ROSENTHAL: LEHNE'S PHARMACOTHERAPEUTICS FOR ADVANCED PRACTICE
NURSES AND PHYSICIAN ASSISTANTS REVIEW NEWEST ACTUAL EXAM WITH
COMPLETE QUESTIONS AND CORRECT VERIFIED ANSWERS (DETAILED
ANSWERS) ALREADY GRADED A+ 100% GUARANTEED TO PASS
CONCEPTS!!!
A patient who breastfeeds her infant asks the nurse about the immunity the infant
receives from breast milk. What does the nurse tell the patient about immunity through
breastfeeding?
a. "The immunity protects the infant from hypersensitivity reactions."
b. "The immunity provides phagocytes to help the infant fight infections."
c. "The immunity results from the transfer of IgA through the breast milk."
d. "The immunity protects the infant from respiratory and gastrointestinal (GI) microbes."
- <<ANSWER>>ANS: C
IgA crosses breast milk and, in the GI tract, where it is not absorbed, provides passive
immunity to
microbes. Infants do not receive protection from hypersensitivity reactions through
breast milk.
Phagocytes are not transmitted through breast milk. Infants are not protected from
respiratory
microbes via breast milk. DIF: Cognitive Level: Analysis REF: p. 574TOP: Nursing
Process:
Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic
Adaptation
A patient with a history of renal calculi has fever, flank pain, and bacteriuria. The nurse
caring for this patient understands that it is important for the provider to:
a. begin antibiotic therapy after urine culture and sensitivity results are available.
b. give prophylactic antibiotics for 6 weeks after the acute infection has cleared.
c. initiate immediate treatment with broad-spectrum antibiotics.
d. refer the patient for intravenous antibiotics and hospitalization. - <<ANSWER>>ANS:
A
,Patients with renal calculi are more likely to have complicated urinary tract infections
that have less predictable microbiologic etiologies. Because the symptoms are mild, it is
important first to obtain a culture and sensitivity to assist with antibiotic selection. If
symptoms worsen, a broad-spectrum antibiotic may be started until sensitivity
information is available. Intravenous antibiotics are indicated for severe pyelonephritis.
Long-term prophylaxis is not indicated unless this patient develops frequent reinfection.
DIF: Cognitive Level: Application REF: p. 828TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
A 30-year-old male patient reports having two to four urinary tract infections a year.
What will the nurse expect to teach this patient?
a. "Make sure you void after intercourse and drink extra fluids to stay well hydrated."
b. "We will treat each infection as a separate infection and treat with short-
coursetherapy."
c. "You will need to take a low dose of medication for 6 months to prevent infections."
d. "You will need to take antibiotics for 4 to 6 weeks each time you have an infection." -
<<ANSWER>>ANS: C
This patient has reinfection of his urinary tract at a rate of more than three per year,
which is an indication for long-term prophylaxis. Voiding after intercourse is a good
teaching point for sexually active women to prevent urinary infections, but it is not a
sufficient preventive measure for recurrent infections in men. Short-course therapy may
be used for each occurrence of infection if the reinfection rate is less than three per
year. Long-term treatment for individual infections is recommended if relapse occurs or
if infections do not clear with shorter-term therapy. DIF: Cognitive Level: Application
REF: p. 828TOP: Nursing Process: Implementation MSC: NCLEX Client Needs
Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
A patient has a positive urine culture 1 week after completion of a 3-day course of
antibiotics. The nurse anticipates that the prescriber will:
a. begin a 2-week course of antibiotics.
b. evaluate for a structural abnormality of the urinary tract.
c. initiate long-term prophylaxis with low-dose antibiotics.
d. treat the patient with intravenous antibiotics. - <<ANSWER>>ANS: A
Patients who develop a subsequent urinary tract infection after treatment are treated in
a stepwise fashion, beginning with a longer course of antibiotics. The next steps would
be to begin a 4- to 6- week course of therapy, followed by a 6-month course of therapy if
that is unsuccessful. If urinary tract infections are thought to be caused by other
complicating factors, an evaluation for structural abnormalities may be warranted.
Unless the infections are severe or are complicated, intravenous antibiotics are not
indicated. DIF: Cognitive Level: Application REF: p. 829TOP: Nursing Process:
Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic
and Parenteral Therapies
A young, nonpregnant female patient with a history of a previous urinary tract infection
is experiencing dysuria, urinary urgency and frequency, and suprapubic pain of 3 days'
,duration. She is afebrile. A urine culture is positive for more than 100,000/mL of urine.
The nurse caring for this patient knows that which treatment is most effective?
a. A 14-day course of amoxicillin with clavulanic acid [Augmentin]
b. A 7-day course of ciprofloxacin[Cipro]
c. A single dose of fosfomycin [Monurol]
d. A 3-day course of trimethoprim/sulfamethoxazole [Bactrim] - <<ANSWER>>ANS: D
Short-course therapy is recommended for uncomplicated, community-acquired lower
urinary tract infections. The short course is more effective than a single dose, and
compared with longer-course therapies, it is less costly, has fewer side effects, and is
more likely to foster compliance. Amoxicillin with clavulanic acid is a second-line drug
used for pyelonephritis. Fosfomycin is a second-line drug and can be useful in patients
with drug allergies. DIF: Cognitive Level: Application REF: p. 828TOP: Nursing Process:
Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic
and Parenteral Therapies
A patient who is taking nitrofurantoin calls the nurse to report several side effects.
Which side effect of this drug causes the most concern and would require
discontinuation of the medication?
a. Anorexia, nausea, and vomiting
b. Brown-colored urine
c. Drowsiness
d. Tingling of the fingers - <<ANSWER>>ANS: D
Tingling of the fingers can indicate peripheral neuropathy, which can be an irreversible
side effect of nitrofurantoin. The other side effects are not serious and can be reversed.
DIF: Cognitive Level: Application REF: p. 830TOP: Nursing Process: Evaluation MSC:
NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral
Therapies
Before giving methenamine [Hiprex] to a patient, it is important for the nurse to review
the patient's history for evidence of which problem?
a. Elevated blood urea nitrogen and creatinine
b. History of reactions to antibiotic agents
c. Possibility of pregnancy
d. Previous resistance to antiseptic agents - <<ANSWER>>ANS: A
Methenamine should not be given to patients with renal impairment, because
crystalluria can occur. There is no cross-reactivity between methenamine and antibiotic
agents. Methenamine is safe for use during pregnancy. There is no organism drug
resistance to methenamine. DIF: Cognitive Level: Application REF: p. 831TOP: Nursing
Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
A pregnant female patient with bacteriuria, suprapubic pain, urinary urgency and
frequency,
and a low-grade fever is allergic to sulfa, ciprofloxacin, and amoxicillin. The nurse
knows that
the best alternative for treating this urinary tract infection is with:
, a. cephalexin [Keflex].
b. fosfomycin [Monurol].
c. methenamine [Hiprex].
d. nitrofurantoin [Macrodantin]. - <<ANSWER>>ANS: C
Methenamine is an excellent second-line drug for this patient and is indicated because
of the patient's multiple drug sensitivities. It is safe in pregnancy, and there is no drug
resistance. Nitrofurantoin has potential harmful effects on the fetus and should not be
used during pregnancy. Single-dose regimens are not recommended in pregnant
women. Cephalexin can have cross-reactivity with amoxicillin. DIF: Cognitive Level:
Application REF: p. 831TOP: Nursing Process: Planning MSC: NCLEX Client Needs
Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
The parent of a 5-year-old child who has had four urinary tract infections in the past
year asks the nurse why the provider doesn't just order an antibiotic for the child's
current symptoms of low-grade fever, flank pain, and dysuria since these are similar
symptoms as before. Which is the most important reason given by the nurse?
a. "Your child may need to be hospitalized for treatment."
b. "Your child may need a urine culture before and after treatment."
c. "Your child may need tests to assess for urinary tract abnormalities."
d. "Your child may need additional medications, such as urinary tract antiseptics." -
<<ANSWER>>ANS: C
Children with recurrent urinary tract infections should be assessed for underlying urinary
tract abnormalities to help determine a possible cause for recurrence. This child has
mild fever and therefore may not require hospitalization. Urine cultures are important
when treating patients with recurrent UTI prophylactically, but this is not the most
important consideration. Urinary tract antiseptics are used to treat uncomplicated lower
urinary tract infections. DIF: Cognitive Level: Analysis REF: p. 830TOP: Nursing
Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
Which patient with a urinary tract infection will require hospitalization and intravenous
antibiotics?
a. A 5-year-old child with a fever of 100.5° F, dysuria, and bacteriuria
b. A pregnant woman with bacteriuria, suprapubic pain, and fever
c. A young man with dysuria, flank pain, and a previous urinary tract infection
d. An older adult man with a low-grade fever, flank pain, and an indwelling catheter -
<<ANSWER>>ANS: D
The patient with an indwelling catheter and signs of pyelonephritis shows signs of a
complicated UTI, which is best treated with intravenous antibiotics. Three other patients
show signs of uncomplicated urinary tract infections that are not severe and can be
treated with oral antibiotics. DIF: Cognitive Level: Analysis REF: p. 828TOP: Nursing
Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
