Chapter 19
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." • "Do not take antacids." • "Limit fluids to a couple of glasses per day." • "Take the medication as prescribed."
"Drink at least 2 liters of fluids per day."
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? "I feel like I'm having trouble hearing the last little while." "My IV site feels really itchy a lot of the time." "I definitely feel like my appetite has suffered since I started these antibiotics." "I've got this pounding headache that never seems to go away."
"I feel like I'm having trouble hearing the last little while
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?
225 mg Explanation: Each dose is limited to 75 mg of gentamicin (30 kg × 2.5 mg/kg = 75 mg). Since three doses will be administered daily (i.e., q8h, or "every 8 hours"), the client will receive a maximum total dose of 225 mg per day.
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 • at the midpoint between scheduled doses. • as soon as possible after the patient awakens in the morning. • 30 minutes after the drug has finished infusing. • immediately after the third intravenous dose of the drug.
30 minutes after the drug has finished infusing.
The nurse instructs the client who is taking oral ciprofloxacin to avoid which food while taking this medication? • Tuna • Cheese • Hamburger • Chicken
Cheese
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 bestresponse? • Administer an antipyretic. • Notify the health care provider. • Administer an extra dose of levofloxacin. • Continue to monitor vital signs.
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? • Electrolyte panel • Culture and sensitivity • Complete blood count • White blood count
Culture and sensitivity
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 client to:
Discontinue the drug immediately and return to the clinic. Explanation: The nurse will instruct the client to discontinue the drug immediately and return to the clinic. These are signs and symptoms of a potentially serious photosensitivity reaction. The nurse should never tell the client to change a dosage schedule that involves stopping and starting a drug.
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? • Drink at least 2L of fluid per day. • Minimize sodium intake. • Eliminate red meat and seafood from the diet. • Avoid all caffeine and alcohol.
Drink at least 2L of fluid per day.
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?
Drink at least 2L of fluid per day. Explanation: Clients should be encouraged to drink a lot of fluids and maintain nutrition, even though nausea, vomiting, and diarrhea may occur. There is no need to eliminate red meat, seafood, caffeine, or alcohol from the diet, although alcohol may increase the risk of GI irritation. There is no need to minimize sodium intake.
Which of the following classes of antibiotics is a direct inhibitor of DNA synthesis in bacteria? • Ketolides • Fluoroquinolones • Macrolides • Penicillins
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? • Kanamycin • Tobramycin • Neomycin • Gentamicin
Gentamicin
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? • Tobramycin • Gentamicin • Neomycin • Kanamycin
Gentamicin
Which of the following drugs would be classified as an aminoglycoside? • Levofloxacin • Gentamicin • Cefaclor • Clarithromycin
Gentamicin
Which of the following drugs would be classified as an aminoglycoside?
Gentamicin Explanation: Gentamicin is classified as an aminoglycoside. Levofloxacin is a fluoroquinolone; clarithromycin is a macrolide; and cefaclor is a cephalosporin.
The nurse is caring for a client who is receiving IV gentamicin and who reports difficulty hearing this morning. What should the nurse do? • Administer the dose and report this information to the oncoming nurse. • Hold the dose and notify the provider immediately. • Administer the dose and document the finding in the client's health record. • Make a referral for auditory testing.
Hold the dose and notify the provider immediately.
Which of the following should a nurse recognize as an aminoglycoside? Select all that apply. • Vancomycin (Vancocin) • Kanamycin (Kantrex) • Amikacin (Amikin) • Amoxicillin (Amoxil) • Azithromycin (Zithromax)
Kanamycin (Kantrex) Amikacin (Amikin)
A male client is prescribed aminoglycosides for a bladder infection secondary to benign prostatic hypertrophy. The nurse understands that these drugs reach higher concentrations in which areas of the body? (Select all that apply.)
Kidneys Inner ears Explanation: Aminoglycosides reach higher concentrations in the kidneys and inner ears than in other body tissues; this is a major factor in nephrotoxicity and ototoxicity. There is low concentration in the central nervous system.
Which of the following are examples of fluoroquinolones? Select all that apply
Levofloxacin (Levaquin) Ciprofloxacin (Cipro) Explanation: The fluoroquinolones include ciprofloxacin (Cipro), moxifloxacin , ofloxacin , and levofloxacin (Levaquin)
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.
When administering aminoglycosides, the nurse must be aware of which of the following adverse reactions? • Hypoglycemia and hyperglycemia • Glaucoma and renal failure • Liver necrosis, or hepatic failure • Ototoxicity and nephrotoxicity
Ototoxicity and nephrotoxicity
Your patient is receiving a multiple-dose regimen of an aminoglycoside. On what serum drug levels will you base the patient's maintenance dose? • Mean and trough levels • Mean levels only • Peak and trough levels • Peak levels only
Peak and trough levels
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 Explanation: In patients receiving aminoglycosides, both peak and trough serum levels are measured to maintain therapeutic levels without excessive toxicity. For accuracy, blood samples must be drawn at the correct times and the timing of drug administration and blood sampling must be accurately documented and based on institutional recommendations.
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? • Peak and trough serum levels • Measurement of electrolytes every 48 hours • A complete blood count every 48 hours • A serum albumin determination 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?
Question the prescriber about the dosage of the medication. Explanation: The dosage is outside the recommended dosage range at 10 mg/kg/day, so the nurse should question the dosage before administering the medication. It is appropriate to administer gentamicin three times per day to pediatric clients, so there would be no need to question frequency of dosage. The drug should not be administered until the correct dosage is ordered, so there is no need to assess hearing or renal function.
A client in the critical care unit is receiving aminoglycosides for an infectious process. What does the nurse need to monitor? Serum albumin concentration Complete blood count White blood count Renal function tests
Renal function tests
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? • Take precautions to prevent photosensitivity. • Take a missed dose, even if close to the next dose. • Take the necessary vitamins along with the drug. • Avoid foods high in sodium such as processed meats.
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? • The client will require a lower dose and longer course of ciprofloxacin than a nonpregnant, adult client. • Ciprofloxacin is safe to use in pregnancy and the client may use to same dose and route as a nonpregnant client. • It is safe for the client to use topical ciprofloxacin but the oral route is potential teratogenic. • The use of ciprofloxacin is contraindicated in pregnancy.
The use of ciprofloxacin is contraindicated in pregnancy.
What symptom should the nurse expect to find if the client begins to exhibit signs of ototoxicity? Tinnitus Anorexia Rash Fatigue
Tinnitus
The nurse should advise the client to avoid taking which medication at the same time as a fluoroquinolone?
antacids Explanation: The client should not take antacids or drugs containing iron or zinc at the same time as taking a fluoroquinolone because these drugs will decrease the absorption of the fluoroquinolones. There are no listed contraindications of giving fluoroquinolones with antihypertensives, antidiabetic agents, or oral contraceptives.
A local bioterrorism medical team is responding to a possible anthrax attack. The team is instructed that a fluoroquinolone may be used to treat exposure to anthrax. The nurse should prepare to administer what antibiotic?
ciprofloxacin Explanation: Ciprofloxacin is used to treat exposure to anthrax. Gemifloxacin is most useful in treating acute episodes of chronic bronchitis and community-acquired pneumonia. Finafloxacin is used in treatment of acute otitis externa. Amoxicillin is a penicillin, not a fluoroquinolone.
A client has endocarditis and is taking gentamicin. The nurse will be sure to monitor the client's: • serum albumin level. • creatinine clearance. • potassium level. • prothrombin time.
creatinine clearance.
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 client to: • decrease the dosage by half until being seen by the health care provider. • continue to take the drug; the rash will eventually subside. • stop the drug for 3 days and then continue with the prescribed schedule. • discontinue the drug immediately and return to the clinic.
discontinue the drug immediately and return to the clinic.
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? • viral infections • fungal infections • gram-negative infections • gram-positive infections
gram-negative infections
The client has been prescribed a fluoroquinolone. The nurse knows that nursing interventions for clients taking fluoroquinolones include which? • restrict fluid intake. • increase fluid intake. • restrict sodium intake. • increase sodium intake.
increase fluid intake.
When considering known adverse reactions to gentamicin therapy, the nurse should focus assessment of what body structure? • lymph nodes • eyes • oral cavity • inner ears
inner ears
A nursing instructor is preparing a teaching plan for a nursing pharmacology class on the action of fluoroquinolones. Which would the instructor include?
interfering with DNA synthesis in the bacterial cell Explanation: The fluoroquinolones exert their bactericidal effect by interfering with the synthesis of bacterial DNA by not allowing the cell to reproduce. The tetracyclines are bacteriostatic and exert their effect by inhibiting bacterial protein synthesis. Penicillins act to disrupt the bacterial cell wall. The aminoglycosides exert their bactericidal effect by blocking the ribosome from reading the mRNA, a step in protein synthesis necessary for bacterial multiplication.
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? • gemifloxacin • metronidazole • levofloxacin • ciprofloxacin
metronidazole
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?
metronidazole Explanation: Metronidazole is not an example of a fluoroquinolone. Ciprofloxacin is an example of a fluoroquinolone. Levofloxacin is an example of a fluoroquinolone. Gemifloxacin is an example of a fluoroquinolone.
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. Explanation: If a patient taking vitamins or herbal supplements is prescribed ciprofloxacin, the nurse should advise the patient to take the vitamins at least 2 hours before or after taking ciprofloxacin. Changing or alternating the dosage must be determined by the prescriber
A client with a gram-negative infection is being treated with an aminoglycoside. What assessment should the nurse prioritize during treatment? • muscle strength and coordination • urine output and BUN and creatinine levels • visual acuity • breath sounds and oxygen saturation
urine output and BUN and creatinine levels
A client with a gram-negative infection is being treated with an aminoglycoside. What assessment should the nurse prioritize during treatment?
urine output and BUN and creatinine levels Explanation: Renal function should be tested daily because aminoglycosides depend on the kidney for excretion and if the glomerular filtration rate (GFR) is abnormal, it may be toxic to the kidney. The results of the renal function testing could change the daily dosage. Aminoglycosides do not usually adversely affect respiratory or musculoskeletal function, although baseline data concerning these systems is always needed. Auditory effects are more likely than visual effects.
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?
urine output and creatinine clearance Explanation: Aminoglycosides such as amikin come with a black box warning alerting healthcare professionals to the serious risk of nephrotoxicity. Visual alterations are not usually reported in relation to this drug. Similarly, cardiac and liver function are not usually impacted by this drug.
Which of the following drugs is likely to be administered as a first-line treatment for anthrax exposure? Ciprofloxacin Tobramycin Gentamicin Norfloxacin
Ciprofloxacin
Which of the following are examples of fluoroquinolones? Select all that apply. • Ciprofloxacin (Cipro) • Spectinomycin (Trobicin) • Amoxicillin (Amoxil) • Levofloxacin (Levaquin) • Cephalexin (Keflex)
Ciprofloxacin (Cipro) Levofloxacin (Levaquin)
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 bestresponse?
Continue to monitor vital signs. Explanation: The provider should be notified if the client's temperature is greater than 101ºF. The nurse cannot discontinue or administer additional doses without a provider's order. The body's normal defense to infection is an elevated temp until it reaches 101 degrees. Only then would an antipyretic be given if ordered.
When fluoroquinolones are administered intravenously, the nurse would check the needle site and area around the needle site for extravasation at which frequency?
Every hour Explanation: When fluoroquinolones are administered intravenously, the nurse would check the needle site and area around the needle site for extravasation—escape of fluid from a blood vessel into surrounding tissue, every hour. Times longer than every hour can lead to necrosis of the tissue if extravasation occurs.
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? • Document the client's reports and integrate them into his plan of care. • Administer the next scheduled dose of gentamicin over 90 to 120 hours. • Hold the next scheduled dose of gentamicin until the health care provider has been consulted. • Continue the gentamicin as ordered and monitor the client's symptoms closely.
Hold the next scheduled dose of gentamicin until the health care provider has been consulted.
An older adult client diagnosed with a drug-resistant urinary tract infection has been started on a regimen of aminoglycosides. The client is concerned about adverse reactions such as nephrotoxicity. When providing client education about the medication, what statement would the nurse make? • The drug is given for no longer than 30 days unless necessary for the treatment of certain infections. • Clients are at a lower risk for complications when high doses are given for prolonged periods. • Kidney function tests will reveal any decrease in function before damage occurs. • If nephrotoxicity occurs, it is usually reversible if the drug is stopped.
If nephrotoxicity occurs, it is usually reversible if the drug is stopped.
When administering aminoglycosides, the nurse must be aware of which of the following adverse reactions?
Ototoxicity and nephrotoxicity Explanation: After parenteral administration, aminoglycosides are widely distributed in extracellular fluid and reach therapeutic levels in blood, urine, bone, inflamed joints, and pleural and ascitic fluids. They accumulate in high concentrations in the proximal renal tubules of the kidney leading to acute tubular necrosis. This damage to the kidney is termed nephrotoxicity. They also accumulate in high concentrations in the inner ear, damaging sensory cells in the cochlea and the vestibular apparatus. This damage to the inner ear is termed ototoxicity.
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?
Peak and trough serum levels Explanation: Multiple-dose regimens (conventional dosing) of aminoglycosides must be carefully monitored with evaluation of peak and trough serum levels. Once-daily regimens are monitored with random level (12-hour) serum evaluation.
A client in the critical care unit is receiving aminoglycosides for an infectious process. What does the nurse need to monitor?
Renal function tests Explanation: Because critically ill clients are at high risk for development of nephrotoxicity and ototoxicity with aminoglycosides, guidelines for safe drug use should be strictly followed. Renal function should be monitored to assess for needed dosage reductions in clients with renal dysfunction who are receiving aminoglycosides.
A client scheduled to undergo major abdominal surgery has been prescribed preoperative neomycin. Neomycin is used preoperatively for what reason?
Suppress intestinal bacteria. Explanation: Neomycin and kanamycin may be given before bowel surgery to suppress intestinal bacteria. They may be given to treat hepatic coma. In hepatic coma, intestinal bacteria produce ammonia, which enters the bloodstream and causes encephalopathy. Drug therapy to suppress intestinal bacteria decreases ammonia production.
A client with a gram-negative infection is being treated with an aminoglycoside. What assessment should the nurse prioritize during treatment? • muscle strength and coordination • urine output and BUN and creatinine levels • breath sounds and oxygen saturation • visual acuity
urine output and BUN and creatinine levels