Ch 17 - Aminoglycosides and Fluoroquinolones

You are preparing to discharge a patient who is taking ciprofloxacin. What guidance would you offer this patient to prevent crystalluria?

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

A nurse is teaching a client about the medication regimen surrounding fluoroquinolones. Which of the following statements made by the client would indicate the need for additional education?

"I will limit my fluid intake."

The physician has ordered levofloxacin 500 mg orally. The drug is available in 250 mg tablets. The nurse administers how many tablets?

2

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

30 minutes after the drug has finished infusing.

A client with a severe infection has an order for IV gentamicin and IV penicillin. How will the nurse administer these medications?

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

Fluoroquinolones treat infection by which of the following effects? (Choose one)

Bactericidal

The nurse instructs the client who is taking oral ciprofloxacin to avoid which food while taking this medication?

Cheese

Which of the following drugs is likely to be administered as a first-line treatment for anthrax exposure?

Ciprofloxacin

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)

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

Culture and sensitivity

Prior to administration of fluoroquinolones, which laboratory test should be obtained?

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?

Decreased absorption

The nurse should advise the client which of the following in regards to the administration of fluoroquinolones? (Choose one)

Do not take antacids while taking fluoroquinolones

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

Fluoroquinolones

Which of the following classes of antibiotics is a direct inhibitor of DNA synthesis in bacteria?

Fluoroquinolones

After teaching a group of students about aminoglycosides, the instructor determines that the teaching was successful when the group identifies which drug as the prototype for this class?

Gentamicin

Aminoglycosides are used primarily in the treatment on what type of infection? (Choose one)

Gram-negative infections

Mr. Thiessen is a 60-year-old man whose bacteremia is being treated with intravenous gentamicin. After 4 days of treatment, the care team is pleased with the improvement in Mr. Thiessen's condition and the effect of the drug treatment on his blood cultures. During morning care, he 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 patient's complaints?

Hold the next scheduled dose of gentamicin until the physician has been consulted.

You are caring for a patient who is receiving an aminoglycoside. What would be a priority assessment on this patient?

Impairment of balance

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?

In the home using oral drugs

The client has been taking a fluoroquinolone and calls the physician's office to report that she is experiencing redness and is excoriated in her groin area. What is the best response of the nurse?

Notify the physician.

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 of the following ways?

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

Your patient is receiving a multiple-dose regimen of an aminoglycoside. On what serum drug levels will you base the patient's maintenance dose?

Peak and trough levels

A male client develops a wound infection, and the physician orders once-daily intravenous multiple-dose regimens of aminoglycosides. What kinds of monitoring does the nurse expect the physician to order?

Peak and trough serum levels

A client is receiving levofloxacin (Levaquin) IV. During an infusion, the client complains of pain and the nurse notes a reddened area along the vein. What does the nurse suspect?

Phlebitis

A young lifeguard has been prescribed moxifloxacin (Avelox). The nurse focuses education on which adverse reaction?

Photosensitivity

Which of the following would be the priority assessment when preparing to administer amikacin to a patient?

Renal function

You are a critical care nurse caring for a patient taking aminoglycosides. Which of the following should you monitor closely to determine whether dosage adjustment is required?

Renal function

A patient with a gram-negative infection is being treated with an aminoglycoside. What system should the nurse expect to be tested daily while on this medication?

Renal system

The client has been prescribed levofloxacin. The nurse knows that the client should be taught to do which of the following?

Swallow the pill.

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.

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 patient's pregnancy affect the potential use of ciprofloxacin to treat her conjunctivitis?

The use of ciprofloxacin is contraindicated in pregnancy.

The nurse knows that pseudomembranous colitis is a superinfection of fluoroquinolones, especially when they are administered in high doses, because these medications have what effect in the body?

They disrupt the microbial flora of the body.

What symptom should the nurse expect to find if the client begins to exhibit signs of ototoxicity?

Tinnitus

Your client is scheduled to undergo major abdominal surgery. A preoperative order for neomycin has been given. Neomycin is used preoperatively for the following reason:

To suppress intestinal bacteria.

A patient's risk for ototoxicity, nephrotoxicity, and neurotoxicity increases dramatically if he receives an aminoglycoside in conjunction with a potent diuretic.

True

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 23-year -old man who works in construction calls the clinic to report that he has a rash all over his body, his skin is red, and it feels like it is burning. The nurse suspects that he is having a photosensitivity reaction from Lomefloxacin (Maxaquin), which was prescribed the day before. The nurse will instruct the patient to

discontinue the drug immediately and return to the clinic.

A patient has been admitted to the critical care unit with a diagnosis of peritonitis that has necessitated treatment with gentamicin. As a result, the care team should be cautious when concurrently administering other medications that may cause

ototoxicity or nephrotoxicity.

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

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

The nurse should notify the physician immediately if a client has any of the following because they may be signs of serious neurotoxicity when a client is receiving an aminoglycoside? (Select all that apply)

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