Pharmacology Chapter 9 Antibiotics

A 72-year-old client has been prescribed ciprofloxacin. What instruction for home care has the highest priority?

Take this medication with extra fluid.

Tetracyclines should not be used in children younger than 8 years of age because of their effects on what?

Teeth and bones

Which of the following is true in regards to the oral administration of tetracyclines? (Choose one)

Tetracyclines should be administered with a full glass of water.

A client is diagnosed with an infection and is ordered to receive a fluoroquinolone. Which of the following would the nurse expect upon evaluation?

The client's temperature is returning to normal.

While discussing tuberculosis, the nursing instructor explains that treatment is typically divided into two phases. What is the second phase called?

The continuation phase

A patient is admitted to hospice with the diagnosis of XDR-TB. Knowing some of the contributing factors to this disease, the nurse understands this disease is a major indication of:

The failure to adequately diagnose, prevent, and treat MDR-TB.

The nurse identifies which of the following as the correct method to instill ear drops in the adult patient?

The nurse pulls the pinna of the ear up and back.

The nurse has administered a patient's first scheduled dose of amoxicillin after the patient was diagnosed with acute otitis media. What subsequent assessment finding should prompt the nurse to discontinue the use of this drug?

The patient complains of shortness of breath.

A patient has presented with signs and symptoms characteristic of otitis externa and is requesting prescription ear drops. The nurse would recognize that the safe and effective use of Cortisporin Otic would be contraindicated by what variable?

The patient's infection is thought to have a viral etiology.

A patient is to begin taking tobramycin (Nebcin) for a nosocomial infection. Which of the following assessments should the nurse prioritize?

The peak and trough blood levels

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

They disrupt the microbial flora of the body.

A 70-year-old woman is assessed in the clinic for signs and symptoms of chronic bronchitis related to pneumococci. Which of the following sulfonamides will be prescribed?

Trimethoprim-sulfamethoxazole (Bactrim)

Lincosamides are similar to macrolides, but they are more toxic.

True

The nurse is preparing a teaching plan for a client who is receiving cephalosporins. Which of the following would the nurse identify as the most commonly occurring adverse effects?

Vomiting and diarrhea

Which of the following public health efforts will assist in reducing drug-resistant tuberculosis in third world countries?

Worldwide screening for tuberculosis

A 34-year-old male has been diagnosed with TB and will be started on INH therapy. The medication history reveals that he currently takes antacids on a regular basis. The nurse will instruct the patient to take

antacids not less than 1 hour before or 2 hours after taking INH.

You are caring for a 61-year-old client whose physician has ordered 2200 mg of ethambutol daily. The recommended dose for ethambutol is 15-25 mg/kg/day. The client weighs 90 kg. Based on your dosage calculation, you know that the prescribed dose is

at the high end of the recommended range.

The nurse understands that tuberculosis (TB) can affect the lungs as well as other organs of the body. The term used for TB outside the lungs is what?

extrapulmonary

A patient is receiving cefazolin in combination with anticoagulants. To minimize the adverse effects during therapy, the nurse will

monitor the patient for bleeding gums.

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

oral contraceptives.

A 19-year-old Mexican American is about to start taking ethambutol (Myambutol). Before beginning drug therapy, it would be critical for the nurse to assess the patient's

visual acuity and establish a baseline.

A 7-year-old child has tonsillitis and is prescribed penicillin V, which is to be administered at home. The nurse will instruct the parents to administer the drug

with a glass of water 1 hour before or 2 hours after a meal.

A client has been on an antibiotic for two weeks for treatment of an infection. The client asks the nurse why a superinfection has been caused by this medication. What is the nurse's best response?

"Antibiotics can disrupt the normal bacteria in your body, causing another infection to occur."

The nurse is preparing to administer a sulfonamide to a client when the client states, "I woke up this morning with a lot of sores in my mouth." What is the nurse's next best action?

"I'm going to contact your health care provider before I administer your medication."

A nurse in an extended care facility has instilled medicated ear drops into a resident's left ear as ordered. What instruction should the nurse provide after administering this medication?

"Keep lying on your right side for the next 20 minutes or so."

You are the clinic nurse responsible for teaching a patient about his new prescription for doxycycline. Which of the following instructions should you include in your teaching?

"Limit your exposure to the sun."

A pregnant woman calls the clinic and asks if it is suitable to use ofloxacin otic drops that she used prior to pregnancy for a current ear infection. What would be an appropriate response from the nurse?

"Some medications are contraindicated in pregnancy, and ofloxacin is one of these medications." Correct

A 15-year-old female patient is receiving tetracycline for the treatment of severe acne. When providing patient education to this patient, the nurse includes which of the following points for the patient?

"When taking tetracycline, wear extra sun block."

The client has been taking a fluoroquinolone and now reports that he has a white patch in his mouth. What is the best response of the nurse?

"You may be experiencing an additional infection. I will discuss with your physician."

A patient is to receive rifampin. Which of the following would be most important for the nurse to include in the teaching plan for this patient?

"Your urine or sweat may become orange in color."

A patient is receiving gentamicin (Garamycin) to treat meningitis. The physician has ordered a peak serum level be drawn in association with the 07:00 am dose. When should the peak serum level be drawn?

08:00 am

Organisms that are resistant to the most effective drugs available are referred to as multidrug-resistant tuberculosis (MDR-TB). Due to the seriousness of this type of infection, what is the expected time span from diagnosis to death?

4 to 16 weeks

Levofloxacin 750 mg IV is ordered for a client with a urinary tract infection. The medication is mixed in a syringe for an IV pump as a solution of 250 mg/15 mL. How many mL should be in the syringe?

45

A patient receiving isoniazid (INH) and rifampin (Rifadin) has a decreased urinary output and peripheral neuropathy. Which laboratory values should be assessed?

ALT/AST and creatinine

In the rare instance in which penicillin is considered essential, which procedure may be helpful in assessing hypersensitivity?

Administering a skin test

A child's otitis media has resulted in pain and fever. The child's mother has asked the nurse to recommend OTC remedies to address these problems. Which of the following recommendations is most likely to be safe and effective?

Alternating doses of acetaminophen and ibuprofen

A patient is diagnosed with the gram-negative microorganism Pseudomonas. Which of the following anti-infective agents is most reliable in treating this microorganism?

Aminoglycosides

Antipyrine is used in otic preparations as which of the following? (Choose one)

Analgesic

A 25-year-old female patient who presents at the clinic with vaginal discharge and discomfort is diagnosed with chlamydia. The nurse knows that the drug of choice to treat this infection is doxycycline. What would be a priority assessment for this patient before beginning the medication?

Asking the patient if she is pregnant

If a nurse needs to administer otic preparations in both of the patient's ears, how long should the nurse wait to place drops in the second ear? (Choose one)

At least 5 minutes

Which of the following would a nurse identify as being classified as a macrolide?

Azithromycin

Drugs that slow or retard the multiplication of bacteria are known as which of the following? (Choose one)

Bacteriostatic

Tuberculosis is transmitted when a previously uninfected person inhales infectious particles that have been exhaled by an infected individual. In the approximately 30% of exposed individuals who become infected following exposure, spontaneous healing typically begins within six months. What physical change does the disease create in the infected person?

Calcified tubercles

After teaching a group of students about carbapenems, the instructor determines the need for additional teaching when the students identify which of the following as an example?

Cefuroxime

Beta-lactam antibiotics, such as penicillins and cephalosporins, fight infection by inhibiting development of the causative bacteria. What specific component of bacterial development do these drugs affect?

Cell wall synthesis

The nurse is administering ciprofloxacin intravenously to a 60-year-old client with necrotizing otitis externa who is recently widowed and has type 2 diabetes that is controlled by diet. What factor related to this client would be of most concern to the nurse?

Client's age

A female client is admitted to the critical care unit with sepsis related to a contaminated central line. The physician orders intravenous beta-lactam antimicrobials. The client's current laboratory report reflects renal impairment. What would the nurse expect the physician to do?

Decrease the drug dose

A client who takes zinc daily is diagnosed with a severe infection and is ordered levofloxacin (Levaquin). The nurse is aware that taking these two drugs may have what affect on the antibiotic?

Decreased absorption

A patient has been prescribed a tetracycline drug for Rocky Mountain spotted fever. The patient also takes antacids. Which of the following effects is likely to occur due to an interaction between the two drugs?

Decreased absorption of tetracycline

An 87-year-old resident of a long-term care facility has been prescribed oral clindamycin for the treatment of an infected pressure ulcer. The care providers at the facility should be instructed to monitor the resident closely for what potential adverse effect of clindamycin?

Diarrhea

Which of the following symptoms may indicate optic neuritis resulting from the use of ethambutol?

Difficulty differentiating between red and green

A nurse is caring for a 6-year old child with a severe case of typhoid fever. The patient was mistakenly administered tetracycline, which can cause adverse reactions. Which of the following could be a permanent effect in the child?

Discoloration of the teeth

The nurse should advise the client which of the following in regards to the administration of fluoroquinolones? (Choose one)

Do not take antacids while taking fluoroquinolones

A patient is admitted to the emergency room with a diagnosis of Legionnaire's disease and is placed on isolation. Which of the following medications is the drug of choice for Legionnaire's disease?

Erythromycin (Ery-Tab)

A patient is allergic to penicillin and has been diagnosed with a genitourinary infection caused by Chlamydia trachomatis. Which of the following medications will be administered?

Erythromycin (Ery-Tab)

The nurse is giving instructions to a client age 77 years who has been prescribed a sulfonamide for treatment of a urinary tract infection. The nurse has instructed the client to increase fluids while taking this medication. What does the nurse anticipate will be the client's greatest fear related to this instruction?

Fear of incontinence.

A young boy has just returned home from his family's tropical vacation and is now complaining of worsening tenderness in his right ear. He is subsequently diagnosed with otitis externa. What causative factor of this infection should the nurse suspect?

Frequent swimming and water sports while the boy was on vacation.

A patient is administered a third-generation cephalosporin. Which of the following organisms are cephalosporins most effective in treating?

Gram-negative

Aminoglycosides are used primarily in the treatment on what type of infection? (Choose one)

Gram-negative infections

As a class, penicillins usually are more effective in infections caused by which type of bacteria?

Gram-positive

A nurse teaching the patient with tuberculosis (TB) should include the following information about ethambutol:

It can cause optic neuritis.

A 2-year-old boy has been diagnosed with an ear infection and the prescriber has chosen to treat the child's infection with Cipro HC, a combination medication that contains ciprofloxacin and hydrocortisone. What is a potential advantage of this medication over Cortisporin Otic?

It does not have to be administered as frequently as Cortisporin Otic.

A nursing student is learning about the effects of bactericidal agents. Which of the following actions is noted when rifampin (Rifadin) is administered to treat both intracellular and extracellular tuberculosis organisms?

It inhibits synthesis of RNA

A patient is administered isoniazid (INH) for latent tuberculosis. Which of the following factors will result in discontinuation of the medication?

Jaundice

The nurse is caring for a 6-year-old girl who has been diagnosed with active tuberculosis. The physician is unlikely to prescribe which of the following drugs because its use is not recommended in children?

Levofloxacin

Macrolides must be used with caution in clients who have which of the following conditions?

Liver dysfunction

A male client is placed on an IV regimen of aztreonam. The nurse would expect the physician to order which laboratory test?

Liver function

A major concern among public health authorities is an increase in drug-resistant TB infections. Traditionally, this has been attributed to patient lack of adherence to medication regimen. New evidence indicates that:

Many drug-resistant infections are new infections, especially in those who are immunosuppressed

Mr. Marks is a 35-year-old man who is being treated with isoniazid (INH) for exposure to TB. He has the following medical history: diabetes mellitus type 2, hypertension, hyperlipidemia, and coronary artery disease. He drinks one to two glasses of wine on the weekend and smokes two packs of cigarettes per day. Which adverse reaction should you as the nurse alert Mr. Marks to report to his physician right away?

Numbness and tingling in his feet

A patient is hospitalized due to noncompliance with an antitubercular drug treatment. Which of the following is most important for the nurse to do?

Observe the patient taking the medications

The nurse is assisting in the admission of a client with a suspected urinary tract infection. The health care provider has written the following orders: acetaminophen 500 mg PO for elevated temperature; urinalysis for culture and sensitivity; sulfasalazine (Azulfidine) 500 mg PO four times daily; and force fluids to 3 L/day. Which order will the nurse complete first?

Obtain urine for culture and sensitivity

A male client has been diagnosed with otitis externa. He also has a history of a perforated ear drum. What topical otic preparation does the nurse anticipate the physician ordering for this client?

Ofloxacin otic

Michael, 25 years old, has had mitral valve regurgitation since age four, after having rheumatic fever. Michael is planning to go to his dentist to have his teeth cleaned. Because of Michael's history he will need to take antibiotics in conjunction with this procedure to prevent bacteremia. Which class of antibiotics will Michael most likely receive if he has no allergies?

Penicillin

A client is receiving levofloxacin (Levaquin) IV. During an infusion, the client complains of pain and the nurse notes a reddened area along the vein. What does the nurse suspect?

Phlebitis

Mr. Martin had been prescribed lomefloxacin (Maxaquin) for a respiratory infection. What must the nurse closely monitor for in Mr. Martin?

Photosensitivity

A nurse is demonstrating the correct technique for instilling antibiotic ear drops into a child's ear canal. The nurse should teach the child's caregivers to do which of the following?

Place a cotton ball in the ear canal after instilling the ear drops.

A pediatric nurse is providing inpatient care for a child who was diagnosed with necrotizing otitis externa. The child is currently being treated with ciprofloxacin. What microorganism is the most likely cause of this child's infection?

Pseudomonas aeruginosa

A 2 year old with an ear infection is seen in the clinic. The physician orders ear drops and asks the nurse to teach the mother the correct way to instill them. Which of the following would be correct to tell the mother?

Pull the pinna down and back before instilling the drops. Correct

The nurse is teaching a patient about his prescription for a macrolide antibiotic. What should the nurse teach the patient to report?

Recurring symptoms of infection

A patient has been prescribed combination ear drops to treat otitis externa. What nursing action should be performed prior to drug administration?

Removing any excess cerumen from the patient's ear.

A patient is being treated for a urinary tract infection with trimethoprim-sulfamethoxazole (Bactrim). What assessment should the nurse make prior to the administration of the medication?

Renal insufficiency

A nurse is caring for a patient undergoing the second phase of standard TB treatment. The nurse knows that which of the following combinations of drugs need to be administered to the client?

Rifampin and isoniazid

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?

Risk of toxicity

The nurse understands that an infection caused by a secondary pathogen, which can occur during prolonged antibiotic therapy, is known as which of the following?

Superinfection

Cephalosporins should be used cautiously in clients with which of the following? Select all that apply.

• Renal disease • Hepatic impairment • Bleeding disorder • Known penicillin allergy

A febrile client is ordered to receive sulfonamide therapy for an infection. The nurse needs to evaluate the client for which of the following during the course of therapy? Select all that apply.

• Response to drug therapy • Occurrence of adverse reactions • Decrease in temperature

A patient newly diagnosed with tuberculosis (TB) asks the nurse if medications will make him better. The nurse informs the patient that sometimes treatment fails and why this happens. Which of the following are reasons for treatment failure? (Select all that apply.)

• inadequate initial drug treatment • noncompliance with the therapeutic regimen

A client is to receive gentamicin for treatment of an infection. Which of the following would be most important for the nurse to assess to establish a baseline?

Auditory function

Gary is a construction worker who is diagnosed with leprosy and is prescribed rifampin. Gary is married, an alcoholic, and wears contact lenses. At the time of initiating the therapy, what should the nurse instruct the patient about the drug therapy?

Inform him that he should wear glasses during the therapy.

Tetracyclines treat infection by which of the following effects? (Choose one)

Inhibiting bacterial protein synthesis

The nurse is caring for a client who is receiving IV vancomycin. The nurse infuses the medication at the prescribed rate to prevent what from occurring?

Red man syndrome

A patient is receiving a cephalosporin and an aminoglycoside as combination therapy. Which of the following would be most important for the nurse to assess?

Serum BUN levels

How do aminoglycosides elicit there bactericidal effects? Select all that apply.

• Block a step in bacterial protein synthesis. • Disrupt the functional ability of the bacterial cell wall. • Block bacterial RNA synthesis.

Ms. Ellis has been prescribed INH for the treatment of tuberculosis. You are teaching her about dietary restrictions while taking this medication. What is the most important instruction to give her about dietary restrictions?

"Do not drink beer or red wine while taking this medication because a serious adverse reaction can occur."

A client comes to the emergency department complaining of a throbbing headache, nausea, vomiting, chest pain, dyspnea, vertigo, and blurred vision. The client reveals that he has been taking cefaclor for an infection. Which question would the nurse ask next?

"Have you had any alcohol to drink in the past 72 hours?"

A client has been prescribed daptomycin for treatment of an infection. What instruction is most important for the nurse to tell this client?

"Tell the physician immediately if you develop any muscle pain."

A client has been on sulfonamide therapy for the last six weeks. What client report may cause the health care provider to discontinue the sulfonamide?

10 lb weight loss

The nurse cautions a patient who is receiving a cephalosporin to avoid alcohol intake for at least which time period after completing the therapy?

72 hours

A patient has a diagnosis of otitis media and has just begun antibiotic treatment. The patient complains of otalgia and has asked for medication. The nurse should anticipate the administration of

Acetaminophen (Tylenol)

Your client has been diagnosed with intermittent colitis. You know that the following antibiotic is contraindicated for use in this client:

Clindamycin.

A patient is hospitalized with active tuberculosis. The patient is receiving antitubercular drug therapy and is not responding to the medications. What do you suspect the patient is suffering from?

Drug-resistant tuberculosis

Aminoglycosides due to their low risk of toxicity are replacing many of the other antibiotics today

False

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?

Inspect mouth and gums regularly.

When a person is diagnosed with tuberculosis, family members may be treated prophylactically with which antitubercular drug? (Choose one)

Isoniazid (Nydrazid)

What is the rationale for not administering tetracycline (Sumycin) in children under the age of 8 years?

It will interfere with enamel development.

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?

Kernicterus

A college student has a TB test prior to starting college. The tuberculin test site is noted with a reddened, raised area. What condition will the student be diagnosed with if the chest radioagraph is negative?

Latent tuberculosis

A client in the critical care unit is receiving aminoglycosides for an infectious process. What does the nurse need to monitor?

Liver function tests

An HIV-positive patient is in a continuing phase of TB. The patient has completed the initial phase of the treatment program. In the continuing phase, the patient has shown no positive sputum results for six months. The nurse knows that under what circumstances does the treatment in the second phase last for four months or more?

Positive sputum culture after the completion of initial treatment

A 43-year-old man has been diagnosed with active TB. He is prescribed a multiple drug therapy, including INH and rifampin. A priority assessment by the nurse will be to monitor which combination of laboratory test results?

Serum alanine transaminase, aspartate transaminase, and bilirubin

You are speaking to a 62-year-old female patient who has been started on sulfisoxazole, a sulfonamide antibiotic. You should teach this patient to contact the physician if she experiences what adverse effect associated with the drug?

Skin rash or itching

A male client presents to the emergency department in pain. He is diagnosed with mild to moderate burns on his forearms secondary to exposure to hot pipes in his home. The nurse expects the physician to order what topical medication?

Sulfadiazine

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

The client has developed a superinfection.

Chest radiography and sputum sample microscopy have confirmed a diagnosis of TB in a 40-year-old man who has a history of type 1 diabetes and who currently has a diabetic foot ulcer. How should the nurse account for this patient's health status when planning care during INH treatment?

The patient will require vigilant monitoring of blood glucose levels.

A nurse is caring for a patient with HIV who is suspected to also have tuberculosis (TB). Which of the following is true about patients with HIV and TB?

The skin test may not show a reaction even though the disease is present.

Ms. Kim, age 54, is taking penicillin for an upper respiratory infection. She calls the office after 2 days of therapy, complaining of nausea and abdominal pain. Which would be the best instruction to give Ms. Kim?

These are normal side effects, but if they increase in severity or frequency, you need to contact the office again.

An older adult with necrotizing otitis externa has been receiving IV ciprofloxacin and is now transitioning to the oral form of the drug. What health education should the nurse provide to the patient?

You can take this medication with food to reduce the chance that it will upset your stomach."

A patient has been prescribed oral tetracycline. The nurse will instruct the patient to take the drug

on an empty stomach 1 hour before or 2 hours after taking any meals or other drugs.

The nurse triaging an infant client may note which of the following behaviors in infants with ear infections? Select all that apply:

• Change in behavior • Irritability • Ear tugging • Fever

When instilling ear drops, the nurse informs the patient that to facilitate penetration of the drug into the ear canal, the patient should lie on the untreated side for how many minutes after receiving the drops?

5 minutes

A client with a positive sputum culture for TB has been started on streptomycin antitubercular therapy. Upon review of the laboratory results, the nurse notes that the client may be experiencing toxicity if which of the following results is abnormal?

BUN and creatinine

A client is receiving rifampin and isoniazid in combination for treatment of tuberculosis. Which of the following would the nurse need to monitor closely?

Liver function studies

Which of the following should a nurse carefully monitor in a patient who has been administered cephalosporin as well as aminoglycosides for a wound infection?

Nephrotoxicity

The client is being started on oral ciprofloxacin (Cipro). The nurse identifies that the client is also taking corticosteroids. What is the most appropriate action of the nurse?

Notify the physician

A nurse is caring for a 73-year-old TB patient. The patient has been prescribed ethambutol. Which of the following adverse reactions of ethambutol should the nurse assess for in the patient?

Optic neuritis

A patient visits his primary care physician with pneumonia-like symptoms. The patient recently retuned from Calcutta, where he worked in the slums. Which phase of tuberculosis could the nurse suspect?

Primary infection

After several rounds of treatment for TB over past several years, a patient continues to test positive for active TB, a fact that the care team attributes to the patient's nonadherence to treatment. The patient's most recent diagnostic workup reveals that he now has multidrug resistant TB. The nurse should anticipate that the patient may require treatment with

a fluoroquinolone.

A nursing student studying pharmacology is focusing on drugs used to treat tuberculosis (TB). This student correctly identifies the classifications of antitubercular drugs as which of the following?

primary and secondary

A patient has been treated several times for a recurring ear infection with ofloxacin. The nurse instructs the patient to look for side effects from the prolonged use of the antibiotic and informs the patient that this is known as which of the following?

superinfection

The physician has prescribed ciprofloxacin. For which patient would you contact the physician to clarify the order because the medication is contraindicated? (Select all that apply.)

• Children younger than 18 • Pregnant and lactating mothers

A nursing student learns that various preparations are used to treat otic disorders. Such preparations fall into which of the following categories? (Select all that apply.)

• antibiotics • antibiotic and steroid combinations • miscellaneous preparations