Immune

Question 1

An infant is prescribed an antibiotic after cardiac surgery. Which instruction would the nurse emphasize to the parents regarding administration of the medication?
A. Give the antibiotic between feedings.
B. Ensure that the antibiotic is administered as prescribed.
C. Shake the bottle thoroughly before giving the antibiotic.
D. Keep the antibiotic in the refrigerator after the bottle has been opened.

Answer 1

B. Ensure that the antibiotic is administered as prescribed.

Ensuring that the antibiotic is administered as prescribed is a priority because inadequate antibiotic therapy may predispose the infant to the development of bacterial endocarditis

Question 2

The nurse in an ambulatory clinic is speaking with the parents of a 2-year-old child diagnosed with acute otitis media. Which information is most important for the nurse to include in the instructions to the parents?
A. The child may be given acetaminophen or ibuprofen drops for pain.
B. The child must complete the entire course of the prescribed antibiotic.
C. The child should return to the clinic to evaluate effectiveness of the treatment.
D. The child may be given a decongestant to relieve pressure on the tympanic

Answer 2

B. The child must complete the entire course of the prescribed antibiotic.

When antibiotics are necessary, it is most important to complete the entire course to prevent antibiotic resistance.

Question 3

The nurse in an urgent care clinic is preparing discharge instructions for the parents of a 15-month-old child with a first episode of otitis media. Which information is the priority to include?
A. Explain that the child should complete the full 10 days of antibiotics
B. Describe the tympanocentesis most likely needed to clear the infection
C. Offer information on recommended immunizations around the child’s second birthday
D. Provide a written handout describing the care of myringotomy tubes

Answer 3

A. Explain that the child should complete the full 10 days of antibiotics

If a client is prescribed antibiotics, the priority is to make sure that they take the full prescription for the prescribed number of days to prevent recurrence or antibiotic resistance.

Question 4

A nurse is assessing a 9-year-old child after several days of treatment for a documented strep throat. Which statement is incorrect and suggests that further teaching is needed?
A. “Sometimes I take my medicine with fruit juice.”
B. “Sometimes I take the pills in the morning and other times at night.”
C. “I am feeling much better than I did last week.”
D. “My mother makes me take my medicine right after school.”

Answer 4

B. “Sometimes I take the pills in the morning and other times at night.”

Strep throat is a bacterial infection that is treated with antibiotics. It is important to take antibiotics on a regular schedule and at approximately the same time each day.

Question 5

Which of the following instructions is most important for the nurse to include when discharging a client with an infection caused by staphylococcus?
A. Schedule follow-up blood cultures
B. Monitor for signs of recurrent infection
C. Visit the provider in a few weeks
D. Complete the full course of the antibiotic

Answer 5

D. Complete the full course of the antibiotic

Not completing the full course of antibiotics can lead to antibiotic resistant infections

Question 6

A client with burns develops a wound infection. The nurse plans to teach the client that simple local wound infections are primarily treated with which antibiotic formulation?
A. Oral
B. Topical
C. Intravenous
D. Intramuscular

Answer 6

B. Topical

Topical antibiotics are applied directly to the wound and are effective against many gram-positive and gram-negative organisms found on the skin.

Question 7

A client being discharged home is prescribed an antibiotic with a dosage three times higher than it was administered when the client was in the hospital (IV route). Which route of administration should the nurse anticipate will be prescribed for the greatest first-pass effect?
A. Oral.
B. Sublingual.
C. Intravenous.
D. Subcutaneous.

Answer 7

A. Oral.

The first-pass effect is a pharmacokinetic phenomenon that is related to the drug’s metabolism in the liver. After oral medications are absorbed from the gastrointestinal tract, the drug is carried directly to the liver via the hepatic portal circulation, where hepatic inactivation occurs and reduces the bioavailability (strength/concentration) of the drug.

Question 8

A nurse is preparing to administer ampicillin and gentamicin sulfate via IV infusion. Which of the following resources should the nurse consult first regarding medication compatibility?

A. Nurse manager

B. Hospital pharmacist

C. Health care provider

D. Medication sales representative

Answer 8

B. Hospital pharmacist

The greatest risk to the client is injury form medication error; therefore, the nurse should consult the hospital pharmacist first.

Question 9

Which action will the nurse take after stopping the antibiotic infusion of a client who becomes restless and flushed, and begins to wheeze during the administration of an antibiotic?
A. Check the client’s temperature.
B. Take the client’s blood pressure.
C. Obtain the client’s pulse oximetry.
D. Assess the client’s respiratory status.

Answer 9

D. Assess the client’s respiratory status.

The client is experiencing an allergic reaction that may progress to anaphylaxis. Anaphylactic shock can lead to respiratory distress as a result of laryngeal edema or severe bronchospasm. Assessing and maintaining the client’s airway is the priority

Question 10

The nurse is preparing to administer an intravenous piggyback antibiotic that has been newly prescribed. Shortly after initiation, the client becomes restless and flushed and begins to wheeze. After stopping the infusion, which priority action will the nurse take?
A. Notify the primary health care provider immediately about the client’s condition.
B. Take the client’s blood pressure.
C. Obtain the client’s pulse oximetry.
D. Assess the client’s respiratory status

Question 11

The nurse is preparing to administer an intravenous piggyback antibiotic that has been newly prescribed. Shortly after initiation, the client becomes restless and flushed and begins to wheeze. After stopping the infusion, which priority action will the nurse take?
A. Notify the primary health care provider immediately about the client’s condition.
B. Take the client’s blood pressure.
C. Obtain the client’s pulse oximetry.
D. Assess the client’s respiratory status.

Answer 11

D. Assess the client’s respiratory status.

The client is experiencing an allergic reaction. Severe allergic reactions commonly cause respiratory distress as a result of laryngeal edema or severe bronchospasm. Assessing and maintaining the client’s airway is the priority.

Question 12

The nurse is assessing a client who is receiving antibiotic therapy for an infection. Which finding should indicate to the nurse that the client may be experiencing an allergic reaction to a medication?
A. Xerostomia
B. Hypertension
C. Pruritus
D. Lymphadenopathy

Answer 12

C. Pruritus

If the client experiences pruritus, the nurse should be concerned about the possibility of an allergic reaction.

Question 13

Which issue related to antibiotic use is an increased risk for the older adult?
A. Allergy
B. Toxicity
C. Resistance
D. Superinfection

Answer 13

B. Toxicity

The older adult is at increased risk for toxicity related to antibiotic use because of reduced metabolism and excretion of medications

Question 14

Which explanation would the nurse include when teaching a client scheduled for a bowel resection about the purpose of preoperative antibiotics?
A. “They prevent incisional infection.”
B. “Antibiotics prevent postoperative pneumonia.”
C. “These medications limit the risk of a urinary tract infection.”
D. “They are given to eliminate bacteria from the gastrointestinal (GI) tract.”

Answer 14

D. “They are given to eliminate bacteria from the gastrointestinal (GI) tract.”

The GI tract contains numerous bacteria; antibiotics are given to decrease the number of microorganisms in the bowel before surgery.

Question 15

A client with advanced cancer of the bladder is scheduled for a cystectomy and ileal conduit. Which intervention would the nurse anticipate the health care provider will prescribe to prepare the client for surgery?
A. Intravesical chemotherapy
B. Instillation of a urinary antiseptic
C. Administration of an antibiotic
D. Placement of an indwelling catheter

Answer 15

C. Administration of an antibiotic

Intestinal antibiotics and a complete cleansing of the bowel with enemas until returns are clear are necessary to reduce the possibility of fecal contamination when the bowel is resected to construct the ileal conduit.

Question 16

The nurse is caring for a client with sepsis receiving broad-spectrum antibiotics. Which finding might indicate to the nurse the need for a dosage adjustment?
A. Elevated creatinine level
B. Elevated heart rate
C. Decreased white blood cell count
D. Decreased platelet count

Answer 16

A. Elevated creatinine level

Septic shock is the most common type of distributive shock that threatens multi-system organ failure with a rapid onset, which is the leading cause of death in noncoronary ICU patients. Gram-negative bacteria have been the most implicated organism, and broad-spectrum antibiotics are given to help increase the likelihood of increasing tissue perfusion. The majority of broad-spectrum antibiotics are excreted through the kidneys, and an elevated creatine level will indicate the need for dosage adjustments. Elevated lactic acid levels, heart rate, and white blood cell (WBC) levels are all signs of sepsis and need to be monitored closely.

Question 17

Trimethoprim/sulfamethoxazole is prescribed for a child with a urinary tract infection. Which statement by the parent indicates the nurse’s instructions about administration have been understood?
A. ‘Mealtime is a good time to give the medication.’
B. ‘I’ll make sure to give each pill with 6 to 8 oz of fluid.’
C. ‘It must be taken with orange juice to ensure acidity of urine.’
D. ‘The medication has to be taken every 4 hours to maintain a blood level.’

Answer 17

B. ‘I’ll make sure to give each pill with 6 to 8 oz of fluid.’

This is a sulfa medication; water must be encouraged to prevent urine crystallization in the kidneys

Question 18

Trimethoprim-sulfamethoxazole is prescribed for a client with cystitis. Which instruction would the nurse include when providing medication teaching?
A. ‘Drink eight to ten glasses of water daily.’
B. ‘Take this medication with orange juice.’
C. ‘Take the medication with meals.’
D. ‘Take the medication until symptoms subside.’

Answer 18

A. ‘Drink eight to ten glasses of water daily.’

A urinary output of at least 1500 mL daily should be maintained to prevent crystalluria (crystals in the urine)

Question 19

Trimethoprim-sulfamethoxazole is prescribed for a client with cystitis. Which instruction would the nurse include when providing medication teaching?
A. ‘Drink eight to ten glasses of water daily.’
B. ‘Take this medication with orange juice.’
C. ‘Take the medication with meals.’
D. ‘Take the medication until symptoms subside.’

Answer 19

A. ‘Drink eight to ten glasses of water daily.’

A urinary output of at least 1500 mL daily should be maintained to prevent crystalluria (crystals in the urine).

Question 20

A client is prescribed trimethoprim/sulfamethoxazole for recurrent urinary tract infections. Which statement by the nurse about this medication is correct?
A. “You can stop the medication after five days.”
B. “Be sure to take the medication with food.”
C. “It is safe to take with oral contraceptives.”
D. “Drink at least eight glasses of water a day.”

Answer 20

D. “Drink at least eight glasses of water a day.”

Trimethoprim/sulfamethoxazole is a highly insoluble medication and should be taken with a large volume of fluid.

Question 21

A client is prescribed trimethoprim/sulfamethoxazole for recurrent urinary tract infections. Which information should the nurse include during client teaching?
A. “A harmless skin rash may appear.”
B. “Drink at least eight large glasses of water a day.”
C. “Be sure to take the medication with food.”
D. “Stop the medication when your symptoms disappear.”

Answer 21

B. “Drink at least eight large glasses of water a day.

Trimethoprim/sulfamethoxazole (Bactrim) is a highly insoluble drug that can cause crystalluria and clients should drink plenty of fluids while taking this medication to lower the risk of developing kidney stones

Question 22

A sulfonamide preparation is prescribed for a child with a urinary tract infection. Which nursing responsibility is a priority when administering this medication?
A. Weighing the child daily
B. Giving the medication with milk
C. Taking the child’s temperature frequently
D. Administering the medication at the prescribed time

Answer 22

D. Administering the medication at the prescribed time

For the desired blood level to be maintained, the medication must be administered in the exact amount at the times directed.

Question 23

After teaching a client about sulfonamide use for a urinary tract infection, which client statement would the nurse review for correction?
A. ‘I will avoid the sunlight.’
B. ‘I will increase my fluid intake.’
C. ‘I will let my doctor know if I develop a rash.’
D. ‘I will stop taking the medication when my symptoms subside.’

Answer 23

D. ‘I will stop taking the medication when my symptoms subside.’

The nurse instructs the client to complete the entire course of treatment, not stop when symptoms subside.

Question 24

The nurse is teaching a client with diabetes about newly prescribed trimethoprim and sulfamethoxazole (TMP-SMX) to treat a urinary tract infection. Which statement by the client indicates understanding?
A. I will stop taking this medication if I develop a rash.”
B. This antibiotic will kill mature bacteria in my urinary tract.”
C. I should avoid dairy products when taking this medication.”
D. “My blood sugar will not be affected by this medication.”

Answer 24

A. I will stop taking this medication if I develop a rash.

TMP-SMX is the most common
cause of erythema multiforme. Sulfonamides are also often implicated in cases of both
toxic epidermal necrosis and Stevens-Johnson syndrome, which can be fatal

Question 25

The nurse is preparing to administer trimethoprim and sulfamethoxazole (TMP-SMX) to a client. When assessing client allergies, the client reports that they are allergic to glipizide. What action by the nurse is most appropriate? A. Prepare to administer the medication B. Report the allergies to the healthcare provider C. Review the health record to see if the client is on glipizide D. Assess the client blood sugar

Answer 25

B. Report the allergies to the healthcare provider ## Footnote While administering a sulfonamide with a sulfonylurea may increase the risk of a hypoglycemic reaction, the real concern is the potential allergy to TMP-SMX.

Question 26

A nurse is assessing a client who is taking oxacillin to treat an infection. The nurse should recognize which of the following findings is a manifestation of an allergic reaction? A. Pruritus (itching) B. Diarrhea C. Dark urine D. Fever

Answer 26

A. Pruritus (itching) ## Footnote An allergic reaction is an immune response that can manifest as pruritus and urticaria and can progress to anaphylaxis.

Question 27

A nurse is caring for a client who has streptococcal pneumonia and a prescription for penicillin G by intermittent IV bolus. 10 minutes into the infusion of the third dose, the client reports that the IV site itches and that he feels dizzy and short of breath. Which of the following actions should the nurse take first? A. Stop the infusion. B. Call the client's provider. C. Elevate the head of the bed. D. Auscultate the client's breath sounds.

Answer 27

A. Stop the infusion. ## Footnote When using the airway, breathing, circulation approach to client care, the nurse should place the priority on stopping the infusion. The client is exhibiting signs of penicillin anaphylaxis and the first action that should be taken is to withdraw the medication.

Question 28

A nurse is teaching a client who has a new prescription for amoxicillin-clavulanate to treat pharyngitis. Which of the following statements by the client indicates an understanding of the teaching? A. "I will take this medication until my sore throat goes away." B. "I should take this medication on an empty stomach between meals." C. "I will stop taking this medication if I develop itching." D. "I will double my dose, if I miss one."

Answer 28

C. "I will stop taking this medication if I develop itching." ## Footnote Penicillin-derived medications are a common cause of medication allergic reactions. Manifestations of allergic reactions include rashes, hives, itchy and watery eyes, and swollen lips, tongue, or face. Anaphylactic reactions can develop within 1 hr of taking the dose, and include difficulty breathing, shortness of breath, stridor, and angioedema. The client should discontinue the medication and notify the provider if these manifestations occur. The client should not double a dose and take this medication as prescribed to reduce the risk for adverse effects.

Question 29

When a female client with a new infant is prescribed amoxicillin for a urinary tract infection, which instruction would the nurse include when teaching about the use of this medication? A. 'Take this medication on an empty stomach.' B. 'Report signs of allergic reaction such as skin rash or itching.' C. 'Stop taking the medication as soon as you void without burning.' D. 'Breast-feeding should stop until you have finished with this medication.'

Answer 29

B. 'Report signs of allergic reaction such as skin rash or itching.' ## Footnote Penicillin class medications have a high incidence of allergic reaction, so the client should monitor for allergy and report symptoms of an allergic reaction.

Question 30

A client is prescribed ampicillin sodium (Omnipen) for a sinus infection. The nurse should instruct the client to notify the healthcare provider immediately if which symptom occurs? A. Rash. B. Nausea. C. Headache. D. Dizziness.

Answer 30

A. Rash. ## Footnote Rash is the most common adverse effect of all penicillins, indicating an allergy to the medication that could result in anaphylactic shock, a medical emergency.

Question 31

The nurse is monitoring a client who received a first dose of intravenous ampicillin. Which finding should indicate to the nurse that the client may be experiencing an allergic reaction? A. Abdominal pain B. Increase in blood pressure C. Hypotensive bowel sounds D. Hives on the extremities

Answer 31

D. Hives on the extremities ## Footnote If the client experiences an allergic reaction to medications they may display systemic signs such as hives, pruritus, dyspnea, etc. Abdominal pain, hypertension, and hyperactive bowel sounds do not indicate an allergic reaction.

Question 32

A nurse is administering an intravenous piggyback infusion of penicillin. Which client statement would require the nurse's immediate attention? A. "I am itching all over." B. "I have soreness and aching in my muscles." C. "I have cramping in my stomach." D. "I have a burning sensation when I urinate."

Answer 32

A. "I am itching all over." ## Footnote Allergic reactions to medications can include itching all over. This can be further supported by the presence of hives or welts.

Question 33

A nurse is collecting data on a client who has a new prescription for ampicillin. The nurse should recognize which of the following findings is a priority? A. Nausea B. Vomiting C. Wheezing D. Moniliasis

Answer 33

C. Wheezing ## Footnote When using the airway, breathing, circulation approach to client care, the nurse should determine the priority finding is wheezing. Wheezing is a manifestation of an anaphylactic allergic reaction due to bronchospasm and edema in the airway. Wheezing indicates a constriction of the airway and requires immediate intervention to support respiratory function.

Question 34

Which information would the nurse include in the teaching plan on ampicillin? A. 'Take the ampicillin with meals.' B. 'Store the ampicillin in a light-resistant container.' C. 'Notify the health care provider if diarrhea develops.' D. 'Continue the medication until a negative culture is obtained.'

Answer 34

C. 'Notify the health care provider if diarrhea develops.' ## Footnote Diarrhea is a possible side effect that can be related to superinfection or to the destruction of bacterial flora in the intestine; it can lead to fluid and electrolyte imbalance.

Question 35

A client has an anaphylactic reaction after receiving intravenous penicillin. Which would the nurse conclude is the cause of this reaction? A. An acquired atopic sensitization occurred. B. There was passive immunity to the penicillin allergen. C. Antibodies to penicillin developed after a previous exposure. D. Genes encoded for allergies cause a reaction on an initial penicillin exposure.

Answer 35

C. Antibodies to penicillin developed after a previous exposure. ## Footnote Hypersensitivity results from the production of antibodies in response to exposure to certain foreign substances (allergens).

Question 36

A nurse working on a medical unit is completing the admission of a client who reports a severe allergy to penicillin. Which of the following actions should the nurse take? A. Have the client purchase a medication alert bracelet to wear in the hospital. B. Notify dietary services to adjust the client’s diet. C. Remove all objects that contain latex from the client’s room. D. Verify the client’s medication prescriptions do not include cephalosporin.

Answer 36

D. Verify the client’s medication prescriptions do not include cephalosporin. ## Footnote The nurse should verify that the client’s prescriptions do not include a cephalosporin. This medication should not be prescribed to a client who has a known severe allergy to penicillin, as its structure is very similar to that of penicillin, and clients who have allergies to penicillin often have similar reactions to cephalosporins.

Question 37

A nurse is preparing to administer cephalexin oral suspension to an older adult client who has difficulty swallowing pills. Which of the following actions should the nurse take? A. Check the client for a penicillin allergy. B. Monitor the client for constipation. C. Store the medication at room temperature. D. Avoid shaking the medication before administering

Answer 37

A. Check the client for a penicillin allergy. ## Footnote The nurse should check the client for a penicillin allergy because cephalexin is a beta-lactam antibiotic that is similar in actions and structure to penicillin.

Question 38

A nurse is caring for a child who is allergic to penicillin. The nurse should verify which of the following prescriptions with the provider? A. Amoxicillin-clavulanate B. Gentamicin C. Erythromycin D. Amphotericin B

Answer 38

A. Amoxicillin-clavulanate ## Footnote Penicillin is the most common medication allergy. Clients who are allergic to one penicillin medication should be considered allergic to all penicillins, which would include amoxicillin-clavulanate.

Question 39

While taking a medical history, the client states, "I am allergic to penicillin." What related allergy to another type of antiinfective agent should the nurse ask the client about when taking the nursing history? A. Aminoglycosides. B. Cephalosporins. C. Sulfonamides. D. Tetracyclines.

Answer 39

B. Cephalosporins. ## Footnote According to research, there appears to be a cross sensitivity between penicillins and first generation cephalosporins; however, research shows there is no evidence of cross sensitivity between PCN and third or fourth generation cephalosporins.

Question 40

The nurse is preparing to administer ceftriaxone to a client. Which of the following findings from the client’s medical record should cause the nurse to question this prescription? A. White blood cells in the urine B. History of hypertension C. Allergy to cephalexin D. Current tobacco smoker

Answer 40

C. Allergy to cephalexin ## Footnote Ceftriaxone and cephalexin are both cephalosporins; therefore, an allergy to cephalexin should cause the nurse to question any prescription for a cephalosporin.

Question 41

Which therapy is indicated for a client admitted to the hospital after general paresis develops as a complication of syphilis? A. Penicillin therapy B. Major tranquilizers C. Behavior modification D. Electroconvulsive therapy

Answer 41

A. Penicillin therapy ## Footnote Massive doses of penicillin may limit central nervous system damage if treatment is started before neural deterioration from syphilis occurs.

Question 42

Which medication is considered first-line therapy for an infant with congenital syphilis? A. Vidarabine B. Pyrimethamine C. Intravenous (IV) penicillin D. Trimethoprim-sulfamethoxazole

Answer 42

C. Intravenous (IV) penicillin ## Footnote IV penicillin destroys the cell wall of Treponema pallidum, the causative organism of syphilis.

Question 43

At 6 weeks’ gestation a client is found to have gonorrhea. For which medication would the nurse anticipate preparing a teaching plan? A. Ceftriaxone B. Levofloxacin C. Sulfasalazine D. Trimethoprim/sulfamethoxazole

Answer 43

A. Ceftriaxone ## Footnote Ceftriaxone, a broad-spectrum antibiotic, is preferred during pregnancy.

Question 44

At 6 weeks’ gestation a client is found to have gonorrhea. For which medication would the nurse anticipate preparing a teaching plan? A. Ceftriaxone B. Levofloxacin C. Sulfasalazine D. Trimethoprim/sulfamethoxazole

Answer 44

A. Ceftriaxone ## Footnote Ceftriaxone, a broad-spectrum antibiotic, is preferred during pregnancy.

Question 45

Which fact about ceftriaxone medication therapy will the nurse emphasize when teaching a client diagnosed with gonorrhea? A. Cures the infection B. Prevents complications C. Controls its transmission D. Reverses pathologic changes

Answer 45

A. Cures the infection ## Footnote Ceftriaxone, followed by doxycycline, is specific for Neisseria gonorrhoeae and eradicates the microorganism; other treatment regimens are available for resistant strains.

Question 46

Which statement by a client prescribed ampicillin indicates that teaching by the nurse was effective? A. "I will miss eating grapefruit." B. "I must increase my fluid intake." C. "I can stop taking this medication any time." D. "I should take this medication just after eating."

Answer 46

B. "I must increase my fluid intake." ## Footnote The client should increase fluid intake when taking ampicillin to prevent nephrotoxicity; side effects include oliguria, hematuria, proteinuria, and glomerulonephritis.

Question 47

The nurse is preparing a client for discharge from the emergency department. Which client statement provides evidence that the client understands medication teaching for high-dose ampicillin? A. 'I should take this medication with meals.' B. 'This medicine may cause constipation.' C. 'I must avoid dairy products while taking this medicine.' D. 'I must increase my intake of fluids while taking this medication.'

Answer 47

D. 'I must increase my intake of fluids while taking this medication.' ## Footnote Because penicillin in high doses is nephrotoxic, keeping hydrated maintains adequate renal perfusion for medication excretion.

Question 48

Which statement by a client prescribed ampicillin 250 mg by mouth every 6 hours indicates to the nurse that teaching has been effective? A. "I should drink a glass of milk with each pill." B. "I should drink at least six glasses of water every day." C. "The medicine should be taken with meals and at bedtime." D. "The medicine should be taken 1 hour before or 2 hours after meals."

Answer 48

D. "The medicine should be taken 1 hour before or 2 hours after meals." ## Footnote Ampicillin is a form of penicillin that should be given on an empty stomach; food delays absorption.

Question 49

The nurse provides teaching about ampicillin. Which client statement indicates that additional teaching is needed? A. 'I should take this on an empty stomach with a full glass of water.' B. 'This medicine will work best if I space the time out evenly.' C. 'I can stop this medication after I am symptom-free for 48 hours.' D. 'If I get worse, I will notify my primary health care provider.'

Answer 49

C. 'I can stop this medication after I am symptom-free for 48 hours.' ## Footnote It is most important for the client to complete the full antibiotic prescription to prevent the development of antibiotic-resistant bacteria.

Question 50

Which rationale will the nurse give for the need to take penicillin G and probenecid for syphilis? A. "Each medication attacks the organism during different stages of cell multiplication." B. "The penicillin treats the syphilis, and the probenecid relieves the severe urethritis." C. "Probenecid delays excretion of penicillin, thus maintaining blood levels for longer periods." D. "Probenecid decreases the potential for an allergic reaction to penicillin, which treats the syphilis."

Answer 50

C. "Probenecid delays excretion of penicillin, thus maintaining blood levels for longer periods." ## Footnote Probenecid results in better use of penicillin by delaying the excretion of penicillin through the kidneys.

Question 51

A nurse receives a prescription to administer intravenous cefepime to a client with a bacterial infection. The client has a history of lung cancer and is on a continuous cisplatin infusion. How will the nurse administer the prescribed medication? A. Piggyback the cefepime onto the cisplatin infusion B. Wait for the cisplatin infusion to finish before administering cefepime C. Infuse the cefepime via IV push at the proximal port D. Initiate a new intravenous line for the cefepime infusion

Answer 51

D. Initiate a new intravenous line for the cefepime infusion ## Footnote Cefepime and cisplatin are not compatible and should not be mixed. The nurse should initiate a new intravenous line for the administration of cefepime.

Question 52

A nurse is teaching a client who has a new prescription for erythromycin. Which of the following information should the nurse include? A. "Take this medication with a glass of grapefruit juice." B. "Expect your skin to turn yellow." C. "Monitor for ringing in your ears." D. "Increase fiber intake to prevent constipation."

Answer 52

C. "Monitor for ringing in your ears." ## Footnote Ototoxicity is an adverse effect of erythromycin. The client should monitor and report manifestations of ototoxicity, such as tinnitus, dizziness, and vertigo.

Question 53

The nurse is caring for a client with osteomyelitis who is receiving IV infusion of prescribed vancomycin. Which statement by the client would be a priority for the nurse to report to the healthcare provider? A. I fell some burning at the catheter site B. I feel a little nauseous C. I have a ringing in my ears D. I have a headache

Answer 53

C. I have a ringing in my ears ## Footnote The nurse who is caring for a client with osteomyelitis who is receiving IV infusion of vancomycin should assess the client for toxicity. The client who reports ringing in the ear could be experiencing ototoxicity, which is an adverse effect of vancomycin and should be reported to the healthcare provider.

Question 54

Use of which medication would the nurse identify as a potential risk for hearing impairment in a child? A. Amoxicillin B. Gentamicin C. Penicillin D. Ciprofloxacin

Answer 54

B. Gentamicin ## Footnote Gentamicin can be ototoxic because of its effects on the eighth cranial nerve.

Question 55

A client with pulmonary tuberculosis develops tinnitus and vertigo. Which antitubercular medication would the nurse suspect is causing these symptoms? A. Isoniazid B. Rifampin C. Streptomycin D. Ethambutol

Answer 55

C. Streptomycin ## Footnote Streptomycin is ototoxic and can cause damage to the eighth cranial nerve, resulting in deafness.

Question 56

A client with a history of tuberculosis reports difficulty hearing. Which medication would the nurse consider is causing this response? A. Streptomycin B. Pyrazinamide C. Isoniazid D. Ethambutol

Answer 56

A. Streptomycin ## Footnote Ototoxicity is an adverse effect of aminoglycosides such as streptomycin. Ototoxicity is not an adverse effect of pyrazinamide, isoniazid, or ethambutol.

Question 57

A client receiving intravenous vancomycin reports ringing in both ears. Which initial action would the nurse take? A. Notify the primary health care provider. B. Consult an audiologist. C. Stop the infusion. D. Document the finding and continue to monitor the client.

Answer 57

C. Stop the infusion.

Question 58

After receiving streptomycin sulfate for 2 weeks as part of the medical regimen for tuberculosis, the client reports feeling dizzy and having some hearing loss. Which part of the body is the medication affecting? A. Pyramidal tracts B. Cerebellar tissue C. Peripheral motor end plates D. Eighth cranial nerve’s vestibular branch

Answer 58

D. Eighth cranial nerve’s vestibular branch ## Footnote Streptomycin sulfate is ototoxic and may cause damage to auditory and vestibular portions of the eighth cranial nerve

Question 59

A nurse is assessing a client after administering IV vancomycin. Which of the following findings is the nurse's immediate priority to report to the provider (best answer)? A. Localized redness at the catheter insertion site B. Client report of a headache C. Client report of tinnitus D. Audible inspiratory stridor/difficulty breathing

Answer 59

D. Audible inspiratory stridor/difficulty breathing ## Footnote When using the airway, breathing, circulation approach to client care the nurse determines the priority finding is inspiratory strider. The client is at risk for bronchospasms, hypotension and circulatory collapse due to anaphylaxis.

Question 60

The nurse is caring for a client who is prescribed erythromycin 500 mg orally every six hours for the treatment of pneumonia. The nurse should monitor the client for which common side effect? A. Esophagitis B. Tendon rupture C. Orange-red discoloration of urine D. Nausea and vomiting

Answer 60

D. Nausea and vomiting ## Footnote Erythromycin is a macrolide anti-infective medication used that interferes with protein synthesis in susceptible bacteria. Nausea, vomiting and gastrointestinal (GI) upset are common with erythromycin. The other side effects are not commonly seen with this drug.

Question 61

A nurse is assessing a client who is receiving IV vancomycin. The nurse notes a flushing of the neck and tachycardia. Which of the following actions should the nurse take? A. Document that the client experienced an anaphylactic reaction to the medication. B. Change the IV infusion site. C. Decrease the infusion rate on the IV. D. Apply cold compresses to the neck area

Answer 61

C. Decrease the infusion rate on the IV. ## Footnote This client is experiencing Red man syndrome, which includes a flushing of the neck, face, upper body, arms and back along with tachycardia, hypotension and urticaria. This can lead to an anaphylactic reaction if the IV infusion rate is not slowed down to run greater than 1 hour. The nurse should document that this client is experiencing Red man syndrome, but this is not anaphylaxis.

Question 62

Which action would the nurse take to avoid red man syndrome when preparing to administer a vancomycin infusion? A. Infuse slowly. B. Change the intravenous (IV) site. C. Reduce the dosage. D. Administer vitamin K

Answer 62

A. Infuse slowly. ## Footnote Vancomycin should be infused slowly to avoid the occurrence of the reaction known as 'red man syndrome.' Changing the IV site reduces the incidence of thrombophlebitis.

Question 63

Which action would the nurse take when a client develops a maculopapular rash on the upper extremities and audible wheezing during the admistinration of intravenous vancomycin? A. Stop the infusion. B. Decrease the flow rate. C. Reassess in 15 minutes. D. Notify the health care provider

Answer 63

A. Stop the infusion. ## Footnote The first action the nurse would take is to stop the infusion immediately. The client may be experiencing an allergic reaction. Decreasing the flow rate is not an appropriate action. Infusions must be stopped if an allergic reaction is suspected. This could be an emergent situation, so reassessing in 15 minutes is not the most appropriate action. The nurse would stop the medication infusion and then notify the health care provider.

Question 64

The nurse teaches an adolescent about the side effects of azithromycin. The nurse determines the teaching has been understood when the adolescent identifies which problem as the most common side effect of this medication? A. Tinnitus B. Diarrhea C. Dizziness D. Headache

Answer 64

B. Diarrhea ## Footnote Diarrhea initially is related to gastrointestinal irritation; later it is related to loss of intestinal flora, which may lead to overgrowth of drug-resistant microbes, resulting in superinfection. This also causes diarrhea. Tinnitus, dizziness (vertigo), and headache all may occur, but none is the most common side effect.

Question 65

The home health nurse is teaching a female client about self-administering vancomycin. Which statement by the client demonstrates understanding of the teaching? A. I need to call my provider if my urine changes B. Muscle tingling and weakness is an expected side effect of this medication C. Ringing in the ears is common when taking vancomycin D. I should avoid eating food with active cultures in it

Answer 65

A. I need to call my provider if my urine changes ## Footnote Vancomycin is commonly linked to nephrotoxicity, leading to the need for monitoring trough levels. Signs of kidney injury include decreased urination, blood in the urine, and other changes in urine color and clarity.

Question 66

The nurse is preparing to administer the next dose of prescribed vancomycin to the client being treated for sepsis. Which of the following laboratory results would be the priority for the nurse to review? A. Peak serum drug level B. Serum potassium level C. Serum creatinine level D. White blood cell count

Answer 66

C. Serum creatinine level ## Footnote Vancomycin can lead to interstitial nephritis and therefore, serum creatinine should be monitored. Prior to a dose, a trough level would be drawn to help assess minimum inhibitory concentration;

Question 67

A hospitalized infant is receiving gentamicin. While monitoring for drug toxicity, the nurse should focus on which laboratory result? A. Platelet counts B. Serum creatinine C. Thyroxin levels D. Growth hormone levels

Answer 67

B. Serum creatinine ## Footnote Toxicity to the aminoglycoside antibiotic gentamicin is seen in increased BUN and serum creatinine levels.

Question 68

The nurse receives an order to administer intravenous gentamicin to a client. For which finding should the nurse contact the health care provider to clarify the order? A. Low serum albumin B. Low serum blood urea nitrogen C. High gastric pH D. High serum creatinine

Answer 68

D. High serum creatinine ## Footnote Gentamicin is an aminoglycoside antibiotic that is excreted primarily by the kidneys. If there is reduced renal function as evidenced by the elevated serum creatinine level, the client is at greater risk for drug toxicity and further renal damage.

Question 69

The nurse receives an order to administer intravenous gentamicin to a client. For which finding should the nurse contact the health care provider to clarify the order? A. Low serum albumin B. Low serum blood urea nitrogen C. High gastric pH D. High serum creatinine

Answer 69

D. High serum creatinine ## Footnote Gentamicin is an aminoglycoside antibiotic that is excreted primarily by the kidneys. If there is reduced renal function as evidenced by the elevated serum creatinine level, the client is at greater risk for drug toxicity and further renal damage.

Question 70

A client with an infection is receiving vancomycin. Which laboratory blood test result would the nurse report? A. Hematocrit: 45% B. Calcium: 9.0 mg/dL (2.25 mmol/L) C. White blood cells (WBC): 10,000 mm 3 (10 × 10 9/L) D. High Blood urea nitrogen (BUN): 30 mg/dL (10.2 mmol/L)

Answer 70

D. High Blood urea nitrogen (BUN): 30 mg/dL (10.2 mmol/L) ## Footnote Vancomycin is a nephrotoxic medication. An elevated BUN can be an early sign of toxicity. The BUN of a healthy adult is 10 to 20 mg/dL (3.6–7.1 mmol/L).

Question 71

A nurse is caring for a client who has a bacterial infection and is receiving gentamicin. Which of the following actions should the nurse take to minimize the risk of an adverse effect of the medication? A. Limit the client's fluid intake. B. Instruct the client to report agitation. C. Monitor the serum medication levels. D. Administer the medicine with food.

Answer 71

C. Monitor the serum medication levels. ## Footnote A disadvantage of gentamicin, an aminoglycoside, is the association with nephrotoxicity and ototoxicity, both of which are a result of elevated trough levels. Monitoring the serum medication levels is an important action to minimize the risk of an adverse effect of gentamicin.

Question 72

A nurse is caring for a client who has an infection and a prescription for gentamicin intermittent IV bolus every 8 hr. A peak and trough is required with the next dose. Which of the following actions should the nurse take to obtain an accurate gentamicin serum level? A. Draw a trough level at 0900 and a peak level at 2100. B. Draw a peak level 90 min prior to administering the medication and a trough level 90 min after the dose. C. Draw a trough level immediately prior to administering the medication and a peak level 30 min after the dose. D. Draw a peak level at 0900 and a trough level at 2100.

Answer 72

C. Draw a trough level immediately prior to administering the medication and a peak level 30 min after the dose. ## Footnote For divided doses, correct timing for the trough is just before administering the next dose. The peak is the highest serum level of the medication; if this level is too low, then the medication will not be effective. Correct timing for the peak is between 30 and 60 min after the dose has finished infusing.

Question 73

The nurse is caring for a client who is receiving intermittent intravenous piggyback (IVPG) doses of vancomycin every 12 hours. The primary health care provider prescribes trough levels of the antibiotic. The nurse schedules the blood sample to be obtained at which time? A. Just before the medication is administered B. Between 30 and 60 minutes after the infusion is completed C. Six hours after the dose is completely infused D. In the morning before the client eats breakfast

Answer 73

A. Just before the medication is administered ## Footnote Trough levels are measured in relation to the time a medication is administered. The trough level for a medication is drawn just before a medication is given, when the medication’s level is at its lowest

Question 74

A peak and trough level is prescribed for a client receiving antibiotic therapy. When should the nurse should obtain the trough level? A. Sixty minutes after the antibiotic dose is administered. B. Immediately before the next antibiotic dose is given. C. Upon completion of the prescribed antibiotic regime. D. An hour before the next antibiotic dose is given.

Answer 74

B. Immediately before the next antibiotic dose is given. ## Footnote Trough levels are drawn when the blood level is at its lowest, which is typically just before the next dose is given.

Question 75

The nurse is caring for a client who has been prescribed vancomycin intravenous infusion for the treatment of methicillin-resistant staphylococcus aureus. Which of the following laboratory values should be immediately reported to the healthcare provider? A. Vancomycin trough of 15 mcg/dl (normal less than 10 mcg/dl) B. Blood urea nitrogen level of 18 mg/dl (normal 6-24 mg/dl) C. Creatinine level of 1.1 mg d/l (normal 0.5 – 1.3 mg/dl) D. White blood cell count of 11,500 per microliter ( normal 4,500 – 11,000 per microliter)

Answer 75

A. Vancomycin trough of 15 mcg/dl (normal less than 10 mcg/dl) ## Footnote Vancomycin has a low therapeutic index, with nephrotoxicity and ototoxicity complicating therapy if toxicity develops. In contrast, underdosing (less than the minimum inhibitory concentration) can lead to treatment failure. Nephrotoxicity is associated with a trough level above 10 mcg/dl.

Question 76

The health care provider prescribes peak and trough levels after initiation of intravenous antibiotic therapy. The client asks why these blood tests are necessary. Which reason would the nurse provide? A. 'They determine if the dosage of the medication is adequate.' B. 'They detect if you are having an allergic reaction to the medication.' C. 'The tests permit blood culture specimens to be obtained when the medication is at its lowest level.' D. 'These allow comparison of your fever to changes in the antibiotic level.'

Answer 76

A. 'They determine if the dosage of the medication is adequate.' ## Footnote Medication dose and frequency are adjusted according to peak and trough levels to enhance efficacy by maintaining therapeutic levels.

Question 77

When would the nurse have the laboratory obtain a blood sample to determine the peak level of an antibiotic administered by intravenous piggyback (IVPB)? A. Halfway between two doses of the medication B. Between 30 and 60 minutes after a dose C. Immediately before the medication is administered D. Anytime it is convenient for the client and the laboratory

Answer 77

B. Between 30 and 60 minutes after a dose ## Footnote Because the medication was administered by IV, the blood level of the medication will be at its highest shortly after administration.

Question 78

Which reason will the nurse explain is the purpose for neomycin being prescribed to a client with cirrhosis? A. Prevents an infection B. Limits abdominal distention C. Minimizes intestinal edema D. Reduces the blood ammonia level

Answer 78

D. Reduces the blood ammonia level ## Footnote Reducing the blood ammonia level decreases the effect of bacterial activity on blood and wastes in the gastrointestinal tract. Although neomycin is an aminoglycoside antimicrobial, it is not administered to prevent infection. Neomycin does not reduce abdominal distention. Neomycin has little or no effect on intestinal edema.

Question 79

Neomycin is prescribed preoperatively for a client with colon cancer. The client asks why this is necessary. Which response would the nurse provide? A. 'It kills cancer cells that may be missed during surgery.' B. 'This medication is helpful in decreasing the inflammatory response associated with surgical procedures.' C. 'It kills intestinal bacteria to decrease the risk for infection.' D. 'This medication alters the body flora to prevent the occurrence of superinfections.'

Answer 79

C. 'It kills intestinal bacteria to decrease the risk for infection.' ## Footnote Neomycin is an aminoglycoside antibacterial medication that provides preoperative intestinal antisepsis.

Question 80

The clinic nurse is planning care for a client with chlamydia. Which treatment would the nurse anticipate implementing? A. Administration of 250 mg of acyclovir orally in a single dose B. Administration of 1 g of azithromycin orally in a single dose C. Administration of 250 mg of ceftriaxone intramuscularly in a single dose D. Administration of 2.4 million units of benzathine penicillin G intramuscularly in a single dose

Answer 80

B. Administration of 1 g of azithromycin orally in a single dose ## Footnote The treatment of choice for chlamydial infection is 1 g of azithromycin orally in a single dose. The one-dose course is preferred because of its ease of completion.

Question 81

An older adult client is to receive intravenous (IV) gentamicin for urosepsis. Before administering the medication, for which finding should the nurse notify the health care provider (HCP)? A. The client has a history of acid reflux disease. B. The client has a history of retinopathy. C. The client has a history of chronic kidney disease. D. The client has a history of urinary retention.

Answer 81

C. The client has a history of chronic kidney disease. ## Footnote Aminoglycosides are nephrotoxic and requires close monitoring of renal function. A client with chronic kidney disease should not receive this medication.

Question 82

Which condition would the nurse monitor for in the client on aminoglycoside therapy (the “-mycin, micins”) and skeletal muscle relaxants? A. Stroke B. Respiratory arrest C. Myocardial infarction D. Abdominal discomfort

Answer 82

B. Respiratory arrest ## Footnote Aminoglycosides can intensify the effect of skeletal muscle relaxants, placing the client at risk for respiratory arrest.

Question 83

Which effect has resulted in the avoidance of tetracycline use in children under 8 years old? A. Birth defects B. Allergic responses C. Severe nausea and vomiting D. Permanent tooth discoloration

Answer 83

D. Permanent tooth discoloration ## Footnote Tetracycline use in children under the age of 8 years has been discontinued because it causes permanent tooth discoloration.

Question 84

A child is prescribed tetracycline. The nurse understands which possible medication-related reaction is associated with this medication? A. Kernicterus B. Gray syndrome C. Reye syndrome D. Staining of teeth

Answer 84

D. Staining of teeth ## Footnote Tetracycline causes staining or discoloration of developing teeth in children.

Question 85

A mother complains that her child’s teeth have become yellow in color. The nurse understands that with prolonged use, which medication may be responsible? A. Tetracycline B. Promethazine C. Chloramphenicol D. Fluoroquinolones

Answer 85

A. Tetracycline ## Footnote When administered to neonates and infants, tetracycline may cause staining of developing teeth.

Question 86

A pregnant client with an infection tells the nurse that she has taken tetracycline for infections in the past and prefers to take it now. Which response would the nurse give regarding the avoidance of tetracycline administration during pregnancy? A. 'It affects breast-feeding adversely.' B. 'Tetracycline causes fetal allergies.' C. 'It alters the development of fetal teeth buds.' D. 'It increases fetal tolerance to the medication.'

Answer 86

C. 'It alters the development of fetal teeth buds.' ## Footnote Tetracycline has an affinity for calcium; if used during tooth bud development it may cause discoloration of teeth.

Question 87

The nurse is preparing to administer doxycycline to a client to treat syphilis. Which lab results should the nurse review before administering this medication? A . Pregnancy test B. Hematocrit C. Sodium level D. Arterial blood gas

Answer 87

A . Pregnancy test ## Footnote Tetracyclines, such as doxycycline, may cause fetal harm and should not be administered during pregnancy

Question 88

The health care provider has prescribed tetracycline for a 28-year-old female client with severe acne. When teaching the client about this medication, which information is important for the nurse to include? A. It may cause staining of the teeth. B. It may decrease the effectiveness of oral contraceptives. C. It should be taken with food or milk. D. It may cause hearing loss.

Answer 88

B. It may decrease the effectiveness of oral contraceptives. ## Footnote Tetracycline, a broad-spectrum antibiotic, can decrease the effectiveness of oral contraceptives; therefore, it is important to recommend use of an additional form of contraception such as a condom when taking this medication.

Question 89

Which action would the nurse take when administering tetracycline? A. Administer the medication with meals or a snack. B. Provide orange or other citrus fruit juice with the medication. C. Administer the medication at least an hour before ingestion of milk products. D. Offer antacids 30 minutes after administration if gastrointestinal side effects occur.

Answer 89

C. Administer the medication at least an hour before ingestion of milk products. ## Footnote Any product containing aluminum, magnesium, or calcium ions should not be taken in the hour before or after an oral dose of tetracyclines (with the exception of doxycycline) because it decreases absorption by as much as 25% to 50%. Food interferes with absorption; it should be given 1 hour before or 2 hours after meals. Citrus juice does not improve absorption. Antacids will interfere with absorption.

Question 90

How would the nurse reply when a client prescribed a tetracycline class medication asks why milk and antacids should be avoided before and after dosing? A. 'Taking these together can lead to kidney impairment.' B. 'The pairing of these substances leads to tooth staining.' C. 'Severe diarrhea can occur when taking these substances together.' D. 'This can lead to decreased absorption of the medication you need.'

Answer 90

D. 'This can lead to decreased absorption of the medication you need.' ## Footnote Tetracyclines chelate with calcium, iron, and magnesium, so substances containing these minerals are avoided to optimize absorption of the antimicrobial.

Question 91

The nurse is providing medication teaching for a client who has been prescribed tetracycline. The client regularly takes calcium supplements to prevent osteoporosis. Which statement is appropriate for the nurse to make? A. Take your calcium two hours before you take the antibiotic B. You can take the calcium with the antibiotic to decrease an upset stomach C. Try taking the antibiotic and calcium with orange juice D. It is best to take the antibiotic and calcium on an empty stomach

Answer 91

A. Take your calcium two hours before you take the antibiotic ## Footnote Tetracyclines have a high affinity to form chelates with iron, aluminum, magnesium, and calcium. These complexes are poorly absorbed in the gastrointestinal tract; therefore, an interval between the ingestion of tetracyclines and cations is necessary.

Question 92

The nurse in the urgent-care clinic is reviewing discharge instructions with a client who is prescribed doxycycline. Which statement by the client indicates understanding of the instructions? A. "I will not wear my contact lenses while taking this medication." B. "I will carry glucose tablets with me in case I experience low blood sugar." C. "I will take this medication with an antacid to prevent an upset stomach." D. "I will apply sunscreen when outside to prevent a sunburn."

Answer 92

D. "I will apply sunscreen when outside to prevent a sunburn." ## Footnote Doxycycline is a tetracycline antibiotic. All tetracyclines can increase the sensitivity of the skin to ultraviolet light. The most common result is a sunburn. Clients on these types of medications should prevent sunburn by avoiding prolonged exposure to sunlight, wearing protective clothing and applying sunscreen to exposed skin while outdoors.

Question 93

A nurse is teaching a client who has a new prescription for ciprofloxacin to treat an uncomplicated UTI. Which of the following instructions should the nurse include? A. "Take this medication with an antacid." B. "Monitor for tendon pain." C. "Drink 1,000 milliliters of fluid daily." D. "Expect urine to turn dark orange."

Answer 93

B. "Monitor for tendon pain." ## Footnote Ciprofloxacin can cause tendinitis and tendon rupture. The client should monitor and report tendon pain or inflammation.

Question 94

A nurse is teaching a client who has a urinary tract infection (UTI) and is taking ciprofloxacin. Which of the following instructions should the nurse give to the client? A. "If the medicine causes an upset stomach, take an antacid at the same time." B. "Limit your daily fluid intake while taking this medication." C. "This medication can cause photophobia, so be sure to wear sunglasses outdoors." D. "You should report any tendon discomfort you experience while taking this medication."

Answer 94

D. "You should report any tendon discomfort you experience while taking this medication." ## Footnote The nurse should instruct the client to report any tendon discomfort as well as swelling or inflammation of the tendons due to the risk of tendon rupture.

Question 95

The nurse is educating an older adult client about newly prescribed levofloxacin for the treatment of pneumonia. The nurse should teach the client that which side effect is a priority for the client to report to the provider? A . Joint tenderness B. Diarrhea C. Dizziness D. Difficulty sleeping

Answer 95

A . Joint tenderness ## Footnote There is a black box warning for fluoroquinolones alerting health professionals not only to the increased disabling risk of tendinitis and tendon rupture but also to the significant risk of peripheral neuropathy, central nervous system and cardiac effects, and dermatologic and hypersensitivity reactions.

Question 96

A 5-year-old child is given fluoroquinolones, levofloxacin. Which potential adverse effect unique to pediatric clients would the nurse anticipate? A. Tendon rupture B. Cartilage erosion C. Staining of developing teeth D. Central nervous system toxicity

Answer 96

A. Tendon rupture ## Footnote Fluoroquinolones may cause tendon rupture in children. Nalidixic acid can cause cartilage erosion, and tetracycline can cause staining of developing teeth. Hexachlorophene may cause central nervous system toxicity in infants.

Question 97

The nurse is reviewing discharge instructions with a client who has been prescribed ciprofloxacin following a minor burn injury. Which statement by the client requires additional teaching? A. "I will protect my skin from the sun with sunscreen and clothing." B. "I will not take ciprofloxacin prior to sun exposure." C. "After healing, I should have no scarring from this burn." D. "I can take ibuprofen for the pain related to this burn."

Answer 97

B. "I will not take ciprofloxacin prior to sun exposure." ## Footnote It is inappropriate for the client to stop taking their antibiotic. However, if the client cannot avoid sun exposure, the nurse may contact the health care provider and request that the antibiotic be changed to one that does not cause photosensitivity.

Question 98

The nurse teaches a teenage client about the administration of levofloxacin to treat a sinus infection. The nurse concludes the teaching is effective when the client makes which statement? A. 'I should take the medication at mealtime.' B. 'I should take the medication just before a meal.' C. 'I should take the medication 1 hour before a meal.' D. 'I should take the medication 30 minutes after a meal.'

Answer 98

C. 'I should take the medication 1 hour before a meal.' ## Footnote Absorption of the oral solution levofloxacin is enhanced when the stomach is empty, and it should be taken 1 hour before meals or 2 hours after meals.

Question 99

Levofloxacin is prescribed for a woman who has been experiencing urinary frequency and burning for the past 24 hours. The nurse concludes the teaching has been effective when the client states she will make which change in her routine? A. Limit her fluid intake. B. Strain her urine for calculi. C. Monitor her urine output. D. Take mineral supplements 2 hours before or after levofloxacin.

Answer 99

D. Take mineral supplements 2 hours before or after levofloxacin. ## Footnote Mineral substances taken within 2 hours of a levofloxacin dose decrease the medication’s effectiveness.

Question 100

A child with pinworms is prescribed mebendazole. Which expected response to the medication would the nurse teach the parents watch for? A. Blood B. Constipation C. Yellow stools D. Passage of worms

Answer 100

D. Passage of worms ## Footnote Passage of worms is the expected response because the medication causes the death of the worms.

Question 101

The nurse is caring for a pregnant client who has contracted a trichomonal protozoan infection. For which oral medication would the nurse anticipate preparing to provide education? A. Penicillin G B. Acyclovir C. Nystatin D. Metronidazole

Answer 101

D. Metronidazole ## Footnote Metronidazole is a potent amebicide that is safe in pregnancy. It is effective in eradicating the protozoan Trichomonas vaginalis.

Question 102

Which explanation would the nurse provide to a client with gastric ulcer disease who asks the nurse why the health care provider has prescribed metronidazole? A. To augment the immune response B. To potentiate the effect of antacids C. To treat Helicobacter pylori infection D. To reduce hydrochloric acid secretion

Answer 102

C. To treat Helicobacter pylori infection ## Footnote Approximately two-thirds of clients with peptic ulcer disease are found to have Helicobacter pylori infecting the mucosa and interfering with its protective function.

Question 103

A client with giardiasis is taking metronidazole (Flagyl) 2 grams PO. Which information should the nurse include in the client's instruction? A. Notify the clinic of any changes in the color of urine. B. Encourage the use of over-the-counter cough/cold syrup when a cough/cold develops. C. Stop the medication after the diarrhea resolves. D. Take the medication with food.

Answer 103

D. Take the medication with food. ## Footnote Flagyl, an amoebicide and antibacterial agent, may cause gastric distress, so the client should be instructed to take the medication on a full stomach.

Question 104

The nurse is teaching the client with bacterial vaginosis who has been prescribed metronidazole tablets. What statement is appropriate? A. You may continue to experience symptoms after you stop the medication B. You should avoid drinking alcohol while taking this medication C. Call your healthcare provider if you experience diarrhea D. Your sexual partner will need to be treated as well

Answer 104

B. You should avoid drinking alcohol while taking this medication ## Footnote Alcohol should be avoided while on metronidazole to reduce the risk of a disulfiram reaction.

Question 105

A nurse is teaching a client who is taking metronidazole. Which of the following sense alterations should the nurse include as an adverse effect of metronidazole? A. Olfactory changes B. Metallic taste C. Alterations in touch D. Hearing loss

Answer 105

B. Metallic taste ## Footnote Metronidazole is an antiprotozoal medication that treats giardiasis and trichomoniasis. It most common adverse effects are headaches, nausea, dry mouth, and an unpleasant metallic taste in their mouth.

Question 106

The nurse is educating a client prescribed metronidazole. Which of the following findings should the nurse include in the education as reportable to the healthcare provider? A. Pinpoint red spots on the skin B. Nausea after beginning the medication C. Metallic taste D. Occasional diarrhea

Answer 106

A. Pinpoint red spots on the skin ## Footnote Drug-induced immune thrombocytopenia (DITP) is a rare, but serious, adverse effect where medications cause the body to produce antibodies to platelets. The medication must be stopped immediately because DITP can be life-threatening. Heparin-induced thrombocytopenia is one example. Metronidazole is associated with DITP. Petechiae are pinpoint, round spots that appear on the skin as a result of bleeding. The bleeding causes the petechiae to appear red, brown, or purple.

Question 107

A nurse is caring for a client who has tuberculosis and new prescriptions for rifampin and pyrazinamide. Which of the following laboratory tests should the nurse instruct the client will be required while on this medication regimen? A. Liver function tests B. Gallbladder studies C. Thyroid function studies D. Blood glucose levels

Answer 107

A. Liver function tests ## Footnote Pyrazinamide and rifampin can both cause hepatotoxicity, thus the provider will monitor liver function regularly.

Question 108

Which essential test results will the nurse review before starting antitubercular pharmacotherapy when caring for a client with human immunodeficiency virus (HIV) infection who is diagnosed with tuberculosis? A. Liver function studies B. Pulmonary function studies C. Electrocardiogram and echocardiogram D. White blood cell counts and sedimentation rate

Answer 108

A. Liver function studies ## Footnote Antitubercular medications, such as isoniazid (INH) and rifampin (RIF), are hepatotoxic; liver function should be assessed before initiation of pharmacological therapy.

Question 109

Which laboratory test result would the nurse review before initiating a prescribed antitubercular pharmacotherapy for a client with tuberculosis associated with human immunodeficiency virus? A. Liver function studies B. Pulmonary function studies C. Electrocardiogram D. White blood cell (WBC) count

Answer 109

A. Liver function studies ## Footnote Antitubercular medications, such as isoniazid and rifampin, are hepatotoxic.

Question 110

The nurse is preparing a client for discharge following inpatient treatment for pulmonary tuberculosis. Which instruction should be given to the client? A. Continue taking medications as prescribed. B. Continue taking medications until symptoms are relieved. C. Avoid contact with children, pregnant women or immunosuppressed persons. D. Take medication with aluminum hydroxide if epigastric distress occurs.

Answer 110

A. Continue taking medications as prescribed. ## Footnote Early cessation of treatment may lead to development of drug-resistant tuberculosis (TB). Active TB is usually treated with a combination of four different antibiotics (Isoniazid, rifampin, ethambutol and pyrazinamide) and can now take anywhere from 6-12 months to completely kill the bacteria. As with any antibiotics, clients should continue to take medications even after they begin to feel better.

Question 111

The nurse provides discharge teaching to a client with tuberculosis. Which treatment measure would the nurse reinforce as the highest priority? A. Getting sufficient rest B. Getting plenty of fresh air C. Maintaining a healthy lifestyle D. Consistently taking prescribed medication

Answer 111

D. Consistently taking prescribed medication ## Footnote Tubercle bacilli are particularly resistant to treatment and can remain dormant for prolonged periods; medication must be taken consistently as prescribed.

Question 112

A client has been admitted for the second time to treat tuberculosis (TB). Which referral does the nurse initiate as a priority? A. Psychiatric nurse liaison to assess reasons for noncompliance B. Infection control nurse to arrange testing for drug resistance C. Social worker to see if the client can afford the medications D. Visiting nurses to arrange for directly observed therapy (DOT)

Answer 112

D. Visiting nurses to arrange for directly observed therapy (DOT) ## Footnote Clients with TB must take multiple drugs for six months or longer, making adherence a very real problem. Non-adherence is the most common cause of treatment failure and relapse. This client has a risk of non-adherence, as evidenced because this is their second admission to treat TB. When the client is discharged, they most likely will need to be placed on DOT to ensure compliance. This is the priority referral in order to prevent transmission of TB to others in the community.

Question 113

A nurse is instructing a client who is newly diagnosed with pulmonary tuberculosis (TB) about the use of antitubercular medications. Which of the following information should the nurse include in the teaching? A. Medications will need to be taken for the rest of the client's life, even if the client feels better. B. Medications will need to be taken until the Mantoux test is negative. C. A typical course of treatment involves 6 to 9 months of consistent medication use. D. The client's family will also need to take medications to prevent infection.

Answer 113

C. A typical course of treatment involves 6 to 9 months of consistent medication use. ## Footnote A 6- to 9-month regimen consisting of two, and often four, different medications is used. The client should not drink alcohol during this time. Active TB is usually treated with the simultaneous administration of a combination of medications until the disease is controlled, usually 6 to 9 months but possibly as long as 2 years.

Question 114

The client is diagnosed with tuberculosis (TB). The nurse understands that the treatment plan for this client will involve what type of drug therapy? A. Administering two antituberculosis drugs B. Aminoglycoside antibiotics C. An anti-inflammatory agent D. High doses of B complex vitamins

Answer 114

A. Administering two antituberculosis drugs ## Footnote In order to prevent drug-resistant strains of TB, clients are always prescribed at least two different anti-tubercular medications. Rifampin and isoniazid are the most effective drugs used to treat TB and are always used together, for at least six months.

Question 115

A client with tuberculosis takes combination therapy with isoniazid, rifampin, pyrazinamide, and streptomycin. The client says, 'I’ve never had to take so much medication for an infection before.' How would the nurse respond? A. 'The bacteria causing this infection are difficult to destroy.' B. 'Streptomycin prevents the side effects of the other medications.' C. 'You only need to take the medications for a couple of weeks.' D. 'Aggressive therapy is needed because the infection is well advanced.'

Answer 115

A. 'The bacteria causing this infection are difficult to destroy.' ## Footnote Multiple medications are administered because of concerns regarding medication resistance.

Question 116

Which response by the nurse is appropriate when a client asks what to expect when beginning treatment for tuberculosis? A. 'Therapy will last a few weeks.' B. 'Therapy will occur over two phases.' C. 'Therapy will involve one medication.' D. 'Therapy will require monitoring kidney function.'

Answer 116

B. 'Therapy will occur over two phases.' ## Footnote Therapy for tuberculosis occurs over two phases. The target of the induction phase is to achieve noninfectious sputum, and the target of the continuation phase is to eradicate the intracellular bacteria.

Question 117

A nurse is providing discharge teaching to a client who has pulmonary tuberculosis and a new prescription for rifampin. Which of the following information should the nurse provide? A. "Treatment with this medication will last for 1 month." B. "This medication can cause insomnia." C. "It is best to take the medication with meals." D. "Urine and other secretions might turn orange."

Answer 117

D. "Urine and other secretions might turn orange." ## Footnote Rifampin might turn the urine and other secretions reddish-orange. This includes sputum, tears, and sweat.

Question 118

A client who takes rifampin tells the nurse, 'My urine looks orange.' Which action would the nurse take? A. Explain that this is expected. B. Check the liver enzymes. C. Ask the provider to order a urinalysis. D. Ask what foods were eaten.

Answer 118

A. Explain that this is expected. ## Footnote Rifampin causes a reddish-orange discoloration of secretions such as urine, sweat, and tears.

Question 119

A client with tuberculosis is started on rifampin. The nurse evaluates that the teaching about rifampin is effective when the client makes which statement? A. 'I need to drink a lot of fluid while I take this medication.' B. 'My sweat will turn orange from this medication.' C. 'I should have my hearing tested while I take this medication.' D. 'Most people who take this medication develop a rash.'

Answer 119

B. 'My sweat will turn orange from this medication.' ## Footnote Rifampin causes body fluids, such as sweat, tears, and urine, to turn orange.

Question 120

A client diagnosed with tuberculosis is prescribed rifampin and isoniazid. Which information should the nurse include when reinforcing information about these medications? A. "You can take the medication with food." B. "You may experience an increase in appetite." C. "You may notice an orange-red color to your urine." D. "You may have occasional problems sleeping."

Answer 120

C. "You may notice an orange-red color to your urine."

Question 121

A client begins treatment with rifampin for suspected pulmonary tuberculosis. Which information should the nurse include when teaching the client about this drug? A. "It is important to stay upright for 30 minutes after taking this drug." B. "Check your radial pulse before taking the drug." C. "Avoid prolonged exposure to the sun while taking this drug." D. "You may notice an orange-red color to your urine."

Answer 121

D. "You may notice an orange-red color to your urine." ## Footnote Rifampin can cause a harmless reddish-orange discoloration of urine, feces, saliva, sweat, tears, and skin, even contact lenses.

Question 122

A nurse is caring for a client who has active pulmonary tuberculosis (TB) and a new prescription for IV rifampin. The nurse should instruct the client that they should expect to experience which of the following manifestations while taking this medication? A. Constipation B. Black-colored stools C. Staining of teeth D. Reddish Orange-colored urine

Answer 122

D. Reddish Orange-colored urine ## Footnote Rifampin is used in combination with other medicines to treat TB. Rifampin will cause the urine, stool, saliva, sputum, sweat, and tears to turn reddish-orange to reddish-brown.

Question 123

Which statement by the client indicates to the nurse a need for further teaching on rifampin therapy? A. 'I can expect my skin to turn yellow.' B. 'I can expect my sweat to change color.' C. 'I can expect my urine to turn red-orange.' D. 'I can expect my contact lenses to stain orange.'

Answer 123

A. 'I can expect my skin to turn yellow.' ## Footnote The skin turning yellow indicates jaundice, a serious unexpected adverse effect of rifampin therapy that needs to be reported to the prescriber.

Question 124

A client is prescribed rifampin after being exposed to active tuberculosis. Which finding would the nurse immediately report to the health care provider? Select all that apply. One, some, or all responses may be correct. A. Reddish-orange color urine B. Yellow-colored teeth stains C. Orange-colored sweat and tears D. Small, red, pinpoint areas on the arms E. Numbness, tingling, and burning of extremities

Answer 124

D. Small, red, pinpoint areas on the arms ## Footnote Pinpoint red areas that appear on the arms, legs, or trunk of the body are known as petechiae. The petechiae are tiny hemorrhages that occur under the skin as a result of a low circulating platelet count (thrombocytopenia). Thrombocytopenia occurs with liver stress or damage. As hepatotoxicity is a possible adverse reaction to rifampin, the health care provider must be notified of the appearance of petechiae.

Question 125

Which class is contraindicated in clients who take rifampin? A. Loop diuretics B. Oral contraceptives C. Proton pump inhibitor D. Intermediate-acting insulin

Answer 125

B. Oral contraceptives ## Footnote Rifampin increases metabolism of oral contraceptives, which may result in an unplanned pregnancy

Question 126

Clients who take rifampin should not take medications from which class? A. Loop diuretics B. Oral contraceptives C. Proton pump inhibitor D. Intermediate-acting insulin

Answer 126

B. Oral contraceptives ## Footnote Rifampin increases metabolism of oral contraceptives, which may result in an unplanned pregnancy.

Question 127

A client is diagnosed with pulmonary tuberculosis, and the health care provider prescribes a combination of rifampin and isoniazid. The nurse evaluates that the teaching regarding the medications is effective when the client reports which action as most important? A. 'Report any changes in vision.' B. 'Take the medicine with my meals.' C. 'Call my doctor if my urine or tears turn red-orange.' D. 'Continue taking the medicine even after I feel better.'

Answer 127

D. 'Continue taking the medicine even after I feel better.' ## Footnote The medication should be taken for the full course of therapy; most regimens last from 6 to 9 months, depending on the state of the disease.

Question 128

Which purpose would the nurse identify as the reason for prescribing vitamin B 6 when a chemotherapy protocol prescribed for a client with tuberculosis includes vitamin B 6 and isoniazid (INH)? A. To improve the nutritional status of the client B. To enhance the tuberculostatic effect of INH C. To accelerate the destruction of dormant tubercular bacilli D. To counteract the peripheral neuritis that INH may cause

Answer 128

D. To counteract the peripheral neuritis that INH may cause ## Footnote One of the most common side effects of INH is peripheral neuritis, and vitamin B 6 will counteract this problem.

Question 129

Which explanation would the nurse provide to a client with tuberculosis who asks why vitamin B 6 (pyridoxine) is given with isoniazid? A. "It will improve your immunologic defenses." B. "The tuberculostatic effect of isoniazid is enhanced." C. "Isoniazid interferes with the synthesis of this vitamin." D. "Destruction of the tuberculosis organisms is accelerated."

Answer 129

C. "Isoniazid interferes with the synthesis of this vitamin." ## Footnote Isoniazid often leads to vitamin B 6 (pyridoxine) deficiency because it competes with the vitamin for the same enzyme; this deficiency most often is manifested by peripheral neuritis, which can be controlled by the regular administration of vitamin B 6

Question 130

Pyridoxine (vitamin B 6) and isoniazid (INH) are prescribed as part of the medication protocol for a client with tuberculosis. Which response indicates that vitamin B 6 is effective? A. Weight gain B. Improvement of stomatitis C. Absence of paresthesias D. Absence of night sweats

Answer 130

C. Absence of paresthesias ## Footnote One of the most common side effects of INH is peripheral neuritis due to vitamin B 6 deficiency, and vitamin B 6 will counteract this problem.

Question 131

The chemotherapy protocol prescribed for a client with tuberculosis includes vitamin B 6 and isoniazid (INH). Which would the nurse identify as the reason for prescribing vitamin B 6? A. To improve the nutritional status of the client B. To enhance the tuberculostatic effect of INH C. To accelerate the destruction of dormant tubercular bacilli D. To counteract the peripheral neuritis that INH may cause

Answer 131

D. To counteract the peripheral neuritis that INH may cause ## Footnote One of the most common side effects of INH is peripheral neuritis, and vitamin B 6 will counteract this problem.

Question 132

A client who is taking isoniazid for tuberculosis asks the nurse about the possible side effects of this medication. The nurse informs the client to report which side effect of this medication to the primary health care provider (HCP)? A. Extremity tingling and numbness B. Confusion and light-headedness C. Double vision and visual halos D. Photosensitivity and photophobia

Answer 132

A. Extremity tingling and numbness ## Footnote Peripheral neuropathy is a common side effect of isoniazid and other anti-tubercular medications.

Question 133

Which adverse response to isoniazid (INH) in a client with tuberculosis would cause the nurse to determine that prompt intervention is needed? A. Orange feces B. Yellow sclera C. Temperature of 96.8°F (36°C) D. Weight gain of 5 pounds (2.3 kilograms)

Answer 133

B. Yellow sclera ## Footnote An adverse reaction to isoniazid (INH) is hepatitis, resulting in jaundice.

Question 134

A health care provider has prescribed isoniazid for a client. Which instruction will the nurse give the client about this medication? A. Prolonged use can cause dark, concentrated urine. B. The medication is best absorbed when taken on an empty stomach. C. Take the medication with aluminum hydroxide to minimize gastrointestinal (GI) upset. D. Drinking alcohol daily can cause medication-induced hepatitis.

Answer 134

D. Drinking alcohol daily can cause medication-induced hepatitis. ## Footnote Alcohol may increase hepatotoxicity of the medication; instruct client to avoid drinking alcohol during treatment; monitor for signs of hepatitis before and while taking medication.

Question 135

When caring for a client on isoniazid therapy for tuberculosis, the nurse would focus on which diagnostic testing for this client? A. Creatinine B. Hearing tests C. Electrocardiogram D. Liver function tests

Answer 135

D. Liver function tests ## Footnote Isoniazid can damage the liver enough to lead to death, so liver function should be monitored.

Question 136

The nurse is caring for a client who is receiving isoniazid for tuberculosis (TB). Which assessment finding would indicate the client is having a possible adverse response to this medication? A. Yellowing of the sclera B. Tinnitus and decreased hearing C. Headache and sore throat D. Urinary frequency

Answer 136

A. Yellowing of the sclera ## Footnote Clients receiving this medication are at risk for drug-induced hepatitis. The appearance of jaundice (yellowing of the sclera) may indicate an elevation of the client's serum bilirubin levels and liver enzymes (AST and ALT).

Question 137

A client diagnosed with tuberculosis is taking isoniazid. To prevent a food and medication interaction, the nurse will advise the client to avoid which food item? A. Hot dogs B. Red wine C. Sour cream D. Grapefruit juice

Answer 137

B. Red wine ## Footnote Clients taking isoniazid should avoid foods containing tyramine such as red wine, tuna fish, and hard cheese.

Question 138

A parent of three young children has contracted tuberculosis. Which medication would the nurse anticipate being prescribed for members of the family who have been exposed? A. Isoniazid B. Multiple-puncture test C. Bacille Calmette-Guérin D. Tuberculin purified protein derivative

Answer 138

A. Isoniazid ## Footnote Isoniazid is used as a prophylactic agent for people who have been exposed to tuberculosis; also, it is one of several medications used to treat the disease.