Question 1

A patient recently began receiving clindamycin to treat an infection. After 8 days of treatment, the patient reports having 10 to 15 watery stools per day. What action will the provider take to address the patient's diarrhea?

Accepted Answer

Clindamycin can cause Clostridium difficile-associated diarrhea, which can be severe. Discontinuing the antibiotic is the appropriate action to prevent further complications.

Question 2

A patient with a history of renal calculi has fever, flank pain, and bacteriuria. What action will the provider take?

Accepted Answer

The answer of A patient with a history of renal...

Question 3

The provider is reviewing the culture results of a patient receiving an aminoglycoside. The report reveals an anaerobic organism as the cause of infection. What action will the provider take?

Accepted Answer

Aminoglycosides are not effective against anaerobic bacteria because these organisms do not facilitate the uptake of these antibiotics into their cells. Therefore, prescribing a different class of antibiotic that is effective against anaerobes is the appropriate action.

Question 4

A provider has ordered intravenous gentamicin at a dose that is half the usual dose for an adult patient. What factor noted in the patient's medical history would be a likely reason for this action?

Accepted Answer

Gentamicin is primarily excreted by the kidneys, and renal disease can impair this process, leading to accumulation of the drug in the body and increased risk of toxicity. Therefore, dosing adjustments, such as reducing the dose, are often necessary in patients with renal impairment.

Question 5

A patient who takes an ACE inhibitor and an angiotensin receptor blocker (ARB) medication will begin taking TMP/SMZ to treat a urinary tract infection. Which serum electrolyte will the provider monitor closely?

Accepted Answer

TMP/SMZ (trimethoprim/sulfamethoxazole) can cause hyperkalemia, especially when used with ACE inhibitors and ARBs, which also increase potassium levels. Therefore, potassium is the electrolyte that will be monitored closely.

Question 6

A patient who has been receiving intravenous gentamicin for several days reports having had a headache for 2 days. What action will the provider take?

Accepted Answer

The answer of A patient who has been receiving intravenous...

Question 7

A patient shows signs and symptoms of conjunctivitis. Which aminoglycoside will the provider order?

Accepted Answer

Neomycin is often used in topical formulations for the treatment of bacterial infections, including conjunctivitis, due to its broad-spectrum antibacterial activity.

Question 8

A 20-year-old female patient presents with suprapubic discomfort, pyuria, dysuria, and bacteriuria greater than 100,000/mL of urine. Which are the most likely diagnosis and treatment?

Accepted Answer

The symptoms and findings suggest an uncomplicated lower urinary tract infection (UTI), typically presenting with dysuria, frequency, and urgency, without signs of systemic infection or upper urinary tract involvement. Short-course therapy, such as a 3-day regimen of antibiotics, is effective for uncomplicated UTIs in otherwise healthy, non-pregnant women.

Question 9

A patient is to begin taking doxycycline to treat a rickettsial infection. Which statement by the patient indicates a need for further teaching by the provider about this drug?

Accepted Answer

Doxycycline absorption can be impaired by food, especially dairy products, due to chelation with calcium. It is generally recommended to take it on an empty stomach, although it can be taken with food if gastric irritation occurs, but not with dairy products or other calcium-rich foods.

Question 10

A patient with a urinary tract infection is given a prescription for TMP/SMZ. When reviewing the drug with the patient, the provider learns that the patient has type 1 diabetes mellitus and consumes alcohol heavily. What action will the provider take?

Accepted Answer

TMP/SMZ (trimethoprim/sulfamethoxazole) can cause hyperkalemia and may have interactions with alcohol, potentially leading to adverse effects. Additionally, it can affect blood sugar levels, posing a risk to patients with diabetes. Given these considerations, prescribing a different antibiotic would be a safer option for this patient.

Question 11

Which patient diagnosed with a urinary tract infection will be hospitalization and prescribed intravenous antibiotics?

Accepted Answer

The answer of Which patient diagnosed with a urinary tract...

Question 12

A patient has a positive urine culture 1 week after completion of a 3-day course of antibiotics. What action will the prescriber take?

Accepted Answer

The answer of A patient has a positive urine culture...

Question 13

A drug history from a patient about to receive sulfadiazine identifies that the patient takes warfarin, glipizide, and a thiazide diuretic. Based on this information, what action will the provider take?

Accepted Answer

Sulfadiazine, like other sulfonamides, can potentiate the effects of warfarin by displacing it from its plasma protein binding sites, increasing the risk of bleeding. Therefore, monitoring coagulation levels (e.g., INR) closely is necessary to adjust the warfarin dose as needed.

Question 14

A patient presents to the emergency department with chills, severe flank pain, dysuria, and urinary frequency. The patient has a temperature of 102.9 $\degree$F, a pulse of 92 beats/minute, respirations of 24 breaths/minute, and a blood pressure of 119/58 mm Hg. The provider suspects that the patient is showing signs and symptoms of what pathology?

Accepted Answer

The patient's symptoms of chills, severe flank pain, dysuria, urinary frequency, and fever are indicative of pyelonephritis, which is a type of urinary tract infection (UTI) that affects the kidneys.

Question 15

An older male patient comes to the clinic with reports of chills, malaise, myalgia, localized pain, dysuria, nocturia, and urinary retention. The provider will suspect what cause for the patient's symptomology?

Accepted Answer

The symptoms described, including chills, malaise, myalgia, localized pain, dysuria, nocturia, and urinary retention, are indicative of prostatitis, especially in an older male patient. Prostatitis is the inflammation of the prostate gland, which can cause a variety of urinary symptoms.

Question 16

A patient will be discharged from the hospital with a prescription for TMP/SMZ. When providing teaching for this patient, the provider will discuss the importance of what action while taking this medication?

Accepted Answer

TMP/SMZ (trimethoprim/sulfamethoxazole) can cause crystalluria, so it is important for patients to drink plenty of water to prevent kidney stones and ensure proper kidney function.

Question 17

A pregnant female patient diagnosed with bacteriuria, suprapubic pain, urinary urgency and frequency, and a low-grade fever is allergic to sulfa, ciprofloxacin, and amoxicillin. The provider will prescribe which alternative medication to treat this patient?

Accepted Answer

The answer of A pregnant female patient diagnosed with bacteriuria,...

Question 18

A patient is receiving tobramycin three times daily. The provider has ordered a trough level with the 8:00 AM dose and will expect the level to be drawn at what time?

Accepted Answer

The trough level for tobramycin, an aminoglycoside antibiotic, should be drawn just before the next dose is administered to ensure the lowest concentration in the bloodstream is measured. Since the dose is scheduled for 8:00 AM, the trough level should be drawn at 7:45 AM.

Question 19

A patient is diagnosed with a lung infection caused by P. aeruginosa. The culture and sensitivity report shows sensitivity to all aminoglycosides. The provider knows that the rate of resistance to gentamicin is common in this hospital. What provider will order which medication?

Accepted Answer

Amikacin is often used when there is a concern for resistance to other aminoglycosides like gentamicin, as it tends to have a broader spectrum and is less susceptible to resistance.

Question 20

A young, nonpregnant female patient with a history of a previous urinary tract infection is experiencing dysuria, urinary urgency and frequency, and suprapubic pain of 3 days' duration. She is afebrile. A urine culture is positive for more than 100,000/mL of urine. The provider orders which treatment to assure the most effective treatment for this patient?

Accepted Answer

A 3-day course of trimethoprim/sulfamethoxazole is a standard and effective treatment for uncomplicated urinary tract infections in nonpregnant women.

Quiz 18: Therapy of Infectious and Parasitic Diseases