Chapter 39: Antibiotic part 2
A nurse is teaching a group of nursing students about aminoglycosides. Which statement by the nurse regarding aminoglycosides is accurate? "Aminoglycosides can potentiate warfarin toxicity." "Aminoglycosides can be used by lactating women." "Aminoglycosides are used alone to treat gram-positive infections." "Concurrent use with loop diuretics reduces the risk for ototoxicity."
"Aminoglycosides can potentiate warfarin toxicity." Aminoglycosides kill intestinal bacterial flora that produce vitamin K. Vitamin K plays a significant role in blood clotting. Therefore, aminoglycosides administered along with warfarin may cause warfarin toxicity. Normal gut flora balances the effects of oral anticoagulants such as warfarin. Therefore, aminoglycosides can potentiate warfarin toxicity. Aminoglycosides cannot be used by lactating women, because these drugs are present in breast milk and may cause adverse effects in the infant. Aminoglycosides are not used alone to treat gram-positive infections; they are given in combination with penicillin. Concurrent use of aminoglycosides and loop diuretics increases the risk for ototoxicity. pp. 626, 627
What should the nurse instruct a patient about administering topical clindamycin? "Squeeze the tube of medication into the vagina." "Refrigerate the reconstituted medication between uses." "Cleanse the skin with an exfoliating agent before application." "Apply a thin layer to the affected area after it has been cleansed.
"Apply a thin layer to the affected area after it has been cleansed." The patient needs to apply a thin layer of the drug after gently cleansing the affected area. Patients are advised to avoid using abrasive or irritating products while using topical forms of clindamycin and to avoid refrigerating the reconstituted form, which causes thickening. Proper vaginal administration of clindamycin involves the use of gloves and insertion of the medication with an applicator to prevent hand contamination and cross-contamination of the medication tube.
A patient taking intravenous gentamicin has elevated blood urea nitrogen (BUN). What is the nurse's best course of action? Hold the medication. Insert a Foley catheter. Monitor peak and trough levels. Have the patient increase fluid intake.
Hold the medication. Gentamicin has a high potential for nephrotoxicity and is thus contraindicated in patients with elevated renal function tests such as BUN and creatinine. The nurse should hold the medication and call the health care provider. Increasing fluids will not decrease the patient's BUN, and insertion of a Foley catheter will not impact the gentamicin level.
A patient with a staphylococcal infection is prescribed tobramycin. About which assessment findings in the follow-up visit will the nurse immediately notify the primary health care provider? Nausea Vertigo Headache Skin turgor Visual acuity
Nausea Vertigo Headache During the follow-up visit, the nurse should monitor the patient for symptoms of persistent vertigo, nausea, and headache, because these are severe adverse effects of tobramycin. Therefore, the nurse should immediately report these symptoms to the primary health care provider to prevent complications. Tobramycin does not affect skin integrity or visual acuity. Therefore, changes in these are not related to tobramycin treatment. pp. 627, 636
A patient is being discharged after treatment for hospital-acquired pneumonia. The nurse notes linezolid in the patient's discharge summary. What advice should the nurse give to the patient before administering linezolid? "Avoid eating yogurt before taking the drug." "Avoid eating citrus fruits before taking the drug." "Avoid eating smoked meat or fish while taking the drug." "Avoid eating food containing excess fiber while taking the drug."
"Avoid eating smoked meat or fish while taking the drug." Foods containing tyramine, such as smoked meat or fish, can interact with linezolid and lead to an increase in blood pressure. Therefore, the nurse should instruct the patient to avoid meat until the therapy is completed. Yogurt does not interact with linezolid; therefore, the patient need not be asked to avoid eating yogurt. There is no evidence of citrus fruits interacting with linezolid and producing any adverse effects. Fiber-rich foods do not interact with linezolid. Moreover, patients are advised to take fiber-rich food with the drug to reduce blood pressure by reducing cholesterol levels.
A nurse is counseling a patient who is taking neomycin to prevent drug-induced superinfections. What advice should the nurse provide? "Eat yogurt." "Drink milk." "Eat eggs daily." "Eat green leafy vegetables."
"Eat yogurt." Antibiotic-induced superinfections are antibiotic-associated adverse effects. Neomycin may cause a superinfection; therefore, the patient should be instructed to consume buttermilk or yogurt to prevent this complication. Drinking milk or eating eggs and green leafy vegetables does not help prevent antibiotic-associated superinfections induced by neomycin. These foods do not affect the action of neomycin; neither do they prevent its adverse effects. p. 636
What should the nurse inform a patient about allergic reactions to an antibacterial drug? "Allergic reactions always manifest as urticaria or pruritus." "An allergic reaction will only occur after the first dose of medication." "Any adverse effect of an antibacterial is considered an allergic reaction." "Stop taking the medication immediately at the first sign of an allergic reaction."
"Stop taking the medication immediately at the first sign of an allergic reaction." If an allergic reaction occurs, the patient should stop taking the drug and report to the primary health care provider immediately. Possible reactions include anaphylaxis, skin rashes, urticaria, or bronchospasm. Allergic reactions are not limited to urticaria or pruritus and may also manifest as rashes or shortness of breath. These reactions are possible after either the first or the successive doses of a medication. An allergy is a side effect of a medication. p. 634
A primary health care provider prescribes an antacid to a patient who is taking ciprofloxacin. What information should the nurse mention while counseling the patient? "Take both drugs simultaneously." "Take the drug on an empty stomach." "Take the antacid every alternate day." "Take the antacid 2 hours before the drug."
"Take the antacid 2 hours before the drug." The nurse should instruct the patient to take the antacid 2 hours before taking ciprofloxacin to improve the drug's absorption. Ciprofloxacin causes gastric irritation when administered on an empty stomach. The antacids should not be taken on alternate days, because this may not help prevent gastrointestinal problems. Ciprofloxacin interacts with antacids, and this decreases the absorption of the ciprofloxacin.
Which instruction to a patient prescribed nitrofurantoin is most important to facilitate adherence to the therapeutic regimen? "Report tingling and numbness." "Take all pills in the prescription." "Watch for jaundice, itching, or rash." "Take the medication with meals or milk."
"Take the medication with meals or milk." Gastrointestinal (GI) disturbances, such as anorexia and vomiting, are common during nitrofurantoin therapy. The nurse instructs the patient to take this medication with food, milk, or other fluids to decrease those symptoms. If symptoms such as nausea and anorexia continue, the patient is less likely to continue the therapy. Tingling or numbing sensations indicate peripheral neuropathy. Instructing the patient to take all pills will not facilitate adherence if the patient is not advised how to counter the adverse effects. Jaundice and rash indicate toxic effects to the liver. p. 636
A patient on antibiotic therapy needs drug trough levels drawn. Which is the most appropriate time for the nurse to draw the trough level? 10 minutes before administration of the intravenous antibiotic 60 minutes after completion of the intravenous antibiotic infusion 30 minutes after beginning administration of the intravenous antibiotic 90 minutes after the intravenous antibiotic is scheduled to be administered
10 minutes before administration of the intravenous antibiotic Trough levels are drawn just before infusion. Peak serum drug levels should be drawn 30 to 60 minutes after the medication is infused. The nurse should document the time drug administration is started and completed and the exact time a peak and/or trough level is drawn.
A nurse is reviewing a patient's laboratory reports and finds the serum concentration of amikacin to be normal. What value did the nurse observe? 10 mcg/mL 16 mcg/mL 32 mcg/mL 41 mcg/mL
16 mcg/mL A serum concentration of 15 to 30 mcg/mL is considered the normal concentration of amikacin. Because the nurse concludes that the patient had a normal concentration of amikacin in the blood, it is likely that the patient had a serum concentration value of 16 mcg/mL. A value of 10 mcg/mL is considered to be a subtherapeutic concentration, and 32 and 41 mcg/mL are considered to be toxic concentrations. 625
In which solution should the nurse infuse quinupristin before administering it to a patient with a staphylococcal infection? 5% saline solution 5% heparin solution 10% heparin solution 5% dextrose in water (D 5W)
5% dextrose in water (D 5W) Quinupristin should be given as an infusion with D 5W, because they are compatible. Quinupristin cannot be mixed with 5% saline solution or 5% or 10% heparin solutions, including flushes, because the drug interacts with saline and heparin. This interaction can precipitate the drug and cause adverse effects.
Which patient is a potential candidate for antibiotic therapy involving aminoglycoside? A patient with increased serum creatinine levels A patient with Pseudomonas aeruginosa pneumonia A patient with a history of neuromuscular dysfunction A patient with elevated serum alanine aminotransferase
A patient with Pseudomonas aeruginosa pneumonia Pseudomonas aeruginosa pneumonia, or P. aeruginosa, is susceptible to treatment with amikacin, gentamicin, or tobramycin; the patient with this infection is a suitable candidate for aminoglycoside therapy. Neuromuscular dysfunction and increased serum creatinine levels are adverse effects of aminoglycoside therapy. Elevated serum alanine aminotransferase may indicate a liver problem; therefore, aminoglycoside therapy is contraindicated, because it may cause toxicity.
Which antibiotic is the drug of choice for the treatment of anthrax? Gentamicin Daptomycin Vancomycin Ciprofloxacin
Ciprofloxacin Ciprofloxacin is the drug of choice for the treatment of anthrax, which is caused by Bacillus anthracis. Gentamicin is the drug of choice for the treatment of staphylococcal infections. Daptomycin is used to treat complicated skin and soft-tissue infections caused by susceptible gram-positive bacteria. Vancomycin is the antibiotic of choice for the treatment of methicillin-resistant Staphylococcus aureus infection and infections caused by many other gram-positive bacteria.
What should the nurse use to help prevent ototoxicity in a patient receiving gentamicin? A peak level A trough level 0.9% NaCl solution Baseline renal function Baseline hearing acuity Super infection prevention
A trough level Baseline renal function Baseline hearing acuity The risk of ototoxicity associated with gentamicin increases when the trough level (the lowest circulating level of the medication during its administration) of the drug exceeds the range of normal values. Peak levels are not used to monitor toxicity, because elevations in peak levels are short-lived; assessment of peak levels helps to guide decisions about therapeutic dose ranges. Poorly functioning kidneys eliminate gentamicin more slowly, thus allowing excessively high serum levels of gentamicin to circulate for a longer time. Baseline hearing assessment data is important to establish for use in the early detection of hearing impairment. A peak trough level, 0.9% NaCl as diluents, and super infections are not related to the prevention of ototoxicity in patients receiving gentamicin.
The nurse is assessing a patient with pneumonia who is prescribed amikacin. After reviewing the medication history, the nurse finds that the patient is taking anticoagulants. For what should the nurse primarily monitor in the patient? Abnormal bleeding Venous thrombosis Impaired consciousness Burning sensation of feet
Abnormal bleeding Anticoagulants are given to prevent the formation of a clot or thrombus. When they are combined with an aminoglycoside they cause anticoagulant toxicity by inhibiting the action of vitamin K in the body. Therefore, the nurse should check for abnormal bleeding in a patient who is administered both amikacin and anticoagulants. Formation of a thrombus is prevented by anticoagulants, and their effects are not decreased by the concomitant administration of amikacin. Loss of consciousness is not caused by amikacin or by a drug interaction with anticoagulants. A burning sensation of the feet is a symptom of paresthesia, which is a rare side effect caused by prolonged use of amikacin but it is not related to anticoagulants.
A patient with a severe urinary tract infection is prescribed amikacin and penicillin. What administration process will the nurse be asked to implement? Administer penicillin followed by amikacin. Administer amikacin first and then penicillin. Administer amikacin orally and penicillin intravenously. Administer both amikacin and penicillin simultaneously.
Administer penicillin followed by amikacin. Penicillin is administered first, because it breaks the bacterial cell wall. Then amikacin is administered; this drug destroys the bacterial cell, thereby enhancing the effect of the antibiotic. Amikacin can be administered only via the intravenous and intramuscular routes. The nurse should not infuse the drugs simultaneously, because this would not be as effective in treating the severe infection. Beta-lactam antibiotics are initially administered to enhance the drug's activity against microbes. p. 626
The laboratory reports of a patient confirm the presence of Enterobacter aerogenes infection. A nurse finds that the patient has a history of infection that was resistant to gentamicin and tobramycin. Which medication will the nurse expect the primary health care provider to prescribe to the patient? Linezolid Amikacin Neomycin Streptomycin
Amikacin Amikacin is a semisynthetic aminoglycoside antibiotic that is often used to treat infections that are resistant to gentamicin or tobramycin. Hence, in this patient the Enterobacter aerogenes infection is treated with amikacin. Linezolid is not used to treat E. aerogenes infections; instead it is used in infections caused by various Staphylococcus and Streptococcus species. Neomycin is not used to treat E. aerogenes infections. Streptomycin is active against Mycobacterium spp., but is not used in patients who are resistant to gentamicin and tobramycin. pp. 626, 627
The nurse is assessing a patient who has a bone infection who has been prescribed clindamycin. The primary health care provider also has prescribed vecuronium for the patient's persistent pain. Which intervention will the nurse perform to ensure the patient's safety? Elevate the patient's legs. Provide support to the patient's hip. Rub the patient's foot continuously. Assess the patient's respiratory rate.
Assess the patient's respiratory rate. Clindamycin has neuromuscular-blocking properties, and when administered with vecuronium (neuromuscular blockade), it may cause respiratory paralysis. Therefore, the nurse should regularly monitor the patient's respiratory rate and provide ventilation support if required. The patient's legs are elevated to prevent clot formation, which is not a side effect of clindamycin. The nurse should support the patient's hip in conditions such as supine hypotension, which is not a side effect of these drugs. The patient's feet are rubbed to aid in thermoregulation, which has no relation to these drugs. p. 630
What does the nurse assess before starting antibacterial therapy for a patient? Fluid status Baseline vital sign values Cardiac history Hypersensitivity Neurologic abnormalities
Baseline vital sign values Cardiac history Hypersensitivity Neurologic abnormalities Baseline vital sign values are important for the nurse to assess prior to administration of antibiotics. Antibiotics have been associated with serious hypersensitivity reactions, including cardiac arrest; it is therefore important to assess the patient's cardiac history. The nurse assesses the presence of any neurologic abnormalities to prevent any adverse effects of the antibacterial therapy on the central nervous system. Fluid status is monitored once the therapy begins, because the patient needs to increase fluid intake in case of nephrotoxicity.
A nurse is caring for a patient who has hepatic encephalopathy who is prescribed neomycin. What laboratory reports will the nurse evaluate to ensure optimum drug activity? Blood glucose concentration Blood ammonia concentration Serum creatinine concentration Blood cholesterol concentration
Blood ammonia concentration In hepatic encephalopathy, neomycin helps reduce the number of ammonia-producing bacteria in the gastrointestinal tract. A reduced blood ammonia concentration indicates improvement of neurologic symptoms of the patient's hepatic illness. Neomycin does not affect blood glucose, serum creatinine, or blood cholesterol concentrations. p.628
A patient is prescribed levofloxacin for the treatment of a bacterial infection. During the assessment, the nurse finds that the patient is taking calcium supplements. The nurse instructs the patient to take the calcium supplements at least 1 hour after taking levofloxacin. What could be the reason for this? Calcium supplements interfere with levofloxacin absorption. Calcium supplements increase the serum concentration of levofloxacin. Calcium supplements antagonize the antibacterial activity of levofloxacin. Calcium supplements and levofloxacin interact, affecting the intestinal flora.
Calcium supplements interfere with levofloxacin absorption. Levofloxacin is a quinolone antibiotic. Calcium supplements interfere with levofloxacin absorption and reduce oral absorption of levofloxacin. Therefore, the nurse instructs the patient to take calcium supplements at least 1 hour before or after taking levofloxacin to prevent this interaction. Calcium supplements do not increase the serum concentration of levofloxacin. Calcium supplements do not antagonize the antibacterial activity of levofloxacin. Nitrofurantoin interacts with levofloxacin and antagonizes its antibacterial activity. The interaction between calcium supplements and levofloxacin does not affect the intestinal flora. Oral anticoagulant and levofloxacin interaction affects the intestinal flora. pp. 629, 636
A patient is scheduled for a computed tomography (CT) scan. The nurse notifies the primary health care provider that the patient is receiving treatment with amikacin. What instruction will the primary health care provider give to the nurse after completion of the CT scan? Check the patient's blood glucose concentrations. Check the patient's blood ammonia concentrations. Check the patient's serum thyroxine concentrations. Check the patient's serum creatinine concentrations.
Check the patient's serum creatinine concentrations. Amikacin is an aminoglycoside associated with serious adverse effects such as ototoxicity and nephrotoxicity. The risk of nephrotoxicity increases with the use of other nephrotoxic drugs, such as cyclosporine and the intravenous contrast used during CT scans. An increasing serum creatinine concentration suggests reduced creatinine clearance by the kidneys and is indicative of declining renal function. Hence, to determine whether to adjust the dose of the amikacin, the primary health care provider instructs the nurse to check the patient's serum creatinine concentration. Checking the blood glucose concentration is important but is not associated with the administration of amikacin. Blood ammonia concentrations are checked with neomycin therapy but not amikacin. Serum thyroxine concentrations are not affected by amikacin. pp. 627, 634
Which antibiotic does the nurse administer if the culture of a patient with bacterial endocarditis reveals the presence of gram-positive streptococcus? Amikacin Gentamicin Tobramycin Clindamycin
Clindamycin Clindamycin is effective against streptococcus because it is a protein-synthesis inhibitor, but it may be reserved for use after other antibiotic treatments have failed. The aminoglycoside indicated in the treatment of streptococcus is streptomycin. Amikacin is used in the treatment of tuberculosis caused by mycobacterium tuberculosis. Gentamicin is used in the treatment of gram-negative infections. Tobramycin is used to treat viral infections, like pulmonary infections. pp. 630, 631
Which antibiotic can be used against several anaerobic organisms? Daptomycin Quinupristin Clindamycin Nitrofurantoin
Clindamycin is active against several anaerobic organisms. Daptomycin is used for treatment of infections caused by gram-positive organisms. Quinupristin is used for skin infections caused by streptococcal and staphylococcal infections. Nitrofurantoin is used for urinary tract infections caused by gram-negative organisms and Staphylococcus aureus. p. 630
To prevent a serious complication of the therapy in a patient who is taking linezolid, which laboratory parameter should the nurse monitor? Hepatotoxicity Complete blood count Serum creatinine level Peak and trough drug levels
Complete blood count
The primary health care provider prescribes levofloxacin to treat a patient's urinary tract infection. What foods will the nurse instruct the patient to avoid during the course of the therapy? Sugary foods Dairy products Fiber-rich foods Protein-rich foods
Dairy products Levofloxacin is a quinolone antibiotic. When taken with dairy products, the absorption of quinolones may decrease. Hence, the nurse instructs the patient to reduce the intake of dairy products during quinolone therapy. Foods rich in sugar, fiber, and proteins do not affect absorption of quinolones. Thus, these foods can be eaten when the patient is receiving quinolone therapy.
The primary health care provider instructs a nurse to administer intravenous vancomycin. During infusion, the patient has excessive sweating, flushes on the neck and head, and reports itching on the head, face, and upper trunk. What is the best nursing intervention in this situation? Increase the rate of infusion of vancomycin. Decrease the rate of infusion of vancomycin. Stop the administration of the vancomycin infusion. Advise the patient to get the blood pressure checked.
Decrease the rate of infusion of vancomycin. Rapid infusion of vancomycin results in red man syndrome. This syndrome is characterized by flushing and itching of the head, face, neck, and upper trunk. It is most commonly seen when the drug is infused too rapidly. The symptoms of red man syndrome can usually be alleviated by slowing the rate of infusion of the dose to at least 1 hour. Rapid infusions of vancomycin may cause hypotension; hence the patient sweats excessively. Rapid administration of the vancomycin infusion worsens the itching and hypotension. Stopping the administration of the vancomycin infusion may worsen the methicillin-resistant Staphylococcus aureus infection. Checking the blood pressure is a secondary intervention and is done once the patient is stabilized. 633
The nurse is assessing a patient who is prescribed metronidazole for amoebiasis. What is the most relevant question asked by the nurse before administering the drug to the patient? "Did you eat fish at your last meal?" "Did you drink milk in the morning?" "Did you consume soy sauce within the past 1 hour?" "Did you consume alcohol within the past 24 hours?"
Did you consume alcohol within the past 24 hours?" The nurse should ask the patient about alcohol intake before administering metronidazole, because it causes potential drug interactions, causing acetaldehyde (metabolite of alcohol) toxicity in the body. Therefore, it may cause a disulfiram-like reaction (i.e., severe vomiting). Fish and soy sauce would slow down the absorption of linezolid by interacting with it. However, they do not interact with metronidazole. Milk does not interact with metronidazole. However, milk does slow the absorption of quinolones. 632
A patient who is prescribed intravenous (IV) vancomycin reports frequent ringing in the ears. Which condition should the nurse suspect? Red man syndrome Probable convulsion Early vestibular damage Ineffective antibiotic therapy
Early vestibular damage Frequent ringing in the ears, or tinnitus, is an adverse effect of vancomycin. Red man syndrome is more likely to occur when the drug is infused too rapidly. Convulsion is an adverse effect of quinolones. Secondary infection can be caused by ineffective antibiotic therapy, not vestibular damage.
Which action will the nurse implement when administering colistimethate sodium via inhalation? Administering diphenhydramine initially Informing the patient that it will not taste bitter Ensuring that emergency equipment is near the patient Monitoring the patient for increased bruising or bleeding
Ensuring that emergency equipment is near the patient One of the critical adverse effects of colistimethate sodium is renal failure; therefore, the nurse ensures that emergency equipment, including an airway and oxygen, are near the patient when administering colistimethate sodium through inhalation. Diphenhydramine is a hypnotic drug used for treating histamine-mediated allergies, motion sickness, and sleep promotion. Bruising and bleeding, rashes and allergic reactions, and a bad taste are not associated with the inhalational administration of this medication. pp. 630-631
Which microbe is included in the spectrum of antimicrobial activity for the drug amikacin? Yersinia pestis Escherichia coli Salmonella species Citrobacter species
Escherichia coli Amikacin is active against Escherichia coli and Acinetobacter species. Streptomycin is active against Yersinia pestis. Gentamicin is active against Salmonella species. Tobramycin is active against Citrobacter species. p. 626
Which actions does the nurse take if a patient who underwent heart transplantation has septicemia and is receiving quinupristin, dalfopristin, and cyclosporine? Checking the cardiac rhythm hourly Evaluating the serum cyclosporine level Monitoring the site of antibiotic infusion Preparing to adjust the cyclosporine dosage
Evaluating the serum cyclosporine level When the nurse administers a combination of quinupristin/dalfopristin and cyclosporine, the nurse evaluates the cyclosporine level; this combination medication is likely to increase the serum cyclosporine level, possibly leading to renal toxicity. Periodic examination, not hourly, of the cardiac rhythm is reasonable; impaired renal function may lead to hyperkalemia, evidenced by dysrhythmias. Depending on the cyclosporine level and renal function, the cyclosporine dosage may be adjusted. Therapy with quinupristin and dalfopristin is associated with pain, inflammation, and thrombophlebitis at the infusion site. p. 633
Which antibiotic binds to 30S ribosomes to prevent protein synthesis in bacteria? Gentamicin Clindamycin Ciprofloxacin Nitrofurantoin
Gentamicin Aminoglycosides such as gentamicin bind to ribosomes, specifically the 30S ribosome, and thereby prevent protein synthesis in bacteria. Clindamycin binds to the 50S subunit of the prokaryotic ribosome, preventing formation of the initiation complex for protein synthesis. Quinolones such as ciprofloxacin act by interfering with the bacterial enzymes DNA gyrase and topoisomerase IV. Nitrofurantoin acts by interfering with the activity of enzymes that regulate bacterial carbohydrate metabolism and by disrupting bacterial cell wall formation. p. 626
A primary health care provider has prescribed neomycin to a patient with hepatic encephalopathy. What should the nurse check before administering the drug to the patient? Thyroxine concentration Adrenaline concentration Glucose concentration in urine Glomerular filtration rate (GFR)
Glomerular filtration rate (GFR) Neomycin causes nephrotoxicity as an adverse effect. Therefore, monitoring the serum creatinine concentration and checking the GFR determines drug concentrations. This in turn helps adjust the dosage for the patient. Thyroxine concentration is monitored to check the function of the thyroid gland; neomycin has no adverse effect on the thyroid gland. Adrenaline concentrations are not altered by infusion of neomycin. Thus the nurse need not check the patient's adrenaline concentration. Glucose concentration in urine is altered in patients with diabetes. However, this is not an adverse effect associated with neomycin.
The nurse is assessing a patient who is being treated with amikacin. The patient has increased serum creatinine concentrations, for which loop diuretics are prescribed. What will the nurse primarily monitor in the patient? Orientation Hearing ability Glucose concentrations Serum bilirubin concentrations
Hearing ability When administered with aminoglycosides, loop diuretics may increase the risk of ototoxicity, so the nurse should monitor the patient's hearing ability. Orientation is not affected by the interaction of amikacin and loop diuretics. Glucose concentrations in the body are not altered by aminoglycosides or amikacin. Serum bilirubin is an indicator of liver function, which is not affected by amikacin or loop diuretics. p. 627
For which adverse effect should the nurse be alert in a patient who is taking tobramycin as an antibiotic therapy? Nausea Confusion Hearing loss Pain on injection
Hearing loss Tobramycin belongs to the class of aminoglycosides, whose adverse effects may cause hearing loss or ototoxicity. Pain on injection is an adverse effect of gonadotropin-releasing hormone (GnRH) agonists. Confusion is an adverse effect of interferons. Nausea is an adverse effect of antineoplastic drugs.
The nurse administers ampicillin to a patient who also receives tobramycin. Which condition may occur with this concomitant pharmacotherapy? Red man syndrome Impaired renal function Drug-resistant organism Infusion site inflammation
Impaired renal function Ampicillin and tobramycin have a tendency to cause renal dysfunction. Administering both medications at the same time can lead to renal impairment through enterococcal infection. Vancomycin is responsible for causing red man syndrome. Properly administered combination therapy with penicillin and an aminoglycoside is not associated with the development of drug-resistant organisms; however, prevention of the development of drug-resistant organisms is always a nursing goal. The nurse ensures that the infusion site remains protected to help prevent interruptions in therapy. 627, 634
The nurse administers ampicillin to a patient who also receives tobramycin. Which condition may occur with this concomitant pharmacotherapy? Red man syndrome Impaired renal function Drug-resistant organism Infusion site inflammation
Impaired renal function Ampicillin and tobramycin have a tendency to cause renal dysfunction. Administering both medications at the same time can lead to renal impairment through enterococcal infection. Vancomycin is responsible for causing red man syndrome. Properly administered combination therapy with penicillin and an aminoglycoside is not associated with the development of drug-resistant organisms; however, prevention of the development of drug-resistant organisms is always a nursing goal. The nurse ensures that the infusion site remains protected to help prevent interruptions in therapy.
A patient with a methicillin-resistant Staphylococcus aureus (MRSA) infection is prescribed vancomycin. The nurse collects a blood sample from the patient before administering the second dose of the drug and finds the serum drug concentration is 8 mcg/mL. What change will the nurse expect in the primary health care provider's prescription? Rapidly infuse the vancomycin Increase the dose of vancomycin Stop the administration of vancomycin Replace vancomycin with another antibiotic
Increase the dose of vancomycin The blood concentration of vancomycin is 8 mcg/mL. This indicates that the dose of the drug is less than that required to achieve therapeutic effects. Optimal blood concentrations of vancomycin are 18 to 50 mcg/mL (peak concentration) and 10 to 20 mcg/mL (trough concentration). Hence, the primary health care provider should increase the dose of vancomycin to reach a therapeutic concentration and obtain the desired effects. The nurse should not rapidly infuse vancomycin, because it may result in red man syndrome and hypotension. The nurse should not stop administrating vancomycin, because it may worsen the MRSA infection. The nurse does not observe any side effects associated with vancomycin in the patient. Therefore, replacing vancomycin with another medicine is not required. 633
A patient with asthma is prescribed prednisone. The primary health care provider has also prescribed levofloxacin for the treatment of a hospital-acquired urinary tract infection. For what will the nurse primarily check after administering the drugs? Joint pain Abdominal pain Reduced appetite Reduced respiratory rate
Joint pain Prednisone interacts with levofloxacin and causes tendinitis, which causes joint pain. Thus, the nurse should regularly monitor whether the patient has developed joint pain. Pain in the abdomen and reduced appetite are not adverse effects or effects caused by the interaction of levofloxacin and prednisone. Respiratory rate is reduced by prednisone. However, levofloxacin does not aggravate respiratory depression. 629
Which antibiotic is used in patients who have infections of the eyes, ears, or skin and for suppressing bowel flora before bowel surgery? Amikacin Neomycin Gentamicin Tobramycin
Neomycin Neomycin is an antibiotic commonly used for bacterial decontamination of the gastrointestinal (GI) tract before any surgical procedures and can be administered orally, topically, and rectally. Neomycin is used to treat eye, ear, and skin infections. Amikacin is used to treat infections resistant to neomycin and gentamicin. Tobramycin is one of the most common antibiotics for the treatment of recurring pulmonary infections in patients with cystic fibrosis. Gentamicin is an aminoglycoside antibiotic, administered intravenously or intramuscularly for the treatment of susceptible gram-positive and gram-negative bacteria. p. 627
After prescribing an aminoglycoside antibiotic to a patient with an enterococcal infection, the primary health care provider tells the nurse to administer the drug by the rectal route. Which drug will the nurse find in the patient's prescription? Amikacin Neomycin Levofloxacin Ciprofloxacin
Neomycin The medications that are available in the form of suppositories and enemas should be administered via the rectal route. Neomycin is an aminoglycoside that is available as an enema. Amikacin is available in a parental form, so it can be administered by either the intravenous route or intramuscular route. Levofloxacin and ciprofloxacin belong to the fluoroquinolone class of drugs. Therefore, the nurse would not find amikacin, or levofloxacin, or ciprofloxacin in the patient's prescription.
A patient who is scheduled for an appendectomy has been prescribed neomycin by the primary health care provider. Which nursing action is most suitable in this situation? Oral administration of neomycin after the surgery Oral administration of neomycin before the surgery Topical administration of neomycin after the surgery Topical administration of neomycin before the surgery
Oral administration of neomycin before the surgery Neomycin is the most commonly used aminoglycoside for bacterial decontamination of the gastrointestinal tract. Because it is used to decontaminate the body of bacteria, it is administered before surgical procedures, and it is given both orally and rectally (as an enema) for this purpose. Administration of neomycin through the oral route after the surgery is of no use; after the surgery there is no need for bacterial decontamination. Administration of neomycin through the topical route before the surgery removes the bacteria on the external body parts but does not clean the internal bacteria. Topical administration of neomycin after the surgery is of no benefit because the surgery has already been done. pp. 627-628
Which patients are at the highest risk of developing tendinitis from the use of quinolones? Patients with liver failure Patients with ulcerative colitis Patients on glucocorticoid therapy Patients who eat food that contains tyramine
Patients on glucocorticoid therapyTendinitis is the inflammation of tendons and may be caused by the use of quinolones. Incidence of tendinitis and tendon rupture increases with the use of quinolones together with glucocorticoids. It is more common in patients with renal failure, not liver failure, because of compromised kidney function and resulting accumulation of the drug. Patients with ulcerative colitis should use clindamycin cautiously. Patients taking linezolid are at risk of hypertension if they eat food that contains tyramine. 629
Which action should the nurse take if a patient receiving intravenous vancomycin complains of facial pruritus? Give diphenhydramine with the infusion Wrap the infusion in foil to protect it from light Program the vancomycin to infuse at a slower rate Document that the patient has a hypersensitivity reaction
Program the vancomycin to infuse at a slower rate The nurse infuses vancomycin over at least 1 hour, because rapid infusion can cause red man syndrome. It is indicated by flushing or itching of the face, neck, and trunk, as well as more serious problems like tachycardia and hypotension. Diphenhydramine is an anticholinergic drug used for treating histamine-mediated allergies and motion sickness and to promote sleep. Orally disintegrating medicines are wrapped in foils that, once administered, dissolve on the patient's tongue. Pruritus in a patient taking vancomycin is more an indication of red man syndrome than hypersensitivity.
Which infections are treated with metronidazole? Protozoans Clostridium Bacteroides Streptococcus Escherichia coli
Protozoans Clostridium Bacteroides Streptococcus Metronidazole is indicated for use against infections involving anaerobic bacteria, including Clostridium, Streptococcus, and Bacteroides, and against other pathogens, including protozoans. Gram-negative infections, such as Escherichia coli, are treated with aminoglycosides.
What is the most common adverse effect of the drug vancomycin when it is infused too rapidly? Hearing loss Kidney damage Red man syndrome Acute respiratory failure
Red man syndrome Red man syndrome is characterized by flushing and/or itching of the head, face, neck, and upper trunk area. It is the most common adverse effect of vancomycin when the drug is infused too rapidly. Hearing loss and kidney damage are adverse effects that occur if the blood levels of the drug are too high. Colistimethate is a polypeptide antibiotic that may cause respiratory failure when administered by inhalation. p. 633
The primary health care provider prescribes vancomycin to a patient who has a streptococcal infection. What will the nurse assess in the patient to ensure safe administration of the drug? Skin integrity Renal function Red blood cell count Blood glucose concentration
Renal function Vancomycin is a tricyclic glycopeptide, which causes nephrotoxicity. Therefore, the nurse should check the patient's renal function before administering vancomycin. Renal impairment may lead to severe toxicity. The dosing frequency of vancomycin is dependent on renal function. Therefore, it is important to check the patient's renal function. Vancomycin does not affect skin integrity, red blood cell counts, or blood glucose concentration; therefore, the nurse need not check these in the patient.
Which parameter is most important to assess before administering vancomycin to a patient? Platelet count Liver function Renal function Hemoglobin level
Renal function Vancomycin should be used cautiously in patients with preexisting renal dysfunction. Platelet count is done before administering linezolid. Liver function should be assessed before administering nitrofurantoin. Hemoglobin levels should be assessed before administering antibiotics.
Which laboratory reports should the nurse evaluate if the patient is administered vancomycin and tobramycin? Serum glucose Serum creatinine Prothrombin time Serum electrolytes
Serum creatinine There is a risk of a drug interaction resulting in ototoxicity and nephrotoxicity when vancomycin is given concurrently with aminoglycosides. For this reason, the nurse should evaluate serum creatinine reports to assess kidney function. Concomitant administration of vancomycin and tobramycin does not necessitate monitoring of serum glucose, prothrombin time, or serum electrolytes.
While reviewing the blood reports of a patient who is on amikacin therapy, the nurse finds that the serum drug concentration is 4 mcg/mL. What further laboratory reports will the nurse check to ensure the patient's safety? Blood platelet count Blood glucose concentration Serum thyroxine concentration Serum creatinine concentration
Serum creatinine concentration Amikacin is an aminoglycoside antibiotic. Aminoglycosides have the potential to cause nephrotoxicity, and thus the patient's serum drug concentrations should be monitored regularly. The usual serum drug concentration of aminoglycosides is expected to be less than or equal to 1 mcg/mL (considered as the safe range). Concentrations higher than this may cause adverse effects. Therefore, the nurse should check the serum creatinine concentration to evaluate proper renal function.
The nurse is assessing a patient who has tuberculosis-associated plague. Which medication will the nurse expect the primary health care provider to prescribe? Amikacin Gentamicin Tobramycin Streptomycin
Streptomycin Streptomycin is used to treat tuberculosis; it kills the bacteria Mycobacterium tuberculosis. Streptomycin also is used to treat plague that is caused by the bacteria Yersinia pestis. Hence, to reduce the risk factors for both tuberculosis and plague, the primary health care provider prescribes streptomycin, an aminoglycoside. Tuberculosis and plague are not cured by other aminoglycosides such as amikacin, gentamicin, and tobramycin. These drugs do not affect the bacteria M. tuberculosis and Y. pestis.
The nurse has administered the morning dose of tobramycin to a patient according to the prescription. In the evening, the nurse collects a blood sample from the patient and observes that the serum drug concentration is greater than 2 mcg/mL. What does the nurse infer from this? The patient is at risk for heartburn. The patient is at risk for nasal congestion. The patient is at risk for renal dysfunction. The patient is at risk for red man syndrome.
The patient is at risk for renal dysfunction. The safe therapeutic serum concentration of tobramycin is less than or equal to 1 mcg/mL (which is undetectable in blood tests). Serum concentration of the drug greater than 2 mcg/mL is associated with greater risk for both ototoxicity and nephrotoxicity (renal dysfunction). Increased serum concentrations of this drug cause increased serum creatinine concentrations. This indicates declining renal function. Heartburn is an adverse effect of quinolones. The use of metronidazole is associated with nasal congestion and red man syndrome, which is characterized by flushing and/or itching of the head, face, neck, and upper trunk area and is an adverse effect of vancomycin. p. 625
The nurse is caring for multiple patients receiving antibiotics. Which patient will the nurse assess first? The patient who is taking amikacin with furosemide The patient who is taking ciprofloxacin and is 18 years old The patient who is taking clindamycin and has gastric upset The patient who just started azithromycin therapy and has a fever
The patient who is taking amikacin with furosemide The risk of ototoxicity with amikacin is increased for patients taking furosemide. The nurse should assess this patient first. Ciprofloxacin is recommended for patients 18 years and older. Gastric upset is common with this antibiotic. A patient who has started antibiotic therapy would be expected to have a fever. p. 627
Why should the nurse assess a patient's serum creatinine level before starting antibiotic therapy? To assess liver function To assess renal function To assess cardiac function To assess neurologic function
To assess renal function Serum creatinine levels should be measured to assess renal function before a patient starts antibiotic therapy. A patient's aspartate aminotransferase level is assessed to determine liver function. Cardiac enzyme levels are measured to assess cardiac function. Several parameters, such as motor function, sensory function, and vital signs, are assessed to determine neurologic function.
A primary health care provider instructs a nurse to administer vancomycin to a patient. The nurse administers intravenous vancomycin to the patient over 1 hour. Why will the nurse do this? To prevent edema To prevent hemolysis To prevent hypotension To prevent abdominal flatulence
To prevent hypotension
A primary health care provider instructs a nurse to administer vancomycin to a patient. The nurse administers intravenous vancomycin to the patient over 1 hour. Why will the nurse do this? To prevent edema To prevent hemolysis To prevent hypotension To prevent abdominal flatulence
To prevent hypotension Rapid infusion of vancomycin may precipitate hypotension as well as cause red man syndrome. Therefore, intravenous vancomycin should be infused slowly. Vancomycin does not cause edema during administration. However, edema may be observed because of nephrotoxicity when the drug is given in excess. Hemolysis and abdominal flatulence are not major effects observed during infusion of vancomycin. Vancomycin does not affect the structural integrity of red blood cells. Abdominal flatulence is a common adverse effect associated with quinolones.
A nurse is assessing a patient who has pneumonia and is receiving aminoglycoside therapy. The nurse continues sending the patient's blood samples to be checked for drug concentrations for another 1 week after the patient recovers. What is the reason for checking the serum drug concentrations after the patient's recovery? To prevent hepatoxicity To prevent neurotoxicity To prevent cardiotoxicity To prevent nephrotoxicity
To prevent nephrotoxicity The serum concentrations of the aminoglycosides are monitored even after the patient's recovery to ensure that the patient is not experiencing any adverse effects of the drug. Nephrotoxicity is an adverse effect of aminoglycosides. Hepatotoxicity, cardiotoxicity, and neurotoxicity are not side effects of aminoglycosides. pp. 620, 634
Why should the nurse administer gentamicin intravenously to a patient over a period of 60 minutes or longer? To prevent infiltration To prevent hepatotoxicity To prevent nephrotoxicity To prevent neuromuscular blockade
To prevent neuromuscular blockade The nurse dilutes gentamicin and administers it intravenously over a period of 30 to 60 minutes to prevent neuromuscular blockade as a result of toxic serum levels. The side effects of this antibiotic do not involve symptoms such as infiltration, hepatotoxicity, and nephrotoxicity. p. 634
The nurse is assessing a patient who has cystic fibrosis who has developed a pulmonary infection. Which inhalational medication should the nurse expect the primary health care provider to prescribe for this patient? Amikacin Neomycin Gentamicin Tobramycin
Tobramycin Tobramycin is an aminoglycoside drug that is administered through the inhalation route for the treatment of pulmonary infections caused by cystic fibrosis. Amikacin, neomycin, and gentamicin are administered through the intravenous or intramuscular routes. They are not inhaled to treat pulmonary infections caused by cystic fibrosis.
