answer: True.
Healthcare associated MRSA is often more severe and difficult to treat. It is usually transmitted through person-to-person contact, likely health care workers to patients. Risk factors include advanced age, recent surgery, several indwelling lines like in ICU care and long-term hospitalization. First line treatment is IV vancomycin. Community acquired MRSA is less severe and can be the result of being a carrier. In this instance you treat nasal passage colonization and oral antibiotics (carrier). Could be the result of contact sports and found in younger and healthy people. Chapter 71 audioclip
A nurse is preparing to administer IM PCN to a patient infected with Treponema pallidum and notes the order is for Sodium PCN G. Which action is correct?
a) Administer as prescribed
b) Considering changing route to IV
c) Change drug to IM benzathine PCN G
d) Request an order for a different class of PCN
Answer: C - Change drug to IM benzathine PCN G
The procaine and benzathine PCN salts are absorbed slowly and considered repository preparations. When benzathine PCN G is given IM, it is absorbed for weeks and useful only in highly sensitive organisms such as T. Palladium. Sodium PCN G is absorbed rapidly, with peak effects in 15 minutes. Giving the drug IV will not yield repository effects. PCN G is used to treat T. Palladium. Pg 664
True/ False: PCN can be given safely throughout the lifespan including infancy, pregnant/ breastfeeding women and older adults.
Answer: True.
The only life span consideration is that doses should be adjusted in elderly with renal dysfunction. Pg 666
What is NOT an effect of Histamine 1?
A) Vasodilation
B) Increased capillary permeability
C) Bronchoconstriction
D) Decreased capillary permeability
Answer: D - Decreased capillary permeability
Reasoning: The effects of histamine 1 are vasodilation, Increased capillary permeability, bronchoconstriction, CNS effects, itching, pain, and secretion of mucus (p488)
Diphenhydramine is a ____ generation H1 antagonist. It is ____ sedating and has ____ anticholinergic effects
A) 2nd generation; mild; mild
B) 2nd generation; highly; significant
C) 1st generation; highly; significant
D) 1st generation; mild; no
Answer: C -1st generation; highly; significant
Reasoning: Diphenhydramine is a 1st generation H1 antagonist. It is highly sedating, and has significant anticholinergic effects. (p 490, table 56.1)
Cetirizine is a ____ generation H1 antagonist. It is ____ sedating and has ____ anticholinergic effects
A) 2nd generation; highly; significant
B) 2nd generation; minimally; little to none
C) 1st generation; highly; moderate
D) 1st generation; moderately, little to none
Answer: B - 2nd generation; minimally; little to none
Reasoning: Cetirizine is a 2nd generation H1 antagonist. It is minimally sedating, and has little to none anticholinergic effects. (p 490, table 56.1)
What is NOT included in the Black Box warning for Promethizine.
A) it can cause severe respiratory depression
B) Deaths have occurred
C) It is contraindicated in children younger that 6 years old.
D) it is contraindicated in children younger than 2 years old
Answer: C - It is contraindicated in children younger that 6 years old.
Reasoning: Promethazine can cause severe respiratory depression which have caused death. It is contraindicated in children under 2 and should be used with caution in children older than 2.
If any adult patient with no known medical history is experiencing allergic rhinitis and taking cetirizine, but experiencing relief, what would be your next recommendation? his major complaint is sneezing, itching, and rhinorrhea.
A) stop taking cetirizine and start taking diphenhydramine
B) continue with cetirizine and add fluticasone propionate
C) add a oral decongestant
D) add cromolyn
Answer: b - continue with cetirizine and add fluticasone propionate
Reasoning: figure 63.1 p581
If a patient has been taking a decongestant spray, what would you educate them on:
A) only take for 3-5 days because they can develop rebound congestion
B) only take for 3-5 days because it can cause severe drop in BP
C) only take for 3-5 days because it can cause dry mouth
D) only take for 3-5 days because they can develop epistaxis
Answer: A - only take for 3-5 days because they can develop rebound congestion
Reasoning: p582
A mother brings her 2 year old child in for stuffy nose and cough. What would NOT be a recommendation?
A) use saline drops to decrease nasal stuffiness
B) use a cold-mist humidifier to thin nasal secretions
C) start an OTC nasal decongestant at bedtime so she can get some rest
D) Give her honey to relieve cough
Answer: C - start an OTC nasal decongestant at bedtime so she can get some rest
Reasoning: OTC are not recommended in children P586
What would be first line therapy for a patient complaining of allergic rhinitis with a main complaint of nasal decongestion?
A) intranasal glucocorticoids and oral decongestant
B) oral antihistamine
C) allergy testing
D) intranasal glucocorticoid and intranasal antihistamine
Answer: A - intranasal glucocorticoids and oral decongestant
Reasoning: P581 Fig 63.1
What is the main action of sympathomimetics?
A) prevents inflammatory response to allergens
B) blocks nasal cholinergic receptors
C) blocks leukotriene receptors
D) activates vascular alpha1 receptors, causing vasoconstriction
Answer: D - activates vascular alpha1 receptors, causing vasoconstriction
Reasoning: p 581, table 63.1
What is the most widely used non-opioid antitussive?
A) codeine
B) guaifenesin
C) dextromethorphan
D) benzonatate
Answer: C - dextromethorphan
A) codeine - is a opioid antitussive
B) guaifenesin - is an expectorant
C) dextromethorphan - correct answer
D) benzonatate - is also a non-opioid antitussive, but not the most used
- The two main pharmacologic classes for asthma and COPD are:
A. anti-inflammatory agents (aspirin) and vasodilators (captopril)
B. glucocorticoids and anti-inflammatory agents
C. anti-inflammatory agents (glucocorticoids) and bronchodilators (B2 agonist)
D. bronchodilators (B1 agonist) and anti-inflammatory agents (glucocorticoids)
Answer C - anti-inflammatory agents (glucocorticoids) and bronchodilators (B2 agonist)
Drugs for asthma and COPD fall into two main pharmacologic classes. Anti-inflammatory agents (principal anti-inflammatory agents being glucocorticoids) and bronchodilators (principal bronchodilators are B2 agonist) Answer:C pg 558.
What is true regarding drugs by inhalation
A. systemic effects are maximized because delivery is directly at the site of action.
B. relief of chronic symptoms is rapid
C. Inhaled drugs are only used for asthma
D. therapeutic effects are enhanced by delivering drugs directly to their site of action
D. therapeutic effects are enhanced by delivering drugs directly to their site of action
Drugs by inhalation have three advantages. 1.) therapeutic effects are enhanced by delivering drugs directly to their site of action. 2.) systemic effects are minimized and 3.) relief of acute attacks is rapid. Answer:D pg 558
When using most MDI’s (metered-dose inhalers)
A. Without a spacer 81% affects the oropharynx
B. With a spacer 95% of the dose reaches the lung
C. Most MDI’s are easier to use compared to DPI’s
D. With optimal use 80% of the dose reaches the lungs
A. Without a spacer 81% affects the oropharynx
When using most MDI’s the patient begins to inhale before activating the device. This requires hand breath coordination making MDI’s difficult to use correctly.Patients will need both verbal and written instructions. Even with optimal use (without a spacer) only 10% reaches the lungs, about 80% reaches the oropharynx and is swallowed, and the remaining 10% is left in the device or exhaled. With a spacer 21% reaches the lungs, 22% affects the mouth and throat and 57% is left in the inhaler device. Dry-Powder inhalers deliver drugs in the form of a dry, micronized powder directly to the lung and unlike MDI’s are breath activated so DPI’s do not require hand breath coordination and are easier to use. Answer: A pg 559-560
Anti-inflammatory drugs used for asthma and COPD include
A. Only Inhaled glucocorticoids
B. Inhaled and oral glucocorticoids
C. Glucocorticoids, leukotriene receptor antagonists, cromolyn, Immunoglobulin E antagonist, and Phosphodiesterase-4 inhibitors
D. Glucocorticoids (inhaled and oral), and Phosphodiesterase-4 inhibitors
B. Inhaled and oral glucocorticoids
Anti-inflammatory drugs for asthma and COPD are glucocorticoids (both oral and inhaled). leukotriene receptor antagonists are used for asthma only, cromolyn is used for asthma only, Immunoglobulin E antagonist is used for asthma only, and Phosphodiesterase-4 inhibitor is used for COPD only. Answer B. pg 560 table 62.1 and pg. 567
Beclomethasone dipropionate (QVAR)
A. is given as preventive therapy and contraindicated in pregnancy
B. is contraindicated in a patient who has oral candidiasis
C. Is an inhaled glucocorticoid, which is considered the preferred long-term treatment for children
D. Is a systemic formulation and contraindicated when breastfeeding
C. Is an inhaled glucocorticoid, which is considered the preferred long-term treatment for children
Inhaled glucocorticoids are the preferred long term treatment for children of all ages, including infancy. Beclomethasone dipropionate (QVAR) is an inhaled glucocorticoid. Inhaled glucocorticoids are preferred for uncontrolled asthma in pregnant women and are not contraindicated while breastfeeding. Women taking systemic glucocorticoids should not breastfeed. Inhaled glucocorticoids are contraindicated for patients with persistently positive sputum cultures for Candida albicans not for oral candidiasis. If candidiasis develops, it can be treated with an antifungal medicine. Using a spacer will decrease deposits onto the oropharynx. Answer:C pg 561-563 (boxes)
What adverse effects are caused by long term use of oral glucocorticoids?
A. Hyperglycemia, oropharyngeal candidiasis, adrenal suppression
B. Peptic ulcer disease, hyperglycemia, adrenal suppression, osteoporosis
C. Growth suppression in adults, adrenal suppression, osteoporosis
D. Dysphonia, peptic ulcer disease, adrenal suppression
B. Peptic ulcer disease, hyperglycemia, adrenal suppression, osteoporosis
When used acutely (less than 10 days) even in high doses, oral glucocorticoids do not cause significant adverse effects. Prolonged therapy even in moderate doses can cause adrenal suppression, osteoporosis, hyperglycemia, and growth suppression in young patients. Inhaled glucocorticoids most common adverse effects are oropharyngeal candidiasis, and dysphonia (hoarseness, speaking difficulty). For young children using inhaled glucocorticoids longer than 6 months the Pediatric Endocrine Society Drugs and Therapeutics Committee recommends monitoring for adrenal insufficiency ( hypoglycemia, hypotension, mental status alterations) and testing for adrenal insufficiency. Answer B pg. 561-562
Jane is a 7 year old female with a history of asthma. Her mom brings her into the office because she needs a refill for her nebulized inhaled glucocorticoid. The APRN will prescribe
A. Budesonide (Pulmicort Flexhaler) 40 mcg daily
B. Ciclesonide (Alvesco) 80mcg twice daily
C. Budesonide (Pulmicort Respules) 250 mcg twice daily
D. Budesonide (Pulmicort Respules) 500 mcg daily
D) Budesonide (Pulmicort Respules) 500 mcg daily
Budesonide suspension (Pulmicort Respules) is the first inhaled glucocorticoid formulated for nebulized dosing. The product was approved for maintenance therapy of persistent asthma in children 1-8 years old. Improvements usually begin in 2-8 days with maximum benefits in 4-6 weeks. Suspension is available in 2-ml ampules containing 250-500 mcg of the drug. Children 1-8 years of age dosing can be prescribed from 500-1000 mcg/day. Adult dosing can be 250-500 mcg twice a day or 1000mcg daily. Answer: D pg 562
What statement is true of leukotriene receptor antagonist (LTRAs)
A. Montelukast a LTRA is used for maintenance therapy of asthma in newborns
B. Decrease bronchoconstriction while increasing the inflammatory process
C. Zileuton a LTRA combined with theophylline can increase theophylline levels
D. LTRAs increase the effects of leukotrienes, causing bronchodilation
C. Zileuton a LTRA combined with theophylline can increase theophylline levels
LTRAs suppress the effects of leukotrienes, which are compounds that promote smooth muscle constriction, blood vessel permeability, and inflammatory responses through direct action as well as through the recruitment of eosinophils and other inflammatory cells. In patients with asthma these drugs can decrease bronchoconstriction and inflammatory responses such as edema and mucus secretion. Three LTRAs are currently available: zileuton-approved for asthma prophylaxis and maintenance therapy in adults and children 12 years and older (increases theophylline levels), zafirlukast-approved for maintenance therapy of chronic asthma in adults and children over 5 years and older , and montelukast-most commonly used, approved for 1) prophylaxis and maintenance therapy of asthma in patients at least 1 year old; 2) prevention of exercise-induced bronchospasm (EIB) in patients at least 15 years old and; 3) relief of allergic rhinitis. Answer:C pg 563-564
Which statement is true about anti-inflammatory drugs
A. Omalizumab is an antagonist of antibody IgE indicated for allergy-related asthma
B. Monoclonal antibodies are the newest first-line agents used for the management of airway inflammation
C. Two phosphodiesterase-4 inhibitors Roflumilast and Reslizumab are approved for the management of COPD
D. Cromolyn is an oral agent that suppresses bronchial inflammation
A. Omalizumab is an antagonist of antibody IgE indicated for allergy-related asthma
Cromolyn is an inhalation agent that suppresses bronchial inflammation. Monoclonal antibodies are the newest drug category for the management of airway inflammation but are not approved as first-line agents and none are approved for acute asthmatic episodes. There is only one phosphodiesterase-4 inhibitor, which is Roflumilast (Daliresp, Daxas) that is approved for the management of COPD. Reslizumab is an interleukin-5 receptor antagonist. Omalizumab (Xolair) was the first monoclonal antibody to receive FDA approval. It is only approved for allergy-related asthma and only when preferred options have failed. It is given subcutaneously and also poses a risk for anaphylaxis and cancer. Answer: A pg. 564-567
The APRN understands B2 adrenergic agonists
A. Are used to promote bronchodilation and are available only as inhaled agents
B. Are the most effective drugs available to relieve acute bronchospasm and preventing EIB
C. Provide symptomatic relief in patients with asthma and COPD by altering the underlying inflammation
D. Must be monitored closely in pregnant women because they cause uterine contractions leading to premature delivery.
B. Are the most effective drugs available to relieve acute bronchospasm and preventing EIB
B2 agonists provide symptomatic relief in patients with asthma and COPD but do not alter the underlying inflammation that is part of the disease process. Most patients who use a bronchodilator also use an inhaled glucocorticoid for long term suppression of inflammation. Monotherapy with a bronchodilator is appropriate only when asthma is very mild and attacks are infrequent. B2 agonists cause uterine relaxation not contractions and are not contraindicated during pregnancy or breastfeeding. They can be administered orally or by inhalation. Answer: B pg. 567
Which antiviral drug is a first line choice for most infections caused by Herpes Simplex Virus (HSV) and Varicella Zoster Virus (VZV)?
a. Zanamivir
b. Valganciclovir
c. Acyclovir
d. Cidofovir
Answer: C - Acyclovir
Acyclovir is the agent of first choice. It can be administered orally, topically and intravenously. Serious side effects are uncommon. Zanamivir is an Influenza drug, and Valganciclovir and Cidofovir are used to treat Cytomegalovirus. P. 723
Note: Acyclovir MUST undergo activation first in order to work. P. 723
Valacyclovir (Valtrex) is a pro drug form of Acyclovir. What conditions is this drug approved for?
a. Herpes Labialis, Herpes Simplex genitalis, Herpes Zoster infection
b. Herpes Simplex genitalis
c. Varicella, Herpes labialis and Herpes genitalis
d. Herpes Labialis, Herpes Simplex genitalis, Herpes Zoster infection and Varicella
Answer: D.
Herpes Labialis, Herpes Simplex genitalis, Herpes Zoster infection and Varicella
Valacyclovir is approved to treat four conditions. These include 1) herpes labialis, 2) Varicella (chickenpox), 3) herpes zoster infection and 4) herpes simplex genitalis (genital herpes). P. 725
When prescribing Acyclovir, what patient education would the Advanced Practice Nurse provide the patient?
a. Acyclovir only decreases symptoms and does not eliminate nor produce a cure for the virus.
b. If started with onset of symptoms, Acyclovir will not only decrease symptoms, it will cure the virus.
c. Oral Acyclovir is unsafe to be given during pregnancy.
d. If given intravenously at the start of onset of symptoms, the patient will have no side effects and be cured of the virus.
Answer: A. Acyclovir only decreases symptoms and does not eliminate nor produce a cure for the virus.
Acyclovir does not eliminate nor produce a cure for HSV, however it will decrease the symptoms of the virus. It is a safe drug to use in pregnancy and although it can be given intravenously, this is not a drug that will cure this virus. As for side effects, there are some noted side effects with taking Acyclovir. P. 724
Which of the following Herpes Simplex Virus and Varicella Zoster Virus drugs are safe to use in pregnancy?
a. Acyclovir, Famciclovir
b. Acyclovir, Famciclovir, Valacyclovir, Foscarnet
c. Acyclovir, Famciclovir, Valacyclovir
d. Acyclovir, Famciclovir, Foscarnet
Answer: C. Acyclovir, Famciclovir, Valacyclovir have been found to be safe in pregnancy. However, Foscarnet, which is deposited in bone and teeth, has caused abnormal development of tooth enamel and is not recommended during pregnancy. P. 724 (Patient centered care across the lifespan).
In immunocompetent patients, resistance to Acyclovir is ¬____________.
a. Rare in all populations
b. Common in all populations
c. Rare in immunocompetent populations but resistance has been reported in transplant patients and patients with AIDs.
d. Rare in immunocompetent patients but has been reported in only patients with AIDS.
Answer: C. Rare in immunocompetent populations but resistance has been reported in transplant patients and patients with AIDs.
Resistance to Acyclovir is rare in immunocompetent patients but many cases have been reported in transplant recipients and patients with AIDS. Lesions caused by resistant HSVs can be extensive and severe, progressing despite continued Acyclovir therapy. Acyclovir-resistant HSVs and VZV usually respond to intravenous foscarnet or cidofovir, which are primary used for treatment of CMV infection. P. 723.
Topical preparations such as Penciclovir (Denavir) and Docosanol (Abreva) are used to treat
a. Herpes Labialis
b. Herpes Genitalis
c. Herpes Labialis, Herpes Genitalis, Herpes Ocular
d. Herpes Labialis, Herpes Genitalis
Answer: A. Herpes Labialis
Topical preparations are used to treat Herpes Labialis. The patient will be required to apply the preparations multiple times a day, beginning at the first signs of symptoms. The benefits of both preparations were found to be modest in clinical trials. P. 727
NOTE: Docosanol (Abreva) will NOT suppress shedding of the virus (Per Study Guide audio clip Ch. 80).
Acyclovir, Famciclovir, Foscarnet, and Valacyclovir are all systemic drugs used to treat HSV and VZV infections. What baseline data will the APRN need to monitor when prescribing these drugs?
a. Serum creatinine, blood urea nitrogen (BUN), urinalysis
b. CBC with WBC differential, Liver enzymes
c. CBC with WBC differential, liver enzymes, ECG
d. Serum Creatinine, blood urea nitrogen (BUN), urinalysis, CBC with WBC differential, liver enzymes, electrolytes, ECG
Answer: D. Refer to table “Summary of Key Prescribing Considerations” P. 727 for detail on which drugs need which specific baseline data.
Note: Foscarnet is not used in pregnant women, it causes QT elongation (per study guide recording ch. 80), an ECG, electrolytes and a 24-hour urine are needed as additional baseline data prior when prescribing this antiviral drug.
Both Acyclovir and Valacyclovir are approved for use in children, however Foscarnet and Famciclovir are not. At what age can a child be prescribed Acyclovir and Valacyclovir?
a. Acyclovir: 3 Months, Valacyclovir: 2 Years
b. Acyclovir: 3 Years, Valacyclovir: 2 Years
c. Acyclovir: 3 Months, Valacyclovir: 2 Months
d. Acyclovir: 3 Days, Valacyclovir: 2 Days
Answer: A. Acyclovir: 3 Months, Valacyclovir: 2 Years
See box “Patient-Centered Care Across the Lifespan” P. 724, for specifics on each population.
What adverse effects are common with oral Acyclovir?
a. Headache, nausea, vomiting
b. Nausea, vomiting diarrhea, headache and vertigo
c. Nausea, vomiting, diarrhea, renal failure
d. Headache and vertigo
Answer: B. Nausea, vomiting diarrhea, headache and vertigo
Acyclovir is devoid of serious adverse effects. Renal Impairment has not been reported. The most common reactions are nausea, vomiting diarrhea, headache and vertigo. Topical Acyclovir frequently causes transient local burning or stinging: systemic reactions do not occur.
Note: Unlike oral formulations of Acyclovir, IV Acyclovir can cause renal failure. Patients with preexisting renal disease and dehydration are at increased risk.
Which of the following topical drugs are used for ocular herpes infections?
a. Ganciclovir
b. Trifluride, Zanamivir
c. Trifluride, Ganciclovir
d. Zanamivir, Valacyclovir
Answer: C. Trifluride, Ganciclovir
Trifluride and Ganciclovir are both topical drugs used to treat ocular herpes infections. P. 727.
Note: Ocular Herpes infections are a medical emergency (per study guide audio clip ch. 80).
When choosing an antibiotic, which of the following is NOT one of the three principle factors that must be considered:
A. host factors, such as the site of infection and the status of the host defenses
B. drug sensitivity of the infecting organism
C. the first-choice drug should be used
D. the identity of the infecting organism
Answer C -the first-choice drug should be used
p. 655
A, B, & D are the three principles. Drugs of first choice may not be used when the patient has an allergy to the drug of choice, inability of the drug of choice to penetrate the site of infection, and heightened susceptibility of the patient to toxicity of the first-choice drug.
Which group of antibiotics interfere with an enzyme that is necessary to produce folic acid?
A. Penicillins
B. Sulfonamides
C. Tetracyclines
D. Cephalosporins
Answer: B - Sulfonamides
p. 651
How do antibiotics develop resistance? Check all that apply.
A. Microbes can alter the structure of drug target molecules
B. Microbes can decrease the concentration of a drug at the site of action
C. Microbes can decrease active export of certain drugs
D. Microbes can cause drug inactivation
Answer: A, B, D
p. 653-4
not C - when microbes decrease the concentration of a drug at its site of action, microbes can increase (not decrease) active export of certain drugs.
Tetracycline is (check all that apply):
A. a narrow spectrum antibacterial drug
B. an inhibitor of cell wall synthesis
C. a bacteriostatic inhibitor of protein synthesis
D. a broad spectrum antibacterial drug
Answer: C & D
p. 652 Tables 70.1 & 70.2
Empiric therapy should be started:
A. after drug sensitivity has been completed so that you can identify a broad spectrum agent that can be used
B. before completion of laboratory tests, after completing a clinical evaluation
C. only when the infection is minor
D. after you receive the results of the C&S so that you know the infecting organism and determine its drug sensitivity
Answer: B - before completion of laboratory tests, after completing a clinical evaluation
p 655
Which of the following is NOT a drug of first choice for the organism?
A. azithromycin for bordetella pertussis (whooping cough)
B. larithromycin + amoxicillin + esomeprazole for H. pylori
C. cefotaxime for E-coli
D. ceftazidime for pseudomonas aeruginosa (UTI)
Answer: D - ceftazidime for pseudomonas aeruginosa (UTI)
p. 656-7 Table 70.5 ciprofloxacin is drug of first-choice for pseudomonas aeruginosa
What classification of antimicrobial drug are cephalosporins (choose all that apply)?
A. narrow spectrum gram-positive
B. narrow spectrum gram-negative
C. broad spectrum gram-positive
D.broad spectrum gram-negative
Answer: B, C, & D p. 652
1st and 2nd gen are narrow spectrum gram-negative, while 3rd gen is broad spectrum gram-positive and gram-negative
The mechanism of action of the antimicrobials penicillin and vancomycin involves:
A. disruption of cell membrane
B. suppression of viral replication
C. inhibition of protein synthesis
D. inhibition of cell wall synthesis
Answer A - disruption of cell membrane
p. 652
Oseltamivir and Zanamivir are classified by what mechanism of action?
A. influenza neuraminidase inhibitors
B. antimetabolites
C. bacteriostatic inhibitors of protein synthesis
D. bactericidal inhibitors of protein synthesis
Answer: A influenza neuraminidase inhibitors
p.652 table 70.2
Patient centered care across the lifespan for patients regarding antimicrobials includes:
A. sulfonamides bind to developing teeth of children, causing discoloration
B. gentamicin used by pregnant women can cause irreversible hearing loss in the newborn
C. tetracyclines are generally safe in children
D. use of penicillin causes kernicterus in infants
Answer: B gentamicin used by pregnant women can cause irreversible hearing loss in the newborn
p659
A patient who has seasonal allergies in the spring and fall asks the nurse about oral antihistamines. Which response by the nurse is correct?
A. “Anticholinergic effects are more common with second-generation antihistamines.”
B. “First-generation antihistamines, such as diphenhydramine [Benadryl], are more
effective.”
C. “Make sure you take antihistamines only when you have symptoms to minimize side
effects.”
D. “You should take oral antihistamines daily during each allergy season to get maximum
effects.”
D. “You should take oral antihistamines daily during each allergy season to get maximum
effects.”
Antihistamines are most effective when they are taken prophylactically, and they should be administered on a regular basis throughout the allergy season, even when symptoms are not present. p. 696
A patient admitted to the hospital has been using phenylephrine nasal spray [Neo- Synephrine], 2 sprays every 4 hours, for a week. The patient complains that the medication is not working, because the nasal congestion has increased. What will the nurse do?
A. Request an order for an oral decongestant to replace the intranasal phenylephrine.
B. Request an order for an intranasal glucocorticoid to be used while the phenylephrine is
withdrawn.
C. Tell the patient to increase the dose of phenylephrine to 4 sprays every 4 hours.
D. Tell the patient to stop using the phenylephrine and begin using an intranasal antihistamine.
B) Request an order for an intranasal glucocorticoid to be used while the phenylephrine is
withdrawn.
This patient is experiencing rebound congestion, which develops when topical sympathomimetics are used for longer than a few days. Abrupt withdrawal can stop the cycle of rebound congestion but is uncomfortable, so using an intranasal glucocorticoid, beginning 1 week before discontinuing the decongestant, while withdrawing the decongestant, is recommended. p. 698
A nurse provides teaching to a patient with allergic rhinitis who will begin using an intranasal glucocorticoid. Which statement by the patient indicates understanding of the teaching?
A. “If the glucocorticoid causes burning or itching, I should use it every other day.”
B. “I should use a decongestant if necessary before using the glucocorticoid.”
C. “I should use the glucocorticoid whenever I have symptoms.”
D. “I will probably develop systemic effects from the topical glucocorticoid.”
B. “I should use a decongestant if necessary before using the glucocorticoid.”
Patients using intranasal glucocorticoids should be taught to use a decongestant to unblock nasal passages if needed before using the medication. p. 695
.A patient with allergic rhinitis is taking a compound product of loratadine/pseudoephedrine [Claritin-D] every 12 hours. The patient complains of insomnia. The nurse notes that the patient is restless and anxious. The patient’s heart rate is 90 beats/minute, and the blood pressure is 130/85 mm Hg. The nurse will contact the provider to:
A. discuss using an intranasal glucocorticoid and loratadine [Claritin].
B. report acute toxicity caused by pseudoephedrine.
C. suggest using an agent with a sympathomimetic drug only.
D. suggest using a topical decongestant to minimize systemic symptoms.
A. discuss using an intranasal glucocorticoid and loratadine [Claritin].
This patient is showing central nervous system (CNS) and cardiovascular side effects of the pseudoephedrine. A better option would be to use single-ingredient products for each symptom; an intranasal glucocorticoid and an oral antihistamine are considered first-line treatments. p. 698
A child who has perennial allergic rhinitis has been using an intranasal glucocorticoid. The provider has ordered montelukast [Singulair] to replace the glucocorticoid because the child has frequent nosebleeds. When teaching this child’s parents about montelukast, the nurse will include which statement?
A. “Montelukast is also effective for treating infectious rhinitis.”
B. “Montelukast may cause behavior changes in your child.”
C. “Montelukast will treat both congestion and rhinitis.”
D. “Montelukast works best when combined with a topical decongestant.”
B. “Montelukast may cause behavior changes in your child.”
Montelukast can cause rare but serious neuropsychiatric effects (i.e. behavior changes) in patients, and parents should be warned of this possibility. p. 700
A patient who has a viral upper respiratory infection reports having a runny nose and a cough that prevents sleep and asks the nurse to recommend an over-the-counter medication. Which medication will the nurse recommend?
A. Diphenhydramine [Benadryl]
B. Fexofenadine/pseudoephedrine [Allegra-D]
C. Guaifenesin [Mucinex]
D. Phenylephrine drops
A. Diphenhydramine [Benadryl]
Diphenhydramine is effective in suppressing cough and also has sedative effects when used in doses to suppress cough. p. 701
A child with seasonal rhinitis has used budesonide [Rhinocort Aqua] for several years. The parents are concerned that the child’s rate of growth has slowed. What will the nurse do?
A. Reassure the parents that this is an expected side effect.
B. Suggest that the parents discuss using fluticasone [Flonase] with the provider.
C. Tell the parents to administer the drug only when symptoms are severe.
D. Tell the parents that antihistamines work as well as intranasal glucocorticoids.
B. Suggest that the parents discuss using fluticasone [Flonase] with the provider.
A worrisome systemic effect of intranasal glucocorticoids is suppression of linear growth in children. Although rare, it can occur; however, it is less likely with fluticasone and mometasone, so these two preparations are better options for children. p. 695
A parent asks a nurse to recommend an intranasal decongestant for a 6-year-old child. Which response by the nurse is correct?
A. “Decongestants are too sedating for children and should not be used.”
B. “Decongestants should not be given to children under 7 years old.”
C. “Decongestant drops are recommended instead of decongestant sprays.”
D. “Decongestant sprays should be used no longer than 5 to 10 days.”
C. “Decongestant drops are recommended instead of decongestant sprays.”
Decongestant drops are recommended for children, because the number of drops can be controlled precisely. When sprays are used, the amount given is not well controlled. p. 699
A 7-year-old child has a cough, runny nose, congestion, and fever, and the parents ask the nurse to recommend an over-the-counter product. Which response by the nurse is correct?
A. “Any product will be effective when combined with vitamin C and zinc.”
B. “It is best to use single-agent medications to treat individual symptoms.”
C. “The fever indicates that your child may need an antibiotic; you should call your provider.”
D. “You should ask your provider to prescribe a combination product that will treat multiple
symptoms.”
B. “It is best to use single-agent medications to treat individual symptoms.”
Combination medications may provide ingredients that are not needed or may provide ingredients that are either excessive or subtherapeutic. It is best to use single-agent drugs to treat individual symptoms. p. 701
Which medication used for asthma has off-label uses to treat allergic rhinitis?
A. Diphenhydramine [Benadryl]
B. Fexofenadine/pseudoephedrine [Allegra-D]
C. Guaifenesin [Mucinex]
D. Omalizumab [Xolair]
D. Omalizumab [Xolair]
Omalizumab is a monoclonal antibody directed against IgE that plays a role in the release of inflammatory mediators from mast cells and basophils. It is currently only approved for allergy- mediated asthma but is being used off-label to treat other allergic symptoms. p. 700
A patient with a cough has been advised to use guaifenesin. The patient asks the nurse to explain the purpose of the drug. The nurse will explain that guaifenesin:
A. dries secretions to help suppress coughing so patients can rest.
B. helps stimulate the flow of secretions to increase cough productivity.
C. helps to relieve chest pain associated with a cough.
D. stimulates the body’s natural immune responses.
B. helps stimulate the flow of secretions to increase cough productivity.
Expectorants stimulate the flow of respiratory tract secretions to improve cough productivity. p. 701
A parent asks a nurse about giving diphenhydramine [Benadryl] to a child to relieve cold symptoms. Which response by the nurse is correct?
A. “Benadryl must be given in higher doses to provide relief for cold symptoms.”
B. “Intranasal glucocorticoids are more effective for treating cold symptoms.”
C. “Nasal antihistamines are more effective for treating cold symptoms.”
D. “Because histamine does not cause cold symptoms, Benadryl would not be effective.”
D. “Because histamine does not cause cold symptoms, Benadryl would not be effective.”
Histamine does not contribute to symptoms of infectious rhinitis; therefore, antihistamines are of no use in treating cold symptoms. p. 696
A patient asks the nurse what type of medications would be most effective for treating seasonal and perennial rhinitis. Which response by the nurse is correct? A. Pseudoephedrine [Sudafed] B. Fluticasone propionate [Fluticasone] C. Loratadine [Claritin] D. Intranasal cromolyn sodium [Atrovent]
B. Fluticasone propionate [Fluticasone]
Intranasal glucocorticoids, such as fluticasone propionate, are the most effective drugs for prevention and treatment, because they prevent or suppress all the major symptoms of allergic rhinitis (congestion, rhinorrhea, sneezing, nasal itching, and erythema). p. 695
What is ipratropium bromide [Atrovent]?
A. A cholinergic agent used for perennial rhinitis
B. An anticholinergic used for allergic rhinitis and colds
C. A medication that is used only in patients with asthma
D. A drug that is inappropriate for use in patients with allergic rhinitis
B. An anticholinergic used for allergic rhinitis and colds
Ipratropium bromide is an anticholinergic that is indicated for allergic rhinitis, asthma, and the common cold. The drug reduces rhinorrhea p. 700
Telavancin could have drug interactions with all of the following EXCEPT:
a. NSAIDs
b. ACEIs
c. Cytochrome P450 enzymes
d. Clarithromycin
c. Cytochrome P450 enzymes
p. 675 Telavancin should be used with caution in patients taking other drugs that can damage the kidneys (e.g., NSAIDs, angiotensin-converting enzyme inhibitors, and aminoglycosides) and in patients taking drugs that prolong the QT interval (e.g., clarithromycin and ketoconazole). Clinically significant interactions involving cytochrome P450 enzymes have not been observed.
All of the following antibiotics work by weakening the bacterial cell wall and have a β-lactam ring on them EXCEPT:
a. Vancomycin (Vancocin)
b. Imipenem (Primaxin)
c. Cephalexin (Keflex)
d. Aztreonam (Azactam)
Answer A- Vancomycin (Vancocin)
p. 673 “Vancomycin (Vancocin) is the most widely used antibiotic in the US hospitals. Principal indications are Clostridiodies difficile infection (CDI), MRSA infection, and treatment of serious infections with susceptible organisms in patients allergic to penicillins. The major toxicity is renal failure. Unlike most other drugs discussed here, vancomycin does not contain a β-lactam ring.”
- What should a nurse practitioner educate a patient to avoid while taking a cephalosporin antibiotic?
a. Grapefruit juice
b. Alcohol
c. Cheese
d. Greasy foods
Answer B. - Alcohol
disulfiram-like reaction could occur. (from outline slides for the cephaloporins and p. 669 in our text. Although in our text it states that “cefazolin and cefotetan—can induce a state of alcohol intolerance. If a patient taking these drugs were to ingest alcohol, a disulfiram-like reaction could occur.”
- The NP needs to prescribe a cephalosporin antibiotic for a patient with renal insufficiency. Which of these medications can be given to this patient without adjusting the recommended dosage?
a. Cephalexin (Keflex)
b. Cefdinir (Omnicef)
c. Cefuroxime (Ceftin)
d. Ceftriaxone (Rocephin)
Answer D. Ceftriaxone (Rocephin)
p. 669 “One cephalosporin—ceftriaxone—is eliminated largely by the liver. Consequently dosage reduction is unnecessary in patients with renal impairment.”
- A patient presents to the NP with complaints of nausea, abdominal cramping and watery diarrhea for a day. The patient has been taking ciprofloxacin for a kidney infection. The NP orders a stool test for c. diff which comes back positive. This is the first time the patient tests positive for c. diff. What course of action should the NP take?
a. Prescribe vancomycin 125 mg PO QID for 10 days.
b. Discontinue the ciprofloxacin and prescribe vancomycin 125 mg PO QID for 10 days
c. Continue the ciprofloxacin and prescribe vancomycin 500 mg PO QID PO for 10 days
d. Prescribe metronidazole (Flagyl) 500 mg TID for 10 days.
Answer B - Discontinue the ciprofloxacin and prescribe vancomycin 125 mg PO QID for 10 days
p. 673 “Treatment of CDI consists of stopping one antibiotic and starting another, as recommended in a clinical guideline issued by the Infectious Disease Society of America (IDSA). As soon as possible after CDI has been diagnosed, the antibiotic that facilitated C. diff. overgrowth must be stopped because doing so (1) will reduce the risk for reinfection after CDI has cleared and (2) in 25% of patients with mild CDI, it will cause the infection to resolve. At the same time, an antibiotic to eradicate C. diff. should be started. Drug selection is based on number of previous episodes and infection severity as judged by two laboratory values: white blood cell (WBC) counts and serum creatinine (SCr) values. For initial occurrences of CDI, treatment with oral vancomycin or fidaxomicin, a narrow spectrum macrolide, is recommended (Table 72.6)”
- A 60 year old patient presents to the NP with dysuria, frequency and chills. Upon examination, the patient has a low grade fever and her urine is indicative of a UTI. She states that she is allergic to sulfas. What should the NP prescribe?
a. Ciprofloxacin 500 mg PO daily for 3 days
b. Bactrim DS q12 hr for 10 days
c. Fosfomycin 3 g PO x1 dose
d. Ciprofloxacin 500 mg PO BID for 7 days
Answer C - Fosfomycin 3 g PO x1 dose
p. 675 “Fosfomycin (Monurol) is a unique antibiotic approved for single-dose therapy in women with uncomplicated urinary tract infections (i.e., acute cystitis) caused by E. coli or E. faecalis.” She is allergic to sulfas, so the only other first line agent, Bactrim DS, is contraindicated. The article in the “drugs for common infection” link states “Fluoroquinolones (especially ciprofloxacin) have been the most common class of antibiotics prescribed for urinary tract infections, but they should no longer be used for empiric treatment, unless no other treatment options exist”
- In cephalosporins, as we progress from the 1st generation to the 5th generation, which of the following is true?
a. Increasing ability to reach the CSF
b. Greater resistance to β-lactamases
c. Increasing activity against gram-negative bacteria and anaerobes
d. All of the above
Answer D. - All of the above
p. 669 In general, as we progress from first-generation agents to fifth-generation agents, there is (1) increasing activity against gram-negative bacteria and anaerobes, (2) increasing resistance to destruction by β-lactamases, and (3) increasing ability to reach the cerebrospinal fluid (CSF).
- Which of the following is TRUE about carbapenems?
a. They have a narrow antimicrobial spectrum
b. They work only against gram-positive bacteria
c. One of them, imipenem, can be administered orally
d. Combined usage of imipenem and valproate should be avoided.
d. Combined usage of imipenem and valproate should be avoided.
Answer D. p. 671 section on carbapenems. “combined use of imipenem and valproate should be avoided.”
- All of the following about vancomycin is true EXCEPT:
a. It is the drug of choice for infections caused by MRSA
b. It is active against both gram positive and gram negative bacteria
c. It is poorly absorbed in the GI tract
d. The dosage needs to be adjusted in patients with renal impairment
Answer B - It is active against both gram positive and gram negative bacteria
p. 673 Vancomycin is active only against gram-positive bacteria
- The NP should be cautious when administering ceftriaxone (Rocephin) with all of the following drugs EXCEPT?
a. Clopidrogel (Plavix)
b. Warfarin (Coumadin)
c. Valproate
d. Ibuprofen
Answer C. - Valproate
p 670 “Cefotetan, cefazolin, and ceftriaxone can promote bleeding as they contain a side chain that interferes with Vitamin K metabolism which can inhibit the formation of clotting factors. Caution is needed if these drugs are combined with other agents that promote bleeding (anticoagulants, thrombolytics, nonsteroidal anti-inflammatory drugs [NSAIDs], and other antiplatelet agents).”
Which of the following is NOT a bacteriostatic inhibitor of protein synthesis?
a. Clindamycin
b. Erythromycin
c. Linezolid
d. Tetracyclines
e. Penicillin
e. Penicillin
( PCN is an inhibitor of cell wall synthesis)
ch 70
Which of the following drugs is NOT appropriate for Gram + cocci and bacilli?
a. PCN G and V b. Fluoroquinolones c. Clindamycin d. Rifampin
b. Fluoroquinolones
( This drug class treats gram + and gram negative bacilli)
ch 70
Which of the following drugs is the first choice for uncomplicated UTI?
a. Nitrofurantoin b. Fluoroquinolone c. Amoxicillin d. Fosfomycin
C) Amoxicillin
( the other three are alternative drugs)
Ch 70
which of the following is NOT a first choice drug for treating Escherichia coli?
a. cefotaxime b. Ampicillin c. cefepime d. ceftriaxone
B) Ampicillin
(this is an alternative drug for e. coli)
ch 70
What is the correct first choice combination to treat H-pylori?
a. Tetracycline + metronidazole + bismuth subsalicylate + esomeprazole b. clarithromycin + amoxicillin + esomeprazole c. clarithromycin + amoxicillin d. Tetracyline+Metronidazole+bismuth subsalicylate
b. clarithromycin + amoxicillin + esomeprazole
ch 70
Which of the following is NOT appropriate to treat Mycoplasma pneumoniae
a. Erythromycin b. clarithromycin c. azithromycin d. Levofloxacin e. tetracycline
d. Levofloxacin
ch 70
Which of the following is NOT a broad spectrum antibiotic?
a. Sulfonamides b. Fluoroquinolones c. piperacillin d. third generation cephalosporins e. vancomycin
e. vancomycin
( narrow spectrum for gram + cocci and bacilli)
ch 70
Gram + cocci and bacilli should be treated with
a. broad spectrum b. narrow spectrum c. antivirals d. antifungals
b. narrow spectrum
Ch 70
Which of the following is the first choice for treating Haemophilus influenzae?
a. Cefuroxime b. chloramphenicol c. meropenem d. ceftriaxone ( the others are alternative drugs)
d. ceftriaxone
( the others are alternative drugs)
ch 70
The first choice drug for a UTI caused by Psuedomonas aeruginosa is
a. Levofloxacin b. piperacillin/tazobactam c. cefepime d. ciprofloxacin e. imipenem
d. ciprofloxacin
ch 70
A 55-year old with a history of asthma and BPH presents to your clinic with complaint of seasonal allergy symptoms. Should you prescribe this patient an antihistamine and why?
a. No, the patient’s history of BPH puts them at risk for worsening prostatic hyperplasia
b. No, the patient’s history of asthma puts them at risk due to suppression of secretion of mucous
c. No, BPH and asthma are both contraindications for antihistamines
d. Yes, an antihistamine would provide relief for the seasonal allergies
Answer: A - No, the patient’s history of BPH puts them at risk for worsening prostatic hyperplasia
Rationale: Muscarinic receptors in the lungs constrict the bronchi and promote secretion. So if we block them, the lungs won’t be constricted and there will be less secretions. Sometimes we have to questions what we read, thinking well that doesn’t really make sense to me. Asthma treated appropriately and correctly, the way asthma should be treated à would NOT be a high risk patient for antihistamine use. Most patients have to be treated with antihistamines to help control their asthma. Be REAL aware of that per Dr. Mello. A patient with urinary retention, glaucoma, BPH WOULD be a patient to be cautious of treating because of how the muscarinic receptors work. (Ch 56 study guide video)
A nurse is preparing to give an antibiotic to a patient who reports being allergic to antibiotics. Before giving the medication, what will the nurse do first?
a. Ask whether the patient has taken this antibiotic for other infections
B) Question the patient about allergies to other medications
C) Request an order for a lower dose of the antibiotic
D) Request an order for an antihistamine
Answer: A Ask whether the patient has taken this antibiotic for other infections
Rationale: The nurse needs to assess whether the patient is truly allergic to this drug. Allergic reactions require previous exposure to the drug, so the nurse should ask whether the patient has taken this antibiotic before. If a patient is allergic to a drug, lowering the dose will not decrease the risk of allergic reaction. Antihistamines sometimes are given when patients must take a drug to which they are allergic. (Ch 56 study guide video)
A patient has allergies and takes an antihistamine. The patient wants to know how the drug works. The nurse understands that antihistamines work because they are what?
a. Activators
b. Agonists
c. Antagonists
d. Antidotes
Answer: C
Rationale: Antihistamines bind to receptors to prevent activation by histamine; this makes antihistamines antagonist drugs. Antihistamines do not activate receptors. Agonist drugs activate receptors; they are not antidotes. (Ch 56 study guide video)
The nurse understands what antihistamines are classified as, related to how the drug works. The nurse is explaining how H1 blockers interact with histamine to produce effects. She explains it as they:
a. Block the release of histamine from mast cells and basophils
b. Bind selectively to H1 receptors in the stomach to block actions of histamine at the site
c. Bind selectively to H1 receptors in the vascular system and CNS to block actions of histamine at the site
d. Stimulate antibodies to release IgE needed to block the allergen from creating symptoms
Answer: C
Rationale: H1 blockers bond selectively to H1 receptors, blocking the actions of histamine at the site, they do NOT block the release of histamine from the mast cells and basophils. This explains why antihistamines take a while to control symptoms if the symptoms have already started. (Ch 56 study guide video)
Fill in the blanks. _____ - generation antihistamines have _____ molecules that readily cross the blood brain barrier. They have a ____ affinity for H1 receptors in the CNS, which ____ sedating effects.
a. First, small, high, causes
b. Second, small, high, does not cause
c. First, large, high, does not cause
d. First, small, low, causes
Answer: A
Rationale: First-generation antihistamines have small molecules with high lipid solubility and readily cross the blood brain barrier. They have a high affinity for H1 receptors in the CNS causing sedative effects. Second generation antihistamines have little sedative effects because they are larger molecules that do not cross the blood brain barrier. Second generation antihistamines have a low affinity for H1 receptors in the CNS.
A patient who has seasonal allergies in the spring and fall asks the nurse about oral antihistamines. Which response by the nurse is correct?
a. “Anticholinergic effects are more common with second-generation antihistamines.”
b. “First-generation antihistamines, such as diphenhydramine [Benadryl], are more effective.”
c. “Make sure you take antihistamines only when you have symptoms to minimize side effects.”
d. “You should take oral antihistamines daily during each allergy season to get maximum effects.”
Answer: D
Antihistamines are most effective when they are taken prophylactically, and they should be administered on a regular basis throughout the allergy season, even when symptoms are not present. They are less helpful when taken after symptoms appear. Second-generation antihistamines have fewer anticholinergic effects than first-generation antihistamines. First- generation antihistamines are not more effective than second-generation antihistamines. Oral antihistamines are not as effective when given on a PRN basis. (Ch 63 study guide video)
A patient admitted to the hospital has been using phenylephrine nasal spray [Neo- Synephrine], 2 sprays every 4 hours, for a week. The patient complains that the medication is not working, because the nasal congestion has increased. What will the nurse do?
a. Request an order for an oral decongestant to replace the intranasal phenylephrine.
b. Request an order for an intranasal glucocorticoid to be used while the phenylephrine is withdrawn.
c. Tell the patient to increase the dose of phenylephrine to 4 sprays every 4 hours.
d. Tell the patient to stop using the phenylephrine and begin using an intranasal antihistamine.
Answer: B
Rationale: This patient is experiencing rebound congestion, which develops when topical sympathomimetics are used for longer than a few days. Abrupt withdrawal can stop the cycle of rebound congestion but is uncomfortable, so using an intranasal glucocorticoid, beginning 1 week before discontinuing the decongestant, while withdrawing the decongestant, is recommended. An oral decongestant is not recommended. Increasing the dose of the intranasal decongestant will only compound the problem of rebound congestion. Stopping the intranasal decongestant will only increase the congestion; using an intranasal antihistamine will not help with congestion. (Ch 63 and Ch 63 study guide video)
A patient with a cough has been advised to use guaifenesin. The patient asks the nurse to explain the purpose of the drug. The nurse will explain that guaifenesin:
a. dries secretions to help suppress coughing so patients can rest.
b. helps stimulate the flow of secretions to increase cough productivity.
c. helps to relieve chest pain associated with a cough.
d. stimulates the body’s natural immune responses.
Answer: B
Rationale: Expectorants stimulate the flow of respiratory tract secretions to improve cough productivity. Guaifenesin does not dry secretions, because it does not have anticholinergic effects. Guaifenesin does not alleviate pain associated with cough. Guaifenesin does not stimulate immune responses (Ch 63 and Ch 63 study guide video)
A patient asks the nurse what type of medications would be most effective for treating seasonal and perennial rhinitis. Which response by the nurse is correct?
a. Pseudoephedrine [Sudafed]
b. Fluticasone propionate [Fluticasone]
c. Loratadine [Claritin]
d. Intranasal cromolyn sodium [Atrovent]
ANS: B
Intranasal glucocorticoids, such as fluticasone propionate, are the most effective drugs for prevention and treatment, because they prevent or suppress all the major symptoms of allergic rhinitis (congestion, rhinorrhea, sneezing, nasal itching, and erythema). Pseudoephedrine is an oral sympathomimetic used to reduce nasal congestion associated with allergic rhinitis. It has no effect on other symptoms. Loratadine, an oral antihistamine, reduces sneezing, rhinorrhea, and nasal itching only and is less effective than intranasal glucocorticoids. Intranasal cromolyn sodium is moderately effective in the treatment of allergic rhinitis, but the benefits are much less than those of intranasal glucocorticoids. (Ch 63 and Ch 63 study guide video)
7-year-old child has a cough, runny nose, congestion, and fever, and the parents ask the nurse to recommend an over-the-counter product. Which response by the nurse is correct?
a. “Any product will be effective when combined with vitamin C and zinc.”
b. “It is best to use single-agent medications to treat individual symptoms.”
c. “The fever indicates that your child may need an antibiotic; you should call your provider.”
d. “You should ask your provider to prescribe a combination product that will treat multiple symptoms.”
Answer: B
Rationale: Combination medications may provide ingredients that are not needed or may provide ingredients that are either excessive or subtherapeutic. It is best to use single-agent drugs to treat individual symptoms. The efficacy of vitamin C and zinc for treating colds in children has not been established. Fever may accompany viral respiratory infections and not necessarily bacterial infections that need an antibiotic (Ch 63 and Ch 63 study guide video)
Which of the following interacts with Sofosbuvir, decreasing its levels in the body?
A. CYP3A Inducers
B. P-Glycoprotein Inducers (St. John’s Wort)
C. CYP1A2 Inhibitors
D. Grapefruit Juice
Correct Answer: B. P-Glycoprotein Inducers (St. John’s Wort)
Rationale: If administered with P-gp inducers such as St. John’s wort, the level of sofosbuvir may decrease. Chapter 80, Page 735
Which of the following are the principal concerns with Ribavirin administration? Select all that apply.
A. Hemolytic Anemia
B. Fetal Injury
C. Fever
D. Nausea/Vomiting
Correct Answer. A. Hemolytic Anemia & B. Fetal Injury
Rationale: Ribavirin can cause hemolytic anemia that can worse heart disease and lead to myocardial infarction. Ribavirin is both embryolethal and teratogenic. Chapter 80, Page 735
Which of the following is NOT a contraindication for Ribavirin?
A. Pregnancy
B. Blood Disorders
C. Cardiac Disease
D. Diabetes
Correct Answer: D. Diabetes
Rationale: Ribavirin should not be prescribed for pregnant women or women who want to become pregnant. Because ribavirin increases the risk for hemolytic anemia, careful consideration should be given before prescribing the drug for patients with a history of blood disorders or cardiac disease. Chapter 80, Page 735
- Which of the following is the most common side effect from Interferon Alfa in treatment of Hepatitis B?
a. Neuropsychiatric symptoms
b. Bone marrow suppression
c. Thyroid dysfunction
d. Flu – like syndrome
Correct Answer: D. Flu – Like Syndrome
Rationale: Flu like syndrome occurs in 50% of patients receiving Interferon Alfa. It is characterized by fever, fatigue, myalgia, headache, and chills. Chapter 80, Page 737.
- Which of the following should be ruled out before starting treatment with Lamivudine?
a. HAV
b. CMV
c. HSV
d. HIV
Correct Answer. D. HIV
Rationale: Because lamivudine is also used against HIV, if a patient is infected with HIV, giving lamivudine in the low doses employed against HBV may allow emergence of HIV viruses resistant to nucleoside analogs. Accordingly, HIV infections should be ruled out before lamivudine is used. Chapter 80, Page 738.
. Which of the following is the principal concern when receiving treatment with Adefovir?
A. Hypertension
B. Neutropenia
C. Metabolic Alkalosis
D. Nephrotoxicity
Correct Answer: D. Nephrotoxicity
Rationale: Nephrotoxicity is the principal concern with Adefovir. To reduce risk, kidney function should be assessed at baseline and periodically thereafter. Chapter 80, Page 638
Which of the following is true regarding Entecavir?
A. It is used to treat Hepatitis C
B. It is given SubQ
C. It can reverse cirrhosis and fibrosis
D. It is less effective than lamivudine
Correct Answer: C. It can reverse cirrhosis and fibrosis
Rationale: Entecavir is used for oral therapy in treatment of chronic Hepatitis B. It is more effective than lamivudine and long-term use can reverse fibrosis and cirrhosis. Chapter 80, Page 739.
Which of the following influenza vaccines is given by intranasal spray?
A. Inactivated Influenza Vaccine (IIV)
B. Recombinant Hemagglutinin Vaccine (RIV)
C. Live, attenuated Influenza Vaccine (LAIV)
D. All of the above
Correct Answer. C. Live, attenuated Influenza Vaccine (LAIV).
Rationale. IIV and RIV are administered by IM Injection. LAIV is administered by intranasal spray. Chapter 80. Page 740
Which of the following is NOT a potential side effect for the Live Attenuated Influenza Vaccine?
A. Guillain-Barre Syndrome (GBS)
B. Rhinorrhea
C. Lethargy
D. Headache
Correct Answer: A. Guillain – Barre Syndrome (GBS)
Rationale: GBS is a side effect for the Inactivated Influenza Vaccine. The Live Attenuated Influenza Vaccine can cause nasal congestion with rhinorrhea, lethargy, headache, sore throat, and decreased appetite. Chapter 80, Page 740.
Which of the following individuals should NOT be given the flu vaccine?
A. Pregnant Women
B. History of egg allergies
C. Current common cold infection
D. History of severe allergic reaction to influenza vaccine or a vaccine component
Correct Answer. D. History of severe allergic reaction to influenza vaccine or a vaccine component is a contraindication for the flu vaccine. Chapter 80, Page 741.
Histamine is synthesized and stored in (select all that apply)
a. Mast cells
b. Basophils
c. Eosinophils
d. Neutrophils
Correct: A/B
Rationale: Chapter 56 & 63 Study Guide Video, Chapter 56 Pg. 488
Effects of histamine include: (select all that apply)
a. Constriction of smooth muscle
b. Relaxation of smooth muscle
c. Small vessel constriction
d. Small vessel dilation
e. Increased capillary permeability
f. Decreased capillary permeability
g. Hypertension
h. Hypotension
Correct A, D, E, H
Rationale: Chapter 56 & 63 Study Guide Video, Chapter 56 Pg. 488
In the body, levels of histamine are especially high in the
a. Lungs, GI tract, nasal passageways
b. GI tract, lungs, skin
c. Skin, GI tract, arteries/vessels
d. GI tract, lungs, posterior hypothalamus
Correct B - GI tract, lungs, skin
Rationale: Chapter 56 & 63 Study Guide Video, Chapter 56 Pg. 488
The initial requirement for histamine release is production of antibodies of
a. IgA
b. IgE
c. IgM
d. IgG
Correct: B - IgE
Rationale: Chapter 56 & 63 Study Guide Video, Chapter 56 Pg. 488
The stark difference in stimulation of histamine-1 and histamine-2, is that histamine-2 has a role in
a. Vasodilation
b. Bronchoconstriction
c. Seizure suppression
d. Secretion of gastric acid
Correct D - Secretion of gastric acid
Rationale: Chapter 56 & 63 Study Guide Video, Chapter 56 Pg. 488
Antihistamines should be avoided in (select all that apply)
a. Pregnancy
b. Breastfeeding
c. Children
d. Geriatric adults
Correct A, B, D
Rationale: Chapter 56 Pg. 490 Green Box
- Caution should be used in pregnancy, yet should be avoided in third trimester d/t newborn sensitivity to adverse reaction.
- Can be used in small doses with children, yet should be avoided in children under the age of 2 years old.
- Occasional, small doses of antihistamines do not appear to cause sedation in infants, caution should be used in breastfeeding.
- BEERS criteria, avoid.
Annie comes to the PCP office with the complaints of nasal congestion. It would be best to prescribe the patient
a. Astelin
b. Pseudoephedrine
c. Xyzal
d. Clarinex
Correct: B-Pseudoephedrine
Rationale: Ch. 63 Pg. 583-584
• Sympathomimetics (decongestant) is only used for nasal decongestion.
• All other options are for allergic rhinitis.
Mrs. Thomas presents to the PCP office. His chart reveals that he came in a few months ago and was prescribed multiple medications for allergic rhinitis, including Afrin Nasal Spray. He complains today that his nasal congestion is worsening and he is having to increase the need for the Afrin, almost doubling his initial prescribed dose. The possibilities to discontinuing the Afrin include (Select all that apply)
a. Discontinue decongestant abruptly
b. Discontinue the spray in one nostril at a time
c. Prescribe intranasal glucocorticoid for 2-6 weeks before discontinuing
d. Adding antihistamine oral tablet and an intranasal glucocorticoid for 4 weeks, at which time the Afrin is decreased in dosage for another 2 weeks, slowly tapering thereafter.
Correct: A, B, C
Rationale: Chapter 63 Pg. 583
• A, B, C can all be correct. Option A is extremely uncomfortable, but can be done. Option D is not a recommended option.
Ms. Johnson comes to the office as a walk-in patient with complaints of nasal decongestion, headache to the frontal and temporal regions, intermittent sneezing throughout day, but denies fever. Her daily medication regimen includes Losartan, Metoprolol, Atorvastatin, Aspirin, and Metformin. What medication should the PCP avoid prescribing at today’s visit?
a. Allegra
b. Sudafed
c. Loratadine
d. Fexofenadine
Correct: B
Chapter 63 Page 583 Read “Cardiovascular Effects”
To be effective, Phenylephrine must be prescribed as
a. Topical
b. Oral
c. IM
d. Subcu
Correct A - topical
Rationale: Ch. 63 Pg. 584 “Comparison of Phenylephrine and Psuedoephedrine”
What are harmful effects of COX 1 inhibitors? Select all that apply
A. Gastric Erosion
B. Bleeding Tendencies
C. Renal Impairment
D. Platelet Aggregation
Answer: A, B, C
D is incorrect because Cox-1 inhibitors (Aspirin) suppress platelet aggregation pg. 493
What are the benefits of COX 2 inhibitors? Select all that apply.
A. Prevention of M.I/Stroke
B. Alleviate Pain
C. Reduce Fever
D. Promote against colorectal cancer
Answer: B, C, D
COX 2 Inhibitors does not prevent M.I/Stroke, it actually promotes it secondary to vasodilation p. 493
True or false?
Second generation NSAID selective Cox 2 inhibitors are a safer option than first generation Cox 1/Cox 2 inhibitors because they are more selective.
False- In theory, second generation Cox-2 inhibitors can suppress pain and inflammation while (possibly) cause fewer adverse that First generation NSAIDS. However, in reality, Cox 2 inhibitors appear to be even less safe than first generation agents, owning the increase rick of M.I/STROKE P.493
