Unit 2: ATI Infection

A nurse is caring for a client who is about to begin gentamicin therapy to treat an infection. The nurse should monitor the client for an alteration in which of the following? A. Bowel function B. Peripheral pulses C. Urine output D. Level of consciousness

C Gentamicin, an aminoglycoside, can cause nephrotoxicity. The nurse should monitor the client's BUN and creatinine levels and for an increased output of diluted urine. It is also essential to monitor serum gentamicin levels and maintain a therapeutic range.

A nurse is caring for a client who has a prescription for rifampin to treat TB. The nurse should expect the provider to prescribe which of the following drugs to the client to prevent possible resistance to rifampin? A. Gentamicin B. Vancomycin C. Isoniazid D. Metronidazole

C Isoniazid is used to treat tuberculosis and reduces the possibility of resistance to rifampin when combined with the drug. Drug resistance can develop quickly if the client only takes rifampin.

A client is prescribed amoxicillin to treat an ear infection. The health care provider instructs the client to monitor and report which of the following? A. Rash B. Blurred vision C. Peripheral edema D. Insomnia

A

Imipenem should be used with caution in which of the following clients? A client with: A. Seizure disorder B. Thyroid disease C. Diabetes D. Immunosuppression

A

A nurse in a provider's office receives a call from a client who has been taking penicillin V three times daily and reports abdominal cramping with bloody diarrhea for several days. Which of the following instructions should the nurse give the client? A. "Bring in a stool sample for testing." B. "Take the drug only twice daily." C. "Use an over-the-counter anti-diarrheal medication." D. "Return to the clinic for blood work."

A Abdominal cramping and bloody diarrhea can be caused by an overgrowth of the organism Clostridium difficile. The client should bring a stool sample in to be tested for the presence of this organism.

A nurse is reviewing a client's prescriptions prior to administering gentamicin to the client to treat a systemic infection. The nurse should clarify the use of gentamicin with the provider if the client is taking which of the following drugs? A. Ethacrynic acid B. Diphenhydramine C. Acetaminophen D. Levothyroxine

A Gentamicin, an aminoglycoside, and ethacrynic acid, a loop diuretic, are ototoxic drugs. The nurse should identify that concurrent use increases the client's risk for hearing loss.

A nurse is caring for a client who is about to begin taking metronidazole to treat an anaerobic intra-abdominal bacterial infection. The nurse should recognize that cautious use of the drug is indicated if the client also has which of the following conditions? A. Seizure disorder B. Hearing loss C. Asthma D. Anemia

A Metronidazole, an antiparasitic drug, can cause ataxia, vertigo, and seizures. It requires cautious use with clients who have a history of seizure activity, liver or renal failure, or heart failure.

A nurse in a provider's office receives a call from a client who is taking ciprofloxacin to treat a respiratory tract infection and reports dyspepsia. Which of the following instructions should the nurse give the client? A. Take an antacid at least 2 hr after taking the drug. B. Take the drug with a cup of coffee. C. Take an iron supplement with the drug. D. Take the drug with 240 mL (8 oz) of milk.

A The nurse should recommend that the client take an antacid to relieve the dyspepsia at least 2 hr after taking ciprofloxacin, a fluoroquinolone. This is because antacids decrease the absorption of the drug.

A nurse is caring for a client who is taking warfarin and has a new prescription for trimethoprim/ sulfamethoxazole to treat a UTI. The nurse should clarify the prescriptions with the provider because taking these two drugs concurrently can increase the client's risk for which of the following? A. Bleeding B. Thrombosis C. ECG changes D. Ototoxicity

A Trimethoprim/sulfamethoxazole, a sulfonamide combination, can increase the effects of warfarin and increase the client's risk for bleeding. The nurse should request another prescription to treat the infection, or, if the client decides to take the drug, ask the provider to prescribe a lower warfarin dose and monitor prothrombin time carefully. The client should report any sign of bleeding, such as easy or unexplained bruising.

A nurse is caring for a client who is about to begin taking isoniazid to treat tuberculosis. The nurse should instruct the client to report which of the following adverse effects of the drug? Select all that apply. A. Jaundice B. Numbness of the hands C. Dizziness D. Hearing loss E. Oral ulcers

A, B, and C Jaundice is correct. Isoniazid, an antimycobacterial drug, can cause liver toxicity, especially in clients who abuse alcohol. The nurse should monitor liver enzymes during therapy and instruct the client to report indications of liver damage, such as jaundice, abdominal pain, and fatigue. Numbness of the hands is correct. Isoniazid can cause peripheral neuropathy. The nurse should instruct the client to report numbness, pain, or tingling in the hands or feet. Administering pyridoxine (vitamin B6) can help minimize these effects. Dizziness is correct. Isoniazid can cause dizziness, ataxia, and seizures. The nurse should instruct the client to report these CNS effects. Hearing loss is incorrect. Isoniazid is more likely to cause visual disturbances than hearing loss. Oral ulcers is incorrect. Isoniazid is unlikely to cause a superinfection and oral ulcers, but it can cause dry mouth.

Intravenous vancomycin has been prescribed to treat meningitis. When administering this drug IV, which of the following actions should the health care professional take? Select all that apply. A. Do not mix it with other drugs B. Administer it rapidly via IV bolus C. Monitor the IV insertion site for phlebitis D. Monitor vital signs during the infusion E. Dilute the drug before administering it

A, C, D, and E

Match the pharmacologic term with the therapeutic use. A. Cephalexin B. Acyclovir C. Isoniazid D. Ketoconazole 1. Cutaneous fungal infections 2. Gram positive infections 3. TB highly specific for Mycobacterium TB 4. Viral infections

A-2 B-4 C-3 D-1

A client is prescribed trimethoprim/sulfamethoxazole for treatment of a UTI. The health care provider should instruct the client to monitor and report which of the following, which may indicate a serious adverse effect of the drugs? A. Blurred vision B. Sore throat C. Insomnia D. Swelling in calf

B

A client receiving vancomycin should be closely monitored for which of the following? A. Visual disturbances B. Hearing loss C. Perioral numbness D. Metallic taste

B

A nurse is caring for a client who is about to begin receiving acyclovir IV to treat a viral infection. The nurse should recognize that cautious use of the drug is essential if the client also has which of the following conditions? A. Heart failure B. Dehydration C. Asthma D. Tinnitus

B Acyclovir, an antiviral drug, can cause renal toxicity, especially in clients who are dehydrated. Hydration during and after IV infusion of the drug can help prevent crystalluria.

A nurse is caring for a client who has streptococcal pharyngitis and an allergy to penicillin. The nurse should recognize that which of the following drugs can be safely administer to this client? A. Nafcillin B. Azithromycin C. Cephalexin D. Amoxicillin/clavulanic acid

B Azithromycin, a macrolide, is an acceptable alternative to penicillin for patients who have bacterial infections and are allergic to penicillin. The medication is effective against many gram-positive and gram-negative bacteria and is used for streptococcal pharyngitis.

A nurse in a provider's office receives a call from a client who was recently hospitalized and treated with imipenem IV for a bacterial infection and reports an inability to eat due to mouth pain. The nurse should identify that the client might be experiencing which of the following adverse effects of this drug? A. Malabsorption B. Superinfection C. Anorexia D. Dental caries

B Imipenem, a carbapenem, can cause the superinfection Candida albicans in the mouth, throat, or vagina. It can also cause glossitis, an inflammation or infection of the tongue. Clients taking the drug should report any mouth pain or vaginal discharge and itching because they might require treatment with an antifungal drug.

A nurse is caring for a client who has a new diagnosis of bacterial meningitis. The nurse should expect the provider to prescribe a drug from which of the following classifications of antibiotics? A. First generation cephalosporins B. Third generation cephalosporins C. Monobactams D. Macrolides

B Later generation cephalosporins are used to treat infections that cross the blood-brain barrier, and third-generation are specifically prescribed to treat bacterial meningitis.

A nurse in a provider's office receives a call from a client who is taking tetracycline orally to treat a chlamydia infection and reports severe blood-tinged diarrhea. The nurse should suspect the client is experiences which of the following? A. Hemorrhoids B. Clostridium difficile-associated diarrhea C. Diverticular disease D. Small bowel obstruction

B Severe diarrhea, often containing mucus and blood, can indicate Clostridium difficile-associated diarrhea. Treatment includes stopping drug therapy and replacing fluids and electrolytes. Clients should immediately report severe diarrhea and blood in the stools.

A nurse is caring for a client who has a new prescription for acyclovir to treat a herpes simplex infection. Which of the following lab values should the nurse monitor for this client? A. Prothrombin time B. Hct C. BUN D. Aspartate aminotransferase

C Acyclovir, an antiviral drug, can cause renal toxicity due to drug accumulation in renal tubules. The nurse should monitor the client's urine output, BUN, and creatinine levels, and increase fluid intake to hydrate and flush the kidneys.

A nurse in a provider's office receives a call from a client who is taking amoxicillin to treat a respiratory infection and reports a rash and wheezing. Which of the following instructions should the nurse give the client? A. Wait 1 hr and contact the provider if there is no improvement. B. Skip today's dose of amoxicillin and resume taking the drug tomorrow. C. Call emergency services immediately. D. Take an NSAID to reduce skin and airway inflammation.

C Amoxicillin can cause a severe anaphylactic reaction. A client who has difficulty breathing should call emergency services and seek immediate care. The client will need to be treated with epinephrine and an antihistamine, such as diphenhydramine, to treat an anaphylactic reaction.

A nurse is caring for a client who is about to begin taking itraconazole to treat a fungal infection. The nurse should instruct the client to report which of the following adverse effects of the drug? A. Tingling in the hands and feet B. Joint pain C. Swelling of hands or feet D. Excessive sweating

C Itraconazole, an azole antifungal drug, can cause edema, which can also indicate heart dysfunction, and should be monitored closely.

A nurse is caring for a client who is about to begin taking nitrofurantoin to treat a urinary tract infection. The nurse should tell the client to report which of the following adverse effects of the drug? A. Constipation B. Dark brown urine C. Cough D. Tremors

C Nitrofurantoin, a urinary tract antiseptic, can cause cough, shortness of breath, chest pain, and fever. These adverse effects can indicate an acute allergic reaction and require immediate discontinuation of drug therapy.

A nurse is preparing to administer amphotericin B IV to a client who has a systemic fungal infection. Which of the following drugs should the nurse prepare to administer prior to the infusion to prevent or minimize adverse reactions? Select all that apply. A. Aspirin B. Hydrocortisone C. Acetaminophen D. Diphenhydramine E. Ibuprofen

C and D Aspirin is incorrect. Infusion reactions to IV amphotericin B include fever, chills, nausea, and headache. Although aspirin, an NSAID, can help for these symptoms, it also increases the client's risk for renal injury because aspirin is nephrotoxic and is therefore not an appropriate drug to prevent or minimize adverse reactions. Hydrocortisone is incorrect. Although a hydrocortisone, a glucocorticoid, can reduce fever and chills, it can also decrease the client's resistance to infection and is therefore not an appropriate drug to prevent or minimize adverse reactions. Acetaminophen is correct. Infusion reactions to amphotericin B IV, such as fever, chills, nausea, and headache, start 1 to 2 hr after the infusion begins and subside within 4 hr. The nurse can help prevent these effects by administering acetaminophen prior to the infusion. Diphenhydramine is correct. The nurse can help prevent adverse reactions by administering diphenhydramine prior to the infusion. Ibuprofen is incorrect. Although ibuprofen, an NSAID, can help prevent adverse reactions, it also increases the client's risk for renal injury because ibuprofen is nephrotoxic and is therefore not an appropriate drug to prevent or minimize adverse reactions.

A client is prescribed gentamicin for the treatment of a respiratory tract infection. The provider instructs the client to monitor and report which of the following adverse effects of gentamicin? A. Blurred vision B. Tremor C. Sweating D. Tinnitus

D

Because a client is allergic to penicillin, which of the following antibiotics is appropriate to prescribe for meningitis? A. Cephalexin B. Amoxicillin C. Cefotetan D. Vancomycin

D

While receiving vancomycin, the client becomes flushed and warm. Which of the following additional adverse reactions to vancomycin should be expected? A. Muscle weakness B. Pupil change C. Ecchymosis D. Hypotension

D

A nurse is caring for a client who has a new prescription for aztreonam to treat a respiratory tract infection. Which of the following findings in the client's medical record should the nurse recognize as requiring cautious use for this prescription and report to the provider? A. Glaucoma B. Closed-head injury C. Heart failure D. Renal impairment

D Aztreonam, a monobactam, requires cautious use with clients who have renal dysfunction because it is excreted in the urine. Renal impairment could affect the excretion of aztreonam, allowing the level of the drug to accumulate. The nurse should report this finding to the provider, so the provider can prescribe a lower dose for the client or prescribe a different antimicrobial drug.

A nurse is caring for a client who is taking ciprofloxacin to treat a urinary tract infection. The client also takes prednisolone to treat rheumatoid arthritis. Recognizing the adverse effects of ciprofloxacin, the nurse should instruct the client to report which of the following adverse effects? A. Tachycardia B. Hair loss C. Insomnia D. Tendon pain

D Ciprofloxacin, a fluoroquinolone, can cause tendon rupture, most often of the Achilles tendon. This adverse effect is especially common for older adults or clients who take glucocorticoids, such as prednisolone. The nurse should tell the client to report tendon pain and stop taking the drug.

When administering oral erythromycin to a client who has acute diphtheria, a nurse should monitor for which of the following adverse effects? A. Hypothermia B. Blurred vision C. Constipation D. Cardiac dysrhythmias

D Erythromycin, a macrolide, can cause ECG changes, including a prolonged QT interval, and put the client at risk for a potentially fatal ventricular dysrhythmia. The nurse should monitor the client's ECG and tell the client to report palpitations, fainting, or dizziness. The drug is contraindicated for clients who have a history of QT prolongation.

A nurse is providing teaching for a client who takes an oral contraceptive and is about to begin rifampin therapy to treat TB. Which of the following instructions should the nurse include? A. Increase the rifampin dose. B. Increase the oral contraceptive dose. C. Allow 2 hr between taking the two drugs. D. Use a non-hormonal form of contraception.

D Rifampin, an antimycobacterial drug, can increase the metabolism of oral contraceptives, reducing their effectiveness. Clients who are taking oral contraceptives and rifampin should use additional, non-hormonal contraceptive methods to prevent an unwanted pregnancy.

A nurse is providing teaching for a client who takes an oral contraceptive and is about to begin rifampin therapy to treat tuberculosis. Which of the following instructions should the nurse include? A. Increase the rifampin dose. B. Increase the oral contraceptive dose. C. Allow 2 hour between taking the two drugs. D. Use a non-hormonal form of contraception.

D Rifampin, an antimycobacterial drug, can increase the metabolism of oral contraceptives, reducing their effectiveness. Clients who are taking oral contraceptives and rifampin should use additional, non-hormonal contraceptive methods to prevent an unwanted pregnancy.

A nurse is administering cefotetan IV to a client to treat an intraabdominal infection. The nurse notes that the IV insertion site is warm, edematous, and painful to the touch. Which of the following actions should the nurse take? A. Decrease the rate of the cefotetan infusion. B. Administer diphenhydramine to the client. C. Request a prescription for another antibiotic. D. Stop the cefotetan infusion.

D The nurse should stop the infusion, remove the IV catheter, assess for tissue damage, and treat the client accordingly. The nurse should then initiate IV access via another site, continuing cefotetan therapy according to prescribed parameters.

A nurse is caring for a client whose sputum culture results indicate MRSA. The nurse should recognize that which of the following medications will likely be administered to this client? A. Trimethoprim/ sulfamethoxazole B. Tetracycline C. Cephalexin D. Vancomycin

D Vancomycin, a potentially toxic antibiotic, is used primarily to treat serious infections in clients who are allergic to penicillin or whose infecting bacteria are resistant to penicillin, such as MRSA. The term methicillin-resistant refers generally to a lack of susceptibility to methicillin (no longer prescribed), all penicillins, cephalosporins, tetracyclines, beta-lactams, and many other antimicrobial drugs.

A nurse is caring for a client who has a gynecologic infection and has a history of alcohol use disorder. The nurse should identify that which of the following drugs can cause a reaction similar to disulfiram if the client drinks alcohol while taking it? Select all that apply. A. Nitrofurantoin B. Amoxicillin C. Aztreonam D. Cefotetan E. Metronidazole

D and E Nitrofurantoin is incorrect. Nitrofurantoin, a urinary tract antiseptic, does not cause a reaction similar to disulfiram when clients consume alcohol. However, the drug can cause diarrhea, nausea, and vomiting. Amoxicillin is incorrect. Amoxicillin, a penicillin, does not cause a reaction similar to disulfiram when clients consume alcohol. However, the drug can cause diarrhea, nausea, and vomiting. Aztreonam is incorrect. Aztreonam, a monobactam, does not cause a reaction similar to disulfiram when clients consume alcohol. However, the drug can cause a superinfection with Candida albicans. Cefotetan is correct. Cefotetan, a second-generation cephalosporin, can cause a reaction similar to what disulfiram causes when clients consume alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension. Metronidazole is correct. Metronidazole, an antiparasitic drug, can cause a reaction similar to what disulfiram causes when clients consume alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension.

A client is prescribed itraconazole for the treatment of systemic mycoses. The provider should include which information when instructing the client about the administration of itraconazole? Select all that apply. A. Take with food to reduce gastric distress B. Take in the morning to avoid insomnia C. Take with 8 oz of acidic liquid, like cola or orange juice to increase absorption D. Take with an antacid to reduce dyspepsia E. Increase fluid intake to 2-3 L/day if tolerated.

A and C

Match the pharmacologic term with the therapeutic use. A. Chloroquine B. Vancomycin C. Amphotericin B D. Metronidazole 1. Malaria 2. Systemic Candidiasis 3. MRSA 4. Trichomoniasis

A- 1 B- 3 C- 2 D- 4

A client is prescribed rifampin for treatment of TB. The health care provider should instruct the client to monitor and report which of the following, which may indicate a serious adverse effect of the rifampin? A. Tremor B. Jaundice C. Sweating D. Insomnia

B

A client is prescribed oral tetracycline for treatment of acne vulgaris. When instructing the client about the tetracycline, which of the following information should the provider include? (Select all that apply). A. Increase weight bearing activity B. Report mouth pain C. Taken 1 hour before meals D. Wear sunscreen and protective clothing E. Swallow pill with 8 oz of milk

B, C, and D

Because a client is allergic to penicillin, which of the following drugs should be available in case the client has a severe allergic reaction to the antibiotic that has been prescribed? A. Atropine B. Naloxone C. Epinephrine D. Neostigmine

C

Which of the following interventions may prevent a serious adverse reaction to acyclovir? A. Premedicate with a nonsteroidal inflammatory drug B. Ambulate after infusion C. Increase fluid intake D. Remain flat for 2 hr after infusion

C