ADVANCED P 508 Chapter 58: Treatment of Specific Infections and Miscellaneous Antibiotics Test PREP | (urinary tract infection, primary care NP) | 100% CORRECT

Chapter 58: Treatment of Specific Infections and Miscellaneous Antibiotics Test Bank MULTIPLE CHOICE 1. A primary care nurse practitioner (NP) sees a child who has several honey-colored crust ed lesions around the nose and mouth. The NP notes that no other lesions are present. The NP should prescribe: a. dicloxacillin. b. clarithromycin. c. mupirocin topical. d. trimethoprim-sulfamethoxazole (TMP-SMX). ANS: C Although systemic antibiotics are often required to treat impetigo, mupirocin can be used for topical treatment of mild impetigo. Because this is a localized infection, mupirocin can be ordered empirically. Dicloxacillin and clarithromycin are used when systemic empirical treatment is indicated. TMP-SMX is used to treat cellulitis. DIF: Cognitive Level: Applying (Application) REF: 658 - 659 2. A patient comes to the clinic several days after an outpatient surgical procedure complaining of swelling and pain at the surgical site. The primary care NP notes a small area of erythema but no abscess or induration. The NP should: a. prescribe TMP-SMX. b. prescribe topical mupirocin four times daily. c. suggest that the patient apply warm soaks three times daily. d. refer the patient to the surgeon for further evaluation. ANS: A This patient has cellulitis, so empirical treatment with TMP-SMX is indicated. Topical mupirocin is used for superficial skin infections, not cellulitis. Warm soaks may be used as an adjunct to antimicrobial treatment. Unless the cellulitis becomes worse, it is not necessary to refer the patient to the surgeon. DIF: Cognitive Level: Applying (Application) REF: 661 3. A 5-year-old child who has no previous history of otitis media is seen in clinic with a temperature of 100° F. The primary care NP visualizes bilateral erythematous, nonbulging, intact tympanic membranes. The child is taking fluids well and is playing with toys in the examination room. The NP should: a. prescribe azithromycin once daily for 5 days. b. prescribe amoxicillin twice daily for 10 days. c. prescribe amoxicillin-clavulanate twice daily for 10 days. d. initiate antibiotic therapy if the child’s condition worsens. ANS: D Signs and symptoms of otitis media that indicate a need for antibiotic treatment include otalgia, fever, otorrhea, or a bulging yellow or red tympanic membrane. This child has a low- grade fever, no history of otitis media, a nonbulging tympanic membrane, and no otorrhea, so watchful waiting is appropriate. When an antibiotic is started, amoxicillin is the drug of choice. DIF: Cognitive Level: Applying (Application) REF: 661 4. A primary care NP sees a patient who reports a 2-week history of nasal congestion and runny nose. The NP performs a history and learns that the nasal discharge has changed from yellow to green in the past few days, accompanied by a fever of 102° F and unilateral facial pain. To treat this patient, the NP should: a. order azithromycin daily for 5 days. b. prescribe cefdinir twice daily for 10 days. c. prescribe amoxicillin-clavulanate twice daily for 10 days. d. recommend symptomatic treatment because this is probably a viral infection. ANS: C Evidence of a bacterial sinus infection includes prolonged symptoms without improvement for 10 to 14 days, fever greater than 102° F, and unilateral pain. A bacterial infection should be suspected if nasal discharge turns from yellow to green. Amoxicillin-clavulanate is a recommended first-line drug to treat sinusitis. DIF: Cognitive Level: Applying (Application) REF: 661 5. A school-age child comes to the clinic with a 5-day history of cough and low-grade fever. The primary care NP auscultates crackles and diminished breath sounds bilaterally. The NP should: a. order azithromycin. b. prescribe doxycycline. c. obtain a sputum culture. d. recommend symptomatic treatment. ANS: A Community-acquired pneumonia in school-age children is commonly caused by Mycoplasma. Azithromycin is a first-line drug of choice to treat this type of pneumonia. DIF: Cognitive Level: Applying (Application) REF: 662 6. A patient has recently returned from travel in Central America and reports having seven to eight liquid stools each day with severe tenesmus. The primary care NP notes a temperature of 102° F. A stool specimen is Hemoccult positive with leukocytes present. The NP will: a. order tests for Clostridium difficile. b. prescribe tinidazole 2000 mg for 3 days. c. give 750 mg of ciprofloxacin one time only. d. order a stool culture and begin therapy with a fluoroquinolone. ANS: D By history, this patient likely has traveler’s diarrhea. The NP should obtain a culture and should start a fluoroquinolones antibiotic empirically. C. difficile is suspected in patients who have been taking antibiotics, which is not true in this case. Tinidazole is used for amebiasis or giardiasis. Ciprofloxacin may be given as a single dose for mild traveler’s diarrhea. DIF: Cognitive Level: Applying (Application) REF: 663 7. A woman has a urinary tract infection (UTI) and has been taking TMP-SMX for 3 days along with increased fluids. She reports continued dysuria and urinary frequency and has a consistent, low-grade fever. The primary care NP should: a. prescribe ciprofloxacin twice daily for 3 days. b. order doxycycline twice daily for 7 to 14 days. c. prescribe amoxicillin-clavulanate twice daily for 7 days. d. order TMP-SMX DS twice daily for 7 days. ANS: A Initial treatment of uncomplicated UTI is a 3-day course of TMP-SMX. Ciprofloxacin is used if the patient is still symptomatic. Doxycycline is a second-line treatment. Amoxicillin-clavulanate is used to treat pyelonephritis. DIF: Cognitive Level: Applying (Application) REF: 663 - 664 8. During a gynecologic examination of a sexually active adolescent girl, the primary care NP notes mucopurulent cervicitis. A culture is positive for Neisseria gonorrhoeae. The NP should: a. give a single dose of 2 g of oral azithromycin. b. administer benzathine penicillin G 2.4 million units intramuscularly. c. prescribe oral doxycycline 100 mg daily for 7 days. d. give intramuscular ceftriaxone and a single dose of 1 g of azithromycin. ANS: D Many patients who present with one sexually transmitted disease (STD) have other concomitant STDs. When gonorrhea or urethritis/cervicitis is diagnosed, the NP should treat for both N. gonorrhoeae and Chlamydia. A single-dose treatment ensures compliance. A single, 2-g dose of azithromycin is indicated to treat chancroid. Benzathine penicillin G is indicated to treat syphilis. A 7-day regimen of doxycycline is used to treat Chlamydia, but not gonorrhea. DIF: Cognitive Level: Applying (Application) REF: 664 - 665 9. A female patient presents with grayish, odorous vaginal discharge. The primary care NP performs a gynecologic examination and notes vulvar and vaginal erythema. Testing of the discharge reveals a pH of 5.2 and a fishy odor when mixed with a solution of 10% potassium hydroxide. The NP should: a. order topical fluconazole. b. order metronidazole 500 mg twice daily for 7 days. c. withhold treatment until culture results are available. d. prescribe a clotrimazole vaginal suppository for 7 days. ANS: B This patient has classic symptoms of bacterial vaginosis. The treatment of choice is metronidazole. Fluconazole is used to treat fungal infections. Cultures are generally not helpful in the diagnosis of bacterial vaginosis. Clotrimazole is used to treat Candida infections. DIF: Cognitive Level: Applying (Application) REF: 666 10. A patient has confirmed Rocky Mountain spotted fever, and the infectious disease specialist is treating the patient with doxycycline 100 mg orally for 7 days. The patient comes to the clinic for follow-up care with the primary care NP at the end of therapy and reports continued fever, headache, and myalgia. The NP will consult with the infectious disease specialist and order: a. 7 more days of doxycycline. b. erythromycin 250 mg four times daily for 7 days. c. amoxicillin 500 mg three times daily for 10 to 14 days. d. hospital admission for intravenous chloramphenicol. ANS: D With treatment, the patient’s condition should start to improve in 2 to 3 days. Continued elevation of the temperature may indicate lack of efficacy or drug fever. Chloramphenicol is used to treat Rocky Mountain spotted fever. It is not correct to continue therapy with doxycycline because treatment failure is likely. Erythromycin is used to treat Lyme disease. Amoxicillin is not indicated. DIF: Cognitive Level: Applying (Application) REF: 666 Show Less