Chapter 9 Antibiotics PrepU
When administering aminoglycosides, the nurse must be aware of which of the following adverse reactions?
Ototoxicity and nephrotoxicity
Tetracyclines should not be used in children younger than 8 years of age because of their effects on:
Teeth and bones
A client is diagnosed with VRE, and the physician orders chloramphenicol. The nurse should monitor the client for the development of which side effect?
Blood dyscrasias
A client has been on an antibiotic for two weeks for treatment of an infection. The client asks the nurse why a superinfection has been caused by this medication. What is the nurse's best response?
"Antibiotics can disrupt the normal bacteria in your body, causing another infection to occur."
The ability of bacteria to produce substances that inactivate or destroy the antibiotic is known as which of the following?
Bacterial resistance
A male client is admitted to the unit with Pseudomonas aeruginosa sepsis. The health care provider orders aminoglycoside to be given concomitantly with penicillin intravenously. How would the nurse administer these drugs?
By administering the drug in separate IV bags
After teaching a group of students about cephalosporins, the instructor determines that the teaching was successful when the students identify which of the following as a cephalosporin?
Cefaclor
Which of the following drugs would be classified as a third-generation cephalosporin?
Ceftazidime
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
Which of the following drugs would be classified as an aminoglycoside?
Gentamicin
The pharmacology instructor is discussing ways to decrease adverse effects on clients taking aminoglycosides. Which would the instructor include?
Keeping the client well hydrated
When discussing cephalosporins with the nursing class, the pharmacology instructor explains that this classification of drug is primarily excreted through which organ?
Kidney
An instructor is describing an antibiotic that is resistant to the enzyme penicillinase. What would the nurse identify as an example?
Oxacillin
Your client has been diagnosed with streptococcal pharyngitis. Which of the following would you anticipate being ordered?
Penicillin G
A client is receiving a cephalosporin and an aminoglycoside as combination therapy. What assessment should the nurse prioritize?
Serum BUN and creatinine levels
The nurse is caring for a client who is taking tetracycline for Rocky Mountain spotted fever. The nurse notices that the client has developed painful mouth ulcers. The nurse knows that the client has developed what adverse reaction to the medication?
Stomatitis
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.
Extreme caution would be necessary with the use of gentamicin in which client?
a client who has chronic renal failure secondary to diabetes mellitus
A young adult client's acne has responded well to treatment with tetracycline. However, the client has now returned to the clinic 6 weeks later with signs and symptoms of oral candidiasis. The nurse should recognize that this client's current health problem is likely attributable to which occurrence?
superinfection following the eradication of normal oral flora
A client newly diagnosed with syphilis is allergic to penicillin. What medication should this client be prescribed?
tetracycline
A client with an upper respiratory infection has been prescribed macrolides. Which changes during an ongoing assessment would lead the nurse to notify the health care provider? Select all that apply.
• drop in blood pressure • increase in respiratory rate • sudden increase in temperature
The health care provider is preparing to order rifampin and pyrazinamide for a female client with active tuberculosis. What question should the provider ask this client before confirming this order?
"Are you pregnant?"
A client has been prescribed INH for the treatment of tuberculosis. The nurse teaches the client about dietary restrictions while taking this medication. What is the most important instruction to give the client about dietary restrictions?
"Do not drink beer or red wine while taking this medication because a serious adverse reaction can occur."
A client has been prescribed INH for the treatment of tuberculosis. The nurse teaches the client about dietary restrictions while taking this medication. What is the most important instruction?
"Do not drink beer or red wine while taking this medication because a serious adverse reaction can occur."
A 5-year-old child has been brought to the clinic with signs and symptoms that are consistent with otitis externa. What assessment question is most likely to address the etiology of this health problem?
"Has he been swimming a lot in the last little while?"
A client comes to the emergency department reporting a throbbing headache, nausea, vomiting, chest pain, dyspnea, vertigo, and blurred vision. The client reveals taking cefaclor for an infection. Which question would the nurse ask next?
"Have you had any alcohol to drink in the past 72 hours?"
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."
After teaching a client who is prescribed oral erythromycin, the nurse determines that the teaching was successful when the client states which of the following?
"I should drink a full 8-oz glass of water when I take the medicine."
A nurse is teaching a client how to apply a topical sulfonamide to a burn. Which statement by the client would indicate that the teaching was effective?
"I will apply it in a very thin layer over the area."
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."
A nurse is teaching a client about the medication regimen surrounding fluoroquinolones. Which statement made by the client would indicate the need for additional education?
"I will only drink enough water to swallow the drug."
The nurse is conducting discharge teaching to the caregiver of a 6-month-old child diagnosed with acute otitis media prescribed amoxicillin and alternating acetaminophen and ibuprofen for fever. Which statement by the caregiver establishes a need for additional teaching by the nurse?
"If the fever increases after alternating acetaminophen and ibuprofen, baby aspirin may be used."
The clinic nurse is responsible for teaching a client about a new prescription for doxycycline. The nurse should increase which instruction in the teaching?
"Limit your exposure to the sun."
You are the clinic nurse responsible for teaching a patient about his new prescription for doxycycline. Which of the following instructions should you include in your teaching?
"Limit your exposure to the sun." Tetracyclines increase sensitivity to sunlight, placing the patient at increased risk of sunburn. Antacids can decrease the effects of tetracyclines.
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."
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."
A patient has just been diagnosed with TB. She is extremely upset and is asking questions concerning the medications she will have to take and how long she will have to take them. Which of the following is an appropriate response by the nurse?
"You will have multidrug therapy for 6 to 24 months."
A client is to receive rifampin. Which would be most important for the nurse to include in the teaching plan for this client?
"Your urine or sweat may become orange in color."
The nurse would question the use of sulfonamide therapy in which client? Select all that apply.
-18-month-old female client -breastfeeding client 32 years of age
Levofloxacin 750 mg IV is ordered for a client with a urinary tract infection. The medication is mixed in a syringe for an IV pump as a solution of 250 mg/15 mL. How many mL should be in the syringe?
45mL
A patient has a diagnosis of otitis media and has just begun antibiotic treatment. The patient complains of otalgia and has asked for medication. The nurse should anticipate the administration of
Acetaminophen (Tylenol) Tylenol is the first-line analgesic for most cases of otalgia accompanying otitis.
A patient seen in the clinic has symptoms of persistent cough, fever, and night sweats. He recently entered the United States from the Philippines. From what condition is the patient suffering?
Active tuberculosis
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
A client diagnosed with infective endocarditis would be most effectively treated with which medication?
Ampicillin
A nurse works in a community setting and follows clients who have TB. Which clients would likely require the most follow-up from rifampin therapy?
An HIV-positive client
A nurse is caring for an adult client diagnosed with bacterial sinusitis. The nurse has cautioned the client against taking prescribed oral erythromycin together with antacids. What is the basis of this instruction?
Antacids decrease the absorption of the drug.
A 25-year-old female patient 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 patient before beginning the medication?
Asking the patient if she is pregnant
A child has been diagnosed with acute otitis media. Before the child begins antibiotic treatment, what assessment should the nurse perform?
Assess the child for allergies to penicillins.
A patient with TB has been admitted to a health care facility. When providing instructions for the patient teaching related to antitubercular drugs, which instructions should the nurse provide in order to avoid complications in the patient's GI tract?
Avoid the consumption of alcohol.
Which of the following would a nurse identify as being classified as a macrolide?
Azithromycin
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
Drugs that destroy bacteria are known as which type of drug?
Bactericidal
Beta-lactam antibiotics, such as penicillins and cephalosporins, fight infection by inhibiting development of the causative bacteria. What specific component development do these drugs affect?
Cell wall synthesis
An older adult client, diagnosed with community-acquired pneumonia, has been prescribed aztreonam. What action should the nurse perform before administering the first dose?
Confirm the client's allergy status
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.
A client who takes zinc daily is diagnosed with a severe infection and is ordered levofloxacin (Levaquin). The nurse is aware that taking these two drugs may have what affect on the antibiotic?
Decreased absorption
A patient is hospitalized with active tuberculosis. The patient is receiving antitubercular drug therapy and is not responding to the medications. What do you suspect the patient is suffering from?
Drug-resistant tuberculosis
Because of their low risk of toxicity, aminoglycocides are replacing many of the other antibiotics today.
False
Your client is 32 weeks pregnant. She has just been diagnosed with a urinary tract infection. You know that tetracycline is contraindicated for her because
It can cause a life-threatening toxicity for the fetus.
An elderly patient comes to the clinic and informs the nurse that he feels as if his ear is clogged. He states that he frequently has to have his ears irrigated to get out the wax. He asks the nurse what causes this wax build-up. What is the nurse's best response?
Modified sweat glands in the ear canal
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.
The nurse is assisting in the admission of a client with a suspected urinary tract infection. The health care provider has written the following orders: acetaminophen 500 mg PO for elevated temperature; urinalysis for culture and sensitivity; sulfasalazine (Azulfidine) 500 mg PO four times daily; and force fluids to 3 L/day. Which order will the nurse complete first?
Obtain urine for culture and sensitivity.
The nurse understands that which is the highest priority when teaching about antitubercular medications?
Taking medications as prescribed
The nurse understands that which of the following is the highest priority when teaching about antitubercular medications?
Taking medications as prescribed
The drug's effect on what best reflects the major reason for avoiding the use of tetracyclines in children under 8 years of age?
Teeth
What is an important precaution of fluoroquinolones that should be included in the client teaching?
Tendon Rupture
A client asks why three medications are prescribed to treat his tuberculosis. The nurse informs the client of which reasons?
To prevent resistance
The nurse is caring for a client taking sulfonamides. The nurse observes sloughing of the skin and mucous membranes. The nurse suspects which hypersensitivity reaction?
Toxic epidermal necrolysis
A client's risk for ototoxicity, nephrotoxicity, and neurotoxicity increases dramatically if he or she receives an aminoglycoside in conjunction with a potent diuretic.
True
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.
abdominal discomfort diarrhea nausea
When providing health education to a client prescribed isoniazid, the nurse should emphasize the need to avoid what element?
alcohol
A client is diagnosed with an infection attributable to the gram-negative microorganism Pseudomonas. Which anti-infective agent is most reliable in treating this microorganism?
aminoglycoside
After teaching a group of nursing students about the action of penicillin, the instructor determines that the teaching was effective when the students identify natural penicillin as exerting which type of effect on microorganisms?
bactericidal
After teaching a group of nursing students about the different classes of drugs, the instructor determines that the teaching was successful when the students identify drugs that slow or retard the multiplication of bacteria as which types of medication?
bacteriostatic
A 9-year-old client has been admitted to the pediatric unit after being diagnosed with pertussis. The pediatric nurse is processing the client's admission orders and notes that IV demeclocycline has been prescribed. After beginning this treatment, the nurse should confirm the results of what laboratory test?
blood urea nitrogen (BUN)
The physician is selecting an antibiotic for a patient with a known penicillin allergy. The physician knows that cephalosporins are a poor choice for this patient because cephalosporins
can cause allergic reactions in patients who are allergic to penicillins.
A client previously experienced an anaphylactic reaction to penicillin G. Which medication should not be administered to this client due to the potential for cross-sensitivity?
cefadroxil
Which drug is a first-generation cephalosporin used as a surgical prophylaxis?
cefazolin
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
When reviewing an older client's most recent laboratory values, which finding may contraindicate the use of tetracycline?
creatinine of 2.8 mg/dL (247.52 µmol/L) (high)
A nurse is preparing to administer a fluoroquinolone. Which infections are treated with fluoroquinolones? Select all that apply.
• skin infections • urinary tract infections • sexually transmitted disease
The nurse is caring for a client whose prescribed course of cefaclor will soon be completed. What health education should the nurse provide to the client?
"Make sure to avoid drinking any alcohol for the next three days."
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."
A client diagnosed with tuberculosis (TB) has begun multi-drug therapy. The client has asked the nurse why it is necessary to take several different drugs. How should the nurse respond to the client's question?
"The use of multiple drugs prevents the development of drug-resistant TB."
An adult client prescribed trimethoprim-sulfamethoxazole should receive what information concerning potential adverse effects?
"This drug might make your stomach a bit upset, so let me know if you experience that."
A client has been on sulfonamide therapy for the last six weeks. What client report may cause the health care provider to discontinue the sulfonamide?
10 lb weight loss
A client is prescribed isoniazid and rifampin for the treatment of active tuberculosis (TB). The client's medication education should stress that initial symptom improvement is likely to take how long?
2 to 3 weeks
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
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
A client on cephalosporin therapy is prescribed cefazolin for a sinus infection. After administration of the first dose of the cefazolin, the client reports itching. The nursing assessment reveals a rash over the client's torso. What is the most likely cause of the itching?
A cross-sensitivity reaction.
Beta-lactam antibacterial drugs, such as penicillins and cephalosporins, combat infection by binding to proteins in bacterial cell membranes. What does this binding produce?
A defective cell wall
Natural penicillins exert what types of effects on microorganisms?
Bactericidal
Drugs that destroy the bacteria are known as which of the following? (Choose one)
Bacteriocidal
After teaching a group of nursing students about the different classes of drugs, the instructor determines that the teaching was successful when the students identify drugs that slow or retard the multiplication of bacteria as which types of medication?
Bacteriostatic
Drugs that slow or retard the multiplication of bacteria are known as which of the following?
Bacteriostatic
A male client is admitted to the unit with Pseudomonas aeruginosa sepsis. The physician orders aminoglycoside to be given concomitantly with penicillin intravenously. How would the nurse administer these drugs?
By administering the drug in separate IV bags
Tuberculosis is transmitted when a previously uninfected person inhales infectious particles that have been exhaled by an infected individual. In the approximately 30% of exposed individuals who become infected following exposure, spontaneous healing typically begins within six months. What physical change does the disease create in the infected person?
Calcified tubercles
A nurse is providing education to a client who is taking INH. The nurse is teaching the client to avoid which foods?
Cheese, dairy products, and bananas
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
A nurse is caring for a 35-year-old male taking telithromycin. For what type of infection is this client being treated?
Community-acquired pneumonia
A nurse is required to administer an anti-infective drug to a patient. The nurse knows that which of the following tests need to be conducted before administering the first dose of an anti-infective drug to the patient?
Culture tests The nurse should check whether culture tests are conducted before the first dose of drug is administered to the client. Ulcer tests and stool tests are not required to be conducted before administering the first dose of an anti-infective drug to the client. The nurse has to ensure that urinalysis is conducted before the administration of the drug but not specifically before the first dose of the anti-infective drug.
A patient has been prescribed a tetracycline drug for Rocky Mountain spotted fever. The patient also takes antacids. Which of the following effects is likely to occur due to an interaction between the two drugs?
Decreased absorption of tetracycline
A client with TB is prescribed pyrazinamide. The nurse should assess and monitor for which of the following adverse reactions of pyrazinamide in the client?
Diarrhea
A nurse is caring for a 6-year old child with a severe case of typhoid fever. The client was mistakenly administered tetracycline, which can cause adverse reactions. What could be a permanent effect in the child?
Discoloration of the teeth
A client treated for a respiratory infection is being treated with levofloxacin. The client reports diarrhea, abdominal cramping, and a fever. What is the action of the nurse?
Discontinue the levofloxacin.
A client is diagnosed with an infectious process that is sensitive to penicillin. The client is allergic to penicillin, so the physician orders a drug with a similar antibacterial spectrum. The nurse anticipates that the physician will order what antibiotic?
Erythromycin
A patient is admitted to the emergency room with a diagnosis of Legionnaire's disease and is placed on isolation. Which of the following medications is the drug of choice for Legionnaire's disease?
Erythromycin (Ery-Tab)
Aminoglycosides due to their low risk of toxicity are replacing many of the other antibiotics today. True or False?
False Aminoglycosides have potentially serious adverse effects, thus they are being replaced by newer, less toxic drugs in the treatment of serious infections.
The nurse is giving instructions to a client age 77 years who has been prescribed a sulfonamide for treatment of a urinary tract infection. The nurse has instructed the client to increase fluids while taking this medication. What does the nurse anticipate will be the client's greatest fear related to this instruction?
Fear of incontinence
The nurse is giving instructions to a client age 77 years who has been prescribed a sulfonamide for treatment of a urinary tract infection. The nurse has instructed the client to increase fluids while taking this medication. What does the nurse anticipate will be the client's greatest fear related to this instruction?
Fear of incontinence.
After teaching a group of students about aminoglycosides, the instructor determines that the teaching was successful when the group identifies which drug as the prototype for this class?
Gentamicin
A patient is administered a third-generation cephalosporin. Which of the following organisms are cephalosporins most effective in treating?
Gram-negative
The nurse is preparing to administer a sulfonamide to a client who is a Type 2 diabetic taking an oral hypoglycemic agent. The nurse will monitor the client for what reaction?
Hypoglycemia
A patient has just been diagnosed with tuberculosis (TB). The nurse can expect to start the patient on which of the following drugs for the initial phase of treatment?
INH, rifampin, pyrazinamide, ethambutol
Penicillins and cephalosporins are used cautiously in neonates due to what factor?
Immature kidney function
The nurse knows that sulfonamides are chosen to treat ulcerative colitis because of what action?
Inflammation is decreased because of interaction with intestinal bacteria.
A nurse is caring for a patient who is being administered penicillin. What are the common adverse reactions to penicillin a nurse should assess for?
Inflammation of the tongue and mouth
A client is diagnosed with community-acquired pneumonia, and the physician orders telithromycin. What is the mechanism of action for this antibiotic?
Inhibition of microbial protein synthesis
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
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.
Which of the following represents the mechanism of action of fluoroquinolones?
Interference with the synthesis of bacterial DNA.
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.
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. 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 female client's medical history includes type 2 diabetes, CVA, dysphasia, and chronic renal failure. She develops an infectious process. The physician orders erythromycin. Based on the client's medical history, why is erythromycin the drug of choice?
It is metabolized in the liver.
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
The nurse is administering erythromycin to a patient. For what common side effects should the nurse monitor the patient?
Nausea, vomiting, and diarrhea
The nurse should monitor the client for which common side effects of erythromycin therapy?
Nausea, vomiting, and diarrhea
Which of the following should a nurse carefully monitor in a patient who has been administered cephalosporin as well as aminoglycosides for a wound infection?
Nephrotoxicity
Your client is being treated for streptococcal pharyngitis and is NPO. Her health care provider has ordered Penicillin G to be given IM. She wants to know why she cannot take her medications via an oral route. Your best response is:
Penicillin G is inactivated by gastric acid, therefore it is only given IM or IV.
The nurse is preparing to administer nafcillin intravenously (IV) to a client. What is the most common reaction related to this method of administration?
Phlebitis
The nurse should advise clients that which of the following are adverse reactions that may occur with the administration of tetracyclines? Select all that apply.
Photosensitivity Diarrhea Stomatitis
The nurse is aware that sulfonamide therapy is used cautiously in older adults because of decreased function of what organ system?
Renal
A 72-year-old female clinic patient is started on trimethoprim-sulfamethoxazole for treatment of a urinary tract infection. Prior to administering this drug, the nurse should assess the patient for which of the following conditions?
Renal Impairment
A client is started on sulfamethoxazole-trimethoprim (Bactrim) for a urinary infection. What adverse effect should the nurse assess with this client?
Renal damage
A client is started on sulfamethoxazole-trimethoprim for a urinary infection. What adverse effect should the nurse assess with this client?
Renal damage
The nurse is preparing to administer amikacin to a client with a complicated Staphylococcus aureus infection. What assessment should the nurse prioritize?
Renal function
A group of students are reviewing information about drugs used to treat tuberculosis. The students demonstrate understanding of the material when they identify which drug as a first-line treatment option?
Rifampin
A nurse is caring for a patient undergoing the second phase of standard TB treatment. The nurse knows that which of the following combinations of drugs need to be administered to the client?
Rifampin and isoniazid
A patient with TB is admitted to a health care facility. The nurse is required to administer an antitubercular drug through the parenteral route to this patient. Which of the following precautions should the nurse take when administering frequent parenteral injections?
Rotate injection sites for frequent parenteral injections.
A nurse is caring for a patient who has a serious infection. The patient is being treated with combination therapy of a cefazolin and an aminoglycoside. The nurse will be sure to monitor which of the following?
Serum BUN and creatinine levels
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
A client has been treated several times for a recurring ear infection with ofloxacin. The nurse instructs the client to look for side effects from the prolonged use of the antibiotic and informs the client that this is known as:
Super infection
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
Which statement is true in regards to the oral administration of tetracyclines?
Tetracyclines should be administered with a full glass of water
Which statement is true in regard to the oral administration of tetracyclines?
Tetracyclines should be administered with a full glass of water.
Which statement is true in regards to the oral administration of tetracyclines?
Tetracyclines should be administered with a full glass of water.
A client with a complex medical history is showing signs and symptoms of sepsis. What aspect of this client's health history would rule out the safe and effective use of an aminoglycoside antibiotic?
The client has chronic renal failure
A client is diagnosed with an infection and is ordered to receive a fluoroquinolone. Which of the following would the nurse expect upon evaluation?
The client's temperature is returning to normal.
The health care provider considers prescribing an oral tetracycline for a client suspected of having a urinary tract infection. What action needs to be completed before the medication can be prescribed?
The health care provider should order culture and susceptibility studies.
A client is prescribed rifampin. What information should the nurse include in the client's medication education?
The urine, tears, sweat, and other body fluids will be a discolored red-orange.
A 30-year-old woman who is in the first trimester of pregnancy has presented to her primary care provider with a 4-day history of a reddened, itchy left eye that is crusted with purulent exudate. The clinician suspects a bacterial, rather than viral, etiology. How will the client's pregnancy affect the potential use of ciprofloxacin to treat her conjunctivitis?
The use of ciprofloxacin is contraindicated in pregnancy.
A client is taking penicillin for an upper respiratory infection. The client calls the office after 2 days of therapy reporting nausea and abdominal pain. Which would be the best instruction for the nurse to give the client?
These are normal side effects, but if they increase in severity or frequency, you need to contact the office again.
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.
A client is asking how fluoroquinolones work. What is the nurse's best response?
They interfere with the DNA of the bacteria.
A client asks the purpose for using three medications in combination to treat his tuberculosis. The nurse informs the client that multiple medications are given for which of the following reasons?
To prevent resistance
A nursing student studying pharmacology is focusing on drugs used to treat tuberculosis (TB). This student correctly identifies the classifications of antitubercular drugs as which of the following?
When classifying antitubercular drugs there are primary (first-line) and secondary (second-line) drugs. Primary drugs provide the foundation for treatment. Secondary drugs are less effective and more toxic than primary drugs.
A 10-year-old client is diagnosed with acute otitis media. What does the nurse anticipate the health care provider will prescribe?
amoxicillin
The nurse should advise the client to avoid taking which medication at the same time as a fluoroquinolone?
antacids
A client is being treated for a urinary tract infection with trimethoprim-sulfamethoxazole. What assessment should the nurse make prior to the administration of the medication?
assessing for renal insufficiency
A client is diagnosed with an infection. What would the nurse anticipate being used to determine the best drug to treat the infection?
culture and sensitivity (C&S)
A client with a gram-negative bacterial infection has been prescribed a fluoroquinolone. During the preadministration assessment, the nurse should ensure that which laboratory tests, if prescribed, are obtained before the first dose of fluoroquinolones is administered to the client?
culture and sensitivity test
What physical characteristic observed in an adult suggests that they were prescribed tetracycline as a child?
discoloration of the teeth
A youngster has just returned home from the family's tropical vacation and is now reporting worsening tenderness in the right ear. When the child is diagnosed with otitis externa, what causative factor of this infection should the nurse focus upon?
frequent swimming and water sports while the child was on vacation
A nursing instructor is preparing a teaching plan for a nursing pharmacology class on the action of fluoroquinolones. Which action would the instructor most likely include?
interfering with DNA synthesis in the bacterial cell
A client taking isoniazid is worried about the side effects/adverse reactions. The nurse tells the client that a common adverse reaction of isoniazid is which of the following?
jaundice
What adverse effect would most likely necessitate discontinuing treatment with isoniazid?
jaundice
The nursing student read about a disease called Hansen's disease, which is caused by the bacterium Mycobacterium leprae and is treated with many of the same drugs as are used for TB. The student learned that another name for Hansen's disease is which?
leprosy
After teaching a group of students about fluoroquinolones, the instructor determines a need for additional teaching when the students identify which drug as being available in an ophthalmic form?
levofloxacin
The nurse is justified in suspecting that a client who recently completed a course of ceftaroline may have been treated for what health problem?
methicillin-resistant Staphylococcus aureus (MRSA) infection
A group of nursing students are reviewing information about fluoroquinolones. The students demonstrate a need for additional review when they identify which as an example?
metronidazole
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
What route of administration is most commonly used for the administration of ciprofloxacin when prescribed to an older adult client?
oral (PO)
Tetracycline is often a viable treatment option when a client has an allergy to what antibiotics?
penicillins
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
A nursing student studying pharmacology is focusing on drugs used to treat tuberculosis (TB). This student correctly identifies the classifications of antitubercular drugs as which of the following?
primary and secondary
A patient has been treated several times for a recurring ear infection with ofloxacin. The nurse instructs the patient to look for side effects from the prolonged use of the antibiotic and informs the patient that this is known as which of the following?
superinfection
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
A nurse is reviewing the medical record of a client who is prescribed tetracycline. Which drug, if found being used by the client, would alert the nurse to the need for a decreased dosage of that drug?
warfarin
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.
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
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.
In general, progression from first-generation cephalosporins to fourth-generations results in which of the following? Select all that apply.
-An increase in sensitivity of gram-negative microorganisms. -A decrease in the sensitivity of gram-positive microorganisms.
Which classes of drugs exert their effects by inhibiting bacterial cell wall synthesis? (Select all that apply)
-Carbapenems -Monobactams
Which of the following are examples of fluoroquinolones? Select all that apply.
-Ciprofloxacin (Cipro) -Levofloxacin (Levaquin)
Clients taking isoniazid (INH) can experience a variety of adverse reactions but should be monitored carefully for which of the following that indicate toxicity? Select all that apply.
-Peripheral neuropathy -Jaundice
Which of the following are teaching points the nurse can use to increase client compliance in tubercular drug treatment programs? Select all that apply.
-Reinforce that short-term treatment is ineffective. -Arrange for direct observation therapy with the client and family. -Review the drug therapy regimen, including the prescribed drug, doses, and frequency of administration. -Instruct client about possible adverse reactions and the need to notify prescriber should any occur
A 67-year-old client with a history of chronic illness is receiving penicillin therapy. The client's age and health history indicate an increased susceptibility to pseudomembranous colitis. The nurse would be alert for which finding? Select all that apply.
-bloody diarrhea -rectal bleeding
What is true regarding the initial phase of tuberculosis therapy? Select all that apply.
-used to kill the rapidly multiplying M. tuberculosis. -prevent drug resistance. -initial phase lasts two months.
The physician has ordered penicillin V for a patient. What should the nurse instruct to take with the medication?
A full glass of water
A patient receiving isoniazid (INH) and rifampin has a decreased urinary output and decreased sensation in the great toes. Which laboratory values should be assessed?
ALT and AST
A nurse is preparing to administer a client's first scheduled dose of tetracycline. The nurse should first ensure that the client has not recently eaten what type of foods?
Dairy products It is important not to take tetracycline with dairy products, antacids, or iron supplements.
A female client is admitted to the critical care unit with sepsis related to a contaminated central line. The health care provider orders intravenous beta-lactam antimicrobials. The client's current laboratory report reflects renal impairment. What would the nurse expect the provider to do?
Decrease the drug dose
A female client is admitted to the critical care unit with sepsis related to a contaminated central line. The physician orders intravenous beta-lactam antimicrobials. The client's current laboratory report reflects renal impairment. What would the nurse expect the physician to do?
Decrease the drug dose.
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
Which nursing diagnoses are used with fluoroquinolones therapy? Select all that apply.
Diarrhea Acute Pain Risk for Impaired Comfort Risk for Impaired Skin Integrity
The nurse is preparing a teaching plan for a client who is prescribed ceftriaxone. What should the nurse identify as common adverse effects associated with this drug?
Diarrhea and nausea
Which of the following symptoms may indicate optic neuritis resulting from the use of ethambutol?
Difficulty differentiating between red and green A major adverse effect associated with ethambutol is optic neuritis, an inflammatory, demyelinating disorder of the optic nerve that decreases visual acuity and ability to differentiate red from green.
A client has been prescribed ciprofloxacin IV for the treatment of cellulitis. After initiating the infusion of the client's first scheduled dose, the client develops a pronounced rash on the chest and arms. How should the nurse respond initially to this event?
Discontinue the infusion and inform the care provider promptly.
The nurse should advise the client which of the following in regards to the administration of fluoroquinolones?
Do not take antacids while taking fluoroquinolones
Oral ampicillin has been ordered for a client whose urinary tract infection will be treated in a home setting. When providing antibiotic teaching to this client, the nurse should stress which instruction?
Drink a full glass of water when taking a dose of the drug
A client diagnosed with tuberculosis was prescribed antitubercular therapy but stopped after 1 month because of difficulty with the medication scheduling. As a result, secondary drugs are being prescribed. Which nursing diagnosis would the nurse most likely identify?
Ineffective Self-Health Management Difficulties with scheduling most likely led to the client not adhering to the treatment plan. As a result, the nursing diagnosis of Ineffective Self-Health Management would be most appropriate. Although nutrition can be affected, there is no indication that this is the problem. Although the client may have difficulty coping with the disease, there is no indication that this is a problem. The client may experience discomfort related to the adverse effects of the drug; however, there is no indication that this is an issue.
What is the rationale for not administering tetracycline to children under the age of 8 years?
It will interfere with enamel development.
A patient is administered isoniazid (INH) for latent tuberculosis. Which of the following factors will result in discontinuation of the medication?
Jaundice
A male client is prescribed aminoglycosides for a bladder infection secondary to benign prostatic hypertrophy. The nurse understands that these drugs reach higher concentrations in which areas of the body? (Select all that apply.)
Kidneys Inner ears
In which condition present in the client should macrolides be used with caution?
Liver dysfunction
A male client is placed on an IV regimen of aztreonam. The nurse would expect the physician to order which laboratory test?
Liver function Aztreonam, imipenem, meropenem, and ertapenem may cause abnormalities in liver function test results
A client is receiving rifampin and isoniazid in combination for treatment of tuberculosis. What would the nurse need to monitor closely?
Liver function studies
A client in the critical care unit is receiving aminoglycosides for an infectious process. What does the nurse need to monitor?
Liver function tests
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.
Ms. Tom, age 24, is prescribed cefazolin for a sinus infection. After administration of the first dose of the medication, Ms. Tom complains of itching. Your nursing assessment reveals a rash over her torso; also, you note that she has a history of allergic reaction to penicillin. What would explain your findings?
Ms. Tom is experiencing an allergic reaction caused by a cross-sensitivity reaction.
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
A nurse is caring for a client who the physician suspects may be infected with an antibiotic-resistant pathogen. What course of action is best used to determine whether this type of pathogen is present?
Perform culture and susceptibility tests.
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.
A young lifeguard has been prescribed moxifloxacin (Avelox). The nurse understands that the focus on education would be which adverse reaction?
Photosensitivity
The nurse is teaching a client about his prescription for a macrolide antibiotic. What should the nurse teach the client to report?
Recurring symptoms of infection
The nurse is caring for a client who is receiving IV vancomycin. The nurse infuses the medication at the prescribed rate to prevent what from occurring?
Red man syndrome
Mr. Toma is prescribed ciprofloxacin for a urinary tract infection. The nurse is preparing to teach him about the medication. What must the nurse include in the education plan?
Take precautions to prevent photosensitivity. Encourage the patient to take precautions to avoid sunlight or ultraviolet light.
The nurse has administered a patient's first scheduled dose of amoxicillin after the patient was diagnosed with acute otitis media. What subsequent assessment finding should prompt the nurse to discontinue the use of this drug?
The patient complains of shortness of breath.
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.
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 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 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.
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
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
A patient has been admitted to the intensive care unit with signs and symptoms of sepsis and preliminary results of the patient's initial blood cultures reveal the presence of methicillin-resistant Staphylococcus aureus (MRSA). This finding is an indication for treatment with
daptomycin.
A patient has been admitted to the intensive care unit with signs and symptoms of sepsis and preliminary results of the patient's initial blood cultures reveal the presence of methicillin-resistant Staphylococcus aureus (MRSA). This finding is an indication for treatment with:
daptomycin.
The nurse caring for a client diagnosed with Mycoplasma pneumonia should prepare medication information on what medication?
doxycycline
A client with an upper respiratory infection has been prescribed macrolides. Which changes during an ongoing assessment would lead the nurse to notify the health care provider? Select all that apply.
drop in blood pressure increase in respiratory rate sudden increase in temperature
A client is allergic to penicillin and has been diagnosed with a genitourinary infection caused by Chlamydia trachomatis. Which medication will most likely be administered?
erythromycin
A client reports having had a "bad reaction" the last time receiving penicillin. Prior to a scheduled dental procedure, the client is likely to be prescribed what drug?
erythromycin
Which medication is the drug of choice for Legionnaires disease?
erythromycin
When fluoroquinolones are administered intravenously, the nurse would check the needle site and area around the needle site for extravasation at which frequency?
every hour
The nurse understands that tuberculosis (TB) can affect other organs of the body. The term used for TB outside the lungs called which?
extrapulmonary.
What potential adverse reaction is most likely to develop during cefazolin therapy?
gastrointestinal upset
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
Penicillins are most effective when used to treat what type of microorganisms?
gram-positive bacteria
Gary is a construction worker who is diagnosed with leprosy and is prescribed rifampin. Gary is married, an alcoholic, and wears contact lenses. At the time of initiating the therapy, the nurse should inform the client:
he should wear glasses during the therapy.
A client being treated for tuberculosis (TB) is determined to be drug resistant. Which medications will no longer be effective in the treatment of the tuberculosis?
isoniazid (INH) and rifampin (RIF) Isoniazid (INH) and rifampin (RIF) are used to treat tuberculosis. In multidrug resistance, the most effective drugs the client is resistant to are isoniazid and rifampin. Carbamazepine and phenytoin are used to control seizures. Dextroamphetamine and doxapram are central nervous system stimulants. Propranolol and sotalol are beta-adrenergic blocking agents.
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
A 35-year-old man is being treated with isoniazid (INH) for exposure to TB. He has the following 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 physician right away?
numbness and tingling in his feet
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
Ampicillin-sulbactam is administered to a client with Staphylococcus aureus. What type of antiinfective is ampicillin-sulbactam?
penicillin-beta-lactamase inhibitor combination
A client has been admitted with leprosy. The nurse completes the health history and physical examination. In addition to a thorough assessment of the skin, what other areas of the body would be important to assess? (Select all that apply.)
peripheral nerves mucosa of the gastrointestinal tract
When instructing the client with tuberculosis (TB) about the drug Isoniazid, the nurse advises that the most common symptom of toxicity is:
peripheral neuropathy.
What event triggers the development of a superinfection?
proliferation of antibiotic-resistant microorganisms
A client is started on sulfamethoxazole-trimethoprim (Bactrim) for a urinary infection. What adverse effect should the nurse assess with this client?
renal damage
A nurse is preparing the medical history report of a patient with a urinary tract infection. Which of the following conditions should the nurse identify as one in which the use of cephalosporins is restricted?
renal disease
A critical care nurse is caring for a client taking aminoglycosides. The dosage may need to be adjusted if the nurse finds monitored changes in what system?
renal function
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
The nurse has administered a client's first scheduled dose of amoxicillin. What subsequent client report should prompt the nurse to seek the discontinuation of this drug?
shortness of breath
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
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 physician if the client experiences what adverse effect associated with the drug?
skin rash or itching
