NCLEX - Week 9

Question 1

A patient is prescribed tetracycline for a Chlamydia infection. The nurse should instruct the patient to avoid taking the medication with which of the following?

A. A glass of water
B. A meal
C. An antacid
D. A multivitamin

Answer 1

C. An antacid

Rationale: Tetracyclines form insoluble chelates with calcium, iron, magnesium, aluminum, and zinc.
Antacids often contain these minerals, which can reduce the absorption of tetracyclines.

Question 2

A patient receiving gentamicin therapy for a urinary tract infection reports ringing in the ears. What is the nurse’s priority action?

A. Administer an analgesic medication.
B. Reassure the patient that this is a common side effect.
C. Notify the healthcare provider immediately.
D. Document the finding in the patient’s chart.

Answer 2

C. Notify the healthcare provider immediately.

Rationale: Ringing in the ears (tinnitus) is an early sign of aminoglycoside-induced ototoxicity, which can lead to permanent hearing loss.
Promptly notifying the healthcare provider allows for assessment, potential medication adjustment, and intervention to prevent further damage.

Question 3

A patient is prescribed trimethoprim-sulfamethoxazole (TMP/SMZ) for a urinary tract infection (UTI). Which of the following statements by the patient indicates a need for further teaching?

A. “I will drink plenty of fluids while taking this medication.”
B. “I can stop taking the medication once my symptoms improve.”
C. “I should avoid prolonged sun exposure while on this medication.”
D. “I will report any rash or skin changes to my healthcare provider.”

Answer 3

B. “I can stop taking the medication once my symptoms improve.”

Rationale:
Patients should be instructed to complete the full course of antibiotic therapy as prescribed, even if symptoms improve.

Premature discontinuation of antibiotics can lead to incomplete eradication of bacteria and increase the risk of antibiotic resistance.

Question 4

Which of the following laboratory tests is essential for monitoring a patient receiving intravenous gentamicin therapy?

A. Complete blood count (CBC)
B. Liver function tests (LFTs)
C. Serum creatinine and blood urea nitrogen (BUN)
D. Serum electrolytes

Answer 4

C. Serum creatinine and blood urea nitrogen (BUN)

Rationale: Gentamicin is an aminoglycoside antibiotic that can be nephrotoxic.

Monitoring serum creatinine and BUN levels helps assess kidney function and detect potential renal impairment.

Question 5

Which of the following antibiotics is effective against both methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE)?

A. Clindamycin
B. Linezolid
C. Erythromycin
D. Doxycycline

Answer 5

B. Linezolid

Rationale:
Linezolid is a unique antibiotic that can suppress multidrug-resistant gram-positive pathogens, including VRE and MRSA.

Question 6

A patient is prescribed doxycycline for Lyme disease. Which instruction should the nurse provide?

A. Take the medication with milk to reduce gastrointestinal upset.
B. Avoid taking the medication with iron supplements.
C. Take the medication just before bedtime.
D. Expect urine to turn a reddish-orange color.

Answer 6

B. Avoid taking the medication with iron supplements.

Rationale: Tetracyclines, including doxycycline, should not be administered with calcium supplements, milk products, iron supplements, magnesium-containing laxatives, and most antacids because they form insoluble chelates, reducing drug absorption

Question 7

The nurse is caring for a patient receiving intravenous gentamicin. What is the priority nursing assessment to monitor for potential adverse effects?

A. Respiratory rate
B. Blood pressure
C. Temperature
D. Hearing acuity

Answer 7

D. Hearing acuity

Rationale:
Aminoglycosides like gentamicin can cause ototoxicity, manifesting as tinnitus (ringing in the ears), headache, dizziness, and hearing loss.
Regular assessment of hearing acuity can help detect early signs of ototoxicity

Question 8

A patient with a urinary tract infection (UTI) is prescribed trimethoprim-sulfamethoxazole (TMP/SMZ). What are essential instructions for the nurse to provide?

A. Take the medication with grapefruit juice to enhance absorption.
B. Limit fluid intake to concentrate the medication in the urine.
C. Complete the full course of treatment, even if symptoms improve.
D. Report any muscle pain or weakness to the healthcare provider.

Answer 8

C. Complete the full course of treatment, even if symptoms improve.

Rationale: Patients should complete the full course of antibiotic therapy as prescribed to ensure complete eradication of bacteria and reduce the risk of resistance, even if symptoms resolve earlier

Question 9

Which adverse effect is associated with clindamycin therapy?

A. Tooth discoloration
B. Clostridium difficile-associated diarrhea (CDAD)
C. Hypokalemia
D. Hyperglycemia

Answer 9

B. Clostridium difficile-associated diarrhea (CDAD)

Rationale:
Clindamycin can disrupt the balance of normal gut flora, leading to an overgrowth of C. difficile, causing severe diarrhea

Question 10

A patient with a history of an allergic reaction to penicillin is prescribed erythromycin. What is an important nursing consideration?

A. Administer the medication with an antihistamine to prevent allergic reactions. B. Monitor the patient for signs and symptoms of an allergic reaction.
C. Administer the medication intravenously instead of orally.
D. Obtain a culture and sensitivity test before administering the medication.

Answer 10

B. Monitor the patient for signs and symptoms of an allergic reaction.

Rationale: While erythromycin is often used as an alternative for patients with penicillin allergies, cross-hypersensitivity can occur. It’s crucial to monitor for any signs of an allergic reaction, such as rash, itching, or difficulty breathing.

Question 11

Which statement accurately describes the mechanism of action of sulfonamides?

A. Sulfonamides inhibit bacterial protein synthesis by binding to the 50S ribosomal subunit.
B. Sulfonamides disrupt bacterial cell wall synthesis by inhibiting peptidoglycan formation.
C. Sulfonamides interfere with bacterial DNA replication by inhibiting DNA gyrase. D. Sulfonamides suppress bacterial growth by inhibiting the synthesis of tetrahydrofolic acid.

Answer 11

D. Sulfonamides suppress bacterial growth by inhibiting the synthesis of tetrahydrofolic acid.

Rationale:
Sulfonamides are structural analogs of para-aminobenzoic acid (PABA), a component necessary for bacterial folate synthesis.
By competitively inhibiting PABA, sulfonamides disrupt folic acid production, essential for bacterial DNA, RNA, and protein synthesis

Question 12

The nurse is preparing to administer intravenous amikacin. Which intervention is crucial to prevent a potential complication associated with aminoglycosides?

A. Monitor the patient’s blood glucose levels.
B. Administer the medication over at least 30 minutes.
C. Assess the patient’s neurological status frequently.
D. Encourage the patient to increase fluid intake.

Answer 12

B. Administer the medication over at least 30 minutes.

Rationale:
Rapid intravenous administration of aminoglycosides can increase the risk of ototoxicity.
Slow infusion over 30 minutes or longer allows for gradual distribution and reduces the potential for inner ear damage

Question 13

A pregnant patient has a UTI. Which medication is contraindicated due to potential risks to the fetus?

A. Nitrofurantoin
B. Trimethoprim-sulfamethoxazole (TMP/SMZ)
C. Amoxicillin
D. Cephalexin

Answer 13

B. Trimethoprim-sulfamethoxazole (TMP/SMZ)

Rationale:
Sulfonamides, including TMP/SMZ, are contraindicated during pregnancy, particularly in the first trimester and near term.
They can cause kernicterus in newborns (a type of brain damage from high bilirubin levels) and are associated with an increased risk of birth defects

Question 14

A patient is receiving once-daily dosing of gentamicin. When should the nurse obtain a trough level?

A. 30 minutes after the intravenous infusion is complete.
B. 1 hour before the next dose is due.
C. Immediately before administering the next dose.
D. 6 hours after the dose is administered.

Answer 14

B. 1 hour before the next dose is due.

Rationale: With once-daily dosing of aminoglycosides, trough levels are typically measured 1 hour before the next dose to ensure adequate drug clearance and minimize the risk of toxicity

Question 15

What is the rationale for obtaining peak and trough levels for aminoglycoside antibiotics like gentamicin?

A. To determine the appropriate route of administration.
B. To assess for allergic reactions to the medication.
C. To monitor for potential ototoxicity and nephrotoxicity.
D. To evaluate the effectiveness of the antibiotic therapy.

Answer 15

C. To monitor for potential ototoxicity and nephrotoxicity.

Rationale:
Peak and trough levels help ensure therapeutic drug levels while minimizing the risk of toxicity.
High peak levels are needed for bacterial kill, while low trough levels reduce the risk of damage to the ears and kidneys

Question 16

Which antibiotic is indicated for the treatment of infections caused by vancomycin-resistant enterococci (VRE)?

A. Azithromycin
B. Linezolid
C. Clindamycin
D. Tetracycline

Answer 16

B. Linezolid

Rationale:
Linezolid is a key treatment option for multidrug-resistant gram-positive infections, including VRE and MRSA

Question 17

A patient with a penicillin allergy develops a severe anaerobic infection. Which antibiotic might be a suitable alternative, considering the potential for cross-sensitivity?

A. Cefazolin
B. Clindamycin
C. Amoxicillin
D. Piperacillin-tazobactam

Answer 17

B. Clindamycin

Rationale:
While clindamycin is not a penicillin, it’s important to be aware of potential cross-sensitivity in individuals with penicillin allergies, though the risk is likely low.

Cefazolin, amoxicillin, and piperacillin-tazobactam are all beta-lactam antibiotics, like penicillin, and therefore pose a greater risk of cross-reactivi

Question 18

The nurse is caring for a child under 8 years of age. Which class of antibiotics is generally contraindicated for this age group?

A. Macrolides
B. Tetracyclines
C. Penicillins
D. Cephalosporins

Answer 18

B. Tetracyclines

Rationale:
Tetracyclines can bind to calcium in developing teeth and bones, causing discoloration and suppressing bone growth in children under 8 years old.

Question 19

A patient taking tetracycline reports experiencing heartburn. What is the best nursing intervention?

A. Administer an antacid to relieve the heartburn.
B. Advise the patient to take the medication with a full glass of milk.
C. Instruct the patient to take the medication with a meal.
D. Encourage the patient to lie down for 30 minutes after taking the medication.

Answer 19

C. Instruct the patient to take the medication with a meal.

Rationale:
Taking tetracycline with food can help minimize gastrointestinal upset. However, it’s important to avoid co-administration with specific foods high in calcium, iron, magnesium, aluminum, or zinc, as these can interfere with drug absorption.
While taking the medication with milk might seem to help the heartburn, it would significantly reduce drug absorption due to calcium content.
Lying down after taking the medication increases the risk of esophageal ulceration

Question 20

What is the primary mechanism of bacterial resistance to aminoglycosides?

A. Production of enzymes that inactivate aminoglycosides
B. Alteration of bacterial ribosomal binding sites
C. Reduced drug uptake into bacterial cells D. Efflux pumps that remove the drug from bacterial cells

Answer 20

A. Production of enzymes that inactivate aminoglycosides

Rationale:
Bacteria can develop resistance to aminoglycosides by producing enzymes that modify the drug, rendering it ineffective

Question 21

Which patient population is at increased risk of developing kernicterus as an adverse effect of sulfonamide therapy?

A. Older adults
B. Newborns
C. Pregnant women
D. Patients with renal impairment

Answer 21

B. Newborns

Rationale:
Sulfonamides can displace bilirubin from protein binding sites, increasing the risk of kernicterus in newborns, particularly premature infants

Question 22

A patient is prescribed silver sulfadiazine cream for burns. What is an important instruction to provide?

A. Apply a thick layer of cream to the affected area.
B. Avoid applying the cream to the face.
C. Expose the treated area to sunlight to enhance drug effectiveness.
D. Wash the affected area with soap and water before applying the cream.

Answer 22

B. Avoid applying the cream to the face.

Rationale:
Silver sulfadiazine can cause a blue-green or gray skin discoloration, so it’s generally avoided on the face

Question 23

A patient is receiving a combination of gentamicin and a beta-lactam antibiotic for a gram-positive infection. How will this combination therapy affect the gentamicin dosage?

A. The gentamicin dosage will be increased.
B. The gentamicin dosage will be decreased.
C. The gentamicin dosage will remain the same.
D. The gentamicin dosage will be adjusted based on peak levels only.

Answer 23

B. The gentamicin dosage will be decreased.

Rationale:
When combined with vancomycin or a beta-lactam antibiotic, the total daily dose of gentamicin is reduced

Question 24

A patient with phenylketonuria (PKU) is prescribed an oral antibiotic. Which formulation should the nurse avoid?

A. Linezolid oral suspension
B. Doxycycline capsules
C. Azithromycin tablets
D. Trimethoprim-sulfamethoxazole tablets

Answer 24

A. Linezolid oral suspension

Rationale:
Linezolid oral suspension contains phenylalanine, which is contraindicated for patients with PKU

Question 25

A patient is prescribed sulfisoxazole-erythromycin suspension (Pediazole). Which condition is this medication commonly used to treat? A. Urinary tract infection B. Otitis media C. Pneumonia D. Skin infection

Answer 25

B. Otitis media Rationale: Sulfisoxazole, in combination with erythromycin (Pediazole), is approved for the treatment of otitis media in children.

Question 26

A patient is receiving tetracycline for acne. What instructions should the nurse provide regarding the administration of this medication? A. Take the medication with meals to enhance absorption. B. Avoid direct sunlight exposure and use sunscreen. C. Expect urine to turn a dark brown color. D. Take the medication with an antacid to prevent gastrointestinal upset.

Answer 26

B. Avoid direct sunlight exposure and use sunscreen. Rationale: Tetracyclines can cause photosensitivity, making the skin more susceptible to sunburn. Patients should be advised to avoid direct sunlight exposure and use sunscreen while taking these antibiotics.

Question 27

Which statement about the mechanism of action of linezolid is accurate? A. Linezolid inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit. B. Linezolid disrupts bacterial cell wall synthesis. C. Linezolid interferes with bacterial DNA replication. D. Linezolid inhibits the formation of the initiation complex, preventing protein synthesis.

Answer 27

D. Linezolid inhibits the formation of the initiation complex, preventing protein synthesis. Rationale: Linezolid binds to the 23S portion of the 50S ribosomal subunit, a unique mechanism that prevents the formation of the initiation complex needed to start protein synthesis in bacteria

Question 28

The nurse is caring for a patient receiving dalfopristin/quinupristin (Synercid). Which administration instruction is essential to reduce the risk of adverse effects? A. Administer the medication by rapid intravenous injection. B. Flush the intravenous line with normal saline before and after the infusion. C. Administer the medication through a central venous line to minimize venous irritation. D. Monitor the patient's blood glucose levels closely during the infusion.

Answer 28

C. Administer the medication through a central venous line to minimize venous irritation. Rationale: Dalfopristin/quinupristin can cause significant venous irritation. Administering it through a central line reduces the risk of phlebitis and discomfort

Question 29

Which of the following antibiotics is effective against methicillin-resistant Staphylococcus aureus (MRSA)? A. Linezolid B. Erythromycin C. Clindamycin D. Doxycycline

Answer 29

A. Linezolid Rationale: Linezolid is an effective treatment option for infections caused by MRSA

Question 30

A patient is prescribed trimethoprim for a urinary tract infection. The nurse knows that careful monitoring is required for which potential adverse effect, particularly in patients with a specific deficiency? A. Hyperkalemia B. Hepatotoxicity C. Megaloblastic anemia D. Nephrotoxicity

Answer 30

C. Megaloblastic anemia Rationale: Trimethoprim can suppress bone marrow and cause megaloblastic anemia in individuals with pre-existing folic acid deficiency

Question 31

A patient with a sulfa allergy is prescribed mafenide acetate (Sulfamylon) cream for burns. What is the priority nursing action? A. Administer the cream as prescribed. B. Contact the healthcare provider to clarify the order. C. Monitor the patient for signs of infection. D. Assess the patient's pain level before applying the cream.

Answer 31

B. Contact the healthcare provider to clarify the order. Rationale: Patients with sulfa allergies may have cross-sensitivity to mafenide. The nurse should contact the prescriber to clarify the order and discuss alternative treatment options

Question 32

Which medication is primarily used to treat Helicobacter pylori infections associated with peptic ulcer disease? A. Tetracycline B. Clindamycin C. Linezolid D. Gentamicin

Answer 32

A. Tetracycline Rationale: Tetracyclines are one of the first-line drug choices for H. pylori infections

Question 33

What is a significant nursing implication for administering topical clindamycin? A. Monitor the patient's blood glucose levels. B. Instruct the patient to avoid sexual intercourse during treatment. C. Assess the patient's respiratory rate frequently. D. Encourage the patient to increase potassium intake.

Answer 33

B. Instruct the patient to avoid sexual intercourse during treatment. Rationale: If a patient is using a topical, intravaginal clindamycin preparation, they should be advised to abstain from intercourse during the treatment period

Question 34

The nurse is administering an aminoglycoside antibiotic. What is essential to monitor to prevent potential nephrotoxicity? A. Peak drug levels B. Trough drug levels C. Serum potassium levels D. Blood glucose levels

Answer 34

B. Trough drug levels Rationale: Monitoring trough levels of aminoglycosides, which are drawn just before the next dose, is crucial in preventing nephrotoxicity. Persistently elevated trough levels indicate that the drug is not being adequately cleared by the kidneys, increasing the risk of kidney damage

Question 35

What is the rationale for instructing a patient to take oral clindamycin with a full glass of water? A. To enhance drug absorption B. To reduce the risk of esophageal irritation C. To prevent crystalluria D. To minimize gastrointestinal upse

Answer 35

B. To reduce the risk of esophageal irritation Rationale: Taking clindamycin with a full glass of water helps the capsule move through the esophagus and into the stomach, reducing the risk of irritation and potential ulceration

Question 36

Which laboratory test is essential to monitor for patients receiving linezolid therapy, particularly for extended durations? A. Liver function tests B. Complete blood count C. Serum creatinine D. Electrolytes

Answer 36

B. Complete blood count Rationale: Linezolid can suppress bone marrow function, potentially leading to thrombocytopenia, anemia, and neutropenia, especially with prolonged treatment. Monitoring complete blood counts helps detect these hematologic effects.

Question 37

A patient is receiving a sulfonamide antibiotic. Which statement indicates a need for further teaching? A. "I should drink plenty of fluids while taking this medication." B. "I will wear sunscreen and protective clothing when going outside." C. "I can stop taking the medication once I feel better." D. "I should report any skin rash or itching to my healthcare provider immediately."

Answer 37

C. "I can stop taking the medication once I feel better." Rationale: It's critical for patients to understand the importance of completing the full course of antibiotic therapy, even if symptoms improve. Stopping prematurely can lead to incomplete bacterial eradication and contribute to antibiotic resistance.

Question 38

What is a potential adverse effect of mafenide acetate (Sulfamylon) that requires careful monitoring? A. Metabolic acidosis B. Hypokalemia C. Hyperglycemia D. Hypernatremia

Answer 38

A. Metabolic acidosis Rationale: Mafenide is metabolized into a compound that can suppress renal excretion of acid, potentially leading to metabolic acidosis

Question 39

A patient with glucose-6-phosphate dehydrogenase (G6PD) deficiency is prescribed a sulfonamide antibiotic. What is a potential complication that the nurse should be aware of? A. Hemolytic anemia B. Thrombocytopenia C. Nephrotoxicity D. Hepatotoxicity

Answer 39

A. Hemolytic anemia Rationale: Sulfonamides can trigger hemolysis (destruction of red blood cells) in patients with G6PD deficiency

Question 40

Which medication is used topically to suppress bacterial colonization in burn patients? A. Silver sulfadiazine B. Linezolid C. Clindamycin D. Tetracycline

Answer 40

A. Silver sulfadiazine Rationale: Silver sulfadiazine is a topical sulfonamide commonly used to prevent and treat infections in burn wounds

Question 41

A patient with a history of severe hypersensitivity to sulfonamides is prescribed an antibiotic. Which antibiotic class is contraindicated due to the risk of cross-hypersensitivity? A. Tetracyclines B. Macrolides C. Thiazide diuretics D. Aminoglycosides

Answer 41

C. Thiazide diuretics Rationale: Patients with sulfonamide hypersensitivity may have cross-reactivity with other drugs that contain a sulfonamide group, including thiazide diuretics

Question 42

What is a key advantage of using once-daily dosing for aminoglycoside antibiotics? A. It allows for lower peak drug levels. B. It reduces the risk of ototoxicity and nephrotoxicity. C. It simplifies the medication regimen for patients. D. It enhances drug penetration into tissues.

Answer 42

B. It reduces the risk of ototoxicity and nephrotoxicity. Rationale: Once-daily dosing allows for a longer period of low drug levels between doses, allowing the drug to "wash out" of vulnerable cells in the inner ear and kidneys, reducing the risk of toxicity

Question 43

Which statement best describes the concept of the "postantibiotic effect" of aminoglycosides? A. The antibiotic continues to kill bacteria even after drug levels have fallen below the minimum inhibitory concentration (MIC). B. The antibiotic stimulates the patient's immune system to enhance bacterial killing. C. The antibiotic prevents bacteria from developing resistance. D. The antibiotic has a prolonged half-life, extending its duration of action.

Answer 43

A. The antibiotic continues to kill bacteria even after drug levels have fallen below the minimum inhibitory concentration (MIC). Rationale: Aminoglycosides exhibit a postantibiotic effect, meaning their bactericidal activity persists for several hours even after serum drug levels have dropped below the level needed to inhibit bacterial growth

Question 44

A patient is prescribed nitrofurantoin for a urinary tract infection. What instruction is essential for the nurse to provide to minimize gastrointestinal upset? A. Take the medication on an empty stomach. B. Take the medication with a full glass of milk or with meals. C. Crush the tablets and mix with applesauce. D. Take the medication with an antacid.

Answer 44

B. Take the medication with a full glass of milk or with meals. Rationale: Taking nitrofurantoin with food or milk can help reduce gastrointestinal side effects

Question 45

What is a potential adverse effect of nitrofurantoin that warrants immediate discontinuation of the medication? A. Rust-yellow discoloration of urine B. Headache C. Nausea D. Pulmonary manifestations, such as dyspnea and cough

Answer 45

D. Pulmonary manifestations, such as dyspnea and cough Rationale: Nitrofurantoin can rarely cause severe lung reactions, including pneumonitis and pulmonary fibrosis. These reactions can be serious and require prompt discontinuation of the medication

Question 46

A patient is prescribed oral neomycin before colorectal surgery. What is the purpose of this medication? A. To treat a pre-existing infection. B. To suppress bowel flora before surgery. C. To prevent postoperative pain. D. To promote wound healing.

Answer 46

B. To suppress bowel flora before surgery. Rationale: Oral neomycin is used to reduce the number of bacteria in the gut before colorectal surgery, helping to prevent infections

Question 47

Which topical antibiotic is effective against impetigo caused by Staphylococcus aureus? A. Mupirocin (Bactroban) B. Retapamulin (Altabax) C. Gentamicin D. Silver sulfadiazine

Answer 47

A. Mupirocin (Bactroban) Rationale: Mupirocin is a topical antibiotic effective against impetigo, a common skin infection caused by Staph. aureus. While retapamulin is also a topical antibiotic, it is primarily used for impetigo caused by Streptococcus pyogenes.

Question 48

Which of the following antibiotics is associated with an increased risk of Clostridium difficile infection? A. Clindamycin B. Azithromycin C. Doxycycline D. Linezolid

Answer 48

A. Clindamycin Rationale: Clindamycin is well-known for its association with C. difficile infection, a serious and potentially life-threatening form of diarrhea

Question 49

What is a unique property of doxycycline that distinguishes it from other tetracyclines? A. It can be administered intravenously. B. It has a longer half-life, allowing for once-daily dosing. C. It is effective against MRSA. D. It does not cause photosensitivity.

Answer 49

B. It has a longer half-life, allowing for once-daily dosing. Rationale: Doxycycline has a longer half-life compared to other tetracyclines, making once-daily dosing possible. It is important to note that all tetracyclines, including doxycycline, can cause photosensitivity.

Question 50

What is the preferred route of administration for aminoglycosides to treat systemic infections? A. Oral B. Intramuscular or intravenous C. Topical D. Inhalation

Answer 50

B. Intramuscular or intravenous Rationale: Aminoglycosides are not well absorbed orally, and they need to reach adequate blood levels to treat systemic infections. Therefore, the preferred routes of administration are intramuscular or intravenous.