TEST BANK LEHNE’S PHARMACOLOGY
CHAPTERS 91-95
Chapter 91: Miscellaneous Antibacterial Drugs:
Fluoroquinolones, Metronidazole, Daptomycin, Rifampin,
Rifaximin, Bacitracin, and Polymyxins
MULTIPLE CHOICE
1. A nurse is preparing to administer an antibiotic to a patient with methicillin-resistant
Staphylococcus aureus (MRSA). The nurse would expect the healthcare provider to order
which antibiotic?
a. Daptomycin (Cubicin)
b. Levofloxacin (Levaquin)
c. TMP/SMZ (Bactrim)
d. Ciprofloxacin (Cipro)
ANS: A
Daptomycin is active against MRSA. Levofloxacin, TMP/SMZ, and ciprofloxacin are
not active against MRSA.
DIF: Cognitive Level: Application REF: Fluoroquinolones | Therapeutic
Uses TOP: Nursing Process: Planning MSC: NCLEX Client Needs
Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
2. A 65-year-old patient who receives glucocorticoids for arthritis is admitted to the hospital
for treatment of a urinary tract infection. The prescriber has ordered intravenous
ciprofloxacin (Cipro). Before administering the third dose of this drug, the nurse reviews
the bacterial culture report and notes that the causative organism is Escherichia coli. The
bacterial sensitivity report is pending. The patient complains of right ankle pain. What
will the nurse do?
a. Withhold the dose of ciprofloxacin and notify the provider of the patient’s
symptoms.
b. Instruct the patient to exercise the right foot and ankle to minimize the pain.
c. Question the patient about the consumption of milk and any other dairy products.
d. Request an order to increase this patient’s dose of glucocorticoids.
ANS: A
A rare but serious adverse effect associated with fluoroquinolones is tendon rupture,
and those at highest risk are children, patients older than 60 years, transplant patients,
, and any patients taking glucocorticoids. Any pain in either heel should be reported
and the drug should be discontinued. Patients should be instructed not to exercise until
tendonitis has been ruled out. Dairy products can reduce the absorption of
ciprofloxacin, so this is not a concern with this patient. Because the pain may be
caused by tendonitis associated with ciprofloxacin, it is not correct to request an
increase in the glucocorticoid dosing.
DIF: Cognitive Level: Application REF: Ciprofloxacin | Adverse Effects
TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs
Category: Physiologic Integrity: Reduction of Risk Potential
3. A patient will receive oral ciprofloxacin (Cipro) to treat a urinary tract infection. The
nurse provides teaching for this patient. Which statement by the patient indicates a need
for further teaching?
a. “I may have abdominal pain and nausea, but these are usually mild.”
b. “I should take this medication with food or milk to improve absorption.”
c. “I should stop taking the medication immediately if I experience heel pain.”
d. “I will need to use sunscreen every time I go outdoors.”
ANS: B
Dairy products inhibit the absorption of ciprofloxacin, so they should be avoided.
Abdominal pain and nausea and vomiting are common and usually mild. Patients
should stop taking the drug if heel pain occurs until tendonitis has been ruled out.
Photosensitivity can occur, so sunscreen should be used.
DIF: Cognitive Level: Application REF: Ciprofloxacin | Adverse Effects
TOP: Nursing Process: Planning MSC: NCLEX Client Needs
Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
4. A patient who is taking calcium supplements receives a prescription for ciprofloxacin
(Cipro) for a urinary tract infection. The nurse will teach this patient to:
a. consume extra fluids while taking the ciprofloxacin to prevent hypercalciuria.
b. stop taking the calcium supplements while taking the ciprofloxacin.
c. take the two medications together to increase the absorption of both.
d. take the calcium either 6 hours before or 2 hours after taking the ciprofloxacin.
ANS: D
Cationic compounds, including calcium supplements, can reduce the absorption of
ciprofloxacin so proper interval dosing is necessary. Consuming extra fluids is not
indicated. With proper interval dosing, it is not necessary to discontinue the calcium
while giving the ciprofloxacin. These two medications should not be given together.
DIF: Cognitive Level: Application REF: Ciprofloxacin | Drug and Food
Interactions TOP: Nursing Process: Implementation MSC: NCLEX
Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral
Therapies
,5. A nurse is preparing to administer oral ofloxacin (Floxin) to a patient. While taking the
patient’s medication history, the nurse learns that the patient takes warfarin and
theophylline. The correct action by the nurse is to request an order to:
a. reduce the dose of ofloxacin.
b. increase the dose of ofloxacin.
c. increase the dose of theophylline.
d. monitor coagulation levels.
ANS: D
Ofloxacin increases plasma levels of warfarin, so coagulation tests should be
monitored. The ofloxacin dose should not be reduced or increased. Ofloxacin does not
affect theophylline levels.
DIF: Cognitive Level: Application REF: Ofloxacin | Basic Pharmacology
TOP: Nursing Process: Assessment MSC: NCLEX Client Needs
Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
6. A patient who is receiving intravenous ciprofloxacin for pneumonia develops diarrhea. A
stool culture is positive for Clostridium difficile. The nurse will expect the provider to:
a. add metronidazole (Flagyl).
b. increase the dose of ciprofloxacin.
c. restrict dairy products.
d. switch to gemifloxacin.
ANS: A
C. difficile is resistant to fluoroquinolones; metronidazole is the drug of choice to treat
this infection. Metronidazole is lethal only to anaerobic organisms, so the
ciprofloxacin should be continued to treat the pneumonia. Increasing the dose of
ciprofloxacin is not indicated, because C. difficile is resistant to ciprofloxacin.
Gemifloxacin is approved for use in respiratory infections.
DIF: Cognitive Level: Application REF: Metronidazole | Therapeutic Uses |
Ciprofloxacin | Therapeutic Uses | Gemifloxacin TOP: Nursing Process:
Implementation MSC: NCLEX Client Needs Category: Physiologic
Integrity: Pharmacologic and Parenteral Therapies
7. A provider orders intravenous moxifloxacin (Avelox) for a patient who has sinusitis.
Before administering the drug, the nurse will review this patient’s chart for:
a. a history of asthma.
b. concurrent use of digoxin.
c. concurrent use of warfarin.
d. recent serum electrolyte levels.
ANS: D
Moxifloxacin prolongs the QT interval and poses a risk of serious dysrhythmias.
Patients with hypokalemia have an increased risk, so serum electrolyte levels should
, be monitored. Having a history of asthma is not significant. Moxifloxacin does not
alter digoxin or warfarin levels.
DIF: Cognitive Level: Application REF: Moxifloxacin | Basic
Pharmacology TOP: Nursing Process: Assessment MSC: NCLEX
Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral
Therapies
MULTIPLE RESPONSE
1. A nursing student is caring for a patient with community-acquired pneumonia (CAP) who
also has a methicillin-resistant Staphylococcus aureus (MRSA) skin infection. The
prescriber has ordered daptomycin (Cubicin). The nurse encourages the student to
approach the provider to request a different antibiotic because of which fact(s) about
daptomycin? (Select all that apply.)
a. It causes significant renal impairment.
b. It is approved only for bloodstream and skin infections.
c. It increases the risk of serious cardiorespiratory events.
d. It is more likely to produce resistant strains of bacteria.
e. It is not effective against MRSA infections.
ANS: B, C
Daptomycin has been approved only for bloodstream and skin infections caused by S.
aureus, including MRSA infections, and would not be indicated for a CAP infection.
In patients with CAP, daptomycin poses a higher risk of serious cardiorespiratory side
effects. Daptomycin does not cause renal impairment and is no more likely to produce
bacterial resistance than other antibiotics. Daptomycin can be used to treat MRSA
infections.
DIF: Cognitive Level: Application REF: Daptomycin | Antibacterial
Spectrum | Therapeutic Use | Resistance | Adverse Effects TOP: Nursing
Process: Assessment MSC: NCLEX Client Needs Category: Physiologic
Integrity: Pharmacologic and Parenteral Therapies
2. Which antibiotic(s) may be administered topically? (Select all that apply.)
a. Bacitracin
b. Daptomycin
c. Ofloxacin
d. Polymyxin B
e. Rifampin
ANS: A, D
Bacitracin and Polymyxin B are both topical antibiotics. Daptomycin, ofloxacin, and
rifampin are not formulated to be administered topically.
DIF: Cognitive Level: Comprehension REF: Bacitracin | Daptomycin |
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