PrepU Ch19 Drug Therapy With Aminoglycosides and Floroquinolones

You are preparing to discharge a patient who is taking ciprofloxacin. What guidance would you offer this patient to prevent crystalluria? 1. "Do not take antacids." 2. "Limit fluids to a couple of glasses per day." 3. "Take the medication as prescribed." 4. "Drink at least 2 liters of fluids per day."

"Drink at least 2 liters of fluids per day."

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? 1. "I will take all of my antibiotics." 2. "I will only drink enough water to swallow the drug." 3. "If I have trouble breathing, I will call 911." 4. "I may have some abdominal pain with this medication."

"I will only drink enough water to swallow the drug."

A client is caring for an 8-year-old child who weighs 30 kg. The health care provider orders gentamicin IM for the client. The recommended dosage range is 2-2.5 mg/kg q8h. What is the maximum amount of gentamicin the client will receive in a day? 1. 180 mg 2. 600 mg 3. 36 mg 4. 225 mg

225 mg

A client with a severe infection has an order for IV gentamicin and IV penicillin. How will the nurse administer these medications? 1. Administer the gentamicin IV and wait 1 hour and administer the penicillin. 2. Administer the penicillin and immediately administer the gentamicin. 3. Mix both antibiotics in an IV piggyback and administer over 1 hour. 4. Mix the two antibiotics in one syringe and push it slowly over 5 minutes.

Administer the gentamicin IV and wait 1 hour and administer the penicillin

A male client is concerned that he cannot afford to have his wife's community-acquired pneumonia (CAP) treated in the hospital. He has limited health insurance, and the cost of intravenous antibiotic therapy is prohibitive. According to the American College of Chest Physicians' position statement, where will the client's wife be treated? 1. In the home using oral drugs 2. In the home using intravenous therapy 3. In the hospital using oral medications 4. In the hospital using intravenous therapy

In the home using oral drugs

While administering aminoglycosides to clients, the nurse must be aware of what toxicities that can result from their use? (Select all that apply.) 1. Neurotoxicity 2. Hepatotoxicity 3. Nephrotoxicity 4. Ototoxicity 5. Cardiotoxicity

Nephrotoxicity Ototoxicity Neurotoxicity

A male client is NPO as a consequence of a cerebrovascular accident sustained 3 years ago. His care is managed at home by his wife, and he receives all medications via gastrostomy tube. The health care provider orders a fluoroquinolone for the client to treat an infection. The nurse would instruct the client's wife to administer the medication in what way? 1. On a full stomach 2. With antacids 3. On an empty stomach 4. With the enteral feeding

On an empty stomach

The client has been prescribed a drug that must be taken on an empty stomach. The nurse knows that to administer a medication on an empty stomach, it is given in which way? 1. One hour prior to a meal or two hours after the meal 2. One hour prior to breakfast and one hour after dinner 3. Two hours prior to a meal or three hours after the meal 4. One hour after breakfast and at bedtime

One hour prior to a meal or two hours after the meal

When administering aminoglycosides, the nurse must be aware of which of the following adverse reactions? 1. Ototoxicity and nephrotoxicity 2. Hypoglycemia and hyperglycemia 3. Liver necrosis, or hepatic failure 4. Glaucoma and renal failure

Ototoxicity and nephrotoxicity

A male client develops a wound infection, and the health care provider orders once-daily intravenous multiple-dose regimens of aminoglycosides. What kinds of monitoring does the nurse expect the provider to order? 1. Measurement of electrolytes every 48 hours 2. A serum albumin determination every 48 hours 3. Peak and trough serum levels 4. A complete blood count every 48 hours

Peak and trough serum levels

The nurse is caring for a child weighing 30 kg. The healthcare provider orders gentamicin 100 mg IV three times per day. The recommended dosage range is 6 to 7.5 mg/kg/day. What action should the nurse take? 1. Administer the medication and assess hearing frequently. 2. Question the prescriber about the dosage of the medication. 3. Question the prescriber about the frequency of administration. 4. Administer the medication and assess renal function frequently.

Question the prescriber about the dosage of the medication.

A client in the critical care unit is receiving aminoglycosides for an infectious process. What does the nurse need to monitor? 1. White blood count 2. Renal function tests 3. Complete blood count 4. Serum albumin concentration

Renal function tests

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? 1. The client has type 2 diabetes, controlled with oral antihyperglycemics 2. The client has a history of not adhering to treatment 3. The client has a known latex allergy 4. The client has chronic renal failure

The client has chronic renal failure

The nurse should advise the client to avoid taking which medication at the same time as a fluoroquinolone? 1. antacids 2. antidiabetic agents 3. oral contraceptives 4. antihypertensives

antacids

Once-daily aminoglycoside (ODA) dosing, also called pulse dosing or extended-interval dosing, has replaced multiple daily dosing in many patients. What is the rationale behind ODA dosing? 1. Lower cost 2. Higher efficacy with less hepatotoxicity 3. Reduction in nursing effort 4. decreased nephrotoxicity while maintaining therapeutic efficacy

decreased nephrotoxicity while maintaining therapeutic efficacy

When considering known adverse reactions to gentamicin therapy, the nurse should focus assessment of what body structure? 1. lymph nodes 2. oral cavity 3. eyes 4. inner ears

inner ears

The client has been diagnosed with a serious infection caused by gram-negative aerobic bacilli. The client has been prescribed IV gentamicin. What statement by the client should the nurse follow up most promptly? 1. "I definitely feel like my appetite has suffered since I started these antibiotics." 2. "My IV site feels really itchy a lot of the time." 3. "I feel like I'm having trouble hearing the last little while." 4. "I've got this pounding headache that never seems to go away."

"I feel like I'm having trouble hearing the last little while."

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? 1. "That is the medication working. Continue to take as directed." 2. "You may be experiencing an additional infection. I will discuss this with your health care provider." 3. "You are allergic to the medication. Stop taking it immediately." 4. "You are experiencing an adverse affect of the medication. Those symptoms will decrease over time."

"You may be experiencing an additional infection. I will discuss this with your health care provider."

A nurse has been performing vigilant assessments of a patient who is receiving doses of intravenous gentamicin, each over 30 minutes. A blood sample for peak gentamicin levels should be drawn 1. at the midpoint between scheduled doses. 2. as soon as possible after the patient awakens in the morning. 3. immediately after the third intravenous dose of the drug. 4. 30 minutes after the drug has finished infusing.

30 minutes after the drug has finished infusing.

You are writing a plan of care for a patient taking an oral fluoroquinolone. What would be an appropriate intervention to include in this plan? 1. Restrict fluids. 2. Teach the patient to increase intake of zinc and calcium with nutritional supplements. 3. Teach the patient to take the medication at mealtime. 4. Avoid concomitant use of nephrotoxic drugs.

Avoid concomitant use of nephrotoxic drugs

The nurse instructs the client who is taking oral ciprofloxacin to avoid which food while taking this medication? 1. Hamburger 2. Chicken 3. Tuna 4. Cheese

Cheese

Which of the following drugs is likely to be administered as a first-line treatment for anthrax exposure? 1. Tobramycin 2. Ciprofloxacin 3. Norfloxacin 4. Gentamicin

Ciprofloxacin

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? 1. Administer an antipyretic. 2. Administer an extra dose of levofloxacin. 3. Continue to monitor vital signs. 4. Notify the health care provider.

Continue to monitor vital signs.

Before the selection of an aminoglycoside to treat a client's wound infection, what would the nurse expect the health care provider to order? 1. Culture and sensitivity 2. White blood count 3. Complete blood count 4. Electrolyte panel

Culture and sensitivity

Prior to administration of fluoroquinolones, which laboratory test should be obtained? 1. Culture and sensitivity 2. Complete blood counts 3. Renal function 4. Hepatic function

Culture and sensitivity

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? 1. Increased absorption 2. Decreased absorption 3. Decreased elimination 4. Increased elimination

Decreased absorption

The nurse is caring for a client who is receiving IV gentamicin and knows that the client should not receive what medication at the same time because it may mask symptoms of ototoxicity? 1. Diphenhydramine 2. Morphine sulfate 3. Acyclovir 4. Diazepam

Diphenhydramine

The nurse is providing client teaching before discharging a client home. The client is taking ciprofloxacin. What action should the nurse encourage the client to prioritize? 1. Drink at least 2L of fluid per day. 2. Minimize sodium intake. 3. Avoid all caffeine and alcohol. 4. Eliminate red meat and seafood from the diet.

Drink at least 2L of fluid per day.

A client is prescribed ciprofloxacin for an acute sinus infection. The nurse knows that this anti-infective medication belongs to which drug category? 1. Penicillins 2. Cephalosporins 3. Tetracyclines 4. Fluoroquinolones

Fluoroquinolones

The nursing student correctly identifies the class of drugs that exerts their bactericidal effect by interfering with the synthesis of bacterial DNA, thus preventing cell reproduction and leading to death of the bacteria, as which of the following groups? 1. Sulfonamides 2. Cephalosporins 3. Penicillins 4. Fluoroquinolones

Fluoroquinolones

Which of the following drugs would be classified as an aminoglycoside? 1. Levofloxacin 2. Cefaclor 3. Clarithromycin 4. Gentamicin

Gentamicin

A 60-year-old male client with a diagnosis of bacteremia is being treated with intravenous gentamicin. After 4 days of treatment, the care team is pleased with the improvement in the client's condition and the effect of the drug treatment on his blood cultures. During morning care, the client has told the nurse that he is having ringing in his ears and woke up this morning with a pounding headache. How should the nurse respond to this client? 1. Continue the gentamicin as ordered and monitor the client's symptoms closely. 2. Document the client's reports and integrate them into his plan of care. 3. Administer the next scheduled dose of gentamicin over 90 to 120 hours. 4. Hold the next scheduled dose of gentamicin until the health care provider has been consulted.

Hold the next scheduled dose of gentamicin until the health care provider has been consulted.

The pharmacology instructor is discussing ways to decrease adverse effects on clients taking aminoglycosides. Which would the instructor include? 1. Keeping the client well hydrated 2. Assessing liver function weekly 3. Decreasing dietary potassium 4. Increasing dietary sodium

Keeping the client well hydrated

Which of the following are examples of fluoroquinolones? Select all that apply. 1. Cephalexin (Keflex) 2. Levofloxacin (Levaquin) 3. Ciprofloxacin (Cipro) 4. Spectinomycin (Trobicin) 5. Amoxicillin (Amoxil)

Levofloxacin (Levaquin) Ciprofloxacin (Cipro)

What route of administration is most commonly used for the administration of ciprofloxacin when prescribed to an older adult client? 1. oral (PO) 2. intravenous (IV) 3. subcutaneous (SQ) 4. intramuscular (IM)

Oral

Your patient is receiving a multiple-dose regimen of an aminoglycoside. On what serum drug levels will you base the patient's maintenance dose? 1. Mean levels only 2. Mean and trough levels 3. Peak levels only 4. Peak and trough levels

Peak and trough levels

A young lifeguard has been prescribed moxifloxacin (Avelox). The nurse understands that the focus on education would be which adverse reaction? 1. Muscle cramping 2. Fatigue 3. Weakness 4. Photosensitivity

Photosensitivity

A client scheduled to undergo major abdominal surgery has been prescribed preoperative neomycin. Neomycin is used preoperatively for what reason? 1. Sterilize the incision site 2. Produce ammonia. 3. Suppress intestinal bacteria. 4. Enhance intestinal flora

Suppress intestinal bacteria.

A client is prescribed ciprofloxacin for a urinary tract infection. The nurse is preparing to teach the client about the medication. What must the nurse include in the education plan? 1. Avoid foods high in sodium such as processed meats. 2. Take precautions to prevent photosensitivity. 3. Take the necessary vitamins along with the drug. 4. Take a missed dose, even if close to the next dose.

Take precautions to prevent photosensitivity.

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? 1. The client will require a lower dose and longer course of ciprofloxacin than a nonpregnant, adult client. 2. Ciprofloxacin is safe to use in pregnancy and the client may use to same dose and route as a nonpregnant client. 3. It is safe for the client to use topical ciprofloxacin but the oral route is potential teratogenic. 4. The use of ciprofloxacin is contraindicated in pregnancy.

The use of ciprofloxacin is contraindicated in pregnancy.

The nurse should notify the health care provider immediately if a client has this possible sign of serious neurotoxicity when a client is receiving an aminoglycoside. (Select all that apply.) 1. Tremors 2. Circumoral paresthesia 3. Muscle twitching or weakness 4. Numbness or tingling of the skin (peripheral paresthesia)

Tremors Circumoral paresthesia Numbness or tingling of the skin (peripheral paresthesia) Muscle twitching or weakness

A client is to receive gentamicin for treatment of an infection. Which of the following would be most important for the nurse to assess to establish a baseline? 1. Muscle strength 2. Nutritional status 3. Gastrointestinal function 4. Auditory function

auditory function

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? 1. culture and sensitivity test 2. complete blood count 3. urinalysis 4. renal and hepatic function tests

culture and sensitivity test

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? 1. fungal infections 2. gram-negative infections 3. viral infections 4. gram-positive infections

gram-negative infections

A nursing instructor is preparing a teaching plan for a nursing pharmacology class on the action of fluoroquinolones. Which would the instructor include? 1. interfering with DNA synthesis in the bacterial cell 2. interfering with protein synthesis 3. blocking ribosomal reading of mRNA 4. disrupting the bacterial cell wall

interfering with DNA synthesis in the bacterial cell

The nurse recognizes that what drug classification increases the risk of ototoxicity and nephrotoxicity when prescribed with gentamicin? 1. proton pump inhibitors 2. tricyclic antidepressants 3. benzodiazepines 4. loop diuretics

loop diuretics

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? 1. metronidazole 2. ciprofloxacin 3. levofloxacin 4. gemifloxacin

metronidazole

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? 1. renal function 2. cardiac function 3. lung function 4. intestinal function

renal function

The nurse is preparing to administer amikacin to a client with a complicated Staphylococcus aureus infection. What assessment should the nurse prioritize? 1. Gastrointestinal function 2. Nutritional status 3. Muscle strength 4. Renal function

renal function

A 45-year-old female patient is prescribed ciprofloxacin to treat a bronchial infection. A nursing assessment revealed that she started taking daily vitamin supplements about 2 years ago. To maximize the therapeutic effects of the ciprofloxacin therapy, the nurse should advise the patient to 1. take the vitamins at least 2 hours before or after taking ciprofloxacin. 2. reduce the dosage of vitamin supplements. 3. alternate the dosage of ciprofloxacin and vitamin supplements. 4. reduce the dosage of vitamin supplements and double the dosage of ciprofloxacin.

take the vitamins at least 2 hours before or after taking ciprofloxacin.

A nurse is caring for a 52-year-old man with pyelonephritis. The health care provider has prescribed gentamicin. Which pair of symptoms would alert the nurse to a serious adverse reaction? 1. loss of sensation in the extremities and blood in the urine 2. diarrhea and vomiting 3. tinnitus and decreased urinary output 4. visual changes and hearing difficulty

tinnitus and decreased urinary output

The nurse is caring for a client who is receiving amikacin for the treatment of a serious Staphylococcus aureus infection. What assessment should the nurse prioritize? 1. skin assessment and monitoring of liver enzyme levels 2. vision assessment 3. cardiac monitoring 4. urine output and creatinine clearance

urine output and creatinine clearance