Question 1

A primary care NP is preparing to prescribe a fluoroquinolone for a patient who has a history of alcohol abuse that has caused liver damage.The NP should choose:&#10;A) norfloxacin.&#10;B) levofloxacin.&#10;C) gemifloxacin.&#10;D) ciprofloxacin.

Accepted Answer

Levofloxacin has less risk of hepatic adverse events than other fluoroquinolones.

Question 2

A patient is taking levofloxacin to treat sinusitis.The patient calls the primary care NP to report pain just above the heel of the right foot.The NP should:&#10;A) change to ofloxacin.&#10;B) change to ciprofloxacin.&#10;C) discontinue the levofloxacin.&#10;D) reassure the patient that this is a common side effect.

Accepted Answer

Warnings have been issued for the fluoroquinolone antibiotics for the increased risk of tendon ruptures.Ruptures have occurred unilaterally and bilaterally,and have involved the Achilles tendon; however,ruptures in the shoulder joint,hand,biceps,thumb,and other tendon sites have been reported.The risk of tendon rupture is further increased in those over age 60,those receiving concomitant steroid therapy,and in kidney,heart,and lung transplant recipients.Reasons for tendon ruptures also include physical activity or exercise,kidney failure,and tendon problems in the past.These ruptures may occur during therapy or up to several months after discontinuation of drugs.

Question 3

A patient has been taking ciprofloxacin for 3 days and calls the primary care nurse practitioner (NP)to report having headaches and dizziness.The NP should:&#10;A) change to levofloxacin.&#10;B) decrease the dose of ciprofloxacin.&#10;C) change to an antibiotic in another drug class.&#10;D) reassure the patient that these are common side effects.

Accepted Answer

Headaches and dizziness are common side effects of fluoroquinolones.It is not necessary to change to another fluoroquinolone,decrease the dose,or change to another antibiotic class.

Question 4

A patient who has been taking ciprofloxacin for 14 days for treatment of a UTI is seen in the clinic for a follow-up urinalysis.The urinalysis reveals crystalluria.The primary care NP should:&#10;A) discontinue the ciprofloxacin.&#10;B) decrease the dose of ciprofloxacin.&#10;C) change the antibiotic to norfloxacin.&#10;D) counsel the patient to increase fluid intake.

Accepted Answer

Fluoroquinolones can cause renal irritation and urine crystals.Patients should be advised to maintain proper hydration to avoid this.It is not necessary to discontinue the ciprofloxacin or to decrease the dose.

Question 5

A patient who is taking a fluoroquinolone antibiotic for pyelonephritis develops Clostridium difficile-associated disease (CDAD).The primary care NP should treat for C.difficile and _____ fluoroquinolone.

A) continue the
B) discontinue the
C) increase the dose of
D) decrease the dose of

Accepted Answer

Patients who develop CDAD while taking fluoroquinolones should stop taking the drug immediately

Question 6

A primary care NP sees a patient who has fever,flank pain,and dysuria.The patient has a history of recurrent urinary tract infections (UTIs)and completed a course of trimethoprim-sulfamethoxazole (TMP/SMX)the week before.A urine test is positive for leukocyte esterase.The NP sends the urine for culture and should treat this patient empirically with:

A) gemifloxacin.
B) ciprofloxacin.
C) azithromycin.
D) TMP/SMX.

Accepted Answer

Fluoroquinolones are effective in treatment of UTIs that are resistant to other antibiotics.Because this patient recently completed a course of TMP/SMX,the NP can assume that the bacterium causing the infection is resistant to TMP/SMX.Gemifloxacin is not indicated for UTI,but ciprofloxacin is.Azithromycin is not a fluoroquinolone.

Question 7

A primary care NP provides teaching for a patient who is about to begin taking levofloxacin tablets to treat an infection.Which statement by the patient indicates a need for further teaching?&#10;A) &#34;I should use sunscreen while taking this medication.&#34;&#10;B) &#34;I should take this medication on an empty stomach.&#34;&#10;C) &#34;I should use caution while driving when taking this medication.&#34;&#10;D) &#34;I should take the tablet 2 hours before taking vitamins or an antacid.&#34;

Accepted Answer

Levofloxacin tablets may be taken without regard to food,although levofloxacin solution must be taken on an empty stomach.Patients should be cautioned to use sunscreen and to avoid situations where drowsiness may impair function.Levofloxacin should not be taken with antacids or vitamins.

Deck 63: Fluoroquinolones