Antimicrobials PREPU

To maximize the prevention of an incisional infection, when will the nurse administer the prophylactic antibiotic therapy prescribed for a surgical client?

1 hour prior to the first planned skin incision Explanation: When used perioperatively, cephalosporins should be given within 60 minutes before the first skin incision is made so the drug has time to reach therapeutic serum and tissue concentrations. It is not done as part of the surgical prep since that timing is not as specific.

A nurse is caring for a hospitalized client with a urinary tract infection (UTI). The nurse is preparing to administer nitrofurantoin, which is a bacteriostatic antibiotic. Which statement best differentiates bacteriostatic and bactericidal medications?

Bacteriostatic medications slow or retard the multiplication of bacteria. Explanation: Bacteriostatic medications slow or retard the multiplication of bacteria and bactericidal destroys bacteria. Bactericidal medications do not improve the destruction of bacteria.

A patient has been administered linezolid. The patient is fond of eating chocolates and coffee, both of which contain tyramine. What should the nurse inform the patient about the risk involved when linezolid interacts with foods containing tyramine?

Causes severe hypertension. Explanation: The nurse should inform the patient that if tyramine found in chocolates and coffee interacts with linezolid, the patient will develop an increased risk for severe hypertension. Nausea is the adverse reaction of quinupristin-dalfopristin. It is not reported to occur due to the interaction of linezolid and tyramine. Nervousness and drowsiness are not reported to be risks developed due to the interaction of linezolid and tyramine.

A nurse is instructing a client on the antibiotic regimen for the treatment of pneumonia. Which statement is most important to share with client?

Complete the entire prescription of medication. Explanation: Interruption or inadequate antimicrobial treatment of infections may also contribute to the emergences of antibiotic resistant organisms. The administration of an antibiotic with orange juice is not recommended in all instances. The medication does not need to be supplemented with multivitamins. Antibiotics need not be administered with dairy products.

A client is prescribed indinavir sulfate for the treatment of human immunodeficiency virus (HIV) infection. What client teaching should be provided regarding renal function?

Consume 48 ounces (1,419 ml) of fluid per day. Explanation: When taking indinavir, the client should be instructed to consume 48 ounces (1,419 ml) of water or fluid per day to prevent nephrolithiasis. The consumption of grape juice with antioxidants will assist in preventing nephrolysis but must be in sufficient amounts. The consumption of grapefruit juice is usually contraindicated. The nurse would not need to assess for pulmonary edema.

Before the selection of an aminoglycoside to treat a client's wound infection, what would the nurse expect the health care provider to order?

Culture and sensitivity Explanation: The choice of aminoglycoside depends on local susceptibility patterns and specific organisms causing an infection.

An 87-year-old resident of a long-term care facility has been prescribed oral clindamycin for the treatment of an infected pressure ulcer. The care providers at the facility should be instructed to monitor the resident closely for what potential adverse effect of clindamycin?

Diarrhea Explanation: The most serious adverse effect of clindamycin is pseudomembranous colitis, also known as Clostridium difficile colitis. Diarrhea, abdominal cramps, and abdominal tenderness may suggest antibiotic-associated colitis.

A client has a history of deep vein thrombosis, for which he is taking warfarin. When providing education for this client, who is now also taking fluconazole to treat a localized candidal infection, the nurse should instruct the client that:

Fluconazole increases the effects of warfarin. Have routine lab tests done. Explanation: Fluconazole increases the effects of several drugs, including cyclosporine, phenytoin, oral sulfonylureas, and warfarin, but has fewer interactions than ketoconazole and itraconazole.

The nurse is preparing to administer a sulfonamide to a client who is a Type 2 diabetic taking an oral hypoglycemic agent. The nurse will monitor the client for what reaction?

Hypoglycemia Explanation: Diabetic clients who take a sulfonamide may experience a hypoglycemic reaction because the sulfonamides may inhibit the hepatic metabolism of the oral hypoglycemic drugs tolbutamide and chlorpropamide. The nurse would not expect to see increased bruising or an elevated temperature, which may be a reaction related to bone marrow suppression.

When preparing to administer a fluoroquinolone, the nurse understands that the majority of drugs belonging to this class are administered by which route?

Oral Explanation: Most fluoroquinolones are administered orally; levofloxacin and moxifloxacin may also be given intravenously.

Many of the residents of a long-term care facility have become sick with influenza this winter despite the fact that all residents were immunized earlier in the fall. A nurse who provides care in the facility should recognize the need to have which of the following drugs readily available at the facility?

Oseltamivir phosphate Explanation: Oseltamivir phosphate (Tamiflu) is a neuraminidase inhibitor used to manage infection with influenza A or B virus; it is also used as prophylaxis against influenza A and B. Docosanol is indicated in the treatment of oral-facial herpes and ganciclovir (Cytovene) is an antiviral agent used to treat CMV infections. Acyclovir is not used to treat or prevent influenza.

Common, potentially serious, adverse effects of antibiotic drugs include:

Skin rash Explanation: 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.

A client's health care provider is considering the addition of efavirenz to the client's drug regimen for the treatment of recently diagnosed HIV. Which aspects of the client's medical history should prompt the nurse to question the use of this drug?

The client has hepatitis C and a history of heavy alcohol use. Explanation: Efavirenz is used cautiously in clients with concomitant use of alcohol or psychoactive drugs because they increase the risk of CNS adverse effects. The drug should be used with caution in clients with a history of hepatitis B or C; they have an increased risk of hepatotoxicity. Obesity, diabetes, and adverse reactions to vaccination do not contraindicate the use of efavirenz.

The nurse is caring for a client whose fungal infection is being treated with ketoconazole. What change in the client's health status should the nurse prioritize when updating the provider on the client's condition?

The client's aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels are elevated Explanation: An increase in AST and ALT could signal hepatotoxicity, which is a significant adverse effect of ketoconazole. The client's electrolyte levels are within norms and the nurse can normally manage a single episode of vomiting independently. The client's temperature is nominally elevated, so liver enzymes would be a clear priority.

A 79-year-old woman comes to the emergency department with flu-like symptoms. A diagnosis of influenza A is made. Which medication could be prescribed?

amantadine Explanation: Amantadine can be prescribed for the treatment of influenza A. The other medications are used for the treatment of other viral infections, not influenza A.

A client is diagnosed with an infection attributable to the gram-negative microorganism Pseudomonas. Which anti-infective agent is most reliable in treating this microorganism?

aminoglycoside Explanation: Aminoglycosides penetrate the cell walls of susceptible bacteria. As a result, the bacterial cell membrane becomes defective and cannot synthesize the proteins necessary for their function and replication. Aminoglycosides are used to treat infections caused by gram-negative microorganisms, such as Pseudomonas. Antifungals are effective in the resolution of fungus infections. Aminopenicillin agents are not effective in treating gram-negative microorganisms. A GABA analog is used to treat pain related to neuropathy.

When reviewing an older client's most recent laboratory values, which finding may contraindicate the use of tetracycline?

creatinine of 2.8 mg/dL (247.52 µmol/L) (high) Explanation: An elevated creatinine level is associated with renal dysfunction, which may contraindicate the use of tetracycline in an older adult due to the risk of further kidney damage. Leukocytosis or low potassium or hemoglobin does not preclude the use of tetracycline.

A high school student, who has experienced repeated outbreaks of cold sores, reports no success with an over-the-counter (OTC) topical cream. The nurse should recognize that this student used what OTC drug?

docosanol Explanation: Docosanol is an over-the-counter topical antiviral agent that works in the early stages of intracellular events of viral entry into the target cells. Famciclovir is an oral antiviral agent administered for herpes zoster and recurrent genital herpes. Valacyclovir is not an over-the-counter medication. Cold sores are not treated with ganciclovir.

A woman is seen in the clinic for treatment of vaginal itching and discharge. The nurse should be prepared to provide the client with information concerning which single-dose medication?

fluconazole Explanation: Fluconazole is used for vaginal candidiasis in a single oral dose of 150 mg. Caspofungin is not used for vaginal candidiasis but for invasive aspergillosis. Terbinafine is used for interdigital tinea pedis. Ketoconazole is used for clients with organ transplants to manage organ rejection.

The nursing instructor is talking with students about anti-infective medications. Drugs that are very selective in their actions are said to be:

narrow spectrum. Explanation: Some anti-infectives are so selective in their action that they are effective against only a few microorganisms with a very specific metabolic pathway or enzyme. These drugs are said to have a narrow spectrum of activity. They are not called broad spectrum, bactericidal, or bacteriostatic.

A young adult, diagnosed with hepatitis B virus (HBV), has been prescribed treatment with lamivudine. Shortly after beginning treatment, the client reports experiencing intense abdominal pain. The nurse should recognize the possibility of what medication-associated adverse effect?

pancreatitis Explanation: A main adverse effect of lamivudine is pancreatitis. GERD, obstruction, and gastroenteritis do not typically result from lamivudine therapy. In addition, these problems do not typically manifest with intense and sudden abdominal pain.

A client is receiving fluoroquinolone therapy. Which finding would the nurse most likely report to the primary health care provider immediately when conducting an ongoing assessment of the client?

significant drop in blood pressure Explanation: When conducting the ongoing assessment, the nurse would notify the primary health care provider if there are changes in the vital signs, such as a significant drop in blood pressure, an increase in the pulse or respiratory rate, or a sudden increase in temperature.

A client is seen in the clinic after a bite from a tick. She has a rash over her arms and legs and arthritic pain in the joints. What is the drug of choice for treating the infection associated with Lyme disease?

tetracycline Explanation: Antibiotics like tetracyclines are useful in treating some animal bites and Lyme disease through their ability to inhibit microbial protein synthesis. Ibuprofen is administered for the inflammation associated with the arthritic pain but not to treat the infection. Phenazopyridine, a urinary analgesic, is not administered for Lyme disease. Nitrofurantoin is administered for urinary tract infections.

A client is prescribed imipenem-cilastatin for the treatment of an E. coli infection. The nurse should be aware that cilastatin is combined with the imipenem for what purpose?

to eliminate adverse effects of imipenem administration Explanation: Cilastatin inhibits the destruction of imipenem, increasing the urinary concentration of imipenem and reducing its potential renal toxicity. Cilastatin's effect on imipenem does not include improving its ability to cross the blood-brain barrier, increasing its effects, or eliminating all of its adverse effects.

A client prescribed metronidazole to treat Clostridium difficile is also prescribed which medication orally to assist in restructuring the flora of the intestinal tract?

vancomycin Explanation: Oral vancomycin, active only against gram-positive microorganisms, is used to treat pseudomembranous colitis caused by C. difficile. Spectinomycin, rifaximin, and quinupristin-dalfopristin are not administered to treat pseudomembranous colitis caused by C. difficile.