Ch. 8 Anti-Infectives: Antibacterial Drugs

A patient receiving antibiotics for 3 days reports a skin rash over the chest, back, and arms. What is your first action? a. Ask the patient whether he or she has ever developed a rash while taking another drug. b. Reassure the patient that many people have this expected reaction to antibiotic therapy. c. Ask the patient whether the rash itches, burns, or causes other types of discomfort. d. Document the report as the only action.

ANS: A A rash is an indication that the patient is allergic to the drug; however, at this time it is not an emergency. First explore the patient's response further and hold the dose, then notify the prescriber of this problem.

Which laboratory blood test result for a patient taking trimethoprim/sulfamethoxazole (Septra) should you report immediately to the prescriber? a. Red blood cells (RBCs) 2.2 million/mm3 b. International normalized ratio (INR) 1.6 c. White blood cells (WBCs) 6000/mm3 d. Sodium 134 mEq/L

ANS: A Trimethoprim/sulfamethoxazole is a combination drug composed of two metabolism inhibitors. One of the most serious adverse effects of the metabolism inhibitors is suppression of bone marrow cell division, leading to fewer red blood cells and anemia. This patient's RBC level is only about half of normal.

A patient is prescribed ciprofloxacin (Cipro) 500 mg every 8 hours. Which are common side effects of this drug? (select all that apply) a. Rash b. Flatulence c. Muscle pain d. Photosensitivity e. Joint pain f. Headache

ANS: A, C, E Ciprofloxacin is a fluoroquinolone drug. Common side effects of these drugs include rash, nausea/vomiting, abdominal pain, and muscle and joint pain.

Which antibacterial drugs are most likely to cause severe skin reactions? a. Erythromycins and aminoglycosides b. Sulfonamides and trimethoprim c. Penicillins and cephalosporins d. Macrolides and tetracyclines

ANS: B Although any drug can cause an allergic skin rash, the sulfonamides and trimethoprim are more likely to cause any type of skin problem. These drugs work by interfering with bacterial cell metabolism. They also disrupt skin cell metabolism to some degree, causing skin rashes, dry skin, and peeling skin (as a side effect).

The patient with an elevated temperature is prescribed antibacterial therapy to be taken at home. The prescribed drug is amoxicillin (Amoxil) 250 mg three times a day. What would you teach the patient about dosing intervals for this drug? a. "Take the drug three times a day with meals." b. "Take the drug every 8 hours throughout the day." c. "Take the drug when you first get up, at lunch time, and with your evening meal." d. "Take the drug every 6 hours while you are awake."

ANS: B For all antibacterial therapy, it is important to keep the blood level high enough to affect the bacteria causing the infection. Therefore teach the patient to take the drug evenly throughout a 24-hour day. If the drug is to be taken three times daily, teach the patient to take it every 8 hours.

Which drug can cause tooth discoloration when given to young children? a. Aminoglycosides b. Macrolides c. Lincosamides d. Tetracyclines

ANS: D Tetracyclines disrupt the layering of tooth enamel during tooth development, causing discoloration. For this reason, is it avoided drug pregnancy (when the first teeth are forming) and in children under 14 years of age (when the secondary teeth are forming). These drugs have no effect on teeth that have already formed and have erupted through the gums.

A patient is taking trimethoprim (Primsol) 200 mg orally once a day. For which adverse effect will you monitor? a. GI bleeding b. Kidney failure c. Anaphylaxis d. Angioedema

ANS: B Trimethoprim is a sulfonamide. The sulfonamides are a type of chemical that can easily turn into crystals. Crystals that form and clump in the kidneys can cause kidney failure or kidney stones.

A patient experiences facial angioedema after receiving a dose of a new antibacterial drug. Which assessment should be performed first? a. Airway adequacy b. Peripheral lung sounds c. Rate and depth of respirations d. Symmetry of respiratory movement

ANS: A Angioedema of the face includes the mouth and throat and can quickly lead to laryngeal edema. Edema in either place can obstruct the airway. Although assessing respirations is important, assess the airway first to determine patency.

The patient who is receiving intravenous (IV) penicillin is prescribed to also receive intravenous doxycycline (Doxy). Which action is most important for nurse to implement? a. Use IV tubing for doxycycline that has never come into contact with penicillin. b. Use a glass container for the tetracycline and a plastic container for the penicillin. c. Infuse the doxycycline only into a central line and the penicillin into a peripheral line. d. Administer doxycycline with sterile saline and administer the penicillin with sterile water.

ANS: A Doxycycline is a tetracycline drug. Tetracyclines interfere with the action of penicillin. It is important not to give these two drug types at the same time. They should not be mixed together in the same IV bag or run through the same IV tubing.

A patient who has been prescribed amoxicillin (Amoxil) 250 mg orally every 8 hours asks if a higher dose of the drug just once a day can be taken instead. What is your best response? a. "Taking this drug every 8 hours helps keep the blood level of the drug high enough to affect the bacteria." b. "Giving the drug at regular intervals over a 24-hour period helps prevent side effects." c. "Let me contact your prescriber and ask whether the drug can be given once a day." d. "When given once a day, the dose is higher so allergic reactions are more common."

ANS: A For all antibacterial therapy, it is important to keep the blood level high enough to affect the bacteria causing the infection. For this reason it is best for a patient to take the drug evenly throughout a 24-hour period.

An older patient is prescribed azithromycin (Zithromax) 500 mg on the first day and 250 mg for days 2 through 5. For which drug also prescribed for this patient would you notify the prescriber? a. Digoxin (Lanoxin) b. Atorvastatin (Lipitor) c. Atenolol (Tenormin) d. Furosemide (Lasix)

ANS: A If a patient is prescribed a macrolide, check to see whether he or she is also taking digoxin, warfarin, pimozide, astemizole, terfenadine, or ergotamine. If so, notify the prescriber immediately because macrolides change the metabolism of these drugs, which can cause adverse effects.

Why is it important to avoid killing off normal flora with antibacterial drugs? a. Normal flora can help provide protection against the development of pathogenic infections. b. Normal flora result in opportunistic infections while other bacteria result in pathogenic infections. c. When normal flora are not present, the immune system is suppressed, increasing the risk for infection. d. When normal flora are not present, the immune system is overactive, increasing the risk for autoimmune diseases.

ANS: A Normal flora are the nonpathogenic bacteria that are always present on skin, mucous membranes, and in the digestive tract. They provide protection by "crowding out" pathogenic organisms and preventing them from entering the body.

Why must fluoroquinolone drugs be avoided during pregnancy, lactation, and childhood? a. The drug damages muscles, tendons, and bones in the fetus and growing children. b. The fetal and newborn liver cannot metabolize the drug, leading to anemia and jaundice. c. The fetus and newborn are more likely to have allergic reactions to fluoroquinolones. d. The drug interferes with tooth enamel development causing permanently stained teeth.

ANS: A The fluoroquinolones have a moderate likelihood of increasing the risk for bone, joint, and tendon defects. These drugs should not be used during pregnancy, lactation, or children younger than 18 years of age unless the infection is life threatening and not sensitive to other drugs.

For which patient with a bacterial infection do you question a prescription for tetracycline (Tetracon)? a. 35-year-old patient with AIDS b. 16-year-old patient with severe acne c. 65-year-old patient with hypertension d. 25-year-old patient taking oral contraceptives

ANS: A The tetracyclines are broad-spectrum drugs that are bacteriostatic against most of the organisms that are sensitive to penicillins. Because they are only bacteriostatic, tetracyclines should be given only to patients with healthy immune systems. The person with AIDS has a severely compromised immune system that cannot fight the infection and needs a drug that is bactericidal rather than bacteriostatic. Although these drugs can interfere with tooth development and are not given to children, the 16-year-old patient's teeth should be fully developed and therefore not susceptible to that effect of the drug.

A 75-year-old patient taking levofloxacin (Levaquin) reports all of the following new problems. For which problem do you advise the patient to stop taking the drug immediately and notify the prescriber? a. Having to get up at night to urinate b. Swelling and pain in the right wrist c. Feeling the heart pound after drinking coffee d. Feeling light-headed when changing positions rapidly

ANS: B A rare adverse effect of fluoroquinolones is the rupture of a tendon, most often in the shoulder, hand, wrist, or heel (Achilles tendon). This complication is most likely to happen in an older patient and in those who also take corticosteroids.

A patient who has been prescribed oral cephalexin (Keflex) also takes aluminum hydroxide (Mylanta) 1 hour after each meal. When should you give this drug? a. Give the two drugs at the same time to prevent GI upset. b. Give the cephalexin 1 hour before the aluminum hydroxide. c. Give the aluminum hydroxide 1 hour before the cephalexin. d. Give the aluminum hydroxide 4 hours after the cephalexin.

ANS: B Cephalexin is a cephalosporin. These drugs are poorly absorbed with iron supplements or antacids. If a patient is receiving an antacid, the cephalosporin should be given 1 hour before or 4 hours after the antacid or iron supplement.

A patient is prescribed intravenous ertapenem (Invanz). Which question is most important to ask before giving the first dose of this drug? a. "Do you have a hearing problem or any trouble with your ears?" b. "Do you take medications for seizures?" c. "Are you allergic to sulfa drugs?" d. "Have you ever had asthma?"

ANS: B Ertapenem belongs to the carbapenem antibacterial class. Drugs in this class can cause seizures in susceptible people. If a patient has a seizure disorder, the drug should be used with caution. The prescriber is notified of this problem because the dosage of anticonvulsive drug or drugs may need to be adjusted before the ertapenem is administered.

A patient is prescribed an oral fluoroquinolone drug. Which precaution should you follow when administering this drug? a. Give this drug with food. b. Give a full glass of water to drink with this drug. c. Give the drug before meals. d. Give the drug with a glass of milk.

ANS: B Give patients a full glass of water to drink with oral fluoroquinolone capsules or tablets and urge them to drink more fluids throughout the day. This action prevents forming a concentrated amount of drug in the urine that can irritate the urethra and perineum.

A patient with a respiratory bacterial infection asks why a sputum sample is being collected before starting antibacterial drug therapy. What is your best response? a. "Drug therapy for lung infections works better when less sputum is present." b. "A sputum sample will help us determine what bacteria is causing your infection." c. "The test will determine whether you already have any damage in your lung tissues. d. "The dosage of your antibacterial drug is determined by the organism that is causing your infection."

ANS: B Identifying the type of bacteria causing an infection is important for selection of the appropriate drug to treat the infection. The most common way of identifying bacteria is culture and sensitivity. When a drug is effective against the bacteria, the bacteria do not grow. The laboratory test identifying the specific organism does not indicate drug dosage.

Which drug is most often used to treat ear infections in children? a. Imipenem (Primaxin) b. Amoxicillin (Amoxil) c. Vancomycin (Vancocin) d. Sulfamethoxazole/trimethoprim (Bactrim)

ANS: B Most of the bacteria that invade the middle ear of children (and adults) have cell walls and are sensitive to the less potent cell wall synthesis inhibitors, especially amoxicillin. Both imipenem and vancomycin are powerful antibacterial drugs and are only used for severe infections that do not respond to less potent drugs. Sulfamethoxazole/trimethoprim is used mainly for infections of the urinary tract.

A patient taking erythromycin reports experiencing nausea and upset stomach. What is your best action? a. Hold the drug and notify the prescriber immediately. b. Ensure that the drug is given with or after food. c. Ask if the patient has any drug allergies. d. Document the report as the only action.

ANS: B Side effects common to erythromycin include nausea, vomiting, and GI upset. This is not an indication of allergic reaction. Giving the drug with or after food will help prevent these side effects.

A patient with a bacterial infection has been placed on antibacterial therapy. Which assessment finding in the patient indicates that the therapy is effective? a. Red blood cell count is 4,500,000 cells/mm3. b. White blood cell (WBC) count is 8000 cells/mm3. c. Wound drainage is thick and yellow. d. Temperature is 102.4° F.

ANS: B Signs and symptoms of a resolving infection include reduced or absent fever; no chills; wound drainage that is no longer thick, foul-smelling, brown, green, or yellow; wound edges that are not red and raw-looking; and a WBC count that is in the normal range (5000 to 10,000 mm3).

Why must sulfonamide drugs be avoided during the last trimester of pregnancy and lactation? a. The drug crosses the placenta and causes brain hemorrhage in the fetus. b. The fetal and newborn liver cannot metabolize the drug and jaundice results. c. The fetus and newborn are more likely to have allergic reactions to sulfonamides. d. The drug interferes with tooth enamel development causing permanently stained teeth.

ANS: B Sulfonamides can cause severe jaundice in the infant and should be avoided during the last 2 months of pregnancy to reduce the chances that the baby will be born while the mother is still taking the drug. For the same reason, the breastfeeding mother should use alternate methods of infant feeding during the time she is taking the drug.

Which drug category includes the penicillins? a. Protein synthesis inhibitors b. Cell wall synthesis inhibitors c. DNA synthesis inhibitors d. Metabolism inhibitors

ANS: B The action of penicillin is disruption of the ability of a bacterium to make, repair, or maintain its cell walls. So, penicillins belong to the cell wall synthesis inhibitor class of antibacterial drugs. Penicillins do not interfere with the bacteria's ability to make proteins, make DNA, or metabolize.

Which condition is most likely to lead to antibacterial drug resistance? a. Having a parent with antibacterial drug resistance b. Receiving prolonged antibacterial drug therapy c. Taking an antibacterial drug for the very first time d. Being allergic to a specific antibacterial drug

ANS: B The most common reason why bacteria become resistant to an antibacterial drug is that the organisms were previously exposed to the drug and had a chance to develop specific biologic changes within each bacterium that protected the organism against the action(s) of the drug. Resistance is not inherited by a person and the person is NOT resistant to the drug, the organism is.

A patient is prescribed azithromycin (Zithromax) 500 mg on the first day and 250 mg for days 2 through 5. Which side effects will you watch for after the patient starts taking this drug? (select all that apply) a. Increased appetite b. Abdominal pain c. Constipation d. Nausea e. Sun sensitivity f. Weight gain

ANS: B, D, E Azithromycin is a macrolide antibacterial drug. Macrolides have side effects that occur more in the GI tract. They include nausea, vomiting, abdominal pain, diarrhea, loss of appetite, and changes in taste sensation. These drugs greatly increase sun sensitivity (photosensitivity), making serious sunburns possible.

A patient is being discharged home on antibacterial drug therapy. What instructions should you teach the patient about allergic reactions? (select all that apply) a. "Notify your prescriber immediately if you vomit." b. "Stop taking the drug if you develop hives or a rash." c. "If you notice diarrhea be sure to stop taking the drug." d. "Continue taking the drug even if you feel well because it is fighting the infection." e. "Call 911 if you experience difficulty with breathing." f. "Avoid drinking caffeinated beverages with the drug."

ANS: B, E GI upset, vomiting, and diarrhea are fairly common side effects of antibacterial drugs and are not signs of allergic reactions. When a patient experiences an allergic reaction, he or she should be taught to stop taking the drug if rash or hives develop and to call the prescriber immediately. A patient should also be taught to call 911 immediately for difficulty breathing or a feeling of a lump in the throat because these are signs of a serious allergic reaction.

An older adult patient has been prescribed oral erythromycin tablets. Which precaution is most important to teach? a. "Take this drug with food or right after eating to reduce intestinal side effects." b. "Avoid driving or operating dangerous equipment while taking this drug." c. "Take your pulse daily and notify your prescriber if it becomes irregular." d. "Wear a hat and sunscreen when outdoors."

ANS: C All macrolide antibiotics, including erythromycin, have many side effects and interfere with other drugs. They can all cause GI side effects and increase sun sensitivity. The most dangerous side effect among older adults is the development of cardiac rhythm problems. The patient must be instructed to check his or her pulse at least once daily and report any new or worsening irregularities immediately.

A woman who is breastfeeding is prescribed amoxicillin/clavulanic acid (Augmentin) 250 mg every 8 hours to treat a bacterial infection. What should you teach her? a. "This drug does not pass into breast milk so continue to breastfeed while you are taking this drug." b. "This drug passes into breast milk but has no side effects so it is safe to continue breastfeeding." c. "This drug passes into breast milk and may cause your child to develop an allergy to this drug." d. "This drug does not pass into breast milk but you might want to avoid breastfeeding while taking it."

ANS: C All of these drugs pass into breast milk and will affect a nursing infant, possibly causing the infant to develop a drug allergy. These drugs are usually prescribed for only 5 to 14 days, and the breastfeeding mother should be urged to reduce infant exposure to the drug.

What is the most important action needed when a patient is first started on an intravenous (IV) antibacterial drug? a. Check the IV site every 4 hours for redness around the site and the presence of cordlike veins. b. Check the drip rate every hour to ensure that the proper blood drug level is maintained. c. Assess the patient's pulse, blood pressure, and respiratory effect every 15 minutes. d. Assess the patient's white blood cell count daily to determine drug effectiveness.

ANS: C Anaphylaxis is a severe drug allergy that can quickly lead to death. Although drug-induced anaphylaxis can occur at any time, it is most likely to occur early during IV administration of the drug. Signs and symptoms are hives at the IV site, low blood pressure, rapid irregular pulse, swelling of the lips or lower face, and the patient feeling a "lump in the throat." When the patient is receiving the first dose of an IV antibiotic, checking the patient at least every 15 minutes for symptoms of anaphylaxis is critical.

Which statement made by a patient prescribed to take antibiotic therapy for a wound infection indicates a correct understanding of the therapy? a. "If my temperature is normal for 3 days in a row, the infection is gone and I can stop taking the drug." b. "If my temperature goes above 100° F for 2 days, I should double the dose of the drug." c. "Even if I feel completely well, I should take the drug exactly as prescribed until it is gone." d. "I should notify my prescriber to change the medication if I develop diarrhea while taking this drug."

ANS: C Antibiotic therapy is most effective when the patient takes the prescribed drug for the entire course and not just when symptoms are present. Most antibiotic therapy results in some degree of diarrhea. Although additional drugs may be needed to control this side effect, it is usually not necessary to stop the drug.

How are bactericidal drugs different from bacteriostatic drugs? a. Bacteriostatic drugs are more likely to cause an allergic response than bactericidal drugs. b. Bacteriostatic drugs work only on bacteria, whereas bactericidal drugs are effective against other types of organisms. c. Bactericidal drug actions result in killing the bacteria, whereas bacteriostatic drugs only slow bacterial growth. d. Bactericidal drugs require assistance from the patient's immune system to be effective, whereas bacteriostatic drugs are effective even when function is poor.

ANS: C Bactericidal drugs directly kill bacteria; bacteriostatic drugs only stop bacteria from reproducing while the immune system kills the bacteria.

Which two drug types have almost identical chemical structures? a. Aminoglycosides and "sulfa drugs" b. Macrolides and fluoroquinolones c. Penicillins and cephalosporins d. Tetracyclines and penicillins

ANS: C Both the penicillins and the cephalosporins have a beta lactam ring as part of their chemical structures, making them nearly identical in how they work and the side effects they have. All of the other drugs on this list have unique chemical structures

After starting to take clindamycin (Cleocin) 150 mg every 8 hours, which laboratory results are important for you to monitor? a. Potassium b. Sodium c. Creatinine d. Red blood cells

ANS: C Check the patient's current laboratory work, especially BUN and serum creatinine levels, because clindamycin, linezolid, and streptogramin are toxic to the kidneys. If these values are higher than normal before starting the drug, the risk for kidney damage is greater.

A patient taking ciprofloxacin (Cipro) reports pain and burning on urination. What is your best action? a. Notify the prescriber that the patient's urinary tract infection is not responding to the drug. b. Remind the patient that the pain is related to the body eliminating the infectious bacteria. c. Instruct the patient to drink a full glass of water with each drug dose and increase fluids. d. Ask the patient whether blood or pus is also present in the urine.

ANS: C Ciprofloxacin is a fluoroquinolone drug that concentrates in the urine, making the urine irritating to surrounding tissues. The patient may experience pain or burning of the urethra and nearby tissues during urination. An incontinent patient may have skin irritation over the entire perineal area. To avoid this, teach the patient to drink a full glass of water with each dose and to drink more fluids throughout the day.

A patient is receiving intravenous gentamicin. Which change in condition do you report to the prescriber immediately? a. Temperature increases from 38° C to 39° C. b. Blood pressure decreases from 132/80 to 118/66. c. Total 24-hour urine output decreases from 2100 to 1100 mL. d. White blood cell (WBC) count decreases from 11,000/mm3 to 8500/mm3.

ANS: C Gentamicin is an aminoglycoside antibacterial drug. These drugs are toxic to the kidneys (nephrotoxic). A decrease of urine output by 1000 mL in a 24-hour time period is cause for concern about kidney function. The drug may need to be stopped or the dosage decreased.

Which side effect should you monitor for when a child is prescribed penicillin V potassium 250 mg twice daily? a. Gastrointestinal upset b. Decreased urine output c. Allergic reaction d. Constipation

ANS: C Most cell wall synthesis inhibitors have fewer side effects than other types of antibacterial drugs. However, the cell wall synthesis inhibitors, especially penicillin, are more likely to cause allergic reactions. If a rash or hives develop while taking an antibacterial drug, remind the parents to stop giving the drug and call the prescriber immediately. Explain that this is a sign of drug allergy. Tell the parents to call 911 immediately if the child has trouble breathing or has the feeling of a "lump in the throat" because these are signs of a more serious allergic reaction.

Which antibacterial drug kills bacteria by binding to cell wall proteins and preventing them from being incorporated into cells walls? a. Levofloxacin (Levaquin) b. Minocycline (Vectrin) c. Vancomycin (Vancocin) d. Gentamicin

ANS: C Of the drugs on this list, only vancomycin is a cell wall synthesis inhibitor. Minocyline and gentamicin are protein synthesis inhibitors. Levofloxacin is a DNA synthesis inhibitor.

Which precaution is most important to teach a patient who has been prescribed sulfisoxizole (Gantrisin)? a. Evenly space this drug throughout the 24-hour day. b. Take the drug 1 hour before or 2 hours after a meal. c. Drink at least 3 L of liquids throughout the day. d. Stop the drug immediately if diarrhea develops.

ANS: C Sulfisoxizole is a sulfonamide, which is a type of chemical that can easily turn into crystals. Crystals that form and clump in the kidneys can cause kidney failure or kidney stones. Drinking at least 3 L of fluids daily while taking this drug can prevent crystallization in the kidneys.

Which side effect of fluoroquinolones is more likely to occur among older adults? a. Fever b. Hair loss c. Tendon rupture d. Low blood pressure

ANS: C Tendon rupture while taking or shortly after stopping the fluroquinolones is a potential adverse reaction with this drug. It is more likely to occur among older adults than any other age-group. The drug does concentrate in muscle, cartilage, and bone. It is not known whether having the drug concentrate in these tissues affects their strength.

A patient is prescribed minocycline (Dynacin) 750 mg orally. What should you do before giving the first dose? a. Check that the patient is not allergic to penicillin or sulfa drugs. b. Use a new IV administration set to administer the drug. c. Hold the dose and contact the prescriber. d. Give the drug with milk or food.

ANS: C The dosage of minocycline is smaller than most other tetracyclines. The average dose for an adult is 100 mg. It is likely that the prescriber intended to write 75 mg rather than 750 mg, which would be nearly 10 times the usual dosage.

A patient prescribed vancomycin (Vancocin) has developed redness on the face, neck, chest, back, and arms. The family asks the nurse if the drug should be stopped because of this response. What is your best answer? a. "Yes, these problems indicate an allergic reaction." b. "Yes, these side effects eventually lead to difficulty breathing." c. "No, these uncomfortable problems are an expected drug side effect." d. "No, the problems are caused by the presence of the infection and are not related to the drug."

ANS: C Vancomycin is a powerful antibacterial drug that has many side effects, including "red man syndrome." This problem is caused by a histamine release that dilates blood vessels, giving a red appearance to the face, neck, chest, back, and arms. Sometimes this reaction can be reduced by slowing the infusion rate; however, it is not an indication to stop the drug.

What does the term "virulence" mean? a. Bacteria that do not cause infection or systemic disease b. How easily a bacterium can be killed by antibiotic therapy c. How well bacteria can invade and spread within the body d. How many different types of bacteria an antibiotic can kill

ANS: C Virulence is a measure of how well or efficiently a microorganism can gain entry into the body, reproduce there, and make the host sick even when the host has a normal immune system. The more virulent a bacterium is, the more dangerous it is and the harder it is to kill or eliminate.

An older adult patient is prescribed linezolid (Zyvox) 500 mg oral suspension. The drug on hand is 100 mg/5 mL. How many milliliters should you prepare for the correct dose? a. 2 b. 10 c. 25 d. 50

ANS: C Want 500 mg in X mL/Have 100 mg in 5 mL. 500/100 = 5X × 5 mL = 25 mL.

A patient has a bacterial infection, but the causative organism is not known. Which type of antibacterial drug will most likely be prescribed? a. Narrow-spectrum b. Limited-spectrum c. Extended-spectrum d. Broad-spectrum

ANS: D A broad-spectrum antibacterial drug is effective against a wide range of bacteria, both gram-positive and gram-negative. Narrow-spectrum drugs are effective against a few bacteria, while extended-spectrum drugs are effective against several types of bacteria.

Which statement made by a patient prescribed to take azithromycin (Zithromax) indicates that additional teaching is needed? a. "To avoid nausea, I will take my medicine along with food." b. "I will use another form of birth control along with my oral contraceptives." c. "Since I only have to take this drug once a day, it will be easy to remember." d. "To help get rid of the infection, I will spend 30 minutes each day out in the sun."

ANS: D Although fresh air and sunshine are important, azithromycin is a macrolide and increases skin sensitivity to the sun (photosensitivity), greatly increasing the risk for sunburn, even among patients with dark skin. You must teach patients to avoid direct sunlight and tanning beds while they are taking this drug and for at least 1 week after stopping the drug.

An older adult patient is prescribed amikacin (Amikin). Which assessment technique is most important to perform daily? a. Asking about numbness in fingers and toes b. Measuring calf circumference of both legs c. Checking the mouth for open sores d. Asking about ringing in the ears

ANS: D Amikacin can be toxic to the ears (ototoxic), especially among older adults. One of the first signs of ototoxicity is ringing in the ears (tinnitus) which often occurs before actual hearing loss. The nurse must check the patient daily for tinnitus and changes in hearing.

A patient is to receive trimethoprim/sulfamethoxazole (Septra) intravenously. The drug is mixed in 250 mL of D5W and is to be administered over 90 minutes. With a drop factor of 15 gtt/mL, how many drops per minute is the correct infusion rate? a. 10 b. 20 c. 30 d. 40

ANS: D At a rate of 250 mL in 90 minutes, the drug must infuse at 2.7 mL/min (250 mL/90 minutes = 2.7 mL/min). With 15 gtt equaling 1 mL, 2.7 mL × 15 = 40.5 gtt/min, rounded down to 40 gtt/min.

A patient who has been prescribed cephalexin (Keflex) reports having a severe allergic reaction to penicillin in the past. What is your best first response or action? a. Reassure the patient that Keflex is not penicillin. b. Place an allergy alert band on the patient's wrist. c. Notify the prescriber immediately before the first Keflex dose. d. Highlight this important information in the patient's medical record.

ANS: D Cephalexin is a cephalosporin and has a chemical structure that is very similar to the structure of penicillin. Often a person who is allergic to penicillin is also allergic to cephalosporins. Even if the prescriber wishes to go ahead with cephalosporin therapy, he or she may first prescribe premedication to reduce the risk for an allergic response.

Which laboratory blood test result for a patient taking clarithromycin (Biaxin) and warfarin (Coumadin) should you report immediately to the prescriber? a. Potassium 3.6 mEq/L b. Sodium 134 mEq/L c. Blood urea nitrogen (BUN) 21 mg/dL d. International normalized ratio (INR) 4.6

ANS: D Clarithromycin is a macrolide and can interfere with metabolism of many drugs. In particular, they increase the effects of warfarin. This patient's INR of 4.6 indicates a dangerously long clotting time and a greatly increased risk for bleeding. Although some of the other values are slightly out of the normal range, only the INR requires immediate action.

Which problem is a sign or symptom of an allergic or anaphylactic response to an antibacterial drug? a. Diarrhea b. Hair loss c. High blood pressure d. Swelling of the face or lips

ANS: D Most antibacterial drugs induce diarrhea when taken for a week or longer because they kill off so many of the normal bacteria in the intestinal tract. This is not an allergy and the immune system is taking no part in causing the diarrhea. Hair loss is not a common side effect of antibacterial therapy nor is it an allergic reaction. When a true systemic allergic reaction occurs, it is usually accompanied by low blood pressure because of widespread blood vessel dilation. This blood vessel dilation of a true allergic response often causes swelling of the face, lips, and tongue.

Which protein synthesis inhibitors can raise the pressure inside the brain? a. Aminoglycosides b. Macrolides c. Lincosamides d. Tetracyclines

ANS: D Of the drugs on this list, only the tetracyclines have a potential adverse effect of increasing pressure inside the brain.

Which drug is a first-generation cephalosporin? a. Cefepime (Maxipime) b. Cefotaxime (Claforan) c. Cefoxitin (Mefoxin) d. Cefazolin (Kefzol)

ANS: D Only cefazolin (Kefzol) is a first-generation cephalosporin. The other drugs are all cephalosporins but cefepime is fourth-generation, cefotaxime is third-generation, and cefoxitin is second-generation.

Which type of bacteria cause infection when a patient's immune system is impaired? a. Pathogenic b. Nonpathogenic c. Gram-negative d. Opportunistic

ANS: D Pathogenic bacteria cause disease or tissue damage while nonpathogenic bacteria do not. Opportunistic bacteria cause disease or tissue damage only when the immune system is not working well.

A patient who has been on antibiotic therapy for 3 weeks has a cottage cheese-like coating on the teeth, gums, and roof of the mouth. What your best action? a. Take a specimen and send it to the laboratory for culture. b. Hold the dose and notify the prescriber immediately. c. Document this expected finding as the only response. d. Assist the patient to perform frequent mouth care

ANS: D Prolonged antibacterial therapy can cause an oral yeast infection (thrush) by killing off the normal flora of the mouth. This infection causes a white, cottage cheese-like coating on the gums, roof of the mouth, or insides of the cheeks, which is not an allergic reaction nor is it a reason to stop the drug therapy. Teach patient to use good oral hygiene performing frequent toothbrushing and using mouthwash.

Which question would you be sure to ask a patient after giving any antibacterial drug? a. "Are you allergic to any foods or medications?" b. "Have you noticed any changes in your ability to remember things?" c. "Do you know how to check your blood pressure and heart rate?" d. "How many bowel movements do you have each day and what are they like?"

ANS: D Pseudomembranous colitis is a complication of antibacterial therapy that causes severe inflammation in areas of the colon (large intestine). The cause of the problem is the overgrowth of an intestinal organism called Clostridium difficile (also known as "C. difficile"). This organism is not killed by most antibacterial drugs, and it can take over the patient's intestinal tract when normal flora are killed off. The lining of the colon becomes raw and bleeds. Other symptoms include watery diarrhea, the constant feeling of the need to move the bowels, abdominal cramps, low-grade fever, and bloody stools.

Why should tetracycline drugs be avoided during pregnancy and lactation? a. Tetracycline crosses the placenta and causes brain hemorrhage in the fetus. b. The fetal and newborn liver cannot metabolize the drug and anemia results. c. The fetus and newborn are more likely to have allergic reactions to tetracycline. d. The drug interferes with tooth enamel development causing permanently stained teeth.

ANS: D Tetracyclines used during tooth development in the last half of pregnancy and in infancy can cause a permanent yellow-gray discoloration of the teeth and make the tooth enamel thinner. So, these drugs should not be used during pregnancy or when breastfeeding except for anthrax exposure or for another serious infection that is not likely to respond to other antibacterial drugs.

A patient is to receive penicillin G benzathine (Bicillin LA) 2,400,000 units intramuscularly. The drug on hand is penicillin G benzathine 600,000 units/mL. How many milliliters should your nurse prepare for the correct dose? a. 0.25 b. 0.5 c. 2 d. 4

ANS: D Want 2,400,000 units/Have 600,000 units/mL. 2,400,000/600,000 = 24/6 = 4 mL.

A patient is to receive ticarcillin (Ticar) 3 g by intravenous piggyback. The solution you have is ticarcillin 200 mg/mL. How many milliliters of this solution will you add to the piggyback bag to make a dose of 3 g? a. 3 mL b. 5 mL c. 10 mL d. 15 mL

ANS: D Want 3 g (3000 mg) in X mL/Have 200 mg in 1 mL. 3000/200 = 15X = 15 mL.

A patient is to receive linezolid (Zyvox) 300 mg orally. You have on hand linezolid tablets of 600 mg/tablet. How many tablets will you give for a 300 mg dose? a. 3 tablets b. 2 tablets c. 1 tablet d. 0.5 tablet

ANS: D Want 300 mg in X tablets/Have 600 mg in 1 tablet. 300/600 = 0.5 tablet.

What is the main feature of an opportunistic infection? a. It usually leads rapidly to sepsis. b. Children are not susceptible to this type of infection. c. It is most often caused by pathogenic microorganisms. d. It is only found in people who are immunosuppressed.

ANS: D We have many microorganisms that are on or in our bodies and do not cause an infection because our immune systems are able to keep their numbers low and prevent them from moving beyond their normal body location. For example, we all have E. coli in our intestinal tracts and this does not cause us harm as long as our immune systems are working well. Even if a few E. coli leave the intestinal tract and enter the blood or the urine, they usually do not cause an infection because our immune systems get rid of these organisms when they are located where they do not belong. However, a person with a suppressed or weak immune system may not be able to remove or destroy these organisms when they are located outside of the intestinal tract and an infection develops. This is called an opportunistic infection because the organism is taking advantage of the host's weakened immune system and using the opportunity to grow elsewhere in the body.

A patient is having an anaphylactic reaction to an intravenous (IV) antibacterial drug. Which action should you perform first? a. Discontinue the IV therapy immediately and place the patient in shock position. b. Hold the next dose and notify the prescriber immediately. c. Discontinue the IV therapy and restart it at a different site. d. Discontinue the drug and maintain the IV access.

ANS: D When a patient is having an anaphylactic reaction to an IV drug, the first priority is to prevent any more drug from entering the patient. Stop the drug from infusing but keep the IV access open. If the drug is infusing high into the IV tubing, change the tubing after stopping the drug, and do not let any drug left in the tubing run into the patient. Starting a new IV line may be difficult or impossible during the hypotension that occurs during anaphylaxis.