Chapter 9: Antibiotics Notes
The ability of bacteria to produce substances that inactivate or destroy the antibiotic is known as which of the following?
Bacterial resistance
The nurse is teaching the patient about amoxicillin prior to discharge and includes what important teaching point?
Blackening of the tongue may occur but will subside when the drug is discontinued.
A 12-year-old patient with a complicated skin infection has been admitted to the pediatric unit. The physician has ordered Ertapenem (Invanz). What is the nursing priority?
Question the order by calling the physician who prescribed it.
How would the nurse describe selective toxicity?
Selective toxicity is the ability of the drug to kill foreign cells without causing harm to one's own body cells.
The nurse understands that which is the highest priority when teaching about antitubercular medications?
Taking medications as prescribed
A client has been on an antibiotic for two weeks for treatment of an infection. The client asks the nurse why a superinfection has been caused by this medication. What is the nurse's best response?
"Antibiotics can disrupt the normal bacteria in your body, causing another infection to occur."
A client diagnosed with tuberculosis (TB) has begun multidrug therapy. The client has asked the nurse why it is necessary to take several different drugs. How should the nurse respond to the client's question?
"The use of multiple drugs prevents the development of drug-resistant TB."
A clinic nurse is caring for a 66-pound child who has acute otitis media. The physician has ordered ceftibuten (Cedax) 9 mg/kg per day PO for 10 days. The drug comes in an oral suspension of 90 mg/5 mL. How many mL will the nurse administer?
15 mL
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
A nursing student asks the pharmacology instructor for ways to minimize the emergence of drugresistant microbial agents. What would be an appropriate response by the instructor? (Select all that apply.)
A) Avoid the use of broad-spectrum antibacterial drugs when treating trivial or viral infections. B) Use narrow-spectrum agents if they are thought to be effective. C) Do not use vancomycin unnecessarily.
When the nurse cares for a patient receiving an antibiotic, what instructions will the nurse provide no matter what medication is prescribed? (Select all that apply.)
A) Drink plenty of fluids to avoid kidney damage. B) Take all medications as prescribed until all of the medication is gone. C) Report difficulty breathing, severe headache, or changes in urine output.
The pharmacology instructor is discussing antimicrobials with the nursing class. What would the instructor tell the students about the mechanism of action of antimicrobials? (Select all that apply).
A) Preventing cell division B) Causing cell death C) Inhibiting cell wall synthesis
The nurse provides discharge teaching for a patient who will receive a prescription for cefaclor (Ceclor). What important information will the nurse provide this patient?
Avoid alcohol until 72 hours after stopping this medication.
What severe reaction would the nurse assess for if it were necessary to administer trimethoprim/sulfamethoxazole (TMP/SMX) to an older adult?
Bone marrow depression
The nurse is caring for a patient with a gram-positive infection. What antibiotic would be most effective in treating this infection?
Cefaclor (Ceclor)
After teaching a group of students about carbapenems, the instructor determines the need for additional teaching when the students identify what as an example?
Cefuroxime
A local bioterrorism medical team is learning about germ warfare. The team is instructed that a fluoroquinolone may be used to prevent an outbreak of anthrax infection. What fluoroquinolone would the nurse be most likely to administer for this purpose?
Ciprofloxacin (Cipro)
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 best tresponse?
Continue to monitor vital signs.
A 32-year-old female patient is admitted to the floor with a superinfection. Her orders read tigecycline (Tygacil) 100 mg IV followed by 50 mg IV every 12 hours infused over 30 to 60 minutes for 5 days. What would be important for the nurse to educate this patient about?
Contraceptives
The nurse is preparing to contact the physician for an antibiotic order for the patient's infection. What information will the nurse be prepared to provide for the physician to choose the proper antibiotic?
Culture and sensitivity test result
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
A client who takes zinc daily is diagnosed with a severe infection and is ordered levofloxacin (Levaquin). The nurse is aware that taking these two drugs may have what affect on the antibiotic?
Decreased absorption
A 28-year-old patient has been prescribed penicillin for the first time. What nursing diagnosis would be most appropriate for this patient?
Deficient knowledge regarding drug therapy
The nurse is caring for a patient receiving an antimycobacterial who reports dizziness, headache, and drowsiness. What is the priority nursing diagnosis?
Disturbed sensory perception (kinesthetic) related to central nervous system (CNS) effects of the drug
The nurse is providing patient teaching before discharging a patient home. The patient is taking ciprofloxacin (Cipro). What would the nurse teach this patient is the best way to prevent crystalluria caused by ciprofloxacin (Cipro)?
Encourage at least 2 liters of fluid per day.
A client is administered a third-generation cephalosporin. The broad-spectrum agents like cephalosporins are most effective in treating which type of microorganism?
Gram negative
The nurse is admitting a 12-year-old girl to the acute care facility and notices discolored secondary teeth. The mother says she doesn't know why the teeth are discolored because the child is very good about brushing and flossing and sees the dentist regularly. What question would the nurse ask?
Has she ever received tetracycline?
The nurse is caring for a 62-year-old patient who is receiving IV gentamicin (Garamycin). The patient complains of difficulty hearing. What should the nurse do?
Hold the dose and notify the physician immediately
A nurse is caring for a patient who is being administered penicillin. What are the common adverse reactions to penicillin a nurse should assess for?
Inflammation of the tongue and mouth
The pharmacology instructor is discussing antimicrobials with the nursing class. What would the instructor tell the students is the mechanism of action of some antimicrobials?
Inhibiting cell wall synthesis
The nurse is caring for a female patient whose tests confirm she is 10 weeks pregnant and has contracted tuberculosis. The health care provider orders a combination of antimycobacterials. What combination of drugs would the nurse identify as safest for this pregnant patient?
Isoniazid, ethambutol, and rifampin
The mother of a 5-year-old asks the nurse why it seems amoxicillin is always prescribed when her child needs an antibiotic. What is the priority rationale the nurse should give the mother?
It is better absorbed.
A 78-year-old woman, who lives alone and is forgetful, is being seen by her home health nurse. In reviewing the patient's medication, the nurse discovers that the patient is taking Azithromycin (Zithromax) for urethritis. Why would this be a good choice of antibiotics for this patient?
It is taken only once a day.
When discussing cephalosporins with the nursing class, the pharmacology instructor explains that this classification of drug is primarily excreted through which organ?
Kidney
What is a contraindication to use of a fluoroquinolone?
Lactation
What medication would the nurse question if ordered for a pediatric patient?
Levofloxacin
In which condition present in the client should macrolides be used with caution?
Liver dysfunction
A male client is placed on an IV regimen of aztreonam. The nurse would expect the health care provider to order which laboratory test?
Liver function
A client is receiving rifampin and isoniazid in combination for treatment of tuberculosis. What would the nurse need to monitor closely?
Liver function studies
An intensive care unit nurse is caring for a patient taking kanamycin. What is the nurse's priority action?
Monitoring renal function daily
Which of the following should a nurse carefully monitor in a patient who has been administered cephalosporin as well as aminoglycosides for a wound infection?
Nephrotoxicity
Michael, 25 years old, has had mitral valve regurgitation since age four, after having rheumatic fever. Michael is planning to go to his dentist to have his teeth cleaned. Because of Michael's history he will need to take antibiotics in conjunction with this procedure to prevent bacteremia. Which class of antibiotics will Michael most likely receive if he has no allergies?
Penicillin
Your client has been diagnosed with streptococcal pharyngitis. Which of the following would you anticipate being ordered?
Penicillin G
The health care provider suspects a client may be infected with an antibiotic-resistant pathogen. The nurse caring for this client knows that what course of action is best used to determine whether this type of pathogen is present?
Perform culture and susceptibility tests.
What drug administered by the nurse belongs to the group of Carbapenems?
Primaxin
What drug belongs to the group of carbapenems?
Primaxin
The nurse is caring for a child weighing 30 kg. The physician orders gentamicin (Garamycin) 100 mg tid for the patient. The recommended dosage range is 6 to 7.5 mg/kg/day. What action should the nurse take?
Question the physician about the dosage of the medication.
After administering an antibiotic, the nurse assesses the patient for what common, potentially serious, adverse effect?
Rash
The nurse is caring for a client who is receiving IV vancomycin. The nurse infuses the medication at the prescribed rate to prevent what from occurring?
Red man syndrome
The nurse is aware that sulfonamide therapy is used cautiously in older adults because of decreased function of what organ system?
Renal
A patient with a gram-negative infection is being treated with an aminoglycoside. What system should the nurse expect to monitor closely while the patient is taking this medication?
Renal system
The nurse is caring for a patient who is receiving an aminoglycoside. What would be a priority assessment on this patient?
Respiratory function
The clinic nurse is providing health teaching to a patient who has been prescribed doxycycline (Doxycin). What is a priority teaching point for this patient?
Stay out of the sun.
The nurse is providing discharge teaching to a patient who is being sent home on oral tetracycline (Sumycin). What instructions should the nurse include?
Take the drug on an empty stomach.
The patient is admitted to the acute care facility with acute septicemia and has orders to receive gentamicin and ampicillin IV. The nurse is performing an admission assessment that includes a complete nursing history. What information provided by the patient would indicate the need to consult the health care provider before administering the ordered medication?
Takes furosemide (Lasix), a potent diuretic, daily
Which of the following is true of cephalosporins given via injection? (Select all that apply.)
Tenderness can occur when cephalosporins are given IM. Thrombophlebitis can occur when cephalosporins are given IV. Inflammation can occur when cephalosporins are given IM. Pain can occur when cephalosporins are given IM.
What is the priority reason for the nurse to consider questioning an order for tetracycline in a child younger than 8 years of age?
Tetracyclines can damage developing teeth and bone in children younger than 8 years of age.
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
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.
Chest radiography and sputum sample microscopy have confirmed a diagnosis of TB in a 40-year-old man who has a history of type 1 diabetes and who currently has a diabetic foot ulcer. How should the nurse account for this patient's health status when planning care during INH treatment?
The patient will require vigilant monitoring of blood glucose levels.
A client is taking penicillin for an upper respiratory infection. The client calls the office after 2 days of therapy reporting nausea and abdominal pain. Which would be the best instruction for the nurse to give the client?
These are normal side effects, but if they increase in severity or frequency, you need to contact the office again.
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.
Fluoroquinolones, such as norfloxacin (Noroxin), are commonly prescribed antibiotics given to treat which of the following?
Urinary tract infections
A student asks the pharmacology instructor if there is a way to increase the benefits and decrease the risks of antibiotic therapy. What would be an appropriate response by the instructor?
Use antibiotics cautiously and teach patients to complete the full course of an antibiotic prescription
A 22-year-old female is diagnosed with mycobacterial tuberculosis. The physician orders rifampin (Rifadin) 600 mg PO daily. What should the nurse question the patient about?
Use of contact lenses
The nurse is preparing a teaching plan for a client who is receiving cephalosporins. Which of the following would the nurse identify as the most commonly occurring adverse effects?
Vomiting and diarrhea
The health care provider is selecting an antibiotic for a client with a known penicillin allergy. The provider knows that cephalosporins are a poor choice for this client because cephalosporins:
can cause allergic reactions in clients who are allergic to penicillins.
A client prescribed rifaximin for diarrhea has developed frank bleeding in the stool. What intervention should the nurse anticipate being implemented to best ensure client safety?
changing to a different antibiotic
A youngster has just returned home from the family's tropical vacation and is now reporting worsening tenderness in the right ear. When the child is diagnosed with otitis externa, what causative factor of this infection should the nurse focus upon?
frequent swimming and water sports while the child was on vacation
Penicillins are most effective when used to treat what type of microorganisms?
gram-positive bacteria
A nursing instructor is preparing a teaching plan for a nursing pharmacology class on the action of fluoroquinolones. Which action would the instructor most likely include?
interfering with DNA synthesis in the bacterial cell
A client is receiving levofloxacin (Levaquin) IV. During an infusion, the client reports pain and the nurse notes a reddened area along the vein. What does the nurse suspect?
phlebitis
A client has been treated several times for a recurring ear infection with ofloxacin. The nurse instructs the client to look for side effects from the prolonged use of the antibiotic and informs the client that this is known as:
superinfection.