PrepU Chapter 9

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?

Discontinue the infusion and inform the care provider promptly. 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. Administration of acetylcysteine or diphenhydramine is not indicated. Slowing down the rate of infusion would not address the problem as it relates to exposure to the medication. Neither the administration of acetylcysteine nor diphenhydramine is indicated initially. Acetylcysteine is prescribed to treat thick mucus lung secretions. Treatment with diphenhydramine would be ineffective if the ciprofloxacin were not first discontinued.

A client diagnosed with tuberculosis was prescribed antitubercular therapy but stopped after 1 month because of difficulty with the medication scheduling. As a result, secondary drugs are being prescribed. Which nursing diagnosis would the nurse most likely identify?

Ineffective Self-Health Management Difficulties with scheduling most likely led to the client not adhering to the treatment plan. As a result, the nursing diagnosis of Ineffective Self-Health Management would be most appropriate. Although nutrition can be affected, there is no indication that this is the problem. Although the client may have difficulty coping with the disease, there is no indication that this is a problem. The client may experience discomfort related to the adverse effects of the drug; however, there is no indication that this is an issue.

A client is prescribed penicillin V orally for a strep throat. What is the mechanism of action of this medication?

It inhibits cell wall synthesis. Beta-lactam antibacterial drugs inhibit synthesis of bacterial cell walls by binding to proteins in bacterial cell membranes. Penicillin V does not inhibit protein synthesis. Penicillin V does not inhibit protein synthesis, cause mutations, or lower the pH of a bacterium's cellular contents.

How does rifampin achieve a therapeutic action against both intracellular and extracellular tuberculosis organisms? It binds to acetylcholine. It inhibits synthesis of RNA. It is metabolized in the liver. It causes phagocytosis.

It inhibits synthesis of RNA.

A female client's medical history includes type 2 diabetes, CVA, dysphasia, and chronic renal failure. She develops an infectious process. The health care provider orders erythromycin. Based on the client's medical history, why is erythromycin the drug of choice? It is metabolized in the kidneys. It is excreted into the GI tract. It is excreted into the bloodstream. It is metabolized in the liver.

It is metabolized in the liver.

A patient with TB is admitted to a health care facility. The nurse is required to administer an antitubercular drug through the parenteral route to this patient. Which of the following precautions should the nurse take when administering frequent parenteral injections? Rotate injection sites for frequent parenteral injections. Monitor patient's vital signs each morning. Monitor signs of liver dysfunction weekly. Administer streptomycin to promote nutrition.

Rotate injection sites for frequent parenteral injections.

A nurse is caring for a patient who has a serious infection. The patient is being treated with combination therapy of a cefazolin and an aminoglycoside. The nurse will be sure to monitor which of the following? Aspartate aminotransferase levels Serum BUN and creatinine levels Prothrombin time (PT) and partial thromboplastin time (PTT) Serum sodium and potassium levels

Serum BUN and creatinine levels

The nurse is caring for a client who is taking tetracycline for Rocky Mountain spotted fever. The nurse notices that the client has developed painful mouth ulcers. The nurse knows that the client has developed what adverse reaction to the medication? Hypersensitivity reaction Gastritis Stomatitis Acne

Stomatitis

A client is prescribed rifampin. What information should the nurse include in the client's medication education? It decreases hepatic enzymes and decreases metabolism of drugs. The urine, tears, sweat, and other body fluids will be a discolored red-orange. When taking it with warfarin, an increased anticoagulant effect occurs. It has an increased serum half-life, so it is more effective than rifabutin.

The urine, tears, sweat, and other body fluids will be a discolored red-orange.

The nurse is caring for a client who is taking a sulfonamide and notices that the client has developed itchy hives. After contacting the health care provider, what term will the nurse use to describe the client's symptoms?

Urticaria Hives or itchy wheals on the skin resulting from contact with, or ingestion of, an allergic substance is known as urticaria. Pruritis is simple itching. Toxic epidermal necrolysis is sloughing of skin and mucous membranes. Stevens-Johnson syndrome consists of fever, cough, muscular aches and pains, headache and lesions of the skin (blisters or wheals).

After teaching a group of nursing students about the action of penicillins, the instructor determines that the teaching was effective when the students identify natural penicillins as exerting which type of effect on microorganisms? fungistatic bacteriostatic bactericidal fungicidal

bactericidal

Drugs that destroy bacteria are known as which type of drug?

bacteriocidal Drugs that destroy bacteria are known as bactericidal. Drugs that slow or retard the multiplication of bacteria are known as bacteriostatic. Bacteriostationary keeps the bacteria in place, and bacteriophage uses enzymatic substances to destroy the bacteria.

A client with an upper respiratory infection has been prescribed macrolides. Which changes during an ongoing assessment would lead the nurse to notify the health care provider? Select all that apply.

drop in blood pressure increase in respiratory rate sudden increase in temperature The nurse must notify the primary health care provider if there is a drop in blood pressure, increase in respiratory rate, or sudden increase in temperature during an ongoing assessment after administration of the drug. Regular urine output or pulse rate within usual parameters need not be reported to the health care provider because these would be normal findings.

After teaching a group of students about the indications for use for aminoglycosides, the instructor determines that the teaching was successful when the students identify which type of infection as a primary indication? gram-positive infections gram-negative infections viral infections fungal infections

gram-negative infections

A group of students are reviewing information about drugs used to treat tuberculosis. The students demonstrate understanding of the material when they identify which drug as a first-line treatment option? Rifampin Kanamycin Ciprofloxacin Capreomycin

Rifampin

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? Decreased appetite Loose stools for the last two days 10 lb weight loss Unable to eat spicy foods

10 lb weight loss

What is the rationale for not administering tetracycline to children under the age of 8 years? It will not treat the infection effectively. It will increase the risk of heart failure. It will interfere with enamel development. It will increase the risk for future infections.

It will interfere with enamel development.

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 Tetracycline Vancomycin Cephalosporin

Penicillin

Ampicillin-sulbactam is administered to a client with Staphylococcus aureus. What type of antiinfective is ampicillin-sulbactam? Aminopenicillin Penicillin-beta-lactamase inhibitor combination Cephalosporin Extended-spectrum antipseudomonal penicillin

Penicillin-beta-lactamase inhibitor combination

A client with a gram-negative bacterial infection has been prescribed a fluoroquinolone. During the preadministration assessment, the nurse should ensure that which laboratory tests, if prescribed, are obtained before the first dose of fluoroquinolones is administered to the client? complete blood count renal and hepatic function tests urinalysis culture and sensitivity test

culture and sensitivity test

The nurse understands that tuberculosis (TB) can affect other organs of the body. The term used for TB outside the lungs called which? interstitial. extrapulmonary. encapsulated. metastisized.

extrapulmonary.

The ability of bacteria to produce substances that inactivate or destroy the antibiotic is known as which of the following? Bacterial resistance Bacterial adaptation Bacterial evolution Bacterial shift

Bacterial resistance

A nurse is preparing to administer a client's first scheduled dose of tetracycline. The nurse should first ensure that the client has not recently eaten what type of foods? Leafy green vegetables Any high-fat foods Acidic foods Dairy products

Dairy products

Which of the following drugs would be classified as an aminoglycoside? Levofloxacin Clarithromycin Cefaclor Gentamicin

Gentamicin

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? Impaired oral mucous membranes Inflammation of the tongue and mouth Sudden loss of consciousness Severe hypotension

Inflammation of the tongue and mouth

The health care provider has prescribed ciprofloxacin. For which client would you contact the provider to clarify the order because the medication is contraindicated? (Select all that apply.) Pregnant and lactating mothers Women above the age of 60 Children younger than 18 People suffering from hypertension

Pregnant and lactating mothers Children younger than 18

Which of the following antitubercular drugs are used during the continuation treatment phase of tuberculosis? Select all that apply: Pyrazinamide Ciprofloxacin Rifampin Ethambutol Isoniazid

Rifampin Isoniazid

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 inability to swallow. Fear of incontinence. Fear of an allergic reaction. Fear of diarrhea.

Fear of incontinence.

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? Monitor for appearance of adverse reactions. Assess patient's history of contacts. Use DOT to administer the drug to the patient. Monitor patient's vital signs every 24 hours.

Monitor for appearance of adverse reactions.

Levofloxacin 750 mg IV is ordered for a client with a urinary tract infection. The medication is to mixed yielding 250 mg/15 mL. How many mL should be drawn up in the syringe?

45 mL 750/250 = 3; 3 x 15 mL = 45 mL

Oral ampicillin has been ordered for a client whose urinary tract infection will be treated in a home setting. When providing antibiotic teaching to this client, the nurse should stress which instruction?

Drink a full glass of water when taking a dose of the drug. Clients taking penicillins should take oral doses with a full glass of water to ensure sufficient hydration while taking the medication. The drugs should otherwise be taken on an empty stomach. Tapering is unnecessary, and it is not advised to take the drug with diphenhydramine in an effort to reduce the allergy risk.

What event triggers the development of a superinfection? bone marrow suppression triggered by antibiotic treatment the infection is well established before antibiotic treatment begins proliferation of antibiotic-resistant microorganisms unforeseen interactions between the antibiotic and other prescribed medications

proliferation of antibiotic-resistant microorganisms

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? dizziness tachycardia polydipsia skin rash or itching

skin rash or itching

A 25-year-old female client 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 client before beginning the medication? Asking the client if she has had an allergic reaction to a penicillin Measuring the client's blood pressure Asking the client if she is allergic to sulfonamides Asking the client if she is pregnant

Asking the client if she is pregnant

A nurse is required to administer an anti-infective drug to a patient. The nurse knows that which of the following tests need to be conducted before administering the first dose of an anti-infective drug to the patient?

Culture tests The nurse should check whether culture tests are conducted before the first dose of drug is administered to the client. Ulcer tests and stool tests are not required to be conducted before administering the first dose of an anti-infective drug to the client. The nurse has to ensure that urinalysis is conducted before the administration of the drug but not specifically before the first dose of the anti-infective drug.

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 sulfonamide for treatment? Has the child taken tetracycline for treatment? Has the child taken a cephalosporin for treatment? Has the child taken a corticosteroid for treatment?

Has the child taken tetracycline for treatment?

A patient has been admitted to the intensive care unit with signs and symptoms of sepsis and preliminary results of the patient's initial blood cultures reveal the presence of methicillin-resistant Staphylococcus aureus (MRSA). This finding is an indication for treatment with

daptomycin. Daptomycin is FDA approved for treatment of bacteremia due to S. aureus (including MRSA). Ciprofloxacin, levofloxacin and polymyxin B are not typically used in cases of MRSA sepsis.

A client being treated for tuberculosis (TB) is determined to be drug resistant. Which medications will no longer be effective in the treatment of the tuberculosis?

isoniazid (INH) and rifampin (RIF) Isoniazid (INH) and rifampin (RIF) 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.

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 client concerning her the use of: alcohol. oral contraceptives. fats in her diet. nicotine.

oral contraceptives.

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 miscarrage?" "Are you pregnant?" "Are you allergic to penicillin?"

"Are you pregnant?"

A nurse is teaching a client about the medication regimen surrounding fluoroquinolones. Which statement made by the client would indicate the need for additional education?

"I will only drink enough water to swallow the drug." Clients taking fluoroquinilones should increase, not limit, their fluid intake. It is important that the client take all of the prescribed antibiotics and understand adverse reactions, such as abdominal pain. Difficulty breathing may indicate hypersensitivity and is an emergency.

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

"Your urine or sweat may become orange in color." This drug causes body fluids to turn orange. The client needs to be informed of this to avoid being frightened when it occurs. Any drug can cause a hypersensitivity reaction. Although this information is important, it is not the priority. GI adverse effects are common. Although this instruction would be important, it would not be the priority. Headache and dizziness are common CNS effects of the drug that do not need to be reported.

A public health nurse interacts with many members of the community who are at risk for sexually transmitted infections (STIs). The nurse should anticipate the use of tetracycline in a client who is diagnosed with what STI?

Chlamydia The action of tetracycline makes it effective for treating Mycoplasma, Chlamydia, and Rickettsia. It is not efficacious in the treatment of trichomoniasis, HPV, or vaginitis.

A 40-year-old is being treated for an ear infection with a cephalosporin. Which adverse reactions should the nurse monitor for in the client? Nausea Chest pain Excessive tearing Hypotension

Nausea

When administering aminoglycosides, the nurse must be aware of which of the following adverse reactions?

Ototoxicity and nephrotoxicity After parenteral administration, aminoglycosides are widely distributed in extracellular fluid and reach therapeutic levels in blood, urine, bone, inflamed joints, and pleural and ascitic fluids. They 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.

A client is prescribed ciprofloxacin for a urinary tract infection. The nurse is preparing to teach the client about the medication. What must the nurse include in the education plan? Avoid foods high in sodium such as processed meats. Take a missed dose, even if close to the next dose. Take precautions to prevent photosensitivity. Take the necessary vitamins along with the drug.

Take precautions to prevent photosensitivity.

The drug's effect on what best reflects the major reason for avoiding the use of tetracyclines in children under 8 years of age? Hearing Vision Kidneys Teeth

Teeth

Which statement is true in regards to the oral administration of tetracyclines?

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, diagnosed with a genitourinary infection, is being treated with a fluoroquinolone. What is the advantage of a fluoroquinolone over an aminoglycoside? The fluoroquinolone does not have adverse effects. The fluoroquinolone can be given orally. The fluoroquinolone has a broader spectrum. The fluoroquinolone has a nearly immediate peak.

The fluoroquinolone can be given orally.

Cephalosporins are used to treat which of the following infections? Select all that apply. Urinary tract infections Skin infections Community acquired pneumonias Bone infections Nosocomial pneumonias

Urinary tract infections Skin infections Bone infections Nosocomial pneumonias

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 Although headache and dizziness, superinfections, and phlebitis (with intravenous administration) can occur, the most common adverse effects of cephalosporins involve the GI tract and include vomiting, diarrhea, nausea, anorexia, abdominal pain, and flatulence.

Extreme caution would be necessary with the use of gentamicin in which client? A client who has chronic renal failure secondary to diabetes mellitus A client who has an atrioventricular block A client who is morbidly obese and who has primary hypertension A client who has bipolar disorder and who is on long-term lithium therapy

a client who has chronic renal failure secondary to diabetes mellitus Gentamicin is nephrotoxic, and with impaired renal function, a reduction in dosage is essential. Heart blocks, obesity, and lithium therapy do not severely complicate, or contraindicate, the use of an aminoglycoside since they are not associated with nephrotoxicity.

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: are derived from penicillin. can cause kidney damage in clients who are allergic to penicillins. are ineffective in clients who are allergic to penicillins. can cause allergic reactions in clients who are allergic to penicillins.

can cause allergic reactions in clients who are allergic to penicillins.

A client prescribed rifaximin for diarrhea has developed frank bleeding in the stool. What intervention should the nurse anticipate being implemented to best ensure client safety? changing to parenteral administration of rifaximin changing to a different antibiotic supplementing the antibiotic with vitamin K increasing the dose of rifaximin

changing to a different antibiotic

A group of nursing students are reviewing information about fluoroquinolones. The students demonstrate a need for additional review when they identify which as an example? metronidazole ciprofloxacin gemifloxacin levofloxacin

metronidazole

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

superinfection Prolonged use of otic preparations containing an antibiotic may result in a superinfection (an overgrowth of bacterial or fungal microorganisms not affected by the antibiotic being administered).

A nurse is reviewing the medical record of a client who is prescribed tetracycline. Which drug, if found being used by the client, would alert the nurse to the need for a decreased dosage of that drug? warfarin vancomycin atorvastatin losartan

warfarin