EAQs Ch. 26-28 Adaptive Quiz

Which penicillinase-resistant drug may be included in the prescription for a patient diagnosed with a respiratory infection caused by staphylococci? A. Amoxicillin B. Ampicillin C. Penicillin G D. Dicloxacillin

D. Dicloxacillin Penicillinase-resistant penicillins are antibiotics that are able to resist breakdown by the penicillin-destroying enzyme, penicillinase. This enzyme is commonly produced by bacteria such as staphylococci. Dicloxacillin is a penicillinase-resistant drug. Thus it may be prescribed for a patient. Amoxicillin and ampicillin are aminopenicillin drugs. Penicillin G is an example of a natural penicillin. p.316

Which information would the nurse include when teaching a patient about the administration of an antacid and ciprofloxacin? A. "Take both drugs simultaneously." B. "Take the antacid every alternate day." C. "Take the drug on an empty stomach." D. "Take ciprofloxacin 2 hours before or after the antacid."

D. "Take ciprofloxacin 2 hours before or after the antacid." The nurse would instruct the patient to take ciprofloxacin 2 hours before or after the antacid for the best absorption. The antacids should not be taken on alternate days because this may not help prevent gastrointestinal problems. Ciprofloxacin interacts with antacids, and this decreases the absorption of the ciprofloxacin. Ciprofloxacin causes gastric irritation when administered on an empty stomach. p. 337

Which term is used to describe when an antibacterial drug is no longer effective due to repeated use? A. Potentiative effect B. Antagonistic effect C. Inherent resistance D. Acquired resistance

D. Acquired resistance Acquired resistance occurs with repeated use of antibiotics. The bacteria mutate and become resistant to the drug. The potentiative effect occurs when one antibiotic increases the effectiveness of a second antibiotic. The antagonistic effect is when two antibiotics are used and the second antibiotic reduces the effectiveness of the first. Inherent resistance occurs without exposure to any antibiotic. An example is Pseudomonas aeruginosa, which will always naturally be resistant to penicillin G. p.314

Which organ can be damaged by antibacterial drugs? A. Eyes B. Liver C. Brain D. Spleen E. Kidneys

B. Liver E. Kidneys Organs that can develop toxicities from antibacterial medications include the liver and kidneys. The eyes, brain, and spleen are not damaged by antibiotics. p. 315

Which issue related to antibiotic use is an increased risk for the older adult

Toxicity The older adult is at increased risk for toxicity related to antibiotic use because of reduced metabolism and excretion of medications. Allergy, resistance, and superinfection are a risk for all antibiotic recipients but not an increased risk in the older adult population.

Within which time frame would the nurse draw the trough level for a patient on intravenous gentamicin? A. 10 min before administration of gentamicin B. 30 minutes after beginning administration of gentamicin C. 60 minutes after completion of the gentamicin infusion D. 90 minutes after gentamicin is scheduled to be administered

A. 10 min before administration of gentamicin Trough levels are drawn just before infusion of gentamicin. Peak serum drug levels should be drawn 30-60 minutes after the medication is infused. The nurse should document when the drug administration is started and completed and the exact time a peak and/or trough level is drawn. Thirty, 60, and 90 minutes are not appropriate times to draw trough levels. p. 335

Which action will the nurse take if a patient who has been prescribed erythromycin for a respiratory infection has a penicillin allergy? A. Administer the medication as prescribed. B. Report the penicillin allergy to the provider. C. Ask the provider if a test dose for allergies is appropriate. D. Discuss the decision with the pharmacist for further review.

A. Administer the medication as prescribed. Macrolides can be used when a patient has an allergy to penicillin. Erythromycin is the drug most often used for patients who are hypersensitive to penicillin. Reporting the penicillin allergy is not required, since macrolides can be used for patients with allergies to penicillin. A test dose is not required for erythromycin. Discussion with the pharmacist is not needed at this time; the medication can be safely administered as prescribed. pp. 326, 324

Which drug is used to treat Helicobacter pylori? SATA A. Bismuth subsalicylate B. Metronidazole C. Eravacycline D. Cefadroxil E. Tetracycline

A. Bismuth subsalicylate B. Metronidazole E. Tetracycline H. pylori is a bacterium in the stomach that can cause ulcers. Tetracycline in combination with bismuth subsalicylate and metronidazole can be used to treat H. pylori. Eravacycline and cefadroxil are not used to treat H. pylori. p. 330

Which medication, when taken with vancomycin, is likely to increase the risk of renal toxicity? A. Cisplatin B. Calcium antacid C. Cholestyramine D. Dimenhydrinate

A. Cisplatin The risk of nephrotoxicity is most likely potentiated when vancomycin is taken with cisplatin. Cisplatin is a chemotherapy drug that contributes to renal toxicity. Antacids may impair the absorption of some medications. The absorption of oral vancomycin can be decreased when it is given with cholestyramine. Dimenhydrinate can mask ototoxicity when taken with vancomycin. p.328

Which action would the nurse take if a patient has been prescribed telithromycin and simvastatin? A. Hold the medications and call the health care provider. B. Administer the medications as prescribed. C. Separate the medications by 6 hours. D. Have the patient take the medications with food or milk.

A. Hold the medications and call the health care provider. Telithromycin should not be taken with simvastatin due to the risk for an increase in simvastatin levels, which could cause toxicity. Thus the nurse would hold the medications and contact the health care provider. Separating the medications by 6 hours or taking the medications with milk or food would not lessen the drug interaction risk. The nurse would not administer these medications together. p. 328

Which antimicrobial drug(s) would the nurse anticipate the health care provider (HCP) prescribing to a patient with a urinary tract infection? Select all that apply. One, some, or all responses may be correct. A. Ofloxacin B. Delafloxacin C. Levofloxacin D. Minocycline E. Neomycin

A. Ofloxacin C. Levofloxacin Ofloxacin is a synthetic fluoroquinolone drug used to treat respiratory tract infections and urinary tract infections. Though levofloxacin is primarily used to treat respiratory problems, it also treats urinary tract infections. Thus the nurse would anticipate the HCP prescribing ofloxacin or levofloxacin. Delafloxacin is a fluroquinolone, but it is not is not used for urinary tract infections; it is used to treat respiratory and skin infections. Minocycline is a long-acting tetracycline used in treatment of acne and bacterial infections. Neomycin is an aminoglycoside used to treat skin infections and diarrhea. p.335

Which instruction would the nurse include when teaching a patient about the administration of demeclocycline for the treatment of a respiratory infection? A. "Avoid eating high-protein foods." B. " Avoid the consumption of dairy products." C. "Avoid eating low-carbohydrate foods." D. "Avoid eating high-calorie foods."

B. " Avoid the consumption of dairy products." A food-drug interaction occurs between demeclocycline and dairy products that results in decreased gastrointestinal absorption of demeclocycline. If the gastrointestinal absorption of demeclocycline is decreased, it may not have therapeutic effects. Therefore the nurse would instruct the patient to avoid consumption of dairy products. Because demeclocycline does not cause any interaction with high-protein foods, low-carbohydrate foods, or high-calorie foods, the patient can consume such foods. p. 331

A patient was prescribed fidaxomicin 400 orally every 12 hours for 14 days. If the patient returns to an urgent care clinic concerned about symptoms, which patient statement would be most concerning to the nurse? A. "I feel nauseated." B. "My skin looks yellowish." C. "I have a headache." D. "I am constipated."

B. "My skin looks yellowish." Liver damage can occur from prolonged use and high dosages of fidaxomicin. The medication is typically prescribed for 10 days. Signs of liver dysfunction include elevated liver enzyme levels and jaundice (yellow skin tone). Nausea, headache, and constipation are common side effects of the medication. The signs of jaundice would be more concerning. pp. 325, 327

Which response would the nurse offer if a patient who has been prescribed azithromycin asks the nurse why the medication does not have to be taken as the erythromycin previously taken? A. "I'll call the pharmacy and ask about the chemical makeup of the drug." B. "This drug has a longer duration of action than erythromycin." C. "You'll need to ask your health care provider questions like that." D. "This is much more effective drug than what you received previously."

B. "This drug has a longer duration of action than erythromycin." Azithromycin is a macrolide antibiotic. It has a longer duration of action as well as fewer and less severe gastrointestinal side effects than erythromycin. Thus the nurse would inform the patient that the drug has a longer duration of action than erythromycin. The nurse would be knowledgeable regarding the chemical makeup of the medication and would not defer the question to the health care provider. Azithromycin is an antibiotic that has a longer duration of action than erythromycin. p.326

Which instruction would the nurse include in the discharge teaching for a patient receiving tetracycline? A. "Take the medication until you feel better." B. "Use sunscreen and protective clothing when outdoors." C. "Keep the remainder of the medication in case of recurrence." D. "Take the medication with food or milk to minimize gastrointestinal upset."

B. "Use sunscreen and protective clothing when outdoors." Photosensitivity is a common side effect of tetracycline. Exposure to the sun can cause severe burns; therefore the nurse would instruct the patient to use sunscreen and wear protective clothing when outdoors. The medication should not be taken with milk and should be completely Þnished, not taken only up until the patient feels better and retained in case of recurrence pp. 332-333

Which timing reflects when the first does of tetracycline is given to a patient? A. At admission B. After the culture is obtained C. At the initial signs of infection D. Within the first 4 hours of admission

B. After the culture is obtained If a culture has been ordered, it should always be collected before starting the Þrst dose of an antibiotic, including tetracycline. The Þrst dose would not necessarily be given at admission, at the initial signs of infection, or within the Þrst 4 hours of admission p.332

Which intervention is the most important when caring for a 22- year-old woman who has been prescribed amoxicillin? A. Obtain a baseline complete blood count (CBC) B. Assess if the patient is on oral contraceptives. C. Inform the patient about possible superinfections. D. Instruct the patient not to take the medication before meals

B. Assess if the patient is on oral contraceptives. This medication may decrease the effectiveness of oral contraceptives. Thus the most important intervention is assessing whether the patient is on oral contraceptives and whether the patient is sexually active. Long-term use of antibiotics can cause blood dyscrasias, but a baseline assessment is not indicated. Obtaining a baseline CBC, informing the patient about possible superinfections, and instructing the patient not to take the medication before meals are not priorities. p.318

A patient received clarithromycin for 14 days. Which outcome likely indicates a superinfection? A. Vomiting B. Bloody stools C. Elevated liver enzymes D. Rash

B. Bloody stools Clostridium difficile- associated diarrhea is a potential superinfection that can occur in patients taking antibiotics. Bloody stools can indicate a superinfection. The release of bacterial toxins causes bleeding in the colon lining, which results in bloody stools. Nausea and vomiting occur from gastric irritation from the medication but are not specific to a superinfection. Elevated liver enzymes are associated with toxic levels of the medication rather than with superinfection. A rash is more likely to occur with an allergic sensitivity to the medication, not a superinfection. p.326

Which medication would the nurse anticipate administering to a patient who develops wheezing, difficulty breathing, swelling of the throat, and dizziness during an initial dose of ampicillin? A. Ranitidine B. Epinephrine C. Tetracycline D. Azithromycin

B. Epinephrine Ampicillin is a penicillin antibiotic. The assessment findings make it evident that the patient has a penicillin anaphylactic reaction. Difficulty breathing, wheezing, swelling of the throat or tongue, and the dizziness are the symptoms of a penicillin anaphylactic reaction. Thus the nurse would anticipate immediately administering epinephrine to the patient. Ranitidine is an antacid; it helps relieve acidity but is not helpful in treating anaphylactic reactions. Tetracycline and azithromycin are antibiotics, which are helpful in the treatment of bacterial infections but ineffective in the treatment of penicillin anaphylactic reaction. p.318

Which medication(s) is (are) better absorbed from the gastrointestinal tract when taken with food? SATA A. Tigecycline B. Minocycline C. Tetracycline D. Doxycycline E. Demeclocycline

B. Minocycline, D. Doxycycline Because minocycline and doxycycline are lipid-soluble tetracyclines, they are better absorbed from the gastrointestinal tract when taken with food. Tigecycline, tetracycline, and demeclocycline have decreased absorption if administered with food. Therefore they should be administered 1 hour before food or 2 hours after food. p. 330

Which information is accurate when switching a patient from lincomycin to clindamycin? A. Has a risk for higher toxic effects B. Provides effective treatment when given orally C. Provides continued treatment at a lower serum level D. Targets gram-negative bacteria

B. Provides effective treatment when given orally Clindamycin is absorbed better through the gastrointestinal tract than lincomycin. Clindamycin has fewer toxic effects than lincomycin. Clindamycin will maintain a higher serum drug concentration than lincomycin. Clindamycin is not effective against gram-negative bacteria. p. 327

Which laboratory value would the nurse assess to ensure safe administration of vancomycin to a patient? A. Vitamin B12 B. Renal function C. Red blood cell count D. Blood glucose concentration

B. Renal function Vancomycin is a tricyclic glycopeptide, which causes nephrotoxicity. Therefore the nurse would check the patient's renal function before administering vancomycin. Renal impairment may lead to severe toxicity. The dosing frequency of vancomycin is dependent on renal function. Therefore it is important to check the patient's renal function. Vancomycin does not affect vitamin B12, blood glucose concentration, or red blood cell counts; therefore the nurse need not check these in the patient. p.328

The nurse is assessing a patient who has received a vancomycin infusion intravenously over 15 minutes. Which complication is most likely to occur in this patient? A. Diarrhea for 1 to 2 hours B. Sudden facial redness. C. Complete hearing loss D. Neutropenia the next day

B. Sudden facial redness. Too-rapid injection of IV vancomycin can cause a vancomycin infusion reaction, a condition formerly known as "red man syndrome." The reaction is characterized by red blotching of the face, neck, arms, upper body, and back. Adverse effects of vancomycin include diarrhea from intestinal irritation. When the medication is administered by the intravenous route, this complication is less likely to occur than an infusion reaction. Diarrhea from superinfection would occur more than 1 to 2 hours after the administration of the medication. Damage to cranial nerve VII is an adverse reaction to vancomycin that can occur. Tinnitus (ringing of the ears) or reduced hearing is more likely to occur from multiple doses of vancomycin, not a single IV dose. Neutropenia is an adverse effect of prolonged vancomycin use. p. 328

The nurse is reviewing a patient's medical history before administering azithromycin. Which patient factor would most likely contribute to hepatotoxicity? A. Drinks fruit juice with the medication B. Takes acetaminophen at maximum dosing C. Uses antacids after taking the medication D. Prescribed theophylline twice a day

B. Takes acetaminophen at maximum dosing Hepatoxicity (liver toxicity) can occur if azithromycin is taken with other hepatotoxic drugs, such as high doses of acetaminophen. Fruit juice taken with azithromycin can alter the absorption of the medication. Antacids can alter the absorption of azithromycin. Theophylline levels are increased if taken with azithromycin. p. 326

Which drug or drug class would the nurse anticipate incorporating into the plan of care for a patient who has developed a mild rash and hives after 2 days on ampicillin therapy? A. Nystatin B. Epinephrine C. Antihistamines D. Bronchodilators

C. Antihistamines Rashes and hives indicate that the patient has had a mild allergic reaction. Mild allergic reactions are treated with antihistamines. Thus the nurse would anticipate incorporating an antihistamine into the patient's plan of care. Nystatin is used for the treatment of fungal infection in the mouth, which is a superinfection, occuring with the use of broad-spectrum antibiotics. Epinephrine and bronchodilators are used for the treatment of anaphylactic reactions, such as vascular collapse, bronchospasm, or shortness of breath. p.315

Which statement is true if the nurse is comparing the mechanisms of action for penicillin and nystatin? A. Both nystatin and penicillin inhibit cell-wall synthesis. B. Nystatin has only bactericidal effects, whereas penicillin has only bacteriostatic effects. C. Penicillin causes enzyme breakdown of the cell wall, whereas nystatin increases membrane permeability. D. Nystatin inhibits the enzyme responsible for cell-wall synthesis, whereas penicillin inhibits the synthesis of nucleic acid in bacteria.

C. Penicillin causes enzyme breakdown of the cell wall, whereas nystatin increases membrane permeability. The mechanism of action is the inhibition of cell-wall synthesis; penicillin does this by causing enzyme breakdown of the cell wall. The mechanism of action of nystatin is causing an alteration in membrane permeability; nystatin does this by increasing membrane permeability, which causes loss of cellular substances, leading to lysis of the cell. Only penicillin causes inhibition of bacterial cell-wall synthesis; nystatin causes an alteration in membrane permeability. Nystatin has both bactericidal and bacteriostatic effects, whereas penicillin has only bactericidal effects. Penicillin inhibits the enzyme responsible for the synthesis of the cell wall; neither nystatin nor penicillin inhibits the synthesis of nucleic acid in bacteria. p.313

Which medication would be given with piperacillin to treat skin, urinary tract, and respiratory infections? A. Sulbactam B. Vancomycin C. Tazobactam D. Clavulanic acid

C. Tazobactam Tazobactam is a beta-lactamase that extends the effectiveness of its antimicrobial action. Sulbactam is combined with ampicillin. Vancomycin is an aminoglycoside; it is not combined with piperacillin. Clavulanic acid is combined with amoxicillin, not piperacillin. pp. 316,17

Which rationale describes the reason that the nurse administers intravenous vancomycin to a patient over 1 hour? A. To prevent edema B. To prevent hemolysis C. To prevent red man syndrome D. To prevent abdominal flatulence

C. To prevent red man syndrome Rapid infusion of vancomycin may precipitate red man syndrome. It causes red blotching of the face, neck, and arms and may also be associated with hypotension, tachycardia, pruritus, and wheezing. Therefore intravenous infusion of vancomycin should be done slowly. Vancomycin does not cause edema during administration. However, edema may be observed because of nephrotoxicity when the drug is given in excess. Hemolysis and abdominal flatulence are not major effects observed during infusion of vancomycin. Vancomycin does not affect the structural integrity of red blood cells. Abdominal flatulence is a common adverse effect associated with quinolones. p. 328

Which response by the nurse explains the mechanism of bacteriostatic action of tetracycline? A. "Tetracycline blocks RNA synthesis." B. "Tetracycline degrades the bacterial cell wall." C. "Tetracycline binds to magnesium ions." D. "Tetracycline inhibits protein synthesis."

D. "Tetracycline inhibits protein synthesis." Tetracyclines are bacteriostatic drugs that inhibit bacterial protein synthesis by binding to the 30S bacterial ribosome. Thus the nurse's statement that tetracycline inhibits protein synthesis explains the mechanism of bacteriostatic action of tetracycline. The antibiotic rifamycin blocks synthesis of RNA from a DNA template. When administered with magnesium, tetracyclines bind to the magnesium, and the therapeutic action of the tetracycline is reduced; magnesium binding has no role in the bacteriostatic action of tetracycline. Tetracycline does not break down bacterial cell walls; penicillin does. p. 330

When teaching will the nurse provide to a patient who has been prescribed azithromycin for otitis media? A. "You can stop taking the medication once your symptoms improve." B. "Take this medication on an empty stomach." C. "Come back to have culture and sensitivity done when you finish the medication." D. "You must complete the full course of the medication."

D. "You must complete the full course of the medication." Completion of the full course of the medication is the most important patient teaching point for all antibacterial medications. Taking the full course is necessary to effectively kill the bacteria and prevent the growth of more bacteria. Patients should be informed that their symptoms might get better before they Þnish the full course of medication, but that they must continue to take the medication as prescribed until the full course is complete. The medication should be taken 1 hour before or 2 hours after eating. However, if gastrointestinal upset occurs, patients may take it with food. A culture and sensitivity specimen will be collected before the antibiotic is started. A repeat test might not be necessary after completion of the treatment p. 327

Which pharmacokinetic consideration applies to azithromycin? A. Intravenous administration is required to achieve absorption. B. The medication is fully absorbed in the gastrointestinal tract. C. Primary elimination occurs through the urine. D. The medication is mostly excreted in the bile.

D. The medication is mostly excreted in the bile. Azithromycin is primarily excreted in bile. Azithromycin can be given orally or intravenously. The absorption rate of azithromycin by the gastrointestinal tract is about 37%. A small amount of azithromycin is excreted in the urine. p. 326

Which Client would benefit most from the administration of prophylactic antibiotics?

Preoperative hip replacement Congenital bicuspid aortic value Current chemotherapy treatment. Prophylactic antibiotics are indicated in the preoperative hip replacement client because this decreases the occurrence of infection postoperatively. Prophylactic antibiotics are indicated for the client with congenital bicuspid aortic valve disease because this decreases the risk of endocarditis with an invasive procedure. Prophylactic antibiotics are indicated for the current chemotherapy treatment client because this decreases the risk of infection due to neutropenia. A client with the chickenpox infection has a viral infection for which antibiotics are ineffective. A fever of unknown origin should not be treated with antibiotics because that may eliminate the ability to discover the causative organism, and a virus could be the cause of the fever.

A toddler with cystic fibrosis has been hospitalized with bacterial pneumonia. The nurse concludes which of the reason the HCP selected a specific antibiotic?

Sensitivity of the bacteria When the causative organism is isolated, it is tested for antimicrobial susceptibility (sensitivity) to various antimicrobial agents. When a microorganism is sensitive to a medication, the medication is capable of destroying the microorganism. The tolerance of the child of the particular antibiotic is unknown because up to this time the child has not exhibited any allergies. Bacteria are not selective. Although the BCP may have a preference for a particular antibiotic, it first must be determined whether the bacteria are sensitive to it.

A health care provider prescribes Lactobacillus granules to a 3 month old infant to manage post antibiotic diarrhea. Which explanation would the nurse give to the infant's parents about the reason for giving lactobacilli?

The flora that inhabit a healthy gastrointestinal tract must be recolonized. Lactobacilli are part of the flora in the healthy gastrointestinal tract. The purpose of administering lactobacilli granules is to help recolonize the normal gastrointestinal flora that were destroyed with antibiotic therapy. The other options (diminishing mucosal edema, lessening discomfort from gastric hyper acidity, and pain relief from gas) are not actions of lactobacilli granules.