NCLEX - Week 8

Question 1

A nurse is caring for a client with a wound infection. What is the nurse’s priority action?

A. Administer antibiotic medication.
B. Obtain a wound specimen for culture.
C. Monitor the client for a superinfection. D. Teach the client about wound care.

Answer 1

B. Obtain a wound specimen for culture.

Obtaining a wound culture before administering antibiotics is crucial to identify the causative organism and its sensitivities.
This guides appropriate antibiotic selection and prevents unnecessary broad-spectrum antibiotic use.
While the other options are important, obtaining a culture is the priority.

Question 2

Which of the following best describes selective toxicity in antimicrobial therapy?

A. The ability of a drug to injure only host cells.
B. The ability of a drug to kill or suppress microbial pathogens without harming host cells.
C. The ability of a drug to work synergistically with host defenses.
D. The ability of a drug to be equally effective against a wide range of pathogens.

Answer 2

B. The ability of a drug to kill or suppress microbial pathogens without harming host cells.

Selective toxicity refers to the drug’s ability to harm the target microbe without harming the host. This is the basis of successful antibiotic therapy

Question 3

A client is prescribed a broad-spectrum antibiotic. What is a potential risk associated with this type of antibiotic?

A. Increased susceptibility to viral infections.
B. Development of superinfection.
C. Decreased drug resistance.
D. Improved immune response.

Answer 3

B. Development of superinfection.

Broad-spectrum antibiotics kill a wider range of bacteria, including beneficial normal flora, leading to the overgrowth of resistant organisms and the development of a superinfection

Question 4

A client develops C. difficile infection (CDI) during antibiotic therapy. This is an example of what?

A. Innate resistance
B. Acquired resistance
C. Superinfection
D. Synergistic effect

Answer 4

C. Superinfection

CDI is a common superinfection that occurs when antibiotics eliminate normal gut flora, allowing C. difficile to overgrow

Question 5

Before initiating antibiotic therapy, what is a crucial nursing intervention?

A. Administer the first dose immediately. B. Obtain a specimen for culture and sensitivity testing.
C. Teach the client about potential drug interactions.
D. Assess the client’s renal function.

Answer 5

B. Obtain a specimen for culture and sensitivity testing.

Collecting specimens for culture and sensitivity before starting antibiotics allows for precise identification of the pathogen and guides selection of the most effective antibiotic

Question 6

What is conjugation in the context of bacterial resistance?

A. A spontaneous genetic mutation.
B. Transfer of extrachromosomal DNA containing resistance genes.
C. The process by which bacteria produce enzymes that inactivate antibiotics.
D. The development of resistant strains through prolonged antibiotic exposure.

Answer 6

B. Transfer of extrachromosomal DNA containing resistance genes.

Conjugation is the transfer of extrachromosomal DNA (R factors) carrying resistance genes between bacteria, leading to multiple drug resistance

Question 7

What is the minimum inhibitory concentration (MIC)?

A. The lowest concentration of antibiotic that kills 99.9% of bacteria.
B. The lowest concentration of antibiotic that completely inhibits bacterial growth. C. The highest concentration of antibiotic that can be safely administered.
D. The concentration of antibiotic needed to prevent bacterial resistance.

Answer 7

B. The lowest concentration of antibiotic that completely inhibits bacterial growth.

The MIC is the lowest antibiotic concentration completely preventing bacterial growth. It’s important for determining appropriate dosage

Question 8

A client with a prosthetic heart valve is scheduled for dental work. What type of antimicrobial therapy is indicated?

A. Empiric therapy
B. Prophylactic therapy
C. Therapeutic therapy
D. Superinfection prevention

Answer 8

B. Prophylactic therapy

Prophylactic antimicrobial therapy is recommended before dental procedures in clients with prosthetic heart valves to prevent bacterial endocarditis

Question 9

Which of the following is an example of a misuse of antibiotics?

A. Treating a bacterial infection based on culture and sensitivity results.
B. Administering antibiotics for a proven bacterial infection.
C. Treating a viral infection with antibiotics. D. Using antibiotics prophylactically before surgery.

Answer 9

C. Treating a viral infection with antibiotics.

Antibiotics are ineffective against viral infections. Their use in such cases promotes antibiotic resistance and exposes the patient to unnecessary risk

Question 10

A nurse is monitoring a client receiving vancomycin. Which lab value is most important to monitor?

A. White blood cell count
B. Liver function tests
C. Serum creatinine
D. Blood glucose

Answer 10

C. Serum creatinine

Vancomycin’s main toxicity is nephrotoxicity, therefore monitoring serum creatinine (a measure of kidney function) is essential

Question 11

A client receiving a penicillin antibiotic reports difficulty breathing and a skin rash. What is the nurse’s priority action?

A. Administer diphenhydramine.
B. Assess the client’s vital signs and notify the provider immediately.
C. Document the findings and continue monitoring the client.
D. Stop the medication and wait for the provider’s order.

Answer 11

B. Assess the client’s vital signs and notify the provider immediately.

This presentation suggests a severe allergic reaction, potentially anaphylaxis, requiring immediate action. Assess vital signs and alert the provider.

Question 12

Which of the following clients is at highest risk for antibiotic toxicity?

A. A 30-year-old with a mild respiratory infection.
B. A 65-year-old with renal impairment.
C. A 25-year-old with a urinary tract infection.
D. A 40-year-old with a localized skin infection.

Answer 12

B. A 65-year-old with renal impairment.

Impaired renal function reduces drug elimination and significantly increases the risk of antibiotic toxicity in older adults

Question 13

What is a key nursing intervention to prevent the spread of C. difficile?

A. Using alcohol-based hand sanitizer.
B. Wearing gloves and a gown when caring for infected clients.
C. Using disposable rectal thermometers. D. All of the above.

Answer 13

D. All of the above.

All these are key interventions to prevent CDI transmission. Alcohol-based sanitizer isn’t effective against C. difficile spores

Question 14

Which of the following antibiotics is considered penicillinase-resistant?

A. Penicillin G
B. Amoxicillin
C. Nafcillin
D. Ampicillin

Answer 14

C. Nafcillin

Nafcillin is a penicillinase-resistant penicillin.

Question 15

A client with a history of penicillin allergy requires treatment for a bacterial infection. Which antibiotic class should be approached with caution?

A. Aminoglycosides
B. Fluoroquinolones
C. Cephalosporins
D. Macrolides

Answer 15

C. Cephalosporins

Cross-reactivity between penicillins and cephalosporins exists, although it is not always significant. Caution is advised

Question 16

16. What is a key component of antimicrobial stewardship?

A. Administering antibiotics to all hospitalized patients.
B. Using broad-spectrum antibiotics routinely.
C. Using antibiotics judiciously only when needed.
D. Discouraging vaccination programs.

Answer 16

C. Using antibiotics judiciously only when needed.

Antimicrobial stewardship focuses on using antibiotics only when necessary to minimize resistance

Question 17

A client is receiving cefazolin. Which of the following should be avoided?

A. Dairy products
B. Caffeine
C. Alcohol
D. Aspirin

Answer 17

C. Alcohol

Cefazolin can cause a disulfiram-like reaction with alcohol

Question 18

18. What is a common adverse effect of vancomycin?

A. Hepatotoxicity
B. Nephrotoxicity
C. Ototoxicity
D. B and C

Answer 18

D. B and C

Vancomycin can cause both nephrotoxicity and ototoxicity

Question 19

What is red man syndrome?

A. A rare allergic reaction to vancomycin. B. An adverse effect of rapid vancomycin infusion.
C. A common side effect of penicillin therapy.
D. A type of superinfection.

Answer 19

B. An adverse effect of rapid vancomycin infusion.

Rapid infusion of vancomycin can cause “red man syndrome” due to histamine release

Question 20

Which antibiotic is effective against methicillin-resistant Staphylococcus aureus (MRSA)?

A. Penicillin G
B. Amoxicillin
C. Ceftaroline
D. Cefazolin

Answer 20

C. Ceftaroline

Ceftaroline is a fifth-generation cephalosporin active against MRSA

Question 21

Which of the following is a bacteriostatic antibiotic?

A. Penicillin G
B. Vancomycin
C. Tetracycline
D. Aminoglycoside

Answer 21

C. Tetracycline

Tetracycline is bacteriostatic, inhibiting bacterial growth rather than killing them directly

Question 22

Which type of antibiotic is active against a wide range of bacteria?

A. Narrow-spectrum
B. Broad-spectrum
C. Bactericidal
D. Bacteriostatic

Answer 22

B. Broad-spectrum

Broad-spectrum antibiotics are effective against a variety of bacteria

Question 23

What is the priority nursing intervention when a patient experiences anaphylaxis to penicillin?
A. Administer epinephrine
B. Administer diphenhydramine
C. Monitor the patient’s vital signs
D. Contact the provider

Answer 23

A. Administer epinephrine

Epinephrine is the first-line treatment for anaphylaxis, a life-threatening allergic reaction

Question 24

What is a characteristic of first-generation cephalosporins?

A. High activity against gram-negative bacteria
B. Resistance to beta-lactamases
C. Good penetration into the cerebrospinal fluid
D. Susceptibility to beta-lactamases

Answer 24

D. Susceptibility to beta-lactamases

First-generation cephalosporins are often susceptible to inactivation by beta-lactamases

Question 25

Which antibiotic is frequently used to treat C. difficile infection (CDI)? A. Penicillin G B. Vancomycin C. Azithromycin D. Ciprofloxacin

Answer 25

B. Vancomycin Oral or rectal vancomycin is a common treatment for CDI

Question 26

What is a crucial nursing intervention for clients receiving intravenous (IV) vancomycin? A. Administering it as a rapid IV push B. Infusing it slowly over 60 minutes or longer C. Discontinuing it if the patient develops a mild rash D. Not monitoring blood levels

Answer 26

B. Infusing it slowly over 60 minutes or longer Slow infusion is crucial to minimize the risk of red man syndrome

Question 27

Which class of antibiotics does imipenem belong to? A. Penicillins B. Cephalosporins C. Carbapenems D. Glycopeptides

Answer 27

C. Carbapenems Imipenem is a carbapenem

Question 28

What is a potential drug interaction with imipenem-cilastatin? A. Valproic acid B. Vitamin K C. Aspirin D. Diphenhydramine

Answer 28

A. Valproic acid Imipenem-cilastatin can lower valproic acid levels, increasing seizure risk

Question 29

Which of the following factors should be considered when selecting an antibiotic? A. The client's age B. The site of infection C. The client's allergies D. All of the above

Answer 29

D. All of the above All these factors are critical in choosing an antibiotic

Question 30

What is a potential adverse effect of cefotetan? A. Ototoxicity B. Nephrotoxicity C. Bleeding tendencies D. Hepatotoxicity

Answer 30

C. Bleeding tendencies Cefotetan can increase bleeding risk

Question 31

What is a sign of clinical improvement in a client receiving antimicrobial therapy? A. Increased white blood cell count B. Resolution of fever C. Increased serum creatinine level D. Development of a new infection

Answer 31

B. Resolution of fever Reduction of fever is a positive indicator of treatment effectiveness

Question 32

Which generation of cephalosporins generally has better penetration into the cerebrospinal fluid (CSF)? Select all that apply A. First generation B. Second generation C. Third generation D. Fourth generation

Answer 32

C. Third generation D. Fourth generation Third and fourth-generation cephalosporins have better CSF penetration

Question 33

What is an important teaching point for clients taking oral antibiotics? A. They can stop taking them as soon as symptoms improve. B. They should take them with food to enhance absorption. C. They should complete the entire prescribed course of therapy. D. They do not need to report any adverse effects.

Answer 33

C. They should complete the entire prescribed course of therapy. Completing the full course is crucial to prevent relapse and development of resistance

Question 34

Which of the following is a risk factor for healthcare-associated MRSA (HCA-MRSA) infection? A. Recent hospitalization B. Long-term care facility residence C. Prolonged antibiotic therapy D. All of the above

Answer 34

D. All of the above All are risk factors for HCA-MRSA

Question 35

Which of the following is a common sign of antibiotic-associated pseudomembranous colitis? A. Constipation B. Diarrhea C. Increased appetite D. Weight gain

Answer 35

B. Diarrhea Diarrhea is a key symptom of antibiotic-associated colitis caused by C. difficile

Question 36

What should be done before administering nafcillin IM to a client? A. Check the client’s blood glucose B. Inquire about any penicillin allergies C. Obtain a urine sample D. Draw a blood culture

Answer 36

B. Inquire about any penicillin allergies Penicillin allergy is a contraindication for nafcillin

Question 37

What is a common mechanism of bacterial resistance to penicillins? A. Increased cell wall permeability B. Production of penicillin-binding proteins with low affinity C. Increased drug efflux D. Altered ribosome function

Answer 37

B. Production of penicillin-binding proteins with low affinity Production of altered PBPs is a major mechanism of penicillin resistance

Question 38

Which of the following is an appropriate indication for prophylactic antibiotic use? A. Treatment of a common cold B. Prevention of infection before surgery C. Treatment of a viral infection D. Treatment of fever of unknown origin

Answer 38

B. Prevention of infection before surgery Prophylactic antibiotics are used before certain surgeries to prevent infection

Question 39

What is a potential adverse effect of extended-spectrum penicillins? A. Hyperkalemia B. Hyponatremia C. Hypokalemia D. Hypernatremia

Answer 39

A. Hyperkalemia High doses of penicillin G potassium can cause hyperkalemia

Question 40

Which of the following is a common side effect of cephalosporins? A. Hepatotoxicity B. Nephrotoxicity C. Allergic reaction D. Ototoxicity

Answer 40

C. Allergic reaction Allergic reactions are common with cephalosporins

Question 41

What is an important nursing assessment to perform before administering a cephalosporin? A. Assess the client's weight B. Assess for penicillin allergy C. Check the client's potassium level D. Measure the client's blood glucose

Answer 41

B. Assess for penicillin allergy Because of the potential for cross-reactivity, penicillin allergy should be assessed

Question 42

What is a crucial nursing intervention when administering IV cephalosporins? A. Rapid IV push B. Slow IV infusion C. Administration with meals D. Continuous IV infusion

Answer 42

B. Slow IV infusion Slow IV infusion is often recommended to reduce the risk of thrombo

Question 43

Which antibiotic can cause a disulfiram-like reaction with alcohol? A. Vancomycin B. Cefazolin C. Erythromycin D. Gentamicin

Answer 43

B. Cefazolin Cefazolin can cause a disulfiram-like reaction with alcohol

Question 44

What type of infection is commonly treated with fosfomycin? A. Pneumonia B. Sepsis C. Urinary tract infection D. Endocarditis

Answer 44

C. Urinary tract infection Fosfomycin is used for uncomplicated urinary tract infections

Question 45

Which antibiotic requires dose adjustments in clients with renal impairment? A. Ceftaroline B. Ceftriaxone C. Most cephalosporins D. Both A and C

Answer 45

D. Both A and C Most cephalosporins (except ceftriaxone) require dosage adjustment for renal impairment. Ceftaroline also needs dose adjustments for renal impairment

Question 46

What is a potential complication associated with aztreonam? A. Ototoxicity B. Nephrotoxicity C. Hepatotoxicity D. Thrombophlebitis

Answer 46

D. Thrombophlebitis Thrombophlebitis at the IV site is a potential adverse effect of aztreonam

Question 47

Which antibiotic is commonly used for severe infections and is often a last resort due to potential toxicity? A. Amoxicillin B. Cephalexin C. Vancomycin D. Amoxicillin/clavulanate

Answer 47

C. Vancomycin Vancomycin is reserved for serious infections due to its potential for toxicity

Question 48

Which of the following is a mechanism of action of vancomycin? A. Inhibition of protein synthesis B. Inhibition of cell wall synthesis C. Disruption of bacterial cell membrane D. Inhibition of nucleic acid synthesis

Answer 48

B. Inhibition of cell wall synthesis Vancomycin inhibits cell wall synthesis

Question 49

Which of the following measures helps prevent MRSA transmission? A. Frequent hand washing B. Avoiding contact with infected individuals C. Keeping infected wounds covered D. All of the above

Answer 49

D. All of the above All measures help prevent MRSA transmission

Question 50

What is an important instruction for patients taking penicillin V? A. Take it on an empty stomach B. Take it with meals C. Take it only when symptoms are present D. Take it with a glass of milk

Answer 50

B. Take it with meals Penicillin V may be taken with food. The other options are incorrect. The full course should be completed even if symptoms improve. It should not be taken with milk due to potential calcium interactions.