Chapter 19, Drug Therapy With Aminoglycosides and Fluoroquinolones

A client is receiving gentamicin to treat meningitis. The health care provider has ordered a peak serum level be drawn in association with the 07:00 dose, which will finish infusing at 07:30. When should the peak serum level be drawn? A. 08:00 B. 09:00 C. 10:00 D. 12:00

A. 08:00

A client is diagnosed with an infection attributable to the gram-negative microorganism Pseudomonas. Which anti-infective agent is most reliable in treating this microorganism? A. Aminoglycoside B. Antifungal C. Aminopenicillin D. GABA analog

A. Aminoglycoside

A client has been prescribed ciprofloxacin after being diagnosed with a sinus infection. What medication should the client avoid taking concurrently with ciprofloxacin? A. Antacids B. Calcium channel blockers C. Beta-adrenergic blockers D. Diuretics

A. Antacids

A client has been prescribed ciprofloxacin IV for the treatment of cellulitis. After initiating the infusion of the client's first scheduled dose, the client develops a pronounced rash on the chest and arms. How should the nurse respond initially to this event? A. Discontinue the infusion and inform the health care provider promptly. B. Slow down the rate so that the infusion takes place over 2 hours. C. Administer oral diphenhydramine to the client during the infusion. D. Administer an STAT dose of acetylcysteine

A. Discontinue the infusion and inform the health care provider promptly.

A client with a diagnosis of osteomyelitis will soon begin treatment with gentamicin. Which schedule is most likely to maximize efficacy and minimize nephrotoxicity? A. Gentamicin 500 mg IV OD at 12:00 B. Gentamicin 250 mg PO BID at 07:30 and 19:30 C. Gentamicin 500 mg PO TID at 08:00, 12:00, and 19:00 D. Gentamicin 125 mg IV QID at 06:00, 12:00, 18:00, and 24:00

A. Gentamicin 500 mg IV OD at 12:00

A client is diagnosed with a gram-negative infection and is prescribed an aminoglycoside. What is the action of an aminoglycoside? A. It blocks protein synthesis of the cell wall. B. It blocks the process of DNA replication. C. It destroys the integrity of the cell wall structure. D. It increases white blood cells viability

A. It blocks protein synthesis of the cell wall.

The nurse prepares to administer ciprofloxacin 250 mg per enteral feeding tube every 12 hours to the adult client diagnosed with pneumonia and a history of renal impairment in the critical care unit. Which measures should the nurse provide for safe and effective drug administration? Select all that apply. A. Stop the enteral tube feeding for 1 hour before administering the drug, and resume feeding 2 hours after providing the drug. B. Wait 1 hour before administering some other medications the client takes: sucralfate, multivitamin, iron supplement. C. Examine the random peak and trough level, and report abnormal levels promptly to prevent further nephrotoxicity. D. Crush the immediate release tablet, and mix with water before administering the medication via the enteral tube. E. Monitor serum creatinine and blood urea nitrogen (BUN), and report any changes from baseline to the prescriber.

A. Stop the enteral tube feeding for 1 hour before administering the drug, and resume feeding 2 hours after providing the drug D. Crush the immediate release tablet, and mix with water before administering the medication via the enteral tube. E. Monitor serum creatinine and blood urea nitrogen (BUN), and report any changes from baseline to the prescriber.

Extreme caution would be necessary with the use of gentamicin in which client? A. A client who is morbidly obese and who has primary hypertension B. A client who has chronic renal failure secondary to diabetes mellitus C. A client who has bipolar disorder and who is on long-term lithium therapy D. A client who has an atrioventricular block

B. A client who has chronic renal failure secondary to diabetes mellitus

Which client has the highest risk of developing ototoxicity secondary to gentamicin? A. A client who received the first dose of IV gentamicin 12 hours ago B. A client who has required repeated courses of gentamicin over the past several months C. A client who has a Pseudomonas infection but who has a hypersensitivity to penicillins D. A client who is immunocompromised and who is being treated with gentamicin

B. A client who has required repeated courses of gentamicin over the past several months

The nurse prepares to administer gentamicin intravenous every 8 hours to an older adult client. Which interventions should the nurse provide to decrease the risk for nephrotoxicity and ototoxicity? Select all that apply. A. Draw the trough level 30 to 60 minutes after drug is administered, and report a level above 10 to 12 mcg/mL. B. Obtain baseline assessment of cranial nerve eight and periodic measurements during therapy. C. Monitor estimated creatinine clearance and BUN at baseline and periodically during therapy. D. Obtain peak level before administering the next dose of drug, and report a level above 2 mcg/mL. E. Provide the client with 2 to 3 L of noncaffeinated oral fluids daily, unless

B. Obtain baseline assessment of cranial nerve eight and periodic measurements during therapy. C. Monitor estimated creatinine clearance and BUN at baseline and periodically during therapy. E. Provide the client with 2 to 3 L of noncaffeinated oral fluids daily, unless contraindicated.

A client diagnosed with a genitourinary infection is being treated with a fluoroquinolone. What is the advantage of a fluoroquinolone over an aminoglycoside? A. The fluoroquinolone does not have adverse effects. B. The fluoroquinolone can be given orally. C. The fluoroquinolone has a nearly immediate peak. D. The fluoroquinolone has a broader spectrum.

B. The fluoroquinolone can be given orally

A client is prescribed ciprofloxacin. Which nursing intervention will best prevent the possible development of crystalluria? A. The nurse should limit oral fluids to 500 mL/day. B. The nurse should encourage fluid intake of 2000 mL/day.. C. The nurse should insert a urinary catheter. D. The nurse should administer phenazopyridine.

B. The nurse should encourage fluid intake of 2000 mL/day..

The nurse is caring for a client who is receiving gentamicin therapy. Why will the nurse monitor the results of a serum gentamicin level? A. To identify possible changes in the client's serum osmolality B. To identify whether the drug is at a therapeutic level C. To identify whether the drug is causing hepatotoxicity D. To identify possible hemolysis following administration

B. To identify whether the drug is at a therapeutic level

A client scheduled for a bowel resection is to receive neomycin sulfate by mouth. The client asks the nurse the purpose of this medication. What is the most appropriate response the nurse can provide to the client? A. "It will prevent renal damage from occurring." B. "It will minimize the risk of ototoxicity." C. "It will decrease the growth of intestinal bacteria." D. "It decreases the risk of airborne contamination of the wound."

C. "It will decrease the growth of intestinal bacteria."

An older adult client has a feeding tube in place to manage dysphagia. After developing an infected pressure ulcer, ciprofloxacin suspension has been prescribed via feeding tube. How should the nurse follow-up this prescription? A. The nurse should flush the client's feeding tube with free water before and after administration of the ciprofloxacin suspension. B. The nurse should dilute the suspension thoroughly before administration. C. The nurse should liaise with the health care provider to provide an alternative route of administration. D. The nurse should administer small, frequent doses of the drug to minimize GI upset.

C. The nurse should liaise with the health care provider to provide an alternative route of administration.

A client is diagnosed with multidrug-resistant tuberculosis. Which aminoglycoside medication is used in a 4- to 6-drug regimen? A. Tetracycline hydrochloride B. Amoxicillin C. Sulfadiazine D. Streptomycin

D. Streptomycin

What is the postantibiotic effect of gentamicin therapy? A. The tendency for clients to exhibit symptoms mimicking hypersensitivity after drug administration B. The tendency for adverse effects of a drug to be masked during administration C. The ability of microorganisms to proliferate between doses of antibiotics D. The ability of an antibiotic to kill bacteria even when serum concentrations are low

D. The ability of an antibiotic to kill bacteria even when serum concentrations are low