86. Chapter 86: Bacteriostatic Inhibitors of Protein Synthesis: Tetracyclines, Macrolides, and Others
87. Chapter 87: Aminoglycosides: Bactericidal Inhibitors of Protein Synthesis
88. Chapter 88: Sulfonamides and Trimethoprim
89. Chapter 89: Drug Therapy of Urinary Tract Infections
90. Chapter ...
TEST BANK LEHNE’S PHARMACOLOGY
CHAPTERS 86-90
Chapter 86: Bacteriostatic Inhibitors of Protein Synthesis:
Tetracyclines, Macrolides, and Others
MULTIPLE CHOICE
1. A nurse is providing education about tetracycline (Sumycin). Which statement by the
patient best demonstrates understanding of the administration of this medication?
a. “I should not take this medication with milk or other dairy products.”
b. “I should not worry if I experience an acnelike rash with this medication.”
c. “I should take an antacid, such as Tums, if I experience gastrointestinal distress.”
d. “I should take this antibiotic with a calcium supplement to improve absorption.”
ANS: A
The patient should avoid taking the medication with dairy products to help prevent
chelation. An acnelike reaction would indicate an allergic response. Taking the
medication with calcium-containing antacids or supplements should be avoided,
because this also leads to chelation.
DIF: Cognitive Level: Application REF: Tetracyclines | Drug and Food
Interactions | Adverse Effects TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
2. A pregnant adolescent patient asks the nurse whether she should continue to take her
prescription for tetracycline (Sumycin) to clear up her acne. Which response by the nurse
is correct?
a. “Tetracycline can be harmful to the baby’s teeth and should be avoided.”
b. “Tetracycline is safe to take during pregnancy.”
c. “Tetracycline may cause allergic reactions in pregnant women.”
d. “Tetracycline will prevent asymptomatic urinary tract infections.”
ANS: A
Tetracyclines can cause discoloration of deciduous and permanent teeth. Tooth
discoloration can be prevented if the drugs are not taken by pregnant women or by
children under 8 years of age. Tetracycline is not appropriate for a pregnant patient.
Pregnancy does not precipitate an allergic response to tetracycline. Tetracycline
should not be used to prevent urinary tract infections (UTIs), especially in pregnant
women.
3. A patient recently began receiving clindamycin (Cleocin) to treat an infection. After 8
days of treatment, the patient reports having 10 to 15 watery stools per day. What will the
nurse tell this patient?
a. The provider may increase the clindamycin dose to treat this infection.
b. This is a known side effect of clindamycin, and the patient should consume extra
fluids.
c. The patient should stop taking the clindamycin now and contact the provider
d. immediately.
e. The patient should try taking Lomotil or a bulk laxative to minimize the diarrheal
symptoms.
ANS: C
Clostridium difficile–associated diarrhea (CDAD) is the most severe toxicity of
clindamycin; if severe diarrhea occurs, the patient should be told to stop taking
clindamycin immediately and to contact the provider so that treatment with
vancomycin or metronidazole can be initiated. Increasing the dose of clindamycin will
not treat this infection. Consuming extra fluids while still taking the clindamycin is
not correct, because CDAD can be fatal if not treated. Taking Lomotil or bulk
laxatives only slows the transit of the stools and does not treat the cause.
DIF: Cognitive Level: Application REF: Clindamycin | Adverse
Effects | Clostridium difficile–Associated Diarrhea TOP: Nursing
Process: Implementation MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
4. A patient is diagnosed with periodontal disease, and the provider orders oral doxycycline
(Periostat). The patient asks the purpose of the drug. What is the nurse’s response?
a. “It is used because of its anti-inflammatory effects.”
b. “It inhibits collagenase to protect connective tissue in the gums.”
c. “It reduces bleeding and the pocket depth of oral lesions.”
d. “It suppresses bacterial growth in the oral mucosa.”
ANS: B
Two tetracyclines are used for periodontal disease. Doxycycline inhibits collagenase,
which destroys connective tissue in the gums. It is not used for anti-inflammatory
effects. Minocycline is used to reduce bleeding and pocket depth and to inhibit
bacterial growth.
DIF: Cognitive Level: Application REF: Tetracyclines | Therapeutic Uses |
Periodontal Disease TOP: Nursing Process: Implementation MSC:
NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
, Parenteral Therapies
5. To prevent yellow or brown discoloration of teeth in children, tetracyclines should not be
given:
a. to children once the permanent teeth have developed.
b. to patients taking calcium supplements.
c. to pregnant patients after the fourth month of gestation.
d. with dairy products or antacids.
ANS: C
Tetracyclines bind to calcium in developing teeth, resulting in yellow or brown
discoloration. They should not be given to pregnant women after the fourth month of
gestation, because they will cause staining of deciduous teeth in the fetus. In children,
discoloration occurs when tetracyclines are given between the ages of 4 and 8 years,
because this is when permanent teeth are developing. Tetracycline binds with
calcium, so absorption is diminished when the drug is given with calcium
supplements, dairy products, or calcium-containing antacids; however, this does not
affect tooth development.
DIF: Cognitive Level: Application REF: Tetracyclines | Adverse Effects |
Effects on Bones and Teeth TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
6. A patient is to begin taking doxycycline to treat a rickettsial infection. Which statement
by the patient indicates a need for teaching about this drug?
a. “I should consult my provider before using laxatives or antacids while taking this
drug.”
b. “I should not take a calcium supplement or consume dairy products with this
drug.”
c. “I should take this drug with food to ensure more complete absorption.”
d. “If I get diarrhea, I should stop taking the drug and let my provider know
immediately.”
ANS: C
Absorption of tetracyclines is reduced in the presence of food. The tetracyclines form
insoluble chelates with calcium, iron, magnesium, aluminum, and zinc, so patients
should not take tetracyclines with dairy products, calcium supplements, or drugs
containing these minerals. Patients who experience diarrhea should stop taking the
drug and notify the provider so they can be tested for C. difficile infection.
DIF: Cognitive Level: Application REF: Tetracyclines | Pharmacokinetics |
Absorption TOP: Nursing Process: Planning MSC: NCLEX Client
Needs Category: Physiologic Integrity: Pharmacologic and Parenteral
Therapies
, 7. A patient who is taking doxycycline for a serious infection contacts the nurse to report
anal itching. The nurse will contact the provider to discuss:
a. adding an antihistamine to the patient’s drug regimen.
b. ordering liver function tests to test for hepatotoxicity.
c. prescribing an antifungal drug to treat a suprainfection.
d. testing the patient for a C. difficile secondary infection.
ANS: C
A suprainfection occurs secondary to suppression of drug-sensitive organisms.
Overgrowth with fungi, especially Candida albicans, is common and may occur in the
mouth, pharynx, vagina, and bowel. Anal itching is a sign of such an infection, not a
sign of hepatotoxicity. Antihistamines will not treat the cause. C. difficile is
characterized by profuse, watery diarrhea.
DIF: Cognitive Level: Analysis REF: Tetracyclines | Adverse Effects |
Suprainfection TOP: Nursing Process: Implementation MSC:
NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
8. A hospitalized patient who is taking demeclocycline (Declomycin) reports increased
urination, fatigue, and thirst. What will the nurse do?
a. Contact the provider to report potential toxic side effects.
b. Notify the provider to discuss changing the medication to doxycycline.
c. Perform bedside glucometer testing to evaluate the serum glucose level.
d. Provide extra fluids and reassure the patient that these are expected side effects.
ANS: D
Demeclocycline stimulates urine flow and sometimes is used to treat patients with
syndrome of inappropriate antidiuretic hormone secretion (SIADH). The patient
should be reassured that increased urination, fatigue, and thirst are known side effects
of demeclocycline. It is not correct to notify the provider of toxic side effects or to
request another tetracycline. Glucometer testing is not necessary, because the
increased urination is not related to an elevated blood glucose level.
DIF: Cognitive Level: Application REF: Tetracyclines | Summary of
Unique Properties of Individual Tetracyclines | Demeclocycline TOP:
Nursing Process: Evaluation MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
9. A 6-week-old infant who has not yet received immunizations develops a severe cough.
While awaiting nasopharyngeal culture results, the nurse will expect to administer which
antibiotic?
a. Clindamycin (Cleocin)
b. Doxycycline (Vibramycin)
c. Erythromycin ethylsuccinate
d. Penicillin G
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