Chapter 21
A health care provider is deciding what medication to prescribe for a client with an upper respiratory infection. What principles guide the provider's decision? Select all that apply. • Available in generic formulation • The client's ability to tolerate the drug • Other drugs the client is taking daily • Medication cost • Resistance of the bacteria
The client's ability to tolerate the drug Other drugs the client is taking daily Resistance of the bacteria The health care provider needs to consider if the medication will kill the bacteria. The provider also needs to think about the other medications the client is taking because some drugs have many interactions. Tolerance also needs to be considered because the client may develop nausea, vomiting, and diarrhea from the antibiotic. While important to many, cost and generic formulation are not be the prescriber's main considerations.
A patient on your unit has bacterial colitis and is being treated with oral vancomycin. Why is vancomycin given orally, rather than intravenously, in the treatment of bacterial colitis? • The oral version of the drug limits the release of histamines. • The oral version of the drug is easier to administer. • Fewer pathogens are resistant to the oral version of the drug than to the IV version. • The oral version of the drug acts within the bowel lumen.
The oral version of the drug acts within the bowel lumen. In antibiotic-associated colitis, stopping the causative drug is the initial treatment. If symptoms do not improve within 3 or 4 days, oral metronidazole or vancomycin is given for 7 to 10 days.
Your patient is receiving a miscellaneous antibacterial to treat an infection. Which of the following goals would be appropriate to include in your plan of care? Select all that apply. • The patient will be monitored regularly for therapeutic and adverse drug effects. • The patient will experience an increase in signs and symptoms of the infection being treated. • The patient will take or receive miscellaneous antimicrobials accurately, for the prescribed length of time. • The patient will verbalize and practice measures to prevent recurrent infection.
The patient will be monitored regularly for therapeutic and adverse drug effects. The patient will take or receive miscellaneous antimicrobials accurately, for the prescribed length of time. The patient will verbalize and practice measures to prevent recurrent infection. The patient should experience decreased signs and symptoms of the infection being treated, not increased.
Your patient is receiving a miscellaneous antibacterial to treat an infection. Which of the following goals would be appropriate to include in your plan of care? Select all that apply.
The patient will take or receive miscellaneous antimicrobials accurately, for the prescribed length of time. • The patient will be monitored regularly for therapeutic and adverse drug effects. • The patient will verbalize and practice measures to prevent recurrent infection. Explanation: The patient should experience decreased signs and symptoms of the infection being treated, not increased.
A male client presents to the emergency department with an abdominal dehiscence. He states he had a hernia repair 18 days earlier, and the health care provider removed his wound staples 5 days ago. The client states that the dehiscence occurred when he lifted a box this morning for his wife. The wound is red, and there is evidence of foul-smelling drainage. The wound is cultured, and an anaerobic bacterium is identified. The nurse understands that the provider orders metronidazole because it is effective against which type of organism?
• Anaerobic bacteria Explanation: Metronidazole is effective against infections with anaerobic bacteria and some protozoa.
After teaching a client who is prescribed oral erythromycin, the nurse determines that the teaching was successful when the client states which of the following? • "I might have some bloody diarrhea after using this medicine." • "I only need to take one pill every day for this medicine to work." • "I should drink a full 8-oz glass of water when I take the medicine." • "I need to take the medicine with a meal so I don't get an upset stomach."
"I should drink a full 8-oz glass of water when I take the medicine." Food in the stomach decreases the absorption of oral macrolides such as erythromycin. Therefore, the drug should be taken on an empty stomach with a full, 8-oz glass of water, 1 hour before or at least 2 to 3 hours after meals. The client may experience diarrhea with this drug, but it should not be bloody. Bloody diarrhea is associated with pseudomembranous colitis, which needs to be reported to the health care provider immediately. Due to its long half-life, azithromycin is usually ordered as a once-daily dose.
A client is diagnosed with VRE, and the health care provider orders chloramphenicol. The nurse should monitor the client for the development of which side effect? • Nausea • Dizziness • Blood dyscrasias • Vomiting
• Blood dyscrasias Chloramphenicol (Chloromycetin) is rarely used due to the possible development of serious and fatal blood dyscrasias with its use. It is effective against some strains of VRE.
Which of the following would a nurse identify as being classified as a macrolide? • Azithromycin • Cephalexin • Gentamicin • Doxycycline
Azithromycin
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 a different antibiotic Explanation: Because of its very limited systemic absorption (97% eliminated in feces), health care providers cannot use rifaximin to treat systemic infections, including infections due to invasive strains of E. coli. Therefore, diarrhea occurring with fever or bloody stools requires treatment with alternative agents. Changing the route or supplementing with vitamin K will not aid in treatment.
Which client should not receive erythromycin as ordered at 8 a.m.?
Correct response: • The client with elevated liver enzymes Explanation: The medication is metabolized by the liver and excreted in the bile. The client with elevated liver enzymes will not be able to tolerate this medication. There is a risk it will build up in the system. The other situations are not contraindications for taking erythromycin.
A client has an upper respiratory infection and is allergic to penicillin. What medication does the nurse expect will be ordered? • Cephalosporin • Ancef • Erythromycin • Ampicillin
Erythromycin A macrolide can be given safely to a client who is allergic to penicillin. Ampicillin, Ancef, and cephalosporins cannot be given because of the risk of cross-sensitivity.
Rifaximin (Xifaxan) is effective to treat traveler's diarrhea from which of the following organisms? • Escherichia coli • Salmonella • Shigella • Campylobacter jejuni
Escherichia coli Rifaximin (Xifaxan) is a miscellaneous antibiotic and is used to treat E. coli. It cannot be used to treat C. jejuni. Effectiveness against Shigella and Salmonella is unknown
Rifaximin (Xifaxan) is effective to treat traveler's diarrhea from which of the following organisms? • Shigella • Escherichia coli • Campylobacter jejuni • Salmonella
Escherichia coli Rifaximin (Xifaxan) is a miscellaneous antibiotic and is used to treat E. coli. It cannot be used to treat C. jejuni. Effectiveness against Shigella and Salmonella is unknown.
A patient has been administered linezolid. The patient is fond of eating chocolates and coffee, both of which contain tyramine. What should the nurse inform the patient about the risk involved when linezolid interacts with foods containing tyramine? • Causes drowsiness. • Causes nausea. • Causes nervousness. • Causes severe hypertension.
• Causes severe hypertension. The nurse should inform the patient that if tyramine found in chocolates and coffee interacts with linezolid, the patient will develop an increased risk for severe hypertension. Nausea is the adverse reaction of quinupristin-dalfopristin. It is not reported to occur due to the interaction of linezolid and tyramine. Nervousness and drowsiness are not reported to be risks developed due to the interaction of linezolid and tyramine.
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 Explanation: 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.
A client presents to the health care provider's office with a skin infection on the forearm. The infection is resistant to over-the-counter antibiotics. After receiving the culture and sensitivity results, the provider orders tigecycline. The nurse knows that this client has what illness?
MRSA Explanation: Tigecycline belongs to the glycylcycline class of antibiotics. It is similar to tetracycline in structure and properties and can be used to treat skin infections caused by MRSA.
A client presents to the health care provider's office with a skin infection on the forearm. The infection is resistant to over-the-counter antibiotics. After receiving the culture and sensitivity results, the provider orders tigecycline. The nurse knows that this client has what illness? • VRE • Clostridium difficile • VREF • MRSA
MRSA Tigecycline belongs to the glycylcycline class of antibiotics. It is similar to tetracycline in structure and properties and can be used to treat skin infections caused by MRSA.
A client presents to the health care provider's office with a skin infection on the forearm. The infection is resistant to over-the-counter antibiotics. After receiving the culture and sensitivity results, the provider orders tigecycline. The nurse knows that this client has what illness? • VREF • VRE • Clostridium difficile • MRSA
MRSA Tigecycline belongs to the glycylcycline class of antibiotics. It is similar to tetracycline in structure and properties and can be used to treat skin infections caused by MRSA.
Which statement is true concerning macrolides? • Macrolides are not absorbed in body fluids. •Macrolides are not absorbed well in body tissues. • Macrolides cannot kill gram-positive bacteria. •Macrolides are bactericidal or bacteriostatic.
Macrolides are bactericidal or bacteriostatic. Macrolides are absorbed well in body tissues and fluids and kill gram-positive bacteria. Depending on the concentration in the body, they can be bactericidal or bacteriostatic.
Which statement is true concerning macrolides?
Macrolides are bactericidal or bacteriostatic. Explanation: Macrolides are absorbed well in body tissues and fluids and kill gram-positive bacteria. Depending on the concentration in the body, they can be bactericidal or bacteriostatic.
A client develops antibiotic-induced colitis. The symptoms have worsened within the past 72 hours. The nurse expects the health care provider to order what medication, which is considered the initial drug of choice?
• Metronidazole Explanation: In antibiotic-associated colitis, stopping the causative drug is the initial treatment. If symptoms do not improve within 3 or 4 days, oral metronidazole or vancomycin is given for 7 to 10 days.
A male client is taking digoxin, SSRIs, and aspirin as part of his daily drug regimen. A client with this drug history who is also receiving linezolid would be at risk for what serious complication?
Serotonin syndrome Explanation: Clients receiving linezolid and selective serotonin reuptake inhibitors (SSRIs) may be at risk for serotonin syndrome, which is characterized by fever and cognitive dysfunction.
A health care provider is deciding what medication to prescribe for a client with an upper respiratory infection. What principles guide the provider's decision? Select all that apply.
• Resistance of the bacteria • Other drugs the client is taking daily • The client's ability to tolerate the drug Explanation: The health care provider needs to consider if the medication will kill the bacteria. The provider also needs to think about the other medications the client is taking because some drugs have many interactions. Tolerance also needs to be considered because the client may develop nausea, vomiting, and diarrhea from the antibiotic. While important to many, cost and generic formulation are not be the prescriber's main considerations.
A client developed a pressure area on the hip that has become infected. If the wound culture reveals methicillin-resistant Staphylococcus aureus, which medication would the nurse expect to be prescribed?
• vancomycin Explanation: Vancomycin is active only against gram-positive microorganisms. It acts by inhibiting cell wall synthesis. Parenteral vancomycin has been used extensively to treat infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant staphylococcal species non-aureus (SSNA, including Staphylococcus epidermidis), and endocarditis caused by Streptococcus viridans (in clients allergic to or with infections resistant to penicillins and cephalosporins) or E. faecalis (with an aminoglycoside). None of the other options would effectively manage this infection.
A male client presents to the emergency department with an abdominal dehiscence. He states he had a hernia repair 18 days earlier, and the health care provider removed his wound staples 5 days ago. The client states that the dehiscence occurred when he lifted a box this morning for his wife. The wound is red, and there is evidence of foul-smelling drainage. The wound is cultured, and an anaerobic bacterium is identified. The nurse understands that the provider orders metronidazole because it is effective against which type of organism? • Staphylococcus • All gram-positive bacteria • All gram-negative bacteria • Anaerobic bacteria
•Anaerobic bacteria Metronidazole is effective against infections with anaerobic bacteria and some protozoa.
A client received erythromycin before dental surgery. The client has a past history of a cardiac surgery. The rest of the client's history is unremarkable. What does the nurse teach the client about this medication?
"You are receiving this medication to prevent infection that may affect your heart." Explanation: The client with a prior history of a heart defect is at risk for bacteria growing in the area of the defect. The client should receive prophylactic antibiotics with any surgery or invasive procedure. The medication does not decrease pain, nor does it make it easier to remove a tooth. Other antibiotics are sometimes given as well as a macrolide.
A patient is required to be administered vancomycin for treatment of an abdominal abscess. What should the nurse ensure when monitoring the IV infusion of vancomycin in the patient when caring for him? • Report an increase in blood pressure. • Administer each dose over 60 minutes. • Report increase in the urinary output.
Administer each dose over 60 minutes. When caring for a client who is being administered vancomycin intravenously, the nurse should ensure that each dose is administered over 60 minutes. The nurse should monitor and report a decrease in blood pressure and not an increase. The nurse should monitor and report any decrease in urinary output and not an increase. The nurse should monitor any signs of throbbing neck pain or back pain and not for signs of headache.
A patient taking erythromycin (E-mycin) is having difficulty hearing the nurse. How should the nurse proceed? • Look in the patient's ears with an otoscope. • Make certain to stand in front of the patient. • Talk louder. • Ask about the patient's hearing prior to medication therapy.
Ask about the patient's hearing prior to medication therapy. The nurse needs to know if this is an effect of the medication, or if the patient had difficulty prior to taking the medication. Hearing difficult caused by the medication is reversible. The nurse should not take steps to "make do" with the deficit until the nurse determines the extent and possible cause.
A patient taking erythromycin (E-mycin) is having difficulty hearing the nurse. How should the nurse proceed? • Look in the patient's ears with an otoscope. • Talk louder. • Ask about the patient's hearing prior to medication therapy. • Make certain to stand in front of the patient.
Ask about the patient's hearing prior to medication therapy. The nurse needs to know if this is an effect of the medication, or if the patient had difficulty prior to taking the medication. Hearing difficult caused by the medication is reversible. The nurse should not take steps to "make do" with the deficit until the nurse determines the extent and possible cause.
A 79-year-old nursing home resident has been prescribed clindamycin. When the resident develops persistent diarrhea, the nurse will include what intervention to help rule out the presence of pseudomembranous colitis? • Request a prescription for an antidiarrheal medication. • Assess the stool for the presence of blood and mucus. • Increase the resident's daily fluid intake. • Eliminate dairy from the resident's diet.
Assess the stool for the presence of blood and mucus. Pseudomembranous colitis is inflammation (swelling, irritation) of the large intestine. In many cases, it occurs after taking antibiotics. Although pseudomembranous colitis may occur with any antibiotic, it has often been associated with clindamycin therapy. With severe and persistent diarrhea, it is critical to check the stools for white blood cells, blood, mucus, and the presence of C. difficile toxin.
Which of the following drugs are considered to be macrolides? Choose all that apply. • linezolid (Zyvox) • azithromycin (Zithromax) • erythromycin • clarithromycin (Biaxin) • metronidazole (Flagyl)
Azithromycin(Zithromax Erythromycin Clarithromycin (Biaxin)
Your client has been diagnosed with intermittent colitis. You know that the following antibiotic is contraindicated for use in this client:
Clindamycin. Explanation: The FDA has issued a BLACK BOX WARNING for clindamycin reporting the development of severe colitis with its use that can be life threatening.
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? • Ulcer tests • Urinalysis • Culture tests • Stool tests
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.
Bacteria have readily evolved. Which type of bacteria are most commonly resistant to vancomycin? • Pseudomonas • Enterococci • Escherichia coli • Spirochetes
Enterococci Enterococci are the bacteria most commonly resistant to vancomycin (Vancocin). Vancomycin is used in the treatment of gram positive bacteria such as enterococci. E. coli, pseudomonas, and spirochetes are all gram-negative bacteria, and vancomycin is not used to treat them. Therefore, acquired resistance does not develop.
A common reaction associated with the intravenous administration of vancomycin is "red man syndrome." What is the cause of red man syndrome?
Histamine release Explanation: Red man syndrome is a histamine reaction characterized by hypotension and skin flushing.
A common reaction associated with the intravenous administration of vancomycin is "red man syndrome." What is the cause of red man syndrome? • Pseudomembranous colitis • Hypotension • Histamine release • Hypertension
Histamine release Red man syndrome is a histamine reaction characterized by hypotension and skin flushing.
While macrolides are widely used for various treatments, they are not prescribed in what situation? • Skin/soft tissue infections • Respiratory tract infections • Infections caused by B. fragilis • Prevention of gonorrhea in newborns
Infections caused by B. fragilis The macrolides are widely used for treatment of respiratory tract and skin/soft tissue infections caused by streptococci and staphylococci. Erythromycin is also used as a penicillin substitute in patients allergic to penicillin; for prevention of rheumatic fever, gonorrhea, syphilis, pertussis, and chlamydial conjunctivitis in newborns (ophthalmic ointment); and to treat other infections (e.g., Legionnaire's disease, genitourinary infections caused by Chlamydia trachomatis, intestinal amebiasis caused by Entamoeba histolytica). Clindamycin is often used to treat infections caused by B. fragilis.
A patient with acne vulgaris was administered macrolides, after which the patient developed diarrhea. What nursing intervention should the nurse perform in this case?
Inspect stools for blood or mucus. Explanation: The nurse should inspect all stools for blood or mucus. Allergy history and signs of infection are obtained in the pre-administration assessment. Urine output is measured in case of renal dysfunctions.
A client develops antibiotic-induced colitis. The symptoms have worsened within the past 72 hours. The nurse expects the health care provider to order what medication, which is considered the initial drug of choice? • Psyllium • Metronidazole • Bismuth subsalicylate • Loperamide
Metronidazole In antibiotic-associated colitis, stopping the causative drug is the initial treatment. If symptoms do not improve within 3 or 4 days, oral metronidazole or vancomycin is given for 7 to 10 days.
The nurse should monitor the client for which common side effects of erythromycin therapy? • Headache and fever • Shortness of breath and sore throat • Nausea, vomiting, and diarrhea • Urticaria and ophthalmic drainage
Nausea, vomiting, and diarrhea Gastrointestinal problems (e.g., nausea, vomiting, and diarrhea) are common side effects of erythromycin and other macrolides. Headache, fever, ophthalmic drainage, urticaria, shortness of breath and sore throat are no common side effects
A client with an infected ulcer on the foot has been prescribed daptomycin. What action should the nurse ensure has been taken to determine that the drug will be effective in treating the infection? • Assess whether the client is being treated for hypercholesterolemia. • Obtain a culture of the client's infection. • Determine whether the client has a known allergy to any lipopeptide class drug • Educate the client of the need to report any muscle pain immediately.
Obtain a culture of the client's infection. Daptomycin is a lipopeptide bactericidal agent effective only for gram-positive infections caused by S. aureus (including oxacillin-resistant strains), S. pyogenes, group B streptococci, and Enterococcus faecalis (vancomycin-susceptible strains only) found in complicated skin and skin structure infections. Prior to beginning daptomycin therapy it is necessary to culture the infection site. The results of the culture and sensitivity report will determine whether daptomycin will be effective in treating the infection. Assessment for allergies, while important, is not directed at determining therapeutic effectiveness of daptomycin. Similarly, determining whether the client is taking cholesterol lowering medications is important--concurrent use of daptomycin and statin drugs should be avoided--but that assessment is not related to drug effectiveness. Daptomycin is known to trigger muscle pain, and the risk is increased by concurrent use of statins, but there is no need to assess for this prior to administration.
A nurse is caring for a client with severe and life-threatening pseudomembranous colitis caused by C. difficile. Which drug would the nurse expect the client's provider to order? • Daptomycin • Linezolid • Oral vancomycin • Tigecycline
Oral vancomycin Oral vancomycin is used to treat staphylococcal enterocolitis and pseudomembranous colitis caused by C. difficile when the colitis fails to respond to metronidazole.
A nurse is caring for a client with severe and life-threatening pseudomembranous colitis caused by C. difficile. Which drug would the nurse expect the client's provider to order? • Tigecycline • Linezolid • Oral vancomycin • Daptomycin
Oral vancomycin Oral vancomycin is used to treat staphylococcal enterocolitis and pseudomembranous colitis caused by C. difficile when the colitis fails to respond to metronidazole.
A health care provider is deciding what medication to prescribe for a client with an upper respiratory infection. What principles guide the provider's decision? Select all that apply. • Available in generic formulation • Other drugs the client is taking daily • Resistance of the bacteria • The client's ability to tolerate the drug • Medication cost
Other drugs the client is taking daily Resistance of the bacteria The client's ability to tolerate the drug The health care provider needs to consider if the medication will kill the bacteria. The provider also needs to think about the other medications the client is taking because some drugs have many interactions. Tolerance also needs to be considered because the client may develop nausea, vomiting, and diarrhea from the antibiotic. While important to many, cost and generic formulation are not be the prescriber's main considerations.
A client who underwent abdominal surgery 6 weeks ago is diagnosed with VREF. The nurse expects the physician to order which medication? • Rifaximin • Rifampin • Quinupristin-dalfopristin • Vancomycin
Quinupristin-dalfopristin Quinupristin-dalfopristin belongs to the streptogramin class of antibiotics. It is indicated for VREF and MSSA.
A client who has been receiving intravenous (IV) vancomycin begins to report neck and back pain as well as feeling hot and having chills. The nurse assesses the client and notices that the neck is red. The client's temperature is 102 degrees F; BP is 86/58. This client is showing signs and symptoms of which syndrome?
Red-man syndrome Explanation: Clients taking vancomycin can develop red-man syndrome, the signs of which include decreased BP, fever, chills, paresthesias, and erythema of the neck and back. Cushing's syndrome is related to increased cortisol levels. Toxic shock syndrome is related to a bacterial infection often resulting from prolonged use of superabsorbent tampons. Stevens-Johnson syndrome is a potentially deadly skin disease that usually results from a drug reaction.
A client, being treated in the intensive care unit, has been diagnosed with ventilator-associated pneumonia. Culture and sensitivity testing of the client's sputum indicates that erythromycin is a treatment option. Which nursing assessment is most appropriate to rule out contraindications for this medication therapy? • Confirm the ability to safely swallow oral medication. • Review lab results to confirm normal liver function. • Question the client about any history of gastrointestinal upset. • Review the medical for a history of nephrotoxic signs or symptoms.
Review lab results to confirm normal liver function. Erythromycin is seldom used in critical care settings, partly because broader spectrum bactericidal drugs are usually needed in critically ill clients and partly because it inhibits liver metabolism and slows elimination of several other drugs. Erythromycin is not nephrotoxic. The drug is administered orally, and GI upset does not contraindicate use.
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. • sudden increase in temperature • regular urine output • decrease in blood pressure • increase in respiratory rate • pulse rate within usual parameters
Sudden increase in temperature Decrease in blood pressure Increase in respiratory rate The nurse must notify the primary health care provider if there is a decrease 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.
Which medication administration information should the nurse include when providing discharge instructions to a client being prescribed oral erythromycin? Select all that apply.
Take medication 1 hour before or 2-3 hours after meals. • Take medication with 8 ounces of water. Explanation: It is necessary to take oral erythromycin according to the manufacturer's instructions. Drinking 6 to 8 ounces of water with the medication is important; adequate intake of water aids the absorption of the medication. It is necessary to take the drug on an empty stomach at evenly spaced intervals around the clock (not just at bedtime). Regular intervals help maintain therapeutic blood levels. People should not take erythromycin after taking antacids. Antacids decrease the absorption of both the tablet and suspension form of erythromycin. Dairy products are not contraindicated but should be ingested considering the need to administer the medication on an empty stomach.
A patient on your unit has bacterial colitis and is being treated with oral vancomycin. Why is vancomycin given orally, rather than intravenously, in the treatment of bacterial colitis? • Fewer pathogens are resistant to the oral version of the drug than to the IV version. • The oral version of the drug limits the release of histamines. • The oral version of the drug is easier to administer. • The oral version of the drug acts within the bowel lumen.
The oral version of the drug acts within the bowel lumen. For bacterial colitis, vancomycin is given orally because it is not absorbed from the GI tract and acts within the bowel lumen.
A client is receiving azithromycin (Zithromax). What assessment best indicates the medication is therapeutic? • The client's WBC decreased • The sputum culture is negative • All medication is taken • Absence of fever
The sputum culture is negative. Azithromycin is often given for lower respiratory infections, pharyngitis, tonsillitis, and ear infections. It is also given for community-acquired pneumonia. A fever should decrease within several days of taking an antibiotic; however, this does not mean the infection is cured or the medication has been therapeutic. A decrease in the WBC may indicate the infection is clearing; however, the answer states "WBC decreased." If it remains elevated, but has decreased, the client can still have an infection. While we encourage clients to take all of their medication, this does not indicate the medication is therapeutic. The bacteria could be resistant to the medication. The best way to indicate that an antibiotic is therapeutic is the absence of bacteria in previously infected body fluids.
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? • increasing the dose of rifaximin • changing to parenteral administration of rifaximin • changing to a different antibiotic • supplementing the antibiotic with vitamin K
changing to a different antibiotic Because of its very limited systemic absorption (97% eliminated in feces), health care providers cannot use rifaximin to treat systemic infections, including infections due to invasive strains of E. coli. Therefore, diarrhea occurring with fever or bloody stools requires treatment with alternative agents. Changing the route or supplementing with vitamin K will not aid in treatment.
A professor of pharmacology has just finished a lecture about a drug called rifaximin (Xifaxan). Which statements by the students indicates that the teaching has been effective?
• "It is used to treat diarrhea due to E. coli." Explanation: Rifaximin (Xifaxan) is a structural analog of rifampin. It is used in infectious (traveler's) diarrhea resulting from Escherichia coli but is not effective in diarrhea from Campylobacter jejuni. Because of its very limited systemic absorption (97% eliminated in feces), rifaximin cannot be used to treat systemic infections, including infections from invasive strains of E. coli.
A client has been prescribed daptomycin for treatment of an infection. What instruction is most important for the nurse to tell this client? • "Expect that this medication may cause bloody diarrhea." • "Maintain a clear liquid diet while on the medication to prevent nausea." • "Take a laxative every day to prevent becoming constipated." • "Tell the health care provider immediately if you develop any muscle pain."
• "Tell the health care provider immediately if you develop any muscle pain." Because of its very limited systemic absorption (97% eliminated in feces), health care providers cannot use rifaximin to treat systemic infections, including infections due to invasive strains of E. coli. Therefore, diarrhea occurring with fever or bloody stools requires treatment with alternative agents. Changing the route or supplementing with vitamin K will not aid in treatment.
A client has been prescribed daptomycin for treatment of an infection. What instruction is most important for the nurse to tell this client? • "Expect that this medication may cause bloody diarrhea." • "Maintain a clear liquid diet while on the medication to prevent nausea." • "Tell the health care provider immediately if you develop any muscle pain." • "Take a laxative every day to prevent becoming constipated."
• "Tell the health care provider immediately if you develop any muscle pain." The presence of muscle pain or weakness is an indication that the client is developing a severe musculoskeletal reaction, and the medication must be discontinued immediately
The nurse is preparing to administer IV vancomycin to a client for the treatment of a systemic infection. How long would the nurse expect the infusion to run? • 30 minutes • 2 to 4 hours • 3 to 4 hours • 1 to 2 hours
• 1 to 2 hours For systemic infections, vancomycin is given IV and reaches therapeutic plasma levels within 1 hour after infusion. It is very important to give IV infusions slowly, over 1 to 2 hours, to avoid an adverse reaction characterized by hypotension, flushing, and skin rash. This reaction, sometimes called "red man syndrome," is attributed to histamine release.
A patient on your unit has bacterial colitis and is being treated with oral vancomycin. Why is vancomycin given orally, rather than intravenously, in the treatment of bacterial colitis?
• The oral version of the drug acts within the bowel lumen. Explanation: For bacterial colitis, vancomycin is given orally because it is not absorbed from the GI tract and acts within the bowel lumen.
A patient is required to be administered vancomycin for treatment of an abdominal abscess. What should the nurse ensure when monitoring the IV infusion of vancomycin in the patient when caring for him? • Observe for signs of headache. • Report an increase in blood pressure. • Report increase in the urinary output. • Administer each dose over 60 minutes.
• Administer each dose over 60 minutes. When caring for a client who is being administered vancomycin intravenously, the nurse should ensure that each dose is administered over 60 minutes. The nurse should monitor and report a decrease in blood pressure and not an increase. The nurse should monitor and report any decrease in urinary output and not an increase. The nurse should monitor any signs of throbbing neck pain or back pain and not for signs of headache.
A 79-year-old nursing home resident has been prescribed clindamycin. When the resident develops persistent diarrhea, the nurse will include what intervention to help rule out the presence of pseudomembranous colitis?
• Assess the stool for the presence of blood and mucus. Explanation: Pseudomembranous colitis is inflammation (swelling, irritation) of the large intestine. In many cases, it occurs after taking antibiotics. Although pseudomembranous colitis may occur with any antibiotic, it has often been associated with clindamycin therapy. With severe and persistent diarrhea, it is critical to check the stools for white blood cells, blood, mucus, and the presence of C. difficile toxin. None of the other options are relevant to determining if pseudomembranous colitis has developed. Increasing fluids will assist in preventing dehydration related to the diarrhea. Avoiding dairy is relevant only when the diarrhea is related to lactose intolerance or some other form of absorption issue. Antidiarrheal medication, while possibly a means to minimizing the liquid stool, has no relevance to determining the cause of the diarrhea or presence of pseudomembranous colitis.
79-year-old nursing home resident has been prescribed clindamycin. When the resident develops persistent diarrhea, the nurse will include what intervention to help rule out the presence of pseudomembranous colitis? • Assess the stool for the presence of blood and mucus. • Increase the resident's daily fluid intake. • Eliminate dairy from the resident's diet. • Request a prescription for an antidiarrheal medication
• Assess the stool for the presence of blood and mucus. Pseudomembranous colitis is inflammation (swelling, irritation) of the large intestine. In many cases, it occurs after taking antibiotics. Although pseudomembranous colitis may occur with any antibiotic, it has often been associated with clindamycin therapy. With severe and persistent diarrhea, it is critical to check the stools for white blood cells, blood, mucus, and the presence of C. difficile toxin. None of the other options are relevant to determining if pseudomembranous colitis has developed. Increasing fluids will assist in preventing dehydration related to the diarrhea. Avoiding dairy is relevant only when the diarrhea is related to lactose intolerance or some other form of absorption issue. Antidiarrheal medication, while possibly a means to minimizing the liquid stool, has no relevance to determining the cause of the diarrhea or presence of pseudomembranous colitis.
The nurse is caring for a client who is receiving chloramphenicol. The nurse will assess this client for what potential adverse effect?
• Blood dyscrasia Explanation: The client who is receiving chloramphenicol is at risk for blood dyscrasias. That is one reason why this medication is not prescribed very often.
An 82-year-old client, who lives alone and has occasional memory lapses, is being seen by the home health nurse. In reviewing the client's medication, the nurse discovers that the client was recently prescribed azithromycin for urethritis. What characteristic of this drug makes it an appropriate choice for this client? • The half-life of the drug is 3 to 7 hours. • It is taken only once a day. • The drug usually achieves results in only a 3-day course. • Zithromax is associated with very few drug-drug interactions.
• It is taken only once a day. Given that the client has occasional memory lapses and lives alone, a daily dose would likely promote improved adherence. Azithromycin can be administered once daily because the half-life is 68 hours. Azithromycin may adversely interact with cardiac glycosides, oral anticoagulants, theophyllines, carbamazepine, and corticosteroids to name a few agents. The course of treatment is likely to exceed 3 days.
John, 34 years old, is being treated with clindamycin for osteomyelitis of his tibia following an open fracture 3 months ago. The nurse is teaching John how to properly administer the medication at home and the side effects that he needs to report to the health care provider. Which would be the best instruction to give John? • Notify the provider if you have any blood in your stool or diarrhea. • Call the provider if you have nausea after taking the medication. • Contact the provider if you are having headaches or visual changes. • Contact the provider's office if you have abdominal distention.
• Notify the provider if you have any blood in your stool or diarrhea. The most serious adverse effect is pseudomembranous colitis (a Black Box warning), also known as Clostridium difficile colitis. Diarrhea, abdominal cramps, and abdominal tenderness may suggest antibiotic-associated colitis. Nausea and vomiting and abdominal pain following oral administration are the most common adverse effects of clindamycin.
The health care provider suspects a client may be infected with an antibiotic-resistant pathogen. The nurse caring for this client knows that what course of action is best used to determine whether this type of pathogen is present? • Perform a complete blood count (CBC) test. • Assess serum electrolyte levels. • Perform culture and susceptibility tests. • Perform a lumbar puncture to assess cerebrospinal fluid.
• Perform culture and susceptibility tests. Before prescribing an antibiotic, the health care provider should review culture and susceptibility reports and local susceptibility patterns to determine if an antibiotic-resistant pathogen is present in the client. Complete blood counts and electrolyte values are standard procedure lab tests. Spinal fluid checks are performed to detect anomalies such as meningitis.
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? • Serotonin syndrome • Gray syndrome • Red man syndrome • Cushing's syndrome
• Red man syndrome The nurse must be careful to infuse vancomycin at the prescribed rate to prevent the occurrence of red man syndrome. With this syndrome, the client's face and upper trunk becomes bright red, and it has led to cardiovascular collapse.
Your patient is receiving a miscellaneous antibacterial to treat an infection. Which of the following goals would be appropriate to include in your plan of care? Select all that apply. • The patient will experience an increase in signs and symptoms of the infection being treated. • The patient will take or receive miscellaneous antimicrobials accurately, for the prescribed length of time. • The patient will be monitored regularly for therapeutic and adverse drug effects. • The patient will verbalize and practice measures to prevent recurrent infection.
• The patient will take or receive miscellaneous antimicrobials accurately, for the prescribed length of time. • The patient will be monitored regularly for therapeutic and adverse drug effects. • The patient will verbalize and practice measures to prevent recurrent infection. The patient should experience decreased signs and symptoms of the infection being treated, not increased.
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.
• decrease in blood pressure • increase in respiratory rate • sudden increase in temperature Explanation: The nurse must notify the primary health care provider if there is a decrease 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.
Which of the following drugs are considered to be macrolides? Choose all that apply.
• erythromycin • azithromycin (Zithromax) • clarithromycin (Biaxin) Explanation: The macrolides, which include erythromycin, azithromycin (Zithromax), and clarithromycin (Biaxin), have similar antibacterial spectra and mechanisms of action. Metronidazole (Flagyl) and linezolid (Zyvox) are considered miscellaneous antibacterials.
A client developed a pressure area on the hip that has become infected. If the wound culture reveals methicillin-resistant Staphylococcus aureus, which medication would the nurse expect to be prescribed? • vancomycin • metronidazole • erythromycin • Penicillin
• vancomycin Vancomycin is active only against gram-positive microorganisms. It acts by inhibiting cell wall synthesis. Parenteral vancomycin has been used extensively to treat infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant staphylococcal species non-aureus (SSNA, including Staphylococcus epidermidis), and endocarditis caused by Streptococcus viridans (in clients allergic to or with infections resistant to penicillins and cephalosporins) or E. faecalis (with an aminoglycoside). None of the other options would effectively manage this infection.
