Question 1

Which infection(s) may be treated with linezolid (Zyvox)? (Select all that apply.)&#10;A) Community-acquired pneumonia (CAP) that is penicillin sensitive&#10;B) Nosocomial pneumonia caused by methicillin-sensitive Staphylococcus aureus (MSSA)&#10;C) Pneumonias caused by Mycoplasma avium&#10;D) Superficial methicillin-resistant Staphylococcal aureus skin infections (MRSA)&#10;E) Vancomycin-resistant infections

Accepted Answer

Linezolid is indicated for CAP caused by PCN-sensitive strains of Streptococcus pneumoniae, nosocomial pneumonia caused by MSSA and MRSA, and vancomycin-resistant enterococcal (VRE) infections. It is not recommended for M. avium infections or for superficial skin infections caused by MRSA.

Question 2

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?

A) The provider may increase the clindamycin dose to treat this infection.
B) This is a known side effect of clindamycin, and the patient should consume extra fluids.
C) The patient should stop taking the clindamycin now and contact the provider immediately.
D) The patient should try taking Lomotil or a bulk laxative to minimize the diarrheal symptoms.

Accepted Answer

Clostridium difficile-associated diarrhea (CDAD) is the most severe toxicity of clindamycin; if severe diarrhea occurs, the patient should be told to stop taking clindamycin immediately and to contact the provider so that treatment with vancomycin or metronidazole can be initiated. Increasing the dose of clindamycin will not treat this infection. Consuming extra fluids while still taking the clindamycin is not correct, because CDAD can be fatal if not treated. Taking Lomotil or bulk laxatives only slows the transit of the stools and does not treat the cause.

Question 3

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?&#10;A) 250 mg at 2000 the same day&#10;B) 500 mg at 2000 the same day&#10;C) 250 mg at 0800 the next day&#10;D) 500 mg at 0800 the next day

Accepted Answer

Azithromycin generally is given as 500 mg on the first day and then 250 mg/day for the next 4 days, so the second dose would be 24 hours after the first dose.

Question 4

A nurse is teaching a nursing student about dalfopristin/quinupristin (Synercid). Which statement by the student indicates an understanding of the teaching?&#10;A) &#34;Patients should stop taking the drug if they experience joint and muscle pain.&#34;&#10;B) &#34;Patients taking this drug should have blood tests performed frequently.&#34;&#10;C) &#34;Patients who are allergic to penicillin should not take this drug.&#34;&#10;D) &#34;This drug will be administered intravenously over a 30- to 60-minute period.&#34;

Accepted Answer

Patients taking dalfopristin/quinupristin should have blood levels measured twice the first week and then weekly thereafter to assess for hepatotoxicity. Joint and muscle pain are not an indication for withdrawing the drug. There is no cross-sensitivity to penicillin. The drug is given intravenously over a period of at least 1 hour.

Question 5

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?&#10;A) &#34;I should consult my provider before using laxatives or antacids while taking this drug.&#34;&#10;B) &#34;I should not take a calcium supplement or consume dairy products with this drug.&#34;&#10;C) &#34;I should take this drug with food to ensure more complete absorption.&#34;&#10;D) &#34;If I get diarrhea, I should stop taking the drug and let my provider know immediately.&#34;

Accepted Answer

Absorption of tetracyclines is reduced in the presence of food. The tetracyclines form insoluble chelates with calcium, iron, magnesium, aluminum, and zinc, so patients should not take tetracyclines with dairy products, calcium supplements, or drugs containing these minerals. Patients who experience diarrhea should stop taking the drug and notify the provider so they can be tested for C. difficile infection.

Question 6

A patient who is taking doxycycline for a serious infection contacts the nurse to report anal itching. The nurse will contact the provider to discuss:&#10;A) adding an antihistamine to the patient's drug regimen.&#10;B) ordering liver function tests to test for hepatotoxicity.&#10;C) prescribing an antifungal drug to treat a suprainfection.&#10;D) testing the patient for a C. difficile secondary infection.

Accepted Answer

A suprainfection occurs secondary to suppression of drug-sensitive organisms. Overgrowth with fungi, especially Candida albicans, is common and may occur in the mouth, pharynx, vagina, and bowel. Anal itching is a sign of such an infection, not a sign of hepatotoxicity. Antihistamines will not treat the cause. C. difficile is characterized by profuse, watery diarrhea.

Question 7

A patient is taking erythromycin ethylsuccinate for a chlamydial infection and develops vaginal candidiasis. The prescriber orders ketoconazole to treat the suprainfection. What will the nurse do?&#10;A) Administer the erythromycin and the ketoconazole as ordered.&#10;B) Contact the provider to discuss changing to a different antifungal medication.&#10;C) Contact the provider to discuss increasing the dose of erythromycin.&#10;D) Contact the provider to suggest using erythromycin stearate.

Accepted Answer

Erythromycin can prolong the QT interval when present in large concentrations. When erythromycin is combined with a CYP3A4 inhibitor, such as ketoconazole, the risk of sudden cardiac death increases fivefold. The nurse should discuss changing the antifungal medication to one that is not a CYP3A4 inhibitor. It is not correct to give the ketoconazole without questioning the order. Increasing the dose of erythromycin would increase the risk of QT prolongation. Changing to a different preparation of erythromycin would not alter the risk.

Question 8

To prevent yellow or brown discoloration of teeth in children, tetracyclines should not be given:&#10;A) to children once the permanent teeth have developed.&#10;B) to patients taking calcium supplements.&#10;C) to pregnant patients after the fourth month of gestation.&#10;D) with dairy products or antacids.

Accepted Answer

Tetracyclines bind to calcium in developing teeth, resulting in yellow or brown discoloration. They should not be given to pregnant women after the fourth month of gestation, because they will cause staining of deciduous teeth in the fetus. In children, discoloration occurs when tetracyclines are given between the ages of 4 and 8 years, because this is when permanent teeth are developing. Tetracycline binds with calcium, so absorption is diminished when the drug is given with calcium supplements, dairy products, or calcium-containing antacids; however, this does not affect tooth development.

Question 9

A nurse is providing teaching for a patient who will begin taking clarithromycin ER (Biaxin XL) to treat an Helicobacter pylori infection. Which statement by the patient indicates understanding of the teaching?

A) "I may experience distorted taste when taking this medication."
B) "I should take 1 tablet twice daily for 10 days."
C) "I should take this medication on an empty stomach."
D) "This medication does not interact with other drugs."

Accepted Answer

Clarithromycin is available in an extended-relief preparation as Biaxin XL. Biaxin can cause distortion of taste, so patients should be warned of this side effect. Biaxin XL should be taken once and not twice daily. Biaxin should be taken with food. Biaxin interacts with other drugs by inhibiting hepatic metabolism of those drugs.

Question 10

Tetracyclines are considered first-line drugs for which disorder(s)? (Select all that apply.)&#10;A) Chlamydia trachomatis cervicitis&#10;B) Clostridium difficile diarrhea&#10;C) Lyme disease&#10;D) Methicillin-resistant Staphylococcal aureus skin infections&#10;E) Typhus fever

Accepted Answer

Tetracyclines are drugs of first choice for rickettsial diseases, infections caused by C. trachomatis, brucellosis, cholera, Mycoplasma pneumonia, Lyme disease, anthrax, and gastric infections caused by H. pylori. They are not first-line drugs for CDAD or MRSA skin infections.

Question 11

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?

A) "Erythromycin eliminates the bacteria that causes the infection, but not the toxin that causes the symptoms."
B) "We may need to add penicillin or another antibiotic to increase the antimicrobial spectrum."
C) "We will need to review the culture sensitivity information to see whether a different antibiotic is indicated."
D) "Your child may have developed a suprainfection that we need to culture and treat."

Accepted Answer

The answer of A child with an upper respiratory infection...

Question 12

A patient who has been taking linezolid (Zyvox) for 6 months develops vision problems. What will the nurse do?&#10;A) Reassure the patient that this is a harmless side effect of this drug.&#10;B) Tell the patient that blindness is likely to occur with this drug.&#10;C) Tell the patient that this symptom is reversible when the drug is discontinued.&#10;D) Tell the patient to take tyramine supplements to minimize this effect.

Accepted Answer

The answer of A patient who has been taking linezolid...

Question 13

A patient develops CDAD. Which antibiotic is recommended for treating this infection?&#10;A) Chloramphenicol&#10;B) Clindamycin (Cleocin)&#10;C) Linezolid (Zyvox)&#10;D) Vancomycin

Accepted Answer

The answer of A patient develops CDAD. Which antibiotic is...

Question 14

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?&#10;A) Clindamycin (Cleocin)&#10;B) Doxycycline (Vibramycin)&#10;C) Erythromycin ethylsuccinate&#10;D) Penicillin G

Accepted Answer

The answer of A 6-week-old infant who has not yet...

Question 15

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?&#10;A) &#34;It is used because of its anti-inflammatory effects.&#34;&#10;B) &#34;It inhibits collagenase to protect connective tissue in the gums.&#34;&#10;C) &#34;It reduces bleeding and the pocket depth of oral lesions.&#34;&#10;D) &#34;It suppresses bacterial growth in the oral mucosa.&#34;

Accepted Answer

The answer of A patient is diagnosed with periodontal disease,...

Question 16

A nurse is providing education about tetracycline (Sumycin). Which statement by the patient best demonstrates understanding of the administration of this medication?&#10;A) &#34;I should not take this medication with milk or other dairy products.&#34;&#10;B) &#34;I should not worry if I experience an acnelike rash with this medication.&#34;&#10;C) &#34;I should take an antacid, such as Tums, if I experience gastrointestinal distress.&#34;&#10;D) &#34;I should take this antibiotic with a calcium supplement to improve absorption.&#34;

Accepted Answer

The answer of A nurse is providing education about tetracycline...

Question 17

A hospitalized patient who is taking demeclocycline (Declomycin) reports increased urination, fatigue, and thirst. What will the nurse do?&#10;A) Contact the provider to report potential toxic side effects.&#10;B) Notify the provider to discuss changing the medication to doxycycline.&#10;C) Perform bedside glucometer testing to evaluate the serum glucose level.&#10;D) Provide extra fluids and reassure the patient that these are expected side effects.

Accepted Answer

The answer of A hospitalized patient who is taking demeclocycline...

Question 18

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?&#10;A) &#34;Tetracycline can be harmful to the baby's teeth and should be avoided.&#34;&#10;B) &#34;Tetracycline is safe to take during pregnancy.&#34;&#10;C) &#34;Tetracycline may cause allergic reactions in pregnant women.&#34;&#10;D) &#34;Tetracycline will prevent asymptomatic urinary tract infections.&#34;

Accepted Answer

The answer of A pregnant adolescent patient asks the nurse...

Question 19

Which side effect of clindamycin (Cleocin) causes the most concern and may warrant discontinuation of the drug?&#10;A) Diarrhea&#10;B) Headache&#10;C) Nausea&#10;D) Vomiting

Accepted Answer

The answer of Which side effect of clindamycin (Cleocin) causes...

Question 20

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?

A) Contact the provider for an order to obtain a chloramphenicol level.
B) Notify the provider that the child's meningitis is worsening.
C) Recognize this as initial signs of a C. difficile infection.
D) Stop the infusion immediately and notify the provider.

Accepted Answer

The answer of A child has been receiving chloramphenicol for...

Deck 86: Bacteriostatic Inhibitors of Protein Synthesis: Tetracyclines, Macrolides, and Others