Chapter 9: Antibiotics
The nurse would contact the physician if ciprofloxacin was prescribed for which client diagnosed with a urinary tract infection?
A 13-year-old client Explanation: Ciprofloxacin should be avoided in children and adolescents under the age of 18 unless the urinary tract infection is extremely severe. Ciprofloxacin may be used in other age groups.
Which of the following should be included in the nurse's pre-administration assessment prior to a client receiving a penicillin? Select all that apply.
Allergy history Medical history Medication history Current symptoms Explanation: An allergy history, medical and surgical history, medication history, and the current symptoms of the infection should be included in the nurse's pre-administration assessment prior to a client receiving a penicillin.
Antibiotic drugs are commonly used in the pediatric population. Why would the tetracyclines be contraindicated in children younger than 8 years of age?
Because of the drugs effects on teeth and bone Explanation: Use tetracyclines with caution in children younger than 8 years of age because they can potentially damage developing bones and teeth; and in patients with hepatic or renal dysfunction because they are concentrated in the bile and excreted in the urine.Fluoroquinolones (e.g., ciprofloxacin [Cipro]) are generally contraindicated for use in children (<18 years of age) because weight-bearing joints have been impaired in young animals given the drugs. Clindamycin (Dalacin C) warrants monitoring liver and kidney function when it is given to neonates and infants. Trimethoprim-sulfamethoxazole (Nu-Cotrimox) is used in children, although children younger than 2 months of age have not been evaluated.
A client is diagnosed with VRE, and the health care provider orders chloramphenicol. The nurse should monitor the client for the development of which side effect?
Blood dyscrasias Explanation: Chloramphenicol (Chloromycetin) is rarely used due to the possible development of serious and fatal blood dyscrasias with its use. It is effective against some strains of VRE.
The client has been taking levofloxacin IV since admission 12 hours ago for a urinary tract infection. The nurse assesses the client's temperature at 99.8ºF. What is the nurse's best response?
Continue to monitor vital signs. Explanation: The provider should be notified if the client's temperature is greater than 101ºF. The nurse cannot discontinue or administer additional doses without a provider's order. The body's normal defense to infection is an elevated temp until it reaches 101 degrees. Only then would an antipyretic be given if ordered.
While the nurse is obtaining a drug history from a client, the client states an allergy to penicillin and an experience of a rash after taking cephalosporin. The nurse interprets this information as indicating which situation?
Cross-sensitivity Explanation: Once an individual is allergic to one penicillin, they are usually allergic to all of the penicillins. Those allergic to penicillin also have a higher incidence of allergy to the cephalosporins. Allergy to drugs in the same or related groups is called cross-sensitivity. Hypersensitivity is an allergic reaction to one substance. Anaphylactoid reaction is an unusual or exaggerated allergic reaction. Anaphylaxis or anaphylactic shock is a severe form of hypersensitivity that occurs immediately and can be fatal.
A client is receiving levofloxacin (Levaquin) IV. During an infusion, the client reports pain and the nurse notes a reddened area along the vein. What does the nurse suspect?
phlebitis Explanation: Tenderness, pain, and redness along the vein may indicate phlebitis or thrombophlebitis. Extravasation occurs when the fluids leak into the surrounding tissue. Adverse reactions and allergic reactions do not occur at the IV site.
A 7-year-old child has tonsillitis and is prescribed penicillin V, which is to be administered at home. The nurse will instruct the parents to administer the drug
with a glass of water 1 hour before or 2 hours after a meal. Explanation: The nurse should instruct the parents to administer penicillin V exactly as prescribed at regular intervals. Penicillin V should be taken on an empty stomach 1 hour before or 2 hours after a meal with a glass of water. Penicillin V should not be taken with meals because food may affect the absorption of the drug. Penicillin V is easy to administer in the home setting; it does not need to be given IV under the supervision of a home health nurse.
In preparation for discharge, the nurse is teaching a client about the prescription for telithromycin. The nurse should instruct the client to contact a health care provider if the client experiences:
yellowing of the eyes or skin. Explanation: Since telithromycin can cause liver dysfunction, clients taking the drug should contact a health care provider if they observe any potential symptoms. These may include yellowing of the eyes or skin, abdominal pain, nausea, vomiting, dark urine, pale stools, or unusual tiredness.
Which statement by a client taking a sulfonamide requires further instruction?
"I will make sure to use extra sunscreen when I go to the tanning booth." Explanation: Clients taking sulfonamides should avoid any exposure to sunlight or ultraviolet light, such as tanning beds or sunlamps. Extra sunscreen would not protect the client from the photosensitivity effect of the medication. The client is correct in stating that he would complete the entire course of the medication, would drink a full glass of water with each pill, and would take the medication with meals.
The client has been prescribed a fluoroquinolone. Which statement by the client indicates additional education is needed?
"If I cover my head, I will be protected from the sun." Explanation: It is important that the client's skin is protected from a sunburn reaction while taking fluoroquinolones. The client needs to wear a wide-brimmed hat and protect the skin from sun exposure, even on a cloudy day. All other responses demonstrate understanding.
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?
"The administration will decrease the growth of intestinal bacteria." Explanation: Neomycin can be given before bowel surgery to suppress intestinal bacterial growth. Neomycin when administered orally is poorly absorbed in the GI tract and so exerts local bactericide effect there. The administration of neomycin will not prevent renal damage or ototoxicity but can actually increase the risk. It will also not affect the risk of airborne contamination since is focused on local effects in the GI tract.
A client is scheduled for abdominal surgery and is ordered to receive neomycin. The client asks the nurse why this drug is prescribed. Which response by the nurse would be most appropriate?
"The drug helps eliminate bacteria so that your GI tract is as clean as possible for surgery." Explanation: Neomycin is used before surgery to reduce intestinal bacteria. It is thought that this reduces the possibility of abdominal infection that may occur after surgery on the bowel. By destroying bacteria in the gut and washing it out with laxatives or enemas, the surgical area becomes as clean as possible before the operation. The drug is not used to control an infection preoperatively. It does help to reduce blood ammonia levels with hepatic coma, but this is not the reason for its use with this client. The drug has no effect on preventing blood clots postoperatively.
A 15-year-old female client is receiving tetracycline for the treatment of severe acne. Which statement would the nurse make when teaching the client about this drug?
"When taking tetracycline, wear extra sunblock and watch for discoloration of your teeth." Explanation: While GI symptoms are most common with tetracyclines, photosensitivity and teeth discoloration are also adverse reactions that can occur. Suggesting a change in diet is not appropriate. Lab work is not required for daily dosing of this medication. Tetracycline can be taken orally, and the client is not required to remain hospitalized.
The client has been taking a fluoroquinolone and now reports that he has a white patch in his mouth. What is the best response of the nurse?
"You may be experiencing an additional infection. I will discuss this with your health care provider." Explanation: A burning sensation of the mouth or throat may be an indication of a superinfection. It is important the nurse notify the provider. The nurse should not minimize the client's concerns or cause panic.
A client has been prescribed 2 tablets of 150 mg isoniazid every day. The available drug is in the form of a 100-mg tablet. To meet the recommended dose, the nurse will administer _______ tablets each time.
3 Explanation: Required dosage is 2 tablets of 150 mg, meaning that the client needs to take in 300 mg of isoniazid daily. Available tablet contains 100 mg of the drug. Therefore, 3 tablets (100*3) of isoniazid need to be administered daily.
A client with a positive sputum culture for TB has been started on streptomycin antitubercular therapy. Upon review of the laboratory results, the nurse notes that the client may be experiencing toxicity if which of the following results is abnormal?
BUN and creatinine Explanation: Streptomycin can cause nephrotoxicity. The nurse would be monitoring the BUN and creatinine levels. Amylase and lipase are related to liver function. Streptomycin does not affect the electrolytes or blood cell counts.
For which client(s) should the nurse question the order of sulfonamide? Select all that apply.
Client with an allergy to a loop diuretic Older adult client over 65 years Lactating female client Client with a history of kidney stones Female client in the second trimester of pregnancy Explanation: The sulfonamides are contraindicated in clients with hypersensitivity to loop diuretics, during lactation, and during any term of pregnancy. The medication should be used with caution in older adults and clients with a history of kidney stones due to risks related to thrombocytopenia, hyperkalemia, and folate dificiency as well as dehydration.
A client who routinely takes antacids has been prescribed tetracycline. The nurse explains to the client that there is an increased risk of which effect related to this combination?
Decreased absorption of tetracycline Explanation: Interaction of antacids with a tetracycline drug causes decreased absorption of tetracycline. Increased action of neuromuscular blocking drugs and increased profound respiratory depression are the result of interaction between neuromuscular blocking drugs and tetracyclines. Increased risk of bleeding is a result of interaction between anticoagulants and tetracyclines.
Which of the following are common adverse reactions to rifampin that the nurse should share with the client? Select all that apply.
Discoloration of body fluids Vertigo Nausea Rash Explanation: Common adverse reactions of rifampin include nausea, vomiting, epigastric distress, heartburn, fatigue, vertigo, rash, reddish-orange discoloration of body fluids, hematological changes, and renal insufficiency.
The tetracyclines are effective against a wide range of which type of organisms?
Gram-positive and gram-negative organisms Explanation: The tetracyclines are effective against a wide range of gram-positive and gram-negative organisms, although they are usually not drugs of choice.
A client's upper respiratory infection is believed to be bacterial so the health care provider has prescribed amoxicillin 500 mg PO q8h. How should the nurse best interpret this prescription?
It aligns with the recommended dose, route and indication for this medication Explanation: This order is within reference ranges for amoxicillin. A typical course is less than one week.
Which of the following medications is contraindicated in children?
Levofloxacin Explanation: Fluoroquinolones are contraindicated in clients who are younger than 18 years of age.
A client, prescribed clindamycin, is now reporting frequent diarrhea. How should the nurse best respond to this client?
Liaise with the client's health care provider to have the drug discontinued. Explanation: The FDA has issued a black box warning for clindamycin regarding the potential of severe and possible fatal colitis. If diarrhea develops in a client receiving clindamycin, discontinuation of the drug is essential. None of the other suggestions provided by the options are accurate statements regarding clindamycin.
The nurse is caring for a client who is taking INH for tuberculosis. What adverse effect is this client most at risk for?
Liver dysfunction Explanation: Clients taking INH are most at risk for hepatotoxicity.
A 72-year-old patient with TB is undergoing standard treatment in a health care facility. Which of the following nursing interventions should the nurse perform during ongoing assessment of the treatment?
Monitor for appearance of adverse reactions. Explanation: The nurse should monitor for the appearance of adverse reactions in the patient during ongoing assessment of the treatment. The nurse should monitor vital signs of the patient every four hours and not every 24 hours when the patient is hospitalized. The nurse should assess the patient's history of contacts as part of the pre-administration assessment and not as part of the ongoing assessment. DOT can only be used by the nurse to administer antitubercular drugs when the patient is at home, at his place of employment, or in school. DOT is not used when the patient is hospitalized.
When preparing to administer a fluoroquinolone, the nurse understands that the majority of drugs belonging to this class are administered by which route?
Oral Explanation: Most fluoroquinolones are administered orally; levofloxacin and moxifloxacin may also be given intravenously.
What drug belongs to the group of carbapenems?
Primaxin Explanation: The group consists of three drugs: Imipenem-cilastatin (Primaxin), Meropenem (Merrem), and Ertapenem (Invanz). Gemifloxacin is a Fluoroquinolones, Cefuroxime is a second-generation cephalosporin, and demeclocycline is a tetracycline.
A client is receiving iron therapy for anemia. The prescriber has ordered tetracycline for an infection. Which action would be most appropriate for the nurse to do?
Separate administration times by 2 hours. Explanation: Iron therapy can interfere with the absorption of tetracycline. Therefore, the nurse should give the iron 2 hours before or after administering tetracycline. The two drugs should not be given at the same time. Withholding the iron would be inappropriate.
A client, receiving linezolid, is fond of eating chocolates and drinking coffee. When teaching the client about this drug which adverse effect should the nurse point out presents the greatest risk to this client?
Severe hypertension Explanation: The nurse should inform the client that if tyramine found in chocolates and coffee interacts with linezolid, the client will develop an increased risk for severe hypertension. Tyramine-containing foods interacting with linezolid do not cause drowsiness, nervousness, or nausea.
A patient has been prescribed oral tetracycline for the treatment of acne. Which of the following must the nurse include in the patient teaching plan?
Take the drug on an empty stomach. Explanation: Oral preparations of tetracycline should be administered on an empty stomach with a full glass of water to maximize absorption. Tetracycline is not absorbed effectively if taken with food, dairy products, or immediately after meals.
A patient is to begin taking tobramycin (Nebcin) for a nosocomial infection. Which of the following assessments should the nurse prioritize?
The peak and trough blood levels Explanation: Peak and trough levels should be closely monitored with serious infections being treated with tobramycin. The patient's blood pressure, diet, weight, and other medications would be important to know and necessary for the plan of care, but are secondary to serum levels.
The nurse is giving discharge instructions to a woman who will be taking amoxicillin for treatment of acute otitis media. The nurse teaches the client that which symptom indicates the development of a superinfection and should be reported to the physician?
Vaginal itching and discharge Explanation: A vaginal infection in a client who is taking amoxicillin is an example of a superinfection. The nausea and abdominal pain are adverse effects of the medication, and swelling and itching of the throat are an example of possible allergy to the drug.
In the rare instance in which penicillin is considered essential, hypersensitivity can be assessed by administering:
a skin test. Explanation: In the rare instance in which penicillin is considered essential, a skin test may be helpful in assessing hypersensitivity.
A 49-year-old client is diagnosed with TB. The client has a history of alcoholism but has been sober for 3 months now. The client has been prescribed INH. What should the nurse ensure is obtained before initiating the therapy?
baseline liver function test values Explanation: For a TB client, the nurse should obtain baseline liver function test values and schedule serial liver function tests throughout therapy. In addition, a nurse should ensure a baseline A1C evaluation for clients who are diabetics, because INH may cause hyperglycemia. Clients with preexisting anemias should have a baseline complete blood count (CBC), because they are at risk for hematologic disorders. For clients with a history of seizures, perform a baseline neurologic examination. Also assess baseline visual acuity. All other assessments such as height, weight, serum glucose level, and bone mass are not applicable to INH therapy.
After teaching a group of students about antitubercular therapy, the instructor determines that additional teaching is needed when the students identify which drug as an antitubercular agent?
dapsone Explanation: Dapsone is used to treat leprosy. Rifampin, isoniazid, and ethambutol are antitubercular drugs.
A client has been treated with ofloxacin multiple times for an ear infection. The nurse instructs the client to report signs of local adverse reactions. What would this include? (Select all that apply.)
ear irritation itching burning Explanation: Local adverse reactions to otic preparations include ear irritation, itching, and burning. The other options are not normally associated with otic preparations; however, even if they occurred, they would not be considered local effects.
A client diagnosed with malaria has been prescribed treatment with sulfadiazine. The nurse should encourage the client to increase consumption of what dietary component?
fluids Explanation: When this medication is used, it is imperative that the client maintain a fluid intake that allows for an output of 1500 mL of urine in 24 hours. While the client should attempt to consume a healthy well-balanced diet, fluid intake is vitally important.
After teaching a group of students about the indications for use for aminoglycosides, the instructor determines that the teaching was successful when the students identify which type of infection as a primary indication?
gram-negative infections Explanation: Aminoglycosides are used primarily in the treatment of infections caused by gram-negative microorganisms. Aminoglycosides are not effective on gram-positive bacteria. Since aminoglycosides are antibacterial, they are not effective on fungal or viral infections.
A patient is receiving cefazolin in combination with anticoagulants. To minimize the adverse effects during therapy, the nurse will
monitor the patient for bleeding gums. Explanation: The nurse should monitor for bleeding gums when the drug is administered in combination with anticoagulants, because patients who receive oral anticoagulants may experience increased bleeding. Administering the medication with small amounts of food and fluids should help minimize adverse effects of GI distress that occur under normal circumstances. Monitoring the site of injection and continuing therapy until 2 days after the symptoms have resolved would represent good general nursing practice.
A 25-year-old woman is being treated with penicillin G as prophylaxis to prevent bacterial endocarditis prior to a dental procedure. The nurse should question the client concerning her the use of:
oral contraceptives. Explanation: The nurse should document the method of birth control used by a woman of childbearing age because antibiotics, such as penicillin G, can counteract the effects of an oral contraceptive. The client should be advised to use a backup method of birth control for the duration of the therapy. Excess fats in the diet, alcohol, and nicotine should be avoided, but pose no special risk when used along with penicillin G.
A client with a diagnosis of rhinosinusitis has been prescribed ciprofloxacin 250 mg SC b.i.d. When contacting the prescriber, the nurse should question the:
route. Explanation: Recommended parameters for ciprofloxacin are 100-500 mg b.i.d. PO for up to 6 weeks. As a result, the nurse should have the provider confirm the correct route.
The client has been prescribed a fluoroquinolone for an infection and is currently taking an NSAID for joint pain. The nurse understands that this puts the client at risk for which complication?
seizures Explanation: The combination of fluoroquinolones and NSAIDs puts the client at risk for seizure activity. Bleeding, inflammation, and arrhythmias are not associated risks of fluoroquinolones and NSAIDs. NSAIDS alone put the client at risk for bleeding in the gastrointestinal system.
A nurse is speaking to a 62-year-old female client who has been started on sulfisoxazole, a sulfonamide antibiotic. The nurse should teach this client to contact the health care provider if the client experiences what adverse effect associated with the drug?
skin rash or itching Explanation: Clients taking sulfonamides should be instructed to contact the prescriber if they experience skin rash or itching. These symptoms may indicate a sulfonamide-induced allergic reaction and the need to change or stop the drug.
Which action would the nurse suggest to a client to reduce the risk of photosensitivity from sulfonamide therapy? Select all that apply.
using sunscreen wearing sunglasses wearing protective clothing Explanation: The nurse should suggest avoiding any exposure to sunlight or ultraviolet light (tanning beds, sunlamps) while taking these drugs and for several weeks after completing the course of therapy. This would include wearing sunblock, sunglasses, and protective clothing when exposed to sunlight. Drinking increased fluids is not indicated unless crystalluria is present.
A client has been prescribed 4 g of sulfamethoxazole/trimethoprim tablets per day. The available drug is in the form of 500 mg. The nurse would administer how many tablets each day?
8 Explanation: The required dosage is 4 g per day. Available drug is in the form of 500 mg. Therefore, eight (4000 mg/500 mg) tablets have to be administered every day.
A client diagnosed with infective endocarditis would be most effectively treated with which medication?
Ampicillin Explanation: Health care providers use ampicillin in the treatment or prophylaxis of infective endocarditis. Ampicillin is effective against bacterial infections. Dicloxacillin, nafcillin, and oxacillin are typically used to treat methicillin-resistant Staphylococcus aureus.
After teaching a group of nursing students about the action of sulfonamides, the instructor determines that the teaching was successful when the students articulate that this class of drugs has primarily what action?
Bacteriostatic Explanation: The sulfonamides are primarily bacteriostatic because of their ability to inhibit the activity of folic acid in bacterial cell metabolism. They are not bactericidal.
A patient who has been on penicillin therapy for several days has developed inflamed oral mucous membranes and swelling in the tongue and the gums. The primary health care provider has diagnosed it as a fungal superinfection of the oral cavity resulting in impaired oral mucous membranes. Which of the following interventions should the nurse perform?
Inspect mouth and gums regularly. Explanation: The nurse should regularly inspect the patient's mouth and gums to assess the patient's progress. The nurse should instruct the patient to use a soft-bristled toothbrush. The patient need not follow a liquid diet; a nonirritating soft diet can be recommended. Gargling every two hours may not help relieve the symptoms and may even aggravate the existing condition.
A 40-year-old is being treated for an ear infection with a cephalosporin. Which adverse reactions should the nurse monitor for in the client?
Nausea Explanation: The most common adverse reactions that are caused due to cephalosporin administration include nausea, vomiting, and diarrhea. Cephalosporin does not cause hypotension, chest pain, or excessive tearing; hypotension and chest pain are some of the adverse reactions of disulfiram.
Which of the following information should the nurse obtain during the pre-administration assessment of a client prescribed a fluoroquinolone or miscellaneous anti-infective? Select all that apply.
Allergy history Signs and symptoms of infection Blood pressure Temperature Explanation: Before administering a fluoroquinolone or miscellaneous anti-infective, the nurse identifies and records the signs and symptoms of the infections, takes a thorough allergy history, takes and records vital signs, and, if ordered, obtains cultures.
A 25-year-old female client who presents at the clinic with vaginal discharge and discomfort is diagnosed with chlamydia. The nurse knows that the drug of choice to treat this infection is doxycycline. What would be a priority assessment for this client before beginning the medication?
Asking the client if she is pregnant Explanation: Tetracyclines, such as doxycycline, are contraindicated in pregnant women and in children under 8 years of age. In the fetus and young children, the drug can inhibit bone growth and the development of enamel in the teeth.
After teaching a group of students about carbapenems, the instructor determines the need for additional teaching when the students identify what as an example?
Cefuroxime Explanation: Cefuroxime is a cephalosporin. Doripenem, imipenem-cilastatin, and ertapenem are carbapenems.
A public health nurse interacts with many members of the community who are at risk for sexually transmitted infections (STIs). The nurse should anticipate the use of tetracycline in a client who is diagnosed with what STI?
Chlamydia Explanation: The action of tetracycline makes it effective for treating Mycoplasma, Chlamydia, and Rickettsia. It is not efficacious in the treatment of trichomoniasis, HPV, or vaginitis.
The nurse is caring for a client diagnosed with Legionnaires disease. What medication would the nurse expect the health care provider to prescribe?
Erythromycin Explanation: Erythromycin is the prototype macrolide used to treat Legionnaires disease. Loxapine hydrochloride is an antipsychotic agent. Meclizine is used to treat nausea and dizziness. Pravastatin is used to treat hypercholesterolemia.
A client develops a mild skin irritation while receiving penicillin therapy. Which products or actions would the nurse advise the client to avoid? Select all that apply.
Harsh soaps Perfumed lotions Rubbing the irritating area Wearing rough or irritating clothing Explanation: When skin irritation is present during the administration of penicillin, the nurse should advise the client to avoid harsh soaps, perfumed lotions, rubbing the irritated area, or wearing rough or irritating clothing.
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 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 75-year-old patient with a history of renal impairment is admitted to the primary health care center with a UTI and has been prescribed a cephalosporin. Which of the following interventions is most important for the nurse to perform when caring for this patient?
Monitoring blood creatinine levels. Explanation: An elderly patient is more susceptible to the nephrotoxic effects of the cephalosporins. Since renal impairment is present, it is important for the nurse to closely monitor the patient's blood creatinine levels. The nurse should conduct a test for occult blood if blood and mucus occur in the stool and monitor the fluid intake if there is a decrease in urine output. The nurse does not need to monitor for increased glucose levels unless the patient has a history of diabetes.
When administering aminoglycosides, the nurse must be aware of which of the following adverse reactions?
Ototoxicity and nephrotoxicity Explanation: After parenteral administration, aminoglycosides are widely distributed in extracellular fluid and reach therapeutic levels in blood, urine, bone, inflamed joints, and pleural and ascitic fluids. They accumulate in high concentrations in the proximal renal tubules of the kidney leading to acute tubular necrosis. This damage to the kidney is termed nephrotoxicity. They also accumulate in high concentrations in the inner ear, damaging sensory cells in the cochlea and the vestibular apparatus. This damage to the inner ear is termed ototoxicity.
Michael, 25 years old, has had mitral valve regurgitation since age four, after having rheumatic fever. Michael is planning to go to his dentist to have his teeth cleaned. Because of Michael's history he will need to take antibiotics in conjunction with this procedure to prevent bacteremia. Which class of antibiotics will Michael most likely receive if he has no allergies?
Penicillin Explanation: Penicillin G may also be used as prophylaxis in special patient populations to prevent bacterial endocarditis prior to procedures likely to produce temporary bacteremia, such as dental procedures. These patients include those with prosthetic heart valves, mitral valve prolapse, most congenital heart diseases, and acquired valvular heart disease. It may also be used as prophylaxis in patients with recurrent rheumatic fever or rheumatic heart disease.
A nurse is to administer sulfasalazine to a client with ulcerative colitis. Which of the following interventions would be most important while caring for this client?
Regularly inspect client's stool samples. Explanation: While providing care to a client receiving sulfasalazine therapy for ulcerative colitis, the nurse should regularly inspect all stool samples and record their number and appearance. Yellow skin or urine in clients receiving sulfasalazine is normal, and the nurse should not stop the dosage. Sulfasalazine is administered with meals or immediately afterward, not on an empty stomach. Administering cranberry juice is helpful for clients with urinary tract infections, but not for clients with ulcerative colitis.
A middle-aged patient has been prescribed tetracycline as part of his Prevpac for the treatment of H. pylori. The patient has a history of atrial fibrillation which is being treated with digitalis drugs. Given his history and current medications, the patient is at risk for which of the following conditions?
Risk of toxicity Explanation: When digitalis drugs interact with tetracyclines, the patient is at a risk for toxicity. Respiratory depression is an effect observed when neuromuscular-blocking drugs interact with lincosamides. Increase in serum levels is observed when digoxin interacts with macrolides. Increase in serum theophylline level occurs when theophylline interacts with macrolides.
A 43-year-old man has been diagnosed with active TB. He is prescribed a multiple drug therapy, including INH and rifampin. A priority assessment by the nurse will be to monitor which combination of laboratory test results?
Serum alanine transaminase, aspartate transaminase, and bilirubin Explanation: The major adverse effect of INH therapy is hepatotoxicity. In hepatotoxicity the hepatic enzyme levels of aspartate transaminase and alanine transaminase will be elevated. Bilirubin will also be elevated, and the patient may present with jaundice. Red and white blood counts and differential would indicate possible hematologic effects, which could be considered adverse effects of the drug therapy, but would not be diagnostic for hepatotoxicity. Thyroid-stimulating hormone, thyroxine, and triiodothyronine levels would indicate a thyroid glandular concern, not hepatotoxicity. Fasting blood sugar and 2-hour postprandial blood sugar would be indicative of diabetes, not hepatotoxicity.
A group of students are separating the various penicillins into their groups. Which drugs will the students differentiate as an example of a beta-lactamase inhibitor? Select all that apply.
Tazobactam Sulbactam Clavulanic acid Explanation: Examples of beta-lactamase inhibitors are clavulanic acid, sulbactam, and tazobactam. Amoxicillin is an example of an aminopenicillin. Piperacillin is an example of an extended-spectrum penicillin.
The client has been taking her antibiotic for five days. She tells the nurse that she is now experiencing vaginal itching and discharge. The nurse suspects what has occurred?
The client has developed a superinfection. Explanation: The client is experiencing a vaginal yeast superinfection related to the use of antibiotics. Adverse reactions include nausea, diarrhea, abdominal pain, headache and photosensitivity. This is not indicative of an STI in this scenario.
The nurse is caring for a client who is taking a sulfonamide and notices that the client has developed itchy hives. After contacting the health care provider, what term will the nurse use to describe the client's symptoms?
Urticaria Explanation: Hives or itchy wheals on the skin resulting from contact with, or ingestion of, an allergic substance is known as urticaria. Pruritis is simple itching. Toxic epidermal necrolysis is sloughing of skin and mucous membranes. Stevens-Johnson syndrome consists of fever, cough, muscular aches and pains, headache and lesions of the skin (blisters or wheals).
The nurse is preparing a teaching plan for a client who is receiving cephalosporins. Which of the following would the nurse identify as the most commonly occurring adverse effects?
Vomiting and diarrhea Explanation: Although headache and dizziness, superinfections, and phlebitis (with intravenous administration) can occur, the most common adverse effects of cephalosporins involve the GI tract and include vomiting, diarrhea, nausea, anorexia, abdominal pain, and flatulence.
The nurse should advise the client to avoid taking which medication at the same time as a fluoroquinolone?
antacids Explanation: The client should not take antacids or drugs containing iron or zinc at the same time as taking a fluoroquinolone because these drugs will decrease the absorption of the fluoroquinolones. There are no listed contraindications of giving fluoroquinolones with antihypertensives, antidiabetic agents, or oral contraceptives.
Penicillins are most effective when used to treat what type of microorganisms?
gram-positive bacteria Explanation: Clinical indications for use of penicillins include bacterial infections caused by susceptible microorganisms. As a class, penicillins usually are more effective in infections caused by gram-positive bacteria than those caused by gram-negative bacteria. However, their clinical uses vary significantly according to the subgroup or individual drug and microbial patterns of resistance. This information makes the remaining options incorrect. Bacilli are a type of bacteria.
A 66-year-old woman with a history of recurrent urinary tract infections has been admitted to the hospital with a diagnosis of pyelonephritis. The client began treatment 36 hours ago with intravenous gentamicin and is being monitored closely. The nurse is aware that the therapeutic effect of the client's drug regimen is primarily a result of:
interference with bacterial reproduction. Explanation: Gentamicin exerts its effect by entering the bacterial cell and binding to the 30S ribosomal subunit. This event leads to a misreading of the information used within the cell to form proteins. This leads indirectly to cell wall rupture. Gentamicin does not enhance immune function or change the osmolarity of bacterial cytoplasm.
When a person is diagnosed with tuberculosis, the nurse prepares the family members to be treated prophylactically with which drug?
isoniazid Explanation: When a person is diagnosed with tuberculosis, family members may be treated prophylactically with isoniazid. Drugs used to treat the client with TB are ethambutol, pyrazinamide, and rifampin.
A nurse monitors a client closely for anaphylactic reactions secondary to penicillin therapy. The nurse understands that this occurs more commonly after which route of administration?
parenteral Explanation: Anaphylactic reactions, although possible after oral administration, occur more commonly after parenteral administration. Penicillins are neither administered topically nor transdermally.
A 7-year-old child has been taking tetracycline for a bacterial infection. The nurse will be sure to inform the parents that this drug could cause
staining of permanent teeth. Explanation: Tetracycline is an example of a drug that can adversely affect a body system during a phase of child development. If administered to a child between the ages of 4 months and 8 years, it can stain the child's permanent teeth. Discolored urine, deep muscle pain, and sleep deprivation are not associated with tetracycline.
A teenager is admitted to a health care facility for a fungal infection. It has been determined that the infection was present for a long time, but there was no treatment undertaken. The teenager now has a systemic fungal infection for which flucytosine is prescribed. Which would be most important for the nurse to assess before beginning therapy?
weight Explanation: With flucytosine, it is important for the nurse to weigh the teenager because the dosage of the drug is determined by the weight. The teenager has a systemic fungal infection, so inspection of the mouth or assessment of vaginal discharge would not be important. Although it would be important to assess the teenager's hydration status, this is not as important as obtaining the weight.
A student asks the pharmacology instructor to explain how beta-lactam antibiotics, such as penicillins and cephalosporins, fight bacterial infection. The instructor responds that the drugs do so by disrupting the bacterial cell wall, a process that is most effective
when the bacterial cells are dividing. Explanation: Beta-lactam antibiotics, such as penicillins and cephalosporins, are most effective when bacterial cells are dividing.
Culture and sensitivity testing of a client's urine sample reveals a bacterium that is susceptible to cephalosporins. What medication would be most likely for the nurse to administer?
Cefaclor Explanation: Cefaclor is an example of a cephalosporin. Imipenem-cilastatin is an example of a carbapenem. Neomycin is an example of an aminoglycoside. Ciprofloxacin is an example of a fluoroquinolone.
The nurse will notify the health care provider immediately if the client taking amoxicillin for otitis media is also taking what medication?
Tetracycline for acne Explanation: Tetracycline, if taken with amoxicillin, inhibits the action of amoxicillin.
What route of administration is most commonly used for the administration of ciprofloxacin when prescribed to an older adult client?
oral (PO) Explanation: While ciprofloxacin is typically administered by the PO or IV route, in most cases, oral administration is used. The medication is not administered by either the SQ or IM routes.
After teaching a client who is receiving doxycycline about the drug, the nurse determines that the teaching was successful when the client makes what statement?
"I need to wear protective clothing when I'm out in the sun." Explanation: Photosensitivity is possible, so the client should use sunscreen and wear protective clothing when outdoors. Fluids should be increased to promote drug excretion. Ice chips or sugarless candy would be appropriate for combating a sore mouth. The drug should be taken on empty stomach 1 hour before or 2 hours after meals; antacids should not be taken with the drug because they can affect absorption.
A pregnant woman calls the clinic and asks if it is suitable to use ofloxacin otic drops that she used prior to pregnancy for a current ear infection. What would be an appropriate response from the nurse?
"The effects of ofloxacin in pregnancy are not known, so the drug should not be used while pregnant." Explanation: The otic drugs are used with caution during pregnancy and lactation. The pregnancy category of most of these drugs is unknown when they are used as otic drugs for this reason, ofloxacin is an otic drug that is contraindicated during pregnancy. Using left-over medication from one illness to the next is not advised. Many otic drugs are not contraindicated during pregnancy. Not all medications that are okay for children are suitable to use during pregnancy.
A client has just been diagnosed with TB. The client is extremely upset and is asking questions concerning the medications. What is an appropriate response by the nurse?
"You will have multidrug therapy for 6 to 24 months." Explanation: The nurse should tell the client that drug therapy for TB is based on the susceptibility of the infecting organism and the immunocompetence of the person affected. Usually clients with active or reactivated TB require multidrug therapy for 6 to 24 months. Telling the client not to worry and that the client needs to be calmer when discussing therapy are not therapeutic and minimize the client's concerns.
The nurse administers cefuroxime to a client at least 1 hour before meals, as prescribed; however, the client experiences GI upset. Which action would be most appropriate for the nurse to do?
Administer the drug with food. Explanation: If the client experiences GI upset, the nurse can administer cefuroxime with food. A decrease in the dosage is suggested in a client with renal impairment. A change in dosage, discontinuation of the drug, or use of an antacid is recommended only if prescribed by the physician.
A nurse is caring for a 39-year-old client who is taking INH, rifampin, and pyrazinamide. The client reports that her urine is red. What is the most likely cause of this discoloration?
Adverse effect of rifampin Explanation: Rifampin causes a harmless red-orange discoloration of urine, tears, saliva, and other body secretions.
A client receiving penicillin therapy reports mouth irritation and a sore throat to the nurse. Inspection reveals a red, swollen tongue with ulcerations. The nurse suspects a fungal superinfection and prioritizes which nursing diagnosis as most appropriate for this client?
Altered Oral Mucous Membranes Explanation: The assessment suggests a fungal superinfection, which would lead to the nursing diagnosis of Altered Oral Mucous Membranes. Although Altered Comfort may be appropriate, Altered Oral Mucous Membranes is more specific. There is no evidence of lack of knowledge or problems with nutrition. However, if the superinfection is not addressed, the client may experience difficulty eating due to the irritation and discomfort.
The nurse prepares to administer tetracycline 500 mg PO every 6 hours to an adult client newly diagnosed with Lyme's disease. The client takes an oral contraceptive for birth control. Which measures would the nurse provide for safe and effective drug administration? Select all that apply.
Assess baseline renal and hepatic profiles, complete blood count, and human chorionic gonadotropin (HCG). Instruct client about the importance of using another form of contraceptive during the antibiotic usage. Educate importance of wearing sunscreen and protective clothing when in the sun while taking the drug. Report severe nausea and vomiting, diarrhea, rash, or perineal itching to the prescriber. Explanation: The nurse should assess and report abnormal serum creatinine and blood urea nitrogen reflecting impaired renal clearance, a contraindication for the drug. Abnormal liver enzymes are a contraindication since the drug could lead to liver failure. A baseline complete blood count is needed to compare with future labs for anemia, an adverse effect, and if the white blood count decreases, an indication that the drug is effective. The HCG is assessed because pregnancy is a contraindication for tetracycline since it can lead to fatal liver necrosis in the mother and cause bone and tooth development problems in the fetus. The drug needs to be taken on an empty stomach with 8 ounces of water. Calcium, iron, aluminum, or magnesium inhibits absorption of tetracycline. The drug decreases effectiveness of oral contraceptives, so the client needs to take another contraceptive until the drug is completed and depending on the oral contraceptive through the next menstrual cycle. The drug causes photosensitivity so when the client must be in the sun, use sunscreen and protective clothing to prevent sunburn. The client needs to report adverse reactions that indicate a need for the prescriber to change antibiotics.
An 87-year-old resident of a long-term care facility has been prescribed oral clindamycin for the treatment of an infected pressure ulcer. The care providers at the facility should be instructed to monitor the resident closely for what potential adverse effect of clindamycin?
Diarrhea Explanation: The most serious adverse effect of clindamycin is pseudomembranous colitis, also known as Clostridium difficile colitis. Diarrhea, abdominal cramps, and abdominal tenderness may suggest antibiotic-associated colitis.
A client, hospitalized with active tuberculosis, is receiving antitubercular drug therapy. When it becomes apparent that the client is not responding to the medications, what condition will the primary health care provider identify as a possible cause?
Drug-resistant tuberculosis Explanation: A client who is being treated with antitubercular drug therapy and is not responding to the medication regime is most likely experiencing drug-resistant tuberculosis. Human immunodeficiency virus causes tuberculosis to move more rapidly. This scenario does not provide any indication that the tuberculosis is related to the diminished client response. The scenario does not identify methicillin-resistant or vancomycin-resistant Staphylococcus aureus.
A client who is being discharged has been instructed to continue with sulfonamide therapy for a week. Which point should the nurse include in the teaching plan to educate the client about the therapy?
Ensure that all follow-up appointments are met. Explanation: The nurse's plan should include educating the client about the importance of keeping the follow-up appointments. The nurse should instruct the client to adhere to the dosage schedule and not discontinue it even if the symptoms of the infection have gone. The client should inform the primary health care provider if fever, skin rash, or nausea occurs during the therapy. The client should be instructed to take the drug on an empty stomach (at least 2 hours before or after a meal) and not just before a meal.
A client is diagnosed with latent tuberculosis infection. The nurse expects that the treatment plan will include which drug?
INH Explanation: INH is the treatment of choice for LTBI.
A nurse is caring for a client who is receiving penicillin. The nurse would assess for what common adverse reaction?
Inflammation of the tongue and mouth Explanation: Some of the common adverse effects of penicillin are glossitis (inflammation of the tongue), stomatitis (inflammation of the mouth), and gastritis (inflammation of the stomach). Unless the adverse effects are severe, the drug may be continued as prescribed and the nurse would intervene to help the client manage the common adverse reactions. Altered oral mucous membranes would suggest a possible fungal superinfection in the oral cavity, whereas severe hypotension and sudden loss of consciousness are signs of anaphylactic shock; these are not common adverse effects of penicillin and require immediate medical attention.
Daptomycin belongs to the lipopeptide class of antibiotics that kills gram-positive bacteria. What is the mechanism of action for this antibiotic?
Inhibition of synthesis of bacterial proteins Explanation: Daptomycin belongs to the lipopeptide class of antibiotics that kills gram-positive bacteria by inhibiting synthesis of bacterial proteins, DNA, and RNA.
A client is prescribed penicillin V orally for a strep throat. What is the mechanism of action of this medication?
It inhibits cell wall synthesis. Explanation: Beta-lactam antibacterial drugs inhibit synthesis of bacterial cell walls by binding to proteins in bacterial cell membranes. Penicillin V does not inhibit protein synthesis. Penicillin V does not inhibit protein synthesis, cause mutations, or lower the pH of a bacterium's cellular contents.
A client is prescribed isoniazid (INH) for a diagnosis of tuberculosis. Which adverse effect will result in discontinuation of the medication?
Jaundice Explanation: Potentially serious adverse effects of INH include hepatotoxicity. Hepatotoxicity may be manifested by symptoms of hepatitis (e.g., anorexia, nausea, fatigue, malaise, jaundice) or elevated liver enzymes. The nurse reports their development to the health care provider promptly to prevent possible liver failure and death. Weight gain, fever, and arthralgia are not the most known adverse effects of INH.
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 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 is prescribed demeclocycline. The nurse would teach the client to be alert for which signs or symptoms?
Photosensitivity Explanation: Demeclocycline causes photosensitivity reactions. Abdominal pain and cramping are adverse reactions of macrolides. Blood dyscrasias are an adverse reaction of lincosamides.
A nurse has administered demeclocycline to a patient. Which of the following adverse reactions should the nurse closely monitor the patient for?
Photosensitivity Explanation: Demeclocycline causes photosensitivity reactions. Abdominal pain and cramping are adverse reactions of macrolides. Blood dyscrasias is an adverse reaction of lincosamides.
A client has been prescribed lomefloxacin (Maxaquin) for a respiratory infection. What must the nurse closely monitor for in this client?
Photosensitivity Explanation: Lomefloxacin may induce serious photosensitivity reactions and should be discontinued at the first sign of rash, redness, or burning sensation on the skin. The drug is not associated with the development of psychosis, anemia, or increased ICP.
The nurse is preparing to administer sulfadiazine to a client who is also taking warfarin. The nurse would be alert for which potential adverse effect?
Prolonged clotting times Explanation: When warfarin and sulfonamides are given concomitantly, an increase in action of the anticoagulant is seen, leading to an increase in clotting time, such as PT/INR, and an increased risk of bleeding. An increased risk of infection and a decrease in the white blood cell count would occur when a sulfonamide is given with methotrexate. The combination of warfarin and sulfonamide does not impact the effect of the antibiotic.
A nurse is about to administer mafenide to a client. The nurse would be alert for which possible reaction?
Rash, itching, or other allergic reactions Explanation: The nurse should assess for allergic reactions such as rash, itching, edema, and urticaria when administering mafenide. Topical sulfonamides like mafenide do not cause crystalluria, inflammation of the mouth, or loss of appetite.
A client in the critical care unit is receiving aminoglycosides for an infectious process. What does the nurse need to monitor?
Renal function tests Explanation: Because critically ill clients are at high risk for development of nephrotoxicity and ototoxicity with aminoglycosides, guidelines for safe drug use should be strictly followed. Renal function should be monitored to assess for needed dosage reductions in clients with renal dysfunction who are receiving aminoglycosides.
A client, being treated in the intensive care unit, has been diagnosed with ventilator-associated pneumonia. Culture and sensitivity testing of the client's sputum indicates that erythromycin is a treatment option. Which nursing assessment is most appropriate to rule out contraindications for this medication therapy?
Review lab results to confirm normal liver function. Explanation: Erythromycin is seldom used in critical care settings, partly because broader-spectrum bactericidal drugs are usually needed in critically ill clients and partly because it inhibits liver metabolism and slows elimination of several other drugs. Erythromycin is not nephrotoxic. The drug is administered orally, and GI upset does not contraindicate use.
Prior to and following a transurethral prostatic resection (TUPR), a 73-year-old man has been scheduled to receive a total of five intravenous doses of cefazolin. Which of the following nursing diagnoses should the nurse associate with this antibiotic therapy?
Risk for Infection related to overgrowth of nonsusceptible organisms Explanation: The administration of cefazolin, like many other antibiotics, creates a potential for superinfection as a result of the overgrowth of nonsusceptible microorganisms. Cefazolin is not among the drugs that are most irritating to the veins and neither constipation nor seizures is associated with its use.
The health care provider orders an aminoglycoside for a ventilator-dependent client who is admitted to the critical care unit. The client's current diagnoses include respiratory arrest, type 2 diabetes, hepatitis C, and chronic obstructive pulmonary disease. Which statement indicates the risk of using this class of medication in this client?
Risk for hepatic impairment is not significant, because the drug is excreted through the kidneys. Explanation: With aminoglycosides, hepatic impairment is not a significant factor, because the drugs are excreted through the kidneys.
The nurse is caring for a 6-year-old child who has pyelonephritis. The use of what group of antibiotics would be contraindicated due to the client's age?
Tetracyclines Explanation: Tetracyclines can potentially damage developing teeth and bones and thus should be used cautiously or avoided in children under the age of 8 years. Penicillins are safe to give to children and commonly used. Cephalosporins are safe to administer to pediatric clients. Aminoglycosides would not be administered to children lightly, but they can be administered when the benefits outweigh the risks, such as an infection that is resistant to other drugs.
A client, being treated for latent tuberculosis (TB) on an out-client basis, tells the nurse, "I've been feeling pretty good lately, so I haven't actually been all that consistent with taking my drugs." Subsequent health education by the nurse should focus on what subject?
The need to consistently take the prescribed drugs in order to cure TB Explanation: Consistent adherence to treatment is imperative to ensure successful treatment of TB. Nonadherence leads to resistance and unsuccessful treatment, not increased adverse effects. Nonadherence has no relationship with matching dosage with signs and symptoms. Antivirals are ineffective against TB.
When conducting health education for a client prescribed an oral penicillin for an infection caused by gram-negative bacilli, the nurse should emphasize which instructions?
The need to take the medication on an empty stomach Explanation: Most penicillins should be best taken on an empty stomach since less medication is absorbed with food in the stomach. Increased fluid intake is not normally necessary. A rash is an unexpected finding that should be reported promptly. The client should take the full course of antibiotics to support the effectiveness of the medication.
Chest radiography and sputum sample microscopy have confirmed a diagnosis of TB in a 40-year-old man who has a history of type 1 diabetes and who currently has a diabetic foot ulcer. How should the nurse account for this patient's health status when planning care during INH treatment?
The patient will require vigilant monitoring of blood glucose levels. Explanation: INH treatment constitutes a risk for hyperglycemia and close monitoring of blood glucose levels is thus indicated. This patient's history will not likely impact the chosen route for the drug and insulin therapy can be safely continued. The patient will be vulnerable to other infections for the foreseeable future, but he will not likely be immunocompromised to the degree that positive-pressure isolation is required.
The nurse knows that pseudomembranous colitis is a superinfection of fluoroquinolones, especially when they are administered in high doses, because these medications have what effect in the body?
They disrupt the normal flora of the body. Explanation: Pseudomembranous colitis is a superinfection that occurs when the antibiotic disrupts the normal flora, causing a secondary infection or superinfection.
A young pregnant patient with intestinal amebiasis is prescribed a tetracycline. Which can be an adverse effect of the drug?
Toxic effects to the developing fetus Explanation: There is a possibility of toxic effects to the developing fetus if the patient takes tetracycline drugs during pregnancy. Tetracyclines may cause permanent yellow-gray-brown discoloration of the teeth in children younger than 9 years of age. Tetracyclines do not cause an increase in the blood pressure. Only prolonged or repeated therapy of tetracyclines may result in bacterial or fungal overgrowth of nonsusceptible organisms.
The nurse is caring for a client who has been prescribed a sulfonamide but does not have an infection. The nurse is aware that the medication has been prescribed to treat what condition?
Ulcerative Colitis Explanation: Sulfonamides are primarily prescribed for treatment of infections but they are also used to manage ulcerative colitis. Stomatitis and crystalluria are possible adverse effects of sulfonamides. Gastritis is an inflammation of the stomach and sulfonamides would not be used to treat this condition.
The nurse is caring for a 23-year-old female client who uses oral contraceptives and has been prescribed ampicillin for treatment of a respiratory infection. What information is most important for the nurse to share with this client?
Use a type of barrier birth control while you are taking this antibiotic. Explanation: Clients taking oral contraceptives should be encouraged to use a barrier type of birth control during penicillin therapy; the penicillin will cause a decreased effectiveness of the contraceptive agent. The client should not be told to stop taking the oral contraceptive. This will not cause a heavier menses. The interaction between oral contraceptives and ampicillin will not cause an increased chance of bleeding, as that interaction is between large doses of penicillins and anticoagulants.
A client who is on sulfonamide therapy is about to be discharged. Which precautions should the nurse instruct the client to follow to reduce the effects of photosensitivity?
Wear protective clothing and sunscreen when outside. Explanation: The nurse should encourage a client to wear protective clothing while going out in the sun to reduce the effect of photosensitivity. While increasing the fluid intake is recommended, it does not help combat the effects of photosensitivity and applying Vitamin E oil will not help. There is no need to avoid lights while indoors; the skin becomes sensitive only to harsh sunlight during sulfonamide therapy. Wearing protective sunglasses may protect the eyes from injury, but it will not protect the skin from the harmful effects of photosensitivity.
The health care provider is selecting an antibiotic for a client with a known penicillin allergy. The provider knows that cephalosporins are a poor choice for this client because cephalosporins:
can cause allergic reactions in clients who are allergic to penicillins. Explanation: Clients who are allergic to penicillins may also be allergic to cephalosporins. Although this cross-allergenicity (allergy to a drug of another class with similar chemical structure) is rare, cephalosporins are not typically administered to clients who have had life-threatening allergic reactions to a penicillin.
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 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. Changing the route or supplementing with vitamin K will not aid in treatment.
A client is started on sulfamethoxazole-trimethoprim for a urinary infection. What adverse effect should the nurse assess with this client?
inner ears Explanation: Gentamicin reaches higher concentrations in the kidneys and inner ears than in other body tissues; this is a major factor in nephrotoxicity and ototoxicity. This situation requires focused assessment of the inner ears and kidney function. The increased concentration does occur in any of the other proposed locations.
The nurse recognizes that what drug classification increases the risk of ototoxicity and nephrotoxicity when prescribed with gentamicin?
loop diuretics Explanation: Loop diuretics given simultaneously with gentamicin increase the risk of nephrotoxicity by decreasing fluid volume, thereby increasing drug concentrations in serum and tissues. Loop diuretics may also contribute to ototoxicity. This risk is not associated with therapies that include both gentamicin and any of the other options.
A nurse is assessing a client for possible adverse reactions associated with fluoroquinolone therapy. Which possible reactions would the nurse attribute to this therapy? Select all that apply.
nausea diarrhea abdominal discomfort Explanation: Adverse reactions associated with fluoroquinolones include nausea, diarrhea, headache, abdominal pain or discomfort, dizziness, and photosensitivity. Ringing in the ears (tinnitus) is associated with the use of tetracyclines and the use of furosemide. Diminished urine output can be a sign of impaired kidney function seen with the use of nephrotoxic medications such as gentamicin.
A 35-year-old man being treated with isoniazid (INH) for exposure to TB has this medical history: diabetes mellitus type 2, hypertension, hyperlipidemia, and coronary artery disease. He drinks one to two glasses of wine on the weekend and smokes two packs of cigarettes per day. Which adverse reaction should the nurse alert the client to report to his health care provider right away?
numbness and tingling in his feet Explanation: INH should also be given with caution to clients with diabetes mellitus, malnutrition, or alcoholism because its effects (antagonism or increased excretion) on pyridoxine (vitamin B6) can cause peripheral neuropathy in these clients. Pyridoxine may be given concurrently with INH to decrease the risk for this adverse effect. Another frequent adverse effect is peripheral neuropathy. This effect may cause paresthesias in the hands and feet. As previously mentioned, malnourished people and those with diabetes and alcoholism have a higher risk for this adverse effect.
A nurse is caring for an older adult client with tuberculosis. The client has been prescribed ethambutol. Which adverse reactions of ethambutol should the nurse assess for?
optic neuritis Explanation: The nurse should assess for optic neuritis as it is one of the more severe reactions of ethambutol. Hypersensitivity and epigastric distress are adverse reactions associated with isoniazid. Vertigo is an adverse reaction of rifampin.