ANTIBIOTICS EAQ
The patient taking antibiotics for strep throat presents to the outpatient clinic to report vaginal candidiasis. The nurse should use which term to describe this phenomenon? 1 Superinfection 2 Allergic reaction 3 Resistant infection 4 Nosocomial infection
1 Antibiotic therapy can destroy the normal flora of the body, which normally would inhibit the overgrowth of fungi and yeast. When the normal flora are decreased, these organisms can overgrow and cause a new infection, or superinfection. The patient's symptoms are not indicative of an allergic reaction or resistant infection. Nosocomial infections are infections patients get in the hospital, not at home.
Which instruction should a nurse include in the discharge teaching for a patient who is to start taking tetracycline? 1 "Use sunscreen and protective clothing when outdoors." 2 "You'll need to return to the clinic for weekly blood work." 3 "You may stop taking the pills when you begin to feel better." 4 "Take the medication with yogurt or milk so you won't have nausea."
1 Tetracyclines are bacteriostatic antibiotics; photosensitivity and severe sunburn are common adverse effects. A full course of antibiotics must always be taken. Blood studies are not necessary for therapeutic levels. Absorption decreases after ingestion of chelates such as calcium and magnesium, so doses should be given 2 hours before or 2 hours after ingestion of milk products.
The nurse is monitoring a patient on vancomycin for indications of major toxicity. Which test should be monitored closely? 1 Creatinine level 2 Alkaline phosphatase 3 Electroencephalogram 4 Creatine phosphokinase (CPK)
1 The creatinine level and other indicators of kidney function should be monitored closely due to the risk of renal failure when a patient is taking vancomycin. Electroencephalogram is used to check brain waves, alkaline phosphatase is a liver function test, and creatine phosphokinase (CPK) is an enzyme in the heart, brain, and skeletal muscle. Abnormal results of those tests or labs are not indicative of kidney failure as are creatinine levels.
A patient on antibiotic therapy needs drug trough levels drawn. Which is the most appropriate time for the nurse to draw the trough level? 1 10 minutes before administration of the intravenous antibiotic 2 60 minutes after completion of the intravenous antibiotic infusion 3 30 minutes after beginning administration of the intravenous antibiotic 4 90 minutes after the intravenous antibiotic is scheduled to be administered
1 Trough levels are drawn just before infusion. Peak serum drug levels should be drawn 30 to 60 minutes after the medication is infused. The nurse should document the time drug administration is started and completed and the exact time a peak and/or trough level is drawn.
A patient is prescribed amoxicillin [Amoxil] for Helicobacter pylori infection. During the follow-up visit, the nurse observes that the patient is wheezing and has difficulty breathing, swelling of the throat, and dizziness. The nurse also notes a drop in blood pressure and a weak pulse. Which medicine would the nurse expect to be included in the patient's treatment plan? 1 Ranitidine [Zantac] 2 Epinephrine [Twinject] 3 Tetracycline [Sumycin] 4 Azithromycin [Zithromax]
2 Amoxicillin [Amoxil] is a penicillin antibiotic. The assessment findings make it evident that the patient has a penicillin anaphylactic reaction. Difficulty breathing, wheezing, swelling of the throat or tongue, and dizziness are the symptoms of a penicillin anaphylactic reaction. In this condition, epinephrine [Twinject] should be administered to the patient immediately to block the action of penicillin. Ranitidine [Zantac] is an antacid; it helps relieve the acidity but is not helpful in treating the anaphylactic reaction. Tetracycline [Sumycin] and azithromycin [Zithromax] are antibiotics and helpful to treat antibacterial infection but are not effective in the treatment of penicillin anaphylactic reaction.
The nurse should teach a patient to observe for which side effects when taking ampicillin? 1 Bruising and petechiae 2 Skin rash and loose stools 3 Digit numbness and tingling 4 Reddened tongue and gums
2 Ampicillin's most common side effects are rash and diarrhea; both reactions occur more frequently with ampicillin than with any other penicillin. Reddened tongue and gums, digit numbness and tingling, and bruising and petechiae are not associated side effects of ampicillin.
When instructing a patient about antibiotic therapy, the nurse explains that normal flora are disturbed during antibiotic therapy when which condition occurs? 1 Organ toxicity 2 Superinfection 3 Hypersensitivity 4 Rebound toxicity
2 Antibiotic therapy can destroy the normal flora of the body, which typically inhibit the overgrowth of fungi and yeast. When the normal flora are decreased, these organisms can overgrow and cause superinfections. When normal flora is destroyed, hypersensitivity, rebound toxicity, and organ toxicity do not result.
Which laboratory result should the nurse monitor more frequently when a patient is receiving clarithromycin [Biaxin] and warfarin [Coumadin]? 1 Platelet count 2 International normalized ratio (INR) 3 Erythrocyte sedimentation rate (ESR) 4 Activated partial thromboplastin time (aPTT)
2 Clarithromycin is a macrolide similar to erythromycin and can inhibit hepatic metabolism of medications such as warfarin and theophylline. The INR is the blood test used to evaluate warfarin ranges. The aPTT is the blood test used in monitoring heparin. The platelet count and ESR are not affected by clarithromycin.
The nurse should question the prescription of tetracycline for which patient? 1 A 40-year-old patient diagnosed with rickettsiae 2 A 6-year old patient with Haemophilus influenzae 3 A 60-year-old patient with a history of hypertension 4 A 45-year-old patient with a history of diabetes mellitus
2 Tetracycline is contraindicated in children younger than 8 years old because it can cause permanent discoloration of the teeth. It would not be prescribed to treat influenza. Tetracycline is not contraindicated for patients diagnosed with diabetes mellitus, hypertension, or rickettsiae.
The nurse teaches the patient taking sulfamethoxazole the importance of which action to reduce crystalluria? 1 Avoid red meat. 2 Increase fluid intake. 3 Increase intake of fruits and vegetables. 4 Avoid milk and other foods high in calcium.
2 The nurse should teach the patient taking sulfamethoxazole the importance of increasing fluid intake to reduce crystalluria. The other answers do not affect crystalluria caused by sulfonamides.
The nurse is caring for a patient who is taking antibiotics. The patient reports flushing, itching, hives, anxiety, and throat and tongue swelling. The nurse finds that the patient has a rapid, irregular pulse. Which condition may the patient have as a result of taking the antibiotic? 1 Tolerance to the antibiotic drugs 2 An allergic anaphylactic reaction 3 Clostridium difficile bacterial infection 4 Glucose-6-phosphate dehydrogenase (G6PD) deficiency
2 The patient has developed an allergic anaphylactic reaction to the antibiotics. Flushing, itching, hives, anxiety, and throat and tongue swelling are symptoms associated with an allergic anaphylactic reaction. In this condition, the patient's pulse rate may become rapid and irregular. Watery diarrhea, abdominal pain, and fever are the symptoms of a Clostridium difficile infection. The administration of antibiotics to patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency leads to hemolysis. The patient has no symptoms associated with hemolysis and therefore does not have G6PD deficiency.
The primary healthcare provider prescribes vancomycin [Vancocin] to a patient who has a streptococcal infection. What should the nurse assess to ensure safe administration of the drug? 1 Skin integrity 2 Renal function 3 Red blood cell count 4 Blood glucose concentration
2 Vancomycin [Vancocin] is a tricyclic glycopeptide, which causes nephrotoxicity. Therefore, the nurse should check the patient's renal function before administering vancomycin [Vancocin]. Renal impairment may lead to severe toxicity. The dosing frequency of vancomycin [Vancocin] is dependent on renal function. Therefore, it is important to check the patient's renal function. Vancomycin [Vancocin] does not affect skin integrity, blood glucose concentration, or red blood cell counts; therefore, the nurse need not check these in the patient.
A patient develops flushing, rash, and pruritus during an intravenous (IV) infusion of vancomycin [Vancocin]. Which action should the nurse take? 1 Change the IV tubing. 2 Reduce the infusion rate. 3 Check the patency of the IV. 4 Administer diphenhydramine [Benadryl].
2 When vancomycin [Vancocin] is infused too rapidly, histamine release may cause the patient to develop hypotension accompanied by flushing and warmth of the neck and face; this phenomenon is called red man syndrome. Diphenhydramine [Benadryl] is not necessary if the infusion is administered slowly over at least 60 minutes. Changing the IV tubing would not help the symptoms. The patency of the IV should be checked before the administration is started.
The nurse observes a red streak and palpates the vein as hard and cordlike at the intravenous (IV) site of a patient receiving cefepime [Maxipime]. Which assessment should the nurse make about the IV site? 1 The drug has infiltrated the extravascular tissues. 2 An allergic reaction has developed to the drug solution. 3 Phlebitis of the vein used for the antibiotic has developed . 4 Local infection from bacterial contamination has occurred.
3 IV cephalosporins may cause thrombophlebitis. To minimize this, the injection site should be rotated, and a dilute solution should be administered slowly. An allergic response would be shown as itching, redness, and swelling. Infiltration would show as a pale, cool, and puffy IV site. Infection would show as purulent discharge, tenderness, and redness.
The nurse is assessing a patient who has developed watery diarrhea. After checking the patient's history, the nurse finds that the patient was recently treated with antibiotics. Which further testing might be needed in this patient? 1 Sputum test 2 Acinetobacter test 3 Clostridium difficile test 4 Culture and sensitivity test
3 If the patient was previously treated with antibiotics and developed watery diarrhea, then the patient needs to be tested for Clostridium difficile (1) (2) infection. If the result of this test is positive, then the patient needs to be treated for a serious superinfection. Infections with Clostridium difficile are increasingly becoming resistant to standard therapy. Watery diarrhea is a common symptom of Clostridium difficile infection. Clostridium difficile bacteria are not present in sputum; therefore, a sputum test is not indicated. A test for Acinetobacter is not helpful in this situation because the symptoms are not suggestive of an infection caused by Acinetobacter. Culture and sensitivity testing is helpful to optimize drug selection in individual cases, but not in this situation.
The nurse teaches a patient to promptly report any diarrhea to the healthcare provider. Which drug is the patient likely being prescribed? 1 Linezolide 2 Doxycycline 3 Clindamycin 4 Minocycline
3 Patients on clindamycin should promptly report any diarrhea to their healthcare provider since clindamycin can cause potentially fatal Clostridium difficile diarrhea. Diarrhea can be a side effect of most antibiotics such as linezolide, doxycycline, and minocycline but does not have the same risk as clindamycin for Clostridium difficile.
The nurse is caring for a patient who has been prescribed cefazolin sodium [Ancef]. What is the priority nursing assessment? 1 Cardiac assessment 2 Neurologic assessment 3 History of immunizations 4 History, including allergies
4 Antibiotic allergy is one of the most common drug allergies. These allergies also have the potential to cause severe anaphylaxis and death and, therefore, have more importance than the other assessments listed.
A patient has been started on a medication regimen that includes sulfamethoxazole/trimethoprim [Bactrim]. The nurse notes that the source of the patient's infection has been determined to be viral in origin. What is the nurse's highest priority action? 1 Ask how the patient contracted the infection. 2 Administer the medication as ordered by the provider. 3 Ensure that the information is documented in the chart. 4 Contact the healthcare provider to discuss the medication.
4 The healthcare provider should be contacted regarding the ordering of sulfamethoxazole/trimethoprim [Bactrim] for this patient, because it has not been shown to be effective in treating viral infections.
A patient is prescribed amoxicillin [Amoxil] for the treatment of a bacterial infection. What instruction should the nurse give to the patient to improve drug efficacy? 1 "Take the medicine with milk." 2 "Take the medicine with food." 3 "Take the medicine with juice." 4 "Take the medicine with water."
4 The nurse should instruct the patient to take the antibiotic with water. Amoxicillin [Amoxil] is a penicillin antibiotic and should be taken with water to improve drug efficacy. Giving the medication with milk will interfere with drug absorption. Oral penicillin should be administered 1 hour before or 2 hours after meals to maximize absorption. It should not be administered with food as this reduces its absorption. Oral penicillin should not be administered with juice, because the latter is acidic in nature and may nullify the drug's antibacterial action.
The nurse is assessing a patient who is receiving a sulfonamide for treatment of a urinary tract infection. To monitor the patient for the most severe response to sulfonamide therapy, the nurse should assess for which condition? 1 Bleeding 2 Diarrhea 3 Hypertension 4 Skin rash and lesions
4 The nurse's priority is to monitor for hypersensitivity reactions. The most serious response to sulfonamide therapy is Stevens-Johnson syndrome, which manifests as severe reactions of the skin and mucous membranes, lesions, fever, and malaise. In rare cases, hematologic effects occur, requiring periodic blood studies.
A patient was diagnosed as having healthcare-associated methicillin-resistant Staphylococcus aureus (HCA-MRSA). Which medication is most likely to be ordered for treatment? 1 Amoxicillin 2 Clindamycin 3 Tetracycline 4 Vancomycin
4 Vancomycin is effective (1) (2) in treating healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA). MRSA is resistant to all penicillins and cephalosporins. The bacteria is resistant to tetracycline and clindamycin as well.
A patient with a Clostridium difficile infection is placed on vancomycin. Which labs should the nurse expect to be drawn for this patient? Select all that apply. A Creatinine levels B Serum electrolytes C Trough serum levels D Alkaline phosphatase E Creatine phosphokinase (CPK)
A B C A patient with a Clostridium difficile infection has experienced severe diarrhea and should have serum electrolytes drawn. To mimimize the risk of renal failure associated with vancomycin, creatinine levels and serum trough should be checked. Alkaline phosphatase is a liver function test, and creatine phophokinase (CPK) is an enzyme in the heart, brain, and skeletal muscle. Abnormal results of those labs are not indicative of kidney failure or toxicity highly associated with vancomycin.
The nurse recognizes which of the following as examples of the improper use of antibiotic therapy? Select all that apply. A Treating a viral infection B Basing treatment on sensitivity reports C Using dosing that results in a superinfection D Treating fever in an immunodeficient patient E Using surgical drainage as an adjunct to antibiotic therapy
A C Common misuses of antibiotics include (1) treatment of a viral infection, which results in exposure of the patient to the risks of the medication without providing any benefits; and (2) improper dosing (dosing that is too high results in superinfection). Basing treatment on sensitivity reports, treating fever in an immunodeficient patient, and using surgical drainage as an adjunct to antibiotic therapy are examples of the proper use of antimicrobial therapy.
The nurse explains to a patient the need for serum blood test monitoring associated with the use of aminoglycosides. Which serum blood tests will be ordered for this patient due to the use of this medication? Select all that apply. A Creatinine B Blood glucose C Peak and trough D Blood urea nitrogen (BUN) E Creatine phophokinase test (CPK)
A C D Tests for creatinine, the peak and trough of the medication, and blood urea nitrogen (BUN) will be ordered to monitor potential risks associated with aminoglycosides. Blood glucose would not necessarily be ordered. The creatine phophokinase test (CPK) is associated with heart muscle concerns.
While instructing a patient about antibiotic therapy, the nurse explains to the patient that bacterial resistance to antibiotics can occur when what happens? Select all that apply. A Antibiotics are taken with water or juice B Antibiotics are prescribed to treat a viral infection C Antibiotics are taken with ascorbic acid (vitamin C) D Patients stop taking an antibiotic after they feel better E Antibiotics are prescribed according to culture and sensitivity reports
B D Not completing a full course of antibiotic therapy can allow bacteria that have been exposed to the antibiotic (but not killed) to adapt their physiology to become resistant to that antibiotic. The same thing can occur when bacteria are exposed to antibiotics in the environment or when antibiotics are erroneously used to treat a viral infection.
A certain group of patients should not be given tetracyclines. Which patients are of most concern? Select all that apply. A Hearing impaired B Pregnant women C Mentally impaired D Breastfeeding women E Children younger than 8 years
B D E Because they can cause permanent tooth discoloration, tetracyclines should not be given to pregnant women, breastfeeding women, or children younger than 8 years. The hearing impaired or mentally impaired are not groups directly affected by this drug unless they also are part of the other groups.
Which drugs are part of the tetracycline group of antibiotics? Select all that apply. A Linezolide B Minocycline C Clindamycin D Doxycycline E Demeclocycline
B D E Doxycycline, minocycline, and demeclocycline are part of the tetracycline group of antibiotics. Linezolide and clindamycin are other bacteriostatic inhibitors of protein synthesis and not part of the tetracycline group.
Which instructions should the nurse include when teaching a patient about cephalosporin therapy? Select all that apply. A "Take aspirin if you develop a headache." B "Cephalosporins may not be taken with food." C "Notify your healthcare provider if you develop a rash." D "Notify your healthcare provider if you develop diarrhea." E "Do not take cephalosporins if you have lactose intolerance."
C D Severe diarrhea should be reported, because it may indicate the development of C. difficile infection. Any indication of an allergic reaction, including a rash, should be reported to the healthcare provider. Cephalosporins may enhance bleeding tendencies, so drugs such as aspirin that may promote bleeding should be avoided. Cephalosporins may be taken with food, and they are safe to take if a patient has lactose intolerance.
