Chapter 35- Anti Infective and TB
A client asks the nurse why the healthcare provider did not prescribe the usual antibiotic for the same infection. Which is the best response by the nurse? a. "It does not matter which antibiotic is taken." b. "If you are not better in 10 days, return to the office." c. "You do not want to take the same antibiotic all the time." d. "Bacteria can become resistant to some antibiotics."
D (Answer: d. "Bacteria can become resistant to some antibiotics." Objective: Using a specific example, explain how resistance can develop to an anti-infective drug. Rationale: Antibiotics help promote the development of drug-resistant bacterial strains by killing populations of bacteria that are sensitive to the drug. The remaining bacteria possess mutations that make them insensitive to the effects of the same antibiotic. Using a different antibiotic can decrease possibility of drug resistance by these pathogens.)
A client has been prescribed oral tetracycline for treatment of severe acne. Which assessment finding is most important for the nurse to communicate with the healthcare provider? a. The client's nutritional status b. The pathogen causing the acne c. The client's pregnancy status d. The presence of open lesions
(Answer: c. The client's pregnancy status Objective: For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanism of action, primary actions, and important adverse effects. Rationale: Tetracyclines, when taken by the mother, can cause teeth discoloration in the developing fetus. As such, the medication should not be used during the second half of pregnancy. The benefits of antibiotic use in pregnant women must be carefully weighed against the potential risks to the fetus.)
A client who has been on antibiotic therapy for peptic ulcer caused by Helicobacter pylori is diagnosed with a superinfection. What is the most appropriate response by the nurse when the client asks why the superinfection occurred? a. "The normal host flora has been destroyed by the antibiotic." b. "The infectious agent has developed resistance to the drug." c. "The infection caused by H. pylori has become severe." d. "The H. pylori restricted the growth of microorganisms."
A (Answer: a. "The normal host flora has been destroyed by the antibiotic." Objective: Explain how host factors can affect the success of anti-infective chemotherapy. Rationale: One common adverse effect of anti-infective therapy is the appearance of secondary infections, known as superinfections, which occur when microorganisms normally present in the body are destroyed. Removal of host flora by an antibiotic gives the remaining microorganisms an opportunity to grow, allowing for overgrowth of pathogenic microbes. Host flora themselves can cause disease if allowed to proliferate without control or if they establish colonies in abnormal locations.)
A nurse is administering oral sulfamethoxazole-trimethoprim (Bactrim) to a client for treatment of urinary tract infection. Which nursing actions are appropriate? (Select all that apply.) a. Ensure the client drinks a full glass of water with each dose. b. Monitor the client's intake of calcium-fortified drinks. c. Administer the medication around the client's meal times. d. Have the client take potassium supplements with this drug. e. Give the client a glass of milk to drink in case of GI upset.
A (Answer: a. Ensure the client drinks a full glass of water with each dose; c. Administer the medication during the client's meal times; e. Give the client a glass of milk to drink in case of GI upset. Objective: For each of the drug classes listed in Drugs at a Glance, list representative drug examples, and explain their mechanisms of action, primary actions, and important adverse effects. Rationale: Oral dosages of sulfamethoxazole-trimethoprim should be administered with a full glass of water to prevent formation of crystals in the urine, which can be a serious adverse effect. The medication can be given with food or milk to prevent GI symptoms. Potassium supplements should not be taken during therapy, unless directed by the healthcare provider. Trimethoprim decreases potassium excretion and should be used with caution in patients with hyperkalemia or those taking potassium-sparing diuretics. Dairy products or calcium-fortified drinks do not interfere with the absorption of the drug.)
A nurse is caring for a client receiving vancomycin intravenous infusion for treatment of a wound infected with MRSA. Which finding should the nurse report immediately to the healthcare provider? a. Hypotension and red rash on the chest area b. Joint and muscle pain with general malaise c. Chest discomfort and decreased heart rate d. Heel pain along with difficulty walking
A (Answer: a. Hypotension and red rash on the chest area Objective: Use the nursing process to care for clients who are receiving drug therapy for bacterial infections. Rationale: A reaction that can occur with rapid intravenous administration of vancomycin is red man syndrome, which results as large amounts of histamine are released in the body. The vasodilation causes the symptoms, which include hypotension, reflex tachycardia, and flushing and a red rash, most often of the face, neck, trunk, or upper body. Other significant side effects of vancomycin include superinfections, generalized tingling after IV administration, chills, fever, skin rash, hives, hearing loss, and nausea. Heel pain with difficulty walking can indicate tendonitis or tendon rupture, which is associated with fluoroquinolones.)
A nurse is preparing to administer a broad-spectrum antibiotic to a client with a severe respiratory infection. Which is an important nursing action to take prior to administering the medication? a. Reviewing the results of the culture and sensitivity test b. Obtaining a specimen for culture and sensitivity testing c. Performing a peak and trough level of the antibiotic d. Determining the course antibiotic therapy based on half-life
B (Answer: b. Obtaining a specimen for culture and sensitivity testing Objective: Use the nursing process to care for patients who are receiving pharmacotherapy for bacterial infections. Rationale: Because antibiotic therapy alters the composition of infected fluids, samples for culture and sensitivity (C & S) testing should be collected prior to starting pharmacotherapy. However, laboratory testing and identification may take several days. With severe infections, therapy is often begun with a broad-spectrum antibiotic. After laboratory testing is completed, the drug may be changed to a narrow-spectrum antibiotic. Drug levels (peak and trough) will be monitored for drugs with known severe adverse effects. The course of the antibiotic therapy is determined by the licensed healthcare provider, not by the nurse.)
For which client conditions should the nurse anticipate administering antibiotic therapy for chemoprophylactic purposes? (Select all that apply.) a. Neurologic abnormality b. Prosthetic heart valve c. Dental surgical procedure d. Chronic respiratory infection e. Kidney transplantation
B (Answer: b. Prosthetic heart valve; c. Dental surgical procedure; e. Kidney transplantation Objective: Use the nursing process to care for patients who are receiving pharmacotherapy for bacterial infections. Rationale: Patients who might receive prophylactic antibiotics include those who have a suppressed immune system, those who have experienced deep puncture wounds such as from dog bites, and those who have prosthetic heart valves and are about to have a medical or dental procedure.)
A client is being prescribed penicillin for an upper respiratory infection. What information should the nurse emphasize in providing instructions to the client? a. The antibiotic therapy can be taken while breast-feeding. b. The entire prescription must be completed as instructed. c. The medication can be taken without regard to eating. d. The most common side effect is urinary discoloration.
B (Answer: b. The entire prescription must be completed as instructed. Objective: Use the nursing process to care for patients who are receiving pharmacotherapy for bacterial infections. Rationale: The nurse should advise patients to take prescribed anti-infective drugs for the full length of therapy. Stopping antibiotic therapy prematurely allows some pathogens to survive, thus promoting the development of resistant strains. Penicillin has few serious adverse effects, with diarrhea, nausea, and vomiting being the most common adverse effects.)
A client has been prescribed ciprofloxacin (Cipro) 500 mg twice daily by mouth. Which information should the nurse include during client teaching about administration of this medication? a. The dose must be taken on an empty stomach to increase absorption. b. The client can have an unlimited amount of caffeinated drinks. c. The drug can be taken with an antacid to decrease GI symptoms. d. The dose should not be taken with supplements containing iron.
D (Answer: d. The dose should not be taken with supplements containing iron. Objective: For each of the drug classes listed in Drugs at a Glance, list representative drug examples, and explain their mechanisms of action, primary actions, and important adverse effects. Rationale: Fluoroquinolones, such as ciprofloxacin, should not be taken concurrently with multivitamins or mineral supplements, because calcium, magnesium, iron, or zinc ions can reduce the absorption of some fluoroquinolones by as much as 90 percent. Antacids can also decrease the absorption of ciprofloxacin. Ciprofloxacin may be administered with food to diminish adverse GI effects. Caffeine consumption should be restricted to prevent excessive nervousness, anxiety, or tachycardia.)
A nurse is caring for a client receiving gentamicin for treatment of a Pseudomonas infection. Which assessment finding should the nurse report to the healthcare provider immediately? a. Dysrhythmia b. Constipation c. Diuresis d. Tinnitus
D (Answer: d. Tinnitus Objective: For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanism of action, primary actions, and important adverse effects. Rationale: Aminoglycosides, such as gentamicin, are noted for their neurotoxic effect. Neurotoxicity may manifest as ototoxicity and produce a loss of hearing or balance, which may become permanent with continued use of the medication. Dysrhythmias, constipation, and diuresis are not adverse effects of aminoglycosides.)