Test Bank For Abrams’ Clinical Drug Therapy Rationales For Nursing Practice 11th Edition By Geralyn Frandsen

$35.00

Description

Abrams’ Clinical Drug Therapy Rationales For Nursing Practice 11th Edition By Geralyn Frandsen –

Test Bank 

Instant Download

 

Sample Questions

 

1. A pediatric nurse is well aware of the many physiological variables that influence safe
pharmacotherapy in patients younger than 18. Which of the following principles should
the nurse integrate into care?
A)
The physiology of patients older than 15 can be considered to be the same as an adult
patient.
B)
The younger the patient, the greater the variation in medication action compared to an
adult.
C)
The larger the patient’s body mass index, the more his or her physiology varies from that
of an adult.
D)
Pediatric patients have a greater potential to benefit from pharmacotherapy than adult
patients.
Ans: B
Feedback:
The younger the patient, the greater the variation in medication action when compared
to an adult. This does not necessarily equate into a greater potential for benefit, however.
BMI is not the main or sole basis of variations between adults and children.
2. An infant who is 3 weeks old was born at full gestation but was just brought to the
emergency department with signs and symptoms of failure to thrive. This pediatric
patient will be classified into what pediatric age group?
A)
Full-term baby
B)
Young infant
C)
Neonate
D)
Early postnatal
Ans: C
Feedback:
Neonates are considered to be infants from full-term newborn 0 to 4 weeks of age.
3. A pediatric nurse practitioner is aware that there are many knowledge gaps that still
exist in the evidence base that underlies pediatric pharmacology. Many of these
knowledge gaps are rooted in
A)
a lack of scientific understanding of the anatomy and physiology of children and infants.
B)
the historical lack of pediatric participation in the drug testing process.
C)
the fact that research grants in pharmacology have traditionally specified adult
participation.
D)
assumptions that there are no physiological differences between adults and children.
Ans: B
Feedback:
Historically, researchers used only adults to test medications, and prescribers simply
assumed that smaller doses would elicit the same results in smaller patients. The
knowledge base surrounding anatomical and physiological differences between adults
and children is substantial, and grant funding is not typically limited to adult
participation.

Page 1

 

4. A 3-year-old Asian American boy has had culture and sensitivity testing performed, and
antibiotic treatment is indicated. The prescriber knows that the recommended antibiotic
has not been extensively studied in pediatric patients. Consequently, the prescriber will
be obliged to do which of the following?
A)
Administer subtherapeutic doses in order to mitigate the potential for adverse effects
B)
Choose a different antibiotic that has been extensively tested in children
C)
Apply vigilant clinical judgment when administering the antibiotic to the child
D)
Have the child’s family sign informed consent forms absolving the care team from
responsibility for adverse effects
Ans: C
Feedback:
Prescribers must continue to treat pediatric patients with drugs for which they lack
information; therefore, they must practice good assessment, dosing, and evaluation
during the administration of any medication to a pediatric patient. Alternative drugs are
not always an option, and a lack of data does not absolve the care team from
responsibility for adverse outcomes.
5. A 9-year-old boy with severe influenza symptoms will be treated with ribavirin
(Rebetol), an antiviral that is usually taken by adults twice daily in doses of 600 mg PO.
After learning that the child’s body surface area (BSA) is 1.10, the nurse will anticipate
that the child will likely receive how much ribavirin for each dose?
A)
110 mg
B)
380 mg
C)
545 mg
D)
660 mg
Ans: B
Feedback:
The prescriber calculates a dose based on a known adult dose by using the following
equation: pediatric dose = BSA/1.73 × adult dose. Thus, 1.1  1.73 × 600 = 381.5 mg.
This would likely be rounded to 380 mg.
6. Significant pharmacodynamic variations exist between adult patients and pediatric
patients. Which of the following factors are known to contribute to differences in the
ways that drugs affect target cells in children and infants? Select all that apply.
A)
Inability of children to accurately describe adverse effects
B)
Immaturity of children’s organ systems
C)
Differences in the body composition of children
D)
The lack of active immunity in children
E)
Differences in the function of humoral immunity in children
Ans: B, C
Feedback:
Immature organ systems and changing body compositions mean that drugs affect
children differently. Causes of pharmacodynamic variability across the lifespan include

Page 2

 

differences in body composition, immature systems, and genetic makeup. Total body
water, fat stores, and protein amounts change throughout childhood and greatly
influence the effectiveness of drugs in the pediatric population. Children are indeed less
able to describe adverse effects, but this is not a pharmacodynamics variation.
Differences in the function of the immune system are not noted to significantly
influence pharmacodynamics.
7. A 2-year-old girl with a recent history of idiopathic nausea and vomiting was prescribed
promethazine (Phenergan) by her primary care provider. The immaturity of this child’s
gastrointestinal system will primarily influence what aspect of pharmacokinetics?
A)
Absorption
B)
Distribution
C)
Metabolism
D)
Elimination
Ans: A
Feedback:
Gastric emptying and intestinal motility greatly affect the child’s drug absorption. The
GI tract is less directly involved in distribution, metabolism, and elimination.
8. A neonate has been prescribed a water-soluble drug for the treatment of an acute
infection. The nurse recognizes that the percentage of body water in an infant is
significantly higher than that of an adult. What implication does this have for
pharmacotherapy of an infant?
A)
The drug will need to be emulsified before administration.
B)
The infant’s fluid intake will be reduced before and after administration.
C)
The infant will have a fat-soluble drug substituted.
D)
The infant may require an increased dose of the drug.
Ans: D
Feedback:
In adults, total body water is approximately 60%, whereas in newborns, it is 80%. This
difference means that water-soluble drugs are diluted easily and readily moved into
intercellular tissue. As a result, serum drug concentrations are lower, and increased
dosages of water-soluble drugs may be necessary to maintain therapeutic drug levels.
Substitutes may not be available, and fluid restriction does not compensate for this
physiological difference.

A)
B)
C)
D)

9. An infant with recent seizures is being treated in the neonatal intensive care unit with
phenytoin (Dilantin). The infant’s low plasma protein levels during the first year of life
have what consequence?
The infant may have an unpredictable drug response.
The infant may have an increased risk of toxicity.
The infant may experience impaired elimination of the drug.
The infant will have an increased rate of drug metabolism.

Page 3

 

Ans: B
Feedback:
In infants, immature liver function leads to very low plasma protein levels, which limit
the amount of protein binding by drugs. Consequently, the serum concentrations of
highly protein-bound drugs may be higher, and toxicity may occur. This is not a result of
differences in elimination or increased metabolism.
10. Which of the following laboratory tests relates most directly with the impaired drug
elimination that is expected in neonates?
A)
C-reactive protein level
B)
Creatine kinase
C)
Serum albumin level
D)
Glomerular filtration rate
Ans: D
Feedback:
Excretion of most drugs occurs via the kidneys, and elimination in the urine follows.
Young children have immature kidneys, a reduced glomerular filtration rate, and slower
renal clearance. Neonates are especially prone to increased levels of drugs that are
eliminated primarily by the kidneys. CK, albumin, and C-reactive protein levels do not
directly relate to this physiological characteristic.
11. The nurse has experienced challenges in administering a 3-year-old boy’s oral
antibiotics due to the boy’s resistance. How can the nurse best ensure that this patient
receives his necessary medication?
A)
Convince the boy that the medication is actually a treat, especially reserved for him.
B)
Mix the medication with pleasantly flavored syrup or pureed fruit.
C)
Withdraw some of the child’s privileges if he refuses to take his medication.
D)
Distract the child with a toy and then put it in his mouth quickly.
Ans: B
Feedback:
To make oral medications more palatable, the nurse may mix them with flavored syrups
or fruit purees. It would be inappropriate to use negative reinforcement, and medications
should not be characterized as candy or treats. Sneaking the medication into the child’s
mouth will not ensure that it will be swallowed.
12. Oral acetaminophen has been ordered for a young child who has a fever. A liquid form
has been obtained by the nurse to increase the chance of problem-free administration.
Prior to administration, the nurse is going through the rights of medication
administration. When confirming the right dose, what term is most appropriate?
A)
“160 mg”
B)
“One teaspoon”
C)
“One third of a tablespoon”
D)
“5 mL”

Page 4

 

Ans: A
Feedback:
To ensure accuracy and safety, the nurse should administer medications based on
individual dosages in milligrams, micrograms, or units, not on variables such as tablets,
teaspoons, or milliliters, for which the concentration may vary.
13. A nurse is preparing to administer a nebulized bronchodilator to a young child with
asthma. The nurse should be aware that this child’s dosage is based primarily on what
characteristic of the child?
A)
Weight
B)
Age
C)
Body type
D)
Development stage
Ans: A
Feedback:
Dosages of pediatric medications are calculated based on weight.
14. An emergency department nurse is confirming that a child’s ordered dose of IV
analgesia is congruent with her body surface area (BSA). In order to calculate the child’s
BSA, the nurse must know which of the following variables? Select all that apply.
A)
The child’s height
B)
The child’s percentage of body water
C)
The child’s weight
D)
The usual adult dose of the drug
E)
The child’s age in months
Ans: A, C
Feedback:
BSA is calculated using the child’s weight and height. The child’s age and the normal
adult dose are normally relevant to dosing, but not to the calculation of BSA.
15. An infant’s antiseizure medication has been ordered after careful consideration of the
unique pharmacokinetics among this population. What characteristic of neonates has the
greatest bearing on drug metabolism?
A)
The undeveloped state of the blood–brain barrier
B)
Increased gastric motility in infants
C)
The infant’s undeveloped renal function
D)
Immaturity of the infant’s liver
Ans: D
Feedback:
The enzyme cytochrome P450 (CYP450) in the liver metabolizes most drugs. In
neonates, the ability to metabolize drugs is very low because of the immaturity of the
liver and the resultant inability to break down drugs. Characteristics of the kidneys, the
blood–brain barrier, and GI function do not primarily affect metabolism.

Page 5

 

16. An infant’s mother is reluctant for the nurse to administer a suppository to her baby,
stating, “It just seems so terribly invasive.” What principle should guide the nurse’s use
of suppositories in infant patients?
A)
Suppositories are generally avoided unless absolutely necessary, due to the risk of
injuring the rectal mucosa.
B)
Suppositories can be an effective means of administering medications to infants, since
oral administration is often challenging.
C)
Suppositories should only be administered after the nurse manually clears the infant’s
rectum.
D)
Suppositories are poorly absorbed in infants due to their immature gastrointestinal tract.
Ans: B
Feedback:
Suppositories are an effective way of administering medications to infants. They do not
require manual clearing of the rectum prior to administration. Suppositories are well
absorbed.
17. A public health nurse is preparing to administer an intramuscular injection of a vaccine
to an 8-year-old girl. The nurse recognizes that the child is uncharacteristically quiet and
appears tense. The nurse should recognize the possibility of what nursing diagnosis?
A)
Fear related to IM injection
B)
Acute confusion related to misunderstanding of the necessity of IM injection
C)
Risk for injury related to IM injection
D)
Ineffective coping related to reluctance to receive IM injection
Ans: A
Feedback:
IM injections are frightening for older children, and they need praise and
encouragement. Fear is a far more likely cause of this child’s behavior than confusion or
ineffective coping. There is risk for injury associated with IM injections, but the nurse
can mitigate this risk through proper technique.
18. A 4-year-old boy is postoperative day one following surgery for trauma suffered in a
motor vehicle accident. The boy is in pain, and the nurse is preparing to administer a
dose of hydromorphone syrup as ordered. To administer this drug, the nurse should use
A)
a teaspoon.
B)
a transparent, 2-ounce medication cup.
C)
a parenteral syringe with the needle removed.
D)
an oral syringe.
Ans: D
Feedback:
The nurse should administer oral medications only in oral syringes. Other methods have
the potential to be inaccurate.

Page 6

 

1. A patient has a low erythrocyte count. How may a colony-stimulating factor affect the
patient’s erythrocyte count?
A)
It stimulates growth of red blood cells.
B)
It suppresses T-cell production.
C)
It inhibits protein synthesis.
D)
It stimulates antibody production.
Ans: A
Feedback:
Colony-stimulating factors stimulate the production of red blood cells, platelets,
granulocytes, granulocyte–macrophages, and monocyte–macrophages. Colonystimulating factors will not suppress the T-cell production, inhibit protein production, or
stimulate antibody production.
2. A patient is exposed to a viral infection. What role will interferon most likely play
during this exposure?
A)
It will stimulate B-lymphocyte activity.
B)
It will interfere with stem cell multiplication.
C)
It will stimulate growth of lymphoid cells.
D)
It will interfere with virus replication.
Ans: D
Feedback:
Interferons interfere with the ability of viruses in infected cells to replicate and spread to
uninfected cells. Interferons will not stimulate B-lymphocyte activity, stem cell
multiplication, or growth of lymphoid cells.
3. A patient has developed a decubitus ulcer on the coccyx. What defense mechanism is
most affected by this homeostatic change?
A)
The mucous membrane is affected.
B)
The respiratory tract is affected.
C)
The skin is affected.
D)
The gastrointestinal tract is affected.
Ans: C
Feedback:
The body’s primary external defense mechanism is intact skin. The development of a
decubitus ulcer allows for entry of microbial growth. The mucous membranes,
respiratory tract, and gastrointestinal tract are not affected primarily.
4. A patient is being administered chemotherapeutic agents for the treatment of cancer.
Which of the following blood cells will be stimulated by the colony-stimulating factors
in response to the effects of the chemotherapy?
A)
White blood cells
B)
Red blood cells
C)
Phagocytes

 

D)
Myocardial cells
Ans: B
Feedback:
Chemotherapeutic agents have the potential to decrease red blood cells and will result in
the colony-stimulating factors stimulating the production of red blood cells. The colonystimulating factors do not affect the white blood cell production, phagocytes, or cardiac
cells.
5. A patient with chronic renal failure is prescribed filgrastim (Neupogen). What is the
major effect of filgrastim (Neupogen)?
A)
Decreases neutropenia related to chemotherapy
B)
Decreases white blood cells related to infection
C)
Decreases growth of blood vessels due to ischemia
D)
Decreases platelet count related to bleeding
Ans: A
Feedback:
Filgrastim (Neupogen) is used to stimulate blood cell production by the bone marrow in
places with bone marrow transplantation or chemotherapy-induced neutropenia.
Filgrastim does not decrease white blood cells in response to infection. Filgrastim
increases growth of blood vessels related to ischemic heart disease. Filgrastim does not
decrease platelet count related to bleeding.
6. A patient has been diagnosed with chronic renal failure. Which of the following agents
will assist in raising the patient’s hemoglobin levels?
A)
Epoetin alfa (Epogen, Procrit)
B)
Pentoxifylline (Pentoxil)
C)
Estazolam (ProSom)
D)
Dextromethorphan hydrobromide
Ans: A
Feedback:
Uses of epoetin include the prevention and treatment of anemia associated with chronic
renal failure, hepatic impairment, or anticancer chemotherapy. Pentoxifylline is used for
intermittent claudication to maintain the flexibility of red blood cells. Estazolam is a
benzodiazepine agent used short term for insomnia. Dextromethorphan hydrobromide is
used to relieve cough.
7. A patient is undergoing a bone marrow transplant. Which of the following medications
is most effective in stimulating the production of granulocytes and macrophages?
A)
Bacillus Calmette-Guérin (BCG)
B)
Epoetin alfa (Epogen)
C)
Aldesleukin (Proleukin)
D)
Sargramostim (Leukine)
Ans: D

 

Feedback:
Sargramostim (Leukine) is a formulation of granulocyte colony-stimulating factor
(GCSF) and granulocyte macrophage colony-stimulating factor (GM-CSF). Bacillus
Calmette-Guérin is a vaccine used to treat bladder cancer. Epoetin alfa stimulates bone
marrow production of red blood cells. Aldesleukin (Proleukin) is a recombinant DNA
version of interleukin-2. It activates cellular immunity.
8. A hospital patient’s complex medical history includes a recent diagnosis of kidney
cancer. Which of the following medications is used to treat metastatic kidney cancer?
A)
Filgrastim (Neupogen)
B)
Aldesleukin (Proleukin)
C)
Interferon alfa-2b (Intron A)
D)
Darbepoetin alfa (Aranesp)
Ans: B
Feedback:
Aldesleukin (Proleukin) is used to treat metastatic kidney cancer but is contraindicated
in patients with serious pulmonary impairment. Filgrastim is a colony-stimulating factor
that is not used for the treatment of kidney cancer. Darbepoetin alfa is a hormone that
stimulates the production of red blood cells by the bone marrow. Interferon alfa-2b
(Intron A) is normally used to treat leukemia.
9. A patient is diagnosed with ischemic heart disease. She is prescribed filgrastim
(Neupogen). What effect will this medication provide in the treatment of ischemic heart
disease?
A)
Increase platelets
B)
Decrease platelets
C)
Promote angiogenesis
D)
Prevent thrombus formation
Ans: C
Feedback:
Experts believe that filgrastim promotes the growth of arterioles around blocked areas in
coronary arteries. Filgrastim does not increase or decrease platelets. Filgrastim does not
prevent thrombus formation.
10. A patient with a diagnosis of renal failure is being treated with epoetin alfa (Epogen).
Frequent assessment of which of the following laboratory values should be prioritized
before and during treatment?
A)
AST
B)
C-reactive protein
C)
CBC
D)
ALT
Ans: C
Feedback:

 

With the use of hematopoietic and immunostimulant drugs, a CBC with WBC
differential and platelet count should be done before and during treatment to monitor
response and prevent avoidable adverse reactions. It is less imperative to monitor liver
enzymes or CRP levels.
11. A patient is receiving epoetin alfa (Epogen) for anemia. Which of the following
adjunctive therapies is imperative with epoetin alfa?
A)
Potassium supplements
B)
Sodium restriction
C)
Iron supplement
D)
Renal dialysis
Ans: C
Feedback:
When administering darbepoetin and epoetin, an adequate intake of iron is required for
drug effectiveness and an iron supplement is usually necessary. It is not necessary to
provide the patient with potassium supplements, restrict sodium, or place the patient on
renal dialysis.
12. A patient is administered a granulocyte colony-stimulating factor (G-CSF). What is the
expected outcome of a G-CSF?
A)
Red blood cell count of 3000 mm3
B)
Decreased number of infections
C)
Decreased fatigue and increased energy
D)
White blood cell count of 20,000 mm3
Ans: B
Feedback:
G-CSFs help to prevent infection by reducing the incidence, severity, and duration of
neutropenia associated with several chemotherapy regimens. The administration of a GCSF should not lower red blood cell count or raise white blood cell count. They assist in
the prevention of infection but do not necessarily resolve fatigue.
13. An oncology nurse is providing for an adult patient who is currently
immunocompromised. The nurse is aware of the physiology involved in hematopoiesis
and immune function, including the salient role of cytokines. What is the primary role of
cytokines in maintaining homeostasis?
A)
Cytokines perform phagocytosis in response to bacterial and protozoal infection.
B)
Cytokines perform a regulatory role in the development of diverse blood cells.
C)
Cytokines can be considered to be the basic “building blocks” of all blood cells.
D)
Cytokines are formed in response to the presence of antibodies.
Ans: B
Feedback:
Hematopoietic cytokines are diverse substances produced mainly by bone marrow and
white blood cells (WBCs). They regulate many cellular activities by acting as chemical

 

messengers among cells and as growth factors for blood cells. Blood cells are not made
up of cytokines, and they do not perform phagocytosis. The presence of antigens, not
antibodies, can prompt the expression of certain cytokines.
14. A patient’s current medical condition is suggestive of impaired erythropoiesis. Which of
the following laboratory studies would be most clinically relevant in diagnosing this
health problem?
A)
White blood cell count with differential
B)
RBC, hemoglobin, and hematocrit
C)
INR and aPTT
D)
d-dimer and C-reactive protein
Ans: B
Feedback:
Parameters used to measure erythropoiesis include RBC count, hemoglobin
concentration and hematocrit, and mean corpuscular volume. Tests related to immune
function, hemostasis, and inflammation are not used to diagnose erythropoiesis.
15. An adult patient has developed renal failure secondary to an overdose of a nephrotoxic
drug. Which of the following assessment findings would the nurse recognize as being
most suggestive of impaired erythropoiesis?
A)
Frequent infections and low neutrophil levels
B)
Fatigue and increased heart rate
C)
Agitation and changes in cognition
D)
Increased blood pressure and peripheral edema
Ans: B
Feedback:
As RBCs decrease, conditions related to inadequate hematopoiesis develop. Clinical
manifestations of inadequate erythropoiesis include anemia. This results in a decrease in
the oxygen-carrying capacity of blood and consequently a decreased oxygen availability
to the tissues. A compensatory increase in heart rate and cardiac output initially
increases cardiac output, offsetting the lower oxygen-carrying capacity of the blood.
16. A patient with a diagnosis of chronic renal failure will soon begin a regimen of epoetin
that will administered by the patient at home. Which of the following statements
indicates that the nurse’s initial health education has been successful?
A)
“I’ll make sure to take my Epogen pill on a strict schedule and make sure I never miss a
dose.”
B)
“I’m glad that Epogen can help to protect me from getting an infection.”
C)
“I’m excited that there’s a medication that can help my kidneys work better.”
D)
“I’m not all that comfortable with giving myself an injection, but I’m sure I’ll be able to
learn.”
Ans: D
Feedback:

 

Epogen is administered parenterally, not orally. It acts by stimulating erythroid
progenitor cells to produce RBCs but does not enhance overall renal function. Epogen
does not enhance immune function.
17. Which of the following patients would likely be the most appropriate candidate for
treatment with filgrastim (Neupogen)?
A)
A patient who has undergone a mastectomy for the treatment of breast cancer
B)
A patient with acquired immune deficiency syndrome (AIDS) who has been diagnosed
with Kaposi’s sarcoma
C)
A patient who developed acute renal failure secondary to rhabdomyolysis
D)
A patient whose acute myelogenous leukemia necessitated a bone marrow transplant
Ans: D
Feedback:
Indications for filgrastim include preventing infection in patients with neutropenia
induced by cancer chemotherapy or bone marrow transplantation. Surgical patients,
patients with AIDS, and patients with renal failure are not typically treated with GCSFs.
18. A 69-year-old female patient has been diagnosed with malignant melanoma. The care
team has collaborated with the patient and her family and agreed on a plan of care that
includes administration of interferon alfa-2b. After administering interferon alfa-2b, the
oncology nurse should anticipate that the patient may develop which of the following
adverse effects?
A)
Profound diaphoresis
B)
Decreased level of consciousness
C)
Flu-like symptoms
D)
Cyanosis and pallor
Ans: C
Feedback:
In the majority of patients, flu-like symptoms (e.g., fever, chills, fatigue, muscle aches,
headache, tachycardia) develop within 2 hours of administration of interferon alfa-2b
and last up to 24 hours. Diaphoresis, changes in LOC, and changes in oxygenation are
not associated with the use of interferon alfa-2b.
19. Which of the following nursing diagnoses would provide the most plausible indication
for the use of epoetin alfa (Epogen) in a patient with renal failure?
A)
Risk for infection related to decreased erythropoiesis
B)
Activity intolerance related to decreased oxygen-carrying capacity
C)
Powerlessness-related sequelae of renal failure
D)
Ineffective breathing pattern related to inadequate erythropoietin synthesis
Ans: B
Feedback:
The impaired erythropoiesis that accompanies renal failure results in fatigue and

 

decreased stamina, symptoms that can be addressed with the administration of epoetin
alfa. Decreased erythropoiesis does not constitute a risk for infection, and the patient
may or may not experience feelings of powerlessness. Inadequate erythropoietin
synthesis causes impaired oxygenation, but this does not normally manifest as breathing
problems.
20. A patient who is undergoing chemotherapy for the treatment of non-Hodgkin’s
lymphoma will soon begin treatment with epoetin alfa (Epogen). The nurse should be
aware that this drug may be administered by which of the following routes? Select all
that apply.
A)
Subcutaneous
B)
Intramuscular
C)
Oral
D)
Buccal
E)
Intravenous
Ans: A, E
Feedback:
Epogen is administered by either IV or sub-Q routes.

 

 

1. A female patient has been treated for strep throat with ampicillin by mouth. She visits
the occupational health nurse and states she has vaginal itching. What organism is the
cause of the vaginal itching?
A)
Klebsiella
B)
Enterobacter
C)
Candida albicans
D)
Proteus
Ans: C
Feedback:
The yeast Candida albicans is a normal resident of the vagina and the intestinal tract.
An antibacterial drug may destroy the normal bacterial flora without affecting the fungal
organism. Klebsiella, Enterobacter, and Proteus will not contribute to the development
of a yeast infection.
2. An elderly patient is treated for pneumonia with clindamycin (Cleocin). One week after
the completion of the medication, she develops diarrhea. What is the most probable
cause of the diarrhea?
A)
Change in normal flora
B)
Food-borne illness
C)
Crohn’s disease
D)
Incontinence
Ans: A
Feedback:
Much of the normal flora can cause disease under certain conditions, especially in the
elderly, debilitated, or immunosuppressed people. The development of infectious
diarrhea is related to the change in the normal flora of the bowel. Food-borne illness,
Crohn’s disease, and incontinence do not contribute to this particular development of
diarrhea.
3. A patient with burns has developed a wound infection. This patient is experiencing what
type of wound infection?
A)
Fungal infection
B)
Opportunistic infection
C)
Nosocomial infection
D)
Food-borne infection
Ans: B
Feedback:
Opportunistic infections are likely to occur in people with severe burns, cancer, human
immunodeficiency virus, and indwelling catheters and are often caused by drug-resistant
microorganisms, are usually serious, and may be life threatening. The patient may be at
risk for a fungal, nosocomial, or food-borne infection, but the risk for all infections is
high due to the patient’s opportunistic nature of the burn.

 

4. An elderly man who is a resident of a skilled nursing facility develops methicillinresistant Staphylococcus aureus. What type of infection has this man developed?
A)
Community acquired
B)
Postoperative
C)
Sustained infection
D)
Nosocomial infection
Ans: D
Feedback:
Nosocomial infections are infections acquired from microorganisms in hospitals and
other health care facilities. The patient’s infection is not community acquired,
postoperative, or sustained.
5. A nurse is instructing a patient on the antibiotic regimen for the treatment of pneumonia.
Which of the following is most important to teach the patient?
A)
Take the medication with orange juice.
B)
Supplement the medication with multivitamins.
C)
Complete the entire prescription of medication.
D)
Administer the medication with dairy products.
Ans: C
Feedback:
Interruption or inadequate antimicrobial treatment of infections may also contribute to
the emergences of antibiotic-resistant organisms. The administration of an antibiotic
with orange juice is not recommended in all instances. The medication does not need to
be supplemented with vitamins. Antibiotics need not be administered with dairy
products.
6. A patient is to be started on an antibiotic. Which of the following is most important to
take into consideration before beginning the antibiotic regimen?
A)
Duration of symptoms
B)
Culture and sensitivity
C)
The patient’s hydration status
D)
The patient’s age and weight
Ans: B
Feedback:
Culture identifies the causative organism, and susceptibility tests determine which drugs
are likely to be effective against the organism. The duration of symptoms and the
patient’s hydration status, age, and weight are important, but not imperative, in
determining the antibiotic of choice.
7. A patient has presented to the emergency department after suffering a severe laceration
to his hand in a workplace accident. During the subsequent process of acute
inflammation, what physiological event took place first?
A)
The patient’s B cells produced antibodies.

 

B)
C)
D)
Ans:

The patient’s blood vessels constricted.
Neutrophils migrated to the injury site.
Opsonization occurred.
B
Feedback:
The process of acute inflammation occurs in three stages. The first stage is the vascular
stage; notable changes occur in the small blood vessels at the site of the cellular and
tissue injury. At the time of the injury, vasoconstriction results, followed by vasodilation
of the capillaries and venules to increase capillary blood flow, increasing temperature
and redness at the site. Opsonization, neutrophil migration, and antibody production
take place in later stages of inflammation.

8. A 12-year-old boy was bitten by a dog, and inflammation took place at the site of the
injury. During the process of opsonization, what physiological event occurred?
A)
The boy’s blood vessels dilated, allowing rapid peripheral blood flow.
B)
Viscosity of the boy’s blood decreased, facilitating the migration of neutrophils.
C)
Antigens were coated, marking them for phagocytosis.
D)
T cells were released from the boy’s thymus gland.
Ans: C
Feedback:
The third stage of inflammation involves opsonization, which facilitates phagocytosis.
During opsonization, a substance coats the foreign antigens, producing inflammation.
This inflammation makes the antigens more susceptible to the macrophages and
leukocytes, thus increasing phagocytic activity. Opsonization is not characterized by Tcell activity or changes in blood flow and viscosity.
9. An adult patient with an autoimmune disorder regularly takes oral corticosteroids. The
nurse knows that corticosteroids can be used in the successful treatment of inflammation
but that they also create a risk for
A)
bleeding.
B)
leukocytosis.
C)
infection.
D)
electrolyte imbalances.
Ans: C
Feedback:
Corticosteroids impair phagocytosis by preventing phagocytic cells from leaving the
bloodstream. They decrease the amount of lymphocytes, fibroblasts, and collagen
needed for tissue repair. This causes a reduction in inflammation but a commensurate
increase in the patient’s risk for infection.
10. The family members of a geriatric patient are angered that she has been colonized with
methicillin-resistant Staphylococcus aureus during her stay in the hospital. The nurse
should explain what characteristic of colonization to the members of the family?

 

A)
B)
C)
D)
Ans:

The bacteria are present but are not causing infection.
The bacteria are causing an infection, but the infection is not spreading.
The bacteria are causing tissue injury at the site of colonization.
The bacteria are spreading within a clearly defined body region.
A
Feedback:
Colonization is the presence and growth of microorganisms. The microorganisms do not
necessarily cause tissue injury or elicit an immune response in the human body.

11. An adult female patient has been living with human immunodeficiency virus (HIV) for
several years but has recently been admitted to the hospital after being diagnosed with
herpes simplex. How would this patient’s herpes infection most likely be characterized?
A)
Community-acquired infection
B)
Opportunistic infection
C)
Secondary infection
D)
Nosocomial infection
Ans: B
Feedback:
Microorganisms may become pathogens in hosts whose defense mechanisms are
impaired. Opportunistic infections are likely to occur in people whose defenses are
compromised due to human immunodeficiency virus (HIV) infection. This is not
characterized as a nosocomial infection (hospital-acquired infection) or a secondary
infection. The infection was likely to have been acquired in the community, but the
patient’s HIV diagnosis means that it would be considered to be an opportunistic
infection.
12. A group of nursing students are learning about the factors that underlie recent increases
in the incidence and prevalence of antibiotic-resistant microorganisms. What factor is
known to contribute to antibiotic resistance?
A)
Increased survival rates from acute infections
B)
Increased population density
C)
Use of antibiotics that are ineffective against the infectious microorganism
D)
Overuse of antibiotics
Ans: D
Feedback:
Antibiotic overuse can contribute to antibiotic resistance. Resistance is not typically
attributable to increased age of patients, increased population density, or the use of
ineffective antibiotics.
13. A 4-month-old baby has been brought to the emergency department by her parents, and
initial assessment is highly suggestive of bacterial meningitis. Consequently, the baby
has been admitted, and empiric antibiotic therapy has been ordered. The nurse should
understand what characteristic of this infant’s current treatment plan?

 

A)
B)
C)
D)
Ans:

Success or failure of treatment will not be apparent for several weeks.
The infant will receive aggressive treatment with a narrow-spectrum antibiotic.
Culture and sensitivity results of the infant’s cerebrospinal fluid are still pending.
The infant is suspected of having an antibiotic-resistant infection.
C
Feedback:
Empiric therapy is based on an informed estimate of the most likely pathogen(s) given
the patient’s signs and symptoms and the site of infection, as well as knowledge of
communicable diseases currently infecting other people in the community. Because
laboratory tests used to definitively identify causative organisms and to determine
susceptibility to antibiotics usually require 48 to 72 hours, the prescriber usually
initiates treatment with an antimicrobial drug that is likely to be effective. The other
listed statements are not true of empiric therapy.

14. A patient with an infection has not responded appreciably to antibiotic therapy, and the
nurse suspects antibiotic resistance. What phenomenon is known to contribute to
acquired antibiotic resistance?
A)
Bacteria take on genetic material from healthy body cells, reducing antigen recognition.
B)
Microorganisms remain in resting (G0) phase during antibiotic treatment.
C)
Distribution of an antibiotic is insufficient to cause resolution of the infection.
D)
The strongest microorganisms survive antibiotic treatment while the weakest are
eradicated.
Ans: D
Feedback:
Selective pressure, or natural selection, refers to the survival of the fittest bacteria.
When antibiotic therapy is initially begun, the weakest bacteria are killed first while the
strongest bacteria, which are best able to withstand the effects of antibiotic therapy,
remain. This contributes to antibiotic resistance. Resistance is not the result of an
extended G0 phase, impaired distribution, or bacterial appropriation of human genetic
material.
15. When participating in the care of a patient who is being treated with antimicrobials, the
nurse can promote the appropriate use of these medications in which of the following
ways?
A)
Encouraging the use of narrow-spectrum, rather than broad-spectrum, antibiotics
B)
Promoting the use of prophylactic antibiotics for patients possessing risk factors for
infection
C)
Initiating empiric therapy for all older adult patients admitted to a health care facility
D)
Promoting the use of herbal treatment for infection rather than antimicrobial drugs
Ans: A
Feedback:
Guidelines to promote more appropriate use of antimicrobial drugs include using a
narrow-spectrum antibacterial drug instead of a broad-spectrum drug, whenever
possible, in order to decrease the risk of a superinfection. Herbal alternatives are

 

frequently not available. Antibiotics should not normally be administered in the absence
of a diagnosed infection.
16. A critically ill patient has developed a fever of 38.9°C, and blood cultures have been
drawn and sent to the laboratory for culture and sensitivity testing. Determination of the
culture will tell the care team
A)
whether the infection is antibiotic resistant.
B)
the exact identity of the infectious microorganism.
C)
the most likely location of the infection.
D)
the most likely origin of the infection.
Ans: B
Feedback:
Culture identifies the causative microorganism. It does not necessarily indicate the
presence of antibiotic resistance. The origin or location of the infection may often been
indirectly determined by the culture, but this is not always the case.
17. A medical nurse on a night shift is reviewing a patient’s medication administration
record for the following day. The nurse notes that a combination antimicrobial drug is
ordered. What is implied by the fact that the patient has been ordered a combination
drug?
A)
The patient’s infection likely has a fungal or protozoal etiology.
B)
The patient likely has a history of recurrent, multisystemic infections.
C)
The patient may be unable to tolerate treatment with a single antimicrobial.
D)
The patient may have an infection caused by multiple microorganisms.
Ans: D
Feedback:
Indications for combination therapy may include infections caused by multiple
microorganisms. A fungal or protozoal infection is not implied, and the patient may or
may not have a history of recurrent infections. Intolerance of single antibiotics is not
normally an indication for combination therapy.
18. A hospital nurse is aware that nosocomial infections pose a significant threat to many
patients’ health status. In order to reduce the spread of nosocomial infections, the nurse
should prioritize which of the following actions?
A)
Increased use of empiric antibiotic therapy
B)
Use of disinfectants when providing patient hygiene
C)
Vigilant and thorough hand hygiene
D)
Patient education on the causes of infection
Ans: C
Feedback:
Good hand hygiene is probably the most effective method of preventing infections. This
supersedes the importance of education regarding the causes of infection or the use of
disinfectants. Antibiotic therapy should only be used on patients who clearly need this

 

treatment.
19. An 81-year-old female patient has been admitted to the hospital after a urinary tract
infection developed into urosepsis. What assessments should the nurse prioritize when
monitoring the course of this patient’s infection? Select all that apply.
A)
Blood urea nitrogen and creatinine
B)
White blood cell count
C)
Heart rhythm
D)
Temperature
E)
Liver panel
Ans: B, D
Feedback:
For patients with an infection, the nurse should prioritize assessment of WBCs and
temperature. Cardiac, renal, and liver function are important measures of health, but
these are less directly affected by the presence of infection.
20. Mr. Garcia has been taking antibiotics at home for the treatment of a respiratory
infection for the past 6 days, and there is no evident improvement in his infection.
Which of the following nursing assessments is most appropriate?
A)
Assess Mr. Garcia’s adherence to his medication regimen.
B)
Assess Mr. Garcia’s home hygiene.
C)
Assess Mr. Garcia’s understanding of his illness.
D)
Assess Mr. Garcia’s use of herbal or alternative remedies.
Ans: A
Feedback:
Nonadherence to antibiotic therapy can result in a continuation or exacerbation of the
infection. Poor hygiene is a risk factor for the development of infection but is less likely
to perpetuate an existing infection that is being treated appropriately with antibiotics.
Herbs may be contraindicated but are unlikely to negate the therapeutic effects of an
antibiotic. The nurse should gauge the patient’s understanding of his illness, but this
does not have a bearing on his lack of improvement.

 

1. A patient is diagnosed with an infection attributable to the gram-negative microorganism
Pseudomonas. Which of the following anti-infective agents is most reliable in treating
this microorganism?
A)
Aminoglycoside
B)
Antifungal
C)
Aminopenicillin
D)
GABA analog
Ans: A
Feedback:
Aminoglycosides are used to treat infections caused by gram-negative microorganisms,
such as Pseudomonas. Antifungal and aminopenicillin agents are not used to treat
Pseudomonas. A GABA analog is used to treat pain related to neuropathy.
2. A patient is diagnosed with a gram-negative infection and is prescribed an
aminoglycoside. What is the action of an aminoglycoside?
A)
It blocks protein synthesis of the cell wall.
B)
It blocks DNA replication.
C)
It destroys the integrity of the cell wall structure.
D)
It increases white blood cell viability.
Ans: A
Feedback:
Aminoglycosides penetrate the cell walls of susceptible bacteria and bind irreversibly to
30S and 50S ribosomes, intracellular structures that synthesize proteins.
Aminoglycosides do not block DNA replication, destroy cell wall structure, or increase
white blood cells.
3. The nurse is preparing to administer gentamicin (Garamycin) to a patient when he
mentions that he has recently been experiencing diminished hearing. What action should
the nurse take based on this statement?
A)
Administer the dosage and notify the physician of the alteration in hearing.
B)
Hold the dosage and notify the physician of the alteration in hearing.
C)
Administer the dosage and report the alteration in hearing to the audiologist.
D)
Hold the dosage and document the finding in the nurses’ notes.
Ans: B
Feedback:
Aminoglycosides accumulate in high concentrations in the inner ear, damaging sensory
cells in the cochlea and vestibular apparatus. The medication should be held and
alteration in hearing reported to the physician. The administration of the medication will
only cause more damage to the cochlea and vestibular apparatus. Holding the
medication and documenting the information in the nurses’ notes will not allow for a
new anti-infective to be administered and for the hearing to be assessed.
4. A patient is diagnosed with multidrug-resistant tuberculosis. Which of the following

 

aminoglycoside medications is used in a 4- to 6-drug regimen?
A)
Tetracycline hydrochloride (Achromycin)
B)
Amoxicillin (Amoxil)
C)
Sulfadiazine (Sulfisoxazole)
D)
Streptomycin (Sulfate)
Ans: D
Feedback:
Streptomycin may be used as part of a 4- to 6-drug regimen for treatment of multidrugresistant tuberculosis. Tetracycline, amoxicillin, and sulfadiazine are not
aminoglycosides or drugs of choice for multidrug-resistant tuberculosis.
5. A patient is scheduled for a bowel resection. He is to receive neomycin sulfate (NeoFradin) by mouth. The patient asks the nurse the purpose of this medication. What is the
most appropriate response the nurse can provide to the patient?
A)
“The administration by mouth will prevent renal damage.”
B)
“The administration by mouth will prevent ototoxicity.”
C)
“The administration will decrease the risk of contamination.”
D)
“The administration decreases the risk of airborne contamination.”
Ans: C
Feedback:
Neomycin can be given before bowel surgery to suppress intestinal bacterial growth.
The administration of neomycin will not prevent renal damage or ototoxicity. It will also
not affect the risk of airborne contamination.
6. A patient has been administered an aminoglycoside. It is time for his next dose, and the
nurse learns his creatinine level is elevated at 3.9 mg/dL. What action should the nurse
take regarding this assessment?
A)
Administer the medication and report the creatinine level.
B)
Hold the dose until another creatinine level is assessed.
C)
Administer the medication with 100 mL of fluids.
D)
Hold the medication and assess the urine output.
Ans: D
Feedback:
Aminoglycosides are nephrotoxic and should not be administered in the presence of
renal impairment. It is important to hold the medication, assess the urine output, and
notify the physician. The medication should not be administered. The medication should
be held, but the creatinine level cannot be reassessed without a doctor’s order. The
administration with fluids will not protect the patient from renal impairment.
7. A patient has a genitourinary infection and is being treated with a fluoroquinolone. What
is the advantage of a fluoroquinolone over an aminoglycoside?
A)
The fluoroquinolone does not have adverse effects.
B)
The fluoroquinolone can be given orally.

 

C)
The fluoroquinolone has a nearly immediate peak.
D)
The fluoroquinolone has a broader spectrum.
Ans: B
Feedback:
Fluoroquinolones are often given orally. Like all drugs, they have adverse effects. Peak
levels are not immediately achieved, and they do not have a broader spectrum than an
aminoglycoside.
8. A patient is receiving gentamicin (Garamycin) to treat meningitis. The physician has
ordered a peak serum level be drawn in association with the 07:00 dose, which will
finish infusing at 07:30. When should the peak serum level be drawn?
A)
08:00
B)
09:00
C)
10:00
D)
12:00
Ans: A
Feedback:
With conventional dosing, it is necessary to take gentamicin peak levels 30 minutes after
the end of a 30-minute IV infusion. Thus, 8:00 AM is the optimal peak time to assess the
serum level of gentamicin.
9. A patient has been prescribed a once-daily aminoglycoside. What is the advantage of
this method of administration?
A)
It is associated with less hepatotoxicity.
B)
It is significantly more cost-effective.
C)
It reduces the risk of nephrotoxicity.
D)
It increases adherence to treatment.
Ans: C
Feedback:
The use of once-daily aminoglycoside dosing has replaced the common multiple daily
dosing. The rationale for this dosing approach is a potential increase in efficacy with a
reduced incidence of nephrotoxicity.
10. A patient is prescribed ciprofloxacin (Cipro). Which of the following nursing
interventions will best prevent crystalluria?
A)
The nurse should limit oral fluids to 500 mL/day.
B)
The nurse should administer 2000 mL of oral fluids per day.
C)
The nurse should insert a urinary catheter.
D)
The nurse should administer phenazopyridine (Pyridium).
Ans: B
Feedback:
Guidelines to decrease the incidence and severity of adverse effects include keeping
patients well hydrated to decrease drug concentrations in serum body tissues. The

 

administration of 500 mL is not a sufficient amount to prevent crystalluria. The
administration of Pyridium will not prevent crystalluria. A urinary catheter is not
indicated.
11. A nurse has informed the laboratory technician that a patient’s gentamicin has finished
infusing and the technician will soon draw a blood sample to determine the patient’s
serum drug concentration. Why is assessment of gentamicin levels necessary?
A)
To identify possible changes in the patient’s serum osmolality
B)
To identify whether the drug is at a therapeutic level
C)
To identify whether the drug is causing hepatotoxicity
D)
To identify possible hemolysis following administration
Ans: B
Feedback:
Measurement of both peak and trough levels of gentamicin helps maintain therapeutic
serum levels without excessive toxicity. Gentamicin is nephrotoxic, not hepatotoxic.
Hematological changes are not assessed by measuring serum drug levels.
12. An adult male patient with a diagnosis of osteomyelitis will soon begin treatment with
gentamicin. Which of the following schedules is most likely to maximize efficacy and
minimize nephrotoxicity?
A)
Gentamicin 500 mg IV OD at 1200
B)
Gentamicin 250 mg PO BID at 07:30 and 19:30
C)
Gentamicin 500 mg PO TID at 08:00, 12:00, and 17:00
D)
Gentamicin 125 mg IV QID at 06:00, 1200, 18:00, and 24:00
Ans: A
Feedback:
The ODA method uses higher doses (e.g., 4 to 7 mg/kg) to produce high initial drug
concentrations, with no repeat dosing until the serum concentration is quite low
(typically 24 hours later). The rationale for this dosing approach is a potential increase
in efficacy with a reduced incidence of nephrotoxicity. Gentamicin is not administered
orally.
13. A medical nurse is aware of the need to assess for potential ototoxicity in patients who
are being treated with gentamicin. Which of the following patients is likely most
susceptible to developing ototoxicity secondary to gentamicin?
A)
A man who received his first dose of IV gentamicin 12 hours ago
B)
A man who has required repeated courses of gentamicin over the past several months
C)
A woman who has a Pseudomonas infection but who has a hypersensitivity to penicillins
D)
A woman who is immunocompromised and who is being treated with gentamicin
Ans: B
Feedback:
Ototoxicity (auditory or vestibular) may develop after extended use of gentamicin and
may not be reversible. Penicillin allergies and immunocompromised status are not risk

 

factors for ototoxicity.
14. A patient with sepsis is being treated with gentamicin, and her medication regimen takes
into account the phenomenon of postantibiotic effects. What are postantibiotic effects?
A)
The tendency for patients to exhibit symptoms mimicking hypersensitivity after drug
administration
B)
The tendency for adverse effects of a drug to be masked during administration
C)
The ability of microorganisms to proliferate between doses of antibiotics
D)
The ability of an antibiotic to kill bacteria even when serum concentrations are low
Ans: D
Feedback:
Postantibiotic effects mean that aminoglycosides continue killing microorganisms even
at low serum concentrations.
15. Extreme caution would be necessary with the use of gentamicin in which of the
following patients?
A)
A patient who is morbidly obese and who has primary hypertension
B)
A patient who has chronic renal failure secondary to diabetes mellitus
C)
A patient who has bipolar disorder and who is on long-term lithium therapy
D)
A patient who has an atrioventricular block
Ans: B
Feedback:
Gentamicin is nephrotoxic, and with impaired renal function, a reduction in dosage is
essential. Heart blocks, obesity, and lithium therapy do not severely complicate, or
contraindicate, the use of an aminoglycoside.
16. A patient has been prescribed ciprofloxacin after being diagnosed with a sinus infection.
Which of the following should the patient avoid taking concurrently with ciprofloxacin?
A)
Antacids
B)
Calcium channel blockers
C)
Beta-adrenergic blockers
D)
Diuretics
Ans: A
Feedback:
Patients should space out ciprofloxacin administration 4 to 6 hours with any of the
following: antacids, multivitamins, sucralfate, or other products containing calcium,
iron, or zinc. Absorption of ciprofloxacin may be impaired when these substances are
administered together with ciprofloxacin, resulting in a decreased antibiotic effect.
17. An older adult patient is recovering in hospital from an ischemic stroke and has a
feeding tube in place due to dysphagia. The patient has developed an infected pressure
ulcer, and ciprofloxacin suspension has been ordered as empiric therapy. How should

 

the nurse follow up this order?
A)
The nurse should flush the patient’s feeding tube with free water before and after
administration of the ciprofloxacin suspension.
B)
The nurse should dilute the suspension thoroughly before administration.
C)
The nurse should liaise with the care provider to provide an alternative route of
administration.
D)
The nurse should administer small, frequent doses of the drug to minimize GI upset.
Ans: C
Feedback:
Administration of the oral suspension of ciprofloxacin via feeding tubes should not
occur, because the oil-based formulation tends to adhere to the feeding tube. An
alternative route is consequently necessary.
18. A hospital patient has been prescribed ciprofloxacin IV for the treatment of cellulitis.
After initiating the infusion of the patient’s first scheduled dose, the patient develops a
pronounced rash to her chest and arms. How should the nurse respond to this event?
A)
Discontinue the infusion and inform the care provider promptly
B)
Slow down the rate so that the infusion takes place over 2 hours
C)
Administer oral diphenhydramine to the patient during the infusion
D)
Administer a STAT dose of acetylcysteine
Ans: A
Feedback:
Severe hypersensitivity reactions have occurred with the administration of
fluoroquinolones. The nurse discontinues the antibiotic immediately if skin rash or other
signs or symptoms occur. Administration of acetylcysteine or diphenhydramine is not
indicated.

 

1. A patient is prescribed acyclovir (Zovirax) for the treatment of genital herpes. What is
the expected outcome of this medication?
A)
Decreased testosterone production
B)
Decreased libido
C)
Decreased viral shedding
D)
Decreased bacterial replication
Ans: C
Feedback:
Acyclovir is used to treat genital herpes, in which it decreases viral shedding and the
duration of skin lesions and pain. Acyclovir does not decrease testosterone or libido.
Acyclovir is used to treat viral, not bacterial, infections.
2. A patient suffers from an autoimmune disorder. Which of the following represents a
potential result of a viral infection in a patient with an autoimmune disorder?
A)
Lymphocytes recognize the host’s tissue as foreign.
B)
Erythrocytes destroy the T cells in the host.
C)
The involution of the thymus gland increases infection cause.
D)
The differential decreases the sedimentation rate.
Ans: A
Feedback:
Autoimmune diseases may be caused by viral alteration of host cells so that
lymphocytes recognize the host’s own tissues as being foreign.
3. An 80-year-old patient with chronic renal failure is admitted to the hospital with herpes
simplex. The acyclovir (Zovirax) is to be administered parenterally. When preparing to
administer this medication, what would the nurse expect in regard to the dose?
A)
The dose is smaller due to the herpes simplex.
B)
The dose is smaller based on the patient’s kidney function.
C)
The dose is higher in treating genital herpes.
D)
The dose is higher if the creatinine is above 4.0 mg/dL.
Ans: B
Feedback:
Oral and IV acyclovir are excreted in the urine, and the dose should be decreased in
patients who are older or have renal impairment. The dose is not smaller due to herpes
simplex. The dose is not higher in treating genital herpes. The dose should be lower if
the creatinine level is above 4.0 mg/dL.
4. A patient who has been diagnosed with human immune deficiency syndrome is given
ganciclovir (Cytovene) to prevent cytomegalovirus. The patient develops
granulocytopenia. How long will it take for the granulocytes to regenerate after the
ganciclovir is discontinued?
A)
5 days
B)
7 days

 

C)
10 days
D)
14 days
Ans: B
Feedback:
Ganciclovir causes granulocytopenia and thrombocytopenia in 20% to 40% of
recipients, often during the first 2 weeks of therapy. If severe bone marrow depression
occurs, ganciclovir should be discontinued; recovery usually occurs within a week of
stopping the drug. Five days after discontinuing the drug is too soon to see a change in
granulocytopenia. Ten to fourteen days is too long for change to occur. It should have
occurred within 1 week.
5. A patient has been diagnosed with cytomegalovirus (CMV). Which of the following
drugs would be ineffective in the treatment of this disease?
A)
Ribavirin (Rebetol)
B)
Ganciclovir (Cytovene) IV
C)
Foscarnet (Foscavir) IV
D)
Valganciclovir hydrochloride (Valcyte)
Ans: A
Feedback:
Ribavirin is administered to treat respiratory syncytial virus. Ganciclovir, foscarnet, and
valganciclovir are used in the treatment of CMV.
6. A 21-year-old male is being started on zidovudine (AZT) for treatment of HIV/AIDS.
Which of the following statements made by the patient indicates that he has understood
the patient teaching?
A)
“AZT inactivates the virus and prevents recurrence of the disease.”
B)
“AZT therapy may result in the development of AZT-resistant strains.”
C)
“AZT slows the progression of the disease but does not cure it.”
D)
“AZT prevents the occurrence of opportunistic infections.”
Ans: C
Feedback:
Zidovudine slows the progression of the disease but does not cure the disease.
Zidovudine does not inactivate the virus. Zidovudine does not result in resistant strains.
Zidovudine does not prevent the occurrence of opportunistic infections.
7. A patient is administered a nucleotide reverse transcriptase inhibitor in combination
with a nonnucleotide reverse transcriptase inhibitor. What is the main rationale for
administering these medications together?
A)
They facilitate increased adherence to treatment.
B)
They decrease the length of illness.
C)
They have synergistic antiviral effects.
D)
They prevent the development of opportunistic infections.
Ans: C

 

Feedback:
Because the two types of drugs inhibit reverse transcriptase by different mechanisms,
they may have synergistic antiviral effects. The use of two medications may decrease
adherence because of the burden of taking two medications. The use of two medications
will not decrease the length of the illness. They will not decrease all opportunistic
infections.
8. A patient is prescribed zanamivir (Relenza) to treat influenza B. The patient has a
history of asthma. For which of the following symptoms should the nurse assess?
A)
Bradycardia
B)
Pneumonia
C)
Bronchospasm
D)
Pulmonary embolism
Ans: C
Feedback:
A patient is administered zanamivir for the treatment of influenza B. The patient has
asthma and should be observed or assessed for decreased respiratory function, including
bronchospasm. Bradycardia, pneumonia, and pulmonary embolism are not adverse
effects the nurse should expect.
9. A neonatal intensive care unit nurse is caring for an infant with RSV. What route of
delivery will the nurse use when ribavirin (Virazole) is administered?
A)
Oral suspension
B)
Topical
C)
Intravenous
D)
Inhaled
Ans: D
Feedback:
Ribavirin is inhaled systemically.
10. A young woman is seen in the physician’s office and wants to ensure that she is
vaccinated against hepatitis. Vaccines are available for which of the following types of
hepatitis? Select all that apply.
A)
Hepatitis A virus
B)
Hepatitis B virus
C)
Hepatitis C virus
D)
Hepatitis D virus
E)
Hepatitis G virus
Ans: A, B
Feedback:
Vaccines are available for hepatitis A and B.

Page 3

 

11. A patient is prescribed indinavir sulfate (Crixivan) for the treatment of HIV infection.
What patient teaching should be provided regarding renal function?
A)
Drink grape juice daily for antioxidants.
B)
Drink grapefruit juice to enhance absorption.
C)
Assess for pulmonary edema.
D)
Consume at least 48 ounces of fluid per day.
Ans: D
Feedback:
When taking indinavir, the patient should be instructed to consume 48 ounces of water
or fluid per day to prevent nephrolithiasis. The consumption of grape juice with
antioxidants will assist in preventing nephrolysis but must be in sufficient amounts. The
consumption of grapefruit juice is usually contraindicated. The nurse would not need to
assess for pulmonary edema.
12. A patient has sought care from her primary care provider after feeling “under the
weather” for several days. The care provider suspects that the patient is suffering from a
viral illness. What signs and symptoms typically accompany viral infections? Select all
that apply.
A)
Increased white cell count
B)
Idiopathic bleeding
C)
Malaise
D)
Fever
E)
Headache
Ans: C, D, E
Feedback:
Symptoms usually associated with acute viral infections include fever, headache, cough,
malaise, muscle pain, nausea and vomiting, diarrhea, insomnia, and photophobia. White
blood cell counts usually remain normal, and bleeding is uncharacteristic.
13. A young adult male who has had multiple sex partners in the preceding months has been
diagnosed with hepatitis B virus (HBV) and begun treatment with lamivudine (Epivir).
Shortly after beginning treatment, the man complains of a 24-hour history of intense
abdominal pain. The nurse should recognize the possibility of what adverse effect of
lamivudine therapy?
A)
Gastroenteritis
B)
Gastroesophageal reflux disease
C)
Bowel obstruction
D)
Pancreatitis
Ans: D
Feedback:
A main adverse effect of lamivudine is pancreatitis. GERD, obstruction, and
gastroenteritis do not typically result from lamivudine therapy. As well, these problems
do not typically manifest with intense and sudden abdominal pain.

 

14. An influenza outbreak has spread through a long-term care residence, affecting many of
the residents with severe malaise, fever, and nausea and vomiting. In an effort to curb
the outbreak, the nurse has liaised with a physician to see if residents may be candidates
for treatment with what drug?
A)
Saquinavir mesylate
B)
Oseltamivir phosphate
C)
Lamivudine
D)
Ribavirin
Ans: B
Feedback:
Oseltamivir phosphate (Tamiflu) is used to treat active influenza. Saquinavir mesylate is
a protease inhibitor. Lamivudine is used to treat hepatitis B. Ribavirin treats RSV.
15. A patient who is undergoing treatment for cytomegalovirus received his first dose of IV
ganciclovir 3 days ago. When reviewing this patient’s most recent blood work, what
abnormality should the nurse most likely attribute to the use of this drug?
A)
Hemoglobin 17 g/dL (high normal)
B)
INR 3.8 (high)
C)
Platelet count 118,000/mm3 (low)
D)
Leukocytes 11,900/mm3 (high)
Ans: C
Feedback:
Ganciclovir causes granulocytopenia and thrombocytopenia in 20% to 40% of
recipients, often during the first 2 weeks of therapy. Leukocytosis, increased
hemoglobin, and hypocoagulation are not typical adverse effects associated with
ganciclovir.
16. A 42-year-old female patient with HIV has been receiving antiretroviral therapy for
several years, and her care team has recently added raltegravir (Isentress) to her drug
regimen. When appraising the success or failure of this change in treatment and the
patient’s ability to fight infection, the nurse should prioritize which of the following
laboratory values?
A)
The patient’s C-reactive protein levels
B)
The patient’s erythrocyte sedimentation rate (ESR)
C)
The patient’s viral load
D)
The patient’s CD4 count
Ans: D
Feedback:
The nurse assesses for an increase in T-helper CD4 cells. The CD4 count measures the
ability to fight against infections. CD4 count is more important than viral load in this
regard. CRP levels and ESR do not reflect the patient’s immune function.

Page 5

 

17. When administering the fusion protein inhibitor enfuvirtide (Fuzeon) to a patient with
HIV, the nurse should
A)
have the patient gargle with normal saline immediately after taking the drug.
B)
flush the patient’s central venous catheter with 100 Unit/mL heparin prior to
administration.
C)
inject the drug into the patient’s ventrogluteal site using the z-track method.
D)
regularly rotate the subcutaneous injection sites that are used.
Ans: D
Feedback:
The nurse injects enfuvirtide subcutaneously into the upper arm, abdomen, or anterior
thigh. Injection of the drug into blood vessels, navel, moles, scars, or other areas of skin
change should never occur. Rotation of injection sites and assessment of the sites for
reactions are necessary.
18. A patient’s antiretroviral therapy has not been as efficacious as her care team had
predicted, and maraviroc (Selzentry) has consequently been added to her drug regimen.
The nurse should recognize this drug as belonging to what category of antiretroviral?
A)
Fusion protein inhibitors
B)
Protease inhibitors
C)
CCR5 antagonists
D)
Integrase strand transfer inhibitors
Ans: C
Feedback:
Currently, maraviroc is the only member of the class of CCR5 antagonists.
19. A school nurse is meeting with a high school student who mentions that she is frustrated
with her repeated outbreaks of cold sores. The student states that she tried an over-thecounter topical cream but that it failed to produce an appreciable improvement. The
nurse should recognize that this student used what drug?
A)
Ganciclovir
B)
Valacyclovir (Valtrex)
C)
Famciclovir (Famvir)
D)
Docosanol (Abreva)
Ans: D
Feedback:
Docosanol (Abreva) is an over-the-counter topical antiviral agent that works in the early
stages of intracellular events of viral entry into the target cells. Famciclovir (Famvir) is
an oral antiviral agent administered for herpes zoster and recurrent genital herpes.
Valacyclovir (Valtrex) is not an over-the-counter medication. Cold sores are not treated
with ganciclovir.
20. A patient began antiretroviral therapy several weeks ago for the treatment of HIV, and
he has now presented to the clinic for a scheduled follow-up appointment. He states to

Page 6

 

the nurse, “I’ve been pretty good about taking all my pills on time, though it was a bit hit
and miss over the holiday weekend.” How should the nurse best respond to this patient’s
statement?
A)
“Remember that if you miss a dose, you need to take a double dose at the next scheduled
time.”
B)
“It’s acceptable to miss an occasional dose as long as your symptoms don’t get worse, but
it’s not really recommended.”
C)
“Remember that your antiretroviral drugs will only be effective if you take them very
consistently.”
D)
“If you’re not consistent with taking your medications, you’re likely to develop more side
effects.”
Ans: C
Feedback:
Effective treatment of HIV infection requires close adherence to drug therapy regimens
involving several drugs and daily doses. Missing as few as one or two doses can
decrease blood levels of antiretroviral drugs and result in increased HIV replication and
development of drug-resistant viral strains.

 

 

Reviews

There are no reviews yet.

Be the first to review “Test Bank For Abrams’ Clinical Drug Therapy Rationales For Nursing Practice 11th Edition By Geralyn Frandsen”

Your email address will not be published. Required fields are marked *