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Exam 3 Patho Pharm 1

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What are the risk factors for a suppressed immune system?

- Age - Nonimmunized state - Environmental factors - Chronic illness - Medical treatments - Genetics - High risk behaviors + substance abuse - Pregnancy

The nurses in a health care facility have developed a new care plan to prevent the risk of infection in clients with an indwelling urinary catheter in place. To determine if the changes prevent infections, the nurse manager uses the plan-do-study-act (PDSA). Place in order the steps that the nurse manager would follow to evaluate the changes. 1. Try out the change 2. Plan to test the change 3. Determine what was learned 4. Analyze what happened from the change

2, 1, 4, 3

Arrange the steps involved in skin testing for an allergen causing a type I allergic reaction in their correct sequence. 1. Clean the inner side of the forearm with soap and water. 2. Apply topical steroid on the skin. 3. Use skin testing needle to scratch surface of skin 4. Place drops of sera containing the known allergen on skin 5. Observe for a wheal formation on the skin. 6. Discontinue corticosteroid medications.

6, 1, 4, 3, 5, 2

For which client would the nurse need to contact the health care provider based upon the client's condition and treatment after reviewing the medication reconciliation documents of four clients? Client A: Enterocolitis faecalis associated UTI, Streptomycin Client B: Staphylococcus epidermidis associated osteomyelitis, Vancomycin Client C: Streptococcus pneumoniae associated pneumococcal pneumonia, Cefotaxime Client D: Klebsiella pneumoniae associated pneumonia, Meropenem

The client is on neutropenic precautions. From which direction does the protective environment isolation help prevent the spread of infection? A. To the client from outside sources B. From the client to others C. From the client by using special techniques to destroy infectious fluids and secretions D. To the client by using special sterilization techniques for linens and personal items

The nurse is changing the dressing of a postoperative client. Another client has fallen near the nursing station and is unconscious. Which is the priority nursing action in this situation? A. Attend to the client who lost consciousness. B. Delegate the dressing change to the nursing assistant. C. Delegate the care of the unconscious client to the nursing assistant. D. Complete the dressing, because the open wound may increase infection risk.

The nurse would include which instruction to the parents of a child being treated with oral ampicillin for otitis media? A. Complete the entire course of antibiotic therapy. B. Herbal fever remedies are highly discouraged. C. Administer the medication with meals. D. Stop the antibiotic therapy when the child no longer has a fever.

When assessing risk factors, which question would the nurse ask a client who has developed pneumonia? A. "Are you diabetic?" B. "Have you ever had pneeumonia?" C. "What do you use for contraception?" D. "Do you have a history of intravenous [IV] drug abuse?"

Which type of immunity would a 4-year-old child develop during the course of an infection with varicella? A. Active natural immunity B. Active artificial immunity C. Passive natural immunity D. Passive artificial immunity

While assessing a client, the nurse finds inflammation of the skin at the bases of the client's nails. Which event or disorder would the nurse associate with the reason behind this condition? A. Trauma B. Trichinosis C. Pulmonary disease D. Iron-deficiency anemia

A client with a history of cardiac dysrhythmias is admitted to the hospital due to a fluid volume deficit caused by a pulmonary infection. The registered nurse assesses the recorded vital signs. Which vital sign assessment requires reassessment? Select all that apply. One, some, or all responses may be correct. A. Respiratory rate of 14 breaths/minute B. Blood pressure of 120/80 mm Hg. C. Oxygen saturation of 95% D. Temporal temperature of 99.3?F (37.4?C) E. Radial pulse rate of 72 and irregular

A, B, C

Which disease process places a client at increased risk for infection? Select all that apply. One, some, or all responses may be correct. A. Leukemia B. Lymphoma C. Emphysema D. Schizophrenia E. Osteoarthritis

A, B, C

Which findings noted during assessment would lead the nurse to determine that a client is at an increased risk for infection? Select all that apply. One, some, or all responses may be correct A. Surgical incision B. Urinary catheter C. Antibiotic therapy D. Intravenous access E. Diminished appetite

A, B, C, D

Which strategies would the nurse apply when vaccinating a child to decrease pain and anxiety? Select all that apply. One, some, or all responses may be correct. A. Applying a topical anesthetic B. Injecting the most painful vaccine last C. Holding the child upright during the vaccination D. Administering intramuscular injections rapidly without prior aspiration E. Administering acetaminophen or ibuprofen after vaccination

A, B, C, D

Which action would the nurse take when a client receiving an infusion of penicillin reports having an anaphylactic reaction to penicillin in the past? Select all that apply. One, some, or all responses may be correct. A. Notifying rapid response B. Measuring oxygen level C. Administering epinephrine D. Inserting an indwelling catheter E. Assessing the respiratory pattern

A, B, C, D, E

Which assessment would the nurse perform before administering a dose of vancomycin to a client? Select all that apply.One, some, or all responses may be correct. A. Creatinine B. Trough level C. Hearing ability D. Intravenous site E. Blood urea nitrogen

A, B, C, D, E

Which complication would the nurse monitor for in a client on strict bed rest for 3 days? Select all that apply. One, some, or all responses may be correct. A. Atelectasis B. Hypotension C. Constipation D. Pressure injuries E. Urinary tract infection

A, B, C, D, E

Which action would the nurse instruct an older client to implement to ensure antibodymediated immunity? Select all that apply. One, some, or all responses may be correct. A. Obtain a shingles vaccination. B. Receive a tetanus booster injection. C. Obtain the pneumococcal vaccination. D. Receive annual testing for tuberculosis. E. Receive an annual influenza vaccination. F. Avoid obtaining the pertussis vaccination.

A, B, C, E

The nurse identifies which antimicrobial medications as safe during breast-feeding? Select all that apply. One, some, or all responses may be correct. A. Penicillins B. Macrolides C. Tetracycline D. Cephalosporins E. Chloramphenicol

A, B, D

Which client condition is an example of a cell-mediated immunity? Select all that apply. One, some, or all responses may be correct, A. Tuberculosis (TB) B. Graft rejection? C.Allergic rhinitis D. Contact dermatitis E. Anaphylactic shock

A, B, D

Which option is an example of actively acquired specific immunity? Select all that apply. One, some, or all responses may be correct. A. Recovery from measles B. Recovery from chickenpox C. Maternal immunoglobulinin the neonate D. Immunization with live or killed vaccines E. Injection of human gamma immunoglobulin

A, B, D

Identify the clinical manifestation associated with the release of histamine during a type l rapid hypersensitivity reaction. Select all that apply. One, some, or all responses may be correct. A. Pruritus B. Erythema C. Fibrotic changes D. Nasal mucus secretion E. Conjunctival mucus secretion F. Hematuria

A, B, D, E

Which assessment finding during the administration of intravenous penicillin would prompt the nurse to stop the infusion? Select all that apply. One, some, or all responses may be correct. A. Hives B. Itching C. Nausea D. Skin rash E. Shortness of breath

A, B, D, E

Which information will the nurse consider when planning care for a client with human immunodeficiency virus (HIV) who has been diagnosed with class 3 tuberculosis? Select all that apply. One, some, or all responses may be correct. A. Class 3 tuberculosis is a clinically active disease, which is contagious. B. Tuberculosis is the leading cause of mortality in clients infected with HIV. C. HIV-positive clients are more likely to have multidrug resistant tuberculosis. D. Individuals with HIV usually have high fevers with active tuberculosis infection. E. Persons with active tuberculosis are usually treated on an outpatient basis.

A, B, E

Which tasks should the nurse perform to comply with public health laws? Select all that apply. One, some, or all responses may be correct A. Report cases of communicable diseases. B. Report incidents of domestic violence. C. Provide emergency assistance at an accident scene. D. Notify the primary health care provider of any client-related problems. E. Ensure that clients in a community have received necessary immunizations.

A, B, E

The nurse is interviewing a client who was diagnosed with systemic lupus erythematosus (SLE). Which clinical findings to this disease would the nurse expect the client to exhibit? Select all that apply. One, some, or all responses may be correct. A. Butterfly facial rash B. Firm skin fixed to tissue C.Inflammation of the joints D. Muscle mass degeneration E. Inflammation of small arteries

A, C

Which function of leukocytes is involved in the inflammation process? Select all that apply. One, some, or all.responses may be correct. A. Destruction of bacteria and cellular debris B. Selective attack and destruction of non-self cells C. Release of vasoactive amines during allergic reactions D. Secretion of immunoglobulins in response to a specific antigen E. Enhancement of immune activity through secretion of various factors, cytokinesis lymphokines

A, C

Which hormones are involved in building and maintaining healthy bone tissue? Select all that apply. One, some, or all responses may be correct. A. Insulin B. Thyroxine C. Glucocorticoids D. Growth hormone E. Parathyroid hormone

A, C, D

According to Maslow's hierarchy, which example belongs to the third level of needs? Select all that apply. One, some, or all responses may be correct. A. "A client is depressed because the client's significant other passed away." B. "A client is constipated due to excess loss of fluids from the body." C."A client wants to reconnect with old friends after being diagnosed with cancer." D. "A client has to live in a rat-infested apartment due to a lack of financial resources." E. "A client never goes to family gatherings because the family members do not accept the client."

A, C, E

Which information is appropriate for the nurse to include in the education for a group of nursing students regarding near-miss events? Select all that apply. One, some, or all responses may be correct. A. No actual harm is caused to the clients. B. Moderate-harm may be caused. C. They are caused by a variation in standard care. D. They are caused by impaired immune functioning. E. The cause may be analyzed by a failure modes effects analysis (FMEA).

A, C, E

Which intervention would the nurse anticipate incorporating into the plan of care for a client with bursitis of the left knee? Select all that apply. One, some, or all responses may be correct. A. Rest the affected joint. B. Apply a heat pack. C. Use a compression splint. D. Do gentle range-of-motion exercises. E. Take nonsteroidal anti-inflammatory drugs (NSAIDs) as needed for pain.

A, C, E

What are the adverse rxns to vancomycin?

ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS DRUG RXN WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS LINEAR IGA BULLOUS DERMATITIS SJS TOXIC EPIDERMAL NECROLYSIS ototoxicity nephrotoxicity

What assessments should you do with amoxicillin?

Assess for infection at beginning and throughout therapy Monitor for signs/symp of anaphylaxis Monitor bowel function Obtain culture and sensitivity test before therapy

What are the assessments for griseofulvin?

Assess skin at site of fungal infection routinely during therapy. Assess patient for allergy to penicillin; potential cross-sensitivity exists. Assess for rash periodically during therapy (may cause Stevens-Johnson syndrome or toxic epidermal necrolysis)

A client arrives at a health clinic reports, "I am here to have my tuberculin skin test read." The nurse notes a 7-mm indurated area at the injection site. Which nurse's statement describes this result? A. "The result indicates that you have active tuberculosis." B. "The result indicates you are infected with the tuberculosis organism." C. "The result indicates there are no tuberculin antibodies in your system." D. "The result indicates you have a secondary infection related to the tuberculin organism."

A client with a methicillin-resistant Staphylococcus aureus (MRSA) infected wound is scheduled for a computed tomography (CT) scan. To ensure client and visitor safety during transport, the nurse would implement which precaution? A. No special precautions are required. B. Cover the infected site with a dressing. C. Drape the client with a covering labeled biohazardous. D. Place a surgical mask on the client.

The nurse is preparing discharge instructions for a client who acquired a nosocomial Clostridium difficile infection. Which would the nurse include in the instructions? A. Anticipate that nausea and vomiting will continue until the infection is no longer present. B. The infection causes diarrhea accompanied by flatus and abdominal discomfort. C. Consume a diet that is high in fiber and low in fat. D. Other than routine hand washing, it is not necessary to perform special disinfection procedures.

The nurse is teaching the parent of a child prescribed a high dose of oral prednisone for asthma. Which information is critical for the nurse to include when teaching about this medication? A. It protects against infection. B. It should be stopped gradually. C. An early growth spurt may occur. D. A moon-shaped face will develop.

Which client receiving antibiotic therapy would the nurse identify as being Achilles tendon rupture? Client A: Gentamicin Client B: Ciprofloxacin Client C: Cefazolin Client D: Tobramycin

Which factor explains why a client who experiences an acute episode of rheumatoid arthritis has swollen finger joints? A. Urate crystals in the synovial tissue B. Inflammation in the joint's synovial lining C. Formation of bony spurs on the joint surfaces D. Deterioration and loss of articular cartilage joints

Which nursing intervention is the priority when a client receiving chemotherapy develops a temperature of 102.2?F (39?C) when the temperature 6 hours ago was 99.2?F (37.3?C)? A. Assess the amount and color of urine; obtain a specimen for a urinalysis and culture. B. Administer the prescribed antipyretic and notify the primary health care provider of this change. C. Note the consistency of respiratory secretions and obtain a specimen for culture and sensitivity. D. Obtain the respirations, pulse, and blood pressure when rechecking the temperature in 1 hour.

Which assessment findings would the nurse identify in a client with clinical manifestations of rheumatoid arthritis (RA)? Select all that apply. One, some, or all responses may be correct. A. Obesity and asymmetric joint disease B. Development of antinuclear antibodies C. Inflammatory disease, pattern D. Bilateral involvement of metacarpophalangeal joints E. Disease process involving the distal interphalangeal joints F. Disease in the weight-bearing joints and hands

B, C, D

Which condition triggers humoral immunity? Select all that apply. One, some, or all responses may be correct. A. Tuberculosis B. Atopic diseases C. Bacterial infection D. Anaphylactic shock E. Contact dermatitis

B, C, D

Which medication would be prescribed when a client reports vaginal itching and the primary health care provider confirms that the client has candidiasis? Select all that apply. One, some, or all responses may be correct. A. Tinidazole B. Miconazole C. Fluconazole D. Clotrimazole E.Metronidazole

B, C, D

Which infection would the nurse monitor for in the toddler based on structural characteristics at this age? Select all that apply. One, some, or all responses may be correct. A. Bronchiolitis B. Ear infection C. Acute sinusitis D. Laryngotracheobronchitis E. Inflammation of the tonsils

B, C, D, E

After a client experiences a cardiac arrest, the client is transferred to the intensive care unit (ICU). Which nursing intervention is the major attribute that affects the quality of care provided to the client? Select all that apply. One, some, or all responses may be correct. A. Develop a diet plan according to the client's food preference. B. Coordinate with the members of the ICU while transferring the client. C. Provide cardiopulmonary resuscitation before transferring the client. D. Encourage the client's family members to visit the client frequently. E. Administer digoxin to the client according to the prescription.

B, C, E

The nurse instructs a client who avoids bathing to take a bath or shower each day as a means of maintaining hygiene and preventing infection. Which of these reactions would the nurse expect if the client is in the action stage? Select all that apply. One, some, or all responses may be correct. A. "I only take a bath once a week, but I don't see any infections on my skin." B. "I try to take a shower every day, but I skip it sometimes because of my tight work schedule." C. "I understand that bathing regularly is a good habit, but my bathroom is very cold in the mornings." D. "Please tell me how to get into the habit of taking a bath daily so that I can keep myself clean and healthy." E. "I want to take a bath regularly, but I don't have time because I need to look after my kids and my parents."

B, C, E

Which therapeutic outcome is expected after administering ibuprofen? Select all that apply. One, some, or all responses may be correct. A. Diuresis B. Pain relief C. Temperature reduction D. Bronchodilation E. Anticoagulation F. Reduced inflammation

B, C, F

Which leukocyte would the nurse include when teaching about antibody-mediated immunity? Select all that apply. One, some, or all responses may be correct. A. Monocyte B. Memory cell. C. Helper T cell D. B-lymphocyte E. Cytotoxic T cell

B, D

A 5-month-old infant is brought to the pediatric clinic because of exposure to an adolescent sibling with measles. Which factor would the nurse consider when determining the infant's risk of infection? A. The infant's immunizations B. The infant's previous viral illnesses C. Maternal diseases and immunizations D. Maternal exposure to tuberculosis and herpes genitalis

A client is admitted to the hospital with severe diarrhea, abdominal cramps, and vomiting for 5 days. Upon further assessment, the primary health care provider finds the symptoms occurred after the client ate eggs, salad dressings, and sandwich fillings. Which food-borne disease would the provider suspect in this client? A. Listeriosis B. Shigellosis C. Salmonellosis D. Staphylococcus

After instructing an older client's adult child about age-related immune system changes and associated care measures, which statement indicates a need for further instruction? A. "My parent has a private room at home." B. "My parent has received the pneumococcal vaccination recently." C. "My parent comes in for checkup's only when experiencing a fever." D. "My parent has been given a second dose of the pertussis vaccination."

The nurse is caring for a client who had an above-the-knee amputation 1 week ago. Which action would the nurse take to control edema of the residual limb? A. Administer a diuretic as needed. B. Restrict the client's oral fluid intake. C. Rewrap the elastic bandage as necessary. D. Keep the residual limb elevated on a pillow.

The nurse is caring for a client with chronic inflammation of the bowel. For which most serious complication would the nurse monitor in this client? A. lleus B. Pain C. Perforation D. Obstruction

Which describes the purpose of preoperative antibiotics for a client scheduled for a surgical resection of the colon and creation of a colostomy? A. To decrease peristalsis B. To minimize electrolyte imbalance C. To decrease bacteria in the intestines D. To treat inflammation caused by the malignancy

Which education would the nurse provide the parent of a 2-month-old infant about home care in the event of an immunization reaction? A. Give aspirin for pain; if swelling at the injection site develops, call the health care provider. B. Apply heat to the injection site for the first day after the injection; apply ice if the arm is inflamed. C. Give acetaminophen for fever; call the health care provider if the child exhibits marked drowsiness or seizures. D. Apply ice to the injection site if soreness develops; call the health care provider if the child comes down with a fever.

Which is the correct response to a parent whose child is, undergoing chemotherapy and is not up to date on required immunizations for school? A. 'By this time your child has developed sufficient antibodies to provide immunity.' B. 'Maintaining current immunizations is critical. Make sure the series is completed." C. 'This isn't the best time to finish the immunizations, because your child's immune system is suppressed." D. 'It's important to complete the immunizations because your child needs to be protected from childhood diseases that could be fatal.'

Which nursing intervention would prevent septic shock in the hospitalized client? A. Maintain the client in a normothermic state. B. Administer blood products to replace fluid losses. C. Use aseptic technique during all invasive procedures. D. Keep the critically ill client immobilized to reduce metabolic demands.

Which response would the nurse provide during an education session at the local community center to a question asking why influenza vaccines are needed annually? A. "The influenza virus has a high level of infectivity, thus requiring an annual booster to keep rates of influenza low." B. "Because influenza is seasonal and has never been eradicated, the need for a vaccine is also seasonal annually." C. "The nature of the virus changes every year; the vaccine is developed based on the most prevalent type and variant being seen." D. "There are several types of influenza viruses with differing levels of virulence, making it difficult to develop a vaccine that will be effective against all types of influenza."

The nurse caring for a client postsurgery takes necessary steps to achieve quality client care. Which nursing action satisfies the Quality and Safety Education for Nurses (QSEN) competency called informatics? Select all that apply. One, some, or all responses may be correct. A. Washing the hands before handling the client's incision site B. Implementing a new. method of monitoring the client's incision site for infection C. Documenting in the electronic health record (EHR) after performing wound debridement D. Locking the electronic health record (EHR) after every entrance of necessary information E. Using a computer-assisted instruction (CAI) program to provide better quality of care to the client

C, D, E

The nurse is collecting case reports that can be analyzed using the failure mode effective analysis (FMEA) tool. Which case files would the nurse collect? Select all that apply. One, some, or all responses may be correct. A. A coma due to severe hemolytic transfusion reaction B. Depression committed suicide by falling off the terrace of the hospital C. Retained foreign body left during surgery that was removed immediately D. Wheelchair-bound client rescued from falling in the corridor of the hospital E. Urinary tract infection after 4 days of continuous catheterization

C, D, E

Which scenario would the nurse consider an output component of the nursing process? Select all that apply. One, some, or all responses may be correct. A. While assessing a client, the nurse finds a history of mental illness. B. While assessing a client who is obese, the nurse finds a history of asthma. C. The nurse notices the client's wounds healed after performing regular wound debridement. D. When changing the surgical site dressing, the nurse notices the client developed an infection. E. The nurse finds the client's blood pressure increased, even with timely medication administration.

C, D, E

The nurse is preparing to insert an intravenous (IV) catheter in a thin, emaciated client who is scheduled to begin intravenous fluid therapy. Which interventions would the nurse follow to provide high-quality care? Select all that apply. One, some, or all responses may be correct. A. Insert an 18-gauge IV catheter B. Change the IV line every 7 days C. Flush the IV line with normal saline D. Insert the IV catheter in the client's femur E. Stop the insertion procedure when there is a break in technique

C, E

What are the labs done with griseofulvin?

CBC serum creatinine hepatic (liver) functions

What are the lab considerations for trimethoprim?

CBC urinalysis

What are the adverse rxns to ceftaroline?

CDAD ENCEPHALOPATHY SEIZURES HYPERSENSITIVITY RXNS hemolytic anemia

What are the adverse rxns to cefepime?

CDAD ENCEPHALOPATHY SEIZURES HYPERSENSITIVITY RXNS rash pain at IM site phlebitis at IV site eosinophilia thrombocytopenia

What are the averse effects of cefoxitin?

CDAD SEIZURES ANAPHYLAXIS bleeding eosinophilia hemolytic anemia leukopenia thrombocytopenia

What are the adverse rxns to imipenem?

CDAD SEIZURES HYPERSENSITIVITY RXNS sweating hypotension dizziness somnolence

What are the adverse rxns of amoxicillin?

CDAD SEIZURES SERUM SICKNESS ANAPHYLAXIS urticaria blood dyscrasias superinfection increased liver enzymes

What are the adverse rxns of cephalexin?

CDAD SEIZURES HYPERSENSITIVITY RXNS eosinophilia hemolytic anemia neutropenia thrombocytopenia

What are the adverse rxns to cefotaxime?

CDAD SEIZURES ANAPHYLAXIS agranulocytosis bleeding eosinophilia hemolytic anemia neutropenia thrombocytopenia

What is ganciclovir used for?

CMV

How would you use ciprofloxacin while breastfeeding?

Can be used while breastfeeding for post-exposure prophylaxis of anthrax if potential maternal benefit justifies potential risk to infant

How do you take ceftaroline?

Completing the course, even if feeling better

A client who has rheumatoid arthritis participates in an individualized exercise program daily. Which statement from the client indicates to the nurse that the client understands the purpose of the program? A. "I know the exercises are important, so I do them as many times as can." B. "I do my exercises when I go to physical therapy in the morning and afternoon." C. "Because I'm stiff in the morning, I do most of my exercises then, so I'm done for the day." D. "I do one set of exercises slowly after breakfast, then I space the rest of them throughout the day."

A prescription for 6 mg of intramuscular dexamethasone, twice a day for 2 days, is issued to a client who is 32 weeks' pregnant and having regular labor contractions. The client asks why she needs this medicine. Which reason would the nurse give the client regarding the reason the medication was prescribed? A. "It will promote sleep." B. "It may stop contractions." C. "The medication relaxes uterine muscles." D. "The medication accelerates fetal lung maturity."

After teaching a male client about measures to maintain sexual health and prevent transmission of sexually transmitted infections (STIs), which client statement indicates effective learning? A. "I will use condoms when having sex with an infected partner." B. "I will perform a self-examination of my genitals every month before bathing." C. "I will refrain from getting the human papilloma virus vaccine (HPV) before the age of 27 years." D. "I willconsult with myprimary health care provider when there is a rash or ulcer on my genitalia."

An adolescent is taken to the emergency department of the local hospital after stepping on a nail. The nurse asks if the client has had a tetanus immunization. The adolescent responds that all immunizations are up to date. A few days later, the client is admitted to the hospital with a diagnosis of tetanus. Which statement describes the nurse's responsibility in this situation? A. The nurse's judgment was adequate, and the client was treated accordingly. B. The possibility of tetanus was not foreseen because the client was immunized. C. Nurses would routinely administer immunization against tetanus after such an injury. D. Assessment by the nurse was incomplete and, as a result, the treatment was insufficient

The nurse creates a plan of care for a client with a risk of infection. Which is the desirable expectedoutcome for the client? A. All nursing functions will be completed by discharge. B. All invasive intravenous lines will remain patent. C. The client will remain awake, alert, and oriented at all times. D. The client will be free of signs and symptoms of infection by discharge.

The parent of a newborn asks the nurse why, except for hepatitis B vaccine, the immunization schedule does not start until the infant is 2 months old. Which response would the nurse provide? A. "A newborn's spleen can't produce efficient antibodies." B. "Infants younger than 2 months are rarely exposed to infectious disease." C. "The immunization will attack the infant's immature immune system and cause the disease." D. "Maternal antibodies interfere with the development of active antibodies by the infant when immunized."

Which client would the nurse suspect as having a type IV hypersensitive reaction when providing care for four clients with hypersensitivity reactions? Client A: IgE, wheal flare Client B: IgM, none Client C: IgG, erythema and edema after 4hr Client D: None, erythema and edema after 24hr

Which instruction indicates a lack of understanding of a nurse teaching a human immunodeficiency virus (HIV)-positive client about strategies to prevent opportunistic infections? A. "Reuse cups after washing them with warm soapy water." B. "Rinse your toothbrush in liquid laundry bleach every week." C. "Wash your armpits, groin, and genitals with antimicrobial soap twice a day" D. "Purchase organic, unpasteurized apple cider for your vitamin C requirements."

Which meal is most appropriate for a client with a large pressure injury? A. Hamburger with french fries B. Turkey meatloaf with brown rice C. Pasta and tomato sauce with a side salad D. Grilled chicken, steamed spinach, and a side of orange slices

Which medication used to treat bacterial vaginosis may be responsible for a client's report of an unpleasant metallic taste, nausea, and vomiting? A. Tinidazole B. Miconazole C. Clotrimazole D. Metronidazole

Which prescription would the nurse anticipate being written for a client experiencing vaginal discharge with a fishy odor who was diagnosed bacterial vaginosis? A. Tinidazole B. Miconazole C. Clotrimazole D. Metronidazole

Which recommendation would the nurse make to the family of a child with juvenile idiopathic arthritis who has difficulty getting ready for school in the morning due to joint pain and stiffness? A. Administer acetaminophen before bedtime. B. Ice the joints that are painful in the evening. C. Encourage a program of active exercise after awakening. D. Provide warm, moist heat to the affected joints before arising.

Which response would the nurse give to a client taking ibuprofen for rheumatoid arthritis who asks the nurse if acetaminophen can be substituted? A. "Yes, both are antipyretics and have the same effect." B. "Acetaminophen irritates the stomach more than ibuprofen does." C. "Acetaminophen is the preferred treatment for rheumatoid arthritis." D. "Ibuprofen has anti-inflammatory properties, and acetaminophen does not."

Which type of delayed hypersensitivity reaction does the client pictured in the image likely have? A. Type I B. Type II C. Type III D. Type IV

What are the adverse rxns with griseofulvin?

HEPATOTOXICITY ERYTHEMA MULTIFORME STEVENS-JOHNSON SYNDROME TOXIC EPIDERMAL NECROLYSIS SERUM SICKNESS headache dizziness hearing loss diarrhea epigastric distress extreme thirst flatulence photosensitivity rashes leukopenia lupus-like syndrome

What are the adverse rxns for amphotericin B?

HYPERSENSITIVITY REACTIONS anxiety confusion headache insomnia dyspnea hypoxia wheezing chest pain hypotension tachycardia edema hypertension hyperbilirubinemia ↑ liver enzymes abdominal pain nephrotoxicity hematuria hyperglycemia hypocalcemia hypokalemia hypomagnesemia anemia leukopenia thrombocytopenia pruritus rashes phlebitis arthralgia myalgia chills fever acute infusion reactions

What is cefoxitin active against?

Haemophilus influenzae E. coli Klebsiella pneumoniae Morganella morganii Neisseria gonorrhoeae Proteus Providencia Moraxella catarrhalis Bacteroides fragilis *not active against methicillin-resistant staphylococci or enterococci

What are the contraindications for nystatin?

Hypersensitivity

What are the contraindications to vancomycin?

Hypersensitivity

What are the contraindications for erythromycin?

Hypersensitivity Hepatic insufficiency Long QT syndrome Hypokalemia Hypomagnesia HR <50 bpm Known alcohol intolerance Tartrazine sensitivity Neonates

What are the contraindications for metronidazole?

Hypersensitivity Hypersensitivity to parabens (topical only) First trimester of pregnancy.

What are the contraindications for amphotericin B?

Hypersensitivity Lactation (may cross into breastmilk)

What are the contraindications for trimethoprim?

Hypersensitivity Megaloblastic anemia secondary to folate deficiency Pregnancy, lactation, or children <12 yr

What are the contraindications of doxycycline?

Hypersensitivity Pregnancy (staining of teeth)

What are the contraindications for griseofulvin?

Hypersensitivity Severe liver disease or porphyria.

What are contraindications for acyclovir?

Hypersensitivity to acyclovir or valacyclovir Hypersensitivity to milk protein concentrate (buccal only)

What are the contraindications for cefepime?

Hypersensitivity to cephalosporins Serious hypersensitivity to penicillins

What are the contraindications for fluconazole?

Hypersensitivity to fluconazole or other azole antifungals use with pimozide, erythromycin, or quinidine Pregnancy

What are the contraindications of gentamicin?

Hypersensitivity to gentamicin or other aminoglycosides Most parenteral products contain bisulfites and should be avoided in patients with known intolerance Pregnancy (may cause fetal harm) Products containing benzyl alcohol should be avoided in neonate

What signs/symp should patients report to HCP when taking vancomycin?

Hypersensitivity, tinnitus, vertigo, or hearing loss

How is cefotaxime administered?

IM or IV

How is ceftaroline administered?

How is imipenem administered?

How is cefoxitin administered?

IV and IM

How is amphotericin B administered?

IV only

How is Penicillin G administered?

IV or IM

How is gentamicin administered?

IV or IM

How is metronidazole administered?

IV or PO

How is vancomycin administered?

IV or PO

How is methylprednisolone administered?

IV push or IV drip

What is vancomycin used for?

IV: Endocarditis Meningitis Osteomyelitis Pneumonia Septicemia Soft tissue infections (if allergic to penicillins) Part of endocarditis prophylaxis (if allergic to penicillins) PO: CDAD Staphylococcus enterocolitis

What should the patient do if they are taking metronidazole?

If needed, use single dose and interrupt nursing for 24 hr after taking

How should nystatin be taken?

Instruct patient to take medication as directed (if a dose is missed, take as soon as remembered but not if almost time for next dose)

What are the labs done for metronidazole?

Liver function

What are the lab tests for ciprofloxacin?

Liver function Blood glucose Alkaline phosphatase

What is imipenem used for?

Lower respiratory infections UTI Abdominal infections Gynecologic infections Skin/skin structure infections Bone and joint infections Bacteremia Endocarditis Polymicrobic infections

What are the lab considerations for ceftaroline?

May cause a seroconversion from a negative to a positive Coombs test result

Why would you not use cefepime with aminoglycosides or loop diuretics?

May increase risk of nephrotoxicity

What are the lab considerations for gentamicin?

Monitor renal function

What is Cushinoid appearance?

Moon face, truncal obesity and the formation of a buffalo hump

What is doxycycline used for?

Mycoplasma Chlamydia Rickettsia B. burgdorferi Inhalational and cutaneous anthrax Gonorrhea and syphilis Chronic bronchitis prophylaxis Treatment of acne Inflammatory lesions associated with rosacea Malaria prophylaxis Rocky Mountain spotted fever (<8y/o)

Should parents use household items to administer amoxicillin to their child?

No, the measuring tool should come from the pharmacy or be included in the product.

Should you drive with fluconazole?

Not until alertness is determined

Should you use doxycycline while lactating?

Only if maternal benefit outweighs infant cost

Should you use imipenem if lactating?

Only if maternal benefit outweighs infant's risk

Should you use ceftaroline while lactating?

Only if maternal benefit outweighs infants risk.

Should you use vancomycin while lactating?

Only if maternal benefit outweighs the infant risk

Should you use cephalexin when lactating?

Only if the benefit outweighs the costs

What are the adverse rxns with nystatin?

Oral: stomach pain (large doses) contact dermatitis Stevens-Johnson syndrome Topical: burning itching local hypersensitivity reactions, redness stinging

How is Penicillin V administered?

How is amoxicillin administered?

How is cephalexin administered?

How is griseofulvin administered?

How is prednisone administered?

How is trimethoprim administered?

What is fluconazole used for?

PO IV Fungal infections caused by susceptible organisms, including: ● Oropharyngeal or esophageal candidiasis ● Serious systemic candidal infections ● Urinary tract infections ● Peritonitis ● Cryptococcal meningitis. Prevention of candidiasis in patients who have undergone bone marrow transplantation. PO Single-dose oral treatment of vaginal candidiasis.

What is ciprofloxacin used for?

PO IV ●Skin and skin structure infections ●Bone and joint infections ●Complicated intra-abdominal infections (with metronidazole) ●Urinary tract infections ●Chronic bacterial prostatitis ●Lower respiratory tract infections ●Acute bacterial sinusitis (should be used only when there are no other alternative treatment options) ●Post-exposure prophylaxis of inhalational anthrax ●Treatment and prophylaxis of plague. PO ●Infectious diarrhea ●typhoid fever ●uncomplicated cervical and urethral gonorrhea. IV ●Nosocomial pneumonia ●Febrile neutropenia (with piperacillin/tazobactam).

How is ciprofloxacin administered?

PO or IV

How is fluconazole administered?

PO or IV

How is nystatin administered?

PO or topically

How is acyclovir administered?

PO, IV, topical

How is erythromycin administered?

PO, parenteral, topical

What are the adverse rxns of Penicillin G + V?

SEIZURES ANAPHYLAXIS SERUM SICKNESS CDAD epigastric distress rash leukopenia eosinophilia pain at IM site phlebitis at IV site interstitial nephritis urticaria

What are the adverse rxns for acyclovir?

STEVENS-JOHNSON SYNDROME RENAL FAILURE THROMBOTIC THROMBOCYTOPENIC PURPURA/HEMOLYTIC UREMIC SYNDROME SEIZURES acne hives rash unusual sweating changes in menstrual cycle, polydipsia ↑ liver enzymes, hyperbilirubinemia abdominal pain anorexia crystalluria hematuria renal pain pain phlebitis local irritation joint pain dizziness headache hallucinations trembling

What are the adverse rxns with metronidazole?

STEVENS-JOHNSON SYNDROME (SJS) SEIZURES rash urticaria burning (topical) mild dryness (topical) skin irritation (topical) transient redness (topical) optic neuropathy tearing (topical) abdominal pain anorexia, diarrhea dry mouth furry tongue glossitis unpleasant taste leukopenia phlebitis at IV site peripheral neuropathy dizziness headache aseptic meningitis (IV) encephalopathy (IV) psychosis superinfection

What is ceftaroline active against?

Staphylococcus aureus Streptococcus pyogenes Streptococcus agalactiae Streptococcus pneumoniae E. coli Klebsiella pneumoniae Klebsiella oxytoca Haemophilus influenzae

What is imipenem active against?

Staphylococcus pneumoniae Group A beta-hemolytic streptococci Enterococcus Staph aureus E. coli Klebsiella Proteus Serratia Pseudomonas aeruginosa Salmonella Shigella Neisseria gonnorhoeae Numerous anareobes

What are the adverse rxns for fluconazole?

TORSADES DE POINTES SJS HEPATOTOXICITY HYPERSENSITIVITY RXNS QT interval prolongation adrenal insufficiency hypokalemia hypertriglyceridemia abdominal discomfort diarrhea headache dizziness seizures

What is the short acting tetracycline?

Tetracycline

What do tetracyclines do?

Tetracyclines bind to 30S subunit, preventing attachment of aminoacyl tRNA

What is trimethoprim used for?

Treatment of uncomplicated urinary tract infections. Treatment of uncomplicated otitis media in children. Prophylaxis of chronic recurrent urinary tract infections. Treatment of head lice.

What assessments should you do with trimethoprim?

UTI (fever, cloudy urine, frequency, urgency, pain and burning on urination) Obtain specimens for culture and sensitivity Monitor intake and output ratios (Fluid intake should be sufficient to maintain urine output of at least 1200-1500 mL daily)

What should patients with rheumatic heart disease or valve replacements do?

Use an antimicrobial prophylaxis before invasive dental/medical procedures.

What assessments do you do with erythromycin?

Vitals Appearance of wound, sputum, and stool WBC Culture and sensitivity Monitor bowel function

How should the patient take Penicillin G + V?

around the clock and finish completely, even if feeling better

How should the patient take amoxicillin?

around the clock and finish completely, even if feeling better

How should the patient take cephalexin?

around the clock at evenly spaced intervals and completely as directed, even if feeling better

How should vancomycin be taken?

as directed, take missed doses ASAP (unless close to time of next dose)

what assessments should you do with prednisone?

assess for adrenal insufficiency monitor intake and output ratios periodic growth assessment in children look for signs of hypokalemia

If tendon pain occurs with ciprofloxacin, what should you avoid?

avoid exercise and use of affected area

What kind of antacids/medications should the patient avoid when taking ciprofloxacin?

containing calcium, magnesium, aluminum, iron, or zinc (should not be taken within 4 hr before and 2 hr after taking ciprofloxacin)

What are the short acting glucocorticoids?

cortisone and hydrocortisone

What are the adverse rxns of prednisone?

depression euphoria cataracts psychosis PEPTIC ULCERATION acne decreased wound healing ecchymoses (bruising) anorexia ADRENAL SUPPRESSION THROMBOEMBOLISM muscle wasting osteoporosis cushingoid appearance

What does narrow spectrum mean?

effective only against a limited variety of microbes; limited toxicity

What are the three macrolides that we need to know?

erythromycin (prototype), clarithromycin, and azithromycin

What signs/symp should a patient report to HCP when taking cefepime?

furry overgrowth on the tongue vaginal itching/discharge loose/foul-smelling stools fever blood, pus, or mucous in stool

What signs/symp should a patient report to HCP when taking cefotaxime?

furry overgrowth on the tongue vaginal itching/discharge loose/foul-smelling stools fever blood, pus, or mucous in stool

What signs/symp should a patient report to HCP when taking imipenem?

furry overgrowth on the tongue vaginal itching/discharge loose/foul-smelling stools fever blood, pus, or mucous in stool

What sings/symp would you report to HCP when taking cefoxitin?

furry overgrowth on the tongue vaginal itching/discharge loose/foul-smelling stools fever blood, pus, or mucous in stool

What kind of diet should someone who takes prednisone have?

high protein, calcium, and potassium with low sodium and carbohydrates. no alcohol

What signs/symp should patients report with gentamicin?

hypersensitivity tinnitus vertigo hearing loss rash dizziness difficulty urinating

What are the contraindications for cefotaxime?

hypersensitivity to cephalosporins serious hypersensitivity to penicillins renal impairment history of GI disease

What are contraindications of cephalexin?

hypersensitivity to cephalosporins serious hypersensitivity to penicillins renal impairment history of GI disease, especially colitis

What would happen if you mixed imipenem with ganciclovir and cyclosporine?

increase risk of seizures

What is prednisone used for?

inflammatory, allergic, hematologic, neoplastic, and autoimmune disorders; alternate day dosing in the management of chronic illness; adjunctive therapy of hypercalcemia; adjunctive management of nausea and vomiting during chemotherapy

What do fluroquinolones do?

inhibit DNA synthesis in bacteria

What do macrolides do?

inhibit bacterial protein synthesis by binding to the 50s ribosomal subunit, thus preventing movement of the ribosome along the mRNA

What do sulfonamides do?

inhibit folic acid synthesis in bacteria

What do "azoles" do?

inhibit the synthesis of membrane sterols (fungi)

What does vancomycin do?

inhibits bacteria cell wall synthesis

What does metronidazole do?

inhibits nucleic acid synthesis in bacteria

What do "VIRS" do?

inhibits viral replication by suppressing synthesis of viral DNA

What should a patient taking metronidazole avoid?

intake of alcoholic beverages or preparations containing alcohol during and for at least 3 days after treatment (vaginal gel)

Why do you not take aminoglycosides with cefoxitin?

it may increase risk of nephrotoxicity

Why would you not use cephalexin with aminoglycosides or loop diuretics?

it may increase the risk of renal toxicity

What are the lab considerations for cefotaime?

may cause false positive Coombs test (esp in patients with azotemia) may cause increased increased AST, ALT, LDH, BUN, alkaline phosphatase, bilirubin, and serum creatinine may cause false increased serum urine creatinine test results may rarely cause leukopenia, neutropenia, agranulocytosis, thrombocytopenia, and eosinophilia

What are the lab considerations for cefoxitin?

What are the lab considerations with cephalexin?

may cause false positive for Coombs test may cause increase in AST, ALT, LDH, BUN, alkaline phosphate, bilirubin, and creatinine may cause neutropenia, thrombocytopenia, and eosinophilia (rare)

Why do you not take Penicillin with oral contraceptives?

may decrease effectiveness of the oral contraceptives

Why do you not take amoxicillin with allopurinol?

may increase frequency of rash

Why would you not use prednisone with insulin/oral hypoglycemics?

may increase requirements

What happens when you mix cefotaxime, aminoglycosides, NSAIDs, and loop diuretics?

may increase risk of nephrotoxicity

Why would you not use prednisone with fluroquinolones?

may increase risk of tendon rupture

What is trimethoprim?

not a sulfonamide but commonly given with sulfonamides

Should a patient treat diarrhea when on Penicillin G + V?

not without consulting a HCP

How are cortisone and hydrocortisone used?

often used as a topical agent

Should acyclovir be used during pregnancy and lactation?

only if maternal benefit outweighs infant/fetal risk

Should you use ciprofloxacin in children 1-17 y/o?

only if no alternatives due to possible arthropathy.

Should you use cefotaxime while pregnant and lactating?

only if the benefit is greater than the risks

Should you take ciprofloxacin with dairy?

only take ciprofloxacin 1 hr before or 2 hr after consuming dairy.

What is nystatin used for?

only used for candidiasis (yeast fungal infection) of skin, mouth, esophagus, and vagina.

What is griseofulvin used for?

only used to treat superficial mycoses (such as with fungal nail infection)

What "VIRS" are used for influenza?

oseltamivir, zanamivir, and peramivir

What are the adverse rxns to gentamicin?

ototoxicity (vestibular and cochlear) nephrotoxicity muscle paralysis (high parenteral doses) ataxia vertigo hypersensitivity reactions

Who is prednisolone used with?

pediatric patients

What is Penicillin G + V used for?

pneumococcal pneumonia streptococcal pharyngitis syphilis gonorrhea strains enterococcal infections prevention of rheumatic fever treatment of Lyme disease septicemia in children with sickle cell

What are the lab considerations with Penicillin G + V?

positive direct Coombs' test result hyperkalemia serum sodium in patients with HF or hypertension hypernatremia increased AST, ALT, LDH, and serum alkaline phosphate leukopenia neutropenia

What is Betamethasone used for?

pre-term labor to help the pre-term infant's lungs

What are the intermediate acting glucocorticoids?

prednisolone and methylprednisolone

What signs/symp should be reported with griseofulvin?

rash, sore throat, fever, diarrhea, or soreness of mouth or tongue

What are the lab considerations with fluconazole?

renal and liver function

Why do you not stop glucocorticoids suddenly?

results in adrenal insufficiency; must be tapered

What is gentamicin used for?

serious gram negative infections

What are the lab considerations with amoxicillin?

serum alkaline phosphatase (goes up) LDH, AST, ALT concentrations (goes up) false-positive direct Coombs' test result

What are the lab considerations with prednisone?

serum sodium (goes up) serum calcium and potassium (goes down) glucose (goes up) hematologic values WBC count (goes down) serum cholesterol and lipid values (goes up) uptake of thyroid hormones (goes down)

What signs/symp should a patient report with fluconazole?

skin rash, abdominal pain, fever, or diarrhea

What signs/symp should the patient report to the HCP with trimethoprim?

skin rash, sore throat, fever, mouth sores, or unusual bleeding or bruising

What is cefotaxime used for?

skin/skin structure infections bone/joint infections gynecological infections (including gonorrhea) lower respiratory infection intra-abdominal infections septicemia meningitis lyme disease preoperative prophylaxis

What is amoxicillin used for?

skin/skin structure infections otitis media sinusitis respiratory infections genitourinary infections endocarditis prophylaxis postexposure inhalational anthrax prophylaxis management of ulcer disease due to H. pylori Lyme disease in children <8 yr

What is cephalexin used for?

skin/skin structure infections respiratory tract infections otitis media urinary tract infections bone infections

What are Penicillin G + V active against?

streptococci staphylococci Bacillus anthracis (anthrax) Neisseria meningitidis (meningitis) N. gonorrhoeae (gonorrhea) Borrelia burgdorferi (Lyme disease)

What is amoxicillin active against?

streptococci pneumococci enterococci Haemophilus influenzae (flu) E. coli Proteus mirabilis (Proteus infections) Neisseria meningitidis (meningitis) N. gonorrhoeae (gonorrhea) Shigella Chlamydia trachomatis (Chlamydia) Salmonella Borrelia burgdorferi (Lyme disease) H. pylori (ulcer)

What should patients taking tetracycline wear when outside?

sunscreen and protective clothing

What signs/symp should the patient notify a HCP of when taking Penicillin G + V?

superinfection fever diarrhea stool containing blood, pus, or mucous

What signs/symp should the patient notify a HCP of when taking amoxicillin?

superinfection fever diarrhea stool containing blood, pus, or mucous

What signs/symp should the patient notify a HCP of when taking cephalexin?

superinfection fever diarrhea stool containing blood, pus, or mucous

What do glucocorticoids do? (pharm)

suppression of inflammation and immune response; this is needed in high doses

What does amphotericin B treat?

systemic mycoses (fungus) infections

Why should a patient avoid alcohol with griseofulvin?

tachycardia, flushing, and ↑ CNS depression may result

How should a patient take trimethoprim?

take medication and to finish medication completely as directed, even if feeling better, and take missed doses as soon as remembered

How should ciprofloxacin be taken?

take medication as directed at evenly spaced times and to finish drug completely, even if feeling better, take missed doses as soon as possible (unless within 6 hr of next dose)

How does someone take metronidazole?

take medication as directed with evenly spaced times between doses, even if feeling better

How should fluconazole be taken?

take medication as directed, even if feeling better, doses should be taken at the same time each day

What drugs cause hypokalemia with prednisone?

thiazide, loop diuretics, amphotericin B, piperacillin, ticarcillin and digoxin

What does metronidazole do?

treats: C. Diff infections Gardnerella vaginalis (female genital infection) H. pylori associated with peptic ulcer disease

What is cefepime used for?

uncomplicated skin/skin structure infections bone and joint infections uncomplicated and complicated UTI Respiratory tract infections. complicated intra-abdominal infections septicemia febrile neutropenic patients

What medicine is the main treatment of MRSA?

vancomycin

What assessments do you do with imipenem?

vital signs appearance of wound sputum, urine, stool (sign of infection) WBC history of previous rxns to penicillins a obtain specimen for culture and sensitivity observe for sign/symp of anaphylaxis

What assessments do you do with cefepime?

vital signs appearance of wound sputum, urine, stool (sign of infection) WBC history of previous rxns to penicillins and cephalosporins obtain specimen for culture and sensitivity observe for sign/symp of anaphylaxis Monitor bowel function (CDAD)

What assessments do you do with cefotaxime?

What assessments do you do with ceftaroline?

What assessments should you do with cephalexin?

What assessments would you do with cefoxitin?

What assessments should you do with ciprofloxacin?

vital signs appearance of wound, sputum, urine, stool WBC urinalysis frequency and urgency of urination cloudy or foul-smelling urine Obtain specimens for culture and sensitivity Observe for signs and symptoms of anaphylaxis Monitor bowel function.

What assessments do you do with gentamicin?

vital signs wound appearance sputum urine stool WBC culture and sensitivity evaluate eighth cranial nerve function by audiometry Monitor blood levels periodically

What signs/symp should a patient report to a HCP when taking erythromycin?

vomiting diarrhea severe abdominal pain yellow discoloration of the skin or eyes darkened urine pale stools unusual tiredness fever if stool contains blood, pus, or mucus

How should a patient apply topical gentamicin?

wash affected skin gently and pat dry, apply a thin film of ointment, apply occlusive dressing (only if ordered by health care professional)

What are the adverse rxns to ciprofloxacin?

●AORTIC ANEURYSM/DISSECTION ●HEPATOTOXICITY ●ELEVATED INTRACRANIAL PRESSURE ●SEIZURES ●SUICIDAL THOUGHTS ●CDAD ●HYPERSENSITIVITY RXNS ●photosensitivity ●rash ●hyperglycemia ●hypoglycemia ●abdominal pain ●↑ liver enzymes ●vaginitis ●arthralgia ●myalgia ●tendinitis ●tendon rupture ●peripheral neuropathy ●agitation ●confusion ●depression ●dizziness ●drowsiness ●hallucinations ●headache ●Insomnia ●nightmare ●paranoia ●toxic psychosis ●tremor

What are the contraindications for ciprofloxacin?

●Hypersensitivity (cross-sensitivity within class may exist) ●History of myasthenia gravis ●Concurrent use with tizanidine ●Patients with or at ↑ risk for aortic aneurysm (use only if no alternatives) ●Avoid breastfeeding during treatment and for 2 days after final dose (except for anthrax)

What are the assessments for amphotericin B?

●Monitor patient closely during test dose and the first 1-2 hr of each dose for fever, chills, headache, anorexia, nausea, or vomiting ●Assess injection site frequently for thrombophlebitis or leakage ●Monitor vital signs every 15 min during test dose and every 30 min for 2-4 hr after administration. ●Assess respiratory status (lung sounds, dyspnea) daily ●Monitor intake and output and weigh daily, adequate hydration (2000-3000 mL/day)

What signs/symp should a patient report to a HCP when taking ciprofloxacin?

●fever and diarrhea develop (especially if stool contains blood, pus, or mucus) ●hepatotoxicity (anorexia, jaundice, dark urine, pruritus, or tender abdomen) ●rash ●signs of hypersensitivity ●serious CNS effects ●peripheral neuropathy (pain, burning, tingling, numbness, and/or weakness, or other alterations in sensations including light touch, pain, temperature, position sense and vibratory sensation, and/or motor strength) ●tendon (shoulder, hand, Achilles, and other) pain swelling ●inflammation

What are the assessments for metronidazole?

●vital signs ●appearance of wound, sputum, urine, and stool ●WBC ●Obtain specimens for culture and sensitivity ●Monitor neurologic status during and after IV infusions. (numbness, paresthesia, weakness, ataxia, or seizures) ●Monitor intake, output, and daily weight ●Assess for rash periodically during therapy (SJS)

Arrange the steps required to stimulate antibody-mediated immunity in the sequence they occur. 1. Invasion of new antigens in the body 2. Interaction of the macrophage and helper T cells to recognize the antigen 3. Sensitization of B lymphocyte to the new antigen 4. Production of antibodies by B lymphocytes 5. Binding of antibodies to the antigen and formation of immune complex 6. Neutralization or elimination of the antigen

1, 2, 3, 4, 5, 6

Arrange the pathophysiological events of acne in the correct sequence. 1. Excessive sebum production 2. Alterations in follicular growth and differentiation 3. Immune response and inflammation 4. Colonization of Propionibacterium acnes

1, 2, 4, 3

How long should someone wait to take doxycycline after taking supplements?

1-3 hr

The nurse is teaching unlicensed assistant personnel about ways to prevent the spread of infection. The nurse decides to emphasize the need to break the cycle of infection. Which teaching would be priority? A. Hand washing before and after providing client care B. Cleaning all equipment with an approved disinfectant after use C. Wearing personal protective equipment (PPE) when providing client care D. Using medical and surgical aseptic techniques at all times

What is cefotaxime active against?

Acinetobacter Citrobacter Enterobacter Haemophilus influenzae Haemophilus parainfluenzae E. coli Klebsiella pneumoniae Morganella morganii N. gonnorhoeae and meningitidis Proteus Providencia Serratia Moraxella catarrhalis Borrelia bugdorferi Bacteroides fragilis *not active against methicillin-resistant staphylococcus

What is ceftaroline used for?

Acute bacterial skin/skin structure infections Community acquired pneumonia

What is the broad spectrum penicillin?

Amoxicillin

How should tetracycline be taken?

Around the clock and finish completely, even if feeling better

How should doxycycline be taken?

Around the clock and finished completely, even if feeling better.

How should you take erythromycin?

Around the clock and until finished, even if feeling better.

What assessments should you do with Penicillin G + V?

Assess for infection History of reactions to penicillin, cephalosporins, and other beta-lactam antibiotics Obtain specimens for culture and sensitivity Observe for signs/symp of anaphylaxis

What assessments would you do with fluconazole?

Assess infected area and monitor CSF Obtain specimens for culture Assess patient for rash (mild to moderate rash usually occurs in the 2nd wk of therapy and resolves within 1-2 wk of continued therapy).

What assessments should be done with acyclovir?

Assess lesions before and daily during therapy. Monitor frequency of recurrences. Monitor neurologic status in patients with herpes encephalitis.

What labs should be done with acyclovir?

BUN, serum creatinine, and CCr

What labs should be done with amphotericin B?

CBC BUN Kidney function

What are the fluoroquinolones noted?

Ciprofloxacin (prototype), ofloxacin, moxifloxacin, levofloxacin, gemifloxacin

What are the adverse rxns with doxycycline?

DRESS ERYTHEMA MULTIFORME EXOFOLIATIVE DERMATITIS SJS TOXIC EPIDERMAL NECROLYSIS CDAD HEPATOTOXICITY PANCREATITIS photosensitivity glossitis

What is the long acting tetracycline?

Doxycycline

What is cefepime active against?

Enterobacter Haemophiles influenzae E.coli Klebsiella pneumoniae Neisseria Proteus Providencia Pseudomonas aeruginosa Serratia Moraxella catarrhalis

What are the lab considerations for cefepime?

Fales positive Coombs test Increase ALT, AST, bilirubin, BUN, and serum creatinine

What is the brand name for metronidazole?

Flagyl

What are the narrow spectrum penicillins?

G+V

What is tetracycline used for?

Gonorrhea and syphilis Prevention of exacerbations of chronic bronchitis Treatment of acne Various infections: -Mycoplasma -Chlamydia -Rickettsia -Borrelia burgdorferi

What is acyclovir used for?

Herpes simplex

How toxic is amphotericin B?

Highly toxic (most toxic in this unit)

What are the contraindications of imipenem?

Hypersensitivity Cross-sensitivity with penicillins and cephalosporins Pregnancy Children with CNS infections

What are contraindications of amoxicillin?

Hypersensitivity to penicillins severe renal imparement infectious mononucleosis acute lymphatic leukemia cytomegalovirus infection

What is erythromycin used for?

IV+PO o Upper and lower respiratory infections o Otitis media o Skin/skin structure infections o Pertussis o Diptheria o Erythrasma o Intestinal amebiasis o Pelvic inflammatory disease o Nongonococcal urethritis o Syphilis o Legionnaire's disease o Rheumatic fever o Streptococcal infections o Gonorrhea Topical o Acne

How is cefepime administered?

IV, IM

What do carbapanems do?

Inhibit bacteria cell wall synthesis

What do cephalosporins do?

Inhibit bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins, causing the cell wall to break apart and kills bacteria. Caution with severe penicillin allergy

What does NYSTATIN do?

Inhibits fungal wall synthesis leading to cell leakage and death

What assessments should be done with nystatin?

Inspect oral mucous membranes before and frequently during therapy

What are the adverse rxns of tetracycline?

Intracranial hypertension Diarrhea Esophagitis Photosensitivity Blood dyscrasias

Why do you not take gentamicin with loop diuretics?

It may increase ototoxicity

What are the contraindications for ceftaroline?

Known serious hypersensitivity to cephalosporins Pregnancy

What are the lab considerations with erythromycin?

Liver function

Why do you not take erythromycin with pimozide?

May increase risk of serious arrhythmias

What are the lab considerations with imipenem?

May increase: BUN AST ALT LDH serum alkaline phosphatase bilirubin and creatinine May decrease: Hemoglobin and hematocrit concentrations

Why do you not take ciprofloxacin with tizanidine?

May ↑ risk of hypotension and sedation

What are the lab considerations with vancomycin?

Monitor for: Casts Albumin Cells in urine Decreased specific gravity CBC Renal function May cause increased BUN lvls

why would you prefer to rake one generation of cephalosporin over the other?

More gram negative coverage with each generation

Should you admix imipenem with aminoglycosides?

Should you take doxycycline with calcium?

Should you take tetracycline with calcium/dairy products?

How is doxycycline administered?

PO and IV

How is tetracycline administered?

What are the contraindications of tetracycline?

Pregnant/breast feeding women Children under 8 y/o (staining of teeth) Hypersensitivity

What is ribavirin used for?

RSV, chronic Hep C

What are the lab considerations with doxycycline?

Renal and hepatic function CBC

What are the lab considerations with tetracycline?

Renal and hepatic function CBC

What is vancomycin active against?

Staphylococci Group A beta-hemolytic streptococci Streptococcus pneumoniae Corynebacterium C. diff Enterococcus faecalis Enterococcus faecium

What is cephalexin active against?

Streptococcus pneumoniae group A beta-hemolytic streptococci staphylococci (including penicillinase-producing strains) E. coli Haemophilus influenzae (flu) Klebsiella pneumoniae (UTI) Moraxella catarrhalis Proteus Enterococcus *not active against anaerobes

What are the adverse rxns of erythromycin?

TORSADES DE POINTES CDAD HYPERSENSITIVITY RXNS ototoxicity abdominal pain infantile hypertrophic pyloric stenosis interstitial nephritis

What should a patient taking tetracycline do before treatment or surgery?

Tell HCP about medication

What do aminoglycosides do?

They bind the 30S and inhibit the formation of the initiation complex and causes the misreading of mRNA.

What sulfonamide is used for burns?

Topical silver sulfadiazine

What assessments do you do with tetracycline?

Vitals Appearance of wound, sputum, and stool WBC Culture and sensitivity

What assessments should you do with doxycycline?

Vitals Appearance of wound, sputum, and stool WBC Culture and sensitivity Monitor bowel function Assess for rash Assess IV site frequently

What assessments should you do with vancomycin?

Vitals Appearance of wound, sputum, and stool WBC Monitor IV site closely Audiometry Intake and output ratios Signs/symps of anaphylaxis (CDAD) Bowel sounds, frequency/consistency of stools, presence of blood in stool

What does chronic treatment of prednisone lead to?

adrenal suppression

What are the adverse rxns to trimethoprim?

altered taste epigastric discomfort glossitis drug-induced hepatitis pruritus rash megaloblastic anemia neutropenia thrombocytopenia fever

What should the fluid intake be with ciprofloxacin?

at least 1500-2000 mL/day

What are the long acting glucocorticoids?

betamethasone and dexamethasone

What does amphotericin B do?

binds to fungi cell membrane, increasing permeability

What is the fourth generation cephalosporin?

cefepime

What is the third generation cephalosporin?

cefotaxime

What is the second generation cephalosporin?

cefoxitin

What is the fifth generation cephalosporin?

ceftaroline

What is the first generation cephalosporin?

cephalexin

How should griseofulvin be taken?

complete full course of therapy; several wk of therapy may be necessary

What should the caregiver know about amphotericin B?

dilution, rate, and administration of drug and proper care of IV equipment

Why would you not use prednisone with live virus vaccines?

due to decreased antibody response and increased risk of adverse rxns

What can nystatin do to clothes or hair?

dye it

What does broad spectrum mean?

effect various groups of microorganisms; more toxic

What are the "AZOLES" noted?

fluconazole (prototype), itraconazole, ketoconazole, clotrimazole, and miconazole

How should someone take care of dry mouth from medication?

frequent mouth rinses, good oral hygiene, and sugarless gum or candy

What are contraindications of cefoxitin?

hypersensitivity to cephalosporins serious hypersensitivity to penicillins renal imparement history of GI disease

Why would you not use prednisone with NSAIDs?

increases risk of adverse GI effects

What is dexamethasone used for?

inflammation of the brain and spine, and eyes

What does griseofulvin do?

inhibits fungal mitosis

What are contraindications of prednisone?

lactation, active untreated infections, OB

What signs/symp should a patient report to HCP when taking ceftaroline?

loose/foul-smelling stools fever blood, pus, or mucous in stool

What is cefoxitin used for?

lower respiratory tract infections skin/skin structure infections urinary tract infections gynecological infections intra-abdominal infections septicemia preoperative prophylaxis

What are contraindications of Penicillin G + V?

previous hypersensitivity to penicillin severe renal insufficiency OB lactation

What do glucocorticoids do? (patho)

raise blood glucose levels by stimulating gluconeogenesis in the liver, stress hormones, affect fat/protein metabolism (low doses)

What should patients taking metronidazole for trichomoniasis do?

refrain from intercourse or use a condom to prevent reinfection (sexual partners may be asymptomatic sources of reinfection and should be treated concurrently)

When taking amoxicillin, what should you teach patients with a history of rheumatic heart disease or a valve replacement?

the importance of using antimicrobial prophylaxis before invasive medical or dental procedures.

What is the use for neomycin?

used as an eye ointment for newborns

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chapter 11

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