Science Test 2
Chapter 38
- 1.
When reviewing the allergy history of a patient, the nurse notes that the patient is allergic to penicillin. Based on this finding, the nurse would question an order for which class of antibiotics?
- A.
Tetracyclines
- B.
Sulfonamides
- C.
Cephalosporins
- D.
Imipenem-cilastatin
Correct Answer
C. CephalosporinsExplanation
Allergy to penicillin may also result in hypersensitivity to cephalosporins. The other options are not correct.Rate this question:
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- 2.
When teaching a patient who will be taking tetracycline, which of the following instructions should the nurse share?
- A.
“Avoid direct sunlight and tanning beds while on this medication.”
- B.
“Milk and cheese products result in increased levels of tetracycline.”
- C.
“Antacids taken with the medication help to reduce gastrointestinal distress.”
- D.
“Take the medication until you are feeling better.”
Correct Answer
A. “Avoid direct sunlight and tanning beds while on this medication.”Explanation
Drug-related photosensitivity occurs when patients take tetracyclines, and it may continue for several days after therapy. Milk and cheese products result in decreased levels of tetracycline when the two are taken together. Antacids also interfere with absorption and should not be taken with tetracycline.Rate this question:
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- 3.
When reviewing the medication orders for a patient who is taking penicillin, the nurse notes that the patient is also taking the oral anticoagulant warfarin (Coumadin). What possible effect may occur as the result of an interaction between these drugs?
- A.
The penicillin will cause an enhanced anticoagulant effect of the warfarin.
- B.
The penicillin will cause the anticoagulant effect of the warfarin to decrease.
- C.
The warfarin will reduce the antiinfective action of the penicillin.
- D.
The warfarin will increase the effectiveness of the penicillin.
Correct Answer
A. The penicillin will cause an enhanced anticoagulant effect of the warfarin.Explanation
Administering penicillin reduces the vitamin K in the gut (intestines); therefore, enhanced anticoagulant effect of warfarin may occur.Rate this question:
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- 4.
A patient is receiving his third intravenous dose of a penicillin drug. He calls the nurse to report that he is feeling “anxious” and is having trouble breathing. What will the nurse do first?
- A.
Notify the physician.
- B.
Take the patient’s vital signs.
- C.
Stop the antibiotic infusion.
- D.
Check for allergies.
Correct Answer
C. Stop the antibiotic infusion.Explanation
Hypersensitivity reactions are characterized by wheezing; shortness of breath; swelling of the face, tongue, or hands; itching; or rash. The nurse should immediately stop the antibiotic infusion, have someone notify the physician, and stay with the patient to monitor the patient’s vital signs and condition. Checking for allergies should have been done before the infusion.Rate this question:
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- 5.
A patient is admitted with a fever of 102.8° F (39.3 ° C), origin unknown. Assessment reveals cloudy, foul-smelling urine that is dark amber in color. Orders have just been written to obtain urine and blood cultures and to administer an antibiotic intravenously stat (now). The nurse will complete these orders in which sequence?
- A.
Blood culture, ampicillin dose, urine culture
- B.
Urine culture, ampicillin dose, blood culture
- C.
Ampicillin dose, blood and urine cultures
- D.
Blood and urine cultures, ampicillin dose
Correct Answer
D. Blood and urine cultures, ampicillin doseExplanation
Culture specimens should be obtained before initiating drug therapy; otherwise, the presence of antibiotics in the tissues may result in misleading culture and sensitivity results.Rate this question:
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- 6.
During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and anorexia. The nurse’s best advice to the patient would be which of the following?
- A.
“Take it with cheese and crackers or yogurt.”
- B.
“Take each dose with a glass of milk.”
- C.
“Take an antacid with each dose as needed.”
- D.
“Drink a full glass of water with each dose.”
Correct Answer
D. “Drink a full glass of water with each dose.”Explanation
Oral doses should be given with at least 8 ounces of fluids and food to minimize gastrointestinal upset; however, antacids and dairy products will bind with the tetracycline and make it inactive.Rate this question:
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- 7.
The nurse is reviewing the medication history of a patient who will be taking an antibiotic. During antibiotic therapy, a significant drug interaction may occur with which drug group?
- A.
Opioids
- B.
Oral contraceptives
- C.
Antihypertensives
- D.
Antihistamines
Correct Answer
B. Oral contraceptivesExplanation
The effectiveness of oral contraceptives may be decreased with certain antibiotics.Rate this question:
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- 8.
The nurse is monitoring for therapeutic results of antibiotic therapy in a patient with an infection. Which laboratory value would indicate therapeutic effectiveness of this therapy?
- A.
Increased red blood cell count
- B.
Increased white blood cell count
- C.
Decreased white blood cell count
- D.
Decreased platelet count
Correct Answer
C. Decreased white blood cell countExplanation
Decreased white blood cell counts are an indication of reduction of infection and are a therapeutic effect of antibiotic therapy. The other options are incorrect.Rate this question:
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- 9.
The nurse is reviewing the sputum culture results of a patient with pneumonia and notes that the patient has a gram-positive infection. Which type of cephalosporin is most appropriate for this infection?
- A.
First generation
- B.
Second generation
- C.
Third generation
- D.
Fourth generation
Correct Answer
A. First generationExplanation
First-generation cephalosporins provide excellent coverage against gram-positive bacteria but limited coverage against gram-negative bacteria.Rate this question:
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- 10.
A patient has received an antibiotic to take for a week before planned oral surgery. The nurse knows that this is an example of which type of therapy?
- A.
Empirical
- B.
Prophylactic
- C.
Definitive
- D.
Resistance
Correct Answer
B. ProphylacticExplanation
Prophylactic antibiotic therapy is used to prevent infection. Empiric therapy involves selecting the antibiotic that can best kill the microorganisms known to be the most common causes of an infection. Definitive therapy occurs once the culture and sensitivity results are known. Resistance is not a type of antibiotic therapy.Rate this question:
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- 11.
A patient has a urinary tract infection. The nurse knows that which class of drugs is especially useful for such infections?
- A.
Sulfonamides
- B.
Carbapenems
- C.
Macrolides
- D.
Tetracyclines
Correct Answer
A. SulfonamidesExplanation
These antibiotics achieve very high concentrations in the kidneys, through which they are eliminated. Therefore, sulfonamides are often used in the treatment of urinary tract infections.Rate this question:
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- 12.
During drug therapy for pneumonia, a female patient develops a superinfection. The nurse explains that this infection is caused by
- A.
Large doses of antibiotics that kill normal flora.
- B.
The infection spreading from her lungs to the new site of infection.
- C.
Resistance of the pneumonia-causing bacteria to the drugs.
- D.
An allergic reaction to the antibiotics.
Correct Answer
A. Large doses of antibiotics that kill normal flora.Explanation
Normally occurring bacteria are killed during antibiotic therapy, allowing other flora to take over and resulting in superinfections.Rate this question:
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- 13.
The nurse is preparing to use an antiseptic. Which statement is correct regarding how antiseptics differ from disinfectants?
- A.
Antiseptics are used to sterilize surgical equipment.
- B.
Disinfectants are used as preoperative skin preparation.
- C.
Antiseptics are used on living tissue to kill microorganisms.
- D.
Disinfectants are used only on nonliving objects to destroy organisms.
Correct Answer
D. Disinfectants are used only on nonliving objects to destroy organisms.Explanation
Antiseptics primarily inhibit microorganisms but do not necessarily kill them. They are applied exclusively to living tissue. Disinfectants are able to kill organisms and are used only on nonliving objects.Rate this question:
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- 14.
A patient with a long-term intravenous catheter is going home. The nurse knows that if he is allergic to seafood, which antiseptic agent is contraindicated?
- A.
Chlorhexidine gluconate (Hibiclens)
- B.
Hydrogen peroxide
- C.
Povidone-iodine (Betadine)
- D.
Isopropyl alcohol
Correct Answer
C. Povidone-iodine (Betadine)Explanation
Iodine compounds are contraindicated in patients with allergies to seafood. The other options are not correct.Rate this question:
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- 15.
During antibiotic therapy, the nurse should monitor closely for signs and symptoms of a hypersensitivity reaction. Which of the following may be an indication of a hypersensitivity reaction? Select all that apply.
- A.
Wheezing
- B.
Diarrhea
- C.
Shortness of breath
- D.
Swelling of the tongue
- E.
Itching
- F.
Black, hairy tongue
Correct Answer(s)
A. Wheezing
C. Shortness of breath
D. Swelling of the tongue
E. Itching -
- 16.
When a patient is on aminoglycoside therapy, the nurse will monitor the patient for which indicators of potential toxicity?
- A.
Fever
- B.
White blood cell count of 7000 mm3
- C.
Tinnitus and hearing loss
- D.
Decreased creatinine levels
Correct Answer
C. Tinnitus and hearing lossExplanation
Tinnitus and hearing loss could indicate ototoxicity, a potentially serious toxicity in a patient. Nephrotoxicity is indicated by rising blood urea nitrogen and creatinine levels. Fever may be indicative of the patient’s infection; a white blood count of 7000 mm3 is within the normal range of 5000 to 10,000.Rate this question:
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- 17.
The nurse is administering a vancomycin (Vancocin) infusion. Which measure is appropriate for the nurse to implement in order to reduce complications that may occur with this drug’s administration?
- A.
Monitoring blood pressure for hypertension during the infusions
- B.
Infusing the drug rapidly
- C.
Restricting fluids during vancomycin therapy
- D.
Infusing the drug over at least 1 hour
Correct Answer
D. Infusing the drug over at least 1 hourExplanation
Adequate hydration (at least 2 liters of fluid in 24 hours) during vancomycin therapy is important for the prevention of nephrotoxicity. The medication should be infused during at least 60 minutes to reduce red man syndrome. Hypotension may occur during the infusion, especially if it is given too rapidly.Rate this question:
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- 18.
Which of the following nursing diagnoses is appropriate for a patient who has started aminoglycoside therapy?
- A.
Constipation
- B.
Risk for injury (hearing loss)
- C.
Disturbed body image related to gynecomastia
- D.
Imbalanced nutrition, less than body requirements, related to nausea
Correct Answer
B. Risk for injury (hearing loss)Explanation
Patients on aminoglycoside therapy have an increased risk for injury caused by ototoxicity. The other options are incorrect.Rate this question:
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- 19.
A patient who has been hospitalized for 2 weeks has developed a pressure ulcer that contains multidrug-resistant Staphylococcus aureus (MRSA). Which drug would the nurse expect to be chosen for his therapy?
- A.
Metronidazole (Flagyl)
- B.
Tobramycin (Nebcin)
- C.
Vancomycin (Vancocin)
- D.
Ciprofloxacin (Cipro)
Correct Answer
C. Vancomycin (Vancocin)Explanation
Vancomycin is the drug of choice for the treatment of MRSA. The other drugs and drug classes are not used for MRSA.Rate this question:
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- 20.
A patient is receiving aminoglycoside therapy and will be receiving a beta-lactam antibiotic as well. The patient asks why two antibiotics have been ordered. What is the nurse’s best response?
- A.
“The combined effect of both antibiotics is greater than each of them alone.”
- B.
“The first antibiotic was not strong enough to work.”
- C.
“We have not yet isolated the bacteria, so the two antibiotics are given to cover a wide range of microorganisms.”
- D.
“We can give a reduced amount of each one if we give them together.”
Correct Answer
A. “The combined effect of both antibiotics is greater than each of them alone.”Explanation
Aminoglycosides are often used in combination with other antibiotics, such as beta-lactams or vancomycin, in the treatment of various infections because the combined effect of the two antibiotics is greater than that of either drug alone.Rate this question:
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- 21.
When reviewing the medication orders for a patient who will be receiving linezolid (Zyvox) therapy, the nurse is aware that this drug may interact with which medications?
- A.
Calcium channel blockers
- B.
Selective serotonin-reuptake inhibitor antidepressants
- C.
Phenytoin
- D.
Phenobarbital
Correct Answer
B. Selective serotonin-reuptake inhibitor antidepressantsExplanation
This drug may cause serotonin syndrome when used concurrently with serotonergic drugs such as the selective serotonin-reuptake inhibitor antidepressants.Rate this question:
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- 22.
The nurse is about to give a dose of vancomycin (Vancocin), but before doing so checks the patient’s lab work and finds that the trough vancomycin level is 24 mcg/mL. What will the nurse do next?
- A.
Administer the vancomycin as ordered and draw a peak level.
- B.
Hold the drug and administer 4 hours later.
- C.
Hold the drug and notify the physician.
- D.
Repeat the test to verify results.
Correct Answer
C. Hold the drug and notify the physician.Explanation
Optimal blood levels of vancomycin are a trough level of 10 to 20 mcg/mL. Measurement of peak levels is no longer routinely recommended, and only trough levels are commonly monitored. Blood samples for measurement of trough levels should be drawn immediately before administration of the next dose. Because of the increase in resistant organisms, many clinicians use a trough level of 15 to 20 mcg/mL as their goal. These trough levels mean that even just before the next dose is due, when drug levels should be low, the drug levels are actually too high.Rate this question:
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- 23.
A patient has been diagnosed with Klebsiella pneumoniae carbapenemases. The nurse expects to see orders for which drug?
- A.
Dapsone
- B.
Ciprofloxacin (Cipro)
- C.
Linezolid (Zyvox)
- D.
Colistimethate sodium or colistin (Coly-Mycin)
Correct Answer
D. Colistimethate sodium or colistin (Coly-Mycin)Explanation
Colistimethate (Coly-Mycin), commonly referred to as colistin, is now being used again, often as one of the only drugs available to treat this infection. The other options are incorrect.Rate this question:
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- 24.
A 79-year-old patient is receiving a quinolone as treatment for a complicated incision infection. The nurse will monitor for which adverse effect that is associated with these drugs?
- A.
Neuralgia
- B.
Double vision
- C.
Hypotension
- D.
Tendinitis and tendon rupture
Correct Answer
D. Tendinitis and tendon ruptureExplanation
See Table 39-4 for common adverse effects of quinolones. A black-box warning is required by the U.S. Food and Drug Administration for all quinolones because of the increased risk for tendinitis and tendon rupture with use of the drugs. This effect is more common in elderly patients, patients with renal failure, and those receiving concurrent glucocorticoid therapy (e.g., prednisone). The other options are not common adverse effects.Rate this question:
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- 25.
The nurse who is administering aminoglycoside therapy must monitor the patient closely for signs of toxicity as manifested by which of the following? Select all that apply.
- A.
Electrocardiogram changes
- B.
Hearing loss
- C.
Dizziness
- D.
Blood dyscrasias
- E.
Decreasing serum creatinine level
- F.
Rising serum creatinine level
Correct Answer(s)
B. Hearing loss
C. Dizziness
F. Rising serum creatinine levelExplanation
Patients on aminoglycoside therapy must be monitored for signs of nephrotoxicity (rising serum creatinine level) and ototoxicity (hearing loss, dizziness). The other options are not signs of toxicity.Rate this question:
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- 26.
The nurse is administering intravenous vancomycin (Vancocin) to a patient who has had gastrointestinal surgery. Which nursing measures are appropriate? Select all that apply.
- A.
Monitoring serum creatinine levels
- B.
Restricting fluids while the patient is on this medication
- C.
Warning the patient that he might feel flushed or have facial itching
- D.
Instructing the patient to report dizziness or a feeling of fullness in the ears
- E.
Reporting a trough drug level of 12 mcg/mL and holding the drug
- F.
Reporting a trough drug level of 24 mcg/mL and holding the drug
Correct Answer(s)
A. Monitoring serum creatinine levels
C. Warning the patient that he might feel flushed or have facial itching
D. Instructing the patient to report dizziness or a feeling of fullness in the ears
F. Reporting a trough drug level of 24 mcg/mL and holding the drugExplanation
Constant monitoring for drug-related neurotoxicity, nephrotoxicity, ototoxicity, and superinfection remain critical to patient safety. Monitor for nephrotoxicity by monitoring serum creatinine levels. Ototoxicity may be indicated if a patient experiences dizziness or a feeling of fullness in the ears, and these symptoms should be reported immediately. Vancomycin infusions may cause red man syndrome, which is characterized by flushing of the neck and face and a decrease in blood pressure. In addition, adequate hydration (at least 2 liters of fluids every 24 hours unless contraindicated) is most important to prevent nephrotoxicity. Optimal trough blood levels of vancomycin are 10 to 20 mcg/mL; therefore, the drug should not be administered when there is a trough level of 24 mcg/mL.Rate this question:
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- 27.
A patient diagnosed with shingles is taking topical acyclovir and the nurse is providing instructions about adverse effects. Which are adverse effects of topical acyclovir that should be discussed with the patient?
- A.
Insomnia and nervousness
- B.
Temporary swelling and rash
- C.
Transient burning when applied
- D.
This medication has no adverse effects.
Correct Answer
C. Transient burning when appliedExplanation
Transient burning may occur with the topical application of acyclovir. The other options are not correct.Rate this question:
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- 28.
A patient who has undergone bone marrow transplantation has contracted cytomegalovirus (CMV) retinitis. The nurse expects which drug to be ordered for this patient?
- A.
Acyclovir (Zovirax)
- B.
Ganciclovir (Cytovene)
- C.
Zanamivir (Relenza)
- D.
Amantadine (Symmetrel)
Correct Answer
B. Ganciclovir (Cytovene)Explanation
Ganciclovir is indicated for the treatment of cytomegalovirus retinitis. Acyclovir is used for herpes simplex types 1 and 2, herpes zoster, and chickenpox; amantadine is used for influenza A; and zanamivir is used for influenza types A and B.Rate this question:
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- 29.
An infant has been hospitalized with a severe lung infection caused by the respiratory syncytial virus (RSV). The nurse expects which drug to be administered via the inhalation route?
- A.
Acyclovir (Zovirax)
- B.
Ganciclovir (Cytovene)
- C.
Amantadine (Symmetrel)
- D.
Ribavirin (Virazole)
Correct Answer
D. Ribavirin (Virazole)Explanation
The inhalational form (Virazole) is used primarily in the treatment of hospitalized infants with severe lower respiratory tract infections caused by RSV. The other drugs listed are not used for the treatment of RSV.Rate this question:
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- 30.
A patient with AIDS has been taking zidovudine (Retrovir) therapy for almost 1 year. At this time, the physician decides to switch her medication to didanosine. The patient is very concerned about this change. What will the nurse explain to her?
- A.
The didanosine is less expensive.
- B.
Didanosine has been shown to improve survival rates.
- C.
The zidovudine therapy is effective for only a year.
- D.
The zidovudine therapy may have caused severe bone marrow suppression.
Correct Answer
D. The zidovudine therapy may have caused severe bone marrow suppression.Explanation
Bone marrow suppression is often the reason that a patient with HIV infection has to be switched to another anti-HIV drug such as didanosine. The two drugs can be taken together, cutting back on the dosages of both and thus decreasing the likelihood of toxicity.Rate this question:
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- 31.
The nurse is administering intravenous acyclovir (Zovirax) to a patient with a viral infection. Which administration technique is correct?
- A.
Intravenous infusions should be administered slowly, over at least 1 hour.
- B.
Intravenous infusions should be administered by rapid bolus.
- C.
Intravenous acyclovir should be refrigerated.
- D.
Oral fluids should be restricted while a patient is taking intravenous acyclovir.
Correct Answer
A. Intravenous infusions should be administered slowly, over at least 1 hour.Explanation
Intravenous acyclovir is stable for 12 hours at room temperature and often precipitates when refrigerated. Intravenous infusions should be diluted as recommended (e.g., with 5% dextrose in water or normal saline) and infused with caution. Infusion over longer than 1 hour is suggested to avoid the renal tubular damage seen with more rapid infusions. Adequate hydration should be encouraged (unless contraindicated) during the infusion and for several hours afterward to prevent drug-related crystalluria.Rate this question:
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- 32.
A patient is receiving cidofovir as part of the treatment for a viral infection, and the nurse is preparing to administer probenecid, which is also ordered. The nurse understands that the probenecid is given for which reason?
- A.
It has a synergistic effect when given with cidofovir, thus making the antiviral medication more effective.
- B.
The probenecid also prevents the replication of the virus.
- C.
Concurrent drug therapy with probenecid reduces the nephrotoxicity of the cidofovir.
- D.
The probenecid reduces the adverse gastrointestinal effects of the cidofovir.
Correct Answer
C. Concurrent drug therapy with probenecid reduces the nephrotoxicity of the cidofovir.Explanation
Probenecid is recommended as concurrent drug therapy with cidofovir to help alleviate the nephrotoxic effects of probenecid. The other options are not correct.Rate this question:
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- 33.
A patient is taking a combination of antiviral drugs as treatment for early stages of HIV infection. While discussing the drug therapy, he asks the nurse if the drugs will kill the virus. When answering him, the nurse keeps in mind the fact that antiviral drugs
- A.
Are given for palliative reasons only.
- B.
Will be effective as long as he is not exposed to the virus again.
- C.
Can be given in large enough doses to eradicate the virus without harming the body’s healthy cells.
- D.
May also kill healthy cells while killing viruses.
Correct Answer
D. May also kill healthy cells while killing viruses.Explanation
Because viruses reproduce in human cells, selective killing is difficult; consequently, many healthy human cells, in addition to virally infected cells, may be killed in the process, and this results in the serious toxicities that are involved with these drugs.Rate this question:
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- 34.
A young adult calls the clinic to ask for a prescription for “that new flu drug.” He says he has had the flu for almost 4 days and just heard about a drug that can reduce the symptoms. Based on knowledge of antiviral therapy for influenza, what is the nurse’s best response to his request?
- A.
“Now that you’ve had the flu, you will need a booster vaccination, not the antiviral drug.”
- B.
“We need to do a blood test to verify that you actually have the flu.”
- C.
“Ideally, drug therapy should be started within 2 days of symptom onset, not 4 days
- D.
“We’ll get you a prescription. As long as you start treatment within the next 24 hours, the drug should be effective.”
Correct Answer
C. “Ideally, drug therapy should be started within 2 days of symptom onset, not 4 daysExplanation
These drugs should be started within 2 days of influenza symptom onset; they can be used for prophylaxis and treatment of influenza. The other options are not correct.Rate this question:
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- 35.
A patient diagnosed with genital herpes is taking topical acyclovir. What teaching is important for this patient? Select all that apply.
- A.
“Be sure to wash your hands thoroughly before and after applying this medicine.”
- B.
“Apply this ointment until the lesion stops hurting.”
- C.
“Sterile gloves are required when applying this ointment.”
- D.
“Use a clean glove when applying this ointment.”
- E.
“If your partner develops these lesions, then he can also use the medication.”
- F.
“You need to avoid touching the area around your eyes.”
- G.
“You will have to practice abstinence when these lesions are active.”
- H.
“Ask your health care provider about getting Pap smears done every 6 months because of an increased risk for cervical cancer.”
Correct Answer(s)
A. “Be sure to wash your hands thoroughly before and after applying this medicine.”
D. “Use a clean glove when applying this ointment.”
F. “You need to avoid touching the area around your eyes.”
G. “You will have to practice abstinence when these lesions are active.”
H. “Ask your health care provider about getting Pap smears done every 6 months because of an increased risk for cervical cancer.”Explanation
This medication should be applied as long as prescribed, and sterile gloves are not needed. Prescriptions should not be shared; if the partner develops these lesions, the partner will have to be evaluated before medication is prescribed, if needed.Rate this question:
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- 36.
A patient is in the HIV clinic for a follow-up appointment. He has been on antiretroviral therapy for HIV for more than 3 years. The nurse will assess for which potential adverse effects of long-term antiretroviral therapy? Select all that apply.
- A.
Lipodystrophy
- B.
Liver damage
- C.
Kaposi’s sarcoma
- D.
Osteoporosis
- E.
Type 2 diabetes
Correct Answer(s)
A. Lipodystrophy
B. Liver damage
D. Osteoporosis
E. Type 2 diabetesExplanation
Anti-HIV drugs produce strain on the liver and may result in liver disease. A major adverse effect of protease inhibitors is lipid abnormalities, including lipodystrophy, or redistribution of fat stores under the skin. In addition, dyslipidemias such as hypertriglyceridemia can occur, and insulin resistance and type 2 diabetes symptoms can result. The increase in long-term antiretroviral drug therapy due to prolonged disease survival has led to the emergence of another long-term adverse effect associated with these medications—bone demineralization and possible osteoporosis. Kaposi’s sarcoma is an opportunistic disease associated with HIV, not a result of long-term drug therapy.Rate this question:
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- 37.
The nurse is discussing adverse effects of antitubercular drugs. Which potential adverse effect should the patient report to his or her prescriber?
- A.
Gastrointestinal upset
- B.
Headache and nervousness
- C.
Reddish-orange urine and stool
- D.
Numbness and tingling of extremities
Correct Answer
D. Numbness and tingling of extremitiesExplanation
Patients on antitubercular therapy should report experiencing numbness and tingling of extremities, which may indicate peripheral neuropathy. Some drugs may color the urine, stool, and other body secretions reddish-orange, but this is not an effect that needs to be reported. Patients should be informed of this expected effect.Rate this question:
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- 38.
A patient who has been taking isoniazid (INH) has a new prescription for pyridoxine. She is wondering why she needs this medication. The nurse explains that pyridoxine is given concurrently with the isoniazid to prevent
- A.
Hair loss.
- B.
Renal failure.
- C.
Peripheral neuropathy.
- D.
Heart failure.
Correct Answer
C. Peripheral neuropathy.Explanation
Pyridoxine (vitamin B6) may be beneficial for isoniazid-induced peripheral neuropathy. The other options are not correct.Rate this question:
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- 39.
When assessing patients who are to receive antitubercular therapy, the nurse should assess for which potential contraindication?
- A.
Glaucoma
- B.
Anemia
- C.
Heart failure
- D.
Hepatic impairment
Correct Answer
D. Hepatic impairmentExplanation
Results of liver function studies (e.g., bilirubin level, liver enzyme levels) need to be assessed because isoniazid and rifampin may cause hepatic impairment; severe liver dysfunction is a contraindication to these drugs. In addition, the patient’s history of alcohol use should be assessed.Rate this question:
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- 40.
When monitoring patients on antitubercular drug therapy, the nurse knows that which drug may cause a decrease in visual acuity?
- A.
Rifampin
- B.
Isoniazid
- C.
Ethambutol
- D.
Streptomycin
Correct Answer
C. EthambutolExplanation
Ethambutol may cause a decrease in visual acuity or even blindness resulting from retrobulbar neuritis.Rate this question:
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- 41.
A patient has been taking antitubercular therapy for 3 months. The nurse notes a therapeutic response to these drugs with which assessment findings?
- A.
The chronic cough is gone.
- B.
There are two consecutive negative purified protein derivative (PPD) results over 2 months.
- C.
There is increased tolerance to the medication therapy and there are fewer reports of adverse effects.
- D.
There is a decrease in symptoms of tuberculosis along with improved chest x-rays and sputum cultures.
Correct Answer
D. There is a decrease in symptoms of tuberculosis along with improved chest x-rays and sputum cultures.Explanation
A therapeutic response to antitubercular therapy is manifested by a decrease in the symptoms of tuberculosis, such as cough and fever, and by weight gain. The results of laboratory studies (culture and sensitivity tests) and the chest radiographic findings should confirm the clinical findings of resolution of the infection.Rate this question:
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- 42.
The nurse is counseling a woman who will be starting rifampin. The patient is on oral contraceptives. Which statement is true regarding rifampin therapy for this patient?
- A.
Women have a high risk for thrombophlebitis while on this drug.
- B.
A higher dose of rifampin will be necessary because of the contraceptive.
- C.
Oral contraceptives are less effective while the patient is taking rifampin.
- D.
The incidence of adverse effects is greater if the two drugs are taken together.
Correct Answer
C. Oral contraceptives are less effective while the patient is taking rifampin.Explanation
Women taking oral contraceptives and rifampin should be counseled about other forms of birth control because of the impaired effectiveness of the oral contraceptives during concurrent use of rifampin.Rate this question:
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- 43.
The nurse is reviewing the medication record of a patient who is taking isoniazid (INH). Which drug or drug class has a significant drug interaction with isoniazid?
- A.
Pyridoxine
- B.
Penicillin
- C.
Antacids
- D.
Benzodiazepines
Correct Answer
C. AntacidsExplanation
Antacids reduce absorption of isoniazid and thus reduce serum levels. Pyridoxine is often given with isoniazid to prevent peripheral neuropathy. The other options are not correct.Rate this question:
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- 44.
A patient who has started drug therapy for tuberculosis wants to know how long he will be on the medications. What is the nurse’s best response?
- A.
“Drug therapy will last until the symptoms have stopped.”
- B.
“Drug therapy will continue until the tuberculosis develops resistance.”
- C.
“You should expect to take these drugs for as long as 24 months.”
- D.
“You will be on antituberculosis drug therapy for the rest of your life.”
Correct Answer
C. “You should expect to take these drugs for as long as 24 months.”Explanation
Drug therapy commonly lasts for 24 months if consistent drug therapy has been maintained.Rate this question:
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- 45.
The nurse is preparing to administer morning medications to a patient who has been newly diagnosed with tuberculosis. The patient asks, “Why do I have to take so many different drugs?” Which answer by the nurse is correct?
- A.
“It is hoped that at least one of these drugs will work to fight the tuberculosis.”
- B.
“Taking multiple drugs reduces the chance that the tuberculosis will become drug resistant.”
- C.
“Using several drugs has a faster effect than single-drug therapy.”
- D.
“Using multiple drugs enhances the effect of each drug.”
Correct Answer
B. “Taking multiple drugs reduces the chance that the tuberculosis will become drug resistant.”Explanation
The use of multiple medications reduces the possibility that the organism will become drug resistant. The other options are not correct.Rate this question:
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- 46.
Important points the nurse should emphasize when teaching a patient who will be taking antitubercular therapy include which of the following? Select all that apply.
- A.
“Take medications until the symptoms disappear.”
- B.
“Take medications at the same time every day.”
- C.
“You will be considered contagious during most of the illness and must take precautions to avoid spreading the disease.”
- D.
“Stop taking the medications if you have severe adverse effects.”
- E.
“Alcoholic beverages should be avoided while on this therapy.”
- F.
“If you notice reddish-brown or reddish-orange urine, stop taking the drug and contact your doctor right away.”
- G.
“If you experience a burning or tingling in your fingers or toes, report it to your physician immediately.”
- H.
“Oral contraceptives may not work while you are taking these drugs, so you will have to use another form of birth control.”
Correct Answer(s)
B. “Take medications at the same time every day.”
E. “Alcoholic beverages should be avoided while on this therapy.”
G. “If you experience a burning or tingling in your fingers or toes, report it to your physician immediately.”
H. “Oral contraceptives may not work while you are taking these drugs, so you will have to use another form of birth control.”Explanation
Medications for tuberculosis must be taken on a consistent schedule to maintain blood levels. Medication therapy for tuberculosis may last up to 24 months, long after symptoms disappear, and patients are infectious during the early part of the treatment. Compliance with antitubercular drug therapy is key, so if symptoms become severe, the prescriber should be contacted for an adjustment of the drug therapy. The medication should not be stopped. Because of potential liver toxicity, patients on this drug therapy should not drink alcohol. Discoloration of the urine is an expected adverse effect, and patients should be warned about it beforehand. A second form of birth control should be used because antitubercular drug therapy makes oral contraceptives ineffective.Rate this question:
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- 47.
During an intravenous (IV) infusion of amphotericin B, a patient develops tingling and numbness in his toes and fingers. What will the nurse do?
- A.
Discontinue the infusion immediately.
- B.
Reduce the infusion rate gradually until the adverse effects subside.
- C.
Administer the medication by rapid IV infusion to reduce the potential adverse effects.
- D.
Nothing; these are expected side effects of this medication.
Correct Answer
A. Discontinue the infusion immediately.Explanation
Once the intravenous infusion of amphotericin B has begun, vital signs should be monitored frequently to assess for adverse reactions such as cardiac dysrhythmias, visual disturbances, paresthesias (numbness or tingling of the hands or feet), respiratory difficulty, pain, fever, chills, and nausea. Should these adverse effects or a severe reaction occur, the infusion should be discontinued (while the patient is closely monitored) and the prescriber contacted. The other options are not correct.Rate this question:
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- 48.
When reviewing the history of a patient who will be taking an antifungal drug, the nurse knows that which of the following conditions is a contraindication to these drugs?
- A.
Diabetes mellitus
- B.
Renal failure
- C.
Hyperthyroidism
- D.
Meningitis
Correct Answer
B. Renal failureExplanation
Liver failure, kidney failure, and porphyria (for griseofulvin) are the most common contraindications for antifungal drugs. The other options are not contraindications.Rate this question:
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- 49.
If a patient is taking an antifungal drug with an oral anticoagulant, the nurse should monitor for which possible interaction?
- A.
Reduced action of oral anticoagulants, resulting in decreased prothrombin time-international normalized ratio (PT-INR)
- B.
Increased action of oral anticoagulants, resulting in increased PT-INR
- C.
Increased change in renal impairment caused by the antifungal drug
- D.
Decreased effectiveness of the antifungal drug
Correct Answer
B. Increased action of oral anticoagulants, resulting in increased PT-INRExplanation
Some antifungal drugs increase the effects of oral anticoagulants, which manifest as increases in PT-INR. As a result, increased bleeding may occur. The other options are not correct.Rate this question:
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- 50.
The nurse is preparing an infusion of amphotericin B for a patient who has a severe fungal infection. Which intervention is appropriate regarding the potential adverse effects of amphotericin B?
- A.
Discontinuing the infusion immediately if fever, chills, or nausea occur
- B.
Gradually increasing the infusion rate until adverse effects occur
- C.
If fever, chills, or nausea occur during the infusion, administering medications to treat the symptoms
- D.
Before beginning the infusion, administering an antipyretic and an antiemetic drug
Correct Answer
D. Before beginning the infusion, administering an antipyretic and an antiemetic drugExplanation
Almost all patients given the drug intravenously experience fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache. For this reason, as noted earlier, pretreatment with an antipyretic (acetaminophen), antihistamines, and antiemetics may be conducted to decrease the severity of the infusion-related reaction. The other options are not correct.Rate this question:
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Feb 12, 2012Quiz Edited by
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Feb 12, 2012Quiz Created by
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