Chapter 21: Drug Therapy With Macrolides and Miscellaneous Anti-Infective Agents

A common reaction associated with the intravenous administration of vancomycin is "red man syndrome." What is the cause of red man syndrome? Hypertension Hypotension Pseudomembranous colitis Histamine release

Histamine release Explanation: Red man syndrome is a histamine reaction characterized by hypotension and skin flushing.

The nurse is caring for a client who is receiving IV vancomycin. The nurse infuses the medication at the prescribed rate to prevent what from occurring? Red man syndrome Cushing's syndrome Serotonin syndrome Gray syndrome

Red man syndrome Explanation: The nurse must be careful to infuse vancomycin at the prescribed rate to prevent the occurrence of red man syndrome. With this syndrome, the client's face and upper trunk becomes bright red, and it has led to cardiovascular collapse.

What medication would the nurse anticipate being prescribed for a client diagnosed with trichomoniasis? metronidazole penicillin rifaximin clindamycin

metronidazole Explanation: .Metronidazole is effective against anaerobic bacteria, including gram-negative bacilli such as Bacteroides, gram-positive bacilli such as Clostridia, and some gram-positive cocci. It is also effective against protozoa that cause amebiasis, giardiasis, and trichomoniasis. None of the other options would effectively manage this infection.

After teaching a client who is prescribed oral erythromycin, the nurse determines that the teaching was successful when the client states which of the following? "I should drink a full 8-oz glass of water when I take the medicine." "I only need to take one pill every day for this medicine to work." "I might have some bloody diarrhea after using this medicine." "I need to take the medicine with a meal so I don't get an upset stomach."

"I should drink a full 8-oz glass of water when I take the medicine." Explanation: Food in the stomach decreases the absorption of oral macrolides such as erythromycin. Therefore, the drug should be taken on an empty stomach with a full, 8-oz glass of water, 1 hour before or at least 2 to 3 hours after meals. The client may experience diarrhea with this drug, but it should not be bloody. Bloody diarrhea is associated with pseudomembranous colitis, which needs to be reported to the health care provider immediately. Due to its long half-life, azithromycin is usually ordered as a once-daily dose.

A client has been prescribed daptomycin for treatment of an infection. What instruction is most important for the nurse to tell this client? "Tell the health care provider immediately if you develop any muscle pain." "Expect that this medication may cause bloody diarrhea." "Maintain a clear liquid diet while on the medication to prevent nausea." "Take a laxative every day to prevent becoming constipated."

"Tell the health care provider immediately if you develop any muscle pain." Explanation: The presence of muscle pain or weakness is an indication that the client is developing a severe musculoskeletal reaction, and the medication must be discontinued immediately.

A client received erythromycin before dental surgery. The client has a past history of a cardiac surgery. The rest of the client's history is unremarkable. What does the nurse teach the client about this medication? "You cannot receive other antibiotics because of your cardiac history." "You are receiving this medication to prevent infection that may affect your heart." "You need this medication to decrease the extraction pain of surgery." "This medication will help them remove your tooth easier."

"You are receiving this medication to prevent infection that may affect your heart." Explanation: The client with a prior history of a heart defect is at risk for bacteria growing in the area of the defect. The client should receive prophylactic antibiotics with any surgery or invasive procedure. The medication does not decrease pain, nor does it make it easier to remove a tooth. Other antibiotics are sometimes given as well as a macrolide.

How long should an infusion of vancomycin be programmed to run to minimize the client's risk of developing symptoms associated with excessive histamine release? 1 to 2 hours 2 to 4 hours 3 to 4 hours 30 minutes

1 to 2 hours Explanation: For systemic infections, vancomycin is given IV and reaches therapeutic plasma levels within 1 hour after infusion. It is very important to give IV infusions slowly, over 1 to 2 hours, to avoid an adverse reaction characterized by hypotension, flushing, and skin rash. This reaction, sometimes called "red man syndrome," is attributed to histamine release.

A patient is required to be administered vancomycin for treatment of an abdominal abscess. What should the nurse ensure when monitoring the IV infusion of vancomycin in the patient when caring for him? Report increase in the urinary output. Report an increase in blood pressure. Administer each dose over 60 minutes. Observe for signs of headache.

Administer each dose over 60 minutes. Explanation: When caring for a client who is being administered vancomycin intravenously, the nurse should ensure that each dose is administered over 60 minutes. The nurse should monitor and report a decrease in blood pressure and not an increase. The nurse should monitor and report any decrease in urinary output and not an increase. The nurse should monitor any signs of throbbing neck pain or back pain and not for signs of headache.

A male client presents to the emergency department with an abdominal dehiscence. He states he had a hernia repair 18 days earlier, and the health care provider removed his wound staples 5 days ago. The client states that the dehiscence occurred when he lifted a box this morning for his wife. The wound is red, and there is evidence of foul-smelling drainage. The wound is cultured, and an anaerobic bacterium is identified. The nurse understands that the provider orders metronidazole because it is effective against which type of organism? Anaerobic bacteria Staphylococcus All gram-negative bacteria All gram-positive bacteria

Anaerobic bacteria Explanation: Metronidazole is effective against infections with anaerobic bacteria and some protozoa.

A patient taking erythromycin (E-mycin) is having difficulty hearing the nurse. How should the nurse proceed? Ask about the patient's hearing prior to medication therapy. Talk louder. Look in the patient's ears with an otoscope. Make certain to stand in front of the patient.

Ask about the patient's hearing prior to medication therapy. Explanation: The nurse needs to know if this is an effect of the medication, or if the patient had difficulty prior to taking the medication. Hearing difficult caused by the medication is reversible. The nurse should not take steps to "make do" with the deficit until the nurse determines the extent and possible cause.

A patient has been administered linezolid. The patient is fond of eating chocolates and coffee, both of which contain tyramine. What should the nurse inform the patient about the risk involved when linezolid interacts with foods containing tyramine? Causes nervousness. Causes nausea. Causes severe hypertension. Causes drowsiness.

Causes severe hypertension. Explanation: The nurse should inform the patient that if tyramine found in chocolates and coffee interacts with linezolid, the patient will develop an increased risk for severe hypertension. Nausea is the adverse reaction of quinupristin-dalfopristin. It is not reported to occur due to the interaction of linezolid and tyramine. Nervousness and drowsiness are not reported to be risks developed due to the interaction of linezolid and tyramine.

Which of the following would a nurse identify as the prototype lincosamide drug? Lincomycin Clarithromycin Erythromycin Clindamycin

Clindamycin Explanation: Clindamycin is considered the prototype lincosamide. Erythromycin and clarithromycin are macrolide antibiotics. Lincomycin is also a lincosamide but not the prototype.

A client is given linezolid for a diagnosis of VREF. The drug will be administered for a period that extends beyond 2 weeks. Which laboratory test would the nurse expect the health care provider to order on a regular basis because of the length of administration of the drug? Potassium Electrolytes Complete blood count Serum albumin

Complete blood count Explanation: With the drug linezolid, myelosuppression (anemia, leukopenia, pancytopenia, and thrombocytopenia) is a serious adverse effect that may occur with prolonged therapy lasting longer than 2 weeks. The client's complete blood count should be monitored; if myelosuppression occurs, linezolid should be discontinued. Myelosuppression usually improves with drug discontinuation.

A nurse is required to administer an anti-infective drug to a patient. The nurse knows that which of the following tests need to be conducted before administering the first dose of an anti-infective drug to the patient? Stool tests Culture tests Urinalysis Ulcer tests

Culture tests Explanation: The nurse should check whether culture tests are conducted before the first dose of drug is administered to the client. Ulcer tests and stool tests are not required to be conducted before administering the first dose of an anti-infective drug to the client. The nurse has to ensure that urinalysis is conducted before the administration of the drug but not specifically before the first dose of the anti-infective drug.

A client has been prescribed metronidazole for treatment of Giardia. What instruction is most important for the nurse to give to this client? Do not drink alcohol while taking this medication. Do not smoke while taking this medication. Do not eat dairy foods while taking this medication. Regularly use sunscreen products while taking this medication.

Do not drink alcohol while taking this medication. Explanation: Clients who are receiving metronidazole should not drink alcohol because the client will develop a disulfiram-type reaction if alcohol is consumed while the client is receiving metronidazole.

Rifaximin (Xifaxan) is effective to treat traveler's diarrhea from which of the following organisms? Shigella Escherichia coli Campylobacter jejuni Salmonella

Escherichia coli Explanation: Rifaximin (Xifaxan) is a miscellaneous antibiotic and is used to treat E. coli. It cannot be used to treat C. jejuni. Effectiveness against Shigella and Salmonella is unknown.

A 22-year-old female patient has been prescribed erythromycin. What is essential for the nurse to assess to minimize the possible risk of undesired outcome of this therapy? If the patient can administer an injection If the patient is compliant If the patient is sexually active If the patient has irritable bowel syndrome

If the patient is sexually active Explanation: Erythromycin can decrease the effectiveness of contraceptives. The nurse has to first find out if the patient is sexually active; if so, then the patient needs to know about the potential decreased effectiveness of any birth control pill. Erythromycin is not given by self-injection. Irritable bowel syndrome does not affect the medication. The nurse cannot assess compliance prior to administration.

A patient with acne vulgaris was administered macrolides, after which the patient developed diarrhea. What nursing intervention should the nurse perform in this case? Record symptoms of infection. Inspect stools for blood or mucus. Obtain allergy history. Measure urine output.

Inspect stools for blood or mucus. Explanation: The nurse should inspect all stools for blood or mucus. Allergy history and signs of infection are obtained in the pre-administration assessment. Urine output is measured in case of renal dysfunctions.

A female client's medical history includes type 2 diabetes, CVA, dysphasia, and chronic renal failure. She develops an infectious process. The health care provider orders erythromycin. Based on the client's medical history, why is erythromycin the drug of choice? It is metabolized in the kidneys. It is excreted into the bloodstream. It is excreted into the GI tract. It is metabolized in the liver.

It is metabolized in the liver. Explanation: Erythromycin is generally considered safe. Because it is metabolized in the liver and excreted in bile, it may be an alternative in clients with impaired renal function.

A 78-year-old female, who lives alone and is forgetful, is being seen by her home health nurse. In reviewing the patient's medication the nurse discovers that the patient is taking azithromycin (Zithromax) for urethritis. Why would this be a good choice of antibiotics for this patient? It is taken only once a day. It can be given without consideration to drug-drug- interactions. It has very few adverse effects. The half-life of the drug is 3 to 7 hours.

It is taken only once a day. Explanation: Since the patient is "forgetful" and lives alone, a daily dose would likely promote compliance. Azithromycin (Zithromax) can be administered once daily because the half-life is 68 hours. Azithromycin (Zithromax) is associated with GI adverse effects and can cause pseudo membranous colitis and neurological symptoms can occur as well. Azithromycin (Zithromax) may adversely interact with cardiac glycosides, oral anticoagulants, theophyllines, carbamazepine, and corticosteroids to name a few.

In which condition present in the client should macrolides be used with caution? Glaucoma Diabetes mellitus Liver dysfunction Hypertension

Liver dysfunction Explanation: All macrolides should be used with caution in clients with liver dysfunction. Pre-existing liver disease is a contraindication.Diabetes, hypertension and glaucoma are not contraindicated.

When quinupristin/dalfopristin (Synercid) is given, the nurse must monitor clients taking which of the following medications closely for toxicities of these drugs due to increase in serum levels? Select all that apply. Lorazepam (Ativan) Atorvastatin (Lipitor) Tacrolimus (Prograf) Quinapril (Accupril) Ritonavir (Norvir)

Lorazepam (Ativan) Ritonavir (Norvir) Atorvastatin (Lipitor) Explanation: When taking Synercid, the serum levels of the following drugs may increase: antiretrovirals, antineoplastic and immunosuppressant agents, calcium channel blockers, benzodiazepines, and cisapride.

A client presents to the health care provider's office with a skin infection on the forearm. The infection is resistant to over-the-counter antibiotics. After receiving the culture and sensitivity results, the provider orders tigecycline. The nurse knows that this client has what illness? Clostridium difficile MRSA VREF VRE

MRSA Explanation: Tigecycline belongs to the glycylcycline class of antibiotics. It is similar to tetracycline in structure and properties and can be used to treat skin infections caused by MRSA.

Which statement is true concerning macrolides? Macrolides are bacteriocidal or bacteriostatic. Macrolides are not absorbed well in body tissues. Macrolides are not absorbed in body fluids. Macrolides cannot kill gram-positive bacteria.

Macrolides are bacteriocidal or bacteriostatic. Explanation: Macrolides are absorbed well in body tissues and fluids and kill gram-positive bacteria. Depending on the concentration in the body, they can be bacteriocidal or bacteriostatic.

A client develops antibiotic-induced colitis. The symptoms have worsened within the past 72 hours. The nurse expects the health care provider to order what medication, which is considered the initial drug of choice? Bismuth subsalicylate Metronidazole Psyllium Loperamide

Metronidazole Explanation: In antibiotic-associated colitis, stopping the causative drug is the initial treatment. If symptoms do not improve within 3 or 4 days, oral metronidazole or vancomycin is given for 7 to 10 days.

The nurse should monitor the client for which common side effects of erythromycin therapy? Shortness of breath and sore throat Nausea, vomiting, and diarrhea Headache and fever Urticaria and opthalmic drainage

Nausea, vomiting, and diarrhea Explanation: Gastrointestinal problems (e.g., nausea, vomiting, and diarrhea) are common side effects of erythromycin and other macrolides. Headache, fever, opthalmic drainage, uticaria, shortness of breath and sore throat are no common side effects.

John, 34 years old, is being treated with clindamycin for osteomyelitis of his tibia following an open fracture 3 months ago. The nurse is teaching John how to properly administer the medication at home and the side effects that he needs to report to the health care provider. Which would be the best instruction to give John? Contact the provider if you are having headaches or visual changes. Call the provider if you have nausea after taking the medication. Notify the provider if you have any blood in your stool or diarrhea. Contact the provider's office if you have abdominal distention.

Notify the provider if you have any blood in your stool or diarrhea. Explanation: The most serious adverse effect is pseudomembranous colitis (a Black Box warning), also known as Clostridium difficile colitis. Diarrhea, abdominal cramps, and abdominal tenderness may suggest antibiotic-associated colitis. Nausea and vomiting and abdominal pain following oral administration are the most common adverse effects of clindamycin.

A nurse is caring for a client with severe and life-threatening pseudomembranous colitis caused by C. difficile. Which drug would the nurse expect the client's provider to order? Oral vancomycin Daptomycin Tigecycline Linezolid

Oral vancomycin Explanation: Oral vancomycin is used to treat staphylococcal enterocolitis and pseudomembranous colitis caused by C. difficile when the colitis fails to respond to metronidazole.

The health care provider suspects a client may be infected with an antibiotic-resistant pathogen. The nurse caring for this client knows that what course of action is best used to determine whether this type of pathogen is present? Perform a lumbar puncture to assess cerebrospinal fluid. Perform culture and susceptibility tests. Perform a complete blood count (CBC) test. Assess serum electrolyte levels.

Perform culture and susceptibility tests. Explanation: Before prescribing an antibiotic, the health care provider should review culture and susceptibility reports and local susceptibility patterns to determine if an antibiotic-resistant pathogen is present in the client. Complete blood counts and electrolyte values are standard procedure lab tests. Spinal fluid checks are performed to detect anomalies such as meningitis.

A client who has been receiving intravenous (IV) vancomycin begins to report neck and back pain as well as feeling hot and having chills. The nurse assesses the client and notices that the neck is red. The client's temperature is 102 degrees F; BP is 86/58. This client is showing signs and symptoms of which syndrome? Red-man syndrome Cushing's syndrome Toxic shock syndrome Stevens-Johnson syndrome

Red-man syndrome Explanation: Clients taking vancomycin can develop red-man syndrome, the signs of which include decreased BP, fever, chills, parasthesias, and erythema of the neck and back. Cushing's syndrome is related to increased cortisol levels. Toxic shock syndrome is related to a bacterial infection often resulting from prolonged use of superabsorbent tampons. Stevens-Johnson syndrome is a potentially deadly skin disease that usually results from a drug reaction.

A health care provider is deciding what medication to prescribe for a client with an upper respiratory infection. What principles guide the provider's decision? Select all that apply. Medication cost Resistance of the bacteria Other drugs the client is taking daily Available in generic formulation The client's ability to tolerate the drug

Resistance of the bacteria Other drugs the client is taking daily The client's ability to tolerate the drug Explanation: The health care provider needs to consider if the medication will kill the bacteria. The provider also needs to think about the other medications the client is taking because some drugs have many interactions. Tolerance also needs to be considered because the client may develop nausea, vomiting, and diarrhea from the antibiotic. While important to many, cost and generic formulation are not be the prescriber's main considerations.

Common, potentially serious, adverse effects of antibiotic drugs include: Hypopnea Skin rash Constipation Pain

Skin rash Explanation: Examine skin for any rash or lesions, examine injection sites for abscess formation, and note respiratory status—including rate, depth, and adventitious sounds to provide a baseline for determining adverse reactions. Report nausea, vomiting, diarrhea, skin rash, recurrence of symptoms for which the antibiotic drug was prescribed, or signs of new infection (e.g., fever, cough, sore mouth, drainage). These problems may indicate adverse effects of the drug, lack of therapeutic response to the drug, or another infection. Pain, constipation, and hypopnea are not common adverse effects of antibiotic drugs.

Which client should not receive erythromycin as ordered at 8 a.m.? The client with an upper respiratory infection The client taking a beta blocker The client with elevated liver enzymes The client who is 60 years old

The client with elevated liver enzymes Explanation: The medication is metabolized by the liver and excreted in the bile. The client with elevated liver enzymes will not be able to tolerate this medication. There is a risk it will build up in the system. The other situations are not contraindications for taking erythromycin.

Your patient is receiving a miscellaneous anitbacterial to treat an infection. Which of the following goals would be appropriate to include in your plan of care? Select all that apply. The patient will take or receive miscellaneous antimicrobials accurately, for the prescribed length of time. The patient will experience an increase in signs and symptoms of the infection being treated. The patient will verbalize and practice measures to prevent recurrent infection. The patient will be monitored regularly for therapeutic and adverse drug effects.

The patient will take or receive miscellaneous antimicrobials accurately, for the prescribed length of time. The patient will be monitored regularly for therapeutic and adverse drug effects. The patient will verbalize and practice measures to prevent recurrent infection. Explanation: The patient should experience decreased signs and symptoms of the infection being treated, not increased.

A client prescribed rifaximin for diarrhea has developed frank bleeding in the stool. What intervention should the nurse anticipate being implemented to best ensure client safety? changing to a different antibiotic increasing the dose of rifaximin changing to parenteral administration of rifaximin supplementing the antibiotic with vitamin K

changing to a different antibiotic Explanation: Because of its very limited systemic absorption (97% eliminated in feces), health care providers cannot use rifaximin to treat systemic infections, including infections due to invasive strains of E. coli. Therefore, diarrhea occurring with fever or bloody stools requires treatment with alternative agents.

A client with an upper respiratory infection has been prescribed macrolides. Which changes during an ongoing assessment would lead the nurse to notify the health care provider? Select all that apply. increase in respiratory rate pulse rate within usual parameters regular urine output drop in blood pressure sudden increase in temperature

drop in blood pressure increase in respiratory rate sudden increase in temperature Explanation: The nurse must notify the primary health care provider if there is a drop in blood pressure, increase in respiratory rate, or sudden increase in temperature during an ongoing assessment after administration of the drug. Regular urine output or pulse rate within usual parameters need not be reported to the health care provider because these would be normal findings.

Which of the following drugs are considered to be macrolides? Choose all that apply. metronidazole (Flagyl) erythromycin clarithromycin (Biaxin) azithromycin (Zithromax) linezolid (Zyvox)

erythromycin azithromycin (Zithromax) clarithromycin (Biaxin) Explanation: The macrolides, which include erythromycin, azithromycin (Zithromax), and clarithromycin (Biaxin), have similar antibacterial spectra and mechanisms of action. Metronidazole (Flagyl) and linezolid (Zyvox) are considered miscellaneous antibacterials.

What time frame should the nurse use to safely administer 500 mg of clindamycin intravenously (IV)? as a bolus over at least 1 hour over 5 to 10 minutes over 10 to 20 minutes

over 10 to 20 minutes Explanation: When administering clindamycin intravenously, the nurse dilutes 300 to 600 mg of the drug in 50 mL of IV fluid and gives it over 10 to 20 minutes, or he or she dilutes 900 mg in 50 to 100 mL and administers it over 20 minutes. The client is at risk for cardiac arrest if the medication is administered as a bolus.

A client comes to the clinic for a follow-up visit. The nurse notes a sunburn-like appearance to the client's skin. The client's history reveals the use of ciprofloxacin. The nurse interprets which adverse effect regarding this finding? pseudomembranous colitis superinfection anaphylactic reaction photosensitivity

photosensitivity Explanation: A superinfection refers to the overgrowth of bacterial or fungal microorganisms not affected by the antibiotic administered. Pseudomembranous colitis is a severe, life-threatening form of diarrhea that occurs when normal flora of the bowel is eliminated and replaced with Clostridium difficile (C. diff) bacteria. Anaphylactic reaction is a severe exaggerated allergic reaction.

A client developed a pressure area on the hip that has become infected. If the wound culture reveals methicillin-resistant Staphylococcus aureus, which medication would the nurse expect to be prescribed? vancomycin penicillin erythromycin metronidazole

vancomycin Explanation: Vancomycin is active only against gram-positive microorganisms. It acts by inhibiting cell wall synthesis. Parenteral vancomycin has been used extensively to treat infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant staphylococcal species non-aureus (SSNA, including Staphylococcus epidermidis), and endocarditis caused by Streptococcus viridans (in clients allergic to or with infections resistant to penicillins and cephalosporins) or E. faecalis (with an aminoglycoside). None of the other options would effectively manage this infection.