Homework answers / question archive / Miami Dade College, Miami - NUR 2212 Chapter 26: Antibacterials McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 9th Edition MULTIPLE CHOICE 1)The nurse is caring for a patient who is receiving an intravenous antibiotic

Miami Dade College, Miami - NUR 2212 Chapter 26: Antibacterials McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 9th Edition MULTIPLE CHOICE 1)The nurse is caring for a patient who is receiving an intravenous antibiotic

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Miami Dade College, Miami - NUR 2212

Chapter 26: Antibacterials

McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 9th Edition

MULTIPLE CHOICE

1)The nurse is caring for a patient who is receiving an intravenous antibiotic. The nurse notes that the provider has ordered serum drug peak and trough levels. The nurse understands that these tests are necessary for which type of drugs?

1. 1. Drugs with a broad spectrum
   2. Drugs with a narrow spectrum
   3. Drugs with a broad therapeutic index
   4. Drugs with a narrow therapeutic index
2. The nurse is caring for a patient who is receiving an intravenous antibiotic. The patient has a serum drug trough of 1.5 mcg/mL. The normal trough for this drug is 1.7 to 2.2 mcg/mL. What will the nurse expect the patient to experience?
   1. Inadequate drug effects
   2. Increased risk for superinfection
   3. Minimal adverse effects
   4. Slowed onset of action
3. The nurse is teaching a nursing student about the minimal effective concentration (MEC) of antibiotics. Which statement by the nursing student indicates understanding of this concept?
   1. “A serum drug level greater than the MEC ensures that the drug is bacteriostatic.”
   2. “A serum drug level greater than the MEC broadens the spectrum of the drug.”
   3. “A serum drug level greater than the MEC helps eradicate bacterial infections.”
   4. “A serum drug level greater than the MEC increases the therapeutic index.”
4. The nurse is caring for a patient who has recurrent urinary tract infections. The patient’s current infection is not responding to an antibiotic that has been used successfully several times in the past. The nurse understands that this is most likely due to

1. acquired bacterial resistance.
2. cross-resistance.
3. inherent bacterial resistance.
4. transferred resistance.

5. The nurse is preparing to administer amoxicillin (Amoxil) to a patient and learns that the patient previously experienced a rash when taking penicillin. Which action will the nurse take?
   1. Administer the amoxicillin and have epinephrine available.
   2. Ask the provider to order an antihistamine.
   3. Contact the provider to discuss using a different antibiotic.
   4. Request an order for a beta-lactamase resistant drug.
6. The nurse is preparing to administer an antibiotic to a patient who has been receiving the antibiotic for 2 days after a culture was obtained. The nurse notes increased erythema and swelling, and the patient has a persistent high fever of 39° C. What is the nurse’s next action?
   1. Administer the antibiotic as ordered.
   2. Contact the provider to request another culture.
   3. Discuss the need to add a second antibiotic with the provider.
   4. Review the sensitivity results from the patient’s culture.
7. The nurse is preparing to administer the first dose of an antibiotic to a patient admitted for a urinary tract infection. Which action is most important prior to administering the antibiotic?
   1. Administering a small test dose to determine whether hypersensitivity exists
   2. Having epinephrine available in the event of a severe hypersensitivity reaction
   3. Monitoring baseline vital signs, including temperature and blood pressure
   4. Obtaining a urine specimen for culture and sensitivity
8. A patient is admitted to the hospital for treatment of pneumonia after complaining of high fever and shortness of breath. The patient was not able to produce sputum for a culture. The nurse will expect the patient’s provider to order
   1. a broad-spectrum antibiotic.
   2. a narrow-spectrum antibiotic.
   3. multiple antibiotics.
   4. the pneumococcal vaccine.
9. The nurse is teaching a patient who will be discharged home from the hospital to take amoxicillin (Amoxil) twice daily for 10 days. Which statement by the nurse is correct?
   1. “Discontinue the antibiotic when your temperature returns to normal and your symptoms have improved.”
   2. “If diarrhea occurs, stop taking the drug immediately and contact your provider.”
   3. “Stop taking the drug and notify your provider if you develop a rash while taking this drug.”
   4. “You may save any unused antibiotic to use if your symptoms recur.”
10. The nurse is preparing to administer the first dose of intravenous ceftriaxone (Rocephin) to a patient. When reviewing the patient’s chart, the nurse notes that the patient previously experienced a rash when taking amoxicillin. What is the nurse’s next action?
    1. Administer the drug and observe closely for hypersensitivity reactions.
    2. Ask the provider whether a cephalosporin from a different generation may be used.
    3. Contact the provider to report drug hypersensitivity.
    4. Notify the provider and suggest an oral cephalosporin.
11. The nurse is preparing to give a dose of a cephalosporin medication to a patient who has been receiving the antibiotic for 2 weeks. The nurse notes ulcers on the patient’s tongue and buccal mucosa. Which action will the nurse take?
    1. Hold the drug and notify the provider.
    2. Obtain an order to culture the oral lesions.
    3. Gather emergency equipment to prepare for anaphylaxis.
    4. Report a possible superinfection side effect of the cephalosporin.
12. The nurse is providing teaching to a patient who will begin taking a cephalosporin to treat an infection. Which statement by the patient indicates a need for further teaching?
    1. “I may stop taking the medication if my symptoms clear up.”
    2. “I should eat yogurt while taking this medication.”
    3. “I should stop taking the drug and call my provider if I develop a rash.”
    4. “I will not consume alcohol while taking this medication.”
13. The nurse is caring for a patient who takes low-dose erythromycin as a prophylactic medication. The patient will begin taking cefaclor for treatment of an acute infection. The nurse should discuss this with the provider because taking both of these medications simultaneously can cause which effect?
    1. Decreased effectiveness of cefaclor
    2. Increased effectiveness of cefaclor
    3. Decreased effectiveness of erythromycin
    4. Increased effectiveness of erythromycin
14. A patient is receiving high doses of a cephalosporin. Which laboratory values will this patient’s nurse monitor closely?
    1. Blood urea nitrogen (BUN), serum creatinine, and liver function tests
    2. Complete blood count and electrolytes
    3. Serum calcium and magnesium
    4. Serum glucose and lipids
15. A patient will begin taking amoxicillin. The nurse should instruct the patient to avoid which foods?
    1. Green leafy vegetables
    2. Beef and other red meat
    3. Coffee, tea, and colas
    4. Acidic fruits and juices
16. The patient will begin taking penicillin G procaine (Wycillin). The nurse notes that the solution is milky in color. What action will the nurse take?
    1. Call the pharmacist and report the milky color.
    2. Add normal saline to dilute the medication.
    3. Call the physician and report the milky appearance.
    4. Administer the medication as ordered by the physician.
17. The nurse caring for a patient who will receive penicillin to treat an infection asks the patient about previous drug reactions. The patient reports having had a rash when taking amoxicillin (Amoxil). The nurse will contact the provider to
    1. discuss giving a smaller dose of penicillin.
    2. discuss using erythromycin (E-Mycin) instead of penicillin.
    3. request an order for diphenhydramine (Benadryl).
    4. suggest that the patient receive cefuroxime (Ceftin).
18. A patient is diagnosed with mycoplasma pneumonia. Which antibiotic will the nurse expect the provider to order to treat this infection?
    1. Azithromycin (Zithromax)
    2. Clarithromycin (Biaxin)
    3. Erythromycin (E-Mycin)
    4. Fidaxomicin (Dificid)
19. The nurse is caring for several patients who are receiving antibiotics. Which order will the nurse question?
    1. Azithromycin (Zithromax) 500 mg IV in 500 mL fluid
    2. Azithromycin (Zithromax) 500 mg PO once daily
    3. Erythromycin 300 mg IM QID
    4. Erythromycin 300 mg PO QID
20. The nurse is caring for a patient who is receiving a high dose of intravenous azithromycin to treat an infection. The patient is also taking acetaminophen for pain. The nurse should expect to review which lab values when monitoring for this drug’s side effects?
    1. Complete blood counts
    2. Electrolytes
    3. Liver enzymes
    4. Urinalysis
21. The nurse provides home-care instructions for a patient who will take a high dose of azithromycin after discharge from the hospital. Which statement by the patient indicates understanding of the teaching?
    1. “I may take antacids 2 hours before taking this drug.”
    2. “I should take acetaminophen for fever or mild pain.”
    3. “I should expect diarrhea to be a common, mild side effect.”
    4. “I should avoid dairy products while taking this drug.”
22. The nurse is preparing to administer clarithromycin to a patient. When performing a medication history, the nurse learns that the patient takes warfarin to treat atrial fibrillation. The nurse will perform which action?
    1. Ask the provider if azithromycin may be used instead of clarithromycin.
    2. Obtain an order for continuous cardiovascular monitoring.
    3. Request an order for periodic serum warfarin levels.
    4. Withhold the clarithromycin and notify the provider.
23. A female patient who is allergic to penicillin will begin taking an antibiotic to treat a lower respiratory tract infection. The patient tells the nurse that she almost always develops a vaginal yeast infection when she takes antibiotics and that she will take fluconazole (Diflucan) with the antibiotic being prescribed. Which macrolide order would the nurse question for this patient?
    1. Azithromycin (Zithromax)
    2. Clarithromycin (Biaxin)
    3. Erythromycin (E-Mycin)
    4. Fidaxomicin (Dificid)
24. The nurse is preparing to give a dose of oral clindamycin (Cleocin) to a patient who is being treated for a skin infection caused by Staphylococcus aureus. The patient has had several doses of the medication and reports having nausea. Which action will the nurse take next?
    1. Administer the next dose when the patient has an empty stomach.
    2. Hold the next dose and contact the patient’s provider.
    3. Instruct the patient to take the next dose with a full glass of water.
    4. Request an order for an antacid to give along with the next dose.
25. The nurse assumes care for a patient who is currently receiving a dose of intravenous vancomycin (Vancocin) infusing at 20 mg/min. The nurse notes red blotches on the patient’s face, neck, and chest and assesses a blood pressure of 80/55 mm Hg. Which action will the nurse take?
    1. Request an order for IV epinephrine to treat anaphylactic shock.
    2. Slow the infusion to 10 mg/min and observe the patient closely.
    3. Stop the infusion and obtain an order for a BUN and serum creatinine.
    4. Suspect Stevens-Johnson syndrome and notify the provider immediately.
26. The nurse is caring for a patient who will begin taking doxycycline to treat an infection. The nurse should plan to give this medication
    1. 1  hour before or 2 hours after a meal.
    2. with an antacid to minimize GI irritation.
    3. with food to improve absorption.
    4. with small sips of water.
27. The nurse is caring for a 7-year-old patient who will receive oral antibiotics. Which antibiotic order will the nurse question for this patient?
    1. Azithromycin (Zithromax)
    2. Clarithromycin (Biaxin)
    3. Clindamycin (Cleocin)
    4. Tetracycline (Sumycin)
28. The nurse is caring for a patient who is receiving a high dose of tetracycline (Sumycin).

Which laboratory values will the nurse expect to monitor while caring for this patient?

28. 1. Blood urea nitrogen (BUN) and creatinine levels
    2. Complete blood counts
    3. Electrolytes
    4. Liver enzyme levels
29. A female patient will receive doxycycline to treat a sexually transmitted illness (STI). What information will the nurse include when teaching this patient about this medication?
    1. Nausea and vomiting are uncommon adverse effects.
    2. The drug may cause possible teratogenic effects.
    3. Increase intake of dairy products with each dose of this medication.
    4. Use a back-up method of contraception if taking oral contraceptives.
30. The nurse is preparing to administer intravenous gentamicin to an infant through an intermittent needle. The nurse notes that the infant has not had a wet diaper for several hours. The nurse will perform which action?
    1. Administer the medication and give the infant extra oral fluids.
    2. Contact the provider to request adding intravenous fluids when giving the medication.
    3. Give the medication and obtain a serum peak drug level 45 minutes after the dose.
    4. Hold the dose and contact the provider to request a serum trough drug level.
31. The nurse is caring for a 70-kg patient who is receiving gentamicin (Garamycin) 85 mg 4 times daily. The patient reports experiencing ringing in the ears. The nurse will contact the provider to discuss
    1. decreasing the dose to 50 mg QID.
    2. giving the dose 3 times daily.
    3. obtaining a serum drug level.
    4. ordering a hearing test.
32. The nurse is preparing to begin a medication regimen for a patient who will receive intravenous ampicillin and gentamicin. Which is an important nursing action?
    1. Administer each antibiotic to infuse over 15 to 20 minutes.
    2. Order serum peak and trough levels of ampicillin.
    3. Prepare the schedule so that the drugs are given at the same time.
    4. Set up separate tubing sets for each drug labeled with the drug name and date.
33. The nurse is reviewing a patient’s chart prior to administering gentamicin (Garamycin) and notes that the last serum peak drug level was 9 mcg/mL and the last trough level was 2 mcg/mL. What action will the nurse take?
    1. Administer the next dose as ordered.
    2. Obtain repeat peak and trough levels before giving the next dose.
    3. Report possible drug toxicity to the patient’s provider.
    4. Report a decreased drug therapeutic level to the patient’s provider.
34. The nurse is providing discharge teaching for a patient who will receive oral levofloxacin (Levaquin) to treat pneumonia. The patient takes an oral hypoglycemic medication and uses over-the-counter (OTC) antacids to treat occasional heartburn. The patient reports frequent arthritis pain and takes acetaminophen when needed. Which statement by the nurse is correct when teaching this patient?
    1. “You may take antacids with levofloxacin to decrease gastrointestinal upset.”
    2. “You may take nonsteroidal anti-inflammatory medications (NSAIDs) for arthritis pain.”
    3. “You should monitor your serum glucose more closely while taking levofloxacin.”
    4. “You should take levofloxacin on an empty stomach to improve absorption.”

 

35. Which is a characteristic that distinguishes sulfonamides from other drugs used to treat bacterial infection?
    1. Sulfonamides are bactericidal.
    2. Sulfonamides are not derived from biologic substances.
    3. Sulfonamides have antifungal and antiviral properties.
    4. Sulfonamides increase bacterial synthesis of folic acid.
36. The nurse is counseling a patient who will begin taking a sulfonamide drug to treat a urinary tract infection. What information will the nurse include in teaching?
    1. “Drink several quarts of water daily.”
    2. “If stomach upset occurs, take an antacid.”
    3. “This is a safe drug to take while pregnant.”
    4. “Sore throat is a common, harmless side effect.”
37. A female patient who is taking trimethoprim–sulfamethoxazole (TMP–SMZ) (Bactrim, Septra) to treat a urinary tract infection reports vaginal itching and discharge. The nurse will perform which action?
    1. Ask the patient if she might be pregnant.
    2. Reassure the patient that this is a normal side effect.
    3. Report a possible superinfection to the provider.
    4. Suspect that the patient is having a hematologic reaction.
38. A patient who will begin taking trimethoprim–sulfamethoxazole (TMP–-SMX) asks the nurse why the combination drug is necessary. The nurse will explain that the combination is used to
    1. broaden the antibacterial spectrum.
    2. decrease bacterial resistance.
    3. improve the taste.
    4. minimize toxic effects.
39. The nurse is preparing to administer trimethoprim–sulfamethoxazole (TMP–SMX) to a patient who is being treated for a urinary tract infection. The nurse learns that the patient has type 2 diabetes mellitus and takes a sulfonylurea oral antidiabetic drug. The nurse will monitor this patient closely for which effect?
    1. Headaches
    2. Hypertension
    3. Hypoglycemia
    4. Superinfection
40. The nurse is preparing to give a dose of trimethoprim–sulfamethoxazole (TMP–SMX) and learns that the patient takes warfarin (Coumadin). The nurse will request an order for
    1. a decreased dose of TMP–SMX.
    2. a different antibiotic.
    3. an increased dose of warfarin.
    4. coagulation studies.
41. A patient who is taking trimethoprim–sulfamethoxazole (TMP–SMX) calls to report developing an all-over rash. The nurse will instruct the patient to perform which action? a.       Increase fluid intake.
    2. Take diphenhydramine.
    3. Stop taking TMP–SMX immediately.
    4. Continue taking the medication.
42. The nurse is caring for a patient who is receiving sulfadiazine. The nurse knows that this patient’s daily fluid intake should be at least which amount? a.        1000  mL/day
    2. 1200  mL/day
    3. 2000  mL/day
    4. 2400  mL/day
43. A patient taking trimethoprim–sulfamethoxazole (TMP–SMX) to treat a urinary tract infection complains of a sore throat. The nurse will contact the provider to request an order for which laboratory test(s)?
    1. Complete blood count with differential
    2. Throat culture
    3. Urinalysis
    4. Coagulation studies
44. The nurse is caring for a patient who is ordered to receive PO trimethoprim– sulfamethoxazole (TMP–SMX) 160/800 QID to treat a urinary tract infection caused by E. coli. The nurse will contact the provider to clarify the correct
    1. dose.
    2. drug.
    3. frequency.
    4. route.
45. The nurse is preparing to give trimethoprim–sulfamethoxazole (TMP–SMX) to a patient and notes a petechial rash on the patient’s extremities. The nurse will perform which action?
    1. Hold the dose and notify the provider.
    2. Request an order for a blood glucose level.
    3. Request an order for a BUN and creatinine level.
    4. Request an order for diphenhydramine (Benadryl).
46. The nurse is caring for a patient who is taking trimethoprim–sulfamethoxazole (TMP– SMX). The nurse learns that the patient takes an angiotensin-converting enzyme (ACE) inhibitor. To monitor for drug interactions, the nurse will request an order for which laboratory test(s)?
    1. A complete blood count
    2. BUN and creatinine
    3. Electrolytes
    4. Glucose
47. A child who weighs 10 kg will begin taking oral trimethoprim–sulfamethoxazole (TMP– SMX). The liquid preparation contains 40 mg of TMP and 200 mg of SMX per 5 mL. The nurse determines that the child’s dose should be 8 mg of TMP and 40 mg of SMX/kg/day divided into two doses. Which order for this child is correct?
    1. 1. 5  mL PO BID
       2. 5  mL PO daily
       3. 10  mL PO BID
       4. 10  mL PO daily

MULTIPLE RESPONSE

1.  Which actions can contribute to bacterial resistance to antibiotics? (Select all that apply.) a.           Frequent use of antibiotics

1. 1. 2. Giving large doses of antibiotics
      3. Skipping doses
      4. Taking a full course of antibiotics
      5. Treating viral infections with antibiotics