M2: anti-biotics, virals, MDR, NSaids

Question 1

Factors that place a patient at risk of developing an antimicrobial-resistant organism include:
1. Age over 50 years
2. School attendance
3. Travel within the U.S.
4. Inappropriate use of antimicrobials

Answer 1

4. Inappropriate use of antimicrobials

Question 2

Infants and young children are at higher risk of developing antibiotic-resistant infections due to:
1. Developmental differences in pharmacokinetics of the antibiotics in children
2. The fact that children this age are more likely to be in daycare and exposed topathogens from other children
3. Parents of young children insisting on preventive antibiotics so they don’t miss
work when their child is sick
4. Immunosuppression from the multiple vaccines they receive in the first 2 yearsof life

Answer 2

2. The fact that children this age are more likely to be in daycare and exposed topathogens from other children

Question 2

Providers should use an antibiogram when prescribing. An antibiogram is:
1. The other name for the Centers for Disease Control guidelines for prescribing antibiotics
2. An algorithm used for prescribing antibiotics for certain infections
3. The reference also known as the Pink Book, published by the Centers for Disease Control
4. A chart of the local resistance patterns to antibiotics developed by laboratories

Answer 2

4. A chart of the local resistance patterns to antibiotics developed by laboratories

Question 3

There is often cross-sensitivity and cross-resistance between penicillins and cephalosporins because:
1. Renal excretion is similar in both classes of drugs.
2. When these drug classes are metabolized in the liver they both produce resistant enzymes.
3. Both drug classes contain a beta-lactam ring that is vulnerable to beta-lactamase-producing organisms.
4. There is not an issue with cross-resistance between the penicillins and
cephalosporins.

Answer 3

3. Both drug classes contain a beta-lactam ring that is vulnerable to beta-lactamase-producing organisms.

Question 4

Jonathan has been diagnosed with strep throat and needs a prescription for an antibiotic. He says the last time he had penicillin he developed a red, blotchy rash. An appropriate antibiotic to prescribe would be:
1. Penicillin VK, because his rash does not sound like a serious rash
2. Amoxicillin
3. Cefadroxil (Duricef)
4. Azithromycin

Answer 4

4. Azithromycin

Question 5

Sarah is a 25-year-old female who is 8 weeks pregnant and has a urinary tract infection. What would be the appropriate antibiotic to prescribe for her?
1. Ciprofloxacin (Cipro)
2. Amoxicillin (Trimox)
3. Doxycycline
4. Trimethoprim-sulfamethoxazole (Septra)

Answer 5

2. Amoxicillin (Trimox)

Question 6

Pong-tai is a 12-month-old child who is being treated with amoxicillin for acute otitis media. His parents call the clinic and say he has developed diarrhea. The appropriate action would be to:
1. Advise the parents that some diarrhea is normal with amoxicillin and recommend probiotics daily.
2. Change the antibiotic to one that is less of a gastrointestinal irritant.
3. Order stool cultures for suspected viral pathogens not treated by the amoxicillin.
4. Recommend increased fluids and fiber in his diet.

Answer 6

1. Advise the parents that some diarrhea is normal with amoxicillin and recommend probiotics daily.

Question 7

Lauren is a 13-year-old child who comes to clinic with a 4-day history of cough, low-grade fever, and rhinorrhea. When she blows her nose or coughs the mucous is greenish-yellow. The
appropriate antibiotic to prescribe would be:
1. Amoxicillin
2. Amoxicillin/clavulanate
3. TMP/SMZ (Septra)
4. None

Answer 7

4. None

Question 8

Joanna had a small ventricle septal defect (VSD) repaired when she was 3 years old and has no residual cardiac problems. She is now 28 and is requesting prophylactic antibiotics for an upcoming dental visit. The appropriate antibiotic to prescribe according to current American
College of Cardiology and American Heart Association guidelines is:
1. None, no antibiotic is required for dental procedures
2. Amoxicillin 2 grams 1 hour before the procedure
3. Ampicillin 2 grams IM or IV 30 minutes before the procedure
4. Azithromycin 1 gram 1 hour before the procedure

Answer 8

1. None, no antibiotic is required for dental procedures

Question 9

Fluoroquinolones have a Black Box Warning regarding even months after treatment.
1. Renal dysfunction
2. Hepatic toxicity
3. Tendon rupture
4. Development of glaucoma

Answer 9

3. Tendon rupture

Question 10

To prevent further development of antibacterial resistance it is recommended that fluoroquinolones
be reserved for treatment of:
1. Urinary tract infections in young women
2. Upper respiratory infections in adults
3. Skin and soft tissue infections in adults
4. Community-acquired pneumonia in patients with comorbidities

Answer 10

4. Community-acquired pneumonia in patients with comorbidities

Question 11

Janet was recently treated with clindamycin for an infection. She calls the advice nurse because she is having frequent diarrhea that she thinks may have blood in it. What would be the appropriate care for her?
1. Encourage increased fluids and fiber.
2. Assess her for pseudomembranous colitis.
3. Advise her to eat yogurt daily to help restore her gut bacteria.
4. Start her on an antidiarrheal medication.

Answer 11

2. Assess her for pseudomembranous colitis.

Question 12

Jamie has glucose-6-phosphate dehydrogenase deficiency (G6PD) and requires an antibiotic. Which class of antibiotics should be avoided in this patient?
1. Penicillins
2. Macrolides
3. Cephalosporins
4. Sulfonamides

Answer 12

4. Sulfonamides

Question 13

Keng has chronic hepatitis that has led to mildly impaired liver function. He has an infection that would be best treated by a macrolide. Which would be the best choice for a patient with liver
dysfunction? If renal fxn not impaired
1. Azithromycin (Zithromax)
2. Clarithromycin (Biaxin)
3. Erythromycin (E-mycin)
4. None of the above

Answer 13

test bank-erythromyacin
Quiz 2: Biaxin

Question 14

If a patient is allergic to sulfonamide antibiotics, he or she will most likely have cross-sensitivity to:
1. Loop diuretics
2. Sulfonylureas
3. Thiazide diuretics
4. All of the above

Answer 14

4. All of the above

Question 15

Tetracyclines such as minocycline are safe to use in:
1. Pregnant women
2. Adolescents
3. Patients with renal dysfunction
4. Patients with hepatic dysfunction

Answer 15

2. Adolescents

Question 16

Tetracyclines should not be prescribed to children younger than 8 years due to:
1. Risk of developing cartilage problems
2. Development of significant diarrhea
3. Risk of kernicterus
4. Adverse effects on bone growth

Answer 16

4. Adverse effects on bone growth

Question 17

Nicole is a 16-year-old female who is taking minocycline for acne. She comes to the
clinic complaining of a headache. What would be the plan of care?
1. Advise acetaminophen or ibuprofen as needed for headaches.
2. Prescribe sumatriptan (Imitrex) to be taken at the onset of the headache.
3. Evaluate her for pseudotremor cerebri.
4. Assess her caffeine intake and sleep patterns

Answer 17

3. Evaluate her for pseudotremor cerebri.

Question 18

Patricia has been prescribed doxycycline for a chlamydia infection. She is healthy and her only medication is an oral combined contraceptive. Patricia’s education would include:
1. Use a back-up method of birth control (condom) until her next menses.
2. Doxycycline may cause tendonitis and she should report any joint pain.
3. Her partner will need treatment if her infection doesn’t clear with the doxycycline.
4. Doxycycline is used for one-dose treatment of STIs; take the whole prescription
at once

Answer 18

1. Use a back-up method of birth control (condom) until her next menses.

Question 19

To prevent the development of peripheral neuropathy in patients taking isoniazid for tuberculosis the patient is also prescribed:
1. Niacin (vitamin B3)
2. Pyridoxine (vitamin B6)
3. Riboflavin (vitamin B2)
4. Thiamine (vitamin B1)

Answer 19

2. Pyridoxine (vitamin B6)

Question 20

Sadie is an 82-year-old patient who has herpes zoster (shingles) and would benefit from an antiviral such as valacyclovir. Prior to prescribing valacyclovir she will need an assessment of:
1. Complete blood count to rule out anemia
2. Liver function
3. Renal function
4. Immunocompetence

Answer 20

3. Renal function

Question 21

When prescribing acyclovir, patients should be educated regarding the:
1. High risk of developing diarrhea
2. Need to drink lots of fluids during treatment
3. Risk for life-threatening rash such as Stevens-Johnson
4. Eccentric dosing schedule

Answer 21

2. Need to drink lots of fluids during treatment

Question 22

Nicholas has been diagnosed with type A influenza. Appropriate prescribing of
oseltamivir (Tamiflu) would include:
1. Starting oseltamivir within the first 48 hours of influenza symptoms
2. Advising the patient he can stop the oseltamivir when his symptoms resolve
3. Educating the patient that oseltamivir will cure influenza
4. Prophylactic treatment of all family members

Answer 22

1. Starting oseltamivir within the first 48 hours of influenza symptoms

Question 23

Monitoring for patients who are on long-term antifungal therapy with ketoconazole includes:
1. Platelet count
2. BUN and creatinine
3. White blood cell count
4. AST, ALT, alkaline phosphatase, and bilirubin

Answer 23

4. AST, ALT, alkaline phosphatase, and bilirubin

Question 24

When prescribing metronidazole (Flagyl) to treat bacterial vaginosis, patient education would include:
1. Metronidazole is safe in the first trimester of pregnancy.
2. Consuming alcohol in any form may cause a severe reaction.
3. Sexual partners need concurrent therapy.
4. Headaches are a sign of a serious adverse reaction and need immediate evaluation

Answer 24

2. Consuming alcohol in any form may cause a severe reaction.

Question 25

Every antibiotic drug class has resistant organisms that influence prescribing decisions.
1. True
2. False

Answer 25

True

Question 26

Which person should be treated with prophylactic antitubercular medication?
1. A child who attends the same school with a child who has tuberculosis
2. A nurse who is working in a hospital
3. An individual who is HIV-positive with a negative TB skin test
4. A patient who has close contact with someone who has
tuberculosis

Answer 26

ANS: 4
Personal contact with a person having a diagnosis of tuberculosis is required to indicate prophylactic treatment
with antitubercular therapy. Attending the same school does not necessarily mean close contact occurs. Health
care professionals do not need prophylactic treatment. HIV-positive individuals with negative TB skin tests do not need prophylaxis.

Question 27

A patient who has chronic liver disease reports contact with a person who has tuberculosis (TB). The
nurse will counsel this patient to contact the provider to discuss
1. a chest x-ray.
2. a TB skin test.
3. liver function tests (LFTs).
4. prophylactic
antitubercular drugs.

Answer 27

ANS: 2
Patients who have exposure to TB should have a TB skin test. A chest x-ray is performed if the skin test is
positive. LFTs do not need to be done simply because of TB exposure. This patient is not a candidate for
antitubercular drug prophylaxis

Question 28

A patient who has tuberculosis asks the nurse why three drugs are used to treat this disease. The nurse will explain that multi-drug therapy is used to reduce the likelihood of
1. disease relapse.
2. drug hypersensitivity reactions.
3. drug resistance.
4. drug adverse effects.

Answer 28

ANS: 3
Without multi-drug therapy, patients easily develop resistance to antitubercular drugs. Using more than one antitubercular drug does not prevent relapse, hypersensitivity reactions, or adverse effects.

Question 29

The nurse is caring for a patient who is diagnosed with tuberculosis. The patient tells the nurse that the provider plans to order a prophylactic antitubercular drug for family members and asks which drug will be ordered. The nurse will expect the provider to order which drug?
1. Isoniazid (INH)
2. Pyrazinamide
3. Rifampin (Rifadin)
4. Streptomycin

Answer 29

ANS: 1
INH is the drug of choice for prophylactic treatment of patients who have had close contact with a patient who has tuberculosis.

Question 29

A patient is being treated with isoniazid (INH), rifampin, and pyrazinamide in phase I of treatment for tuberculosis. The organism develops resistance to isoniazid. Which drug will the nurse anticipate the provider will
order to replace the isoniazid?
1. Ciprofloxacin (Cipro)
2. Ethambutol (Myambutol)
3. Kanamycin
4. Streptomycin sulfate

Answer 29

ANS: 2
If there is bacterial resistance to isoniazid, the first phase may be changed to ethambutol, rifampin, and
pyrazinamide. Ciprofloxacin, kanamycin, and streptomycin are not generally first-line antitubercular drugs.

Question 30

The nurse is teaching a patient about rifampin. Which statement by the patient indicates understanding of the teaching?
1. I should not wear soft contact lenses while taking rifampin.
2. I will need regular eye examinations while taking this drug.
3. I will report orange urine to my provider immediately.
4. I understand that renal toxicity is a common adverse effect.

Answer 30

ANS: 1
Patients taking rifampin should be warned that urine, feces, saliva, sputum, sweat, and tears may turn a harmless
red-orange color. Patients should not wear soft contact lenses to avoid permanent staining. Regular eye exams
are necessary for patients who receive isoniazid and ethambutol. Orange urine is a harmless side effect and does
not need to be reported. Renal toxicity is not common with rifampin.

Question 30

A patient who is taking isoniazid (INH) as part of a two-drug tuberculosis treatment regimen reports tingling of the fingers and toes. The nurse will recommend discussing which treatment with the provider?
1. Adding pyrazinamide
2. Changing to ethambutol
3. Increasing oral fluid intake
4. Taking pyridoxine (B6)

Answer 30

ANS: 4
Peripheral neuropathy is an adverse reaction to INH, so pyridoxine is usually given to prevent this. It is not
necessary to change medications. Increasing fluids will not help with this.

Question 30

The nurse caring for a patient who has tuberculosis and who is taking isoniazid, rifampin, and streptomycin reviews the medical record and notes the patients sputum cultures reveal resistance to
streptomycin. The nurse will anticipate that the provider will take which action?
1. Add ethambutol (Myambutol).
2. Change the streptomycin to clarithromycin.
3. Change the streptomycin to kanamycin.
4. Order renal function tests.

Answer 30

ANS: 3
The patients current regimen is first-phase treatment. If resistance to streptomycin develops, the provider can
change to kanamycin or to ciprofloxacin. Ethambutol is added if there is resistance to isoniazid. Clarithromycin is
used during phase II. Renal function tests are not indicated.

Question 31

A patient who has oral candidiasis will begin using nystatin suspension to treat the infection. What information will the nurse include when teaching this patient?
1. Coat the buccal mucosa with the drug and then rinse your mouth.
2. Gargle with the nystatin and then spit it out without swallowing.
3. Mix the suspension with 4 ounces of water and then drink it.
4. Swish the liquid in your mouth and then swallow after a
few minutes.

Answer 31

ANS: 4
Patients should be taught to swish the suspension in the mouth to coat the tongue and buccal mucosa and then
swallow the medication. It should not be spit out, diluted with water, or swallowed with water

Question 31

A patient who has completed the first phase of a three-drug regimen for tuberculosis has a positive sputum acid- bacilli test. The nurse will tell the patient that
1. drug resistance has probably occurred.
2. it may be another month before this test is negative.
3. the provider will change the pyrazinamide to ethambutol.
4. there may be a need to remain in the first phase of therapy for several weeks.

Answer 31

ANS: 2
The goal is for the patients sputum test to be negative 2 to 3 months after the therapy. The positive test does not
indicate drug resistance. The provider will not change the drugs or keep the patient in the first phase longer than
planned.

Question 31

A patient will begin taking streptomycin as part of the medication regimen to treat tuberculosis. Before administering this medication, the nurse will review which laboratory values in the patients medical record?
1. Complete blood count (CBC) with differential white cell count
2. Blood urea nitrogen (BUN) and creatinine
3. Potassium and magnesium levels
4. Serum fasting glucose

Answer 31

ANS: 2
Streptomycin can cause significant renal toxicity

Question 32

The nurse is teaching a nursing student about the antifungal drug amphotericin B. Which statement by the student indicates a need for further teaching?
1. Amphotericin B may be given intravenously or by mouth.
2. Patients who take this drug should have potassium and magnesium levels assessed.
3. Patients with renal disease should not take amphotericin B.
4. This drug is used for severe systemic infections.

Answer 32

ANS: 1
Amphotericin B is not absorbed from the gastrointestinal tract, so is not given by mouth. It can cause
nephrotoxicity and electrolyte imbalance. It is highly toxic and is reserved for severe, systemic infections.

Question 33

The nurse is preparing to administer an intravenous polymyxin antibiotic. The patient reports dizziness along with numbness and tingling of the hands and feet. The nurse will perform which action?
1. Administer the drug since these are harmless side effects.
2. Hold the drug and notify the provider of these adverse reactions.
3. Obtain an order for an oral form of this medication.
4. Request an order for serum electrolytes.

Answer 33

ANS: 2
Polymyxins can cause nephrotoxicity and neurotoxicity. This patient has signs of neurotoxicity, so the nurse
should notify the provider. These effects are generally reversible when the drug is discontinued. It is not correct to
administer the drug when these symptoms are present. Polymyxins are not absorbed orally. Serum electrolytes are not indicated.

Question 34

A patient who is taking metronidazole (Flagyl) reports reddish-brown urine. Which action will the nurse take?
1. Obtain an order for BUN and creatinine levels.
2. Reassure the patient that this is a harmless effect.
3. Request an order for a urinalysis.
4. Test her urine for occult blood.

Answer 34

ANS: 2
Reddish-brown urine is a harmless side effect of metronidazole and is not cause for concern

Question 35

A young adult female who is taking metronidazole (Flagyl) to treat trichomoniasis calls the nurse
to report severe headache, flushing, palpitations, cramping, and nausea. What will the nurse do next?
1. Ask about alcohol consumption.
2. Reassure her that these are harmless side effects.
3. Tell her that this signals a worsening of her infection.
4. Tell her to go to the emergency department immediately.

Answer 35

ANS: 1
Patients who are taking metronidazole can experience a disulfiram-like reaction when they drink alcohol. These
are not harmless adverse effects or a sign of worsening of her infection.

Question 36

A patient is diagnosed with histoplasmosis and will begin taking ketoconazole. What information
will the nurse include when teaching this patient about this medication?
1. Take the medicine twice daily.
2. Take the medication with food.
3. You may consume small amounts of alcohol.
4. You will not need lab tests while taking this drug.

Answer 36

ANS: 2
Ketoconazole should be taken with food. It is administered once daily. Patients taking antifungals should not
consume alcohol. Antifungals can cause liver and renal toxicity, so patients will need lab monitoring.

Question 37

A patient who has AIDS is at risk to contract aspergillosis. The nurse will anticipate that which antifungal medication will be ordered prophylactically for this patient?
1. Metronidazole (Flagyl)
2. Micafungin (Mycamine)
3. Posaconazole (Noxafil)
4. Voriconazole (Vfend)

Answer 37

ANS: 3
Posaconazole is given for prophylactic treatment of Aspergillus and Candida infections.

Question 38

A patient is diagnosed with tinea capitis. The provider will order which systemic antifungal medication for this patient?
1. Anidulafungin (Eraxis)
2. Fluconazole (Diflucan)
3. Griseofulvin (Fulvicin)
4. Ketoconazole (Nizoral

Answer 38

ANS: 3
Griseofulvin is used to treat tinea capitis. Anidulafungin is used to treat esophageal candidiasis, candidemia, and other Candida infections. Fluconazole is used to treat Candida infections and cryptococcal meningitis.
Ketoconazole is used to treat Candida infections, histoplasmosis, blastomycosis, and other infections.

Question 39

Which topical antifungal medication is used to treat vaginal candidiasis?
1. Haloprogin (Halotex)
2. Miconazole (Monistat)
3. Oxiconazole (Oxistat)
4. Terbenafine HCl (Lamisil)

Answer 39

ANS: 2
Topical miconazole is used to treat vaginal candidiasis.

Question 40

A client is being treated for tuberculosis. Which medications are used to treat this condition?
(Select all that apply.)
1. Streptomycin sulfate
2. Amoxicillin (Amoxil)
3. Ethambutol (Myambutol)
4. Gentamicin (Garamycin)
5. Rifabutin (Mycobutin)
6. Ethionamide (Trecator-SC)
7. Pyrazinamide

Answer 40

ANS: 1, 3, 5, 6, 7
Streptomycin sulfate, ethambutol (Myambutol), rifabutin (Mycobutin), ethionamide (Trecator-SC), and
pyrazinamide are used to treat tuberculosis. The other medications are not used

Question 40

A patient who takes an oral sulfonylurea medication will begin taking fluconazole (Diflucan). The nurse will expect to monitor which lab values in this patient?
1. Blood urea nitrogen (BUN) and creatinine
2. Electrolytes
3. Fluconazole levels
4. Glucose

Answer 40

ANS: 4
Patients taking sulfonylurea drugs may have altered serum glucose when taking antifungal medications.

Question 41

Henry presents to clinic with a significantly swollen, painful great toe and is diagnosed with gout. Of the following, which would be the best treatment for Henry?
1. High-dose colchicine
2. Low-dose colchicine
3. High-dose aspirin
4. Acetaminophen with codeine

Answer 41

2. Low-dose colchicine

Question 42

Patient education when prescribing colchicine includes:
1. Colchicine may be constipating.
2. Colchicine always causes some degree of diarrhea.
3. Mild muscle weakness is normal.
4. Moderate amounts of alcohol are safe with colchicine.

Answer 42

2. Colchicine always causes some degree of diarrhea.

Question 43

Larry is taking allopurinol to prevent gout. Monitoring of a patient who is taking allopurinol includes:
1. Complete blood count
2. Blood glucose
3. C-reactive protein
4. BUN, creatinine, and creatinine clearance

Answer 43

4. BUN, creatinine, and creatinine clearance

Question 44

Phil is starting treatment with febuxostat (Uloric). Education of patients starting febuxostat includes:
1. Gout may worsen with therapy.
2. Febuxostat may cause severe diarrhea.
3. He should consume a high-calcium diet.
4. He will need frequent CBC monitoring.

Answer 44

1. Gout may worsen with therapy.

Question 45

Sallie has been taking 10 mg per day of prednisone for the past 6 months. She should be assessed for:
1. Gout
2. Iron deficiency anemia
3. Osteoporosis
4. Renal dysfunction

Answer 45

3. Osteoporosis

Question 46

Daniel has been on 60 mg of prednisone for 10 days to treat a severe asthma exacerbation. It is time to discontinue the prednisone. How is prednisone discontinued?
1. Patients with asthma are transitioned directly off the prednisone onto inhaled
corticosteroids.
2. Prednisone can be abruptly discontinued with no adverse effects.
3. Develop a tapering schedule to slowly wean Daniel off the prednisone.
4. Substitute the prednisone with another anti-inflammatory such as ibuprofen.

Answer 46

3. Develop a tapering schedule to slowly wean Daniel off the prednisone

Question 47

Patients whose total dose of prednisone will exceed 1 gram will most likely need a second prescription for:
1. Metformin, a biguanide to prevent diabetes
2. Omeprazole, a proton pump inhibitor to prevent peptic ulcer disease
3. Naproxen, an NSAID to treat joint pain
4. Furosemide, a diuretic to treat fluid retention

Answer 47

2. Omeprazole, a proton pump inhibitor to prevent peptic ulcer disease

Question 48

Patients with rheumatoid arthritis who are on chronic low-dose prednisone will need co-treatment with which medications to prevent further adverse effects?
1. A bisphosphonate
2. Calcium supplementation
3. Vitamin D
4. All of the above

Answer 48

4. All of the above

Question 49

Patients who are on or who will be starting chronic corticosteroid therapy need monitoring of:
1. Serum glucose
2. Stool culture
3. Folate levels
4. Vitamin B12

Answer 49

1. Serum glucose

Question 50

Jamie has fractured his ankle and has received a prescription for acetaminophen and hydrocodone
(Vicodin). Education when prescribing Vicodin includes:
1. It is okay to double the dose of Vicodin if the pain is severe.
2. Vicodin is not habit-forming.
3. He should not take any other acetaminophen-containing medications.
4. Vicodin may cause diarrhea; increase his fluid intake.

Answer 50

3. He should not take any other acetaminophen-containing medications.

Question 51

Patients who are on chronic long-term corticosteroid therapy need education regarding:
1. Receiving all vaccinations, especially the live flu vaccine
2. Reporting black tarry stools or abdominal pain
3. Eating a high carbohydrate diet with plenty of fluids
4. Small amounts of alcohol are generally tolerated.

Answer 51

2. Reporting black tarry stools or abdominal pain

Question 51

All nonsteroidal anti-inflammatory drugs (NSAIDS) have an FDA Black Box Warning regarding:
1. Potential for causing life-threatening GI bleeds
2. Increased risk of developing systemic arthritis with prolonged use
3. Risk of life-threatening rashes, including Stevens-Johnson
4. Potential for transient changes in serum glucose

Answer 51

1. Potential for causing life-threatening GI bleeds

Question 52

Josefina is a 2-year-old child with acute otitis media and an upper respiratory infection. Along with an antibiotic she receives a recommendation to treat the ear pain with ibuprofen. What
education would her parent need regarding ibuprofen?
1. They can cut an adult ibuprofen tablet in half to give Josefina.
2. The ibuprofen dose can be doubled for severe pain.
3. Josefina needs to be well-hydrated while taking ibuprofen.
4. Ibuprofen is completely safe in children with no known adverse effects.

Answer 52

3. Josefina needs to be well-hydrated while taking ibuprofen.

Question 52

When prescribing NSAIDS, a complete drug history should be conducted as NSAIDs interact with
these drugs:
1. Omeprazole, a proton pump inhibitor
2. Combined oral contraceptives
3. Diphenhydramine, an antihistamine
4. Warfarin, an anticoagulant

Answer 52

4. Warfarin, an anticoagulant

Question 53

Patients prescribed aspirin therapy require education regarding the signs of aspirin toxicity. An early sign of aspirin toxicity is:
1. Black tarry stools
2. Vomiting
3. Tremors
4. Tinnitus

Answer 53

4. Tinnitus

Question 53

Henry is 82 years old and takes two aspirin every morning to treat the arthritis pain in his back. He states the aspirin helps him to “get going” each day. Lately he has had some heartburn from the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment
for Henry?
1. Add an H2 blocker such as ranitidine to his therapy.
2. Discontinue the aspirin and switch him to Vicodin for the pain.
3. Decrease the aspirin dose to one tablet daily.
4. Have Henry take an antacid 15 minutes before taking the aspirin each day.

Answer 53

1. Add an H2 blocker such as ranitidine to his therapy.

Question 54

The trial period to determine effective anti-inflammatory activity when starting a patient on aspirin for rheumatoid arthritis is:
1. 48 hours
2. 4 to 6 days
3. 4 weeks
4. 2 months

Answer 54

2. 4 to 6 days

Question 55

Monitoring a patient on a high-dose aspirin level includes:
1. Salicylate level
2. Complete blood count
3. Urine pH
4. All of the above

Answer 55

4. All of the above

Question 56

The treatment goals when treating urinary tract infection (UTI) include:
1. Eradication of infecting organism
2. Relief of symptoms
3. Prevention of recurrence of the UTI
4. All of the above

Answer 56

4. All of the above

Question 57

Patients who are on long-term aspirin therapy should have annually.
1. Complete blood count
2. Salicylate level
3. Amylase
4. Urine analysis

Answer 57

1. Complete blood count

Question 58

Sally is a 16-year-old female with a urinary tract infection. She is healthy, afebrile, with no use of antibiotics in the previous 6 months and no drug allergies. An appropriate first-line antibiotic choice for her would be:
1. Azithromycin
2. Trimethoprim/sulfamethoxazole
3. Ceftriaxone
4. Levofloxacin

Answer 58

2. Trimethoprim/sulfamethoxazole

Question 59

Monitoring for a healthy, nonpregnant adult patient being treated for a urinary tract infection is:
1. Symptom resolution in 48 hours
2. Follow-up urine culture at completion of therapy
3. “Test of cure” urinary analysis at completion of therapy
4. Follow-up urine culture 2 months after completion of therapy

Answer 59

1. Symptom resolution in 48 hours

Question 59

Which of the following patients may be treated with a 3-day course of therapy for their urinary tract infection?
1. Juanita, a 28-year-old pregnant woman
2. Sally, a 16-year-old healthy adolescent
3. Jamie, a 24-year-old female
4. Suzie, a 26-year-old diabetic

Answer 59

3. Jamie, a 24-year-old female

Question 59

Jamie is a 24-year-old female with a urinary tract infection. She is healthy, afebrile, and her only
drug allergy is sulfa, which gives her a rash. An appropriate first-line antibiotic choice for her would be:
1. Azithromycin
2. Trimethoprim/sulfamethoxazole
3. Ceftriaxone
4. Ciprofloxacin

Answer 59

4. Ciprofloxacin

Question 59

Juanita is a 28-year-old pregnant woman at 38 weeks’ gestation who is diagnosed with a lower urinary tract infection (UTI). She is healthy with no drug allergies. Appropriate first-line therapy for her UTI would be:
1. Azithromycin
2. Trimethoprim/sulfamethoxazole
3. Amoxicillin
4. Ciprofloxacin

Answer 59

3. Amoxicillin

Question 60

Nicole is a 4-year-old female with a febrile urinary tract infection (UTI). She is generally healthy and has no drug allergies. Appropriate initial therapy for her UTI would be:
1. Azithromycin
2. Trimethoprim/sulfamethoxazole
3. Ceftriaxone
4. Ciprofloxacin

Answer 60

3. Ceftriaxone

Question 61

Monitoring for a child who has had a urinary tract infection is:
1. Symptom resolution in 48 hours
2. Follow-up urine culture at completion of therapy
3. “Test of cure” urinary analysis at completion of therapy
4. Follow-up urine culture 2 months after completion of therapy

Answer 61

2. Follow-up urine culture at completion of therapy

Question 62

Monitoring for a pregnant woman who has had a urinary tract infection is:
1. Symptom resolution in 48 hours
2. Follow-up urine culture at completion of therapy
3. “Test of cure” urinary analysis at completion of therapy
4. Follow-up urine culture every 2 weeks until delivery

Answer 62

4. Follow-up urine culture every 2 weeks until delivery

Question 63

Along with an antibiotic prescription, lifestyle education for a nonpregnant adult female who has had a urinary tract infection includes:
1. Increasing her intake of vitamin C-containing orange juice
2. Voiding 10 to 15 minutes after intercourse
3. Avoiding ingesting urinary irritants, such as asparagus
4. All of the above

Answer 63

2. Voiding 10 to 15 minutes after intercourse

Question 64

Lisa is a healthy nonpregnant adult woman who recently had a urinary tract infection (UTI). She is asking about drinking cranberry juice to prevent a recurrence of the UTI. The correct answer to give her would be:
1. Sixteen ounces per day of cranberry juice cocktail will prevent UTIs.
2. 100% cranberry juice or cranberry juice extract may decrease UTIs in some
patients.
3. There is no evidence that cranberry juice helps prevent UTIs.
4. Cranberry juice only works to prevent UTIs in children.

Answer 64

2. 100% cranberry juice or cranberry juice extract may decrease UTIs in some
   patients.

Prof said the textbook answer would be that it doesn’t prevent or treat, would have to be 30+% cranberry, and the sugar effects both worsen and add calories to diet

Question 65

Caleb is an adult with an upper respiratory infection (URI). Treatment for his URI would include:
1. Amoxicillin
2. Diphenhydramine
3. Phenylpropanolamine
4. Topical oxymetazoline

Answer 65

4. Topical oxymetazoline

Question 66

Rose is a 3-year-old patient with an upper respiratory infection (URI). Treatment for her URI would
include:
1. Amoxicillin
2. Diphenhydramine
3. Pseudoephedrine
4. Nasal saline spray

Answer 66

4. Nasal saline spray

Question 67

Patients who should be cautious about using decongestants for an upper respiratory infection (URI) include:
1. School-age children
2. Patients with asthma
3. Patients with cardiac disease
4. Patients with allergies

Answer 67

3. Patients with cardiac disease

Question 67

The length of treatment for sinusitis in a low-risk patient should be:
1. 5–7 days
2. 7–10 days
3. 14–21 days
4. 7 days beyond when symptoms cease

Answer 67

1. 5–7 days

Question 68

Jaheem is a 10-year-old low-risk patient with sinusitis. Treatment for a child with sinusitis is:
1. Amoxicillin
2. Azithromycin
3. Cephalexin
4. Levofloxacin

Answer 68

1. Amoxicillin

Question 68

Jacob has been diagnosed with sinusitis. He is the parent of a child in daycare. Treatment for sinusitis in an adult who has a child in daycare is:
1. Azithromycin 500 mg q day for 5 days
2. Amoxicillin-clavulanate 500 mg bid for 7 days
3. Ciprofloxacin 500 mg bid for 5 days
4. Cephalexin 500 mg qid for 5 days

Answer 68

2. Amoxicillin-clavulanate 500 mg bid for 7 days

Question 69

Patient education for a patient who is prescribed antibiotics for sinusitis includes:
1. Use of nasal saline washes
2. Use of inhaled corticosteroids
3. Avoiding the use of ibuprofen while ill
4. Use of laxatives to treat constipation

Answer 69

1. Use of nasal saline washes

Question 70

Myles is a 2-year-old patient who has been diagnosed with acute otitis media. He is afebrile and has not been treated with antibiotics recently. First-line treatment for his otitis media would include:
1. Azithromycin
2. Amoxicillin
3. Ceftriaxone
4. Trimethoprim/sulfamethoxazole

Answer 70

2. Amoxicillin

Question 71

Alyssa is a 15-month-old patient who has been on amoxicillin for 2 days for acute otitis media. She is still febrile and there is no change in her tympanic membrane examination. What would be
the plan of care for her?
1. Continue the amoxicillin for the full 10 days.
2. Change the antibiotic to azithromycin.
3. Change the antibiotic to amoxicillin/clavulanate.
4. Change the antibiotic to trimethoprim/sulfamethoxazole.

Answer 71

3. Change the antibiotic to amoxicillin/clavulanate.

Question 72

A child that may warrant “watchful waiting” instead of prescribing an antibiotic for acute otitis
media includes patients who:
1. Are low risk with temperature of less than 39
2. Have reliable parents with transportation
3. Are older than age 2 years
4. All of the above

Answer 72

4. All of the above

Question 73

First-line therapy for a patient with acute otitis externa (swimmer’s ear) and an intact tympanic
membrane includes:
1. Swim-Ear drops
2. Ciprofloxacin and hydrocortisone drops
3. Amoxicillin
4. Gentamicin ophthalmic drop

Answer 73

2. Ciprofloxacin and hydrocortisone drops

Question 73

Whether prescribing an antibiotic for a child with acute otitis media or not, the parents should be educated about:
1. Using decongestants to provide faster symptom relief
2. Providing adequate pain relief for at least the first 24 hours
3. Using complementary treatments for acute otitis media, such as garlic oil
4. Administering an antihistamine/decongestant combination (Dimetapp) so the child
can sleep better

Answer 73

2. Providing adequate pain relief for at least the first 24 hours