Anti-infectives questions
33 questions. Choose an answer to see the rationale.
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Before giving the first dose of IV ampicillin, what is the most important action?
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Answer D: Ask about drug allergies Penicillins are a common cause of anaphylaxis. Allergy history comes first, followed by cultures if ordered.
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Which suffix identifies a penicillin?
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Answer D: -cillin Penicillins end in -cillin (amoxicillin, ampicillin, piperacillin).
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Ten minutes into an IV penicillin infusion, the patient develops wheezing and hives. What is the priority?
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Answer D: Stop the infusion, maintain the airway and call for help; give epinephrine as ordered This is anaphylaxis. Stop the drug, protect the airway, and give IM epinephrine per protocol.
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Which IV solution must not be given at the same time as ceftriaxone?
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Answer A: Lactated Ringer's Ceftriaxone can form a precipitate with calcium; lactated Ringer's contains calcium.
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Which antibiotic is commonly given within 60 minutes before surgical incision for prophylaxis?
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Answer C: Cefazolin Cefazolin is the standard prophylaxis for many surgeries, given within 60 minutes before incision.
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A patient with a history of a mild rash to amoxicillin is ordered cefazolin. What is the best action?
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Answer C: Confirm the allergy is documented and known to the prescriber, then give it as ordered and monitor Cross-reactivity is low; with a non-severe reaction the prescriber may proceed. The nurse confirms the allergy is documented and that the prescriber knows, then gives the drug and monitors.
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A patient develops flushing and a red rash on the face and neck during a vancomycin infusion. What is the first action?
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Answer A: Stop or slow the infusion and notify the provider This is a vancomycin infusion reaction, caused by infusing too fast. Slowing or stopping the infusion and an antihistamine as ordered usually resolve it.
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When should a vancomycin trough level be drawn?
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Answer A: Just before the next dose A trough is the lowest level, measured right before the next dose.
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Which lab result best indicates vancomycin nephrotoxicity?
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Answer D: Rising serum creatinine A rising creatinine and falling urine output suggest kidney injury.
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Which finding should be reported immediately in a patient receiving gentamicin?
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Answer A: Tinnitus Ringing in the ears can signal ototoxicity, which can become permanent.
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A trough level is high in a patient receiving gentamicin. Which risk is increased?
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Answer A: Nephrotoxicity and ototoxicity High troughs mean the drug is not clearing between doses, which raises the risk of kidney and ear toxicity.
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Which drug, given with gentamicin, increases the risk of ototoxicity?
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Answer C: Furosemide Loop diuretics are also ototoxic; the combination increases the risk.
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A 70-year-old patient taking levofloxacin and prednisone reports heel pain. What does the nurse suspect?
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Answer A: Achilles tendinitis or rupture Fluoroquinolones increase the risk of tendon rupture, especially in older adults and with corticosteroids.
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How should ciprofloxacin be timed with an antacid?
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Answer C: Take ciprofloxacin 2 hours before or 6 hours after the antacid Magnesium, aluminum and calcium bind ciprofloxacin and reduce absorption.
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Which suffix identifies a fluoroquinolone?
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Answer D: -floxacin Fluoroquinolones end in -floxacin.
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Which ECG change is a concern with azithromycin?
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Answer D: Prolonged QT interval Macrolides can prolong the QT interval and cause torsades de pointes.
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Which macrolide is a strong CYP3A4 inhibitor with many drug interactions?
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Answer C: Clarithromycin Clarithromycin (and erythromycin) strongly inhibit CYP3A4; azithromycin has fewer interactions.
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A common indication for a macrolide is:
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Answer A: Atypical pneumonia Macrolides cover atypical organisms such as Mycoplasma and Chlamydophila.
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Why is doxycycline generally avoided in children younger than 8?
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Answer A: It can permanently discolor developing teeth Tetracyclines bind calcium in developing teeth and bone. Exceptions exist for serious infections such as Rocky Mountain spotted fever.
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What instruction prevents esophageal injury from doxycycline?
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Answer D: Take it with a full glass of water and stay upright for 30 minutes Tablets that lodge in the esophagus can cause ulcers.
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Which teaching applies to most tetracyclines?
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Answer C: Avoid sun exposure and use sunscreen Tetracyclines cause photosensitivity; sun protection prevents severe sunburn.
Nitroimidazoles (metronidazole)
A patient taking metronidazole asks about drinking wine at a party. What is the correct response?
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Answer C: Avoid alcohol during treatment and for at least 3 days after Alcohol with metronidazole can cause a disulfiram-like reaction: flushing, vomiting, headache and tachycardia.
Nitroimidazoles (metronidazole)
Which change in urine color may occur with metronidazole?
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Answer B: Dark or reddish-brown Metronidazole can darken the urine; this is harmless.
Nitroimidazoles (metronidazole)
Which adverse effect should be reported with long courses of metronidazole?
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Answer B: Numbness and tingling of the feet Peripheral neuropathy can occur with prolonged use.
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A patient taking rifampin is alarmed that their urine is orange. What should the nurse say?
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Answer A: This is an expected, harmless effect Rifampin colors urine, sweat and tears red-orange; it is harmless but can stain contact lenses.
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Which vitamin is given with isoniazid to prevent peripheral neuropathy?
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Answer C: Pyridoxine (vitamin B6) Isoniazid depletes pyridoxine; supplementation prevents neuropathy in at-risk patients.
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Which test should be done before starting ethambutol?
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Answer A: Visual acuity and color vision Ethambutol can cause optic neuritis with loss of visual acuity and red-green color discrimination.
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How should nystatin oral suspension be used for thrush?
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Answer A: Swish in the mouth for as long as possible, then swallow or spit as directed Nystatin acts topically; contact with the oral lesions is what makes it work.
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Which lab values are most important during amphotericin B therapy?
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Answer B: Creatinine, potassium and magnesium Amphotericin B is nephrotoxic and causes potassium and magnesium wasting.
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A patient on warfarin is started on fluconazole. What should the nurse expect?
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Answer A: The INR may rise, increasing bleeding risk Fluconazole inhibits warfarin metabolism, raising the INR.
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Which nursing action helps prevent kidney injury during IV acyclovir therapy?
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Answer B: Ensure adequate hydration and infuse slowly Acyclovir can crystallize in the renal tubules; hydration and slow infusion reduce the risk.
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A patient with genital herpes asks if acyclovir will cure it. What is the correct response?
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Answer A: No, it shortens and lessens outbreaks but does not eliminate the virus Herpes viruses remain latent; antivirals suppress replication but do not cure.
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When is oseltamivir most effective?
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Answer A: Started within 48 hours of flu symptoms Neuraminidase inhibitors work best when started within 48 hours of symptom onset.