Exam 5

When planning care for a client receiving a sulfonamide antibiotic, it is important for the nurse to perform which intervention? A) Take the medication with dairy products such as milk or yogurt. B) Advise the client to report any tinnitus to the health care provider. C) Avoid direct sun exposure and tanning beds. D) Encourage fluid intake of 2000 to 3000 mL/day.

D) Encourage fluid intake of 2000 to 3000 mL/day.

Penicillin/Betalactamase Inhibitors

-Ampicillin/sulbactam (Unasyn) -amoxicillin/clavulanic acid (Augmentin) -piperacillin/tazobactam (Zosyn)

The nurse is reviewing the orders for wound care, which include use of an antiseptic. Which statements best describe the use of antiseptics? SATA

-Antiseptics are appropriate for use on living tissue -The patient's allergies must be assessed before using the antiseptic -Antiseptics are used to inhibit the growth of microorganisms on the wound surface

MOA of Sulfnamides

-Bacteriostatic -inhibits bacterial synthesis folic acid

Sulfonamides Adverse Reactions

-Crystalluria -Photosensitivity -Take with food

Indication of Sulfnamides

-Gram(+) and gram(-) -Streptococcal, staphlyococcus, E.coli infections -UTIs, pneumonia, skin infections, burns

Antibiotic Mechanisms of Action

-Interference with bacterial wall synthesis -interference with protein synthesis -interference with DNA & RNA -Antimetabolite action

PCN drug interactions

-Oral birth control bills - decreases effectiveness -Aminoglycosides - both medications become inactivated -Warfarin & ASA - high dose PCN decreases platelet aggregation

Cephalosporins Indications

-Take with food for GI upset -Categorized by generation according to antimicrobial activity -5 generations:each generation has broader spectrum coverage and is less affected by beta-lactamases

Sulfonamides

-first set of drugs used against bacteria -Sulfonamide-trimethropin-sulfmethaxozole (TMP-SMZ) -Bactrim, Bactrim DS-Silvadene (silver, sulfadiazine) -topical cream -Well absorbed by GI tract

Sulfunylureas

-glyburide -increases hypoglycemia effect

Beta-Lactam Antibiotics

-penicillins -cephalosporins -carbapenems -monobactams

During patient education regarding an oral macrolide such as erythromycin, the nurse will include which information? SATA

-use another form of birth control if the patient is taking oral contraceptive -The patient may take the drug with a small snack to reduce GI irritation

Which information should the nurse include in discharge teaching for a client prescribed doxycycline (Vibramycin)? A) "Take the medication with milk to minimize gastrointestinal upset." B) "Apply sunscreen or wear protective clothing when outdoors." C) "Take the medication until you have no fever and feel better." D) "Keep the remainder of the medication in case of recurrence."

B) "Apply sunscreen or wear protective clothing when outdoors."

A patient has been admitted for treatment of an infected leg ulcer and will be started on intravenous linezolid. The nurse is reviewing the list of the patient's current medications. Which type of medication, if listed, would be of most concern if taken with the linezolid? A. Beta blocker B. Oral anticoagulant C. Selective serotonin reuptake inhibitor antidepressant D. Thyroid replacement hormone

C. Selective serotonin reuptake inhibitor antidepressant

During intravenous (IV) quinolone therapy in an 88-year-old patient, which potential problem is of most concern when assessing for adverse effects? A. Hepatotoxicity B. Rhabdomyolysis C. Tendon rupture D. Nephrotoxicity

C. Tendon rupture

A 58-year-old man is receiving vancomycin as part of the treatment for a severe bone infection. After the infusion, he begins to experience some itching and flushing of the neck, face, and upper body. He reports no chills or difficulty breathing. The nurse should suspect A. an allergic reaction has occurred. B. an anaphylactic reaction is about to occur. C. the medication will not be effective for the bone infection. D. the IV dose may have infused too quickly.

D. the IV dose may have infused too quickly.

clindamycin (cleocin)

chronic bone infections, GU infections, intraabdominal infections, and other serious infections

all enterobacteriaceae are resistant to which antibiotic

clindamycin

which drug May cause pseudomembranous colitis

clindamycin (Cleocin)

During patient education regarding an oral macrolide such as erythromycin, the nurse will include which information? a) If GI upset occurs, the drug will have to be stopped. b) The drug needs to be taken with an antacid to avoid GI problems. c) The patient needs to take each dose with a sip of water. d) The patient may take the drug with a small snack to reduce GI irritation.

d) The patient may take the drug with a small snack to reduce GI irritation.

The classification for the drug erythromycin

Macrolide

vancomycin is similar to the aminoglycosides in that they may cause

May cause ototoxicity and nephrotoxicity

Which parameter is most important to assess before administering vancomycin to a patient? a. Platelet count b. Liver function c. Renal function d. Hemoglobin level

c. Renal function

The patient has been diagnosed with ulcerative colitis. The nurse recognizes that which medication may be ordered to treat this condition? a. Aztreonam b. Amoxicillin c. Sulfasalazine d. Sulfamethoxazol/trimethoprim

c. Sulfasalazine

What is the elimination half-life of amoxicillin? a. 6 to 8 hours b. 1 to 2 hours c. 0.5 to 1 hour d. 1 to 1.5 hours

d. 1 to 1.5 hours

The nurse anticipates that a patient with which of the following infections would be prescribed meropenem? a. Cellulitis b. Pneumonia c. Tooth abscess d. Bacterial meningitis

d. Bacterial meningitis

Which antibiotic does the nurse administer if the culture of a patient with bacterial endocarditis reveals the presence of gram-positive streptococcus? a. Amikacin b. Gentamicin c. Tobramycin d. Clindamycin

d. Clindamycin

A patient has been diagnosed with carbapenemase-resistant Enterobacteriaceae (CRE). The nurse expects to see orders for which drug? a. Dapsone (Cubicin), a miscellaneous antibiotic b. Ciprofloxacin (Cipro), a quinolone c. Linezolid (Zyvox), an oxazolidinone d. Colistimethate sodium (Coly-Mycin), apolypeptide antibiotic

d. Colistimethate sodium (Coly-Mycin), apolypeptide antibiotic

A patient is diagnosed with a respiratory infection caused by staphylococci. Which penicillinase-resistant drug may be included in the prescription? a. Ampicillin b. Penicillin G c. Amoxicillin d. Dicloxacillin

d. Dicloxacillin

The nurse is caring for a patient who has been prescribed cefazolin sodium. Which nursing assessment is the priority? a. Cardiac assessment b. Neurologic assessment c. History of immunizations d. History, including allergies

d. History, including allergies

Which antibiotic may cause hemolysis in a patient who has glucose-6-phosphate dehydrogenase (G6PD) deficiency? a. Penicillin b. Quinolone c. Tetracycline d. Sulfonamide

d. Sulfonamide

colistmethate (coly-mycin)

gram-negative bacteria; not used because effects are too dangerous (acute respiratory failure)

nitrofurantoin (Macrodantin) is contraindicated in what cases

impaired renal function

nitrofurantoin (macrodantin)

primarily used for urinary tract infections; drug concentrates in the urine; use carefully if renal function is impaired

quinolones adverse effects

prolonged QT intervals

what kind of organisims does Metronidazole fight

anaerobic organisms

A patient will be receiving penicillin G potassium, 12 million units daily in divided doses every 4 hours IVPB. Identify how many units will the patient receive for each dose each day. _______

2 million units

A patient will be receiving amoxicillin suspension 300 mg via a gastrostomy tube every 8 hours. The medication comes in a bottle that contains 400 mg/5 mL. Identify how many milliliters will the nurse administer with each dose. (record answer using one decimal place) _______

3.8 mL

The nurse would assess a patient for nephrotoxicity and ototoxicity when administering which antimicrobial? A. Cefazolin B. Erythromycin C. Gentamicin D. Clindamycin

C. Aminoglycoside antibiotics, including gentamicin, have a high risk for nephrotoxicity and ototoxicity.

A patient with a staphylococcal infection is prescribed tobramycin. About which assessment findings in the follow-up visit will the nurse immediately notify the primary health care provider? Select all that apply. a. Nausea b. Vertigo c. Headache d. Skin turgor e. Visual acuity

A, B, C

After an infusion of colistimethate (Coly-Mycin), the nurse will report to the prescriber if the patient complains of which adverse effects? (Select all that apply) A. Numbness B. Vertigo C. Upset stomach D. Insomnia E. Dizziness

A, B, E

The nurse is caring for a patient who has a urinary tract infection and is being treated with sulfamethoxazole/trimethoprim (SMZ-TMP). Which findings does the nurse report to the primary health care provider to prevent complications? Select all that apply. a. Diarrhea b. Yellowish eyes c. Blood in the urine d. Shortness of breath e. Change in the color of the sputum

A, C, D

The nurse is performing a follow-up assessment of a patient who was prescribed a week's worth of antibiotics for gastroenteritis. Which signs and symptoms in the patient may indicate the need for referral to the primary health care provider? Select all that apply. a. Jaundice b. Mild nausea c. Excessive fatigue d. Elevated temperature e. Occasional loose stools

A, C, D

During antibiotic therapy, the nurse will monitor closely for signs and symptoms of a hypersensitivity reaction. Which of these assessment findings may be an indication of a hypersensitivity reaction? (Select all that apply.) a. Wheezing b. Diarrhea c. Shortness of breath d. Swelling of the tongue e. Itching f. Black, hairy tongue

A, C, D, E

The nurse is administering intravenous vancomycin (Vancocin) to a patient who has hadgastrointestinal surgery. Which nursing measures are appropriate? (Select all that apply.) a. Monitoring serum creatinine levels b. Restricting fluids while the patient is on this medication c. Warning the patient that a flushed feeling or facial itching may occur d. Instructing the patient to report dizziness or a feeling of fullness in the ears e. Reporting a trough drug level of 11 mcg/mL and holding the drug f. Reporting a trough drug level of 24 mcg/mL and holding the drug

A, C, D, F

When reviewing the medication orders for a patient who is taking penicillin, the nurse notes that the patient is also taking the oral anticoagulant warfarin (Coumadin). What possible effect may occur as the result of an interaction between these drugs? A. The penicillin will cause an enhanced anticoagulant effect of the warfarin. b. The penicillin will cause the anticoagulant effect of the warfarin to decrease. c. The warfarin will reduce the anti-infective action of the penicillin. d. The warfarin will increase the effectiveness of the penicillin.

A. Administering penicillin reduces the vitamin K in the gut (intestines); therefore, enhanced anticoagulant effect of warfarin may occur. The other options are incorrect.

When providing instructions to patients on use of antibiotics, which instructions would the nurse include in the teaching? (Select all that apply.) A. Complete the entire course of therapy. B. Increase fluid intake up to 3000 mL/day. C. Notify the provider of any possible reactions that occur. D. Save unused medication in a cool dry place for later use. E. Wash your hands before and after preparing food.

A,B,C,E There should not be any leftover medication, but if there is, it needs to be discarded in the appropriate method. The health care provider typically only writes a prescription for the exact amount of medication needed by the patient.

Bacterial resistance to antibiotics can occur with which situations? (Select all that apply.)Select all that apply. A. Patients stop taking an antibiotic when they feel better. B. Antibiotics that are prescribed according to culture and sensitivity reports C. Antibiotics that are prescribed to treat a viral infection D. Taking an antibiotic and an antiviral medication at the same time E. Microorganisms arriving from foreign countries and overseas ports

A,C Not completing a full course of antibiotic therapy can allow bacteria that are not killed but have been exposed to the antibiotic to adapt their physiology to become resistant to that antibiotic. Administering antibiotics to treat viral infections is not effective and may expose small amounts of bacteria that may be present to the antibiotic and therefore risk the development of resistance.

Quinolones are a class of antibiotics known for several significant complications. Which are possible adverse effects with these drugs? (Select all that apply.)Select all that apply. A. Prolongation of the QT interval B. Ototoxicity C. Abnormal cartilage development in children D. Tendon rupture E. Nephrotoxicity

A,C,D Quinolones are not used in prepubescent children because of the risk of cartilage development issues. Quinolones may also cause a cardiac effect that involves prolongation of the QT interval on the electrocardiogram. The use of these medications can result in tendonitis or ruptured tendons in adults. Nephrotoxicity and ototoxicity are not associated with quinolones

Which statement best describes health care-associated infections? A. The infection was not incubating at the time of admission. B. Patients are admitted to the hospital with an infectious disease. C. They develop in more than 15% of hospitalized patients. D. The infection develops in response to various antibiotics.

A. A health care-associated infection is an infection that is acquired during the course of receiving treatment for another condition in a health care facility. The infection is not present or incubating at the time of admission; also known as a nosocomial infection.

During antibiotic therapy, the nurse will assess the patient for a condition that may occur because of the disruption of normal flora. The nurse knows this as what condition? A. Superinfection B. Organ toxicity C. Hypersensitivity D. Allergic reaction

A. Superinfections can occur when antibiotic therapy reduces or completely eliminates the normal bacterial flora of the body, which normally would inhibit the overgrowth of fungi and yeast. When the normal bacterial are flora and are reduced or completely eliminated, these organisms can overgrow and cause infections.

A patient prescribed azithromycin expresses concern regarding GI upset that was experienced when previously prescribed an erythromycin antibiotic. What is the nurse's best response? A. "This drug is like erythromycin with less gastrointestinal adverse effects." B. "Take an over-the-counter antiemetic to lessen the nausea." C. "Stop taking the drug if you experience heartburn and diarrhea." D. "I will call the health care provider and request a different antibiotic."

A. azithromycin is a newer macrolide antibiotic. It has a longer duration of action, as well as fewer and less severe GI adverse effects than erythromycin.

Which intervention is important for the nurse to perform before beginning antibiotic therapy? A. Obtain a specimen for culture and sensitivity B. Give with an antacid to reduce GI upset C. Monitor for adverse effects D. Restrict oral fluids

A. Obtain a specimen for culture and sensitivity

A patient is receiving aminoglycoside therapy and will be receiving a beta-lactam antibiotic as well. The patient asks why two antibiotics have been ordered. What is the nurse's best response? a. "The combined effect of both antibiotics is greater than each of them alone." b. "One antibiotic is not strong enough to fight the infection." c. "We have not yet isolated the bacteria, so the two antibiotics are given to cover a wide range of microorganisms." d. "We can give a reduced amount of each one if we give them together."

ANS: A Aminoglycosides are often used in combination with other antibiotics, such as beta-lactams or vancomycin, in the treatment of various infections because the combined effect of the two antibiotics is greater than that of either drug alone.

The nurse is reviewing the sputum culture results of a patient with pneumonia and notes that the patient has a gram-positive infection. Which generation of cephalosporin is most appropriate for this type of infection? a. First generation b. Second generation c. Third generation d. Fourth generation

ANS: A First-generation cephalosporins provide excellent coverage against gram-positive bacteria but limited coverage against gram-negative bacteria.

During drug therapy for pneumonia, a female patient develops a vaginal superinfection. The nurse explains that this infection is caused by: a. large doses of antibiotics that kill normal flora. b. the infection spreading from her lungs to the new site of infection. c. resistance of the pneumonia-causing bacteria to the drugs. d. allergic reaction to the antibiotics.

ANS: A Normally occurring bacteria are killed during antibiotic therapy, allowing other flora to take over and resulting in superinfections. The other options are incorrect.

The nurse is providing teaching to a patient taking an oral tetracycline antibiotic. Which statement by the nurse is correct? A. "Avoid direct sunlight and tanning beds while on this medication." B. "Milk and cheese products result in increased levels of tetracycline." C. "Antacids taken with the medication help to reduce gastrointestinal distress." D. "Take the medication until you are feeling better."

ANS: A Drug-related photosensitivity occurs when patients take tetracyclines, and it may continue for several days after therapy. Milk and cheese products result in decreased levels of tetracycline when the two are taken together. Antacids also interfere with absorption and should not be taken with tetracycline. Counsel patients to take the entire course of prescribed antibiotic drugs, even if they feel that they are no longer ill.

During antibiotic therapy, the nurse will monitor closely for signs and symptoms of a hypersensitivity reaction. Which of these assessment findings may be an indication of a hypersensitivity reaction? (Select all that apply.) a. Wheezing b. Diarrhea c. Shortness of breath d. Swelling of the tongue e. Itching f. Black, hairy tongue

ANS: A, C, D, E Hypersensitivity reactions may be manifested by wheezing; shortness of breath; swelling of the face, tongue, or hands; itching; or rash.

The nurse is administering intravenous vancomycin (Vancocin) to a patient who has had gastrointestinal surgery. Which nursing measures are appropriate? (Select all that apply.) a. Monitoring serum creatinine levels b. Restricting fluids while the patient is on this medication c. Warning the patient that a flushed feeling or facial itching may occur d. Instructing the patient to report dizziness or a feeling of fullness in the ears e. Reporting a trough drug level of 11 mcg/mL and holding the drug f. Reporting a trough drug level of 24 mcg/mL and holding the drug

ANS: A, C, D, F Constant monitoring for drug-related neurotoxicity, nephrotoxicity, ototoxicity, and superinfection remain critical to patient safety. Monitor for nephrotoxicity by monitoring serum creatinine levels. Ototoxicity may be indicated if the patient experiences dizziness or a feeling of fullness in the ears, and these symptoms must be reported immediately. Vancomycin infusions may cause red man syndrome, which is characterized by flushing of the neck and face and a decrease in blood pressure. In addition, adequate hydration (at least 2 L of fluids every 24 hours unless contraindicated) is most important to prevent nephrotoxicity. Optimal trough blood levels of vancomycin are 10 to 20 mcg/mL; therefore, the drug should not be administered when there is a trough level of 24 mcg/mL.

A patient will be receiving nitrofurantoin (Macrodantin) treatment for a urinary tract infection. The nurse is reviewing the patient's history and will question the nitrofurantoin order if which disorder is present in the history? (Select all that apply.) a. Liver disease b. Coronary artery disease c. Hyperthyroidism d. Type 1 diabetes mellitus e. Chronic renal disease

ANS: A, E Nitrofurantoin is contraindicated in cases of known drug allergy and also in cases of significant renal function impairment, because the drug concentrates in the urine. Because adverse effects include hepatotoxicity, which is rare but often fatal, the nurse should also question the order if liver disease is present. The other options are not contraindications.

Which nursing diagnosis is appropriate for a patient who has started aminoglycoside therapy? a. Constipation b. Risk for injury (renal damage) c. Disturbed body image related to gynecomastia d. Imbalanced nutrition, less than body requirements, related to nausea

ANS: B Patients on aminoglycoside therapy have an increased risk for injury caused by nephrotoxicity. The other options are incorrect.

A patient will be having oral surgery and has received an antibiotic to take for 1 week before the surgery. The nurse knows that this is an example of which type of therapy? a. Empiric b. Prophylactic c. Definitive d. Resistance

ANS: B Prophylactic antibiotic therapy is used to prevent infection. Empiric therapy involves selecting the antibiotic that can best kill the microorganisms known to be the most common causes of an infection. Definitive therapy occurs once the culture and sensitivity results are known. Resistance is not a type of antibiotic therapy.

The nurse is reviewing the medication history of a patient who will be taking a sulfonamide antibiotic. During sulfonamide therapy, a significant drug interaction may occur with which of these drugs or drug classes? (Select all that apply.) a. Opioids b. Oral contraceptives c. Sulfonylureas d. Antihistamines e. Phenytoin (Dilantin) f. Warfarin (Coumadin)

ANS: B, C, E, F Sulfonamides may potentiate the hypoglycemic effects of sulfonylureas in diabetes treatment, the toxic effects of phenytoin, and the anticoagulant effects of warfarin, which can lead to hemorrhage. Sulfonamides may also reduce the efficacy of oral contraceptives.

The nurse identifies Zosyn as being a member of which group? A. Cephalosporins B. Macrolides C. Penicillins D. Sulfonamides

C. Penicillins

The nurse is monitoring a patient who has been on antibiotic therapy for 2 weeks. Today the patient tells the nurse that he has had watery diarrhea since the day before and is having abdominal cramps. His oral temperature is 101° F (38.3° C). Based on these findings, which conclusion will the nurse draw? a. The patient's original infection has not responded to the antibiotic therapy. b. The patient is showing typical adverse effects of antibiotic therapy. c. The patient needs to be tested for Clostridium difficile infection. d. The patient will need to take a different antibiotic.

ANS: C Antibiotic-associated diarrhea is a common adverse effect of antibiotics. However, it becomes a serious superinfection when it causes antibiotic-associated colitis, also known as pseudomembranous colitis or simply C. difficile infection. This happens because antibiotics disrupt the normal gut flora and can cause an overgrowth of Clostridium difficile. The most common symptoms of C. difficile colitis are watery diarrhea, abdominal pain, and fever. Whenever a patient who was previously treated with antibiotics develops watery diarrhea, the patient needs to be tested for C. difficile infection. If the results are positive, the patient will need to be treated for this serious superinfection.

The nurse is monitoring for therapeutic results of antibiotic therapy in a patient with an infection. Which laboratory value would indicate therapeutic effectiveness of this therapy? a. Increased red blood cell count b. Increased hemoglobin level c. Decreased white blood cell count d. Decreased platelet count

ANS: C Decreased white blood cell counts are an indication of reduction of infection and are a therapeutic effect of antibiotic therapy. The other options are incorrect.

When a patient is on aminoglycoside therapy, the nurse will monitor the patient for which indicators of potential toxicity? a. Fever b. White blood cell count of 8000 cells/mm3 c. Tinnitus and dizziness d. Decreased blood urea nitrogen (BUN) levels

ANS: C Dizziness, tinnitus, hearing loss, or a sense of fullness in the ears could indicate ototoxicity, a potentially serious toxicity in a patient. Nephrotoxicity is indicated by rising blood urea nitrogen and creatinine levels. Fever may be indicative of the patient's infection; a white blood cell count of 7000 cells/mm3 is within the normal range of 5000 to 10,000 cells/mm3.

A patient is receiving his third intravenous dose of a penicillin drug. He calls the nurse to report that he is feeling "anxious" and is having trouble breathing. What will the nurse do first? a. Notify the prescriber. b. Take the patient's vital signs. c. Stop the antibiotic infusion. d. Check for allergies.

ANS: C Hypersensitivity reactions are characterized by wheezing; shortness of breath; swelling of the face, tongue, or hands; itching; or rash. The nurse should immediately stop the antibiotic infusion, have someone notify the prescriber, and stay with the patient to monitor the patient's vital signs and condition. Checking for allergies should have been done before the infusion.

A patient with a long-term intravenous catheter is going home. The nurse knows that if he is allergic to seafood, which antiseptic agent is contraindicated? a. Chlorhexidine gluconate (Hibiclens) b. Hydrogen peroxide c. Povidone-iodine (Betadine) d. Isopropyl alcohol

ANS: C Iodine compounds are contraindicated in patients with allergies to seafood. The other options are incorrect.

The nurse checks the patient's laboratory work prior to administering a dose of vancomycin (Vancocin) and finds that the trough vancomycin level is 24 mcg/mL. What will the nurse do next? a. Administer the vancomycin as ordered. b. Hold the drug, and administer 4 hours later. c. Hold the drug, and notify the prescriber. d. Repeat the test to verify results.

ANS: C Optimal blood levels of vancomycin are a trough level of 10 to 20 mcg/mL. Measurement of peak levels is no longer routinely recommended, and only trough levels are commonly monitored. Blood samples for measurement of trough levels are drawn immediately before administration of the next dose. Because of the increase in resistant organisms, many clinicians use a trough level of 15 to 20 mcg/mL as their goal. These trough levels mean that even just before the next dose is due, when drug levels should be low, the drug levels are actually too high.

A patient has a urinary tract infection. The nurse knows that which class of drugs is especially useful for such infections? a. Macrolides b. Carbapenems c. Sulfonamides d. Tetracyclines

ANS: C Sulfonamides achieve very high concentrations in the kidneys, through which they are eliminated. Therefore, they are often used in the treatment of urinary tract infections.

A patient who has been hospitalized for 2 weeks has developed a pressure ulcer that contains multidrug-resistant Staphylococcus aureus (MRSA). Which drug would the nurse expect to be chosen for therapy? a. Metronidazole (Flagyl) b. Ciprofloxacin (Cipro) c. Vancomycin (Vancocin) d. Tobramycin (Nebcin)

ANS: C Vancomycin is the drug of choice for the treatment of MRSA. The other drugs are not used for MRSA.

A patient is admitted with a fever of 102.8° F (39.3° C), origin unknown. Assessment reveals cloudy, foul-smelling urine that is dark amber in color. Orders have just been written to obtain stat urine and blood cultures and to administer an antibiotic intravenously. The nurse will complete these orders in which sequence? a. Blood culture, antibiotic dose, urine culture b. Urine culture, antibiotic dose, blood culture c. Antibiotic dose, blood and urine cultures d. Blood and urine cultures, antibiotic dose

ANS: D Culture specimens should be obtained before initiating antibiotic drug therapy; otherwise, the presence of antibiotics in the tissues may result in misleading culture and sensitivity results. The other responses are incorrect.

A 79-year-old patient is receiving a quinolone as treatment for a complicated incision infection. The nurse will monitor for which adverse effect that is associated with these drugs? a. Neuralgia b. Double vision d. Hypotension e. Tendonitis and tendon rupture

ANS: D A black-box warning is required by the U.S. Food and Drug Administration for all quinolones because of the increased risk for tendonitis and tendon rupture with use of the drugs. This effect is more common in elderly patients, patients with renal failure, and those receiving concurrent glucocorticoid therapy (e.g., prednisone). The other options are not common adverse effects.

The nurse is preparing to use an antiseptic. Which statement is correct regarding how antiseptics differ from disinfectants? a. Antiseptics are used to sterilize surgical equipment. b. Disinfectants are used as preoperative skin preparation. c. Antiseptics are used only on living tissue to kill microorganisms. d. Disinfectants are used only on nonliving objects to destroy organisms.

ANS: D Antiseptics primarily inhibit microorganisms but do not necessarily kill them. They are applied exclusively to living tissue. Disinfectants are able to kill organisms and are used only on nonliving objects.

A patient has been diagnosed with carbapenemase-resistant Enterobacteriaceae (CRE). The nurse expects to see orders for which drug? a. Dapsone (Cubicin), a miscellaneous antibiotic b. Ciprofloxacin (Cipro), a quinolone c. Linezolid (Zyvox), an oxazolidinone d. Colistimethate sodium (Coly-Mycin), a polypeptide antibiotic

ANS: D Colistimethate (Coly-Mycin), commonly referred to as colistin, is now being used again, often as one of the only drugs available to treat CRE. The other options are incorrect.

The nurse is reviewing the medication orders for a patient who will be receiving gentamicin therapy. Which other medication or medication class, if ordered, would be a potential interaction concern? a. Calcium channel blockers b. Phenytoin c. Proton pump inhibitors d. Loop diuretics

ANS: D Concurrent use of aminoglycosides, such as gentamicin, with loop diuretics increases the risk for ototoxicity. The other drugs and drug classes do not cause interactions.

The nurse is administering a vancomycin (Vancocin) infusion. Which measure is appropriate for the nurse to implement in order to reduce complications that may occur with this drug's administration? a. Monitoring blood pressure for hypertension during the infusion b. Discontinuing the drug immediately if red man syndrome occurs c. Restricting fluids during vancomycin therapy d. Infusing the drug over at least 1 hour

ANS: D Infuse the medication over at least 1 hour to reduce the occurrence of red man syndrome. Adequate hydration (at least 2 L of fluid in 24 hours) during vancomycin therapy is important for the prevention of nephrotoxicity. Hypotension may occur during the infusion, especially if it is given too rapidly.

During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and decreased appetite. Which statement is the nurse's best advice to the patient? a. "Take it with cheese and crackers or yogurt." b. "Take each dose with a glass of milk." c. "Take an antacid with each dose as needed." d. "Drink a full glass of water with each dose."

ANS: D Oral doses should be given with at least 8 ounces of fluids and food to minimize gastrointestinal upset; however, antacids and dairy products will bind with the tetracycline and make it inactive.

___ primarily inhibit microorganisms but do not necessarily kill them. They are applied exclusively to living tissue.

Antiseptics

The nurse is reviewing the orders for a patient who has been admitted for treatment of pneumonia. The antibiotic orders include an order for doxycycline. However, the patient is asked about his allergies, he lists " doxycycline" as one of his allergies. What is the nurse's first action at this time?

Ask the patient to explain what happened when he had the allergic reaction?

The nurse is reviewing the list of medications for a patient who will be starting antibiotic therapy with an aminoglycoside. Which medication, if present, may present a potential interaction with the aminoglycoside? (Select all that apply) A. Metoprolol (Lopressor), a beta blocker B. Furosemide (Lasix), a loop diuretic C. Warfarin (Coumadin), an oral anticoagulant D. Vancomycin (Vancocin), an antibiotic E. Levothyroxine (Synthroid), a thyroid hormone

B, C, D

What does the nurse assess before starting antibacterial therapy for a patient? Select all that apply. a. Fluid status b. Baseline vital sign values c. Cardiac history d. Hypersensitivity e. Neurologic abnormalities

B, C, D, E

What are the adverse effects of sulfonamide antibiotics? Select all that apply. a. Polyuria b. Urticaria c. Pancreatitis d. Constipation e. Hepatotoxicity

B, C, E

The nurse is reviewing the medication history of a patient who will be taking a sulfonamide antibiotic. During sulfonamide therapy, a significant drug interaction may occur with which of these drugs or drug classes? (Select all that apply.) a. Opioids b. Oral contraceptives c. Sulfonylureas d. Antihistamines e. Phenytoin (Dilantin) f. Warfarin (Coumadin)

B, C, E, F

The nurse works in a medical-surgical unit. Which patients should the nurse monitor for atypical signs of infection? Select all that apply. a. A 30-year-old patient with fractured tibia b. A 78-year-old patient with urinary incontinence c. A 40-year-old patient with coronary artery disease d. A 35-year-old patient who underwent a renal transplant e. A 55-year-old patient who received radiation therapy for lung cancer

B, D, E

When performing discharge teaching for a patient prescribed oral linezolid to treat methicillin-resistant Staphylococcus aureus (MRSA), the nurse would emphasize which important information? A. Stop the drug as soon as you feel better. B. Avoid ingestion of foods containing tyramine. C. Report any occurrence of constipation or facial flushing. D. Take the drug with an antacid to avoid gastrointestinal (GI) upset.

B. Hypertension may occur in patients consuming tyramine-containing foods such as aged cheese or wine, soy sauce, smoked meats or fish, and sauerkraut while taking linezolid. Linezolid causes diarrhea, not constipation, and should be taken with food to decrease GI distress. An antacid would interfere with absorption.

The patient's culture has grown gram-positive cocci, and the health care provider prescribes two different antibiotics, one of which is gentamicin. To treat this type of infection, which type of antibiotic is typically prescribed together with gentamicin? A. Fluoroquinolone B. Penicillin C.Aminoglycoside D. Cephalosporin

B. In gram-positive cocci, gentamicin is usually given in combination with a penicillin antibiotic. The other antibiotics are not typically prescribed with gentamicin for this culture result.

In an effort to prevent superinfections of the GI tract such as Clostridium difficile, the nurse will instruct patients to eat which foods? A. Multigrain wheat bread B. Cultured dairy products such as yogurt C. Raw fruits and vegetables D. Low-fat meats such as chicken and pork

B. The natural flora in the GI tract may be killed off by antibiotics, leaving other bacteria such as C. difficile to overgrow. This process may be prevented through consumption of probiotics

Which is a complication of vancomycin IV infusions? A. Neurotoxicity B. Red man syndrome C. Angioedema D. Cardiomyopathy

B. When infused too rapidly, patients receiving vancomycin may develop hypotension accompanied by flushing or itching of the head, face, neck, and upper trunk area. This phenomenon is called red man syndrome.

A patient is being prepared for colon surgery and will be receiving neomycin tablets during the day before surgery. He asks the nurse why he needs to take this medicine before he even has surgery. What is the nurse's best response? A. "This medicine helps to clear out your bowels before surgery" B. "It helps to reduce the number of bacteria in your intestines before surgery" C. "It is given to sterilize your bowel before surgery" D. "It is given to prevent an infection after surgery"

B. "It helps to reduce the number of bacteria in your intestines before surgery"

A patient is prescribed linezolid (Zyvox) to treat hospital-acquired pneumonia. It is most important for the nurse to determine if the patient is also taking which medication? A. A diuretic B. An SSRI C. A cardiac glycoside D. A thyroid replacement drug

B. An SSRI

Which medication may result in ineffectiveness of penicillin V potassium? a. Ibuprofen b. Rifampin c. Probenecid d. Methotrexate

b. Rifampin

A patient has been receiving therapy with the aminoglycoside tobramycin, and the nurse notes that the patient's latest trough drug level is 3 mcg/mL. This drug is given daily, and the next dose is to be administered now. Based on this trough drug level, what is the nurse's priority action? A. Administer the drug as ordered B. Hold the drug, and notify the prescriber C. Call the laboratory to have the test repeated and verified D. Hold this dose, but administer the next dose as scheduled

B. Hold the drug, and notify the prescriber

what are Quinolones Indications

gram negativerespritory infectionsSTI's, anthrax, GI infections, bone and joint infections

A patient is receiving Augmentin (amoxicillin and clavulanic acid) liquid solution through a percutaneous endoscopic gastrostomy tube. What is the purpose of the clavulanic acid? A. It works synergistically with the antibiotic to improve potency. B. It inhibits the action of the enzymes produced by beta-lactamase-producing bacteria. C. It protects the antibiotic from the harmful gastric acid secretions in the stomach. D. It enhances the absorption of the antibiotic in the small intestine.

B. It inhibits the action of the enzymes produced by beta-lactamase-producing bacteria.

A patient is scheduled for colorectal surgery tomorrow. He does not have sepsis, his WBC count is normal, he has no fever, and he is otherwise in good health. However, there is an order to administer an antibiotic on call before he goes to surgery. The nurse knows that the rationale for this antibiotic order is to A. provide empiric therapy B. provide prophylactic therapy C. treat for a superinfection D. reduce the number of resistant organisms

B. provide prophylactic therapy

Antibiotics that kill bacteria

Bactericidal

MOA Penicillins

Bind to the enzyme beta lactam in bacterial cell wall and prevent cell wall synthesis

For a patient receiving an intravenous (IV) infusion of gentamicin, the nurse would monitor which laboratory values? A. Hematocrit and hemoglobin B. Serum glutamic-oxaloacetic transaminase and alanine transaminase C. Blood urea nitrogen (BUN) and creatinine D. Prothrombin time and partial thromboplastin time

C Gentamicin has a high potential for nephrotoxicity. Nephrotoxicity typically occurs in 5% to 25% of patients. Thus, the patient's renal function test results for BUN and creatinine must be monitored closely throughout therapy

The nurse is administering an intravenous aminoglycoside to a patient who has had gastrointestinal surgery. Which nursing measures are appropriate? (Select all that apply) A. Report a trough level of 0.8 mcg/mL, and hold the drug B. Enforce strict fluid restriction C. Monitor serum creatinine levels D. Instruct the patient to report dizziness or a feeling of fullness in the ears E. Warn the patient that the urine may turn darker in color

C, D

Which information would the nurse include in discharge teaching for a patient prescribed doxycycline? A. "Keep the remainder of the medication in case of recurrence." B. "Take the medication until you have no fever and feel better." C. "Apply sunscreen or wear protective clothing when outdoors." D. "Take the medication with milk to minimize gastrointestinal upset."

C. Photosensitivity is a common adverse effect of doxycycline, a tetracycline antibiotic. The patient should avoid direct sun exposure and tanning bed use while taking this medication. Exposure to the sun can cause severe burns.

Which adverse effect can result if tetracycline is administered to children younger than 8 years of age? A. Drug-induced neurotoxicity B. Delayed growth development C. Permanent discoloration of the teeth D. Gastrointestinal (GI) and rectal bleeding

C. Tetracycline is contraindicated in children younger than 8 years of age because it can cause permanent discoloration of the adult teeth and tooth enamel, which are still forming in the child.

The nurse is planning care for a patient prescribed once-daily IV gentamicin therapy. When would the nurse schedule a trough drug level to be drawn? A. 18 hours after completing the antibiotic infusion B. 60 minutes after beginning the antibiotic infusion C. 12 hours after completing the antibiotic infusion D. 30 minutes after beginning the antibiotic infusion

C. Trough serum drug levels should be drawn at least 8 to 12 hours after the medication is infused.

When reviewing the allergy history of a patient, the nurse notes that the patient is allergic to penicillin. Based on this finding, the nurse would question an order for which class of antibiotics? a. Tetracyclines b. Sulfonamides c. Cephalosporins d. Quinolones

C. Cephalosporins Allergy to penicillin may also result in hypersensitivity to cephalosporins. The other options are incorrect.

Watery diarrhea, abdominal pain, and fever in the patient who is on long-term antibiotic therapy indicate pseudomembranous colitis, or ___ infection. Fidaxomicin is a newer macrolide antibiotic indicated for this.

C. Diff

When giving intravenous quinolones, the nurse needs to keep in mind that these drugs may have serious interactions with which drugs? A. Selective serotonin reuptake inhibitor antidepressants B. Nonsteroidal antiinflammatory drugs C. Oral anticoagulants D. Antihypertensives

C. Oral anticoagulants

A group of office workers is concerned because a package was opened that contained a white powder substance. There is a concern that the white powder is anthrax. Which drug does the nurse anticipate being prescribed for the office workers? A. daptomycin (Cubicin) B. colistimethate (Coly-Mycin) C. ciprofloxacin (Cipro) D. quinupristin-dalfopristin (Synercid)

C. ciprofloxacin (Cipro)

A newly admitted patient reports a penicillin allergy. The prescriber has ordered a second - generation cephaposporin as part of the therapy. Which nursing action is appropriate?

Call the prescriber to clarify the order because of the patient's allergy

There is a chance between cross-reactivity between this class of antibiotics and penicillin

Cephalosporin

The nurse would teach a patient prescribed metronidazole to avoid ingestion of which drink? A. Milk B. Coffee C. Orange juice D. Wine

D. A disulfiram-like reaction may occur with concurrent ingestion of metronidazole and alcohol, leading to facial flushing, tachycardia, palpitations, nausea, and vomiting.

A patient who is prescribed metronidazole for a gynecologic infection provides the nurse with a list of medications that are routinely taken. Which medication would lead the nurse to question the prescription for Flagyl? A. Levothyroxine B. Ibuprofen C. Multivitamin D. Lithium

D. Concomitant use of lithium and metronidazole may result in lithium toxicity. Thus, a patient who reports taking lithium should alert the nurse to notify the health care provider because of the potential significant interaction.

The nurse will question the use of a fluoroquinolone antibiotic in a patient already prescribed which medication? A. Metoprolol B. Omeprazole C. Furosemide D. Amiodaron

D. Dangerous cardiac dysrhythmias are more likely to occur when quinolones are taken by patients receiving class Ia and class III antidysrhythmic drugs such as disopyramide and amiodarone. For this reason, such drug combinations should be avoided.

When administering a nonsteroidal antiinflammatory drug and a penicillin drug together, the displacement of the penicillin antibiotic from the protein-binding sites will result in which effect? A. Absence of free drug in the blood B. Decreased free drug in blood C. No change in free drug in blood D. Increased free drug in blood

D. Drugs that are not bound to protein are free and thus active to exert their therapeutic (or toxic, if too much free) effect.

A patient who is allergic to penicillin is at increased risk for an allergy to which drug? A. Gentamicin B. Erythromycin C. Demeclocycline D. Cefazolin sodium

D. Patients who are allergic to penicillins have an increased risk of allergy to other beta-lactam antibiotics. The incidence of cross-reactivity between cephalosporins and penicillins is reported to be between 1% and 4%.

A patient with a known heart condition is prescribed an antibiotic before a dental procedure. What type of antibiotic therapy is this considered? A. Definitive B. Empiric C. Supportive D.Prophylactic

D. Prophylactic antibiotic therapy is used to prevent infections in individuals who are at high risk of development of an infection during or after a procedure. The antibiotics are given before the procedure for prophylactic treatment.

Which of the following does the nurse identify as being a concern for patients receiving tetracycline? A. Tetracycline should not be administered to anyone older than age 65 years. B. Tetracycline has no impact on the effectiveness of oral contraceptives. C. Tetracycline used with warfarin decreases its effectiveness and enhances clot formation. D. Tetracyclines should not be administered with dairy products.

D. Tetracyclines should not be administered with dairy products.

A patient has a prescription for a sulfa drug as treatment for a UTI. She is also taking an oral contraceptive, an oral sulfonylurea antidiabetic drug, and phenytoin for a history of seizures. Which drug may pose a potential serious interaction with the sulfa drug? A. The oral contraceptive B. The oral antidiabetic drug C. The phenytoin D. All of these

D. All of these

What is assessment data would be collected for a patient prior to administering prescribed antibiotic therapy? A. Cardiac dysrhythmias B. History of seizures C. Immunizations D. Allergies

D. Antibiotic allergy is one of the most common drug allergies. An allergic reaction that occurs after administration of an antibiotic has the potential to cause severe anaphylaxis and possible death.

what type of antibiotic is vancomycin (Vancocin)

Natural, bactericidal antibiotic

During therapy with an intravenous aminoglycoside, the patient calls the nurse and says, "I'm hearing some odd sounds, like ringing, in my ears." What is the nurse's priority action at this time? A. Reassure the patient that these are expected adverse effects. B. Reduce the rate of the intravenous infusion. C. Increase the rate of the intravenous infusion. D. Stop the infusion immediately.

D. Stop the infusion immediately.

___ therapy is tailored to treat a specific pathogen. This helps avoid unnecessary use of broad-spectrum antibiotics, which contributes to resistance.

Definitive

treatment of an infection before specific culture information has been reported or obtained

Empiric therapy

Administering penicillin reduces the vitamin _ in the gut (intestines); therefore, enhanced anticoagulant effect of warfarin may occur.

K

Cefuroxime is a cephalosporin antibiotic that has a cross-interaction with ___ antibiotics. A patient who developed allergic reactions with one may develop an allergic reaction to the other as well.

Penicillin

Antibiotics taken before exposure to an infectious organism in an effort to prevent the development of infection

Prophylactic

quinolones indications

gram-negative bacteria (pseudomonas); complicated urinary tract, respiratory, bone and joint, GI, skin, and sexually transmitted infections

This class of antibiotics is commonly used for urinary tract infections

Sulfonamide

This class of antibiotics may cause tooth discoloration in children younger than age 8 years

Tetracycline

A teenage patient is taking a tetracycline drug as part of treatment for severe acne. When the nurse teaches this patient about drug-related precautions, which is the most important information to convey?

The patient needs to use sunscreen or avoid exposure to sunlight, because this drug may cause photosensitivity.

Decrease in specific signs and symptoms of infection are noted (fever, elevated white blood cell count, redness, inflammation, drainage, pain)

Therapeutic response

A patient is scheduled for colorectal surgery tomorrow. His WBC count is normal, he has no fever, and he is otherwise in good health. However, there is an order to administer an antibiotic on call just before he goes to surgery. The nurse knows that the rationale for this antibiotic order is which of these?

To provide prophylactic therapy

nitrofurantoin (Macrodantin)Primarily used for

UTI

The primary indication for sulfonamide therapy is ___ because these drugs achieve high concentrations in the kidneys.

Urinary Tract Infection

what is Linezolid used for

Used to treat vancomycin-resistant Enterococcus faecium (VREF, VRE),

A woman who has been taking an antibiotic for a UTI calls the nurse practitioner to complain of severe vaginal itching. She has also noticed a thick, whitish vaginal discharge. The nurse practitioner suspects that.

a superinfection has developed

A nurse is counseling a patient who is taking neomycin to prevent drug-induced superinfections. What advice should the nurse provide? a. "Eat yogurt" b. "Drink milk." c. "Eat eggs daily." d. "Eat green leafy vegetables."

a. "Eat yogurt"

The nurse should question the prescription of tetracycline for which patient? a. A 6-year old patient with Haemophilus influenza b. A 40-year-old patient diagnosed with rickettsia c. A 60-year-old patient with a history of hypertension d. A 45-year-old patient with a history of diabetes mellitus

a. A 6-year old patient with Haemophilus influenza

The nurse should question the prescription of tetracycline for which patient? a. A 6-year old patient with Haemophilus influenza b. A 40-year-old patient diagnosed with rickettsia c. A 60-year-old patient with a history of hypertension d. A 45-year-old patient with a history of diabetes mellitus

a. A 6-year old patient with Haemophilus influenza

While reviewing the blood reports of a patient who is receiving amikacin therapy, the nurse finds that the serum drug concentration is 4 mcg/mL. What additional laboratory reports will the nurse check to ensure the patient's safety? a. Blood platelet count b. Blood glucose concentration c. Serum thyroxine concentration d. Serum creatinine concentration

a. Blood platelet count

A patient with pain and urinary tract infection develops fever, chills, and sores on the tongue. In the chart, the nurse finds an allergy to sulfonamides. Which drug does the nurse suspect is responsible for the patient's reaction? a. Celecoxib b. Glimepiride c. Furosemide d. Hydrochlorothiazide

a. Celecoxib

When planning care for a patient receiving a sulfonamide antibiotic, which is a primary intervention? a. Force fluids to at least 2000 mL/day. b. Encourage liquids that produce acidic urine. c. Encourage a diet that causes an alkaline ash. d. Insert a Foley catheter for accurate input and output measurement.

a. Force fluids to at least 2000 mL/day.

Which antibiotic binds to 30S ribosomes to prevent protein synthesis in bacteria? a. Gentamicin b. Clindamycin c. Ciprofloxacin d. Nitrofurantoin

a. Gentamicin

Which antibiotic binds to 30S ribosomes to prevent protein synthesis in bacteria? a. Gentamicin b. Clindamycin c. Ciprofloxacin d. Nitrofurantoin

a. Gentamicin

A patient taking intravenous gentamicin has elevated blood urea nitrogen (BUN). What is the nurse's best course of action? a. Hold the medication. b. Insert a Foley catheter. c. Monitor peak and trough levels. d. Have the patient increase fluid intake

a. Hold the medication.

A patient has been prescribed sulfamethoxazole/trimethoprim (Bactrim). What is the nurse's primary intervention for this patient? a. Instruct the patient to increase fluid intake. b. Instruct the patient to take the medication for 14 days. c. Assess the patient's urine before and after treatment. d. Ensure the patient does not eat anything when taking the medication.

a. Instruct the patient to increase fluid intake.

How does penicillin work to destroy bacteria? a. It interferes with cell wall synthesis. b. It binds irreversibly to the cell wall. c. It interrupts bacterial DNA processes. d. It interrupts bacterial RNA processes

a. It interferes with cell wall synthesis.

A patient will be receiving nitrofurantoin (Macrodantin) treatment for a urinary tract infection. The nurse is reviewing the patient's history and will question the nitrofurantoin order if which disorder is present in the history? (Select all that apply.) a. Liver disease b. Coronary artery disease c. Hyperthyroidism d. Type 1 diabetes mellitus e. Chronic renal disease

a. Liver disease e. Chronic renal disease

quinolones mechanism of action

alter DNA of bacteria causing death; does not affect human DNA

A client who is prescribed metronidazole (Flagyl) for a gynecologic infection provides the nurse with a list of medications that are routinely taken. Which medication would lead the nurse to question the prescription for Flagyl? a. Multivitamin (Thera-Tabs) b. Lithium (Eskalith) c. Ibuprofen (Advil) d. Levothyroxine (Synthroid)

answer: b Concomitant use of lithium and metronidazole may result in lithium toxicity. Thus, a client who reports taking lithium should alert the nurse to notify the health care provider because of the potential significant interaction.

A nurse is reviewing a patient's laboratory reports and finds the serum concentration of amikacin to be normal. What value did the nurse observe? a. 10 mcg/mL b. 16 mcg/mL c. 32 mcg/mL d. 41 mcg/mL

b. 16 mcg/mL

Which patient is a potential candidate for antibiotic therapy involving aminoglycoside? a. A patient with increased serum creatinine levels b. A patient with Pseudomonas aeruginosa pneumonia c. A patient with a history of neuromuscular dysfunction d. A patient with elevated serum alanine aminotransferase

b. A patient with Pseudomonas aeruginosa pneumonia

A patient has been on sulfonamides for urinary tract infections. The nurse assesses the patient and finds bruises on the legs and arms. What is the nurse's best action? a. Tell the patient to be more careful. b. Assess the patient's platelet counts. c. Administer vitamin K to the patient. d. Ask the patient if someone is abusing her.

b. Assess the patient's platelet counts.

A nurse is caring for a patient who has hepatic encephalopathy who is prescribed neomycin. What laboratory reports will the nurse evaluate to ensure optimum drug activity? a. Blood glucose concentration b. Blood ammonia concentration c. Serum creatinine concentration d. Blood cholesterol concentration

b. Blood ammonia concentration

A primary health care provider prescribes a medication along with ampicillin to enhance the effectiveness of the antibiotic. Which medication will be added to enhance the effectiveness of the ampicillin? a. Calcium citrate b. Clavulanic acid c. Acetaminophen d. Carbamazepine

b. Clavulanic acid

A patient who enjoys drinking socially has been prescribed cefotetan. The nurse explains to the patient that alcohol should be avoided for how long? a. No avoidance of alcohol is warranted b. During drug therapy and for 3 days afterward c. During drug therapy and for 7 days afterward d. During drug therapy and for 14 days afterward

b. During drug therapy and for 3 days afterward

Which microbe is included in the spectrum of antimicrobial activity for the drug amikacin? a. Yersinia pestis b. Escherichia coli c. Salmonella species d. Citrobacter species

b. Escherichia coli

The client's culture has grown gram-positive cocci, and the health care provider prescribes two different antibiotics, one of which is gentamicin (Garamycin). To treat this type of infection, which type of antibiotic is typically prescribed together with gentamicin (Garamycin)? a. Aminoglycoside b. Penicillin c. Fluoroquinolone d. Cephalosporin

b. Penicillin In gram-positive cocci, gentamicin is usually given in combination with a penicillin antibiotic. The other antibiotics are not typically prescribed with gentamicin for this culture result.

A teenage patient is taking a tetracycline drug as part of treatment for severe acne. When the nurse teaches this patient about drug-related precautions, which is the most important information to convey? a) When the acne clears up, the medication may be discontinued. b) This medication needs to be taken with antacids to reduce GI upset. c) The patient needs to use sunscreen or avoid exposure to sunlight, because this drug may cause photosensitivity. d) The teeth should be observed closely for signs of mottling or other color changes.

c) The patient needs to use sunscreen or avoid exposure to sunlight, because this drug may cause photosensitivity.

The nurse will question the use of a fluoroquinolone antibiotic in a client already prescribed which medication? a. Furosemide (Lasix) b. Omeprazole (Prilosec) c. Amiodarone (Cordarone) d. Metoprolol (Lopressor)

c. Amiodarone (Cordarone) Dangerous cardiac dysrhythmias are more likely to occur when quinolones are taken by clients receiving class Ia and class III antidysrhythmic drugs such as disopyramide and amiodarone. For this reason, such drug combinations should be avoided.

When reviewing the allergy history of a patient, the nurse notes that the patient is allergic to penicillin. Based on this finding, the nurse would question an order for which class of antibiotics? a. Tetracyclines b. Sulfonamides c. Cephalosporins d. Quinolones

c. Cephalosporins

Which antibiotic can be used against several anaerobic organisms? a. Daptomycin b. Quinupristin c. Clindamycin d. Nitrofurantoin

c. Clindamycin

For which adverse effect should the nurse be alert in a patient who is taking tobramycin as an antibiotic therapy? a. Nausea b. Confusion c. Hearing loss d. Pain on injection

c. Hearing loss

The nurse checks the patient's laboratory work prior to administering a dose of vancomycin (Vancocin) and finds that the trough vancomycin level is 24 mcg/mL. What will the nurse do next? a. Administer the vancomycin as ordered. b. Hold the drug, and administer 4 hours later c. Hold the drug, and notify the prescriber. d. Repeat the test to verify results.

c. Hold the drug, and notify the prescriber.

Which patients are at the highest risk of developing tendinitis from the use of quinolones? a. Patients with liver failure b. Patients with ulcerative colitis c. Patients on glucocorticoid therapy d. Patients who eat food that contains tyramine

c. Patients on glucocorticoid therapy

What is the most common adverse effect of the drug vancomycin when it is infused too rapidly? a. Hearing loss b. Kidney damage c. Red man syndrome d. Acute respiratory failure

c. Red man syndrome

Why should the nurse administer gentamicin intravenously to a patient over a period of 60 minutes or longer? a. To prevent infiltration b. To prevent hepatotoxicity c. To prevent nephrotoxicity d. To prevent neuromuscular blockade

d. To prevent neuromuscular blockade

How does superinfection occur in a patient? a. When the serum level of an antibiotic is too high b. When the patient has a gram-positive bacterial infection c. When the patient has a gram-negative bacterial infection d. When the antibiotic eliminates the normal bacterial flora

d. When the antibiotic eliminates the normal bacterial flora

During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and decreased appetite. Which statement is the nurse's best advice to the patient? a."Take it with cheese and crackers or yogurt." b."Take each dose with a glass of milk." c."Take an antacid with each dose as needed." d."Drink a full glass of water with each dose."

d."Drink a full glass of water with each dose."

A patient is admitted with a fever of 102.8° F (39.3° C), origin unknown. Assessment reveals cloudy, foul-smelling urine that is dark amber in color. Orders have just been written to obtain stat urine and blood cultures and to administer an antibiotic intravenously. The nurse will complete these orders in which sequence? a.Blood culture, antibiotic dose, urine culture b.Urine culture, antibiotic dose, blood culture c.Antibiotic dose, blood and urine cultures d.Blood and urine cultures, antibiotic dose

d.Blood and urine cultures, antibiotic dose

Food-drug interaction occurs between demeclocycline and ___ products, which results in decreased gastrointestinal absorption of demeclocycline.

dairy

Antimetabolite action

disrupts critical metabolic reactions

what are Symptoms of ototoxicity

dizziness, tinnitus, and hearing loss

quinolones

excellent oral absorption; absorption reduced by antacids; end in floxacin; irreversible effects so very dangerous

what is clindamycin (Cleocin) used for

for chronic bone infections, GU infections, intrabdominal infections

neomycin

given orally to decontaminate the GI tract before surgical procedures

aminoglycosides

natural and semisynthetic; poor oral absorption; prevent protein synthesis; kills mostly gram negative bacteria but some can kill gram positive; end in mycin or micin

telavancin (vibativ)

not used but is effective against MRSA and VRE; lipoglycopeptide

adverse effects of aminoglycosides

ototoxicity and nephrotoxicity

how do quinolones destroy bacteria

they alter bacteria DNA by interfering with their enzymes, causing death

vancomycin (vancocin)

treatment of choice for MRSA; oral used for C.Diff and IV used for MRSA; infuse over at least 60min; red man syndrome may occur (flushing/itching of head, neck, face, and upper trunk)

Sulfonamides, including cotrimoxazole and tetracyclines (especially demeclocycline), are more likely than other antibiotics to cause photosensitivity during their use. True or False?

true

what are Symptoms of nephrotoxicity

urinary casts, proteinuria, and increased BUN and serum creatinine levels

metronidazole (flagyl)

used for anaerobic organisms, used to treat C. Diff, intraabdominal, and gynecologic infections; P.O. option is better; several drug interactions

daptomycin (cubicin)

used for complicated skin and soft tissue infections caused by gram-positive bacteria like MRSA and VRE

linezolid (zyvox)

used to treat vancomycin-resistant enterococcus faecium (VREF, VRE) hospital-acquired and skin structure infections, including those with MRSA, can take at home when off of IV vanco (oxazolidinones)

what drug to you only monitor trough levels

vancomycin

what is the Treatment of choice for MRSA and othergram-positive infections

vancomycin

quinupristin/dalfopristin (synercid)

work synergistically and used for bacteremia and infections caused by VRE (vancomycin-resistant enterococcus)