Medical-Surgical CMS Review 2025/2026
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A physician writes an order for gentamicin 7 mg per kg intravenously every 24 hours and ampicillin
500 mg intravenously every 6 hours. The patient has a diagnosis of endocarditis. This is not an ideal
antibiotic regimen for endocarditis because...
A. it is best to use multiple daily dosing of gentamicin for endocarditis
B. the addition of gentamicin to ampicillin increases the risk of treatment failure in endocarditis
C. the appropriate single daily dose of gentamicin is 15 mg per kg once daily
D. streptomycin is the recommended aminoglycoside for use in endocarditis
A. Once-daily aminoglycoside dosing is contraindicated in patients with endocarditis, and only the
conventional dosing regimen should be used. B is incorrect because gentamicin and ampicillin are
recommended in endocarditis, and they increase the risk of treatment success, not failure. C is incorrect
because the single daily dose of gentamicin is a maximum of 7 mg/kg, not 15 mg/kg, once daily. D is
incorrect because streptomycin is not the recommended aminoglycoside for use in endocarditis.
A patient from a nursing home arrives at the emergency department with acute pyelonephritis. The
physician prescribes ciprofloxacin 500 mg PO twice daily. The patient has a history of seizures and
bradycardia. The nurse should...
A. counsel the patient's caregiver to avoid administering the ciprofloxacin with the patient's
anticonvulsant
B. ask the physician to check blood levels of the patient's anticonvulsant(s) before giving the first dose
of ciprofloxacin
C. call the patient's seizure and dysrhythmia history to the physician's attention and inquire whether
another type of antibiotic might be selected
D. counsel the patient's caregiver to discontinue the ciprofloxacin after the patient's fever is gone
C. The addition of ciprofloxacin has led to documented drug interactions with anticonvulsants and
antidysrhythmics, and the prescriber should choose an alternative if possible. A is incorrect because the
patient needs to take the anticonvulsant for seizures as well as an antibiotic for pyelonephritis. Altering
the administration schedule may precipitate seizures. B is incorrect because even if levels are obtained,
it is the concurrent administration ciprofloxacin that can alter the levels of the anticonvulsant. In
addition, an interaction with the antidysrhythmic agent may prolong the QT interval. D is incorrect
because all antibiotics should be taken for the entire duration of therapy, even if the patient feels better
or the fever is gone.
A nurse reading a patient's chart notices that the patient is scheduled to receive ciprofloxacin 500 mg
PO at 9:00 AM. The medication administration record also indicates that Maalox 30 mL PO and
hydrochlorothiazide 25 mg PO are due at 9:00 AM. The nurse should...
,A. administer all the medications as scheduled
B. hold the Maalox until 11:00 AM
C. ask the physician to discontinue hydrochlorothiazide because of increased risk of ototoxicity
D. administer the Maalox and ciprofloxacin but hold the hydrochlorothiazide
B. Ciprofloxacin can chelate with cations, and iron, multivitamins, calcium, magnesium, aluminum salts,
and sucralfate may significantly reduce the absorption of ciprofloxacin. Therefore, ciprofloxacin should
be taken 2 hours before or 6 hours after administration of the other agents. A is incorrect because
Maalox impairs the absorption of ciprofloxacin. C is incorrect because loop diuretics, not thiazide
diuretics, potentiate the effects of nephrotoxicity. D is incorrect because of the interaction with Maalox
and ciprofloxacin. Thiazide diuretics do not interact with ciprofloxacin like loop diuretics do.
An outpatient has just received a prescription for ciprofloxacin 500 mg PO twice daily for acute
bronchitis. The nurse should teach the patient...
A. not to take ciprofloxacin with a meal
B. to restrict fluid intake to avoid fluid overload
C. to take ciprofloxacin with an antacid (e.g., Tums) to decrease the chance of stomach upset
D. to avoid prolonged exposure to sunlight
D. Photosensitivity may occur with exposure to direct or indirect sunlight; therefore, the patient should
avoid prolonged exposure to the sun. Sunscreens do not prevent photosensitivity reactions. A is
incorrect because patients may take ciprofloxacin with food to avoid gastrointestinal upset. B is
incorrect because adequate fluid intake should accompany a ciprofloxacin dose to prevent drug crystals
from forming in the urinary tract. C is incorrect because ciprofloxacin interacts with antacids, resulting in
impaired ciprofloxacin absorption.
A patient is admitted to the emergency department following opening an envelope containing a
substance that experts have identified as anthrax. Which of the following medications is
administered?
A. tetracycline
B. doxycycline
C. amoxicillin-clavulanic acid combination
D. neomycin
B. Patients who are asymptomatic receive doxycycline or ciprofloxacin for 60 days following exposure to
anthrax.
A patient receiving tetracycline should receive the following instruction regarding the medication?
A. Take tetracycline with food.
B. Take tetracycline in combination with antacids.
C. Take the first dose and then obtain a test known as culture and sensitivity.
D. Take tetracycline with a full glass of water.
,D. Tetracycline should be taken with a full glass of water.
Which of the following foods should not be taken with tetracycline?
A. orange juice with calcium
B. cranberry juice cocktail
C. tomato juice
D. lemonade
A. Tetracycline is contraindicated with calcium or dairy products.
A man is receiving treatment for a Mycoplasma pneumoniae infection. He says that drinking orange
juice hurts his mouth. What priority assessment should the nurse make?
A. Assess the patient's fecal output for signs and symptoms of diarrhea.
B. Assess the patient's mouth for signs of candidal infection.
C. Assess the patient's lung sounds for rales or rhonchi.
D. Assess the patient's intake and output.
B. When a patient complains of mouth pain and difficulty swallowing when taking an antiinfective agent
such as tetracycline, it is necessary to inspect the patient's mouth for white patchy areas. These areas
indicate Candida albicans, a superinfection of the mouth.
Which laboratory value should the nurse assess in patients who are receiving demeclocycline?
A. blood urea nitrogen
B. aspartate aminotransferase
C. alanine aminotransferase
D. creatinine
A. When administering demeclocycline, it is important to monitor the patient's blood urea nitrogen
(BUN). Increases in the BUN are secondary to antianabolic Effect
A woman develops a urinary tract infection following the delivery of an infant. The nurse practitioner
is considering prescribing trimethoprim-sulfamethoxazole. What assessment is necessary to make?
A. if the woman is breast-feeding
B. if the woman has been treated with the medication in the past
C. if anyone in her family has a known allergy to the drug
D. if she is experiencing hematuria
A. It is important to assess if the woman is breast-feeding. If a fetus or young infant receives a
sulfonamide by placental transfer, in breast milk, or by direct administration, the drug displaces bilirubin
from binding sites on albumin. As a result, bilirubin may accumulate in the bloodstream
(hyperbilirubinemia) and central nervous system (kernicterus), causing life-threatening toxicity.
When administering a sulfonamide, which of the following interventions is most effective in
decreasing crystalluria?
, A. administering 8 ounces of cranberry juice
B. providing a full liquid diet during the course of drug therapy
C. inserting a Foley catheter for the measurement of an accurate intake and output
D. providing a minimum of 2000 mL of fluid per day
D. To prevent crystalluria, it is essential that patients receive 2000 mL of fluids in a 24-hour period.
A physician has ordered sulfisoxazole for a woman with a urinary tract infection. The nurse has asked
the patient about whether she takes any over-the-counter medications. The patient reports that she
regularly takes St. John's wort as a mood elevator. Which of the following patient teaching
interventions is most important?
A. Taking St. John's wort and sulfisoxazole results in no known interactions.
B. Sulfisoxazole combined with St. John's wort leads to an increased therapeutic effect of the
sulfisoxazole.
C. Sulfisoxazole has a decreased effect when given with St. John's wort.
D. When given in combination, sulfisoxazole and St. John's wort result in manic tendencies.
B. When taken concurrently with sulfisoxazole, St. John's wort enhances the effects of the sulfisoxazole.
A nurse is applying silver sulfadiazine (Silvadene) to a child's burns. Which of the following nursing
actions is most important when applying the medication?
A. providing pain medication
B. using sterile gloves
C. giving the child a bath
D. teaching the parent to apply the medication
B. When applying silver sulfadiazine (Silvadene) to a burned area, it is important to wear sterile gloves.
A physician has ordered intravenous sulfamethoxazole with trimethoprim. How should the nurse
administer the medication?
A. in 500 mL of 0.45% normal saline
B. in 150 mL of 10% dextrose and water
C. in 125 mL of 5% dextrose and water
D. in 125 mL of 5% dextrose and 0.45% normal saline
C. When administering sulfamethoxazole and trimethoprim intravenously, it is necessary to dilute the
medication in 125 mL of 5% dextrose and water.
A nurse practitioner has prescribed nitrofurantoin (Macrodantin) for a woman with a urinary tract
infection. Which of the following cardiovascular adverse effects is this patient at risk for developing?
A. inverted T wave
B. widened QRS
(100% verified)Latest Update
_____________________________________________________________________________________
A physician writes an order for gentamicin 7 mg per kg intravenously every 24 hours and ampicillin
500 mg intravenously every 6 hours. The patient has a diagnosis of endocarditis. This is not an ideal
antibiotic regimen for endocarditis because...
A. it is best to use multiple daily dosing of gentamicin for endocarditis
B. the addition of gentamicin to ampicillin increases the risk of treatment failure in endocarditis
C. the appropriate single daily dose of gentamicin is 15 mg per kg once daily
D. streptomycin is the recommended aminoglycoside for use in endocarditis
A. Once-daily aminoglycoside dosing is contraindicated in patients with endocarditis, and only the
conventional dosing regimen should be used. B is incorrect because gentamicin and ampicillin are
recommended in endocarditis, and they increase the risk of treatment success, not failure. C is incorrect
because the single daily dose of gentamicin is a maximum of 7 mg/kg, not 15 mg/kg, once daily. D is
incorrect because streptomycin is not the recommended aminoglycoside for use in endocarditis.
A patient from a nursing home arrives at the emergency department with acute pyelonephritis. The
physician prescribes ciprofloxacin 500 mg PO twice daily. The patient has a history of seizures and
bradycardia. The nurse should...
A. counsel the patient's caregiver to avoid administering the ciprofloxacin with the patient's
anticonvulsant
B. ask the physician to check blood levels of the patient's anticonvulsant(s) before giving the first dose
of ciprofloxacin
C. call the patient's seizure and dysrhythmia history to the physician's attention and inquire whether
another type of antibiotic might be selected
D. counsel the patient's caregiver to discontinue the ciprofloxacin after the patient's fever is gone
C. The addition of ciprofloxacin has led to documented drug interactions with anticonvulsants and
antidysrhythmics, and the prescriber should choose an alternative if possible. A is incorrect because the
patient needs to take the anticonvulsant for seizures as well as an antibiotic for pyelonephritis. Altering
the administration schedule may precipitate seizures. B is incorrect because even if levels are obtained,
it is the concurrent administration ciprofloxacin that can alter the levels of the anticonvulsant. In
addition, an interaction with the antidysrhythmic agent may prolong the QT interval. D is incorrect
because all antibiotics should be taken for the entire duration of therapy, even if the patient feels better
or the fever is gone.
A nurse reading a patient's chart notices that the patient is scheduled to receive ciprofloxacin 500 mg
PO at 9:00 AM. The medication administration record also indicates that Maalox 30 mL PO and
hydrochlorothiazide 25 mg PO are due at 9:00 AM. The nurse should...
,A. administer all the medications as scheduled
B. hold the Maalox until 11:00 AM
C. ask the physician to discontinue hydrochlorothiazide because of increased risk of ototoxicity
D. administer the Maalox and ciprofloxacin but hold the hydrochlorothiazide
B. Ciprofloxacin can chelate with cations, and iron, multivitamins, calcium, magnesium, aluminum salts,
and sucralfate may significantly reduce the absorption of ciprofloxacin. Therefore, ciprofloxacin should
be taken 2 hours before or 6 hours after administration of the other agents. A is incorrect because
Maalox impairs the absorption of ciprofloxacin. C is incorrect because loop diuretics, not thiazide
diuretics, potentiate the effects of nephrotoxicity. D is incorrect because of the interaction with Maalox
and ciprofloxacin. Thiazide diuretics do not interact with ciprofloxacin like loop diuretics do.
An outpatient has just received a prescription for ciprofloxacin 500 mg PO twice daily for acute
bronchitis. The nurse should teach the patient...
A. not to take ciprofloxacin with a meal
B. to restrict fluid intake to avoid fluid overload
C. to take ciprofloxacin with an antacid (e.g., Tums) to decrease the chance of stomach upset
D. to avoid prolonged exposure to sunlight
D. Photosensitivity may occur with exposure to direct or indirect sunlight; therefore, the patient should
avoid prolonged exposure to the sun. Sunscreens do not prevent photosensitivity reactions. A is
incorrect because patients may take ciprofloxacin with food to avoid gastrointestinal upset. B is
incorrect because adequate fluid intake should accompany a ciprofloxacin dose to prevent drug crystals
from forming in the urinary tract. C is incorrect because ciprofloxacin interacts with antacids, resulting in
impaired ciprofloxacin absorption.
A patient is admitted to the emergency department following opening an envelope containing a
substance that experts have identified as anthrax. Which of the following medications is
administered?
A. tetracycline
B. doxycycline
C. amoxicillin-clavulanic acid combination
D. neomycin
B. Patients who are asymptomatic receive doxycycline or ciprofloxacin for 60 days following exposure to
anthrax.
A patient receiving tetracycline should receive the following instruction regarding the medication?
A. Take tetracycline with food.
B. Take tetracycline in combination with antacids.
C. Take the first dose and then obtain a test known as culture and sensitivity.
D. Take tetracycline with a full glass of water.
,D. Tetracycline should be taken with a full glass of water.
Which of the following foods should not be taken with tetracycline?
A. orange juice with calcium
B. cranberry juice cocktail
C. tomato juice
D. lemonade
A. Tetracycline is contraindicated with calcium or dairy products.
A man is receiving treatment for a Mycoplasma pneumoniae infection. He says that drinking orange
juice hurts his mouth. What priority assessment should the nurse make?
A. Assess the patient's fecal output for signs and symptoms of diarrhea.
B. Assess the patient's mouth for signs of candidal infection.
C. Assess the patient's lung sounds for rales or rhonchi.
D. Assess the patient's intake and output.
B. When a patient complains of mouth pain and difficulty swallowing when taking an antiinfective agent
such as tetracycline, it is necessary to inspect the patient's mouth for white patchy areas. These areas
indicate Candida albicans, a superinfection of the mouth.
Which laboratory value should the nurse assess in patients who are receiving demeclocycline?
A. blood urea nitrogen
B. aspartate aminotransferase
C. alanine aminotransferase
D. creatinine
A. When administering demeclocycline, it is important to monitor the patient's blood urea nitrogen
(BUN). Increases in the BUN are secondary to antianabolic Effect
A woman develops a urinary tract infection following the delivery of an infant. The nurse practitioner
is considering prescribing trimethoprim-sulfamethoxazole. What assessment is necessary to make?
A. if the woman is breast-feeding
B. if the woman has been treated with the medication in the past
C. if anyone in her family has a known allergy to the drug
D. if she is experiencing hematuria
A. It is important to assess if the woman is breast-feeding. If a fetus or young infant receives a
sulfonamide by placental transfer, in breast milk, or by direct administration, the drug displaces bilirubin
from binding sites on albumin. As a result, bilirubin may accumulate in the bloodstream
(hyperbilirubinemia) and central nervous system (kernicterus), causing life-threatening toxicity.
When administering a sulfonamide, which of the following interventions is most effective in
decreasing crystalluria?
, A. administering 8 ounces of cranberry juice
B. providing a full liquid diet during the course of drug therapy
C. inserting a Foley catheter for the measurement of an accurate intake and output
D. providing a minimum of 2000 mL of fluid per day
D. To prevent crystalluria, it is essential that patients receive 2000 mL of fluids in a 24-hour period.
A physician has ordered sulfisoxazole for a woman with a urinary tract infection. The nurse has asked
the patient about whether she takes any over-the-counter medications. The patient reports that she
regularly takes St. John's wort as a mood elevator. Which of the following patient teaching
interventions is most important?
A. Taking St. John's wort and sulfisoxazole results in no known interactions.
B. Sulfisoxazole combined with St. John's wort leads to an increased therapeutic effect of the
sulfisoxazole.
C. Sulfisoxazole has a decreased effect when given with St. John's wort.
D. When given in combination, sulfisoxazole and St. John's wort result in manic tendencies.
B. When taken concurrently with sulfisoxazole, St. John's wort enhances the effects of the sulfisoxazole.
A nurse is applying silver sulfadiazine (Silvadene) to a child's burns. Which of the following nursing
actions is most important when applying the medication?
A. providing pain medication
B. using sterile gloves
C. giving the child a bath
D. teaching the parent to apply the medication
B. When applying silver sulfadiazine (Silvadene) to a burned area, it is important to wear sterile gloves.
A physician has ordered intravenous sulfamethoxazole with trimethoprim. How should the nurse
administer the medication?
A. in 500 mL of 0.45% normal saline
B. in 150 mL of 10% dextrose and water
C. in 125 mL of 5% dextrose and water
D. in 125 mL of 5% dextrose and 0.45% normal saline
C. When administering sulfamethoxazole and trimethoprim intravenously, it is necessary to dilute the
medication in 125 mL of 5% dextrose and water.
A nurse practitioner has prescribed nitrofurantoin (Macrodantin) for a woman with a urinary tract
infection. Which of the following cardiovascular adverse effects is this patient at risk for developing?
A. inverted T wave
B. widened QRS
