Pharm Exam #2 Ch. 41

As the nurse caring for Mr. Markus, you are providing discharge teaching about ciprofloxacin, which he will be taking at home for a nosocomial urinary tract infection. Which statement by Mr. Markus indicates that he understands how to take his medication properly?

"I should limit my caffeine intake while taking this medication because it can interfere with the action of the medication." • It is important to assess the patient's typical food, caffeine, and over-the-counter drug use. Caution the patient that food or caffeine may interrupt the action of ciprofloxacin. Remind patients with frequent dyspepsia that antacids can decrease the absorption of ciprofloxacin and that some vitamins also can decrease the absorption of ciprofloxacin. The safest advice would be to take any vitamin therapy at least 2 hours before or after the administration of ciprofloxacin. Advise patients to take ciprofloxacin every 12 hours. A forgotten dose can be taken as soon as it is remembered, but not if it is almost time for the next dose. •

Daptomycin (Cubicin) should be administered cautiously in clients taking which of the following drugs?

-Warfarin (Coumadin) • Atorvastatin (Lipitor) Daptomycin should be administered carefully to clients taking warfarin and HMG-CoA reductase inhibitors (statins).

Your client is taking fluoroquinolones. You know that guidelines for reducing adverse reactions, such as nephrotoxicity, include all of the following EXCEPT:

Administering once-daily large loading dosages. Guidelines for reducing nephrotoxicity include using lower dosages, having longer intervals between doses, receiving adequate hydration, and avoiding substances that alkalinize the urine. Self-treatment with cranberry juice may reduce the need for antimicrobials for recurrent urinary tract infection.

A local Bioterrorism Medical Team is learning about germ warfare. The team is instructed that a fluoroquinolone may be used to prevent an outbreak of anthrax. What fluoroquinolone would most likely be used?

Ciprofloxacin (Cipro) Ciprofloxacin (Cipro) is the most widely used fluoroquinolone and is indicated for the prevention of anthrax infection.

A nurse is caring for a 25-year-old patient who has been prescribed daptomycin to treat a skin infection. Which of the following adverse effects of daptomycin should the nurse monitor when caring for the patient?

Constipation The nurse should monitor for constipation in the patient as an adverse reaction of daptomycin.

What must be taken into consideration when an antibiotic is chosen?

Culture and sensitivity test results

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 advise the client which of the following in regards to the administration of fluoroquinolones?

Do not take antacids while taking fluoroquinolones The client should not take antacids or drugs containing iron or zinc because these drugs will decrease the absorption of the fluoroquinolones.

A client is prescribed ciprofloxacin for an acute sinus infection. This drug belongs to what category of anti-infective medications?

Fluoroquinolones Ciprofloxacin (Cipro, Ciloxan) is a fluoroquinolone, a broad-spectrum anti-infective used for UTI, acute sinusitis, bone infections, and anthrax exposure. Levofloxacin is another fluoroquinolone used for community-acquired pneumonia and UTI.

A student asks the pharmacology instructor if there is a way to increase the benefits and decrease the risks of antibiotic therapy. What would be an appropriate response by the instructor?

It is important to use antibiotics cautiously and to teach the patients to complete the full course of an antibiotic prescription. To prevent or contain the growing threat of drug-resistant strains of bacteria, it is very important to use antibiotics cautiously, to complete the full course of an antibiotic prescription, and to avoid saving antibiotics for self-medication in the future. A patient and family teaching program should address these issues, as well as the proper dosing procedure for the drug (even if the patient feels better) and the importance of keeping a record of any reactions to antibiotics. Thus, taking drugs not prescribed for the particular illness tends to maximize risks and minimize benefits. Also, if the infection is viral, antibacterial drugs are ineffective and should not be used.

Mark, age 12, has been admitted to the hospital for bacteremia secondary to treatment failure for urinary tract infection. The physician has prescribed oral ciprofloxacin. The nurse knows what about administering this medication to Mark?

Mark should receive the antibiotic therapy based on the severity of this disease, but the nurse needs to monitor for the complication of arthropathy. Oral and parenteral ciprofloxacin is contraindicated for children younger than 18 years, with the exception of treatment for complicated UTIs and anthrax infection. The most clinically important adverse reaction is arthropathy (joint disease). This often irreversible adverse reaction tends to occur in children under 18 years of age. Mark has a complicated urinary tract infection that has failed to respond to outpatient treatment; therefore, it would be acceptable to administer ciprofloxacin to him but to monitor closely for any adverse reaction.

Mrs. Harold, age 69, just recovered from coronary artery bypass grafting. She presents with the following symptoms: sore throat, cough, and elevated temperature. She is diagnosed with a bacterial throat infection and is prescribed ciprofloxacin. Which of the following adverse effects should the nurse monitor Mrs. Harold for?

Myocardial infarction Cardiovascular disorders, such as angina, myocardial infarction, and syncope, are some of the major adverse effects that Mrs. Harold may develop. Colitis is one of the major conditions, which should alert any nurse to exercise caution while administering ciprofloxacin.

When giving a drug that is potentially neurotoxic, the nurse reports which of the patient's complaints related to neurotoxicity?

Numbness of the extremities and dizziness The nurse should report patient's complaints of numbness of the extremities and dizziness because these are the symptoms of neuromuscular blockade that occurs due the action of a drug that is potentially neurotoxic. Light-headedness and abdominal pain are not the signs and symptoms of neuromuscular blockade which occurs due to neurotoxicity. Severe headache, feeling chilly, blurred vision, and tinnitus are also not associated with neurotoxicity.

A patient has been administered anti-infectives. The nurse has to conduct an ongoing assessment on the patient as part of her care. Which of the following observations is the nurse most likely to make when performing the ongoing assessment for this patient?

Significant drop in blood pressure When conducting the ongoing assessment the nurse is most likely to observe a significant drop in the patient's blood pressure. The nurse should also report this observation to the physician immediately. When conducting an ongoing assessment on a patient who has been administered anti-infectives, the nurse is most likely to observe an increase in the pulse and respiratory rate and not a decrease. The nurse is also likely to observe a sudden increase in the patient's body temperature.

Common, potentially serious, adverse effects of antibiotic drugs include what?

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

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. Caution the patient about possible photosensitivity and encourage the patient to take precautions to avoid sunlight or ultraviolet light. A forgotten dose may be taken as soon as it is remembered, but not if it is almost time for the next dose. Some vitamins also can decrease the absorption of ciprofloxacin; they should be taken at least 2 hours before or after the administration of ciprofloxacin, never along with the drug. The patient need not avoid dry areas, as the drug is not known to increase the risk for asthma.

A patient is prescribed ciprofloxacin 500 mg po twice a day. The nurse notes that the ciprofloxacin is scheduled to be given with breakfast. The nurse correctly administers ciprofloxacin _____

Twice daily po, 2 hours after the meal

A patient undergoing treatment for an infected stage II pressure ulcer on his heel is being administered daptomycin. The nurse knows that which other drug needs cautious use if it has to be administered along with daptomycin?

Warfarin The nurse, when caring for a client who is being administered daptomycin, should ensure that warfarin is administered cautiously.

Which of the following represent nursing diagnoses that may be made during administration of a fluoroquinolone or miscellaneous anti-infective?

• Acute pain • Diarrhea • Anxiety • Risk of impaired skin integrity Drug administration-specific nursing diagnoses that may be made during treatment with fluoroquinolones and miscellaneous anti-infective drugs include acute pain, anxiety, risk for impaired comfort, risk for impaired skin integrity, diarrhea, risk for impaired urinary elimination, and risk for disturbed sensory perception.

The physician has prescribed ciprofloxacin. For which patient would you contact the physician to clarify the order because the medication is contraindicated?

• Children younger than 18 • Pregnant and lactating mothers Children younger than 18 and pregnant and lactating mothers are most definitely contraindicated from using the drug. It can be given to older adults or even to people with hypertension with proper monitoring.

The nurse is caring for a pregnant woman with a lower respiratory infection. The nurse knows that fluoroquinolones are contraindicated because of the woman's pregnancy. Fluoroquinolones are also contraindicated for which of the following patients?

• Children younger than 18 years • Patients with a history of hypersensitivity to fluoroquinolones • People whose lifestyle does not allow for adherence to precautions associated with photosensitivity

Fluoroquinolones should be used with caution in which of the following clients?

• Clients with diabetes • Clients receiving dialysis • Clients with epilepsy Fluoroquinolones should be used with caution in clients with diabetes, renal impairment, history of seizures, older clients, and clients on dialysis.

A client is being given a prescription for ciprofloxacin (Cipro) to treat a urinary tract infection. The nurse should warn the client about which of the following common adverse reactions?

• Headache • Nausea • Dizziness Common adverse reactions to fluoroquinolones include nausea, vomiting, diarrhea, headache, abdominal pain or discomfort, dizziness, and photosensitivity, especially with lomefloxacin and sparfloxacin treatment.

Which of the following are examples of fluoroquinolones?

• Levofloxacin (Levaquin) • Ciprofloxacin (Cipro) The fluoroquinolones include ciprofloxacin (Cipro), moxifloxacin (Avelox), ofloxacin (Floxin), and levofloxacin (Levaquin)

During ongoing assessment of clients taking fluoroquinolones and miscellaneous anti-infectives, which of the following adverse reactions should be reported to the physician immediately? Select all that apply.

• Respiratory difficulty • Severe diarrhea • Hypersensitivity reaction • A decided drop in blood pressure