Practice Multiple Choice: Antimicrobial Drugs

A patient is prescribed an antibiotic to treat a urinary tract infection. What statement by the patient indicates a need for further teaching? a. "I can stop the medication as soon as the symptoms have disappeared." b. "I will drink more fluids to help clear up the infection." c. "I will stop the medication and contact the doctor if I develop a rash." d. "I should immediately report vaginal itching or discharge."

a. "I can stop the medication as soon as the symptoms have disappeared." Rationale: Patients should be taught not to discontinue antibiotics prematurely, but rather to complete the entire course of therapy, even if symptoms improve or resolve. The other responses are appropriate.

The patient is ordered daily divided doses of gentamycin. The patient received an intravenous dose of gentamycin at 4:00 PM. When should the nurse obtain the peak level? a. 4:30 PM b. 5:00 PM c. 5:30 PM d. 6:00 PM

a. 4:30 PM Rationale: When using divided daily doses, draw blood samples for measuring peak levels 1 hour after IM injection and 30 minutes after completing an IV infusion. When a single daily dose is used, measuring peak levels is unnecessary. Draw samples for trough levels just before the next dose (when using divided daily doses) or 1 hour before the next dose (when using a single daily dose).

Which statement about allergic reactions to penicillin does the nurse identify as true? a. Anaphylactic reactions occur more frequently with penicillins than with any other drug. b. Allergy to penicillin always increases over time. c. Benadryl is the drug of choice for anaphylaxis due to penicillin allergy. d. Patients allergic to penicillin are also allergic to vancomycin.

a. Anaphylactic reactions occur more frequently with penicillins than with any other drug. Rationale: Anaphylactic reactions occur more frequently with penicillins than with any other drug. Allergy to penicillin can decrease over time. Epinephrine is the drug of choice for anaphylaxis. Vancomycin, erythromycin, and clindamycin are effective and safe alternatives for patients with penicillin allergy.

A patient with a history of a severe anaphylactic reaction to penicillin has an order to receive cephalosporin. What should the nurse do? a. Administer the cephalosporin as ordered. b. Contact the health care provider for a different antibiotic. c. Administer a test dose of cephalosporin to determine reactivity. d. Have an epinephrine dose available when administering the cephalosporin.

b. Contact the health care provider for a different antibiotic. Rationale: A few patients with penicillin allergy (about 1%) display cross-sensitivity to cephalosporins. If at all possible, patients with penicillin allergy should not be treated with any member of the penicillin family. Use of cephalosporins depends on the intensity of the allergic response to penicillin; if the penicillin allergy is mild, use of cephalosporins is probably safe. However, if the allergy is severe, cephalosporins should be avoided.

A patient is diagnosed with C. difficile infection. The nurse anticipates administering which medication? a. Daptomycin b. Metronidazole c. Rifampin d. Rifaximin

b. Metronidazole Rationale: Metronidazole is a drug of choice for C. difficile infection. Daptomycin has a unique mechanism and can rapidly kill virtually all clinically relevant gram-positive bacteria, including MRSA. Rifampin [Rifadin] is a broad-spectrum antibacterial agent used primarily for tuberculosis. However, the drug is also used against several nontuberculous infections. Rifampin is useful for treating asymptomatic carriers of Neisseria meningitidis. Rifaximin [Xifaxan] is an oral, nonabsorbable analog of rifampin used to kill bacteria in the gut.

A patient is prescribed cefixime. The nurse should teach the patient to immediately report any signs of what? a. Milk intolerance b. Skin rash, hives, or itching c. Constipation, nausea, or vomiting d. Headache, contusions, or seizures

b. Skin rash, hives, or itching Rationale: Hypersensitivity reactions are common with cephalosporins. Patients should be instructed to report any signs of allergy, such as skin rash, itching, or hives. Cefditoren contains a milk protein and should not be prescribed for patients with a milk protein allergy. Cefoperazone and cefotetan can promote bleeding. Diarrhea associated with antibiotic-associated pseudomembranous colitis (AAPMC) is a possible side effect with cephalosporins.

Which statement about superinfections does the nurse identify as true? a. Superinfections are more common in patients treated with narrow-spectrum drugs. b. Superinfection is defined as a new infection that appears. during the course of treatment for a primary infection. c. Superinfections are caused by viruses. d. Superinfections are easy to treat.

b. Superinfection is defined as a new infection that appears. during the course of treatment for a primary infection. Rationale: Because broad-spectrum antibiotics kill off more normal flora than do narrow-spectrum drugs, superinfections are more likely in patients receiving broad-spectrum agents. Suprainfections are caused by drug-resistant microbes; these infections are often difficult to treat.

The nurse is reviewing laboratory values from a patient who has been prescribed gentamicin. To prevent ototoxicity, it is most important for the nurse to monitor which value(s)? a. Serum creatinine and blood urea nitrogen levels b. Trough drug levels of gentamicin c. Peak drugs levels of gentamicin d. Serum alanine aminotransferase and aspartate aminotransferase levels

b. Trough drug levels of gentamicin Rationale: To minimize ototoxicity, trough levels must be sufficiently low to reduce exposure of sensitive sensory hearing cells. The risk of ototoxicity is related primarily to persistently elevated trough drug levels rather than to excessive peak levels.

A patient has been prescribed oral ciprofloxacin [Cipro] for a skin infection. When administering the medication, it is most important for the nurse to do what? a. Monitor for a decrease in the prothrombin time (PT) if the patient is also taking warfarin [Coumadin] b. Withhold antacids and milk products for 6 hours before or 2 hours afterward c. Inform the healthcare provider if the patient has a history of asthma d. Assess the skin for Stevens-Johnson syndrome

b. Withhold antacids and milk products for 6 hours before or 2 hours afterward Rationale: Absorption of ciprofloxacin can be reduced by ingestion of antacids and milk products. Ingestion of these products should occur at least 6 hours before ciprofloxacin or 2 hours afterward. Ciprofloxacin can increase the PT if the patient is also taking warfarin. Use of ciprofloxacin is contraindicated in patients with a history of myasthenia gravis. Patients taking ciprofloxacin are at risk for development of phototoxicity.

Which patient does the nurse identify as most likely to need treatment with trimethoprim/sulfamethoxazole [Bactrim] for a period of 6 months? a. A female patient with acute pyelonephritis b. A male patient with acute prostatitis c. A female patient with recurring acute urinary tract infections d. A male patient with acute cystitis

c. A female patient with recurring acute urinary tract infections Rationale: Female patients with relapses of urinary tract infection may need long-term therapy up to 6 months with trimethoprim/sulfamethoxazole.

A patient is prescribed doxycycline [Vibramycin]. If the patient complains of gastric irritation, what should the nurse do? a. Instruct the patient to take the medication with milk b. Tell the patient to take an antacid with the medication c. Give the patient food, such as crackers or toast, with the medication d. Have the patient stop the medication immediately and contact the health care provider

c. Give the patient food, such as crackers or toast, with the medication Rationale: Tetracyclines form insoluble chelates with calcium, iron, magnesium, aluminum, and zinc; absorption is decreased. Tetracyclines should not be administered together with milk or antacids. Long-acting tetracyclines, such as doxycycline, may be taken with food; food does not affect absorption.

Fluoroquinolones should be discontinued immediately if what happens? a. Nausea, vomiting, or diarrhea is experienced. b. Dizziness, headache, or confusion occurs. c. Tendon pain or inflammation develops. d. Theophylline is prescribed for asthma.

c. Tendon pain or inflammation develops. Rationale: Fluoroquinolones can cause tendon rupture and should be discontinued if tendon pain or inflammation develops.

A patient is prescribed cefazolin. It is most important for the nurse to teach the patient to avoid which substance while taking cefazolin? a. Warfarin b. Milk products c. Digitalis d. Alcohol

d. Alcohol Rationale: Cefazolin and cefotetan can cause alcohol intolerance. A serious disulfiram-like reaction may occur if alcohol is consumed. Inform patients about alcohol intolerance and warn them not to drink alcoholic beverages.

Which tetracycline may be administered with meals? a. Tetracycline b. Demeclocycline c. Doxycycline d. Minocycline

d. Minocycline Rationale: Tetracycline, demeclocycline, and doxycycline should be administered on an empty stomach. Minocycline can be administered with meals.

A patient is prescribed vancomycin orally for antibiotic- associated pseudomembranous colitis. The nurse will monitor the patient for what? a. Leukopenia b. "Red man" syndrome c. Liver impairment d. Ototoxicity

d. Ototoxicity Rationale: The most serious adverse effect of vancomycin is ototoxicity. "Red man" syndrome occurs only with rapid intravenous administration. Thrombocytopenia is an adverse effect of vancomycin.

A prescriber states that a patient will need to receive penicillin intravenously. The nurse anticipates administering which drug? a. Penicillin V b. Procaine penicillin G c. Benzathine penicillin G d. Potassium penicillin G

d. Potassium penicillin G Rationale: When high blood levels are needed rapidly, penicillin can be administered IV. However, only the potassium salt should be administered by this route. Owing to poor water solubility, procaine and benzathine salts must never be administered IV. Penicillin V is administered orally.

Which information should the nurse include when teaching a patient about rifampin therapy? a. Oral contraceptives are safe to use with rifampin therapy. b. Contact your healthcare provider immediately if the color of your body fluids changes to reddish orange. c. Rifampin is safe to use in patients who have hepatic disease. d. Rifampin may be administered intravenously.

d. Rifampin may be administered intravenously. Rationale: Rifampin may be administered intravenously. Women taking oral contraceptives should consider a nonhormonal form of birth control while taking rifampin. Rifampin frequently imparts a red-orange color to urine, sweat, saliva, and tears; patients should be informed of this harmless effect. Permanent staining of soft contact lenses occasionally has occurred, so the patient should consult an ophthalmologist about contact lens use. Rifampin is toxic to the liver, posing a risk of jaundice and even hepatitis. Asymptomatic elevation of liver enzymes occurs in about 14% of patients. However, the incidence of overt hepatitis is less than 1%. Hepatotoxicity is most likely in alcohol abusers and patients with pre-existing liver disease. These individuals should be monitored closely for signs of liver dysfunction.

The nurse is caring for a patient receiving intravenous gentamicin for a severe bacterial infection. Which assessment finding by the nurse indicates the patient is experiencing an adverse effect of gentamycin therapy? a. Blurred vision b. Hand tremors c. Urinary frequency d. Tinnitus

d. Tinnitus Rationale: Ototoxicity can result from accumulation of the drug in the inner ear. Early signs that should be reported include tinnitus or headache. Other major adverse effects include nephrotoxicity and neuromuscular blockade.

A patient who was taking sulfonamides develops Stevens-Johnson syndrome. Upon assessment, the nurse expects to find what? a. Hypotension b. Bronchospasm c. Temperature of 35.5º C d. Widespread skin lesions

d. Widespread skin lesions Rationale: The most severe hypersensitivity response to sulfonamides is Stevens-Johnson syndrome, a rare reaction with a mortality rate of about 25%. Symptoms include widespread lesions of the skin and mucous membranes, combined with fever, malaise, and toxemia. Bronchospasm and hypotension, as well as tachycardia, are manifestations of anaphylactic reactions.