Exam 3 Practice Test Flashcards
1
Q
A patient is about to receive PCN G for an infection that is highly sensitive to this drug. While obtaining the patient’s medication history, the nurse learns the patient experienced a rash when given amoxicillin (Amoxil) 20 years earlier. What will the nurse do?
a) Order a cephalosporin instead
b) Reassure the patient that allergic reactions diminish over time
c) Order a skin test to assess current risk
d) Use a desensitization schedule to administer the drug
A
Answer: C. - Order a skin test to assess current risk
Allergy to PCN can decrease over time; therefore, in patients with previous allergic reaction who need to take PCN, skin tests can be performed to assess the current risk. Until the risk is known, changing to a cephalosporin is not necessary. Reassuring the patient, the allergic reaction has diminished is not correct because this is not always the case. Desensitizing schedules are only used in a confirmed allergy, but the drug is needed nevertheless. Pg 666
2
Q
A child with an ear infection is not responding to amoxicillin (Amoxil). The nurse will expect the provider to order:
a) Amoxicillin- clavulanic acid (Augmentin)
b) Ampicillin
c) Nafcillin
d) PCN G (Benzylpenicillin)
A
Answer: A -Amoxicillin- clavulanic acid (Augmentin)
Beta- lactamase inhibitors are drugs given in combination with penicillinase- sensitive PCN. Augmentin contains PCN and clavulanic acid and is often used in patients that do not respond to Amoxicillin alone. Ampicillin is similar to Amoxicillin, but amoxicillin is preferred; and if drug resistance occurs then ampicillin is usually equally ineffective. Nafcillin is only used in streptococci. PCN G would be ineffective like amoxicillin if beta-lactamase is present. Chapter 71 audioclip
3
Q
A nurse assisting a nursing student with medications asks the student to describe how PCNs work to treat bacterial infections. The student is correct in stating:
a) Disinhibit transpeptidases
b) Disrupt bacterial cell wall synthesis
c) Inhibit autolysins
d) Inhibit host cell wall function
A
Answer: B - Disrupt bacterial cell wall synthesis
PCNs weaken the cell wall, causing bacteria to take up excessive amount of water and rupture. PCNs inhibit transpeptidases and disinhibit autolysins. PCNs do not affect cell walls of the host. Pg 662
4
Q
A parent of an infant with otitis media asks the provider why Amoxicillin (Amoxil) instead of Ampicillin (Unasyn). What does the provider say?
a) Amoxicillin is a broader spectrum antibiotic than ampicillin
b) Amoxicillin is not inactivated by beta- lactamases
c) Ampicillin is associated with more allergic reaction
d) Ampicillin is not as acid stable as amoxicillin
A
Answer: D- Ampicillin is not as acid stable as amoxicillin
These medications are similar in structure and function but differ primarily and acid stability. Amoxicillin is more acid stable when administered orally and results in higher blood levels than can be obtained with equivalent doses of ampicillin. The two drugs have the same spectrum, are inactivated by beta-lactamases and cause allergic reactions. Chapter 71 audioclip
5
Q
A child with otitis media has had 3 ear infections in the last year. The child has just completed a 10- day course of amoxicillin (Amoxil) with no improvement. The parent asks why this drug is not working as it has worked in the past. What will the APRN tell the patient?
a) Amoxicillin is too narrow in spectrum
b) The bacteria have developed a three- layer cell envelope
c) The bacteria have developed penicillin- binding
proteins (PBPs) that have low affinity for PCNs
d) The bacteria have synthesized penicillinase
A
Answer: D - The bacteria have synthesized penicillinase
Beta-lactamases are enzymes that cleave to the beat-lactam ring and render the PCN inactive. This resistance is common in organisms that cause ear infections. Amoxicillin is a broad-spectrum antibiotic. A three-layer envelope occurs in all gram-negative bacteria. Some bacterial strains including MRSA, develop PBPs with low affinity for PCN but MRSA is not a cause of otitis media. Pg 664
6
Q
A patient with a Staphylococcus aureus infection is being treated with Nafcillin. The nurse providing care reviews the patient’s laboratory reports and notes the BUN and serum creatinine are elevated. The provider will:
a) Add an aminoglycoside
b) Order PCN G
c) Reduce the dose of Nafcillin
d) Order Amoxicillin
A
Answer: C - Reduce the dose of Nafcillin
Patients with renal impairment should received reduced dosages of PCNs to prevent toxicity. Aminoglycosides are nephrotoxic. PCN G and amoxicillin do not treat Staph aureus. Pg 665
7
Q
A nurse is discussing MRSA with a group of nursing students; which statement by a student correctly identifies the basis for MRSA resistance?
a) MRSA bacteria have developed PBPs with a low affinity for PCNs
b) MRSA bacteria produce penicillinases that that render PCN ineffective
c) MRSA occurs because of host resistance to PCNs
d) MRSA strains replicate faster than other Staph aureus strains
A
Answer: A - MRSA bacteria have developed PBPs with a low affinity for PCNs
MRSA strains have a unique mechanism of resistance, which is the production of PBPs with a low affinity for PCNs and all other beta-lactam antibiotics. MRSA resistance is not related to beta-lactamase production. MRSA resistance refers to bacterial and not host resistance. The resistance of MRSA strains is not related to speed of replication. Pg 663-664
8
Q
True/ False: Healthcare associated MRSA is typically more severe than community acquired MRSA and first line treatment is IV Vancomycin.
A
Answer: True.
Healthcare associated MRSA is often more severe and difficult to treat. It is usually transmitted through person-to-person contact, likely health care workers to patients. Risk factors include advanced age, recent surgery, several indwelling lines like in ICU care and long-term hospitalization. First line treatment is IV vancomycin. Community acquired MRSA is less severe and can be the result of being a carrier. In this instance you treat nasal passage colonization and oral antibiotics (carrier). Could be the result of contact sports and found in younger and healthy people. Chapter 71 audioclip
9
Q
A nurse is preparing to administer IM PCN to a patient infected with Treponema pallidum and notes the order is for Sodium PCN G. Which action is correct?
a) Administer as prescribed
b) Considering changing route to IV
c) Change drug to IM benzathine PCN G
d) Request an order for a different class of PCN
A
Answer: C - Change drug to IM benzathine PCN G
The procaine and benzathine PCN salts are absorbed slowly and considered repository preparations. When benzathine PCN G is given IM, it is absorbed for weeks and useful only in highly sensitive organisms such as T. Palladium. Sodium PCN G is absorbed rapidly, with peak effects in 15 minutes. Giving the drug IV will not yield repository effects. PCN G is used to treat T. Palladium. Pg 664
10
Q
True/ False: PCN can be given safely throughout the lifespan including infancy, pregnant/ breastfeeding women and older adults.
A
Answer: True.
The only life span consideration is that doses should be adjusted in elderly with renal dysfunction. Pg 666
11
Q
What is NOT an effect of Histamine 1?
A) Vasodilation
B) Increased capillary permeability
C) Bronchoconstriction
D) Decreased capillary permeability
A
Answer: D - Decreased capillary permeability
Reasoning: The effects of histamine 1 are vasodilation, Increased capillary permeability, bronchoconstriction, CNS effects, itching, pain, and secretion of mucus (p488)
12
Q
Diphenhydramine is a ____ generation H1 antagonist. It is ____ sedating and has ____ anticholinergic effects
A) 2nd generation; mild; mild
B) 2nd generation; highly; significant
C) 1st generation; highly; significant
D) 1st generation; mild; no
A
Answer: C -1st generation; highly; significant
Reasoning: Diphenhydramine is a 1st generation H1 antagonist. It is highly sedating, and has significant anticholinergic effects. (p 490, table 56.1)
13
Q
Cetirizine is a ____ generation H1 antagonist. It is ____ sedating and has ____ anticholinergic effects
A) 2nd generation; highly; significant
B) 2nd generation; minimally; little to none
C) 1st generation; highly; moderate
D) 1st generation; moderately, little to none
A
Answer: B - 2nd generation; minimally; little to none
Reasoning: Cetirizine is a 2nd generation H1 antagonist. It is minimally sedating, and has little to none anticholinergic effects. (p 490, table 56.1)
14
Q
What is NOT included in the Black Box warning for Promethizine.
A) it can cause severe respiratory depression
B) Deaths have occurred
C) It is contraindicated in children younger that 6 years old.
D) it is contraindicated in children younger than 2 years old
A
Answer: C - It is contraindicated in children younger that 6 years old.
Reasoning: Promethazine can cause severe respiratory depression which have caused death. It is contraindicated in children under 2 and should be used with caution in children older than 2.
15
Q
If any adult patient with no known medical history is experiencing allergic rhinitis and taking cetirizine, but experiencing relief, what would be your next recommendation? his major complaint is sneezing, itching, and rhinorrhea.
A) stop taking cetirizine and start taking diphenhydramine
B) continue with cetirizine and add fluticasone propionate
C) add a oral decongestant
D) add cromolyn
A
Answer: b - continue with cetirizine and add fluticasone propionate
Reasoning: figure 63.1 p581
16
Q
If a patient has been taking a decongestant spray, what would you educate them on:
A) only take for 3-5 days because they can develop rebound congestion
B) only take for 3-5 days because it can cause severe drop in BP
C) only take for 3-5 days because it can cause dry mouth
D) only take for 3-5 days because they can develop epistaxis
A
Answer: A - only take for 3-5 days because they can develop rebound congestion
Reasoning: p582
17
Q
A mother brings her 2 year old child in for stuffy nose and cough. What would NOT be a recommendation?
A) use saline drops to decrease nasal stuffiness
B) use a cold-mist humidifier to thin nasal secretions
C) start an OTC nasal decongestant at bedtime so she can get some rest
D) Give her honey to relieve cough
A
Answer: C - start an OTC nasal decongestant at bedtime so she can get some rest
Reasoning: OTC are not recommended in children P586
18
Q
What would be first line therapy for a patient complaining of allergic rhinitis with a main complaint of nasal decongestion?
A) intranasal glucocorticoids and oral decongestant
B) oral antihistamine
C) allergy testing
D) intranasal glucocorticoid and intranasal antihistamine
A
Answer: A - intranasal glucocorticoids and oral decongestant
Reasoning: P581 Fig 63.1
19
Q
What is the main action of sympathomimetics?
A) prevents inflammatory response to allergens
B) blocks nasal cholinergic receptors
C) blocks leukotriene receptors
D) activates vascular alpha1 receptors, causing vasoconstriction
A
Answer: D - activates vascular alpha1 receptors, causing vasoconstriction
Reasoning: p 581, table 63.1
20
Q
What is the most widely used non-opioid antitussive?
A) codeine
B) guaifenesin
C) dextromethorphan
D) benzonatate
A
Answer: C - dextromethorphan
A) codeine - is a opioid antitussive
B) guaifenesin - is an expectorant
C) dextromethorphan - correct answer
D) benzonatate - is also a non-opioid antitussive, but not the most used
21
Q
- The two main pharmacologic classes for asthma and COPD are:
A. anti-inflammatory agents (aspirin) and vasodilators (captopril)
B. glucocorticoids and anti-inflammatory agents
C. anti-inflammatory agents (glucocorticoids) and bronchodilators (B2 agonist)
D. bronchodilators (B1 agonist) and anti-inflammatory agents (glucocorticoids)
A
Answer C - anti-inflammatory agents (glucocorticoids) and bronchodilators (B2 agonist)
Drugs for asthma and COPD fall into two main pharmacologic classes. Anti-inflammatory agents (principal anti-inflammatory agents being glucocorticoids) and bronchodilators (principal bronchodilators are B2 agonist) Answer:C pg 558.
22
Q
What is true regarding drugs by inhalation
A. systemic effects are maximized because delivery is directly at the site of action.
B. relief of chronic symptoms is rapid
C. Inhaled drugs are only used for asthma
D. therapeutic effects are enhanced by delivering drugs directly to their site of action
A
D. therapeutic effects are enhanced by delivering drugs directly to their site of action
Drugs by inhalation have three advantages. 1.) therapeutic effects are enhanced by delivering drugs directly to their site of action. 2.) systemic effects are minimized and 3.) relief of acute attacks is rapid. Answer:D pg 558
23
Q
When using most MDI’s (metered-dose inhalers)
A. Without a spacer 81% affects the oropharynx
B. With a spacer 95% of the dose reaches the lung
C. Most MDI’s are easier to use compared to DPI’s
D. With optimal use 80% of the dose reaches the lungs
A
A. Without a spacer 81% affects the oropharynx
When using most MDI’s the patient begins to inhale before activating the device. This requires hand breath coordination making MDI’s difficult to use correctly.Patients will need both verbal and written instructions. Even with optimal use (without a spacer) only 10% reaches the lungs, about 80% reaches the oropharynx and is swallowed, and the remaining 10% is left in the device or exhaled. With a spacer 21% reaches the lungs, 22% affects the mouth and throat and 57% is left in the inhaler device. Dry-Powder inhalers deliver drugs in the form of a dry, micronized powder directly to the lung and unlike MDI’s are breath activated so DPI’s do not require hand breath coordination and are easier to use. Answer: A pg 559-560
24
Q
Anti-inflammatory drugs used for asthma and COPD include
A. Only Inhaled glucocorticoids
B. Inhaled and oral glucocorticoids
C. Glucocorticoids, leukotriene receptor antagonists, cromolyn, Immunoglobulin E antagonist, and Phosphodiesterase-4 inhibitors
D. Glucocorticoids (inhaled and oral), and Phosphodiesterase-4 inhibitors
A
B. Inhaled and oral glucocorticoids
Anti-inflammatory drugs for asthma and COPD are glucocorticoids (both oral and inhaled). leukotriene receptor antagonists are used for asthma only, cromolyn is used for asthma only, Immunoglobulin E antagonist is used for asthma only, and Phosphodiesterase-4 inhibitor is used for COPD only. Answer B. pg 560 table 62.1 and pg. 567
25
Beclomethasone dipropionate (QVAR)
A. is given as preventive therapy and contraindicated in pregnancy
B. is contraindicated in a patient who has oral candidiasis
C. Is an inhaled glucocorticoid, which is considered the preferred long-term treatment for children
D. Is a systemic formulation and contraindicated when breastfeeding
C. Is an inhaled glucocorticoid, which is considered the preferred long-term treatment for children
Inhaled glucocorticoids are the preferred long term treatment for children of all ages, including infancy. Beclomethasone dipropionate (QVAR) is an inhaled glucocorticoid. Inhaled glucocorticoids are preferred for uncontrolled asthma in pregnant women and are not contraindicated while breastfeeding. Women taking systemic glucocorticoids should not breastfeed. Inhaled glucocorticoids are contraindicated for patients with persistently positive sputum cultures for Candida albicans not for oral candidiasis. If candidiasis develops, it can be treated with an antifungal medicine. Using a spacer will decrease deposits onto the oropharynx. Answer:C pg 561-563 (boxes)
26
What adverse effects are caused by long term use of oral glucocorticoids?
A. Hyperglycemia, oropharyngeal candidiasis, adrenal suppression
B. Peptic ulcer disease, hyperglycemia, adrenal suppression, osteoporosis
C. Growth suppression in adults, adrenal suppression, osteoporosis
D. Dysphonia, peptic ulcer disease, adrenal suppression
B. Peptic ulcer disease, hyperglycemia, adrenal suppression, osteoporosis
When used acutely (less than 10 days) even in high doses, oral glucocorticoids do not cause significant adverse effects. Prolonged therapy even in moderate doses can cause adrenal suppression, osteoporosis, hyperglycemia, and growth suppression in young patients. Inhaled glucocorticoids most common adverse effects are oropharyngeal candidiasis, and dysphonia (hoarseness, speaking difficulty). For young children using inhaled glucocorticoids longer than 6 months the Pediatric Endocrine Society Drugs and Therapeutics Committee recommends monitoring for adrenal insufficiency ( hypoglycemia, hypotension, mental status alterations) and testing for adrenal insufficiency. Answer B pg. 561-562
27
Jane is a 7 year old female with a history of asthma. Her mom brings her into the office because she needs a refill for her nebulized inhaled glucocorticoid. The APRN will prescribe
A. Budesonide (Pulmicort Flexhaler) 40 mcg daily
B. Ciclesonide (Alvesco) 80mcg twice daily
C. Budesonide (Pulmicort Respules) 250 mcg twice daily
D. Budesonide (Pulmicort Respules) 500 mcg daily
D) Budesonide (Pulmicort Respules) 500 mcg daily
Budesonide suspension (Pulmicort Respules) is the first inhaled glucocorticoid formulated for nebulized dosing. The product was approved for maintenance therapy of persistent asthma in children 1-8 years old. Improvements usually begin in 2-8 days with maximum benefits in 4-6 weeks. Suspension is available in 2-ml ampules containing 250-500 mcg of the drug. Children 1-8 years of age dosing can be prescribed from 500-1000 mcg/day. Adult dosing can be 250-500 mcg twice a day or 1000mcg daily. Answer: D pg 562
28
What statement is true of leukotriene receptor antagonist (LTRAs)
A. Montelukast a LTRA is used for maintenance therapy of asthma in newborns
B. Decrease bronchoconstriction while increasing the inflammatory process
C. Zileuton a LTRA combined with theophylline can increase theophylline levels
D. LTRAs increase the effects of leukotrienes, causing bronchodilation
C. Zileuton a LTRA combined with theophylline can increase theophylline levels
LTRAs suppress the effects of leukotrienes, which are compounds that promote smooth muscle constriction, blood vessel permeability, and inflammatory responses through direct action as well as through the recruitment of eosinophils and other inflammatory cells. In patients with asthma these drugs can decrease bronchoconstriction and inflammatory responses such as edema and mucus secretion. Three LTRAs are currently available: zileuton-approved for asthma prophylaxis and maintenance therapy in adults and children 12 years and older (increases theophylline levels), zafirlukast-approved for maintenance therapy of chronic asthma in adults and children over 5 years and older , and montelukast-most commonly used, approved for 1) prophylaxis and maintenance therapy of asthma in patients at least 1 year old; 2) prevention of exercise-induced bronchospasm (EIB) in patients at least 15 years old and; 3) relief of allergic rhinitis. Answer:C pg 563-564
29
Which statement is true about anti-inflammatory drugs
A. Omalizumab is an antagonist of antibody IgE indicated for allergy-related asthma
B. Monoclonal antibodies are the newest first-line agents used for the management of airway inflammation
C. Two phosphodiesterase-4 inhibitors Roflumilast and Reslizumab are approved for the management of COPD
D. Cromolyn is an oral agent that suppresses bronchial inflammation
A. Omalizumab is an antagonist of antibody IgE indicated for allergy-related asthma
Cromolyn is an inhalation agent that suppresses bronchial inflammation. Monoclonal antibodies are the newest drug category for the management of airway inflammation but are not approved as first-line agents and none are approved for acute asthmatic episodes. There is only one phosphodiesterase-4 inhibitor, which is Roflumilast (Daliresp, Daxas) that is approved for the management of COPD. Reslizumab is an interleukin-5 receptor antagonist. Omalizumab (Xolair) was the first monoclonal antibody to receive FDA approval. It is only approved for allergy-related asthma and only when preferred options have failed. It is given subcutaneously and also poses a risk for anaphylaxis and cancer. Answer: A pg. 564-567
30
The APRN understands B2 adrenergic agonists
A. Are used to promote bronchodilation and are available only as inhaled agents
B. Are the most effective drugs available to relieve acute bronchospasm and preventing EIB
C. Provide symptomatic relief in patients with asthma and COPD by altering the underlying inflammation
D. Must be monitored closely in pregnant women because they cause uterine contractions leading to premature delivery.
B. Are the most effective drugs available to relieve acute bronchospasm and preventing EIB
B2 agonists provide symptomatic relief in patients with asthma and COPD but do not alter the underlying inflammation that is part of the disease process. Most patients who use a bronchodilator also use an inhaled glucocorticoid for long term suppression of inflammation. Monotherapy with a bronchodilator is appropriate only when asthma is very mild and attacks are infrequent. B2 agonists cause uterine relaxation not contractions and are not contraindicated during pregnancy or breastfeeding. They can be administered orally or by inhalation. Answer: B pg. 567
31
Which antiviral drug is a first line choice for most infections caused by Herpes Simplex Virus (HSV) and Varicella Zoster Virus (VZV)?
a. Zanamivir
b. Valganciclovir
c. Acyclovir
d. Cidofovir
Answer: C - Acyclovir
Acyclovir is the agent of first choice. It can be administered orally, topically and intravenously. Serious side effects are uncommon. Zanamivir is an Influenza drug, and Valganciclovir and Cidofovir are used to treat Cytomegalovirus. P. 723
Note: Acyclovir MUST undergo activation first in order to work. P. 723
32
Valacyclovir (Valtrex) is a pro drug form of Acyclovir. What conditions is this drug approved for?
a. Herpes Labialis, Herpes Simplex genitalis, Herpes Zoster infection
b. Herpes Simplex genitalis
c. Varicella, Herpes labialis and Herpes genitalis
d. Herpes Labialis, Herpes Simplex genitalis, Herpes Zoster infection and Varicella
Answer: D.
Herpes Labialis, Herpes Simplex genitalis, Herpes Zoster infection and Varicella
Valacyclovir is approved to treat four conditions. These include 1) herpes labialis, 2) Varicella (chickenpox), 3) herpes zoster infection and 4) herpes simplex genitalis (genital herpes). P. 725
33
When prescribing Acyclovir, what patient education would the Advanced Practice Nurse provide the patient?
a. Acyclovir only decreases symptoms and does not eliminate nor produce a cure for the virus.
b. If started with onset of symptoms, Acyclovir will not only decrease symptoms, it will cure the virus.
c. Oral Acyclovir is unsafe to be given during pregnancy.
d. If given intravenously at the start of onset of symptoms, the patient will have no side effects and be cured of the virus.
Answer: A. Acyclovir only decreases symptoms and does not eliminate nor produce a cure for the virus.
Acyclovir does not eliminate nor produce a cure for HSV, however it will decrease the symptoms of the virus. It is a safe drug to use in pregnancy and although it can be given intravenously, this is not a drug that will cure this virus. As for side effects, there are some noted side effects with taking Acyclovir. P. 724
34
Which of the following Herpes Simplex Virus and Varicella Zoster Virus drugs are safe to use in pregnancy?
a. Acyclovir, Famciclovir
b. Acyclovir, Famciclovir, Valacyclovir, Foscarnet
c. Acyclovir, Famciclovir, Valacyclovir
d. Acyclovir, Famciclovir, Foscarnet
Answer: C. Acyclovir, Famciclovir, Valacyclovir have been found to be safe in pregnancy. However, Foscarnet, which is deposited in bone and teeth, has caused abnormal development of tooth enamel and is not recommended during pregnancy. P. 724 (Patient centered care across the lifespan).
35
In immunocompetent patients, resistance to Acyclovir is ¬____________.
a. Rare in all populations
b. Common in all populations
c. Rare in immunocompetent populations but resistance has been reported in transplant patients and patients with AIDs.
d. Rare in immunocompetent patients but has been reported in only patients with AIDS.
Answer: C. Rare in immunocompetent populations but resistance has been reported in transplant patients and patients with AIDs.
Resistance to Acyclovir is rare in immunocompetent patients but many cases have been reported in transplant recipients and patients with AIDS. Lesions caused by resistant HSVs can be extensive and severe, progressing despite continued Acyclovir therapy. Acyclovir-resistant HSVs and VZV usually respond to intravenous foscarnet or cidofovir, which are primary used for treatment of CMV infection. P. 723.
36
Topical preparations such as Penciclovir (Denavir) and Docosanol (Abreva) are used to treat
a. Herpes Labialis
b. Herpes Genitalis
c. Herpes Labialis, Herpes Genitalis, Herpes Ocular
d. Herpes Labialis, Herpes Genitalis
Answer: A. Herpes Labialis
Topical preparations are used to treat Herpes Labialis. The patient will be required to apply the preparations multiple times a day, beginning at the first signs of symptoms. The benefits of both preparations were found to be modest in clinical trials. P. 727
NOTE: Docosanol (Abreva) will NOT suppress shedding of the virus (Per Study Guide audio clip Ch. 80).
37
Acyclovir, Famciclovir, Foscarnet, and Valacyclovir are all systemic drugs used to treat HSV and VZV infections. What baseline data will the APRN need to monitor when prescribing these drugs?
a. Serum creatinine, blood urea nitrogen (BUN), urinalysis
b. CBC with WBC differential, Liver enzymes
c. CBC with WBC differential, liver enzymes, ECG
d. Serum Creatinine, blood urea nitrogen (BUN), urinalysis, CBC with WBC differential, liver enzymes, electrolytes, ECG
Answer: D. Refer to table “Summary of Key Prescribing Considerations” P. 727 for detail on which drugs need which specific baseline data.
Note: Foscarnet is not used in pregnant women, it causes QT elongation (per study guide recording ch. 80), an ECG, electrolytes and a 24-hour urine are needed as additional baseline data prior when prescribing this antiviral drug.
38
Both Acyclovir and Valacyclovir are approved for use in children, however Foscarnet and Famciclovir are not. At what age can a child be prescribed Acyclovir and Valacyclovir?
a. Acyclovir: 3 Months, Valacyclovir: 2 Years
b. Acyclovir: 3 Years, Valacyclovir: 2 Years
c. Acyclovir: 3 Months, Valacyclovir: 2 Months
d. Acyclovir: 3 Days, Valacyclovir: 2 Days
Answer: A. Acyclovir: 3 Months, Valacyclovir: 2 Years
See box “Patient-Centered Care Across the Lifespan” P. 724, for specifics on each population.
39
What adverse effects are common with oral Acyclovir?
a. Headache, nausea, vomiting
b. Nausea, vomiting diarrhea, headache and vertigo
c. Nausea, vomiting, diarrhea, renal failure
d. Headache and vertigo
Answer: B. Nausea, vomiting diarrhea, headache and vertigo
Acyclovir is devoid of serious adverse effects. Renal Impairment has not been reported. The most common reactions are nausea, vomiting diarrhea, headache and vertigo. Topical Acyclovir frequently causes transient local burning or stinging: systemic reactions do not occur.
Note: Unlike oral formulations of Acyclovir, IV Acyclovir can cause renal failure. Patients with preexisting renal disease and dehydration are at increased risk.
40
Which of the following topical drugs are used for ocular herpes infections?
a. Ganciclovir
b. Trifluride, Zanamivir
c. Trifluride, Ganciclovir
d. Zanamivir, Valacyclovir
Answer: C. Trifluride, Ganciclovir
Trifluride and Ganciclovir are both topical drugs used to treat ocular herpes infections. P. 727.
Note: Ocular Herpes infections are a medical emergency (per study guide audio clip ch. 80).
41
When choosing an antibiotic, which of the following is NOT one of the three principle factors that must be considered:
A. host factors, such as the site of infection and the status of the host defenses
B. drug sensitivity of the infecting organism
C. the first-choice drug should be used
D. the identity of the infecting organism
Answer C -the first-choice drug should be used
p. 655
A, B, & D are the three principles. Drugs of first choice may not be used when the patient has an allergy to the drug of choice, inability of the drug of choice to penetrate the site of infection, and heightened susceptibility of the patient to toxicity of the first-choice drug.
42
Which group of antibiotics interfere with an enzyme that is necessary to produce folic acid?
A. Penicillins
B. Sulfonamides
C. Tetracyclines
D. Cephalosporins
Answer: B - Sulfonamides
p. 651
43
How do antibiotics develop resistance? Check all that apply.
A. Microbes can alter the structure of drug target molecules
B. Microbes can decrease the concentration of a drug at the site of action
C. Microbes can decrease active export of certain drugs
D. Microbes can cause drug inactivation
Answer: A, B, D
p. 653-4
not C - when microbes decrease the concentration of a drug at its site of action, microbes can increase (not decrease) active export of certain drugs.
44
Tetracycline is (check all that apply):
A. a narrow spectrum antibacterial drug
B. an inhibitor of cell wall synthesis
C. a bacteriostatic inhibitor of protein synthesis
D. a broad spectrum antibacterial drug
Answer: C & D
p. 652 Tables 70.1 & 70.2
45
Empiric therapy should be started:
A. after drug sensitivity has been completed so that you can identify a broad spectrum agent that can be used
B. before completion of laboratory tests, after completing a clinical evaluation
C. only when the infection is minor
D. after you receive the results of the C&S so that you know the infecting organism and determine its drug sensitivity
Answer: B - before completion of laboratory tests, after completing a clinical evaluation
p 655
46
Which of the following is NOT a drug of first choice for the organism?
A. azithromycin for bordetella pertussis (whooping cough)
B. larithromycin + amoxicillin + esomeprazole for H. pylori
C. cefotaxime for E-coli
D. ceftazidime for pseudomonas aeruginosa (UTI)
Answer: D - ceftazidime for pseudomonas aeruginosa (UTI)
p. 656-7 Table 70.5 ciprofloxacin is drug of first-choice for pseudomonas aeruginosa
47
What classification of antimicrobial drug are cephalosporins (choose all that apply)?
A. narrow spectrum gram-positive
B. narrow spectrum gram-negative
C. broad spectrum gram-positive
D.broad spectrum gram-negative
Answer: B, C, & D p. 652
1st and 2nd gen are narrow spectrum gram-negative, while 3rd gen is broad spectrum gram-positive and gram-negative
48
The mechanism of action of the antimicrobials penicillin and vancomycin involves:
A. disruption of cell membrane
B. suppression of viral replication
C. inhibition of protein synthesis
D. inhibition of cell wall synthesis
Answer A - disruption of cell membrane
p. 652
49
Oseltamivir and Zanamivir are classified by what mechanism of action?
A. influenza neuraminidase inhibitors
B. antimetabolites
C. bacteriostatic inhibitors of protein synthesis
D. bactericidal inhibitors of protein synthesis
Answer: A influenza neuraminidase inhibitors
p.652 table 70.2
50
Patient centered care across the lifespan for patients regarding antimicrobials includes:
A. sulfonamides bind to developing teeth of children, causing discoloration
B. gentamicin used by pregnant women can cause irreversible hearing loss in the newborn
C. tetracyclines are generally safe in children
D. use of penicillin causes kernicterus in infants
Answer: B gentamicin used by pregnant women can cause irreversible hearing loss in the newborn
p659
51
A patient who has seasonal allergies in the spring and fall asks the nurse about oral antihistamines. Which response by the nurse is correct?
A. “Anticholinergic effects are more common with second-generation antihistamines.”
B. “First-generation antihistamines, such as diphenhydramine [Benadryl], are more
effective.”
C. “Make sure you take antihistamines only when you have symptoms to minimize side
effects.”
D. “You should take oral antihistamines daily during each allergy season to get maximum
effects.”
D. “You should take oral antihistamines daily during each allergy season to get maximum
effects.”
Antihistamines are most effective when they are taken prophylactically, and they should be administered on a regular basis throughout the allergy season, even when symptoms are not present. p. 696
52
A patient admitted to the hospital has been using phenylephrine nasal spray [Neo- Synephrine], 2 sprays every 4 hours, for a week. The patient complains that the medication is not working, because the nasal congestion has increased. What will the nurse do?
A. Request an order for an oral decongestant to replace the intranasal phenylephrine.
B. Request an order for an intranasal glucocorticoid to be used while the phenylephrine is
withdrawn.
C. Tell the patient to increase the dose of phenylephrine to 4 sprays every 4 hours.
D. Tell the patient to stop using the phenylephrine and begin using an intranasal antihistamine.
B) Request an order for an intranasal glucocorticoid to be used while the phenylephrine is
withdrawn.
This patient is experiencing rebound congestion, which develops when topical sympathomimetics are used for longer than a few days. Abrupt withdrawal can stop the cycle of rebound congestion but is uncomfortable, so using an intranasal glucocorticoid, beginning 1 week before discontinuing the decongestant, while withdrawing the decongestant, is recommended. p. 698
53
A nurse provides teaching to a patient with allergic rhinitis who will begin using an intranasal glucocorticoid. Which statement by the patient indicates understanding of the teaching?
A. “If the glucocorticoid causes burning or itching, I should use it every other day.”
B. “I should use a decongestant if necessary before using the glucocorticoid.”
C. “I should use the glucocorticoid whenever I have symptoms.”
D. “I will probably develop systemic effects from the topical glucocorticoid.”
B. “I should use a decongestant if necessary before using the glucocorticoid.”
Patients using intranasal glucocorticoids should be taught to use a decongestant to unblock nasal passages if needed before using the medication. p. 695
54
.A patient with allergic rhinitis is taking a compound product of loratadine/pseudoephedrine [Claritin-D] every 12 hours. The patient complains of insomnia. The nurse notes that the patient is restless and anxious. The patient’s heart rate is 90 beats/minute, and the blood pressure is 130/85 mm Hg. The nurse will contact the provider to:
A. discuss using an intranasal glucocorticoid and loratadine [Claritin].
B. report acute toxicity caused by pseudoephedrine.
C. suggest using an agent with a sympathomimetic drug only.
D. suggest using a topical decongestant to minimize systemic symptoms.
A. discuss using an intranasal glucocorticoid and loratadine [Claritin].
This patient is showing central nervous system (CNS) and cardiovascular side effects of the pseudoephedrine. A better option would be to use single-ingredient products for each symptom; an intranasal glucocorticoid and an oral antihistamine are considered first-line treatments. p. 698
55
A child who has perennial allergic rhinitis has been using an intranasal glucocorticoid. The provider has ordered montelukast [Singulair] to replace the glucocorticoid because the child has frequent nosebleeds. When teaching this child’s parents about montelukast, the nurse will include which statement?
A. “Montelukast is also effective for treating infectious rhinitis.”
B. “Montelukast may cause behavior changes in your child.”
C. “Montelukast will treat both congestion and rhinitis.”
D. “Montelukast works best when combined with a topical decongestant.”
B. “Montelukast may cause behavior changes in your child.”
Montelukast can cause rare but serious neuropsychiatric effects (i.e. behavior changes) in patients, and parents should be warned of this possibility. p. 700
56
A patient who has a viral upper respiratory infection reports having a runny nose and a cough that prevents sleep and asks the nurse to recommend an over-the-counter medication. Which medication will the nurse recommend?
A. Diphenhydramine [Benadryl]
B. Fexofenadine/pseudoephedrine [Allegra-D]
C. Guaifenesin [Mucinex]
D. Phenylephrine drops
A. Diphenhydramine [Benadryl]
Diphenhydramine is effective in suppressing cough and also has sedative effects when used in doses to suppress cough. p. 701
57
A child with seasonal rhinitis has used budesonide [Rhinocort Aqua] for several years. The parents are concerned that the child’s rate of growth has slowed. What will the nurse do?
A. Reassure the parents that this is an expected side effect.
B. Suggest that the parents discuss using fluticasone [Flonase] with the provider.
C. Tell the parents to administer the drug only when symptoms are severe.
D. Tell the parents that antihistamines work as well as intranasal glucocorticoids.
B. Suggest that the parents discuss using fluticasone [Flonase] with the provider.
A worrisome systemic effect of intranasal glucocorticoids is suppression of linear growth in children. Although rare, it can occur; however, it is less likely with fluticasone and mometasone, so these two preparations are better options for children. p. 695
58
A parent asks a nurse to recommend an intranasal decongestant for a 6-year-old child. Which response by the nurse is correct?
A. “Decongestants are too sedating for children and should not be used.”
B. “Decongestants should not be given to children under 7 years old.”
C. “Decongestant drops are recommended instead of decongestant sprays.”
D. “Decongestant sprays should be used no longer than 5 to 10 days.”
C. “Decongestant drops are recommended instead of decongestant sprays.”
Decongestant drops are recommended for children, because the number of drops can be controlled precisely. When sprays are used, the amount given is not well controlled. p. 699
59
A 7-year-old child has a cough, runny nose, congestion, and fever, and the parents ask the nurse to recommend an over-the-counter product. Which response by the nurse is correct?
A. “Any product will be effective when combined with vitamin C and zinc.”
B. “It is best to use single-agent medications to treat individual symptoms.”
C. “The fever indicates that your child may need an antibiotic; you should call your provider.”
D. “You should ask your provider to prescribe a combination product that will treat multiple
symptoms.”
B. “It is best to use single-agent medications to treat individual symptoms.”
Combination medications may provide ingredients that are not needed or may provide ingredients that are either excessive or subtherapeutic. It is best to use single-agent drugs to treat individual symptoms. p. 701
60
Which medication used for asthma has off-label uses to treat allergic rhinitis?
A. Diphenhydramine [Benadryl]
B. Fexofenadine/pseudoephedrine [Allegra-D]
C. Guaifenesin [Mucinex]
D. Omalizumab [Xolair]
D. Omalizumab [Xolair]
Omalizumab is a monoclonal antibody directed against IgE that plays a role in the release of inflammatory mediators from mast cells and basophils. It is currently only approved for allergy- mediated asthma but is being used off-label to treat other allergic symptoms. p. 700
61
A patient with a cough has been advised to use guaifenesin. The patient asks the nurse to explain the purpose of the drug. The nurse will explain that guaifenesin:
A. dries secretions to help suppress coughing so patients can rest.
B. helps stimulate the flow of secretions to increase cough productivity.
C. helps to relieve chest pain associated with a cough.
D. stimulates the body’s natural immune responses.
B. helps stimulate the flow of secretions to increase cough productivity.
Expectorants stimulate the flow of respiratory tract secretions to improve cough productivity. p. 701
62
A parent asks a nurse about giving diphenhydramine [Benadryl] to a child to relieve cold symptoms. Which response by the nurse is correct?
A. “Benadryl must be given in higher doses to provide relief for cold symptoms.”
B. “Intranasal glucocorticoids are more effective for treating cold symptoms.”
C. “Nasal antihistamines are more effective for treating cold symptoms.”
D. “Because histamine does not cause cold symptoms, Benadryl would not be effective.”
D. “Because histamine does not cause cold symptoms, Benadryl would not be effective.”
Histamine does not contribute to symptoms of infectious rhinitis; therefore, antihistamines are of no use in treating cold symptoms. p. 696
63
```
A patient asks the nurse what type of medications would be most effective for treating seasonal and perennial rhinitis. Which response by the nurse is correct?
A. Pseudoephedrine [Sudafed]
B. Fluticasone propionate [Fluticasone]
C. Loratadine [Claritin]
D. Intranasal cromolyn sodium [Atrovent]
```
B. Fluticasone propionate [Fluticasone]
Intranasal glucocorticoids, such as fluticasone propionate, are the most effective drugs for prevention and treatment, because they prevent or suppress all the major symptoms of allergic rhinitis (congestion, rhinorrhea, sneezing, nasal itching, and erythema). p. 695
64
What is ipratropium bromide [Atrovent]?
A. A cholinergic agent used for perennial rhinitis
B. An anticholinergic used for allergic rhinitis and colds
C. A medication that is used only in patients with asthma
D. A drug that is inappropriate for use in patients with allergic rhinitis
B. An anticholinergic used for allergic rhinitis and colds
Ipratropium bromide is an anticholinergic that is indicated for allergic rhinitis, asthma, and the common cold. The drug reduces rhinorrhea p. 700
65
Telavancin could have drug interactions with all of the following EXCEPT:
a. NSAIDs
b. ACEIs
c. Cytochrome P450 enzymes
d. Clarithromycin
c. Cytochrome P450 enzymes
p. 675 Telavancin should be used with caution in patients taking other drugs that can damage the kidneys (e.g., NSAIDs, angiotensin-converting enzyme inhibitors, and aminoglycosides) and in patients taking drugs that prolong the QT interval (e.g., clarithromycin and ketoconazole). Clinically significant interactions involving cytochrome P450 enzymes have not been observed.
66
All of the following antibiotics work by weakening the bacterial cell wall and have a β-lactam ring on them EXCEPT:
a. Vancomycin (Vancocin)
b. Imipenem (Primaxin)
c. Cephalexin (Keflex)
d. Aztreonam (Azactam)
Answer A- Vancomycin (Vancocin)
p. 673 “Vancomycin (Vancocin) is the most widely used antibiotic in the US hospitals. Principal indications are Clostridiodies difficile infection (CDI), MRSA infection, and treatment of serious infections with susceptible organisms in patients allergic to penicillins. The major toxicity is renal failure. Unlike most other drugs discussed here, vancomycin does not contain a β-lactam ring.”
67
3. What should a nurse practitioner educate a patient to avoid while taking a cephalosporin antibiotic?
a. Grapefruit juice
b. Alcohol
c. Cheese
d. Greasy foods
Answer B. - Alcohol
disulfiram-like reaction could occur. (from outline slides for the cephaloporins and p. 669 in our text. Although in our text it states that “cefazolin and cefotetan—can induce a state of alcohol intolerance. If a patient taking these drugs were to ingest alcohol, a disulfiram-like reaction could occur.”
68
4. The NP needs to prescribe a cephalosporin antibiotic for a patient with renal insufficiency. Which of these medications can be given to this patient without adjusting the recommended dosage?
a. Cephalexin (Keflex)
b. Cefdinir (Omnicef)
c. Cefuroxime (Ceftin)
d. Ceftriaxone (Rocephin)
Answer D. Ceftriaxone (Rocephin)
p. 669 “One cephalosporin—ceftriaxone—is eliminated largely by the liver. Consequently dosage reduction is unnecessary in patients with renal impairment.”
69
5. A patient presents to the NP with complaints of nausea, abdominal cramping and watery diarrhea for a day. The patient has been taking ciprofloxacin for a kidney infection. The NP orders a stool test for c. diff which comes back positive. This is the first time the patient tests positive for c. diff. What course of action should the NP take?
a. Prescribe vancomycin 125 mg PO QID for 10 days.
b. Discontinue the ciprofloxacin and prescribe vancomycin 125 mg PO QID for 10 days
c. Continue the ciprofloxacin and prescribe vancomycin 500 mg PO QID PO for 10 days
d. Prescribe metronidazole (Flagyl) 500 mg TID for 10 days.
Answer B - Discontinue the ciprofloxacin and prescribe vancomycin 125 mg PO QID for 10 days
p. 673 “Treatment of CDI consists of stopping one antibiotic and starting another, as recommended in a clinical guideline issued by the Infectious Disease Society of America (IDSA). As soon as possible after CDI has been diagnosed, the antibiotic that facilitated C. diff. overgrowth must be stopped because doing so (1) will reduce the risk for reinfection after CDI has cleared and (2) in 25% of patients with mild CDI, it will cause the infection to resolve. At the same time, an antibiotic to eradicate C. diff. should be started. Drug selection is based on number of previous episodes and infection severity as judged by two laboratory values: white blood cell (WBC) counts and serum creatinine (SCr) values. For initial occurrences of CDI, treatment with oral vancomycin or fidaxomicin, a narrow spectrum macrolide, is recommended (Table 72.6)”
70
6. A 60 year old patient presents to the NP with dysuria, frequency and chills. Upon examination, the patient has a low grade fever and her urine is indicative of a UTI. She states that she is allergic to sulfas. What should the NP prescribe?
a. Ciprofloxacin 500 mg PO daily for 3 days
b. Bactrim DS q12 hr for 10 days
c. Fosfomycin 3 g PO x1 dose
d. Ciprofloxacin 500 mg PO BID for 7 days
Answer C - Fosfomycin 3 g PO x1 dose
p. 675 “Fosfomycin (Monurol) is a unique antibiotic approved for single-dose therapy in women with uncomplicated urinary tract infections (i.e., acute cystitis) caused by E. coli or E. faecalis.” She is allergic to sulfas, so the only other first line agent, Bactrim DS, is contraindicated. The article in the “drugs for common infection” link states “Fluoroquinolones (especially ciprofloxacin) have been the most common class of antibiotics prescribed for urinary tract infections, but they should no longer be used for empiric treatment, unless no other treatment options exist”
71
7. In cephalosporins, as we progress from the 1st generation to the 5th generation, which of the following is true?
a. Increasing ability to reach the CSF
b. Greater resistance to β-lactamases
c. Increasing activity against gram-negative bacteria and anaerobes
d. All of the above
Answer D. - All of the above
p. 669 In general, as we progress from first-generation agents to fifth-generation agents, there is (1) increasing activity against gram-negative bacteria and anaerobes, (2) increasing resistance to destruction by β-lactamases, and (3) increasing ability to reach the cerebrospinal fluid (CSF).
72
8. Which of the following is TRUE about carbapenems?
a. They have a narrow antimicrobial spectrum
b. They work only against gram-positive bacteria
c. One of them, imipenem, can be administered orally
d. Combined usage of imipenem and valproate should be avoided.
d. Combined usage of imipenem and valproate should be avoided.
Answer D. p. 671 section on carbapenems. “combined use of imipenem and valproate should be avoided.”
73
9. All of the following about vancomycin is true EXCEPT:
a. It is the drug of choice for infections caused by MRSA
b. It is active against both gram positive and gram negative bacteria
c. It is poorly absorbed in the GI tract
d. The dosage needs to be adjusted in patients with renal impairment
Answer B - It is active against both gram positive and gram negative bacteria
p. 673 Vancomycin is active only against gram-positive bacteria
74
10. The NP should be cautious when administering ceftriaxone (Rocephin) with all of the following drugs EXCEPT?
a. Clopidrogel (Plavix)
b. Warfarin (Coumadin)
c. Valproate
d. Ibuprofen
Answer C. - Valproate
p 670 “Cefotetan, cefazolin, and ceftriaxone can promote bleeding as they contain a side chain that interferes with Vitamin K metabolism which can inhibit the formation of clotting factors. Caution is needed if these drugs are combined with other agents that promote bleeding (anticoagulants, thrombolytics, nonsteroidal anti-inflammatory drugs [NSAIDs], and other antiplatelet agents).”
75
Which of the following is NOT a bacteriostatic inhibitor of protein synthesis?
a. Clindamycin
b. Erythromycin
c. Linezolid
d. Tetracyclines
e. Penicillin
e. Penicillin
( PCN is an inhibitor of cell wall synthesis)
ch 70
76
Which of the following drugs is NOT appropriate for Gram + cocci and bacilli?
a. PCN G and V
b. Fluoroquinolones
c. Clindamycin
d. Rifampin
b. Fluoroquinolones
( This drug class treats gram + and gram negative bacilli)
ch 70
77
Which of the following drugs is the first choice for uncomplicated UTI?
a. Nitrofurantoin
b. Fluoroquinolone
c. Amoxicillin
d. Fosfomycin
C) Amoxicillin
( the other three are alternative drugs)
Ch 70
78
which of the following is NOT a first choice drug for treating Escherichia coli?
a. cefotaxime
b. Ampicillin
c. cefepime
d. ceftriaxone
B) Ampicillin
(this is an alternative drug for e. coli)
ch 70
79
What is the correct first choice combination to treat H-pylori?
a. Tetracycline + metronidazole + bismuth subsalicylate + esomeprazole
b. clarithromycin + amoxicillin + esomeprazole
c. clarithromycin + amoxicillin
d. Tetracyline+Metronidazole+bismuth subsalicylate
b. clarithromycin + amoxicillin + esomeprazole
ch 70
80
Which of the following is NOT appropriate to treat Mycoplasma pneumoniae
a. Erythromycin
b. clarithromycin
c. azithromycin
d. Levofloxacin
e. tetracycline
d. Levofloxacin
ch 70
81
Which of the following is NOT a broad spectrum antibiotic?
a. Sulfonamides
b. Fluoroquinolones
c. piperacillin
d. third generation cephalosporins
e. vancomycin
e. vancomycin
( narrow spectrum for gram + cocci and bacilli)
ch 70
82
Gram + cocci and bacilli should be treated with
a. broad spectrum
b. narrow spectrum
c. antivirals
d. antifungals
b. narrow spectrum
Ch 70
83
Which of the following is the first choice for treating Haemophilus influenzae?
a. Cefuroxime
b. chloramphenicol
c. meropenem
d. ceftriaxone ( the others are alternative drugs)
d. ceftriaxone
( the others are alternative drugs)
ch 70
84
The first choice drug for a UTI caused by Psuedomonas aeruginosa is
a. Levofloxacin
b. piperacillin/tazobactam
c. cefepime
d. ciprofloxacin
e. imipenem
d. ciprofloxacin
ch 70
85
A 55-year old with a history of asthma and BPH presents to your clinic with complaint of seasonal allergy symptoms. Should you prescribe this patient an antihistamine and why?
a. No, the patient’s history of BPH puts them at risk for worsening prostatic hyperplasia
b. No, the patient’s history of asthma puts them at risk due to suppression of secretion of mucous
c. No, BPH and asthma are both contraindications for antihistamines
d. Yes, an antihistamine would provide relief for the seasonal allergies
Answer: A - No, the patient’s history of BPH puts them at risk for worsening prostatic hyperplasia
Rationale: Muscarinic receptors in the lungs constrict the bronchi and promote secretion. So if we block them, the lungs won’t be constricted and there will be less secretions. Sometimes we have to questions what we read, thinking well that doesn’t really make sense to me. Asthma treated appropriately and correctly, the way asthma should be treated à would NOT be a high risk patient for antihistamine use. Most patients have to be treated with antihistamines to help control their asthma. Be REAL aware of that per Dr. Mello. A patient with urinary retention, glaucoma, BPH WOULD be a patient to be cautious of treating because of how the muscarinic receptors work. (Ch 56 study guide video)
86
A nurse is preparing to give an antibiotic to a patient who reports being allergic to antibiotics. Before giving the medication, what will the nurse do first?
a. Ask whether the patient has taken this antibiotic for other infections
B) Question the patient about allergies to other medications
C) Request an order for a lower dose of the antibiotic
D) Request an order for an antihistamine
Answer: A Ask whether the patient has taken this antibiotic for other infections
Rationale: The nurse needs to assess whether the patient is truly allergic to this drug. Allergic reactions require previous exposure to the drug, so the nurse should ask whether the patient has taken this antibiotic before. If a patient is allergic to a drug, lowering the dose will not decrease the risk of allergic reaction. Antihistamines sometimes are given when patients must take a drug to which they are allergic. (Ch 56 study guide video)
87
A patient has allergies and takes an antihistamine. The patient wants to know how the drug works. The nurse understands that antihistamines work because they are what?
a. Activators
b. Agonists
c. Antagonists
d. Antidotes
Answer: C
Rationale: Antihistamines bind to receptors to prevent activation by histamine; this makes antihistamines antagonist drugs. Antihistamines do not activate receptors. Agonist drugs activate receptors; they are not antidotes. (Ch 56 study guide video)
88
The nurse understands what antihistamines are classified as, related to how the drug works. The nurse is explaining how H1 blockers interact with histamine to produce effects. She explains it as they:
a. Block the release of histamine from mast cells and basophils
b. Bind selectively to H1 receptors in the stomach to block actions of histamine at the site
c. Bind selectively to H1 receptors in the vascular system and CNS to block actions of histamine at the site
d. Stimulate antibodies to release IgE needed to block the allergen from creating symptoms
Answer: C
Rationale: H1 blockers bond selectively to H1 receptors, blocking the actions of histamine at the site, they do NOT block the release of histamine from the mast cells and basophils. This explains why antihistamines take a while to control symptoms if the symptoms have already started. (Ch 56 study guide video)
89
# Fill in the blanks. _____ - generation antihistamines have _____ molecules that readily cross the blood brain barrier. They have a ____ affinity for H1 receptors in the CNS, which ____ sedating effects.
a. First, small, high, causes
b. Second, small, high, does not cause
c. First, large, high, does not cause
d. First, small, low, causes
Answer: A
Rationale: First-generation antihistamines have small molecules with high lipid solubility and readily cross the blood brain barrier. They have a high affinity for H1 receptors in the CNS causing sedative effects. Second generation antihistamines have little sedative effects because they are larger molecules that do not cross the blood brain barrier. Second generation antihistamines have a low affinity for H1 receptors in the CNS.
90
A patient who has seasonal allergies in the spring and fall asks the nurse about oral antihistamines. Which response by the nurse is correct?
a. “Anticholinergic effects are more common with second-generation antihistamines.”
b. “First-generation antihistamines, such as diphenhydramine [Benadryl], are more effective.”
c. “Make sure you take antihistamines only when you have symptoms to minimize side effects.”
d. “You should take oral antihistamines daily during each allergy season to get maximum effects.”
Answer: D
Antihistamines are most effective when they are taken prophylactically, and they should be administered on a regular basis throughout the allergy season, even when symptoms are not present. They are less helpful when taken after symptoms appear. Second-generation antihistamines have fewer anticholinergic effects than first-generation antihistamines. First- generation antihistamines are not more effective than second-generation antihistamines. Oral antihistamines are not as effective when given on a PRN basis. (Ch 63 study guide video)
91
A patient admitted to the hospital has been using phenylephrine nasal spray [Neo- Synephrine], 2 sprays every 4 hours, for a week. The patient complains that the medication is not working, because the nasal congestion has increased. What will the nurse do?
a. Request an order for an oral decongestant to replace the intranasal phenylephrine.
b. Request an order for an intranasal glucocorticoid to be used while the phenylephrine is withdrawn.
c. Tell the patient to increase the dose of phenylephrine to 4 sprays every 4 hours.
d. Tell the patient to stop using the phenylephrine and begin using an intranasal antihistamine.
Answer: B
Rationale: This patient is experiencing rebound congestion, which develops when topical sympathomimetics are used for longer than a few days. Abrupt withdrawal can stop the cycle of rebound congestion but is uncomfortable, so using an intranasal glucocorticoid, beginning 1 week before discontinuing the decongestant, while withdrawing the decongestant, is recommended. An oral decongestant is not recommended. Increasing the dose of the intranasal decongestant will only compound the problem of rebound congestion. Stopping the intranasal decongestant will only increase the congestion; using an intranasal antihistamine will not help with congestion. (Ch 63 and Ch 63 study guide video)
92
A patient with a cough has been advised to use guaifenesin. The patient asks the nurse to explain the purpose of the drug. The nurse will explain that guaifenesin:
a. dries secretions to help suppress coughing so patients can rest.
b. helps stimulate the flow of secretions to increase cough productivity.
c. helps to relieve chest pain associated with a cough.
d. stimulates the body’s natural immune responses.
Answer: B
Rationale: Expectorants stimulate the flow of respiratory tract secretions to improve cough productivity. Guaifenesin does not dry secretions, because it does not have anticholinergic effects. Guaifenesin does not alleviate pain associated with cough. Guaifenesin does not stimulate immune responses (Ch 63 and Ch 63 study guide video)
93
A patient asks the nurse what type of medications would be most effective for treating seasonal and perennial rhinitis. Which response by the nurse is correct?
a. Pseudoephedrine [Sudafed]
b. Fluticasone propionate [Fluticasone]
c. Loratadine [Claritin]
d. Intranasal cromolyn sodium [Atrovent]
ANS: B
Intranasal glucocorticoids, such as fluticasone propionate, are the most effective drugs for prevention and treatment, because they prevent or suppress all the major symptoms of allergic rhinitis (congestion, rhinorrhea, sneezing, nasal itching, and erythema). Pseudoephedrine is an oral sympathomimetic used to reduce nasal congestion associated with allergic rhinitis. It has no effect on other symptoms. Loratadine, an oral antihistamine, reduces sneezing, rhinorrhea, and nasal itching only and is less effective than intranasal glucocorticoids. Intranasal cromolyn sodium is moderately effective in the treatment of allergic rhinitis, but the benefits are much less than those of intranasal glucocorticoids. (Ch 63 and Ch 63 study guide video)
94
7-year-old child has a cough, runny nose, congestion, and fever, and the parents ask the nurse to recommend an over-the-counter product. Which response by the nurse is correct?
a. “Any product will be effective when combined with vitamin C and zinc.”
b. “It is best to use single-agent medications to treat individual symptoms.”
c. “The fever indicates that your child may need an antibiotic; you should call your provider.”
d. “You should ask your provider to prescribe a combination product that will treat multiple symptoms.”
Answer: B
Rationale: Combination medications may provide ingredients that are not needed or may provide ingredients that are either excessive or subtherapeutic. It is best to use single-agent drugs to treat individual symptoms. The efficacy of vitamin C and zinc for treating colds in children has not been established. Fever may accompany viral respiratory infections and not necessarily bacterial infections that need an antibiotic (Ch 63 and Ch 63 study guide video)
95
Which of the following interacts with Sofosbuvir, decreasing its levels in the body?
A. CYP3A Inducers
B. P-Glycoprotein Inducers (St. John’s Wort)
C. CYP1A2 Inhibitors
D. Grapefruit Juice
Correct Answer: B. P-Glycoprotein Inducers (St. John’s Wort)
Rationale: If administered with P-gp inducers such as St. John’s wort, the level of sofosbuvir may decrease. Chapter 80, Page 735
96
Which of the following are the principal concerns with Ribavirin administration? Select all that apply.
A. Hemolytic Anemia
B. Fetal Injury
C. Fever
D. Nausea/Vomiting
Correct Answer. A. Hemolytic Anemia & B. Fetal Injury
Rationale: Ribavirin can cause hemolytic anemia that can worse heart disease and lead to myocardial infarction. Ribavirin is both embryolethal and teratogenic. Chapter 80, Page 735
97
Which of the following is NOT a contraindication for Ribavirin?
A. Pregnancy
B. Blood Disorders
C. Cardiac Disease
D. Diabetes
Correct Answer: D. Diabetes
Rationale: Ribavirin should not be prescribed for pregnant women or women who want to become pregnant. Because ribavirin increases the risk for hemolytic anemia, careful consideration should be given before prescribing the drug for patients with a history of blood disorders or cardiac disease. Chapter 80, Page 735
98
4. Which of the following is the most common side effect from Interferon Alfa in treatment of Hepatitis B?
a. Neuropsychiatric symptoms
b. Bone marrow suppression
c. Thyroid dysfunction
d. Flu – like syndrome
Correct Answer: D. Flu – Like Syndrome
Rationale: Flu like syndrome occurs in 50% of patients receiving Interferon Alfa. It is characterized by fever, fatigue, myalgia, headache, and chills. Chapter 80, Page 737.
99
5. Which of the following should be ruled out before starting treatment with Lamivudine?
a. HAV
b. CMV
c. HSV
d. HIV
Correct Answer. D. HIV
Rationale: Because lamivudine is also used against HIV, if a patient is infected with HIV, giving lamivudine in the low doses employed against HBV may allow emergence of HIV viruses resistant to nucleoside analogs. Accordingly, HIV infections should be ruled out before lamivudine is used. Chapter 80, Page 738.
100
. Which of the following is the principal concern when receiving treatment with Adefovir?
A. Hypertension
B. Neutropenia
C. Metabolic Alkalosis
D. Nephrotoxicity
Correct Answer: D. Nephrotoxicity
Rationale: Nephrotoxicity is the principal concern with Adefovir. To reduce risk, kidney function should be assessed at baseline and periodically thereafter. Chapter 80, Page 638
101
Which of the following is true regarding Entecavir?
A. It is used to treat Hepatitis C
B. It is given SubQ
C. It can reverse cirrhosis and fibrosis
D. It is less effective than lamivudine
Correct Answer: C. It can reverse cirrhosis and fibrosis
Rationale: Entecavir is used for oral therapy in treatment of chronic Hepatitis B. It is more effective than lamivudine and long-term use can reverse fibrosis and cirrhosis. Chapter 80, Page 739.
102
Which of the following influenza vaccines is given by intranasal spray?
A. Inactivated Influenza Vaccine (IIV)
B. Recombinant Hemagglutinin Vaccine (RIV)
C. Live, attenuated Influenza Vaccine (LAIV)
D. All of the above
Correct Answer. C. Live, attenuated Influenza Vaccine (LAIV).
Rationale. IIV and RIV are administered by IM Injection. LAIV is administered by intranasal spray. Chapter 80. Page 740
103
Which of the following is NOT a potential side effect for the Live Attenuated Influenza Vaccine?
A. Guillain-Barre Syndrome (GBS)
B. Rhinorrhea
C. Lethargy
D. Headache
Correct Answer: A. Guillain – Barre Syndrome (GBS)
Rationale: GBS is a side effect for the Inactivated Influenza Vaccine. The Live Attenuated Influenza Vaccine can cause nasal congestion with rhinorrhea, lethargy, headache, sore throat, and decreased appetite. Chapter 80, Page 740.
104
Which of the following individuals should NOT be given the flu vaccine?
A. Pregnant Women
B. History of egg allergies
C. Current common cold infection
D. History of severe allergic reaction to influenza vaccine or a vaccine component
Correct Answer. D. History of severe allergic reaction to influenza vaccine or a vaccine component is a contraindication for the flu vaccine. Chapter 80, Page 741.
105
Histamine is synthesized and stored in (select all that apply)
a. Mast cells
b. Basophils
c. Eosinophils
d. Neutrophils
Correct: A/B
Rationale: Chapter 56 & 63 Study Guide Video, Chapter 56 Pg. 488
106
Effects of histamine include: (select all that apply)
a. Constriction of smooth muscle
b. Relaxation of smooth muscle
c. Small vessel constriction
d. Small vessel dilation
e. Increased capillary permeability
f. Decreased capillary permeability
g. Hypertension
h. Hypotension
Correct A, D, E, H
| Rationale: Chapter 56 & 63 Study Guide Video, Chapter 56 Pg. 488
107
In the body, levels of histamine are especially high in the
a. Lungs, GI tract, nasal passageways
b. GI tract, lungs, skin
c. Skin, GI tract, arteries/vessels
d. GI tract, lungs, posterior hypothalamus
Correct B - GI tract, lungs, skin
Rationale: Chapter 56 & 63 Study Guide Video, Chapter 56 Pg. 488
108
The initial requirement for histamine release is production of antibodies of
a. IgA
b. IgE
c. IgM
d. IgG
Correct: B - IgE
Rationale: Chapter 56 & 63 Study Guide Video, Chapter 56 Pg. 488
109
The stark difference in stimulation of histamine-1 and histamine-2, is that histamine-2 has a role in
a. Vasodilation
b. Bronchoconstriction
c. Seizure suppression
d. Secretion of gastric acid
Correct D - Secretion of gastric acid
| Rationale: Chapter 56 & 63 Study Guide Video, Chapter 56 Pg. 488
110
Antihistamines should be avoided in (select all that apply)
a. Pregnancy
b. Breastfeeding
c. Children
d. Geriatric adults
Correct A, B, D
Rationale: Chapter 56 Pg. 490 Green Box
* Caution should be used in pregnancy, yet should be avoided in third trimester d/t newborn sensitivity to adverse reaction.
* Can be used in small doses with children, yet should be avoided in children under the age of 2 years old.
* Occasional, small doses of antihistamines do not appear to cause sedation in infants, caution should be used in breastfeeding.
* BEERS criteria, avoid.
111
Annie comes to the PCP office with the complaints of nasal congestion. It would be best to prescribe the patient
a. Astelin
b. Pseudoephedrine
c. Xyzal
d. Clarinex
Correct: B-Pseudoephedrine
Rationale: Ch. 63 Pg. 583-584
• Sympathomimetics (decongestant) is only used for nasal decongestion.
• All other options are for allergic rhinitis.
112
Mrs. Thomas presents to the PCP office. His chart reveals that he came in a few months ago and was prescribed multiple medications for allergic rhinitis, including Afrin Nasal Spray. He complains today that his nasal congestion is worsening and he is having to increase the need for the Afrin, almost doubling his initial prescribed dose. The possibilities to discontinuing the Afrin include (Select all that apply)
a. Discontinue decongestant abruptly
b. Discontinue the spray in one nostril at a time
c. Prescribe intranasal glucocorticoid for 2-6 weeks before discontinuing
d. Adding antihistamine oral tablet and an intranasal glucocorticoid for 4 weeks, at which time the Afrin is decreased in dosage for another 2 weeks, slowly tapering thereafter.
Correct: A, B, C
Rationale: Chapter 63 Pg. 583
• A, B, C can all be correct. Option A is extremely uncomfortable, but can be done. Option D is not a recommended option.
113
Ms. Johnson comes to the office as a walk-in patient with complaints of nasal decongestion, headache to the frontal and temporal regions, intermittent sneezing throughout day, but denies fever. Her daily medication regimen includes Losartan, Metoprolol, Atorvastatin, Aspirin, and Metformin. What medication should the PCP avoid prescribing at today’s visit?
a. Allegra
b. Sudafed
c. Loratadine
d. Fexofenadine
Correct: B
| Chapter 63 Page 583 Read “Cardiovascular Effects”
114
To be effective, Phenylephrine must be prescribed as
a. Topical
b. Oral
c. IM
d. Subcu
Correct A - topical
| Rationale: Ch. 63 Pg. 584 “Comparison of Phenylephrine and Psuedoephedrine”
115
What are harmful effects of COX 1 inhibitors? Select all that apply
A. Gastric Erosion
B. Bleeding Tendencies
C. Renal Impairment
D. Platelet Aggregation
Answer: A, B, C
| D is incorrect because Cox-1 inhibitors (Aspirin) suppress platelet aggregation pg. 493
116
What are the benefits of COX 2 inhibitors? Select all that apply.
A. Prevention of M.I/Stroke
B. Alleviate Pain
C. Reduce Fever
D. Promote against colorectal cancer
Answer: B, C, D
| COX 2 Inhibitors does not prevent M.I/Stroke, it actually promotes it secondary to vasodilation p. 493
117
True or false?
Second generation NSAID selective Cox 2 inhibitors are a safer option than first generation Cox 1/Cox 2 inhibitors because they are more selective.
False- In theory, second generation Cox-2 inhibitors can suppress pain and inflammation while (possibly) cause fewer adverse that First generation NSAIDS. However, in reality, Cox 2 inhibitors appear to be even less safe than first generation agents, owning the increase rick of M.I/STROKE P.493
118
Which of the following drugs prevent M.I/stroke?
A. Celecoxib
B. Aspirin
C. Naproxen
D. All of the above
Answer: B - Aspirin
Pg. 495
119
Which drug should be avoided in children? (Reye syndrome)
A. Acetaminophen
B. Ibuprofen
C. Aspirin
D. Naproxen
Answer: C
Aspirin should be avoided in children and teenagers suspected of having influenza or chickenpox pg. 497
120
Aspirin has drug interaction with which of the following? Select all that apply
```
A. Warfarin/ heparin and other anti-coagulants
B. Glucocorticoids
C. Alcohol
D. ACEI/ARD
E. NSAIDS
F. Vaccines
```
Answer is all of them: A, C, D, E, F
Aspirin like other NSAIDs increases risk of bleeding with coumadin and other anticoagulants, it increases risk of gastric ulcers with glucocorticoids, increases risk of bleeding with alcohol there is actually a STOMACH BLEEDING WARNING with the use of ALCOHOL and NSAIDS! NSAIDS can cause renal impairment with the use of ACEI/ARB and aspirin is an NSAID so combined with another NSAID CAN ACTUALLY REDUCE THE ANTIPLATELET EFFECTS OF ASPIRIN by blocking the access of aspirin to COX 1 in platelets. Lastly. Aspirin and other NSAIDS may blunt the immune response to vaccines pg.496
121
True or false
All First generation NSAID are associated with the increase risk for gastrointestinal bleeding and cardiovascular events that can lead to hospitalization or death.
True BLACK BOX Warning pg. 499
122
What are the uses for Celebrex? Select all that apply.
```
A. Osteoarthritis
B. Rheumatoid arthritis
C. Acute pain
D. Osteoporosis
E. Dysmenorrhea
F. Ankylosing spondylitis
```
Answer: A, B, C, E,F pg. 500
123
Acetaminophen can cause…
A. Kidney impairment
B. Liver impairment
C. Risk for M.I/Stroke
D. Reye syndrome
Answer B. Liver impairment
pg. 501
124
True or false?
| Celebrex is that safest NSAID for a patient with a sulfa allergy.
False- Celebrex contains sulfa.pg. 500
125
```
What is the antidote of acetaminophen?
A. Activated charcoal
B. Salicylate
C. Acetylcysteine
D. Salicylic Acid
```
Answer: C Acetylcysteine
pg. 502
126
Which of these patients is a poor candidate for Zanamivir (Relenza) prophylaxis?
a. Martin, a 74-year-old male living in a nursing home with a history of diabetes, hypertension and a stroke
b. Louise, a 62-year-old Asian female with a history of asthma and a recent hysterectomy
c. Molly, an 18-year-old Caucasian female who is 22 weeks pregnant
d. George, a 9-year-old Hispanic male with multiple congenital heart defects and heart failure currently on the heart transplant list
b. Louise, a 62-year-old Asian female with a history of asthma and a recent hysterectomy
Influenza video
127
Amantadine (Symmetrel) and Rimantadine (Flumadine) is no longer considered the standard of care because
a. Severe reported adverse effects
b. Multiple high-risk drug reactions
c. Minimal effectiveness due to viral resistance
d. Teratogenic effects to fetus in pregnancy
C) Minimal effectiveness due to viral resistance
Influenza video
128
3. Which patient is a good candidate for the live attenuated influenza vaccine?
a. Tatum, an 18-month-old healthy male
b. Victor, a 22-year-old Hispanic male with a history of obesity and hypertension
c. Meredith, a 34-year-old female with a history of lung transplant
d. Lilly, a 58-year-old with osteoarthritis
d. Lilly, a 58-year-old with osteoarthritis
Influenza video
129
4. Which patient has an absolute contraindication to receiving the influenza vaccination?
a. Egg Allergy
b. Patient currently admitted to the ICU with meningitis
c. Woman with history of Guillain-Barre Syndrome in 1979
d. Geriatric patients
b. Patient currently admitted to the ICU with meningitis
Influenza video
130
5. Recommended duration of oseltamivir prophylaxis for nursing home residents is:
a. Continuous for 42 days
b. 14 days after exposure
c. Prophylaxis is not recommended
d. 30 days
a. Continuous for 42 days
Influenza video
131
6. Current recommendation for influenza vaccinations for children include:
a. No live influenza vaccine for those under 2 years old
b. Re-vaccination 4 months after original dose is recommended in order to maintain titer levels
c. Influenza nasal spray is preferred for infants and toddlers
d. 2 doses for patients age 2-8 years old if this is the patients first time to receive the influenza vaccine
d. 2 doses for patients age 2-8 years old if this is the patients first time to receive the influenza vaccine
Influenza Video
132
7. Which one of these patients would be considered high risk for influenza complications?
a. 53-year-old Asian American woman with history of hysterectomy due to uterine fibromas
b. 28-year-old female who is 3 months postpartum with mastitis
c. 9-year-old with history of portal vein thrombosis treated by long-term aspirin therapy
d. 64-year-old male with diverticulitis and GERD
c. 9-year-old with history of portal vein thrombosis treated by long-term aspirin therapy
Influenza video
133
8. Influenza is primarily managed by
a. Isolation of high-risk patients
b. Vaccination
c. Anti-Viral medications
d. Prophylaxis for all patients in the high-risk group for the entire winter
b. Vaccination
Influenza video
134
9. Education for patients receiving the inactivated influenza vaccine should include
a. Nasal congestion, lethargy and headache are the most common side effects and should resolve a few days after vaccine
b. Any leg weakness or loss of feeling should be reported immediately
c. Soreness and arm redness should be reported as signs of an allergy
d. There is risk of getting influenza from the vaccine
b. Any leg weakness or loss of feeling should be reported immediately
Influenza Video
135
10. Education for oseltamivir (Tamiflu) should include
a. Tamiflu is only effective against Influenza A so should not be given for Influenza B infection
b. Medication can be given indiscriminate to food times
c. Tamiflu should be given as a prophylaxis until the morning of live attenuated vaccine administration
d. Tamiflu will decrease symptoms only if started within first 48 hrs of symptoms beginning
d. Tamiflu will decrease symptoms only if started within first 48 hrs of symptoms beginning
Influenza video
136
What Adverse effect is NOT seen with sulfonamides?
a) hemolytic anemia
b) kernicterus
c) renal damage
d) Sun tanned looking skin
Answer: D - Sun tanned looking skin
Rationale: Pg 689-690 7th edition
137
When can sulfonamides be used in pregnant patients?
a) Never
b) After 12 weeks
c) Before 32 weeks
d) No concern
Answer: C - Before 32 weeks
Rationale: Pg 690 7th edition
138
How do sulfonamides promote kernicterus?
a) Increase the amount of bilirubin made by liver
b) Displaces bilirubin from plasma proteins
c) Depletes the blood brain barrier
d) Activates bilirubin in the brain
Answer: B - Displaces bilirubin from plasma proteins
Rationale: p 690 7th edition
139
How do sulfonamides suppress bacterial growth?
a) They are bactericidal.
b) They inhibit protein synthesis.
c) They inhibit the synthesis of tetrahydrofolate.
d) They increase folate production
Answer: C - They inhibit the synthesis of tetrahydrofolate.
Rationale: 688 7th edition
140
Which patient is not considered high risk with sulfonamide use?
a) Hepatic impairment
b) Folate deficiency
c) Newborns under 2 months old
d) Renal impairment
Answer: A - Hepatic impairment
Rationale: Summary on 694 7th edition
141
Uses of sulfonamide antibiotics include all EXCEPT:
a) superficial infections of the eyes
b) suppress bacterial growth in burn patients
c) internal organ necrosis
d) Urinary Tract Infections
Answer: C - internal organ necrosis
| Rationale p 688 7th edition
142
How can older adults minimize renal damage from sulfonamide antibiotics?
a) Take Miralax to promote bowel movement
b) Drink 8-10 glasses of water per day to maintain 1200 mL UOP
c) Take medication with grapefruit juice.
d) Ambulate once an hour while on medication.
Answer: B - Drink 8-10 glasses of water per day to maintain 1200 mL UOP
Rationale pg 690-691 7th edition
143
What is the mechanism of action of trimethoprim?
a) inhibits dihydrofolate reductase
b) increases folate production
c) increases renal clearance
d) decreases bilirubin
Answer: A - inhibits dihydrofolate reductase
Rationale: 692 7th edition
144
Which of the following of your patient's prescriptions would warrant caution with use of sulfanomide antibiotics?
a. HCTZ
b. Glipizide
c. Aspirin
d. Atorvastatin
Answer: B - Glipizide
Rationale: P 694 7th edition and audio clip
145
What symptoms would be expected in a patient on trimethoprim/sulfamethoxazole who is having symptoms of a hypersensitivity reaction?
a) rash, drug fever, photosensitivity
b) increased mucous production and rhinitis
c) body aches and fever
d) localized swelling
Answer: A - rash, drug fever, photo-sensitivity
Rationale: pg 689 7th edition
146
You have recently prescribed a patient with asthma on a reliever drug to be used for acute asthma exacerbations. The patient wants to know why some medications help to relieve acute asthma attacks but not used for maintenance control of asthma. You explain that reliever medication work by,
A) decreasing airway inflammation therefore decrease bronchial hyperreactivity
B) act on mast cells to reduce mediators (histamines, leukotriene, etc.) released
C) reduce mucus production in the airway
D) decrease bronchoconstriction
Answer D -decrease bronchoconstriction
Rationale: Ch 62 Video Clip
147
Glucocorticoids are considered first line treatment for patients with due to their ability to suppress inflammation. This is done by:
A) Block synthesis and release of inflammatory mediators (histamine, leukotrienes, etc.)
B) Reduce bronchial hyperreactivity and decrease airway mucus production
C) Decrease amount of mast cells available to bind with allergen
D) Block infiltration and activity of inflammatory cells (eosinophils, leukocytes, etc.)
Answer B: Reduce bronchial hyperreactivity and decrease airway mucus production
Rationale: Ch 62 Video Clip, Textbook pg 561
148
You are providing a patient education on how to use their new metered dose inhaler. All of the following education is true except:
A) You need to wait at least one minute between each inhalation doses
B) You should inhale before activating inhaler
C) Meter dose inhalers are easy for patients to use because they do not involve hand-breath coordination
D) Spacers should be used to help increase amount of drug reaching the lungs
Answer C- Meter dose inhalers are easy for patients to use because they do not involve hand-breath coordination
Rationale: Ch62 Video Clip, Textbook pg 558-559
149
When choosing the first line treatment for COPD why would a provider choose a long acting muscarinic antagonist over a long acting B2 adrenergic agonist.
A) Less adverse effects have been shown with
B) Reduction in mucus production
C) Reduced dosage and frequency are needed
D) Provider preference
Answer B- Reduction in mucus production
Rationale: Module Ch 62 Video Clip
150
A COPD patient comes in for a regular check up to discuss treatment goals for management of their COPD. Which treatment goals are appropriate for the management of COPD? Select all that apply:
A) Increase exercise tolerance
B) Reduce symptoms
C) Improve patient’s health status
D) Reduce mortality
Answer A, B, C, D Rationale : Video Clip ch 62, Textbook pg 576
151
. A 24-year-old female Caucasian patient comes into the clinic on the current treatment of Beclomethasone dipropionate (QVAR) and Albuterol (ProAIR HFA) Upon your assessment of the patient what symptoms would concern you that the patient’s asthma is not well controlled?
A) Patient states are being woken up at night at least twice a month by her symptoms
B) Patient states she has gone through more than 2 Beclomethasone dipropionate inhalers over the past year.
C) Patient states she is experiencing issues with asthma symptoms once a week during the day.
D) Patient states she uses Albuterol less than twice a week
Answer A- Patient states are being woken up at night at least twice a month by her symptoms
Rationale: Video Clip Ch 62
152
The use of long-term glucocorticoids can cause many adverse effects on patients. All of the following are potential concerns for long-term use except:
A) Bone loss
B) Adrenal excitation
C) Growth suppression in children
D) Glaucoma
Answer B- Adrenal excitation
Rationale: Video Clip Ch 62, Textbook 561
153
A patient is being new diagnosed with COPD. As an advanced provider you know that in order to have this diagnosis requires what criteria:
A) ACQ 0.75 or less
B) FEV1/FVC less than 0.7
C) ATAQ 1-2
D) Predicted FEV1 less than 85%
Answer B- FEV1/FVC less than 0.7
Rationale: Video Clip Ch 62, Textbook pg 576
154
You have recently started a patient on Zileuton as their asthma prophylaxis. With your knowledge for this leukotriene receptor antagonist you are aware the lab to monitor is:
A) H/H
B) WBC
C) ALT
D) CKB
Answer C- ALT
Rationale: Video Clip Ch 62, Textbook pg 563
155
When creating a treatment plan for a patient with asthma, you are aware that all of the following are realistic treatment goals except:
A) Prevent chronic and troublesome symptoms
B) Maintain normal activity levels
C) Reduce need for hospitalization
D) Reduce the use of SABA to 2 days a month
Answer D- Reduce the use of SABA to 2 days a month
Rationale: Video Clip Ch 62, Textbook pg 574
156
Mrs. Jones a 56-year-old patient has come to the clinic today for an evaluation. She has been on long-term glucocorticoid treatment for a chronic health condition. She has developed increased hypertension, hyperglycemia, and osteoporosis. Which of the following is the MOST LIKELY responsible for causing her symptoms?
a. Inhaled fluticasone for asthma
b. Oral fludrocortisone for Addison’s disease
c. Oral prednisone for SLE
d. Hydrocortisone PO twice daily
Answer: C- Oral prednisone for SLE
Those are side effects associated with the chronic use of anti-inflammatory corticosteroids. Inhaled formulations for asthma results in much lower levels of systemic absorption
157
A patient is taking high doses of glucocorticoids develops weakness in muscles of the upper arms and in the legs. What will the APRN plan to do?
a. Consider reducing the dose
b. Encourage the patient to restrict sodium intake
c. Reassure the patient that this is an expected side effect
d. Tell the patient to stop taking the dose
Answer: A- Consider reducing the dose
High-dose glucocorticoid therapy can cause myopathy, manifesting as a weakness. If muscle weakness occurs, the dose should be reduced. Reducing sodium intake is recommended to minimize sodium and water retention. Muscle weakness is not an expected side effect, because it indicates myopathy. It is incorrect to tell the patient to stop taking the drug because a glucocorticoid must be withdrawn slowly to allow time for recovery of adrenal function
158
A clinic patient who has been taking a glucocorticoid for arthritis for several months’ remarks to the APRN, “It is a good thing my symptoms are better because my mother has been quite ill, and I have to take care of her.” The patient’s blood pressure is 100/60 mmHg. What will the advanced practice nurse consider doing for the patient?
a. Reducing the patient’s dose
b. Using every-other-day dosing
c. Increasing the patient’s dose
d. Tapering the dose
Answer: C- Increasing the patient’s dose
Because of their adrenal suppression, patients taking glucocorticoids long-term require increased doses at times of stress and even for a time after stopping the drug until the adrenal function returns. This patient’s lower blood pressure is an indication that glucocorticoid levels may be depleted. Reducing the dose would only exacerbate the patient’s problems. Every other- day dosing is used early in glucocorticoid therapy to reduce adrenal suppression, but it would not be useful now. Tapering of doses is used to allow adrenal function to recover as the drug is discontinued.
159
A patient who is a long-distance runner has been diagnosed with rheumatoid arthritis in both knees and will begin glucocorticoid therapy. When teaching the patient about the medication, the APRN will include what information?
a. “By reducing inflammation, this drug will slow the progression of your disease.”
b. “Glucocorticoids are used as adjunctive therapy during acute flare-ups.”
c. “Oral glucocorticoids cause less toxicity than intra-articular injections.”
d. “You may resume running when the pain and swelling improve.”
Answer: B- “Glucocorticoids are used as adjunctive therapy during acute flare-ups.”
Glucocorticoids are used as adjunctive therapy to treat acute exacerbations of RA. They reduce pain and inflammation. Oral glucocorticoids produce side effects similar to those of all glucocorticoids, but they are absorbed more rapidly and completely than inta-articular injections.
160
A patient who has been taking glucocorticoid for several months arrives in the clinic. The advanced practice nurse notes that the patient’s cheeks appear full and that a prominent hump of fat is present on the upper back. The APRN will order which test(s)?
a. Liver function tests
b. Serum electrolytes
c. Tuberculin skin test
d. Vitamin D levels
Answer- B- Serum electrolytes
This patient shows signs of iatrogenic Cushing syndrome
161
A patient is about to receive prednisone for tendonitis. The APRN reviewing the chart would be concerned about which of the following in the patient’s medical history?
a. Asthma and allergic rhinitis
b. Gouty arthritis
c. Seborrheic dermatitis
d. Systemic fungal infection
Answer- D- Systemic fungal infection
Glucocorticoids are contraindicated in patients with a history of systemic fungal infections. Glucocorticoids are used to treat asthma, allergic rhinitis, gout, and seborrheic dermatitis.
162
A patient taking a glucocorticoid for arthritis reports feeling bloated. The APRN notes edema of the patient’s hands and feet. What is the next action the APRN should take?
a. Ask the patient about sodium intake
b. Obtain a blood glucose level
c. Suggest the patient limit potassium intake
d. Tell the patient to stop taking the drug
Answer-A -Ask the patient about sodium intake
because of their mineralocorticoid activity, glucocorticoids can cause sodium and water retention and potassium loss. Patients with sodium and water retention should be encouraged to increase their potassium intake.
163
A patient who has arthritis has been taking ibuprofen and a glucocorticoid medication. The patient reports having tarry stools but denies gastric pain. Which action by the APRN is correct?
a. Order an antiulcer medication
b. Counsel the patient to use over the counter antacids
c. Reassure the patient not to worry unless there is gastric pain
d. Tell the patient to stop taking the glucocorticoid immediately.
Answer- A- Order an antiulcer medication
Glucocorticoids therapy, especially when combined with NSAIDs, can increase the risk of gastric ulcer and possibly GI bleeding. Treatment with antiulcer medications is indicated but not with OTC antacids. Gastric pain is usually decreased because of the glucocorticoids, so the absence of gastric pain is not reassuring.
164
The APRN is spending time educating their end-stage COPD patient on follow up testing while taking a high dose long term glucocorticoid. What statement by the patient shows an UNDERSTANDING of the education provided?
a. “I know the glucocorticoids are working when my COPD is going away.”
b. “I know I will need a bone density test to monitor for the development of osteoporosis.”
c. “I will need frequent liver enzyme checks”
d. “I will need frequent chest x-rays.”
Answer- B- “I know I will need a bone density test to monitor for the development of osteoporosis.”
osteoporosis and frequent bone fractures are seen with long term use such as in COPD patients. -Chap 58 video
165
When the APRN is deciding on what glucocorticoid to prescribe to their patient. The APRN knows that the more mineralocorticoid activity the medication possesses the more likely a patient will?
a. Retain potassium, sodium, and water
b. Retain potassium, lose sodium and water
c. Retain sodium, water, and potassium
d. Retain sodium, water and lose potassium
Answer- D- Retain sodium, water and lose potassium
chapter 58 video
166
When discussing the use of Acyclovir with a nursing student, the nurse would need to further educate the student if they said?
A. Acyclovir will eliminate the cause of the HSV
B. Acyclovir only eliminates the symptoms of HSV
C. Acyclovir is okay to use during pregnancy
D. Acyclovir can be used on children as young as 3 months of age
A. Acyclovir does not eliminate the virus or cause of the virus. It only eliminates the symptoms. B, C, & D are all correct statements
167
What would be most concerning in a patient receiving an antifungal?
A. Topical Acyclovir causes burning and stinging
B. QT prolongation in a patient receiving Foscarnet
C. Headache is caused from Acyclovir
D. Decreasing the dose of the antifungal because of renal impairment
B. QT prolongation in a patient receiving Foscarnet. Topical Acyclovir does not cause burning and stinging, it is touching of the lesions that cause the burning and stinging. Foscarnet can cause QT prolongation. A side effect of Acyclovir is headache, but it is not concerning.
168
3. Which Cyclooxygenase Inhibitor would you expect to be prescribed to help prevent MI and CVA?
A. Ibuprofen
B. Acetaminophen
C. Aspirin
D. Magnesium Salicylate
C. Aspirin protects against MI and CVA by inhibiting COX-1. Acetaminophen does not suppress platelet aggregation.
169
4. In what patient would you question the use of Aspirin?
A. A 76-year-old patient with a creatinine of 0.6
B. A 15-year-old patient recovering from the flu
C. A 67-year-old patient with a Hgb 8.9
D. A 31-year-old patient with a PTT of 29
B. Anyone under the age of 18 who is recovering from a viral infection is at risk for developing Reye Syndrome when taking Aspirin. Do not give Aspirin to children under the age of 18. Creatinine of 0.6 is normal. A Hgb of 8.9 is okay. A PTT of 29 is normal
170
5. Which drug combination would you question?
A. ACE Inhibitors and Aspirin
B. Aspirin and Coreg
C. Ace Inhibitors and Lasix
D. Coumadin and Metoprolol
A. ACE Inhibitors and Aspirin work within the renal system and they can impair renal function
171
6. As the nurse educating a parent, would know that they understand the education taught when?
A. My child should be given Ibuprofen 30 minutes prior to receiving his flu shot
B. I can give my 10-year-old Aspirin to help get with the discomfort of Chicken Pox
C. I am not to give my child Tylenol prior to getting their vaccination
D. Reye Syndrome is caused by the excessive use of antihistamines
Tylenol and other analgesic-antipyretics can blunt the immune response to childhood vaccines. Anyone under the age of 18 who is recovering from a viral infection is at risk for developing Reye Syndrome when taking Aspirin.
172
What is the first-choice medication for the majority of infections caused by HSV?
A. Valacyclovir
B. Penciclovir
C. Acyclovir
D. Docosanol (Abreva)
C. Acyclovir is the agent of first choice for most infections caused by HSV and VZV.
173
A woman who is breastfeeding her infant and asks the nurse if it is safe to take NSAIDs while nursing. What will the nurse tell this patient?
A. NSAIDs are safe to take while breastfeeding.
B. NSAIDs are not safe, even in small amounts.
C. She should take only herbal medications while breastfeeding
D. She should request a prescription for Hydrocodone
A. NSAIDs are safe to take while breast feeding. Narcotics will cross to the baby via breast milk.
174
A 45 year old female arrives to the emergency department after taking a bottle of Tylenol 9 hours ago? What should the nurse anticipate administering?
A. Intubating the patient upon arrival
B. Narcan
C. Mucomyst
D. Emergent Hemodialysis
C.Mucomyst is the antidote for Tylenol OD. Activated charcoal only works if it is given prior to the medication being absorbed.
175
An immunocompromised patient contracts herpes simplex virus (HSV), and the prescriber orders acyclovir [Zovirax] for 10 days. After 7 days of therapy, the patient reports having an increased number of lesions. The nurse will expect the provider to:
A. Extend this patient’s drug therapy to twice daily for 12 months.
B. Give intravenous Foscarnet every 8 hours for 2 to 3 weeks.
C. Decrease the acyclovir dose
D. Order intravenous valacyclovir [Valtrex] 1 g PO twice daily for 10 days.
B. Foscarnet is active against all known herpesviruses and is used in immunocompromised patients with acyclovir-resistant HSV or VZV. This patient is demonstrating resistance to acyclovir, so decreasing acyclovir therapy will not be effective. Valacyclovir is not approved for use in immunocompromised patients because of the risk for thrombotic thrombocytopenic purpura/hemolytic uremic syndrome.
176
Your patient has a mild penicillin allergy. You know that it would likely be safe to prescribe which cephalosporin antibiotics (Select all that apply):
a. Cephalexin
b. Cefoxitin
c. Ceftriaxone
d. Cefepime
c&d – because 3rd & 4th generation cephalosporins are generally safe in patients with mild PCN allergy
177
All the following are true about Fluroquinolone antibiotics EXCEPT:
a. they should be avoided in patients with CNS disorders as they lower the seizure threshold
b. they are safe for use in patients with myasthenia gravis
c. they may cause tendonitis and tendon rupture if used in children and adolescents
d. they act by inhibiting bacterial DNA replication
b – fluoroquinolones are NOT safe for use in patients with MG d/t increased risk of respiratory failure by exacerbating muscle weakness
178
Which is the most frequently prescribed class of antibiotics:
a. Fluoroquinolones (ciprofloxacin, levofloxacin)
b. Macrolides (azithromycin, clarithromycin, erythromycin)
c. Tetracyclines (doxycycline)
d. Cephalosporines (cephalexin, cefoxitin, ceftriaxone, cefepime)
d – cephalosporines are the most frequently prescribed class of antibiotics
179
The following are true about 1st & 2nd generation cephalosporin antibiotics (Select all that apply):
a. they provide more gram-negative coverage than 3rd & 4th generation cephalosporins
b. they Inhibit bacterial cell wall synthesis
c. they readily cross the blood brain barrier
d. they can be taken with alcohol
a,b&c – they should NOT be taken with alcohol d/t disulfiram reaction (blocks metabolism of ETOH). They do cross the blood brain barrier more effectively than 1st & 2nd gen cephalosporins
180
Your patient reports that he recently went on a camping trip and got a tick bite. He is now experiencing symptoms consistent with Lyme disease. Which antibiotic would be most effective for treatment of Lyme disease?:
a. Azithromycin
b. Doxycycline
c. Ceftriaxone
d. Ciprofloxacin
b – tetracyclines are effective against Lyme disease
181
You are treating your 25-year-old female patient with erythromycin for chlamydia. You should inform the patient that:
a. there is an increased risk of sudden cardiac death if taken with grapefruit juice
b. there is no need to use a backup form of contraception if taking birth control pills
c. it can be taken with or without food as it will not cause GI upset
d. it is not safe to take if the patient has an allergy to penicillin
a – this is the only true statement
there is an increased risk of sudden cardiac death if taken with grapefruit juice
182
Photosensitivity is a potential side effect of the following antibiotics:
a. Tetracyclines and Fluoroquinolones
b. Fluoroquinolones and Macrolides
c. Macrolides and Tetracyclines
d. Cephalosporins and Fluoroquinolones
a – Tetracyclines and Fluoroquinolones can both cause photosensitivity
183
Your patient has C. dif. Which antibiotics should be avoided? (Select all that apply):
a. Tetracyclines
b. Cephalosporines
c. Macrolides
d. Fluoroquinolones
c&d – Cephalosporines can promote C. dif and C. dif is resistant to Fluoroquinolones
184
Which of the following antibiotics would be the best choice for treating meningitis?
a. doxycycline
b. clarithromycin
c. cefdinir
d. levofloxacin
c – cephalosporines cross blood brain barrier and are therefore good for treating meningitis. Fluoroquinolones coud also be used to treat meningitis but poorly cross the blood brain barrier so would not be as effective as cephalosporines.
185
The following drugs interact with Fluoroquinolones (Select all that apply):
a. Antacids
b. Warfarin
c. Glucocorticoids
d. Theophylline
a,b,c,&d – all of these drugs either reduce absorption of or interact with Fluoroquinolones
186
When prescribing tetracyclines in the pediatric population, the NP knows that: (select all that apply)
a. Tetracyclines bind to calcium in developing teeth and will cause permanent staining
b. Tetracyclines should not be prescribed to patients that do not have their permanent teeth
c. Doxycycline can destroy connective tissue in the gums
d. H. pylori is a common infection in children and tetracyclines are an effective treatment for this infection and should be used whenever possible.
Answer: A, B
Tetracyclines will stain developing teeth because it will bind to calcium so they should not be prescribed to children that do not have all their permanent teeth. C & D are untrue.
187
2. When starting patients on tetracyclines, what teaching should be performed? (select all that apply)
a. The patient should call the doctor if diarrhea occurs
b. Tetracyclines should be taken with meals to avoid GI upset
c. Stop the medication if jaundice appears
d. Call the clinic immediately if diarrhea occurs 4-6 weeks after medication is complete
e. Avoid prolonged exposure to sunlight, wear protective clothing and use sunscreen.
Answer: ABCDE
All of the above should be taught when patients are started on tetracyclines. C-Diff is a very serious side effect and if uncontrolled diarrhea occurs, the patient should call the office. GI upset is also a common side effect and tetracyclines should be taken with meals, even though food will decrease absorption. These medications can also cause fatty liver infiltrates and can cause hepatotoxicity which will cause jaundice and fatigue. Excessive sunburn will occur if patient is has prolonged exposure to sunlight.
Chapter 73 & 76 Study guide voice thread
188
3. Common drugs that inhibit bacterial protein synthesis are: (select all that apply)
a. The drug class tetracyclines
b. The drug class macrolides
c. Clindamycin (Cleocin, Dalacin)
d. Linezolid (Zyvox)
e. Mupirocin (Bactroban)
Answer: ABCDE
All of these drugs and drug classes inhibit bacterial protein synthesis.
Chapter 73 & 76 Study guide voice thread
189
4. You, a very astute APRN, just saw a patient with obvious signs and symptoms of chlamydia. You know that drug compliance is very important in this disease process, so you prescribe:
a. Doxycycline 100mg PO QID for 10 days
b. Azithromycin 1 gram PO x’s 1 dose
c. Clarithromycin XL 500mg daily for 7 days
d. Erythromycin 1000mg PO BID daily for 10 days
Answer: B
Azithromycin is first line treatment for chlamydia. A 1-time, 1 gram dose is curative.
Chapter 73 & 76 Study guide voice thread
190
5. Macrolides are good broad spectrum antibiotics, but must be cautiously used in patients with:
a. QT elongation
b. Patients also taking statins
c. Patients that drink quite a bit of grapefruit juice
d. Peptic Ulcer Disease
Answer: a
QT prolongation is a common side effect of Macrolide antibiotic therapy and should be used with caution in patients who have experienced QT prolongation in the past. There used to be concern over drug/drug interactions with statins, but that school of thought is in the past…..and I made the other two up.
Chapter 73 & 76 Study guide voice thread
191
6. Clindamycin should be used judiciously as it contains a serious black box warning. What would you teach your patient after starting them on clindamycin for a severe Group A Strep infection?
a. Promptly report any diarrhea to the health care provider immediately
b. Promptly report any chest pain that you may experience right away
c. Please call the office if you start to feel numbness and tingling in your hands and feet
d. If the whites of your eyes start to turn yellow, please stop the drug and call the office as soon as possible.
Answer: a
Clindamycin’s black box warning states: “Clindamycin can cause potentially fatal Clostridum difficile diarrhea. Patients should promptly report any diarrhea to their health care provider.”
Chapter 73 & 76 Study guide voice thread
192
7. Prostatitis is a complicated urinary tract infection. Which of the following would you teach the patient regarding the treatment for prostatitis?
a. You will have to be treated for this infection for 3 days as the prostate is relatively easy to penetrate with antibiotics
b. Prostatitis is a serious infection that requires a hospital stay and IV antibiotics as the prostate is hard to penetrate with oral antibiotics
c. Prostatitis is a relatively complicated infection to treat, so expect to take oral antibiotics for a minimum of 2-4 weeks, and maybe even 4-6 weeks as the prostate is hard to penetrate with antibiotics
d. A single dose of a high-powered antibiotic will treat your prostatitis as it is a simple and common infection to treat
Answer: c
Prostatitis is classified as a complicated UTI, and requires conventional treatment. As the prostate is hard to penetrate with antibiotics, a minimum of 2-4 weeks on antibiotics is required. Sometimes, a 4-6 week course of antibiotics is needed to treat stubborn prostatitis infections.
Chapter 73 & 76 Study guide voice thread
193
8. What microbe causes 90% of initial community acquired UTI’s?
a. Staph aureus
b. Group A Strep
c. E. coli
d. Enterococcus faecalis
Answer: c
E.coli is responsible for 90% of initial community acquired UTI’s.
Chapter 73 & 76 Study guide voice thread
194
9. A 23 year old female present to the clinic with complaints of urinary frequency, urgency and burning upon urination that started 2 days ago. Her urine dipstick is positive for leukesterase and nitrites. As the APRN, you know that _________________is the first line treatment for uncomplicated cystitis.
a. Cipro
b. Bactrim
c. Nitrofurantoin
d. Cefdinir
Answer: C
Nitrofurantoin is a first line drug for uncomplicated UTI. It is also an urinary tract antiseptic that is selectively toxic to bacterium in the bladder.
Chapter 73 & 76 Study guide voice thread
195
10. In patients with community associated UTI, treatment with a single dose or short course of antibiotics is appropriate when:
a. Symptoms started less than 7 days before treatment begins and the patient is female and not pregnant
b. The patient is a male with prostatitis
c. The patient is a pregnant female with suspected upper tract involvement
d. The patient is a non-pregnant female with suspected upper tract involvement
Answer: a
The most appropriate patient to treat with single dose or a short course of antibiotics is a patient whose symptoms began less than 7 days before treatment is started, and is a female who is NOT pregnant. B,C & D require conventional therapy of 7-14 days of antibiotics.
Chapter 73 & 76 Study guide voice thread
196
Question: How do tetracyclines suppress bacterial growth?
A) By inhibiting amino acids
B) By inhibiting protein synthesis
C) By promoting protein synthesis
D) By promoting cell lysing
Answer: B - By inhibiting protein synthesis
Reasoning: Page 676
197
Question: Why has the use of tetracyclines declined and rarely a first-choice drug?
A) The cost of tetracyclines has increased
B) Antibiotics with greater selectivity and less toxicity
C) Resistance
D) Both B and C
Answer: D - Both B and C
B) Antibiotics with greater selectivity and less toxicity
C) Resistance
Reasoning: Page 676
198
Question: What is the treatment of choice for eradicating peptic ulcer disease?
A) Tetracyclines
B) Metronidazole
C) Bismuth Subsalicylate
D) All of the above
Answer: D - All of the above
Reasoning: Page 676
199
Question: Which two tetracyclines are used for periodontal disease?
A) Eravacycline
B) Demeclocycline
C) Minocycline
D) Doxycycline
Answer: C & D
Reasoning: Page 676
200
Question: What adverse effects are associated with tetracyclines?
A) Blurry vision
B) Urinary retention
C) Dry mouth
D) Yellow/brown discoloration of teeth, n/v/d, epigastric burning
Answer: D - Yellow/brown discoloration of teeth, n/v/d, epigastric burning
Reasoning: Page 677
201
Question: What can be promoted by clindamycin?
A) Renal impairment
B) Abnormal kidney labs
C) CDAD
D) Hepatotoxicity
Answer: C - CDAD
Reasoning: Page 680
202
Question: What is a therapeutic use of Linezolid?
A) Hospital-acquired pneumonia
B) C-diff
C) Gastrointestinal Infection
D) Repeated treatments with other antibiotics
Answer: A -Hospital-acquired pneumonia
Reasoning: Page 680
203
Question: What are the 2 newer macrolides?
A) Azithromycin
B) Tigecycline
C) Clindamycin
D) Clarithromycin
Answer: A & D
Reasoning: Page 678
204
Question: What is the therapeutic use of Tedizolid?
A) Skin and soft tissue infections from MRSA
B) C-diff
C) Infections caused by VRE
D) Community-associated pneumonia
Answer: A - Skin and soft tissue infections from MRSA
Reasoning: Page 682
205
Question: What is an adverse effect of Linezolid?
A) Nausea and Vomiting
B) Diarrhea
C) Diarrhea, nausea, and headache
D) GI burning
Answer: C - Diarrhea, nausea, and headache
Reasoning: Page 681
206
Which of the following inhaled medications should ALWAYS be given with Salmeterol in an asthmatic patient?
A) Arformoterol
B) Cromolyn
C) Fluticasone
D) Albuterol
Answer: C - Fluticasone
Reasoning: Page 568. Black box warning: Salmeterol is a Long acting B2 agonist. ALL LABAs should be given with a glucocorticoid to prevent death. The 6 inhaled glucocorticoids to know are fluticasone, budesonide, mometasone, beclomethasone, flunisolide, ciclesonide. LABAs SHOULD NEVER BE USED IN MONOTHERAPY.
207
A newly diagnosed asthmatic patient is in the clinic. Which of the following medications should be given as the first line for the inflammatory component of asthma?
A) Albuterol
B) Zafirlukast
C) Ipratroprium
D) Beclomethasone
Answer: D - Beclomethasone
Reasoning: In the Chapter 62 audio clip at 10:10, Dr. Mello makes a HUGE point to make it CLEAR that Inhaled glucocorticoids are the FIRST LINE component of treating the inflammatory process of asthma (She said to “burn it into your brain”). I chose beclomethasone, as it is the prototype inhaled glucocorticoid as seen on page 558.
208
With which of the following asthma management medications should the patient avoid consuming caffeine containing beverages?
A) Montelukast
B) Theophylline
C) Terbutaline
D) Fluticasone/salmoterol
Answer: B - Theophylline
Reasoning: Page 570. Theophylline is a methylxanthine, as is caffeine. Caffeine can intensify the adverse effects of theophylline on the CNS and heart. Also, caffeine competes with theophylline for drug-metabolizing enzymes causing theophylline levels to rise. Those taking theophylline should avoid caffeine. (She did mention in the chapter 62 audio clip that theophylline is not used as frequently anymore because of the narrow therapeutic window).
209
Which of the following drugs would the nurse practitioner provide for a patient with known COPD who presents in the clinic with a productive cough for the last 3 months?
A) Formoterol
B) Ipratropium
C) Tiotropium
D) Budesonide
Answer: C - Tiotropium
Reasioning: Page 571. Tiotropium is a LAMA! (Long acting muscarinic antagonist) AKA an Anticholingergic drug. This drug is for long term maintenence of bronchospasm in COPD. Ipratroprium is a distractor- this medication is a short acting anticholinergic.
210
A 3 year old boy presents to the clinic. Mom reports he is having 2 nighttime awakenings a month with shortness of breath and wheezing. During the day he is symptomatic 4 times a week. Which Initial treatment for asthma would the nurse practitioner recommend?
A) Step 1
B) Step 2
C) Step 3
D) Step 4
Answer: B - Step 2
Reasoning: Page 575. In a child 0-4 years of age, mild persistent symptoms which are more than 2 days a week but not daily, 1-2 nighttime awakenings, minimal activity limitations. This would call for Step 2 of asthma management.
211
A 16 year old girl presents in the clinic to a 6 month follow up on her asthma severity. Her symptoms have been intermittent, with only 1-2 days a week of wheezing and symptoms. She reports being well controlled for 3 months. She is currently on 2 asthma medications, which medication should she eliminate to move down to step 1?
A) Budesonide
B) Terbutaline
C) Xopenex
D) Levalbuterol
Answer: A -Budesonide
Reasoning: In Table 62.11: Patients 12 and older in step 2 are taking a SABA PRN and a Low Dose- Inhaled glucocorticoid. According to table 62.12, a well controlled patient can step down if well controlled for 3 months. Therefore, this patient could eliminate the Inhaled glucocorticoid- the budesonide.
212
A 45 year old woman presents to the clinic for her 6 month asthma severity follow up. She reports waking 3 nights a week short of breath. She is experiencing some activity limitation and is needing her rescue inhaler 5 times a week. Which of the following treatment plans would the nurse practitioner expect to recommend?
A) Refer to pulmonologist
B) Step up therapy by 2 steps
C) Continue current therapy
D) Step up therapy by 1 step
Answer: D - Step up therapy by 1 step
Reasoning: Table 62.12, in patients who are not well controlled experiencing the symptoms in this example the recommendation is to step up therapy by 1 step.
213
Which medication can be given prophylactically prior to exercise 15 minutes prior to reduce bronchospasm?
A) Cromolyn
B) Montelukast
C) Xopenex
D) Formoterol
Answer: C - Xopenex
Reasoning: Page 574 Xopenex is a short acting B2 agonist. Short acting Beta agonists prevent exercise induced bronchospasm in 80% of patients.
214
Which of the following lung function tests is the single most useful test of lung function?
A) FEV1
B) PEF
C) Chest X-ray
D) FVC
Answer: A- FEV1
Reasoning: Page 573. FEV1 is the single most useful test of lung function. To determine FEV1, the patient inhales completely, then exhales completely and forcefully as possible into the spirometer. This measures how much air was expelled during the first second of exhalation.
215
Which of the following medications is considered the most important in long term control of asthma?
A) SABAs
B) Inhaled glucocorticoids
C) LABAs
D) LAMAs
Answer: B- Inhaled glucocorticoids
Reasoning: Page 574: of all the long-term control agents in current use, inhaled glucocorticoids are most important.
216
Which of the following is NOT a gram positive bacteria?
a. Staphylococcus aureus
b. Streptococcus pyogens
c. Enterococcus faecalis
d. Clostridium perfringes
(answer D: clostridium perfringes is gram negative)
Antibiotic Therapy Parts A and B:
217
According to antibiotic treatment guidelines, you should prescribe an antibiotic that is:
a. The broadest spectrum of action
b. The most expensive
c. The highest risk for toxicity
d. The narrowest spectrum of action
(answer D: the narrowest spectrum of action drug should be used to prevent superinfection and resistance)
Antibiotic Therapy Parts A and B:
218
As a prescriber, you may need to modify guideline recommendations according to all of the following EXCEPT:
a. Local resistance patterns
b. Gender
c. Comorbidities
d. Patient risk of toxicity
(answer B: changes to antibiotic guidelines are not made on the basis of gender)
Antibiotic Therapy Parts A and B:
219
Penicillins are NOT effective against which bacteria?
a. MRSA
b. Streptococcus
c. Enterococcus
d. S pneumoniae
(answer A)
Antibiotic Therapy Parts A and B:
220
Which of the following is NOT an example of an adverse effect of penicillins?
a. GI upset
b. Rash, itching
c. Psychological effects (insomnia, anxiety)
d. Elevation of BUN
(answer C: penicillins do not cause psychological adverse effects)
Antibiotic Therapy Parts A and B:
221
If a patient is allergic to amoxicillin, what should you consider when prescribing antibiotics? (select two)
a. The patient should be assumed to have an allergy to all penicillins-do not prescribe a penicillin
b. The patient is only allergic to amoxicillin and can be prescribed another kind of penicillin
c. The patient can be prescribed amoxicillin since they have already had an initial sensitivity reaction to it
d. The patient may have a cross allergy to cephalosporins
(answer A, D)
a. The patient should be assumed to have an allergy to all penicillins-do not prescribe a penicillin
d. The patient may have a cross allergy to cephalosporins
Antibiotic Therapy Parts A and B:
222
What should a patient be treated with if they develop an allergic response to penicillin? (select three)
a. NSAIDs
b. Corticosteroids
c. Antihistamines
d. Epinephrine
(answer B, C, D)
Antibiotic Therapy Parts A and B:
223
What enzyme is responsible for developing resistance to penicillin?
a. Amylase
b. Pepsin
c. Beta lactamase
d. Nuclease
(answer C)
c. Beta lactamase
Antibiotic Therapy Parts A and B:
224
What labs should we monitor in a patient taking penicillins?
a. Serum penicillin levels
b. Liver function
c. CBC
d. CMP
(answer B: penicillins may increase AST and ALT levels)
Antibiotic Therapy Parts A and B:
225
Which of the following reactions is considered a TRUE penicillin reaction?
a. Angioedema
b. Diarrhea
c. Stomach pain
d. Drowsiness
(answer A) - Angioedema
Antibiotic Therapy Parts A and B:
226
A 25y/o female patient is being seen in the clinic and has a confirmed UTI. Knowing that 90% of UTI’s are caused by Ecoli. This broad-spectrum antibiotic should be considered for treatment.
A. Sulfamethoxazole/trimethoprim
B. Amoxicillin
C. Levofloxacin
D. Levaquin
Answer: A - Sulfamethoxazole/trimethoprim
Rationale: Ch 75 pg 688: Sulfonamides are often preferred drugs for acute UTI’s. About 90% of these infections are due to Escherichia coli, which is usually sulfonamide sensitive. Of the sulfonamides available, Sulfamethoxazole/trimethoprim is generally favored.
227
When prescribing a patient, a Sulfonamide antibiotic, you should include which of the following in your patient education?
A. Instruct the patient to complete the prescribed course of treatment even though symptoms may abate before the full course is over.
B. Patients taking oral sulfonamides should drink at least 8-10 glasses of water or other noncaffeinated fluids per day to decrease the risk for crystalluria.
C. To prevent photosensitivity reactions, advise patients to avoid prolonged exposure to sunlight, to wear protective clothing, and to apply sunscreen to exposed skin. Tanning beds are to be avoided.
D. All of the above
Answer: D - All of the above
Rationale: Ch 75 pg.689 Table on pt education. Included in instructions should be to observe for alterations that may indicate hypersensitivity (eg rash) and to report these promptly if they occur.
228
What is the most severe hypersensitivity response to sulfonamides?
A. Rash
B. Photosensitivey
C. Stevens-Johnsons syndrome
D. Drug fever
Answer: C - Stevens-Johnsons syndrome
Rationale: ch 75 pg 689. The most severe hypersensitivity response to sulfonamides is Stevens-Johnsons syndrome, a rare reaction with a mortality rate of about 25%. Symptoms include widespread lesions of the skin and mucous membranes combined with fever, malaise and toxemia. Most likely occurs with long-acting sulfonamides that are no longer prescribed, but occasionally can occur with short-acting medication.
229
Sulfonamides should not be given to infants younger than 2 months due to ______________, a disorder in newborns caused by deposition of bilirubin in the brain.
A. Kawasaki’s disease
B. Kernicterus
C. Anaphylaxis
D. Stevens-Johnsons Syndrome
Answer: B - Kernicterus
Rationale: ch 75 pg 690: Kernicterus is a disorder in newborns caused by deposition of bilirubin in the brain. Bilirubin is neurotoxic and can cause severe neurologic deficits and even death. Under normal conditions, infants are not vulnerable to kernicterus. Any bilirubin in the blood is tightly bound to plasma proteins and therefore is not free to enter the CNS. Sulfonamides promote kernicterus by displacing bilirubin from plasma proteins. Because of the risk, sulfonamides should not be given to infants younger than 2 months, pregnant patients after 32 weeks’ gestation, and breast-feeding mothers.
230
When education a 37y/o female patient you should include that she should make sure she is adequately hydrated to prevent crystalluria while taking sulfonamides. Adequate hydration for a normally healthy 37y/o woman would be?
A. 8-10 glasses of water or non-caffeinated beverages each day
B. 2-3 glasses of water
C. 4-6 glasses of water
D. 1-2 cups of coffee
Answer: A - 8-10 glasses of water or non-caffeinated beverages each day
Rationale: ch 75 pg 690-691; To minimize the risk of crystalluria patients should drink 8-10 glasses of water or non-caffeinated beverages each day. Patients should maintain a daily urine output of at least 1200mls per day.
231
A 55y/o patient with 2nd and 3rd degree burns to bilateral legs and bilateral arms comes to the ER. Which topical antibiotic is used to suppress bacterial colonization in the wounds?
A. Hydrocortisone cream
B. Trimethoprim
C. Silver sulfadiazine
D. Amoxicillin
Answer: C- Silver sulfadiazine
Rationale: ch 75 pg 692; Silver sulfadiazine is employed to suppress bacterial colonization in patients with 2nd and 3rd degree burns, however, the antibacterial effects of silver sulfadiazine are due primarily to the release of free silver-not to the sulfonamide molecule.
232
Adverse effects of Trimethoprim include which of the following?
A. Itching
B. Rash
C. Gi reactions
D. All of the above
Answer: D - All of the above
Rationale: ch 75 pg 692; Trimethoprim is generally well tolerated. The most frequent adverse effects are itching and rash. GI reactions (eg epigastric distress, nausea, vomiting, glossitis, stomatitis) occur occasionally.
233
Trimethoprim/sulfamethoxazole is preferred treatment in UTI’s caused by ecoli. It is also prescribed for which of the following? (choose 2)
A. Otitis Media
B. Bronchitis
C. Tuberculosis
D. Chlamydia
Answer: A and B
A. Otitis Media
B. Bronchitis
Rationale: ch 75 pg 693; TMP/SMZ is a preferred or alternative medication for a variety of infectious diseases. The combination is especially valuable for UTI’s, otitis media, bronchitis, shigellosis, and pneumonia cause by p. jirovecii.
234
True or false: Trimethoprim can be given during pregnancy or while breastfeeding
A. True
B. False
Answer: B - False
Rationale: ch 75 pg 692-693; Large doses of trimethoprim have caused fetal malformations in animals. To date, developmental abnormalities have not been observed in humans. Nonetheless, because trimethoprim readily crosses the placenta, prudence indicates avoiding its routine use during pregnancy. The risk for exacerbating pregnancy related folate deficiency is an additional reason to avoid the drug. Trimethoprim is excreted in breastmilk and may interfere with folic acid utilization by nursing the infant. It should be administered with caution to women who are breastfeeding.
235
What would be the goal when evaluating therapeutic effects on a 40y/o patient that has completed a round of Trimethoprim/sulfamethoxazole for a UTI? (choose 3)
A. Absence of evidence of infection (negative urinalysis)
B. White cell differential returns to normal
C. Signs and symptoms have resolved
D. Pt complains of pain and burning with urination
Answers: A,B,C
Rationale: ch 75 pg 694: summary of key prescribing considerations. Evaluating therapeutic effects: absence of evidence of infection (negative urinalysis, white cell differential returns to normal, signs and symptoms resolved).
236
You are treating a patient with pseudomonas, which cephalosporins could you consider prescribing? Select all that apply:
A. Ceftazidime
B. Ceftriaxone
C. Cefepime
D. Ceftolozane/tazobactam
Answer: A, C, D (Cephalosporin Video) Ceftriaxone will not treat pseudomonas
237
The most potent treatment for pseudomonas is?
A. Ceftolozane/tazobactam
B. Ceftriaxone
C. Cefepime
D. Ceftazidime
Answer: A (Cephalosporin Video)
238
The only Cephalosporin treatment for MRSA is:
A. Cefepime
B. Cefuroxime
C. Ceftaroline
D. Cefazolin
Answer: C (Cephalosporin Video)
239
You are using Cefazolin to treat a patient with a skin infection, The nurse practitioner knows that (Select all that apply)
A. Cefazolin is a Second-Generation Cephalosporin
B. Cefazolin has no anaerobic coverage
C. Cefazolin can be used to treat Gram + bacteria
D. Cefazolin can be used to treat Gram – bacteria
Answer: B,C,D (Cephalosporin Video) Cefazolin is a First Generation Cephalosporin
240
Cephalosporins that have + anaerobic coverage include: (Select all that apply)
A. 2nd Generation
B. 3rd Generation
C. 4th Generation
D. 5th Generation
Answer: A, D (Cephalosporin Video)
241
Inhalers to treat COPD and Asthma include (Select all that apply)
A. Muscarinic Antagonist
B. B- Agonist
C. Inhaled Corticosteroid
Answer A, B, C (Inhaler Video)
242
You are treating a patient with asthma that is having to use their Short Acting Beta Agonist (SABA) inhaler > 3 times a week, what additional drug would you prescribe next?
A. Long Acting Muscarinic Antagonist (LAMA)
B. Long Acting Beta Agonist (LABA)
C. Do not prescribe any additional medications, their Asthma is well controlled
D. Inhaled Corticosteroid (ICS)
Answer: D - Inhaled Corticosteroid (ICS)
(Inhaler Video) If a patient is using their SABA inhaler more than 2 times a week, their asthma is not well controlled, and an ICS should be added to their treatment.
243
You are treating a patient with COPD that is having to use their Short Acting Beta Agonist (SABA) inhaler > 3 times a week, what additional drug would you prescribe next?
A. Long Acting Muscarinic Antagonist (LAMA)
B. Long Acting Beta Agonist (LABA)
C. Do not prescribe any additional medications, their COPD is well controlled
D. Inhaled Corticosteroid (ICS)
Answer: A - Long Acting Muscarinic Antagonist (LAMA)
(Inhaler Video) If a patient is using their SABA inhaler more than 2 times a week, their COPD is not well controlled, and a LAMA should be added to their treatment.
244
A patient with Asthma is having to use their Short Acting Beta Agonist (SABA) Inhaler > 3 times a week, the patient is already prescribed an Inhaled Corticosteroid (ICS). What changes should the NP make to their treatment?
A. Add a Long Acting Muscarinic Antagonist (LAMA)
B. Add Long Acting Beta Agonist (LABA)
C. Increase their dose of Inhaled Corticosteroid (ICS)
D. Add a combination Inhaler of LAMA and LABA
Answer B - Add Long Acting Beta Agonist (LABA)
(Inhaler Video).
245
A patient with COPD is having to use their Short Acting Beta Agonist (SABA) Inhaler > 3 times a week, the patient is already prescribed a Long Acting Muscarinic Antagonist (LAMA). What changes should the NP make to their treatment?
A. Do not add any additional medications, their COPD is under control
B. Add Inhaled Corticosteroids (ICM)
C. Increase their dose of Long Acting Muscarinic Antagonist (LAMA)
D. Add a combination Inhaler of LAMA and LABA
Answer D - Add a combination Inhaler of LAMA and LABA
| Inhaler Video
246
It is important to monitor which lab values when prescribing an aminoglycoside to a patient?
a. Drug level
b. Peak and Trough
c. Peak
d. CBC
Answer: B -Peak and Trough
Antibiotic Therapy: Part E
3:33
247
Which aminoglycoside can be used topically?
a. Amikacin
b. Gentamycin
c. Neomycin
Answer: C - Neomycin
Antibiotic Therapy: Part E
1:11
248
Aminoglycosides treat Gram negative aerobic pathogens. They would most likely be used to treat:
a. Meningitis
b. UTI
c. Lung infection
d. STI
Answer: C - Lung infection
Antibiotic Therapy: Part E
1:43
249
Aminoglycosides work by:
a. creating fissures in the outer cell membrane, resulting in leakage of intracellular contents and enhanced antibiotic uptake
b. weakening the cell wall by inhibiting transpeptidases and activation of autolysins
c. bind to PBP’s and disrupt cell wall synthesis
d. suppressing bacterial growth by inhibiting protein synthesis
Answer: A. - creating fissures in the outer cell membrane, resulting in leakage of intracellular contents and enhanced antibiotic uptake
Antibiotic Therapy: Part E
1:53
250
A patient is due to receive her next dose of tobramycin at 9 am. When should her trough be drawn?
a. 9:45 am
b. 8:45 am
c. 5:00 am
d. 10:00 am
Answer: B- 8:45 am
Antibiotic Therapy: Part E
3:47
251
A patient who is receiving gentamycin reports ringing in his ear. What should you do?
a. Educate the patient that ringing in the ear is a normal side effect
b. Increase the dose of gentamycin
c. Immediately discontinue gentamycin
d. Educate the patient to eat before the next dose
Answer: C - Immediately discontinue gentamycin
Antibiotic Therapy: Part E
4:17
252
An important patient education about aminoglycosides is:
a. Aminoglycosides can cause increased urine output, so don’t take before bed
b. Aminoglycosides do not require frequent lab monitoring, so they are a preferred antibiotic
c. Aminoglycosides are safe for patients with decreased renal function
d. Aminoglycosides can cause neuromuscular blockade, so patients should report muscle weakness or paralysis immediately
Answer: D: Aminoglycosides can cause neuromuscular blockade, so patients should report muscle weakness or paralysis immediately
Antibiotic Therapy: Part E
5:11
253
True/False: All aminoglycosides are pregnancy category D?
Answer: False,
Antibiotic Therapy: Part E
6:18
254
Aminoglycosides are:
a. Bacteriostatic inhibitor of protein synthesis
b. Bactericidal inhibitor of protein synthesis
c. Antiprotozoal
d. Effective against gram positive bacteria
Answer: B - Bactericidal inhibitor of protein synthesis
Antibiotic Therapy: Part E
1:55
255
Which drug should not be given in conjunction with an aminoglycoside?
a. Flagyl
b. Amoxicillin
c. Vancomycin
d. Azithromycin
Answer: B-Amoxicillin
Antibiotic Therapy: Part E
2:44
256
A 55-year old with a history of asthma and BPH presents to your clinic with complaint of seasonal allergy symptoms. Should you prescribe this patient an antihistamine and why?
a. No, the patient’s history of BPH puts them at risk for worsening prostatic hyperplasia
b. No, the patient’s history of asthma puts them at risk due to suppression of secretion of mucous
c. No, BPH and asthma are both contraindications for antihistamines
d. Yes, an antihistamine would provide relief for the seasonal allergies
Answer: A - No, the patient’s history of BPH puts them at risk for worsening prostatic hyperplasia
Rationale: Muscarinic receptors in the lungs constrict the bronchi and promote secretion. So if we block them, the lungs won’t be constricted and there will be less secretions. Sometimes we have to questions what we read, thinking well that doesn’t really make sense to me. Asthma treated appropriately and correctly, the way asthma should be treated à would NOT be a high risk patient for antihistamine use.Most patients have to be treated with antihistamines to help control their asthma. Be REAL aware of that per Dr. Mello. A patient with urinary retention, glaucoma, BPH WOULD be a patient to be cautious of treating because of how the muscarinic receptors work. (Ch 56 study guide video)
257
A nurse is preparing to give an antibiotic to a patient who reports being allergic to antibiotics. Before giving the medication, what will the nurse do first?
a. Ask whether the patient has taken this antibiotic for other infections
B. Question the patient about allergies to other medications
C. Request an order for a lower dose of the antibiotic
D. Request an order for an antihistamine
Answer: A - Ask whether the patient has taken this antibiotic for other infections
Rationale: The nurse needs to assess whether the patient is truly allergic to this drug. Allergic reactions require previous exposure to the drug, so the nurse should ask whether the patient has taken this antibiotic before. If a patient is allergic to a drug, lowering the dose will not decrease the risk of allergic reaction. Antihistamines sometimes are given when patients must take a drug to which they are allergic. (Ch 56 study guide video)
258
A patient has allergies and takes an antihistamine. The patient wants to know how the drug works. The nurse understands that antihistamines work because they are what?
a. Activators
b. Agonists
c. Antagonists
d. Antidotes
Answer: C - Antagonists
Rationale: Antihistamines bind to receptors to prevent activation by histamine; this makes antihistamines antagonist drugs. Antihistamines do not activate receptors. Agonist drugs activate receptors; they are not antidotes. (Ch 56 study guide video)
259
The nurse understands what antihistamines are classified as, related to how the drug works. The nurse is explaining how H1 blockers interact with histamine to produce effects. She explains it as they:
a. Block the release of histamine from mast cells and basophils
b. Bind selectively to H1 receptors in the stomach to block actions of histamine at the site
c. Bind selectively to H1 receptors in the vascular system and CNS to block actions of histamine at the site
d. Stimulate antibodies to release IgE needed to block the allergen from creating symptoms
Answer: C - Bind selectively to H1 receptors in the vascular system and CNS to block actions of histamine at the site
Rationale: H1 blockers bond selectively to H1 receptors, blocking the actions of histamine at the site, they do NOT block the release of histamine from the mast cells and basophils. This explains why antihistamines take a while to control symptoms if the symptoms have already started. (Ch 56 study guide video)
260
# Fill in the blanks. _____ - generation antihistamines have _____ molecules that readily cross the blood brain barrier. They have a ____ affinity for H1 receptors in the CNS, which ____ sedating effects.
a. First, small, high, causes
b. Second, small, high, does not cause
c. First, large, high, does not cause
d. First, small, low, causes
Answer: A - First, small, high, causes
Rationale: First-generation antihistamines have small molecules with high lipid solubility and readily cross the blood brain barrier. They have a high affinity for H1 receptors in the CNS causing sedative effects. Second generation antihistamines have little sedative effects because they are larger molecules that do not cross the blood brain barrier. Second generation antihistamines have a low affinity for H1 receptors in the CNS.
261
A patient who has seasonal allergies in the spring and fall asks the nurse about oral antihistamines. Which response by the nurse is correct?
a. “Anticholinergic effects are more common with second-generation antihistamines.”
b. “First-generation antihistamines, such as diphenhydramine [Benadryl], are more effective.”
c. “Make sure you take antihistamines only when you have symptoms to minimize side effects.”
d. “You should take oral antihistamines daily during each allergy season to get maximum effects.”
Answer: D - “You should take oral antihistamines daily during each allergy season to get maximum effects.”
Antihistamines are most effective when they are taken prophylactically, and they should be administered on a regular basis throughout the allergy season, even when symptoms are not present. They are less helpful when taken after symptoms appear. Second-generation antihistamines have fewer anticholinergic effects than first-generation antihistamines. First- generation antihistamines are not more effective than second-generation antihistamines. Oral antihistamines are not as effective when given on a PRN basis. (Ch 63 study guide video)
262
A patient admitted to the hospital has been using phenylephrine nasal spray [Neo- Synephrine], 2 sprays every 4 hours, for a week. The patient complains that the medication is not working, because the nasal congestion has increased. What will the nurse do?
a. Request an order for an oral decongestant to replace the intranasal phenylephrine.
b. Request an order for an intranasal glucocorticoid to be used while the phenylephrine is withdrawn.
c. Tell the patient to increase the dose of phenylephrine to 4 sprays every 4 hours.
d. Tell the patient to stop using the phenylephrine and begin using an intranasal antihistamine.
Answer: B - Request an order for an intranasal glucocorticoid to be used while the phenylephrine is withdrawn.
Rationale: This patient is experiencing rebound congestion, which develops when topical sympathomimetics are used for longer than a few days. Abrupt withdrawal can stop the cycle of rebound congestion but is uncomfortable, so using an intranasal glucocorticoid, beginning 1 week before discontinuing the decongestant, while withdrawing the decongestant, is recommended. An oral decongestant is not recommended. Increasing the dose of the intranasal decongestant will only compound the problem of rebound congestion. Stopping the intranasal decongestant will only increase the congestion; using an intranasal antihistamine will not help with congestion. (Ch 63 and Ch 63 study guide video)
263
A patient with a cough has been advised to use guaifenesin. The patient asks the nurse to explain the purpose of the drug. The nurse will explain that guaifenesin:
a. dries secretions to help suppress coughing so patients can rest.
b. helps stimulate the flow of secretions to increase cough productivity.
c. helps to relieve chest pain associated with a cough.
d. stimulates the body’s natural immune responses.
Answer: B - helps stimulate the flow of secretions to increase cough productivity.
Rationale: Expectorants stimulate the flow of respiratory tract secretions to improve cough productivity. Guaifenesin does not dry secretions, because it does not have anticholinergic effects. Guaifenesin does not alleviate pain associated with cough. Guaifenesin does not stimulate immune responses (Ch 63 and Ch 63 study guide video)
264
A patient asks the nurse what type of medications would be most effective for treating seasonal and perennial rhinitis. Which response by the nurse is correct?
a. Pseudoephedrine [Sudafed]
b. Fluticasone propionate [Fluticasone]
c. Loratadine [Claritin]
d. Intranasal cromolyn sodium [Atrovent]
ANS: B - Fluticasone propionate [Fluticasone]
Intranasal glucocorticoids, such as fluticasone propionate, are the most effective drugs for prevention and treatment, because they prevent or suppress all the major symptoms of allergic rhinitis (congestion, rhinorrhea, sneezing, nasal itching, and erythema). Pseudoephedrine is an oral sympathomimetic used to reduce nasal congestion associated with allergic rhinitis. It has no effect on other symptoms. Loratadine, an oral antihistamine, reduces sneezing, rhinorrhea, and nasal itching only and is less effective than intranasal glucocorticoids. Intranasal cromolyn sodium is moderately effective in the treatment of allergic rhinitis, but the benefits are much less than those of intranasal glucocorticoids. (Ch 63 and Ch 63 study guide video)
265
7-year-old child has a cough, runny nose, congestion, and fever, and the parents ask the nurse to recommend an over-the-counter product. Which response by the nurse is correct?
a. “Any product will be effective when combined with vitamin C and zinc.”
b. “It is best to use single-agent medications to treat individual symptoms.”
c. “The fever indicates that your child may need an antibiotic; you should call your provider.”
d. “You should ask your provider to prescribe a combination product that will treat multiple symptoms.”
Answer: B - “It is best to use single-agent medications to treat individual symptoms.”
Rationale: Combination medications may provide ingredients that are not needed or may provide ingredients that are either excessive or subtherapeutic. It is best to use single-agent drugs to treat individual symptoms. The efficacy of vitamin C and zinc for treating colds in children has not been established. Fever may accompany viral respiratory infections and not necessarily bacterial infections that need an antibiotic (Ch 63 and Ch 63 study guide video)
266
Select the gram-positive cocci that accounts for 10-15% of community associated urinary tract infections?
a. Staphylococcus Saprophyticus
b. Klebsiella Pneumoniae
c. Proteus
d. Enterobacter
Answer A: Staphylococcus Saprophyticus
| Pg. 695 – All others are bacteria are gram negative bacilli
267
Select the best course of treatment for an uncomplicated, community associated infection in a woman who is not pregnant and whose symptoms began less than 7 days before starting treatment.
a. Single dose treatment of oral antibiotics
b. Short dose of oral antibiotics
c. Conventional therapy of oral antibiotics
d. Begin IV antibiotic therapy for 48 hours than transition to a conventional therapy of oral antibiotics.
Answer: B: Short dose of oral antibiotics which is typically 3 days. Single dose is less effective so while still correct, B is more correct. Pg 695
268
What are your first line drug of choice for uncomplicated cystitis?
A. trimethoprim/sulfamethoxazole
B. fluoroquinolones (ciprofloxacin)
C. Fosfomycin
D. Daptomycin
Answer A) trimethoprim/sulfamethoxazole
Trimethoprim/sulfamethoxazole is the first line drug of choice for uncomplicated cystitis. Nitrofurantoin is another first line drug of choice mentioned in the book. Ciprofloxacin is the recommended in communities where there is resistance to the drugs of choice. Fosfomycin is recommended when compliance is a concern because it is given in one dose. (p.695) Daptomycin is a cyclic lipopeptide antibiotic that is active only against gram-positive bacteria (p.713)
269
What is true of severe pyelonephritis? Select all that apply
a. Treated at home
b. Requires hospitalization for IV antibiotics
c. Clinical manifestations include fever, chills, severe flank pain, dysuria, urinary frequency, urinary urgency, pyuria, bacteriuria
d. UTI relapses will almost always occur
Answer: B and C
| p. 695
270
T/F
Relapse is caused by colonization with a new organism.
False.
Relapse is caused by recolonization with the same organism responsible for the initial infection
Reinfection is caused by colonization with a new organism
p. 696
271
Organisms susceptible to Nitrofurantoin include: Select all that apply
a) Proteus
b) Staphylococci
c) Streptococci
d) Pseudomonas
e) Enterobacter
f) Neisseria
Answer: b, c, f
Nitrofurantoin susceptible organisms include staphylococci, streptococci, Neisseria, Bacteroides species and most strains of E. coli.
Organisms that are frequently resistant include Proteus, Pseudomonas, Enterobacter and Klebsiella species.
p.697
272
What is true about Methenamine?
a) Used for chronic infection of the lower urinary tract because it breaks down into ammonia and formaldehyde. Virtually all bacteria are susceptible to formaldehyde so there is virtually no resistance.
b) Injures bacteria by damaging DNA.
c) Can cause tendonitis and tendon rupture, usually of the Achilles tendon.
d) Used to treat protozoal infections and infections caused by obligate anaerobic bacteria.
Answer: A Used for chronic infection of the lower urinary tract because it breaks down into ammonia and formaldehyde. Virtually all bacteria are susceptible to formaldehyde so there is virtually no resistance. p. 698
Nitrofurantoin injures bacteria by damaging DNA
Fluoroquinolones Can cause tendonitis and tendon rupture, usually of the Achilles tendon. (p.711)
Flagyl is used to treat protozoal infections and infections caused by obligate anaerobic bacteria. (p.713)
273
8) Ciprofloxacin is active against what bacteria? Select all that apply
a. Most aerobic gram-negative bacteria
b. Some gram-positive bacteria
c. E.Coli
d. Clostridium difficile
e. Klebsiella species
f. Salmonella
g. Shigella species
h. Campylobacter Jejuni
i. Pseudomonas aeruginosa
j. Bacillus Anthracis
k. Meningococci
l. Many streptococci
m. Haemophilus influenzae
All except Clostridium difficile which is an anaerobe
| p.711
274
9) What drug is the preferred for preventing anthrax in people who have inhaled anthrax spores?
a. Metronidazole (Flagyl)
b. Ciprofloxacin
c. Daptomycin
d. Fosfomycin
Answer: B – Ciproflaxacin p. 711
Flagyl is used for C.difficile and H.pylori – p.713
Daptomycin is used for bloodstream infection with S.aureus (including endocarditis) and complicated skin infections of staph to include MRSA. P. 714
Fosfomycin is recommended for uncomplicated cystitis when compliance is a concern because it is given in one dose. (p.695)
275
10) What should you educate your patient on when prescribing Daptomycin? Select all that apply
a) Your Achilles tendon may rupture.
b) Report any muscle pain or weakness due to the potential for muscle injury
c) We will need to do blood work to measure your CPK levels weekly
d) This drug has been associated with cancer.
Answer: B and C
Fluoroquinolones are associated with tendon rupture which is rare.
Metronidazole should be avoided if possible due to the association with increased carcinogenic risk in mice and rats.
276
Which cell type has the job of making antibodies to mediate humoral immunity?
a. T lymphocytes
b. B lymphocytes
c. Macrophages
d. Eosinophils
Answer: B - B lymphocytes
Reasoning: Chapter 54- B lymphoctyes have the job of making antibodies to mediate humoral immunity
277
Which term best describes, “Triggered by specific antigens, and their purpose is to destroy the antigen that triggered the response. The ability to respond to a specific antigen is due to highly specific receptors on B cells and T cells.
a. Memory
b. Time limitation
c. Diversity
d. Specificity
Answer: D - Specificity
Reasoning: Chapter 54 Specificity is the term being described
278
Which antibody job function is, “binds to the surface of mast cells, binding of antigen stimulates release of histamine and other mediators from the mast cells resulting in symptoms of allergy?”
a. IgA
b. IgG
c. IgE
d. IgM
Answer: C - IgE
Reasoning: Chapter 54: IgE function described
279
Physical barrier such as skin, phagocytic cells, and natural killer cells are classified as what kind of immunity?
a. Natural immunity
b. Specific acquired immunity
c. Cell- mediated immunity
d. Humoral immunity
Answer: A - Natural immunity
Reasoning: Chapter 54: natural immunity includes physical barriers
280
Why are second exposures to an antigen that causes a hypersensitivity reaction more likely to be more severe?
a. Due to time limitation principal
b. Due to diversity principal
c. Due to selectivity of antigens
d. Due to memory principal
Answer: D - Due to memory principal
Reasoning: Chapter 54- B and T lymphocytes that recognize the antigen undergo proliferation, some of the new cells attack while some of the other cells become memory cells, thereby increasing the pool of antigen-specific cells available to respond in the future. When the antigen is presented again the memory cells mobilize and accelerate and intensify the response.
281
What is the cause of most acute uncomplicated cystitis?
a. E. Coli
b. Stphylococcus saprophyticus
c. Klebsiella pneumoniae
d. Proteus spp
Answer: A - E.Coli
Reasoning: Drugs for common bacterial infections in adults
282
What is the most common treatment options for bronchitis in adults?
a. Clindamycin
b. Doxycline
c. Penicillin
d. Supportive measures d/t bronchitis usually being viral unless treating COPD patients
Answer: D - Supportive measures d/t bronchitis usually being viral unless treating COPD patients
Reasoning: Drugs for common bacterial infections in adults hand out
283
What is the most common cause of Community acquired pneumonia?
a. S. pneumoniae and Mycoplasma pneumoniae
b. H. Influenzae
c. Staphylococcus aureus
d. M. Catarrhalis
Answer: A - S. pneumoniae and Mycoplasma pneumoniae
Reasoning: Drugs for common bacterial infections in adults
284
What is the most common treatment regimen for a patient with pharyngitis cause by group A. streptococcus?
a. PCNVK 250mg PO qid x10 days
b. Amoxicillin/ Clavulanate 875/125mg PO bid x 5-7 days
c. Levofloxacin 700mg PO x1/day x 5 days
d. Moxifloxacin 400mg PO once/d x 5 days
Answer: A - PCNVK 250mg PO qid x10 days
Reasoning: Drugs for common bacterial infections in adults
285
What is the most common treatment for hospitalized (not ICU) patients with community acquired pneumonia?
a. Ceftriaxime 1-2g IV q8hr plus azithromycin 500mg IV or PO once/d x5 days
b. PCNVK 250mg PO qid x10 days
c. Amoxicillin/ Clavulanate 875/125mg PO bid x 5-7 days
d. Supportive care
not listed. I will update tomorrow
286
You are seeing a patient with a history of smoking who was diagnosed with pneumonia one week ago and started on amoxicillin/clavulanate. The patient is taking his medication as prescribed and continues to have shortness of breath and low grade fever. Which antibiotic would you consider at this time? (Select all that apply)
a. continue to amoxillin/clavulante for a total of 10 days
b. stop the current antibiotic and change to doxycycline
c. stop the current antibiotic and change to levofloxine
d. add azithromycin to the current antibiotic
b. stop the current antibiotic and change to doxycycline
| d. add azithromycin to the current antibiotic
287
A NP sees an adolescent patient for a hospitalization follow-up after an asthma exacerbation. The patient reports having daily symptoms with nighttime awakening 4 or 5 nights per week and misses school several days each month. The patient currently uses fluticasone/salmeterol 100/50 twice daily and albuterol as needed. The patient requires a refill of the albuterol prescription once a month. The patient does not have any known allergies. The NP should:
a. consider adding theophylline to this patient's regimen.
b. prescribe a high-dose ICS plus a LABA twice daily.
c. continue the current regimen and add omalizumab daily.
d. order a combination product with ipratropium and albuterol.
b. prescribe a high-dose ICS plus a LABA twice daily.
288
A parent asks an NP which over-the-counter medication would be best to give to a 4-year-old child who has a viral respiratory illness with nasal congestion and a cough. The NP should recommend which of the following?
a. An antitussive/expectorant combination such as Robitussin DM
b. Diphenhydramine (Benadryl)
c. Over-the-counter pseudoephedrine with guaifenesin (Sudafed)
d. Increased fluids and rest
d. Increased fluids and rest
289
A 70-year-old patient asks an NP about using diphenhydramine (Benadryl) to control intermittent allergic symptoms that include runny nose and sneezing. The NP should counsel this patient to:
a. monitor for hypertension while taking the drug.
b. watch for symptoms of paradoxical excitation with this medication.
c. take the antihistamine with a decongestant for best effect.
d. take the lowest recommended dose initially.
d. take the lowest recommended dose initially.
290
A nurse practitioner (NP) is evaluating a patient with asthma who reports having wheezing and coughing 1 or 2 days each week and awakening from sleep three or four times each month with asthma symptoms. The patient's forced expiratory volume in 1 second (FEV1) is 80% of the predicted value. The patient's current medication regimen is an albuterol metered-dose inhaler, 2 puffs every 4 hours as needed. The NP should initially prescribe:
a. montelukast (Singulair) po daily.
b. a long-acting β-adrenergic agonist (LABA), 1 puff bid.
c. ipratropium bromide bid with albuterol.
d. a low-dose inhaled corticosteroid (ICS), 2 puffs bid.
d. a low-dose inhaled corticosteroid (ICS), 2 puffs bid.
291
A patient recently began receiving clindamycin to teat an infection. After 8 days of treatment, the patient reports having 10-15 watery stools per day. What action should be taken to address the patient’s diarrhea?
a. Assure the patient that this is a known side effect of clindamycin and suggest consuming extra fluids
b. Prescribe Lomotil or a bulk laxative to minimize the diarrhea
c. Increase the clindamycin dose to aggressively treat the infection
d. Discontinue the clindamycin immediately
d. Discontinue the clindamycin immediately
292
A patient who takes an ACE inhibitor will begin taking TMP/SMZ to treat a urinary tract infection. Which serum electrolyte should be closely monitored?
a. chloride
b. sodium
c. potassium
d. calcium
c. potassium
293
A 6 week old infant who has not yet received immunizations develops a severe cough. While awaiting nasopharyngeal culture results, which antibiotic should be prescribed?
a. Penicillin G
b. Clindamycin
c. Erythromycin
d. Doxycycline
c. Erythromycin
