Chapter 9: Antibiotics

An older adult client, diagnosed with community-acquired pneumonia, has been prescribed aztreonam. What action should the nurse perform before administering the first dose?

Confirm the client's allergy status. As with all antibiotics, it is important to assess the client's allergy status prior to drug administration. This is especially important before the initial dose. An IV bolus is unnecessary, and discoloration of urine is not expected. MRSA testing is not relevant to aztreonam administration.

A client, hospitalized with active tuberculosis, is receiving antitubercular drug therapy. When it becomes apparent that the client is not responding to the medications, what condition will the primary health care provider identify as a possible cause?

Drug-resistant tuberculosis A client who is being treated with antitubercular drug therapy and is not responding to the medication regime is most likely experiencing drug-resistant tuberculosis. Human immunodeficiency virus causes tuberculosis to move more rapidly. This scenario does not provide any indication that the tuberculosis is related to the diminished client response. The scenario does not identify methicillin-resistant or vancomycin-resistant Staphylococcus aureus.

Which of the following drugs would be classified as an aminoglycoside?

Gentamicin Gentamicin is classified as an aminoglycoside. Levofloxacin is a fluoroquinolone; clarithromycin is a macrolide; and cefaclor is a cephalosporin.

Sulfonamides are bacteriostatic against a wide range of gram-positive and gram-negative bacteria, but they are becoming less useful for what reason?

Increasing resistance Sulfonamides are bacteriostatic against a wide range of gram-positive and gram-negative bacteria, although increasing resistance is making them less useful.

A 40-year-old is being treated for an ear infection with a cephalosporin. Which adverse reactions should the nurse monitor for in the client?

Nausea The most common adverse reactions that are caused due to cephalosporin administration include nausea, vomiting, and diarrhea. Cephalosporin does not cause hypotension, chest pain, or excessive tearing; hypotension and chest pain are some of the adverse reactions of disulfiram.

A young lifeguard has been prescribed moxifloxacin (Avelox). The nurse understands that the focus on education would be which adverse reaction?

Photosensitivity The lifeguard will be in the sun, and he is at risk for an exaggerated skin reaction. Weakness, fatigue and muscle cramping are not know adverse reactions to this medication, therefore with the client's job, photosensitivity is the highest priority.

The drug's effect on what best reflects the major reason for avoiding the use of tetracyclines in children under 8 years of age?

Teeth Tetracyclines should be used with caution in children younger than age 8 years because the drugs can potentially damage developing teeth and bones. They do not affect hearing or vision. They are excreted in the urine, so caution is necessary if the client has underlying renal dysfunction; however, this is not the main reason for avoiding use in children.

The nurse understands that tuberculosis (TB) can affect other organs of the body. The term used for TB outside the lungs called which?

extrapulmonary. The term used for TB outside the lungs is extrapulmonary. Interstitial means inside space between cells. Metastasized means that an initial tumor or growth has spread from another site such as in cancer but the cell type remains the same as the original organ upon biopsy. Encapsulated means that the cancer has not spread.

A 25-year-old woman is being treated with penicillin G as prophylaxis to prevent bacterial endocarditis prior to a dental procedure. The nurse should question the client concerning her the use of:

oral contraceptives. The nurse should document the method of birth control used by a woman of childbearing age because antibiotics, such as penicillin G, can counteract the effects of an oral contraceptive. The client should be advised to use a backup method of birth control for the duration of the therapy. Excess fats in the diet, alcohol, and nicotine should be avoided, but pose no special risk when used along with penicillin G.

A young child has been brought to the clinic with signs and symptoms that are consistent with otitis externa. What assessment question should the nurse ask to address the etiology of this health problem?

"Has your child been swimming a lot lately?" Otitis externa in children is often attributable to moisture in the ear, often because of swimming. Poor hygiene, interaction with animals, and lack of immunizations are not likely to be relevant factors.

After teaching a client who is receiving doxycycline about the drug, the nurse determines that the teaching was successful when the client makes what statement?

"I need to wear protective clothing when I'm out in the sun." Photosensitivity is possible, so the client should use sunscreen and wear protective clothing when outdoors. Fluids should be increased to promote drug excretion. Ice chips or sugarless candy would be appropriate for combating a sore mouth. The drug should be taken on empty stomach 1 hour before or 2 hours after meals; antacids should not be taken with the drug because they can affect absorption.

A client diagnosed with acute uncomplicated cystitis has been prescribed ciprofloxacin 250 mg PO BID x 7 days. When teaching the client about this medication, what guidance would the nurse include? Select all that apply.

- "Try to avoid direct sunlight while you are taking this medication." - "Antacids can interfere with the absorption of this medication." Certain minerals, including zinc, calcium, aluminum, and magnesium, can decrease the absorption of ciprofloxacin. Therefore, if the client is also taking a mineral supplement or antacid, administration of those products should be delayed for several hours following administration of the antibiotic. Clients should be encouraged to consume ample fluids (preferably at least 2 L) and to avoid sunlight.

Clients taking isoniazid (INH) can experience a variety of adverse reactions but should be monitored carefully for which of the following that indicate toxicity? Select all that apply.

-Peripheral neuropathy -Jaundice Signs of isoniazid (INH) are peripheral neuropathy and jaundice which can be a sign of severe hepatitis.

A client on cephalosporin therapy is prescribed cefazolin for a sinus infection. After administration of the first dose of the cefazolin, the client reports itching. The nursing assessment reveals a rash over the client's torso. What is the most likely cause of the itching?

A cross-sensitivity reaction. Cefazolin is contraindicated in anyone with a known allergy to cephalosporins. Caution must be used in clients with renal failure and in pregnant or lactating women. Because of the structural similarities between cephalosporins and penicillins, clients who are allergic to one type of drug may experience cross-sensitivity to the other. Cephalosporin hypersensitivity occurs in 5% to 10% of clients with penicillin allergy. Clients with a history of severe allergic reactions to penicillins should not receive cephalosporins because of their increased risk for cross-sensitivity reactions.

A client has been diagnosed with an infected postoperative wound, and cultures reveal methicillin-resistant Staphylococcus aureus (MRSA). The client is currently receiving intravenous ceftaroline because in vitro testing indicates susceptibility. When considering the effectiveness of this client's treatment, what is the nurse's best action?

Administer the medication as prescribed and monitor for expected outcomes. The nurse's responsibility in supporting prescribed medication therapy is to administer the medication as prescribed and to monitor for expected outcomes. Ceftaroline is an IV cephalosporin used for the treatment of community-acquired pneumonia and skin infections. It is the first cephalosporin to be considered active against resistant gram-positive organisms, such as MRSA, vancomycin-resistant S. aureus (VRSA), vancomycin-insensitive S. aureus (VISA), and heteroresistant VISA. Decreased renal function, not hepatic function, is a prescribing concern.

A nurse works in a community setting and follows clients who have TB. Which clients would likely require the most follow-up from rifampin therapy?

An HIV-positive client The nurse should pay special attention to the HIV-positive client because this client will require rifampin therapy for a longer period of time than the other clients. An HIV-positive person is immunocompromised, and it will take longer to fight the infection. This could increase the difficulty of adherence to the drug regimen. In addition, many of the drugs used to treat HIV are contraindicated in clients who take rifampin. Rifampin can be safely administered to nursing mothers, those with cancer, and people over 65 given certain conditions. However, their therapy should not be longer than normally required unless complications occur.

A nurse is required to administer an anti-infective drug to a patient. The nurse knows that which of the following tests need to be conducted before administering the first dose of an anti-infective drug to the patient?

Culture tests The nurse should check whether culture tests are conducted before the first dose of drug is administered to the client. Ulcer tests and stool tests are not required to be conducted before administering the first dose of an anti-infective drug to the client. The nurse has to ensure that urinalysis is conducted before the administration of the drug but not specifically before the first dose of the anti-infective drug.

A client has been prescribed ciprofloxacin IV for the treatment of cellulitis. After initiating the infusion of the client's first scheduled dose, the client develops a pronounced rash on the chest and arms. How should the nurse respond initially to this event?

Discontinue the infusion and inform the health care provider promptly. Severe hypersensitivity reactions have occurred with the administration of fluoroquinolones. The nurse discontinues the antibiotic immediately if skin rash or other signs or symptoms occur. Administration of acetylcysteine or diphenhydramine is not indicated. Slowing down the rate of infusion would not address the problem as it relates to exposure to the medication. Neither the administration of acetylcysteine nor diphenhydramine is indicated initially. Acetylcysteine is prescribed to treat thick mucus lung secretions. Treatment with diphenhydramine would be ineffective if the ciprofloxacin were not first discontinued.

What organ system is responsible for the excretion of cefotaxime sodium from the body?

Renal Cefotaxime sodium, like all cephalosporins, is excreted by the kidneys. Cefotaxime is not excreted by the lungs, liver, or GI tract.

The nurse is preparing to administer amikacin to a client with a complicated Staphylococcus aureus infection. What assessment should the nurse prioritize?

Renal function Amikacin is an aminoglycoside that may cause renal toxicity. Assessing renal function would be a priority. Although the drug can affect the GI tract leading to nausea, vomiting, diarrhea, and weight loss, which could lead to problems with nutrition and cause numbness, tingling and weakness, assessment of GI function, nutritional status, and muscle strength would be considered lower-priority assessments.

A client is being treated for urosepsis with ceftriaxone IV. What assessment finding should prompt the nurse to contact the care provider immediately?

The client has a new onset of jaundice and edema Jaundice and edema suggest liver dysfunction, which the nurse should promptly report. Each of the other changes in status warrant the nurse's thoughtful attention and relevant interventions but none requires immediate input from the client's care provider.

A client with a complex medical history is showing signs and symptoms of sepsis. What aspect of this client's health history would rule out the safe and effective use of an aminoglycoside antibiotic?

The client has chronic renal failure Renal failure would preclude the use of an aminoglycoside. Nonadherence must always be addressed, but this client variable is not specific to aminoglycosides. Neither latex allergies nor type 2 diabetes would necessarily rule out the use of an aminoglycoside.

The client has been taking her antibiotic for five days. She tells the nurse that she is now experiencing vaginal itching and discharge. The nurse suspects what has occurred?

The client has developed a superinfection. The client is experiencing a vaginal yeast superinfection related to the use of antibiotics. Adverse reactions include nausea, diarrhea, abdominal pain, headache and photosensitivity. This is not indicative of an STI in this scenario.

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

They disrupt the normal flora of the body. Pseudomembranous colitis is a superinfection that occurs when the antibiotic disrupts the normal flora, causing a secondary infection or superinfection.

The nurse is caring for a 23-year-old female client who uses oral contraceptives and has been prescribed ampicillin for treatment of a respiratory infection. What information is most important for the nurse to share with this client?

Use a type of barrier birth control while you are taking this antibiotic. Clients taking oral contraceptives should be encouraged to use a barrier type of birth control during penicillin therapy; the penicillin will cause a decreased effectiveness of the contraceptive agent. The client should not be told to stop taking the oral contraceptive. This will not cause a heavier menses. The interaction between oral contraceptives and ampicillin will not cause an increased chance of bleeding, as that interaction is between large doses of penicillins and anticoagulants.