Chapter 26: Antibacterials
During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and anorexia. The nurse's best advice to the patient would be which of the following?
"Drink a full glass of water with each dose."
The nurse is administering vancomycin to a patient. Which should the nurse monitor the patient for? (Select all that apply) A) adequate hearing B) appropriate IV rate C) Clostridium difficile-associated diarrhea D) Stevens-Johnson syndrome E) hypertension and bradycardia F) redness of the face, neck, and chest
A) adequate hearing B) appropriate IV rate C) Clostridium difficile-associated diarrhea D) Stevens-Johnson syndrome F) redness of the face, neck, and chest Hypertension and bradycardia are not side effects associated with vancomycin administration.
Penicillin G has been prescribed for a patient. Which nursing intervention(s) should the nurse perform for this patient? (Select all that apply) A) collect culture and sensitivity before the first dose B) monitor the patient for mouth ulcers C) instruct the patient to limit fluid intake to 1000 mL/day D) have epinephrine on hand for a potential severe allergic reaction E) no particular interventions are required for this patient
A) collect culture and sensitivity before the first dose B) monitor the patient for mouth ulcers D) have epinephrine on hand for a potential severe allergic reaction The patient should be instructed to increase fluid intake, not limit it.
A patient is taking sulfasalazine. What should the nurse teach the patient to do? A) drink at least 10 glasses of fluid per day B) monitor blood glucose carefully to avoid hypoglycemia C) avoid operating a motor vehicle because this drug may cause drowsiness D) take this drug with an antacid to decrease the risk of GI distress
A) drink at least 10 glasses of fluid per day The patient should drink at least 10 glasses of fluid per day to decrease to risk of developing crystalluria (crystals in the urine). The patient should not take sulfasalazine with antacids because antacids decrease the absorption rate of sulfonamide drugs. Hypoglycemia and drowsiness are not considered side effects of sulfonamides.
The nurse is caring for a patient who has been prescribed cefazolin sodium. Which nursing assessment is the priority? A) history, including allergies B) cardiac assessment C) neurological assessment D) history of immunizations
A) history, including allergies Cefazolin is classified as a cephalosporin and patients who have an allergy to an antibiotic typically have an allergy to cephalosporins and/or penicillins. These allergies have the potential to cause severe anaphylaxis and death and, therefore, have more importance than the other assessments listed.
A patient on antibiotic therapy needs trough levels drawn. Which is the most appropriate time for the nurse to draw the trough level? A) ten minutes before administration of the intravenous antibiotic B) thirty minutes after beginning administration of the intravenous antibiotic C) sixty minutes after completion of the intravenous antibiotic infusion D) ninety minutes after the intravenous antibiotic is scheduled to be administered
A) ten minutes before administration of the intravenous antibiotic 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 receiving gentamicin therapy: 100 mg intravenously at 0800, 1600, and 2400. At 0730, the nurse is informed that peak and trough levels need to be drawn. When is the best time to obtain the peak level? A) 0800 B) 0900 C) 1600 D) 2330
B) 0900 To obtain the peak level, blood should be drawn 45-60 minutes after the medication has been administered. To obtain the trough level, blood should be drawn within 30 minutes before the next dose of the drug is due.
A 22-year-old female patient is put on amoxicillin. Which is the most important intervention for this patient? A) instruct the patient to not take the medication before meals B) assess if the patient is on oral contraceptives C) inform the patient about possible superinfections D) assess the patient for cross sensitivity
B) assess if the patient is on oral contraceptives This medication may decrease the effectiveness of oral contraceptives. The nurse needs to assess whether or not the patient is on oral contraceptives and whether or not the patient is sexually active.
A patient who takes multiple antibiotics starts to experience diarrheal stools. The nurse anticipates administration of which antibiotic if a stool sample tests positive for Clostridium difficile? A. Rifaximin (Xifaxan) B. Metronidazole (Flagyl) C. Daptomycin (Cubicin) D. Gemifloxacin (Factive)
B. Metronidazole (Flagyl) Metronidazole is the treatment of choice for antibiotic-associated colitis caused by C. difficile. Rifaximin, daptomycin, and gemifloxacin are not used in the treatment of C. difficile infection.
Which statement by a patient who has received teaching on tetracycline therapy indicates that more teaching is needed? A) "I will store the medication away from light and extreme heat" B) "I will use an additional contraceptive technique because this drug may cause the oral contraceptive I take to be less effective" C) "I will take this medication with an antacid" D) "if my stomach becomes upset when taking this medication, I will take it with nondairy foods"
C) "I will take this medication with an antacid" Patients should avoid milk products, iron, and antacids while on tetracycline therapy.
A patient enters the emergency department with a draining wound. Once the patient is admitted and assessed, the priority nursing intervention is to: A) administer the ordered antibiotics B) teach the patient about the ordered antibiotics C) culture the wound D) enforce droplet isolation precautions
C) culture the wound
The patient has been ordered lincomycin. The patient reports to the nurse that the patient has experienced reduced renal function in the past. The nurse anticipates that the health care provider will take which action? A) place the medication on hold until renal function improves B) increase the original dosage of the medication C) decrease the original dosage of the medication D) continue with the medication as originally ordered
C) decrease the original dosage of the medication Rather than place the medication on hold because of the patient's decreased renal function, the health care provider will likely opt to decrease the originally ordered dosage to accommodate the change in function.
Which antibacterial drug has the potential to cause adverse reactions of tendinitis, tendon rupture, and peripheral neuropathy? A) cephalosporins B) tetracyclines C) fluoroquinolones D) aminoglycosides
C) fluoroquinolones
The nurse is preparing to administer the morning medications, which includes a tetracycline. While preparing to administer the medication, the dietary staff delivers the patient's breakfast tray. Which item on the tray would most concern the nurse? A) coffee B) eggs C) milk D) whole wheat toast
C) milk Milk and foods high in calcium can inhibit tetracycline absorption. To avoid drug interaction, these should be taken at least 2 hours apart from tetracycline.
The nurse identifies which medication as posing a significant risk of causing confusion, somnolence, psychosis, and visual disturbances in elderly patients? A. Metronidazole (Flagyl) B. Rifampin (Rifadin) C. Ciprofloxacin (Cipro) D. Daptomycin (Cubicin)
C. Ciprofloxacin (Cipro) In elderly patients, ciprofloxacin (Cipro) poses a significant risk of confusion, somnolence, psychosis, and visual disturbances. Metronidazole, rifampin, and daptomycin are not associated with confusion in elderly patients.
Which statement will the nurse include when teaching a patient about cephalosporin therapy? A) "avoid ingesting buttermilk or yogurt when taking this medication" B) "stop taking the medication when you feel better" C) "immediately stop taking the medication if you develop nausea" D) "inform your health care provider if you develop mouth ulcers"
D) "inform your health care provider if you develop mouth ulcers" The development of mouth ulcers is a sign of superinfection and will need to be treated.
A patient asks the nurse why she gets yeast infections after a course of antibiotics. The nurse explains: A) "the antibiotics lower your white blood cell count" B) "people are poorly nourished and hydrated after an infection" C) "yeast infections happen if the antibiotic is not taken for the full course" D) "yeast infections are common when the normal body flora are disrupted"
D) "yeast infections are common when the normal body flora are disrupted" Encourage the patient to ingest probiotic-rich foods, such as buttermilk or yogurt, to help prevent the development of a superinfection.
For which serious adverse effect should the nurse closely monitor a patient who is taking lincosamides? A) seizures B) ototoxicity C) hepatotoxicity D) Clostridium difficile-associated diarrhea
D) Clostridium difficile-associated diarrhea The adverse effect seen most often with lincosamides is Clostridium difficile-associated diarrhea so the nurse should closely monitor the patient for this adverse effect.
A patient is taking levofloxacin. What does the nurse know to be true regarding this drug? A) it is administered by intravenous only B) levofloxacin may cause hypertension C) this drug is classified as an aminoglycoside D) an adverse effect is dysrhythmia
D) an adverse effect is dysrhythmia Levofloxacin is classified as a fluoroquinolone. It may cause hypotension, not hypertension, and can be administered by mouth or intravenously.
The nurse who is administering aminoglycoside therapy must monitor the patient closely for signs of toxicity as manifested by which of the following?
Hearing loss Dizziness Rising serum creatinine level
In which of the following groups would the use of tetracycline be contraindicated? (Select all that apply) A) infants B) pregnant women C) older adults D) adolescents E) breastfeeding mothers
A) infants B) pregnant women Pregnant patients should not take tetracycline during the first trimester of pregnancy because of possible teratogenic effects. Women in the last trimester of pregnancy and children younger than 8 years of age should also not take tetracycline because it irreversibly discolors the permanent teeth.
A patient is prescribed daptomycin. Which action(s) should the nurse implement? (Select all that apply) A) monitor blood values for toxicity B) dilute in 50 to 100 mL of normal saline and administer intravenously over 30 minutes C) monitor the patient for allergic reactions such as rhabdomyolysis D) advise the patient to take the medication on an empty stomach, even if GI distress occurs E) culture the infected area before administering the first dose
A) monitor blood values for toxicity B) dilute in 50 to 100 mL of normal saline and administer intravenously over 30 minutes C) monitor the patient for allergic reactions such as rhabdomyolysis E) culture the infected area before administering the first dose Daptomycin is administered intravenously, so answer D would not be correct.
A patient is taking azithromycin. Which nursing intervention(s) would the nurse plan to implement for this patient? (Select all that apply) A) monitor periodic liver function tests B) dilute with 50 mL of 5% dextrose in water for intravenous administration C) instruct the patient to report any loose stools or diarrhea D) instruct the patient to report evidence of superinfection E) teach the patient to take oral drug 1 hour before or 2 hours after meals F) advise the patient to avoid antacids from 2 hours prior to 2 hours after administration
A) monitor periodic liver function tests C) instruct the patient to report any loose stools or diarrhea D) instruct the patient to report evidence of superinfection E) teach the patient to take oral drug 1 hour before or 2 hours after meals F) advise the patient to avoid antacids from 2 hours prior to 2 hours after administration Azithromycin should be diluted with 250 to 500 mL of 5% dextrose in water for intravenous administration.
A patient is taking a cephalosporin. The nurse anticipates which appropriate nursing intervention(s) for this medication? (Select all that apply) A) monitoring renal function studies B) monitoring liver function studies C) infusing intravenous medication over 30 minutes D) monitoring the patient for mouth ulcers E) advising the patient to stop the medication when he or she feels better
A) monitoring renal function studies B) monitoring liver function studies C) infusing intravenous medication over 30 minutes D) monitoring the patient for mouth ulcers The patient should not stop taking the medication when he or she feels better. The patient should take the entire prescription of medication.
Which nursing intervention(s) should the nurse consider for the patient taking ciprofloxacin? (Select all that apply) A) obtain culture before drug administration B) tell the patient to avoid taking ciprofloxacin with antacids C) monitor the patient for tinnitus D) encourage fluids to prevent crystalluria E) infuse intravenous ciprofloxacin over 60 minutes F) monitor blood glucose because ciprofloxacin can decrease effects of oral hypoglycemics
A) obtain culture before drug administration B) tell the patient to avoid taking ciprofloxacin with antacids C) monitor the patient for tinnitus D) encourage fluids to prevent crystalluria E) infuse intravenous ciprofloxacin over 60 minutes The nurse should also monitor blood glucose, but this is because ciprofloxacin can increase effects of oral hypoglycemics, not decrease (patient is at risk for low blood sugar).
Which instruction(s) will the nurse include when teaching patients about gentamicin? (Select all that apply) A) patients should report any hearing loss B) patients should use sunscreen when taking gentamicin C) intravenous gentamicin will be given over 20 minutes D) patients are monitored for mouth ulcers and vaginitis E) peak levels will be drawn 30 minutes before the intravenous dose F) patients should increase fluid intake
A) patients should report any hearing loss B) patients should use sunscreen when taking gentamicin D) patients are monitored for mouth ulcers and vaginitis F) patients should increase fluid intake Gentamicin should be administered intravenously over 30 to 60 minutes. Peak levels are drawn 45 to 60 minutes after the drug has been administered.
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) patients stop taking an antibiotic after they feel better B) environmental dispersion of antibiotic liquid occurs C) antibiotics are prescribed according to culture and sensitivity reports D) antibiotics are prescribed to treat a viral infection E) antibiotics are taken with water or juice F) antibiotics are taken with ascorbic acid (vitamin C)
A) patients stop taking an antibiotic after they feel better B) environmental dispersion of antibiotic liquid occurs D) antibiotics are prescribed to treat a viral infection Not completing a full course of antibiotic therapy can allow bacteria that are not killed but have been exposed to the antibiotic 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.
The nurse is teaching a patient about trimethoprim-sulfamethoxazole. Which instructions will the nurse plan to include? (Select all that apply) A) report any bruising or bleeding B) report any diarrhea or bloody stools C) report any fever, rash, or sore throat D) avoid unprotected exposure to sunlight E) report thirst and polyuria
A) report any bruising or bleeding B) report any diarrhea or bloody stools C) report any fever, rash, or sore throat D) avoid unprotected exposure to sunlight
The nurse enters a patient's room to find that his heart rate is 120, his blood pressure is 70/50, and he has red blotching of his face and neck. Vancomycin is running intravenous piggyback. The nurse believes that this patient is experiencing a severe adverse effect called red man syndrome. What action will the nurse take? A) stop the infusion and call the health care provider B) reduce the infusion to 10 mg/min C) encourage the patient to drink more fluids, up to 2 L/day D) report the onset of Stevens-Johnson syndrome to the health care provider
A) stop the infusion and call the health care provider The patient should drink more than 2 L of fluids per day. The serious adverse effect the patient is experiencing is red man syndrome, not Stevens-Johnson syndrome.
A patient is receiving tetracycline. Which advice should the nurse include when teaching this patient about tetracycline? A) take sunscreen precautions at the beach B) take an antacid with the drug to prevent severe GI distress C) obtain frequent hearing tests for early detection of hearing loss D) obtain frequent eye checkups for early detection of retinal damage
A) take sunscreen precautions at the beach Tetracycline can cause photosensitivity so the patient should use sunscreen and wear protective clothing during sun exposure. The patient should not take an antacid with the drug because antacids decrease the absorption of tetracycline. Tetracycline is not known to cause retinal damage but it can cause ototoxicity; however it mainly affects the part of the ear that controls balance, not hearing.
Amoxicillin is prescribed for a patient who has a respiratory infection. The nurse is teaching the patient about this medication and realizes that more teaching is needed when the patient makes which statement? A) this medication should not be taken with food B) I will take my entire prescription of medication C) I should report to the physician any genital itching D) If I experience any excess bleeding, I will contact the health care provider
A) this medication should not be taken with food Patients should take penicillins with food to avoid gastric irritation.
Which assessment finding in the patient receiving gentamicin would alert the nurse to a possible adverse reaction? A) tinnitus B) diarrhea C) runny nose D) white flaky spots on the tongue
A) tinnitus The aminoglycosides, such as gentamicin, are ototoxic and the nurse must assess changes in patients' hearing, balance, and urinary output. Tinnitus may indicate ototoxicity. Diarrhea may occur but is not a sign of adverse reactions, nor is runny nose. White spots on the tongue may indicate superinfection.
Which statements will the nurse include when teaching a patient about isoniazid therapy for the treatment of tuberculosis? (Select all that apply.) A. "Take the isoniazid on an empty stomach." B. "Notify your healthcare provider if your skin starts to turn yellow." C. "Numbness or tingling in your extremities is a normal response when taking this drug." D. "You urine will turn reddish orange because of the effects of this drug." E. "Use of this drug is associated with vision problems."
A, B Numbness and tingling in the extremities is associated with the development of peripheral neuropathy and should be reported to the healthcare provider. Rifampin, not isoniazid, causes discoloration of body fluids. Ethambutol, not isoniazid, is associated with optic neuritis. The other two statements are true and can be included in patient teaching.
When teaching a patient about tuberculosis, the nurse will include which statements? (Select all that apply.) A. "Most people infected with M. tuberculosis are asymptomatic." B. "Most people infected with M. tuberculosis harbor dormant bacteria for life if they do not receive drug therapy." C. "Treatment of tuberculosis lasts 3 months." D. "Isoniazid can cause peripheral neuropathy by depleting vitamin B12." E. "Rifampin can cause optic neuritis."
A, B Treatment for tuberculosis usually lasts 6 months to 2 years. Isoniazid can cause peripheral neuropathy by depleting vitamin B6. Ethambutol, not rifampin, can cause optic neuritis. The other two statements are true and can be included in patient teaching.
A patient is taking rifampin (Rifadin) for active tuberculosis. Which assessment does the nurse identify as an adverse effect of the drug? A. Jaundice B. Blood glucose level of 60 mg/dL C. Absent deep tendon reflexes D. Moon face
A. Jaundice Rifampin is toxic to the liver, which increases the patient's risk of hepatitis. Jaundice is a sign of liver dysfunction and should be monitored. Rifampin has no effect on the blood glucose level or deep tendon reflexes, nor does it cause a moon face.
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. Patients stop taking an antibiotic after they feel better. B. Environmental dispersion of antibiotic liquid occurs. C. Antibiotics are prescribed according to culture and sensitivity reports. D. Antibiotics are prescribed to treat a viral infection. E. Antibiotics are taken with water or juice. F. Antibiotics are taken with ascorbic acid (vitamin C).
A. Patients stop taking an antibiotic after they feel better. B. Environmental dispersion of antibiotic liquid occurs. D. Antibiotics are prescribed to treat viral infection. Not completing a full course of antibiotic therapy can allow bacteria that are not killed but have been exposed to the antibiotic 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.
After completing a course of ciprofloxacin (Cipro) for a skin infection, the patient says, "I took the whole bottle of pills, but my infection hasn't gotten any better." Which additional information should the nurse recognize as most significant? A. The patient takes antacids on a daily basis. B. The medication was stored in a cool, dry area. C. The patient did not use sunscreen while taking the ciprofloxacin (Cipro). D. The patient took two doses of diphenhydramine (Benadryl) while on ciprofloxacin (Cipro) therapy.
A. The patient takes antacids on a daily basis. Antacids interfere with the absorption of quinolone antibiotics, such as ciprofloxacin (Cipro), and many other drugs; therefore, this patient has not received the full dosing regimen, which is required if ciprofloxacin is to be effective against the infection. Storing the drug in a cool, dry area and using sunscreen or diphenhydramine would not disrupt the effectiveness of ciprofloxacin.
Which nursing intervention has the highest priority for the patient who is taking cefepime? A) wait until culture results are received before initiating antibiotic B) monitor the patient for signs and symptoms of a superinfection C) administer IV over 2 hours to prevent phlebitis D) instruct the patient to take the drug for 5 days only
B) monitor the patient for signs and symptoms of a superinfection Although it is important for the nurse to wait until culture results are received before initiating antibiotic, it is more important for the nurse to monitor the patient for signs and symptoms of a superinfection because a superinfection may be detrimental to patient's health and may prolong the patient's stay in the hospital if it is not treated early. Cefepime should be administered intravenously over 30-45 minutes to prevent phlebitis and the patient should be instructed to take the drug for 10 days.
A patient is taking piperacillin-tazobactam. Which nursing interventions are most appropriate for this drug? (Select all that apply) A) give with an aminoglycoside B) send specimen to lab for C&S before antibiotic therapy is started C) instruct patient to take entire prescribed drug D) instruct patient to restrict fluid intake E) monitor for symptoms of superinfection, including stomatitis and vaginitis
B) send specimen to lab for C&S before antibiotic therapy is started C) instruct patient to take entire prescribed drug E) monitor for symptoms of superinfection, including stomatitis and vaginitis
A patient is admitted to the health care facility with methicillin-resistant Staphylococcus aureus (MRSA). The nurse anticipates administration of which drug? A) nafcillin B) vancomycin C) aztreonam D) piperacillin-tazobactam
B) vancomycin Vancomycin is the treatment of choice for MRSA.
To promote treatment adherence in a patient with tuberculosis, the nurse will include which interventions? (Select all that apply.) A. Use a single medication, to keep the treatment simple. B. Teach the patient about intermittent-dose therapy. C. Teach the patient about the need for long-term treatment. D. Use a signed consent form to enhance patient compliance. E. Directly watch the patient take the medication.
B, C, E In patients with TB, nonadherence is the most common reason for treatment failure, relapse, and increased medication resistance. Because treatment is necessary for at least 6 months, directly observed therapy (DOT) is a standard of care, as is intermittent dosing. Multiple medication regimens are needed to prevent drug resistance. Education about the length of treatment and the regimen is essential to compliance. A signed consent form does not increase patient compliance.
Which teaching by the nurse has highest priority for the patient taking azithromycin? A) instruct the patient to use sunblock and protective clothing during sun exposure B) instruct the patient to store the drug out of light and extreme heat C) inform parents that children younger than 8 years should not take the drug, to avoid tooth discoloration D) instruct the patient to report any loose stools or diarrhea
D) instruct the patient to report any loose stools or diarrhea Loose stools (especially if foul-smelling) and diarrhea are possible indications of a C. diff superinfection.
When instructing a patient about antibiotic therapy, the nurse explains that which condition occurs when the normal flora are disturbed during antibiotic therapy? A) hypersensitivity B) rebound toxicity C) organ toxicity D) superinfection
D) superinfection 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 infections.
When reviewing the medication orders for a patient who will be receiving linezolid (Zyvox) therapy, the nurse is aware that this drug may interact with which medications?
Selective serotonin-reuptake inhibitor antidepressants
A 79-year-old patient is receiving a quinolone as treatment for a complicated incision infection. The nurse will monitor for which adverse effect that is associated with these drugs?
Tendinitis and tendon rupture
