Chapter 7 Antibacterial drugs that disrupt the bacterial cell wall
Beta-lactam antibiotics, such as penicillins and cephalosporins, fight infection by inhibiting development of the causative bacteria. What specific component development do these drugs affect?
Cell wall synthesis
A client is administered a third-generation cephalosporin. The broad-spectrum agents like cephalosporins are most effective in treating which type of microorganism?
Gram negative
A male client who has undergone surgery of the urinary tract is administered cephalosporins to prevent infections. When assessing the client on the day after the surgery, the nurse notices that he has an elevated temperature. Which nursing intervention would be most appropriate in this case?
Inform the primary health care provider.
A nurse is caring for a client who is receiving penicillin therapy. The client has been reporting diarrhea-like symptoms, and the nurse suspects a bacterial superinfection. Which interventions would be most appropriate?
Inspect stools to confirm diarrhea.
Some combination antibacterial drugs consist of a penicillin and a beta-lactamase inhibitor. What is the primary purpose of a beta-lactamase inhibitor in one of these drugs?
It protects the penicillin.
A client has been diagnosed with streptococcal pharyngitis. What drug would the nurse expect to be prescribed by the health care provider?
Penicillin G
A 36-year-old client with a history of rheumatic fever is scheduled for dental surgery. The primary care provider orders this client to take penicillin for 3 days before and for 3 days after surgery. This is a case of which type of therapy?
Prophylaxis
A 34-year-old female client is taking oral cephradine, a first-generation cephalosporin, at regular intervals with a 2-hour gap before meals. The client reports gastrointestinal distress. The nurse will encourage the client to do which?
Take the drug with food.
A 64-year-old client is admitted to your unit with exacerbation of chronic heart failure and pneumonia and started on cefixime. On the third hospital day, you are assessing the client and note white patches in his mouth, and he is complaining of diarrhea. What would be the most likely reason for these symptoms?
The client has developed a superinfection because the antibiotic has destroyed the normal bacterial flora in his body
A client is taking penicillin for an upper respiratory infection. The client calls the office after 2 days of therapy reporting nausea and abdominal pain. Which would be the best instruction for the nurse to give the client?
These are normal side effects, but if they increase in severity or frequency, you need to contact the office again.
The nurse is caring for a 23-year-old female client who uses oral contraceptives and has been prescribed ampicillin for treatment of a respiratory infection. What information is most important for the nurse to share with this client?
Use a type of barrier birth control while you are taking this antibiotic.
The nursing instructor is teaching about a new emerging bacteria that has both natural and acquired resistance and that affects the severely ill, immunocompromised clients in intensive care, transplant, and some cancer treatment units. This is which?
VRE
The client is receiving keflex 1000 mg/day. The nurse properly identifies this drug as a:
first-generation cephalosporin.
All penicillins have the same adverse reactions, including which? Select all that apply.
glossitis nausea rash gastritis
The pharmacology instructor is explaining combination drugs to the nursing class. The instructor tells the students that the combination of a beta-lactamase inhibitor and a penicillin produces what effect?
it extends the spectrum of antibacterial activity of the penicillin
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
Cephalosporins might interfere with the accuracy of which test?
ketone urine test
The nurse is justified in suspecting that a client who recently completed a course of ceftaroline may have been treated for what health problem?
methicillin-resistant Staphylococcus aureus (MRSA) infection
A nurse is assessing a client who is receiving vancomycin intravenously. While the drug is being administered, the client reports a throbbing sensation in their neck and back and paresthesias. The client's blood pressure has dropped and their neck and back are erythematous. The nurse suspects which adverse finding?
red man syndrome
Beta-lactam antibacterial drugs, such as penicillins and cephalosporins, combat infection by binding to proteins in bacterial cell membranes. What does this binding produce?
A defective cell wall
The nurse is caring for a client whose prescribed course of cefaclor will soon be completed. What health education should the nurse provide to the client?
"Make sure to avoid drinking any alcohol for the next three days."
A postoperative client is ordered Keflex 250 mg every 6 hours for 5 days. How much Keflex will the client receive in a 24-hour period?
1 gram
The nurse is giving instructions to a client who is being discharged home with a prescription for Augmentin. The nurse informs the client that the best time to take this medication is:
1 hour before meals and 2 hours after a meal.
When caring for a client who has been administered penicillin, a nurse observes rashes on the client's skin. The primary health care provider has diagnosed it as a minor hypersensitivity reaction. What would the nurse expect to do? Select all that apply.
Apply emollients to the affected area. Ensure the client does not wear tight clothes.
Culture and sensitivity testing of a client's urine sample reveals a bacterium that is susceptible to cephalosporins. What medication would be most likely for the nurse to administer?
Cefaclor
A client with diabetes is ordered a cephalosporin to treat a recurring infection. The client is taking insulin and reports controlling the blood glucose level by monitoring it with urine strips and adjusting doses of insulin accordingly. What instructions should the nurse tell this client?
Cephalosporin may interfere with accurate test results.
Natural penicillins have been available since 1941 to treat infections. What problem has developed since 1941?
Drug-resistant strains of microorganisms have developed.
Which of the following is true of fourth-generation cephalosporins? (Select all that apply)
Fourth-generation cephalosporins have a broader spectrum of action Fourth-generation cephalosporins have a longer duration of resistance to beta-lactamase
A client taking a cephalosporin for a respiratory infection informs the nurse that her tongue feels funny and has white patches on it. She asks the nurse what could be wrong. The nurse informs the client that she has developed which?
Fungal superinfection
What potential adverse reaction is most likely to develop during cefazolin therapy?
Gastrointestinal upset
The nurse understands that bacterial resistance can result when certain bacteria produce penicillinase. What does penicillinase do?
Inactivates penicillin
The nurse is administering penicillin to a client who has strep throat. Which of the following statements accurately describe the action of penicillin?
It is effective against gram-positive organisms
A client is diagnosed with febrile neutropenia. Which medication is most effective in treating this client?
Meropenem
An older adult is to receive a low dose of a cephalosporin for an infection. When realizing that this client has age-related diminished renal function, what intervention should the nurse implement?
Monitor blood creatinine levels.
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
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
Ampicillin-sulbactam is administered to a client with Staphylococcus aureus. What type of anti-infective is ampicillin-sulbactam?
Penicillin-beta-lactamase inhibitor combination
Penicillins are dependent on which of the following for their bactericidal activity? (Choose one)
Serum concentration
While discussing drug combinations, including the beta-lactamase inhibitor combinations, the pharmacology instructor explains their mechanisms of action. What benefit is derived from combining a beta-lactamase inhibitor with a penicillin?
The beta-lactamase inhibitor protects the penicillin.
A client is being treated for urosepsis with ceftriaxone IV. What assessment finding should prompt the nurse to contact the care provider immediately?
The client has a new onset of jaundice and edema
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?
bactericidal
A client is scheduled for a bowel resection. During the perioperative period, which type of medication should the nurse anticipate the client will be given?
cephalosporins
A client is admitted to the hospital with a suspected urinary tract infection. The first thing a nurse should do before administering the ordered cephalosporin is to:
collect urine for testing culture and sensitivity.
The nurse is preparing a teaching plan for a client who is prescribed ceftriaxone. What should the nurse identify as common adverse effects associated with this drug?
diarrhea and nausea
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:
oral contraceptives.
The nursing instructor is teaching the students about different gastrointestinal adverse reactions to penicillin. What other reactions may occur with this medications administration? (Select all that apply.)
pain at the injection site irritation at the vein phlebitis
The nurse is aware that drug resistance has significantly increased. Client education must be reinforced so that complete regimens of medications are taken. In which situation would one expect to find an issue with drug resistance?
residents in a long-term care facility
The client is admitted to the acute care facility with acute septicemia and has orders to receive gentamicin and ampicillin IV. The nurse is performing an admission assessment that includes a complete nursing history. What information provided by the client would indicate the need to consult the healthcare provider before administering the ordered medication?
takes high-dose furosemide daily
A client has been diagnosed with a sinus infection, and the client has been given a prescription for amoxicillin. What teaching point should the nurse make for the client?
"Take your medication every 8 hours, as it's been prescribed."
Penicillin would NOT be indicated for which of the following clients?
A client with gram-negative bacteria allergic to penicillin
When learning about the different classes of cephalosporins, the nurse correctly identifies which of the following statements?
A first-generation cephalosporin is more useful than a third-generation cephalosporin against gram-positive microorganisms.
A hospital client has been prescribed IV ceftriaxone, a cephalosporin antibiotic. What assessment finding related to drug therapy would be of greatest concern to the nurse?
The client develops jaundice
The client has a severe infection in the leg from a boating accident. A diagnosis has been made of the presence of MRSA. MRSA can best be defined as which?
a bacteria resistant to antibiotics
A disulfiram-like reaction may occur if which substance is consumed within 72 hours after administration of certain cephalosporins?
alcohol
A client diagnosed with infective endocarditis would be most effectively treated with which medication?
ampicillin
A client has just received a first dose of intravenous nafcillin when he immediately begins to have difficulty breathing and loses consciousness. The nurse takes the client's vital signs: blood pressure is 88/50 with a pulse oxygenation of 88%.What should the nurse suspect?
anaphylactic reaction
The concentration of any drug in the body is referred to as which of the following?
blood level
A 67-year-old client with a history of chronic illness is receiving penicillin therapy. The client's age and health history indicate an increased susceptibility to pseudomembranous colitis. The nurse would be alert for which finding? Select all that apply.
bloody diarrhea rectal bleeding
The nurse informs the client that most common bacterial superinfections are developed where?
bowel
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:
can cause allergic reactions in clients who are allergic to penicillins.
A group of nursing students are reviewing information about the different cephalosporins. The students demonstrate understanding of the information when they identify which medication should be administered with food to increase the absorption?
cefuroxime
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
A nurse monitors a client closely for anaphylactic reactions secondary to penicillin therapy. The nurse understands that this occurs more commonly after which route of administration?
parenteral
What event triggers the development of a superinfection?
proliferation of antibiotic-resistant microorganisms
The nurse knows that superinfections are a concern for clients who have been taking oral penicillins. Which is one of the more common superinfections?
pseudomembranous colitis
The nurse has administered the first dose of a client's newly-prescribed antibiotic. What assessment finding should the nurse interpret as adverse effect that suggests a more serious concern?
rash to the face and trunk
Penicillins may trigger an anaphylactic reaction in some clients. Within what period following injection of a penicillin is anaphylaxis most likely to occur?
30 minutes
A client has a history of a life-threatening anaphylactic reaction to penicillin G. Which medication should not be administered to this client?
Cefadroxil
A client previously experienced an anaphylactic reaction to penicillin G. Which medication should not be administered to this client due to the potential for cross-sensitivity?
Cefadroxil
Which drug is a first-generation cephalosporin used as a surgical prophylaxis?
Cefazolin
Most cephalosporins may be taken with food except which of the following?
Ceftibuten (Cedax)