NUR266 MEDS Ch 9: Antibiotics - arnold
The health care provider is preparing to order rifampin and pyrazinamide for a female client with active tuberculosis. What question should the provider ask this client before confirming this order? "Do you have a family history of diabetes?" "Have you ever experienced a miscarriage?" "Are you allergic to penicillin?" "Are you pregnant?"
"Are you pregnant?" Explanation: Pyrazinamide and streptomycin are contraindicated in pregnancy. A regimen of INH, rifampin, and ethambutol is usually used in the treatment of pregnant women.
The client has been diagnosed with a serious infection caused by gram-negative aerobic bacilli. The client has been prescribed IV gentamicin. What statement by the client should the nurse follow up most promptly? "I feel like I'm having trouble hearing the last little while." "I've got this pounding headache that never seems to go away." "I definitely feel like my appetite has suffered since I started these antibiotics." "My IV site feels really itchy a lot of the time."
"I feel like I'm having trouble hearing the last little while." Gentamicin is associated with serious and possibly irreversible ototoxicity, which must be addressed immediately. For this reason, it is a priority over anorexia, headache or pruritis at the IV
The nurse is caring for a client whose prescribed course of cefaclor will soon be completed. What health education should the nurse provide to the client? "Remember to have your required blood work drawn in 48 hours." "It's possible that your urine might be pink-tinged for the next little while, but that's expected and it will resolve." "You might develop a mild fever when you finish your antibiotics, but that doesn't mean your infection has returned." "Make sure to avoid drinking any alcohol for the next three days."
"Make sure to avoid drinking any alcohol for the next three days." Explanation: To avoid a disulfiram-like reaction when alcohol and cephalosporins are used together, the client should avoid consuming alcoholic beverages for at least 72 hours after completing the drug course.
A middle-aged client with a complex history has begun multidrug treatment for TB. Which assessment question is most therapeutic? "What do your friends and family think about the fact that you're getting treated for TB?" "Have you given any thought to the choices you made that resulted in your getting tuberculosis?" "What can we do to help you stop smoking?" "What kinds of routines would work for you to ensure that you don't miss doses of your rifampin?"
"What kinds of routines would work for you to ensure that you don't miss doses of your rifampin?" Explanation: Assessments and interventions related to adherence to therapy are always a priority in the care of clients who have TB.
A client is diagnosed with an infection attributable to the gram-negative microorganism Pseudomonas. Which anti-infective agent is most reliable in treating this microorganism? Aminopenicillin Antifungal GABA analog Aminoglycoside
Aminoglycoside Aminoglycosides penetrate the cell walls of susceptible bacteria. As a result, the bacterial cell membrane becomes defective and cannot synthesize the proteins necessary for their function and replication. Aminoglycosides are used to treat infections caused by gram-negative microorganisms, such as Pseudomonas. Antifungals are effective in the resolution of fungus infections. Aminopenicillin agents are not effective in treating gram-negative microorganisms. A GABA analog is used to treat pain related to neuropathy.
A client who takes zinc daily is diagnosed with a severe infection and is ordered levofloxacin (Levaquin). The nurse is aware that taking these two drugs may have what affect on the antibiotic? Increased elimination Decreased absorption Decreased elimination Increased absorption
Decreased absorption Explanation: Antacids, iron salts and zinc can cause decreased absorption of the antibiotic. There is no affect on elimination of the antibiotic.
A nurse is caring for a 6-year old child with a severe case of typhoid fever. The client was mistakenly administered tetracycline, which can cause adverse reactions. What could be a permanent effect in the child? Epigastric distress Visual disturbances Abdominal pain or cramping Discoloration of the teeth
Discoloration of the teeth Explanation: Tetracyclines cause permanent yellow-gray-brown discoloration of the teeth in children less than 9 years of age. Epigastric distress is not a permanent effect of the drug. Abdominal pain or cramping and visual disturbances are adverse reactions of macrolides.
A client has been prescribed ciprofloxacin IV for the treatment of cellulitis. After initiating the infusion of the client's first scheduled dose, the client develops a pronounced rash on the chest and arms. How should the nurse respond initially to this event? Administer an STAT dose of acetylcysteine. Slow down the rate so that the infusion takes place over 2 hours. Discontinue the infusion and inform the health care provider promptly. Administer oral diphenhydramine to the client during the infusion.
Discontinue the infusion and inform the health care provider promptly. Explanation: Severe hypersensitivity reactions have occurred with the administration of fluoroquinolones. The nurse discontinues the antibiotic immediately if skin rash or other signs or symptoms occur.
The nurse is performing an assessment on a 7-year-old child in the clinic. The nurse observes the child's teeth are darkly stained. What information should the nurse obtain from the parent? Has the child taken a cephalosporin for treatment? Has the child taken a sulfonamide for treatment? Has the child taken tetracycline for treatment? Has the child taken a corticosteroid for treatment?
Has the child taken tetracycline for treatment? Tetracycline administered to a child between the ages of 4 months and 8 years will stain the permanent teeth.
The nurse is preparing to administer a sulfonamide to a client who is a Type 2 diabetic taking an oral hypoglycemic agent. The nurse will monitor the client for what reaction? Hypoglycemia Hyperglycemia Increased bruising Elevated temperature
Hypoglycemia Explanation: Diabetic clients who take a sulfonamide may experience a hypoglycemic reaction because the sulfonamides may inhibit the hepatic metabolism of the oral hypoglycemic drugs tolbutamide and chlorpropamide.
A client being treated for tuberculosis is determined to be drug resistant. Which medications will no longer be effective in the treatment of the tuberculosis? Dextroamphetamine and doxapram Isoniazid and rifampin Propranolol and sotalol Carbamazepine and phenytoin
Isoniazid and rifampin Isoniazid and rifampin are used to treat tuberculosis. In multidrug resistance, the most effective drugs the client is resistant to are isoniazid and rifampin. Carbamazepine and phenytoin are used to control seizures. Dextroamphetamine and doxapram are central nervous system stimulants. Propranolol and sotalol are beta-adrenergic blocking agents.
The physician has prescribed cotrimoxazole to a 1-month-old infant for an infection. The nurse knows that this medication is contraindicated because of the potential for what health problem? Hepatotoxicity Kernicterus Nephropathy Neuropathy
Kernicterus Use in pregnant women at term, in children younger than 2 months (except for treating congenital toxoplasmosis), and in mothers nursing infants younger than 2 months is also contraindicated because sulfonamides may promote kernicterus (staining of certain areas of the brain by bilirubin) in the newborn by displacing bilirubin from plasma proteins.
A client is receiving rifampin and isoniazid in combination for treatment of tuberculosis. What would the nurse need to monitor closely? Audiometric studies Urine culture Pulmonary function studies Liver function studies
Liver function studies Explanation: When rifampin and isoniazid are used in combination, the possibility of toxic liver reactions increases, requiring close monitoring. Urine culture would not need to be monitored. Audiometric studies would be monitored for clients receiving ototoxic drugs such as aminoglycosides.
A young lifeguard has been prescribed moxifloxacin (Avelox). The nurse understands that the focus on education would be which adverse reaction? Fatigue Muscle cramping Photosensitivity Weakness
Photosensitivity Explanation: The lifeguard will be in the sun, and he is at risk for an exaggerated skin reaction. Weakness, fatigue and muscle cramping are not know adverse reactions to this medication, therefore with the client's job, photosensitivity is the highest priority.
The nurse is caring for a child weighing 30 kg. The healthcare provider orders gentamicin 100 mg IV three times per day. The recommended dosage range is 6 to 7.5 mg/kg/day. What action should the nurse take? Question the prescriber about the dosage of the medication. Administer the medication and assess hearing frequently. Question the prescriber about the frequency of administration. Administer the medication and assess renal function frequently.
Question the prescriber about the dosage of the medication. it's over the daily max
Erythromycin is sometimes used as a penicillin substitute. For prevention of what condition might a nurse note a substitute of erythromycin for penicillin? Syphilis Botulism Meningitis Community-acquired pneumonia
Syphilis Explanation: Erythromycin is used as a penicillin substitute for prevention of rheumatic fever, gonorrhea, syphilis, pertussis, and chlamydial conjunctivitis in newborns.
A patient has been prescribed oral tetracycline for the treatment of acne. Which of the following must the nurse include in the patient teaching plan? Take the drug along with a meal. Take the drug on an empty stomach. Take the drug immediately after meals. Take the drug along with milk or fruit juice.
Take the drug on an empty stomach. Explanation: Oral preparations of tetracycline should be administered on an empty stomach with a full glass of water to maximize absorption. Tetracycline is not absorbed effectively if taken with food, dairy products, or immediately after meals.
The nurse understands that which is the highest priority when teaching about antitubercular medications? Staying hydrated Eating a well balanced diet Monitoring sputum Taking medications as prescribed
Taking medications as prescribed Explanation: For medications to be effective, it is most important that the nurse reinforce to the client that medications should be taken as prescribed and there should be no missed doses
The nurse will notify the health care provider immediately if the client taking amoxicillin for otitis media is also taking what medication? Tetracycline for acne Aspirin for prevention of blood clots Acetaminophen for pain Ibuprofen for fever
Tetracycline for acne Tetracycline, if taken with amoxicillin, inhibits the action of amoxicillin.
Which statement is true in regards to the oral administration of tetracyclines? Tetracyclines should be administered on a full stomach. Tetracyclines should only be administered in the evening. Tetracyclines should only be administered in the morning. Tetracyclines should be administered with a full glass of water.
Tetracyclines should be administered with a full glass of water. Tetracyclines should always be administered with a full glass of water and on an empty stomach (except minocycline and tigecycline may be taken with food).
A client, being treated for latent tuberculosis (TB) on an out-client basis, tells the nurse, "I've been feeling pretty good lately, so I haven't actually been all that consistent with taking my drugs." Subsequent health education by the nurse should focus on what subject? The fact that nonadherence to treatment exacerbates the risks of adverse effects The need to match drug dosages carefully to signs and symptoms The fact that nonadherence will necessitate the use of antiretrovirals The need to consistently take the prescribed drugs in order to cure TB
The need to consistently take the prescribed drugs in order to cure TB Explanation: Consistent adherence to treatment is imperative to ensure successful treatment of TB. Nonadherence leads to resistance and unsuccessful treatment, not increased adverse effects. Nonadherence has no relationship with matching dosage with signs and symptoms. Antivirals are ineffective against TB.
The nurse is giving discharge instructions to a woman who will be taking amoxicillin for treatment of acute otitis media. The nurse teaches the client that which symptom indicates the development of a superinfection and should be reported to the physician? Swelling and itching of the throat Nausea Vaginal itching and discharge Abdominal pain
Vaginal itching and discharge Explanation: A vaginal infection in a client who is taking amoxicillin is an example of a superinfection. The nausea and abdominal pain are adverse effects of the medication, and swelling and itching of the throat are an example of possible allergy to the drug.
When describing how tetracyclines treat infection, the nurse would incorporate which information into the description? inhibiting bacterial cell wall synthesis depolarizing the bacterial cell wall inhibiting bacterial protein synthesis inhibiting bacterial DNA gyrase
inhibiting bacterial protein synthesis Tetracyclines treat infection by inhibiting bacterial protein synthesis. Penicillins inhibit cell wall synthesis. Tetracyclines do not inhibit DNA or the depolarization of the cell wall.
What route of administration is most commonly used for the administration of ciprofloxacin when prescribed to an older adult client? intramuscular (IM) intravenous (IV) oral (PO) subcutaneous (SQ)
oral (PO) While ciprofloxacin is typically administered by the PO or IV route, in most cases, oral administration is used. The medication is NOT administered by either the SQ or IM routes.
The nurse is caring for a client who requires administration of an aminoglycoside. The nurse should perform focused assessments related to what adverse reactions? Select all that apply. nephrotoxicity liver necrosis glaucoma hypoglycemia ototoxicity
ototoxicity nephrotoxicity : Aminoglycosides accumulate in high concentrations in the proximal renal tubules of the kidney leading to acute tubular necrosis. This damage to the kidney is termed nephrotoxicity. They also accumulate in high concentrations in the inner ear, damaging sensory cells in the cochlea and the vestibular apparatus. This damage to the inner ear is termed ototoxicity. None of the other options are associated with adverse reactions to aminoglycosides.
A nurse is speaking to a 62-year-old female client who has been started on sulfisoxazole, a sulfonamide antibiotic. The nurse should teach this client to contact the health care provider if the client experiences what adverse effect associated with the drug? polydipsia skin rash or itching tachycardia dizziness
skin rash or itching Explanation: Clients taking sulfonamides should be instructed to contact the prescriber if they experience skin rash or itching. These symptoms may indicate a sulfonamide-induced allergic reaction and the need to change or stop the drug.
The nurse is preparing a teaching plan for a client who is prescribed ceftriaxone. What should the nurse identify as common adverse effects associated with this drug? Lethargy and paresthesias Diarrhea and nausea Headache and dizziness Superinfections and phlebitis
Diarrhea and nausea Explanation: The most common adverse effects associated with ceftriaxone, a cephalosporin, include those affecting the GI tract, such as nausea, vomiting, diarrhea, abdominal pain, and flatulence. Headache, dizziness, lethargy, and paresthesias can occur as well as superinfections and phlebitis (with IV administration), but these are not the most common.
A nurse is caring for a 6-year old child with a severe case of typhoid fever. The client was mistakenly administered tetracycline, which can cause adverse reactions. What could be a permanent effect in the child?
Discoloration of the teeth
The nurse is providing client teaching before discharging a client home. The client is taking ciprofloxacin. What action should the nurse encourage the client to prioritize? Drink at least 2L of fluid per day. Eliminate red meat and seafood from the diet. Minimize sodium intake. Avoid all caffeine and alcohol.
Drink at least 2L of fluid per day. Clients should be encouraged to drink a lot of fluids and maintain nutrition, even though nausea, vomiting, and diarrhea may occur. There is no need to eliminate red meat, seafood, caffeine, or alcohol from the diet, although alcohol may increase the risk of GI irritation. There is no need to minimize sodium intake.
A nurse is caring for a patient who is being administered penicillin. What are the common adverse reactions to penicillin a nurse should assess for? Inflammation of the tongue and mouth Impaired oral mucous membranes Severe hypotension Sudden loss of consciousness
Inflammation of the tongue and mouth Explanation: Some of the common adverse effects of penicillin are glossitis (inflammation of the tongue), stomatitis (inflammation of the mouth), and gastritis (inflammation of the stomach). Unless severe, the drug may be continued as prescribed and the nurse would intervene to help the patient manage the common adverse reactions. Impaired oral mucous membranes are signs of a fungal superinfection in the oral cavity, whereas severe hypotension and sudden loss of consciousness are signs of an anaphylactic shock; these are not common adverse effects of penicillin and require immediate medical attention.
A middle-aged patient has been prescribed tetracycline as part of his Prevpac for the treatment of H. pylori. The patient has a history of atrial fibrillation which is being treated with digitalis drugs. Given his history and current medications, the patient is at risk for which of the following conditions? Increase in serum theophylline level Risk of toxicity Increase in serum levels Respiratory depression
Risk of toxicity Explanation: When digitalis drugs interact with tetracyclines, the patient is at a risk for toxicity. Respiratory depression is an effect observed when neuromuscular-blocking drugs interact with lincosamides. Increase in serum levels is observed when digoxin interacts with macrolides. Increase in serum theophylline level occurs when theophylline interacts with macrolides.
Aminoglycosides must be used cautiously in children as in adults. Dosage must be accurately calculated according to which factors? Weight and renal function Height and weight Age and weight Weight and leukocytosis
Weight and renal function Explanation: Aminoglycosides must be used cautiously in children as in adults. Dosage must be accurately calculated according to weight and renal function.
In the rare instance in which penicillin is considered essential, hypersensitivity can be assessed by administering: a loading dose of the medication. the medication in a controlled environment. the medication by the intravenous route only. a skin test.
a skin test. Explanation: In the rare instance in which penicillin is considered essential, a skin test may be helpful in assessing hypersensitivity.
The nurse is assessing a client who has been prescribed treatment with isoniazid. What assessment finding would most likely necessitate contacting the health care provider to recommend discontinuing treatment? jaundice pruritus alopecia persistent nausea
jaundice Explanation: Jaundice is a clear indication of hepatotoxicity and would most likely warrant discontinuing treatment with isoniazid. Nausea would not likely prompt any change in treatment. Pruritus may be associated with liver damage but may also have other potential causes. Alopecia does not typically accompany isoniazid therapy.
After teaching a client who is receiving doxycycline about the drug, the nurse determines that the teaching was successful when the client makes what statement? "I need to wear protective clothing when I'm out in the sun." "I should chew gum and chocolate if my mouth gets sore." "I should limit the amount of fluids that I drink." "I will take the drug with an antacid to prevent an upset stomach."
"I need to wear protective clothing when I'm out in the sun." Explanation: Photosensitivity is possible, so the client should use sunscreen and wear protective clothing when outdoors. Fluids should be increased to promote drug excretion. Ice chips or sugarless candy would be appropriate for combating a sore mouth. The drug should be taken on empty stomach 1 hour before or 2 hours after meals; antacids should not be taken with the drug because they can affect absorption.
A client is being treated for a urinary tract infection with trimethoprim-sulfamethoxazole. What assessment should the nurse make prior to the administration of the medication? Assessing for diabetes mellitus Assessing for renal insufficiency Assessing for the presence of asthma Assessing for hypertension
Assessing for renal insufficiency Explanation: Both tetracyclines and sulfonamides are contraindicated in clients with renal failure because of the risk of increased injury since they are excreted via the kidneys. These medications are not contraindicated in clients with asthma, hypertension, or diabetes mellitus unless there is a preexisting renal issue.
Which of the following are common adverse reactions to rifampin that the nurse should share with the client? Select all that apply. Discoloration of body fluids Rash Joint pain Vertigo Nausea
Discoloration of body fluids Vertigo Nausea Rash Common adverse reactions of rifampin include nausea, vomiting, epigastric distress, heartburn, fatigue, vertigo, rash, reddish-orange discoloration of body fluids, hematological changes, and renal insufficiency.
A client, hospitalized with active tuberculosis, is receiving antitubercular drug therapy. When it becomes apparent that the client is not responding to the medications, what condition will the primary health care provider identify as a possible cause? Methicillin-resistant Staphylococcus aureus Human immunodeficiency virus Drug-resistant tuberculosis Vancomycin-resistant Staphylococcus aureus
Drug-resistant tuberculosis Explanation: A client who is being treated with antitubercular drug therapy and is not responding to the medication regime is most likely experiencing drug-resistant tuberculosis. Human immunodeficiency virus causes tuberculosis to move more rapidly. This scenario does not provide any indication that the tuberculosis is related to the diminished client response. The scenario does not identify methicillin-resistant or vancomycin-resistant Staphylococcus aureus.
A patient who has been on penicillin therapy for several days has developed inflamed oral mucous membranes and swelling in the tongue and the gums. The primary health care provider has diagnosed it as a fungal superinfection of the oral cavity resulting in impaired oral mucous membranes. Which of the following interventions should the nurse perform? Instruct patient to avoid brushing teeth. Inspect mouth and gums regularly. Instruct the patient to gargle every two hours. Offer patient a liquid diet.
Inspect mouth and gums regularly. Explanation: The nurse should regularly inspect the patient's mouth and gums to assess the patient's progress. The nurse should instruct the patient to use a soft-bristled toothbrush. The patient need not follow a liquid diet; a nonirritating soft diet can be recommended. Gargling every two hours may not help relieve the symptoms and may even aggravate the existing condition.
A client, prescribed clindamycin, is now reporting frequent diarrhea. How should the nurse best respond to this client? Reemphasize the importance of taking clindamycin with food. Encourage the client to temporarily use an over-the-counter antidiarrheal. Encourage the client to increase fluid intake until the course of treatment is complete. Liaise with the client's health care provider to have the drug discontinued.
Liaise with the client's health care provider to have the drug discontinued. Explanation: The FDA has issued a black box warning for clindamycin regarding the potential of severe and possible fatal colitis. If diarrhea develops in a client receiving clindamycin, discontinuation of the drug is essential. None of the other suggestions provided by the options are accurate statements regarding clindamycin
In which condition present in the client should macrolides be used with caution? Diabetes mellitus Hypertension Liver dysfunction Glaucoma
Liver dysfunction Explanation: All macrolides should be used with caution in clients with liver dysfunction. Pre-existing liver disease is a contraindication. Diabetes, hypertension and glaucoma are not contraindicated.
A 72-year-old patient with TB is undergoing standard treatment in a health care facility. Which of the following nursing interventions should the nurse perform during ongoing assessment of the treatment? Use DOT to administer the drug to the patient. Monitor for appearance of adverse reactions. Monitor patient's vital signs every 24 hours. Assess patient's history of contacts.
Monitor for appearance of adverse reactions. Explanation: The nurse should monitor for the appearance of adverse reactions in the patient during ongoing assessment of the treatment. The nurse should monitor vital signs of the patient every four hours and not every 24 hours when the patient is hospitalized. The nurse should assess the patient's history of contacts as part of the pre-administration assessment and not as part of the ongoing assessment. DOT can only be used by the nurse to administer antitubercular drugs when the patient is at home, at his place of employment, or in school. DOT is not used when the patient is hospitalized.
A 49-year-old client is diagnosed with TB. The client has a history of alcoholism but has been sober for 3 months now. The client has been prescribed INH. What should the nurse ensure is obtained before initiating the therapy? baseline liver function test values baseline serum glucose levels baseline bone mass determination baseline renal function values
baseline liver function test values For a TB client, the nurse should obtain baseline liver function test values and schedule serial liver function tests throughout therapy. In addition, a nurse should ensure a baseline A1C evaluation for clients who are diabetics, because INH may cause hyperglycemia. Clients with preexisting anemias should have a baseline complete blood count (CBC), because they are at risk for hematologic disorders. For clients with a history of seizures, perform a baseline neurologic examination. Also assess baseline visual acuity. All other assessments such as height, weight, serum glucose level, and bone mass are not applicable to INH therapy.
The health care provider is selecting an antibiotic for a client with a known penicillin allergy. The provider knows that cephalosporins are a poor choice for this client because cephalosporins: can cause allergic reactions in clients who are allergic to penicillins. are ineffective in clients who are allergic to penicillins. are derived from penicillin. can cause kidney damage in clients who are allergic to penicillins.
can cause allergic reactions in clients who are allergic to penicillins. Explanation: Clients who are allergic to penicillins may also be allergic to cephalosporins. Although this cross-allergenicity (allergy to a drug of another class with similar chemical structure) is rare, cephalosporins are not typically administered to clients who have had life-threatening allergic reactions to a penicillin.
The client reports cough, low-grade fever, anorexia, and night sweats. The client has also been coughing up blood at times. What disease does this client most likely have? pneumonia caused by influenza Pneumonitis interstitial infection Kaposi sarcoma tuberculosis
tuberculosis Symptoms of active TB include night sweats, cough, low-grade fever, fatigue, weight loss, and anorexia.
The nurse is caring for a client who is receiving amikacin for the treatment of a serious Staphylococcus aureus infection. What assessment should the nurse prioritize? cardiac monitoring vision assessment skin assessment and monitoring of liver enzyme levels urine output and creatinine clearance
urine output and creatinine clearance Explanation: Aminoglycosides such as amikin come with a black box warning alerting healthcare professionals to the serious risk of nephrotoxicity. Visual alterations are not usually reported in relation to this drug. Similarly, cardiac and liver function are not usually impacted by this drug.