LEHNE’S PHARMACOTHERAPEUTICS FOR ADVANCED PRACTICE NURSES AND PHYSICIAN ASSISTANTS PRACTICE EXAM QUESTIONS WITH CORRECT DETAILED ANSWERS | ALREADY GRADED A+RECENT VERSION

LEHNE’S PHARMACOTHERAPEUTICS FOR ADVANCED PRACTICE NURSES AND PHYSICIAN ASSISTANTS PRACTICE EXAM QUESTIONS WITH CORRECT DETAILED ANSWERS | ALREADY GRADED A+RECENT VERSION 1. Ch 70 basic principles of antimicrobial 740. A patient has a viral sinus infection, and the provider tells the patient that antibiotics will not be prescribed. The patient wants to take an antibiotic and asks the nurse what possible harm could occur by taking an antibiotic. Which response by the nurse is correct? - answer b. "even normal flora can develop resistance and transfer this to pathogens." 2. Ch 70 basic principles of antimicrobial 741. An older adult patient with chronic obstructive pulmonary disease (copd) develops bronchitis. The patient has a temperature of 39.5° c. The nurse will expect the provider to: - answer b. Order empiric antibiotics while waiting for sputum culture results. 3. Ch 70 basic principles of antimicrobial 742. The nurse is caring for a patient on a medical-surgical unit who has a fever of unknown origin. The prescriber has ordered a broad-spectrum antibiotic. Which intervention is the priority? - answer d. Obtaining all cultures before the antibiotic is administered 4. Ch 70 basic principles of antimicrobial 743. The nurse has been caring for a patient who has been taking antibiotics for 3 weeks. Upon assessing the patient, the nurse notices the individual has developed oral thrush. What describes the etiology of the thrush? - answer d. Superinfection 5. Ch 70 basic principles of antimicrobial 744. A child has received amoxicillin [amoxil] for three previous ear infections, but a current otitis media episode is not responding to treatment. The nurse caring for this child suspects that resistance to the bacterial agent has occurred by which microbial mechanism? - answer c. Drug inactivation 6. Ch 70 basic principles of antimicrobial 745. A recent campaign, initiated by the centers for disease control (cdc), to delay the emergence of antibiotic resistance in hospitals, has what as one of its objectives? - answer c. Increased adherence to prescribed antibiotics 7. Ch 70 basic principles of antimicrobial 746. A nursing student asks a nurse to clarify the differences between the mechanisms of spontaneous mutation and conjugation in acquired resistance of microbes. What will the nurse say? - answer c. Spontaneous mutation leads to resistance to only one antimicrobial agent. 8. Ch 70 basic principles of antimicrobial 747. A patient has a localized skin infection, which is most likely caused by a gram-positive cocci. Until the culture and sensitivity results are available, the nurse will expect the provider to order a -spectrum agent. - answer d. Narrow; topical 9. Ch 70 basic principles of antimicrobial 748. A parent asks a nurse if the provider will prescribe an antibiotic for a child who attends school with several children who have strep throat. The child is complaining of a sore throat and has a fever. What will be the nurse's response? - answer d. "your child should come to the clinic to have a throat culture done today." 10. Ch 70 basic principles of antimicrobial 749. The nurse is teaching a nursing student about the mechanism by which antimicrobial agents achieve selective toxicity. Which statement by the student indicates a need for further teaching? - answer c. "some agents cause phagocytosis of bacterial cells." , d. "some agents weaken the cell wall, causing cell wall lysis." 11. Ch 71 drugs that weaken the bacterial cell wall i: penicillins 750. A patient is about to receive penicillin g for an infection that is highly sensitive to this drug. While obtaining the patient's medication history, the nurse learns that the patient experienced a rash when given amoxicillin [amoxil] as a child 20 years earlier. What will the nurse do? - answer c. Request an order for a skin test to assess the current risk. 12. Ch 71 drugs that weaken the bacterial cell wall i: penicillins 751. A patient has an infection caused by pseudomonas aeruginosa. The prescriber has ordered piperacillin and amikacin, both to be given intravenously. What will the nurse do? - answer a. Make sure to administer the drugs at different times using different iv tubing. 13. Ch 71 drugs that weaken the bacterial cell wall i: penicillins 752. A child with an ear infection is not responding to treatment with amoxicillin [amoxil]. The nurse will expect the provider to order: - answer a. Amoxicillin-clavulanic acid [augmentin]. 14. Ch 71 drugs that weaken the bacterial cell wall i: penicillins 753. A patient is receiving intravenous potassium penicillin g, 2 million units to be administered over 1 hour. At 1900, the nurse notes that the dose hung at 1830 has infused completely. What will the nurse do? - answer c. Request an order for serum electrolytes and cardiac monitoring. 15. Ch 71 drugs that weaken the bacterial cell wall i: penicillins 754. A nurse transcribes a new prescription for potassium penicillin g given intravenously (iv) every 8 hours and gentamicin given iv every 12 hours. Which is the best schedule for administering these drugs? - answer a. Give the penicillin at 0800, 1600, and 2400; give the gentamicin [garamycin] at 1800 and 0600. 16. Ch 71 drugs that weaken the bacterial cell wall i: penicillins 755. A nurse assisting a nursing student with medications asks the student to describe how penicillins (pcns) work to treat bacterial infections. The student is correct in responding that penicillins: - answer b. Disrupt bacterial cell wall synthesis. 17. Ch 71 drugs that weaken the bacterial cell wall i: penicillins 756. A patient has an infection caused by streptococcus pyogenes. The prescriber has ordered dicloxacillin po. What will the nurse do? - answer c. Question the need for a penicillinase-resistant penicillin 18. Ch 71 drugs that weaken the bacterial cell wall i: penicillins 757. The parent of an infant with otitis media asks the nurse why the prescriber has ordered amoxicillin [amoxil] and not ampicillin [unasyn]. What will the nurse tell the parent? - answer d. Ampicillin is not as acid stable as amoxicillin. 19. Ch 71 drugs that weaken the bacterial cell wall i: penicillins 758. A child with otitis media has had three ear infections in the past year. The child has just completed a 10-day course of amoxicillin [amoxil] with no improvement. The parent asks the nurse why this drug is not working, because it has worked in the past. What will the nurse tell the patient? - answer d. "the bacteria have synthesized penicillinase." 20. Ch 71 drugs that weaken the bacterial cell wall i: penicillins 759. A patient with no known drug allergies is receiving amoxicillin [amoxil] po twice daily. Twenty minutes after being given a dose, the patient complains of shortness of breath. The patient's blood pressure is 100/58 mm hg. What will the nurse do? - answer a. Contact the provider and prepare to administer epinephrine. 21. Ch 71 drugs that weaken the bacterial cell wall i: penicillins 760. A patient with an infection caused by pseudomonas aeruginosa is being treated with piperacillin. The nurse providing care reviews the patient's laboratory reports and notes that the patient's blood urea nitrogen and serum creatinine levels are elevated. The nurse will contact the provider to discuss: - answer c. Reducing the dose of piperacillin. 22. Ch 71 drugs that weaken the bacterial cell wall i: penicillins 761. A nurse is preparing to administer intramuscular penicillin to a patient who is infected with treponema pallidum and notes that the order is for sodium penicillin g. Which action is correct? - answer c. Contact the provider to discuss changing the drug to benzathine penicillin g. 23. Ch 71 drugs that weaken the bacterial cell wall i: penicillins 762. A nurse is discussing methicillin-resistant staphylococcus aureus (mrsa) with a group of nursing students. Which statement by a student correctly identifies the basis for mrsa resistance? - answer a. "mrsa bacteria have developed pbps with a low affinity for penicillins." 24. Ch 72 drugs that weaken the bacterial cell wall ii: other drugs 763. A patient will be discharged home to complete treatment with intravenous cefotetan with the assistance of a home care nurse. The home care nurse will include which instruction when teaching the patient about this drug treatment? - answer a. Abstain from alcohol consumption during therapy. 25. Ch 72 drugs that weaken the bacterial cell wall ii: other drugs 764. A patient who has cystic fibrosis has a pseudomonas aeruginosa infection and the provider has ordered aztreonam [cayston]. What will the nurse teach this patient about administration of this drug? - answer d. Use the nebulizer to administer the drug three times daily. 26. Ch 72 drugs that weaken the bacterial cell wall ii: other drugs 765. A patient who is receiving a final dose of intravenous (iv) cephalosporin begins to complain of pain and irritation at the infusion site. The nurse observes signs of redness at the iv insertion site and along the vein. What is the nurse's priority action? - answer c. Select an alternate intravenous site and administer the infusion more slowly. 27. Ch 72 drugs that weaken the bacterial cell wall ii: other drugs 766. A woman complains of burning on urination and increased frequency. The patient has a history of frequent urinary tract infections (utis) and is going out of town in 2 days. To treat the infection quickly, the nurse would expect the health care provider to order: - answer b. Fosfomycin [monurol]. 28. Ch 72 drugs that weaken the bacterial cell wall ii: other drugs 767. The nurse is caring for a patient who is receiving vancomycin [vancocin]. The nurse notes that the patient is experiencing flushing, rash, pruritus, and urticaria. The patient's heart rate is 120 beats/minute, and the blood pressure is 92/57 mm hg. The nurse understands that these findings are consistent with: - answer b. Red man syndrome. 29. Ch 72 drugs that weaken the bacterial cell wall ii: other drugs 768. A provider has ordered ceftriaxone 4 g once daily for a patient with renal impairment. What will the nurse do? - answer a. Administer the medication as prescribed. 30. Ch 72 drugs that weaken the bacterial cell wall ii: other drugs 769. A patient has a skin infection and the culture reveals methicillin-resistant staphylococcus aureus (mrsa). What is an appropriate treatment for this patient? - answer d. Ceftaroline 31. Ch 72 drugs that weaken the bacterial cell wall ii: other drugs 770. A nurse is teaching a nursing student what is meant by "generations" of cephalosporins. Which statement by the student indicates understanding of the teaching? - answer b. "cephalosporins have increased activity against gram-negative bacteria with each generation." 32. Ch 72 drugs that weaken the bacterial cell wall ii: other drugs 771. A prescriber has ordered cefoxitin for a patient who has an infection caused by a gram-negative bacterium. The nurse taking the medication history learns that the patient experienced a maculopapular rash when taking amoxicillin [amoxil] several years earlier. What will the nurse do? - answer a. Administer the cefoxitin and observe for any side effects. 33. Ch 72 drugs that weaken the bacterial cell wall ii: other drugs 772. A patient receiving a cephalosporin develops a secondary intestinal infection caused by clostridium difficile. What is an appropriate treatment for this patient? - answer b. Discontinuing the cephalosporin and beginning metronidazole [flagyl] 34. Ch 72 drugs that weaken the bacterial cell wall ii: other drugs 773. Which cephalosporin may be used to treat meningitis? - answer d. Cefotaxime 35. Ch 72 drugs that weaken the bacterial cell wall ii: other drugs 774. A patient is to undergo orthopedic surgery, and the prescriber will order a cephalosporin to be given preoperatively as prophylaxis against infection. The nurse expects the provider to order which cephalosporin? - answer a. First-generation cephalosporin 36. Ch 73 bacteriostatic inhibitors of protein synthesis 775. A patient recently began receiving clindamycin [cleocin] to treat an infection. After 8 days of treatment, the patient reports having 10 to 15 watery stools per day. What will the nurse tell this patient? - answer c. The patient should stop taking the clindamycin now and contact the provider immediately. 37. Ch 73 bacteriostatic inhibitors of protein synthesis 776. A child has been receiving chloramphenicol for a neisseria meningitidis central nervous system (cns) infection. The nurse administers the dose and subsequently notes that the child has vomited and appears dusky and gray in color. The child's abdomen is distended. What will the nurse do? - answer d. Stop the infusion immediately and notify the provider. 38. Ch 73 bacteriostatic inhibitors of protein synthesis 777. A patient is diagnosed with periodontal disease, and the provider orders oral doxycycline [periostat]. The patient asks the purpose of the drug. What is the nurse's response? - answer b. "it inhibits collagenase to protect connective tissue in the gums." 39. Ch 73 bacteriostatic inhibitors of protein synthesis 778. To prevent yellow or brown discoloration of teeth in children, tetracyclines should not be given: - answer c. To pregnant patients after the fourth month of gestation. 40. Ch 73 bacteriostatic inhibitors of protein synthesis 779. A nurse is teaching a nursing student about dalfopristin/quinupristin [synercid]. Which statement by the student indicates an understanding of the teaching? - answer b. "patients taking this drug should have blood tests performed frequently." 41. Ch 73 bacteriostatic inhibitors of protein synthesis 780. A nurse is providing education about tetracycline [sumycin]. Which statement by the patient best demonstrates understanding of the administration of this medication? - answer a. "i should not take this medication with milk or other dairy products." 42. Ch 73 bacteriostatic inhibitors of protein synthesis 781. A hospitalized patient who is taking demeclocycline [declomycin] reports increased urination, fatigue, and thirst. What will the nurse do? - answer d. Provide extra fluids and reassure the patient that these are expected side effects. 43. Ch 73 bacteriostatic inhibitors of protein synthesis 782. A nurse is providing teaching for a patient who will begin taking clarithromycin er [biaxin xl] to treat a helicobacter pylori infection. Which statement by the patient indicates understanding of the teaching? - answer a. "i may experience distorted taste when taking this medication." 44. Ch 73 bacteriostatic inhibitors of protein synthesis 783. A patient is to begin taking doxycycline to treat a rickettsial infection. Which statement by the patient indicates a need for teaching about this drug? - answer c. "i should take this drug with food to ensure more complete absorption." 45. Ch 73 bacteriostatic inhibitors of protein synthesis 784. A patient received 500 mg of azithromycin [zithromax] at 0800 as a first dose. What are the usual amount and time of the second dose of azithromycin? - answer c. 250 mg at 0800 the next day 46. Ch 73 bacteriostatic inhibitors of protein synthesis 785. A child with an upper respiratory infection caused by b. Pertussis is receiving erythromycin ethylsuccinate. After 2 days of treatment, the parent asks the nurse why the child's symptoms have not improved. Which response by the nurse is correct? - answer a. "erythromycin eliminates the bacteria that causes the infection, but not the toxin that causes the symptoms." 47. Ch 73 bacteriostatic inhibitors of protein synthesis 786. A patient develops cdad. Which antibiotic is recommended for treating this infection? - answer d. Vancomycin 48. Ch 73 bacteriostatic inhibitors of protein synthesis 787. A 6-week-old infant who has not yet received immunizations develops a severe cough. While awaiting nasopharyngeal culture results, the nurse will expect to administer which antibiotic? - answer c. Erythromycin ethylsuccinate 49. Ch 73 bacteriostatic inhibitors of protein synthesis 788. A patient is taking erythromycin ethylsuccinate for a chlamydial infection and develops vaginal candidiasis. The prescriber orders ketoconazole to treat the superinfection. What will the nurse do? - answer b. Contact the provider to discuss changing to a different antifungal medication 50. Ch 73 bacteriostatic inhibitors of protein synthesis 789. A patient who has been taking linezolid [zyvox] for 6 months develops vision problems. What will the nurse do? - answer c. Tell the patient that this symptom is reversible when the drug is discontinued. 51. Ch 73 bacteriostatic inhibitors of protein synthesis 790. A pregnant adolescent patient asks the nurse whether she should continue to take her prescription for tetracycline [sumycin] to clear up her acne. Which response by the nurse is correct? - answer a. "tetracycline can be harmful to the baby's teeth and should be avoided." 52. Ch 73 bacteriostatic inhibitors of protein synthesis 791. A patient with severe community-acquired pneumonia has been prescribed telithromycin [ketek]. Which aspect of the patient's medical history is of concern to the nurse? - answer b. Myasthenia gravis