Chapter 8&9 Antiinfective Agents& Antibiotics

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? A. Cefaclor B. Imipenem-cilastatin C. Ciprofloxacin D. Neomycin

A. Cefaclor Rationale: Cefaclor is an example of a cephalosporin. Imipenem-cilastatin is an example of a carbapenem. Neomycin is an example of an aminoglycoside. Ciprofloxacin is an example of a fluoroquinolone.

A hospital client's infection is being treated with gentamicin. When reviewing the results of the client's morning laboratory results for signs of adverse effects, the nurse should pay particular attention to what laboratory value? A. Creatinine clearance B. Platelets C. AST and ALT D. International normalized ratio

A. Creatinine clearance Rationale: Gentamicin is nephrotoxic, and renal function should be monitored throughout treatment. For this reason, the client's creatinine clearance would likely be monitored more closely than tests of liver function or coagulation.

Sensitivity testing of a culture shows A. Drugs that are capable of controlling that particular microorganism. B. The patient's potential for allergic reactions to a drug. C. The offending microorganism. D. An immune reaction to the infecting organism.

A. Drugs that are capable of controlling that particular microorganism.

A client has been placed on isolation precautions for treatment of an infection that is vancomycin-resistant and methicillin-resistant. The nurse would anticipate administering what drug? A. Linezolid B. Daptomycin C. Aztreonam D. Tigecycline

A. Linezolid Rationale: Linezolid is indicated for treatment of infections cause by vancomycin-resistant and methicillin-resistant strains of bacteria. Tigecycline is approved for use in treatment of complicated skin and skin structure infections and intra-abdominal infections caused by susceptible bacteria. Daptomycin is approved for treating complicated skin and skin structure infections caused by susceptible gram-positive bacteria, including methicillin-resistant strains of Staphylococcus aureus. Aztreonam is indicated for the treatment of urinary tract, skin, intra-abdominal, and gynecologic infections as well as septicemia caused by susceptible bacteria.

Bacterial resistance to an antiinfective could be the result of which of the following? Select all that apply: A. Natural intrinsic properties of the bacteria B. Changes in cellular permeability or cellular transport systems C. The production of chemicals that antagonize the drug D. Initial exposure to the antiinfective E. Combination of too many antibiotics for one infection F. Narrow spectrum of activity

A. Natural intrinsic properties of the bacteria B. Changes in cellular permeability or cellular transport systems C. The production of chemicals that antagonize the drug

The nurse is preparing to administer amikacin to a client with a complicated Staphylococcus aureus infection. What assessment should the nurse prioritize? A. Renal function B. GI function C. Muscle strength D. Nutritional status

A. Renal function Rationale: Amikacin is an aminoglycoside that may cause renal toxicity. Assessing renal function would be a priority. Although the drug can affect the GI tract leading to nausea, vomiting, diarrhea, and weight loss, which could lead to problems with nutrition and cause numbness, tingling, and weakness, assessment of GI function, nutritional status, and muscle strength would be considered lower-priority assessments.

An aminoglycoside antibiotic might be the drug of choice in treating A. Serious infections caused by susceptible strains of gram-negative bacteria. B. Otitis media in an infant. C. Cystitis in a woman who is 4 months pregnant. D. Suspected pneumonia before the culture results are available.

A. Serious infections caused by susceptible strains of gram-negative bacteria.

Antiinfective drugs destroy cells that have invaded the body. They do not specifically destroy only the cell of the invader, and because of this, many adverse effects can be anticipated when an antiinfective is used. Which of the following adverse effects are often associated with antiinfective use? Select all that apply: A. Superinfections B. Hypotension C. Renal toxicity D. Diarrhea E. Loss of hearing F. Constipation

A. Superinfections C. Renal toxicity D. Diarrhea

in general all patients receiving antibiotics should receive teaching that includes which of the following points? Select all that apply: A. The need to complete the full course of drug therapy. B. The possibility of oral contraceptive failure. C. When to take he drug related to food and other drugs. D. The need for assessment of blood tests. E. Advisability of saving any leftover medication for future use. F. How to detect superinfection and what to do if they occur.

A. The need to complete the full course of drug therapy. C. When to take he drug related to food and other drugs. D. The need for assessment of blood tests. F. How to detect superinfection and what to do if they occur.

A client with an infected diabetic foot ulcer has been prescribed linezolid. What health education should the nurse provide to the client? A. "Avoid acetaminophen or ibuprofen while you're taking linezolid". B. " It's a good idea to monitor your blood pressure while you're taking this drug". C. "Try to stay out of the sun while taking this drug, or at least wear strong sunscreen". D. "Avoid foods like aged cheese and cured meats while you're taking this drug".

B. " It's a good idea to monitor your blood pressure while you're taking this drug". Rationale: Linezolid can exacerbate hypertension; blood pressure monitoring during treatment is prudent. There is no need to avoid high-tyramine foods. Photosensitivity is not expected. The client should check with the provider before taking OTC medications, but acetaminophen and ibuprofen are not absolutely contraindicated.

A client who has tested positive for active tuberculosis is to receive rifampin. What is the nurse's priority teaching point for this client? A. "Expect to develop a rash for the first day or two. It will resolve spontaneously" B. "Your urine, tears, or sweat may become orange in color" C. "Call your doctor immediately if you experience headache or dizziness" D. "Avoid excessive fluid intake so that you don't dilute your blood levels of the drug"

B. "Your urine, tears, or sweat may become orange in color" Rationale: This drug causes body fluids to turn orange. The client needs to be informed of this to avoid being frightened when it occurs. A rash indicates a hypersensitivity reaction that should be addressed promptly. Headache and dizziness are common CNS effects of the drug that do not need to be immediately reported. Increased fluid intake is recommended.

Cipro, a widely used antibiotic, is an example of A. A penicillin B. A fluoroquinolone C. An aminoglycoside D. A macrolide antibiotic

B. A fluoroquinolone

The penicillins A. Are bacteriostatic. B. Are bactericidal, interfering with bacteria cell walls. C. Are effective only if given intravenously. D. Do not produce cross-sensitivity within their class.

B. Are bactericidal, interfering with bacteria cell walls.

Place the following cephalosporins in the proper sequence beginning with first-generation cephalosporins up to fourth-generation cephalosporins. A. Cefepime B. Cefazolin C. Cefotaxime D. Cefuroxime

B. Cefazolin Rationale: Over time, four generations of cephalosporins have been introduced, each group with its own spectrum of activity. First-generation drugs include cefadroxil, cefazolin, and cephalexin. Second-generation cephalosporins include cefaclor, cefoxitin, cefprozil, and cefuroxime. Third-generation drugs include cefdinir, cefoperazone, cefotaxime, cefpodoxime, ceftazidime, ceftibuten, ceftizoxime, and ceftriaxone. Fourth-generation cephalosporins are in development. The first drug of this group is cefepime.

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? A. Superinfections and phlebitis B. Diarrhea and nausea C. Headache and dizziness D. Lethargy and paresthesias

B. Diarrhea and nausea Rationale: The most common adverse effects associated with ceftriaxone, a cephalosporin, include those affecting the GI tract, such as nausea, vomiting, diarrhea, abdominal pain, and flatulence. Headache, dizziness, lethargy, and paresthesias can occur as well as superinfections and phlebitis (with IV administration), but these are not the most common.

A young woman is found to have a soft-tissue infection that is most responsivve to tetraccline. Your teaching plan for this woman should include which of the following points? Select all of the apply: A. Tetracycline can cause gray baby syndrome. B. Do not use this drug if you are pregnant because it can cause tooth and bone defects in the fetus. C. Tetracycline can cause severe acne. D. You should use a second form of contraception if you are using oral contraceptives because tetracycline can make them ineffective. E. This drug should be taken in the middle of a meal to decrease GI upset. F. You may experience a vaginal yeast infection as a result of this drug therapy.

B. Do not use this drug if you are pregnant because it can cause tooth and bone defects in the fetus. D. You should use a second form of contraception if you are using oral contraceptives because tetracycline can make them ineffective. F. You may experience a vaginal yeast infection as a result of this drug therapy.

A client has been diagnosed with Legionnaires disease and is being treated with a macrolide antibiotic. The nurse should expect the client's mediation administration record to include: A. Cephalexin B. Erythromycin C. Doxycycline D. Gentamicin

B. Erythromycin Rationale: Erythromycin is a macrolide used for treating Legionnaires disease. Gentamicin is an aminoglycoside. Doxycycline is a tetracycline. Cephalexin is a cephalosporin.

A client with a urinary tract infection is being treated with a sulfonamide antibiotic. The nurse should recognize that pathogens are being eradiated by what means? A. Interference with DNA enzymes necessary for bacterial growth. B. Inhibition of folic acid synthesis C. Inhibition of cell membrane synthesis D. Prevention of biosynthesis of bacterial cell wells.

B. Inhibition of folic acid synthesis Rationale: Sulfonamides inhibit the synthesis of folic acid, which is necessary for cells to grow and reproduce. Carbapenems inhibit cell membrane synthesis. Cephalosporins prevent bacteria from biosynthesizing the framework of their cell walls. Fluoroquinolones interfere with the action of DNA enzymes that are necessary for bacterial growth and reproduction.

A client's upper respiratory infection is believed to be bacterial, so the healthcare provider has prescribed amoxicillin 500 mg PO q8h. How should the nurse best interpret this prescription? A. There is a need to contact the provider because intravenous administration is preferable to oral. B. It aligns with the recommended dose, route, and indication for this medication. C. The client's potential for non-adherence should be assessed because the course may be up to 3 weeks. D. The dose is sub-therapeutic and may lead to antibiotic resistance.

B. It aligns with the recommended dose, route, and indication for this medication. Rationale: This order is within reference ranges for amoxicillin. A typical course is less than 1 week.

The nurse is providing care for a client who has been prescribed telithromycin. When assessing the client's underlying health problem, what assessment should the nurse prioritize? A. Skin assessment B. Respiratory assessment C. Urine quantity and character D. Cardiac monitoring

B. Respiratory assessment Rationale: Telithromycin is a ketolide that is structurally similar to the macrolides and which is approved for the treatment of community-acquired pneumonia. It would not normally be used to treat a urinary tract infection or skin infection. A client taking this mediation would be unlikely to have cardiac indications.

A client is receiving a cephalosporin and an aminoglycoside as combination therapy. What assessment should the nurse prioritize? A. Coagulation studies B. Serum BUN and creatinine levels C. Complete blood count D. Signs of disulfiram-like raction

B. Serum BUN and creatinine levels Rationale: The nurse would need to assess renal function indicated by serum BUN and creatinine levels because combining cephalosporins with aminoglycosides increases the client's risk for renal toxicity. Coagulation studies would be important if the client was receiving a cephalosporin with an oral anticoagulant because there is an increased risk for bleeding. Combining cephalosporins with alcohol could result in a disulfiram-like reaction. Assessing the client's complete blood count would not be directly indicated by the combination of cephalosporins and aminoglycosides.

Antibiotics that are used together to increase their effectiveness and limit the associated adverse effects are said to be A. Broad spectrum B. Synergistic C. Bactericidal D. Anaerobic

B. Synergistic

A client with a complex medical history is showing signs and symptoms of sepsis. What aspect of this client's health history would rule out the safe and effective use of an aminoglycoside antibiotic? A. The client has a history of not adhering to treatment. B. The client has chronic renal failure C. The client has type 2 diabetes, controlled with oral antihyperlycemics D. The client has a known latex allergy

B. The client has chronic renal failure. Rationale: Renal failure would preclude the use of an aminoglycoside. Nonadherence must always be addressed, but this client variable is not specific to aminoglycosides. Neither latex allergies nor type 2 diabetes would necessarily rule out the use of an aminoglycoside.

Superinfections can occur when antiinfective agents destroy the normal flora of the body: Candida infections are commonly associated with antibiotic use. A patient with this type of superinfection would exhibit A. Difficulty breathing B. Vaginal discharge or while patches in the mouth C. Elevated blood urea nitrogen D. Dark lesions on the skin

B. Vaginal discharge or while patches in the mouth

A broad-spectrum antibiotic would be the drug of choice when A. the patient has many known allergies. B. one is waiting for culture and sensitivity results. C. the infection is caused by one specific bacterium. D. treatment is being given for an upper respiratory infection of unknown cause.

B. one is waiting for culture and sensitivity results.

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? A. "It's possible that your urine might be pink-tinged for the next little while, but that's expected and will resolve". B. "Remember to have your required blood work drawn in 48 hour". C. "Make sure to avoid drinking any alcohol for the next 3 days". D. "You might develop a mild fever when you finish your antibiotics, but that doesn't mean your infection has returned".

C. "Make sure to avoid drinking any alcohol for the next 3 days". Rationale: To avoid a disulfiram-like reaction when alcohol and cephalosporins are used together, the client should avoid consuming alcoholic beverages for at least 72 hours after completing the drug course. Pink-tinged urine is not expected, and a fever would be clinically significant. There is not normally any need for follow-up blood work.

Which of the following is not a caution for the use of cephalosporins? A. Allergy to penicillin B. Renal failure C. Allergy to aspirin D. Concurrent treatment with aminoglycosides

C. Allergy to aspirin

An example of an antiinfective used as a means of prophylaxis would be A. Amoxicillin used for tonsillitis. B. Penicillin used to treat an abscess. C. An antibiotic used before dental surgery. D. Co-triomoxazole used for a bladder infection.

C. An antibiotic used before dental surgery.

Gram-negative bacteria A. Are mostly found in the respiratory tract. B. Are mostly associated with soft tissue infections. C. Are most likely found in the GI and GU tracts. D. Accept a positive stain when tested.

C. Are most likely found in the GI and GU tracts.

A client has been prescribed oxacillin after the prescriber reviewed the results of culture and sensitivity testing. The nurse should explain what unique benefit of this medication? A. It does not require monitoring in an intensive care or critical care setting. B. It has not appreciable adverse effects on the GI system. C. It is effective against many pathogens that have developed resistance to penicillins. D. It can be administered by an intramuscular depot route, requiring only a one-time dose.

C. It is effective against many pathogens that have developed resistance to penicillins. Rationale: Penicillinase-resistant antibiotics include nafcillin and oxacillin. Oxacillin cannot be given as an IM depot. As with most antibiotics, there is a risk of GI effects. The client would not need critical care monitoring on the sole basis of his or her antibiotic therapy, but this is true of all antibiotics.

The emergence of resistant strains of microbes is a serious public health problem. Healthcare providers can work to prevent the emergence of resistant strains by A. Encouraging the patient to stop the antibiotic as soon as the symptoms are resolved to prevent overexposure. B. Encouraging the use of antibiotics when patients feel they will help. C. Limiting the use of antimicrobial agents to the treatment of specific pathogens known to be sensitive to the drug being used. D. Using the most recent powerful drug available to treat an infection to ensure eradication of the microbe.

C. Limiting the use of antimicrobial agents to the treatment of specific pathogens known to be sensitive to the drug being used.

A client is receiving aztreonam. The nurse understands that this drug is classified as what? A. Leprostatic drug B. Lincosamide C. Monobactam D. Antituberculosis drug

C. Monobactam Rationale: Aztreonam is classified as a monobactam. Clindamycin and lincomycin are classified as lincosamides. Dapsone is classified as a leprostatic drug. Capreomycin, ethambutol, rifampin, isoniazid, and streptomycin are classified as antituberculosis drugs.

A patient receiving a fluoroquinolone should be cautioned to anticipate A. Increased salivation B. Constipation C. Photosensitivity D. Cough

C. Photosensitivity

The spectrum of activity of an antiinfective indicates A. The acidity of the environment in which it is most effective. B. The cell membrane type that the antiinfective affects. C. The antiinfective's effectiveness against different invading organisms. D. The resistance factor that bacteria have developed to this antiinfective.

C. The antiinfective's effectiveness against different invading organisms.

Combination therapy is often used in treating infections. An important consideration for using combination therapy would be that A. It is cheaper to use two drugs in one tablet than one drug alone. B. Most infections are caused by multiple organisms. C. The combination of drugs can delay the emergence of resistant strains. D. Combining antiinfectives will prevent adverse effects from occurring.

C. The combination of drugs can delay the emergence of resistant strains.

The goal of antibiotic therapy is A. To eradicate all bacteria from the system. B. To suppress resistant strains of bacteria. C. To reduce the number of invading bacteria so that the immune system can deal with the infection. D. To stop the drug as soon as the patient feels better.

C. To reduce the number of invading bacteria so that the immune system can deal with the infection.

The nurse is caring for a 6-year-old child who has pyelonephritis. The use of what group of antibiotics would be contraindicated due to the client's age? A. Penicillins B. Cephalosporins C. Tretracyclines D. Aminoglycosides

C. Tretracyclines Rationale: Tetracyclines can potentially damage developing teeth and bones and thus should be used cautiously or avoided in children under the age of 8 years. Penicillins are safe to give to children and commonly used. Cephalosporins are safe to administer to pediatric clients. Aminoglycosides would not be administered to children lightly, but they can be administered when the benefits outweigh the risks, such as an infection that is resistant to other drugs.

What symptoms should lead the nurse to suspect that a client receiving a cefuroxime ingested alcohol during treatment? Select all that apply. A. Bleeding gums B. Chest pain C. Pallor D. Dyspnea E. Throbbing headache

Chest pain, dyspnea, throbbing headache Rationale: Disulfiram reactions occur when alcohol is combined with a cefuroxime antibiotic. Signs of a disulfiram reaction include flushing, throbbing headache, nausea and vomiting, chest pain, palpitations, dyspnea, syncope, vertigo, blurred vision, and, in extreme reactions, cardiovascular collapse, convulsions, and death. Pallor may suggest anemia. Bleeding gums might result if the client combines a cephalosporin with an oral anticoagulant.

After teaching a client who is receiving doxycycline about the drug, the nurse determines that the teaching was successful when the client makes what statement? A. "I should limit the amount of fluids that I drink". B. "I should chew gum and chocolate if my mouth gets sore". C. "I will take the drug with an antacid to prevent an upset stomach". D. "I need to wear protective clothing when I'm out in the sun".

D. "I need to wear protective clothing when I'm out in the sun". Rationale: Photosensitivity is possible, so the client should use sunscreen and wear protective clothing when outdoors. Fluids should be increased to promote drug excretion. Ice chips or sugarless candy would be appropriate for combating a sore mouth. The drug should be taken on empty stomach 1 hour before or 2 hours after meals; antacids should not be taken with the drug because they can affect absorption.

The fluroquinolones A. Are found freely in nature. B. Are associated with severe adverse reactions. C. Are widely used to treat gram-positive infections. D. Are broad-spectrum antibiotics with few associated adverse effects.

D. Are broad-spectrum antibiotics with few associated adverse effects.

A client has been diagnosed with community-acquired pneumonia and the healthcare provider has prescribed levofloxacin 500 mg PO daily. What is the nurse's best action? A. Contact the prescriber to confirm the route. B. Contact the prescriber to confirm the dose. C. Insert a Foley catheter as prescribed to monitor urine output. D. Confirm the client's identity and administer the medication as ordered.

D. Confirm the client's identity and administer the medication as ordered. Rationale: The indication, drug, dose, route, and frequency are within reference ranges. There is no need to insert a urinary catheter for the sole purpose of monitoring urine output.

A client's sudden onset of respiratory distress has been attributed to Legionnaires disease. The nurse should anticipate giving what antibiotic? A. Ampicillin B. Tetracycline C. Ciprofloxacin D. Erythromycin

D. Erythromycin Rationale: Erythromycin is the drug of choice for treatment of Legionnaire's disease. Ciprofloxacin, tetracycline, and ampicillin are not used for this purpose.

A bacteriostatic substance is one that A. Directly kills any bacteria it comes in contact with. B. Directly kills any bacteria that are sensitive to the substance. C. Prevents the growth of any bacteria. D. Prevents the growth of specific bacteria that are sensitive to the substance.

D. Prevents the growth of specific bacteria that are sensitive to the substance.

A client with a diagnosis of rhinosinusitis has been prescribed ciprofloxacin 250 mg SC twice per day. When contacting the prescriber, what should the nurse question? A. Dose B. Choice of drug C. Frequency D. Route

D. Route Rationale: Recommended parameters for ciprofloxacin are 100-500 mg twice per day PO for up to 6 weeks. As a result, the nurse should have the provider confirm the correct route.

True or false: Today, aminoglycosides are replacing many older antibiotics due to their low risk of toxicity.

False Rationale: Aminoglycosides have potentially serious adverse effects; thus, they are being replaced by newer, less toxic drugs in the treatment of serious infections.

True or false: Levofloxacin is the most widely used fluoroquinolone.

False Rationale: Ciprofloxacin is the most widely used fluoroquinolone.

True or false: Infections of the genitourinary tract are commonly the result of gram-positive bacteria.

False Rationale: Gram-negative bacteria, usually E. coli, are frequently associated with infection of the genitourinary tract.

True or False: Streptococcus pneumonia is an example of gram-negative bacteria.

False Rationale: Streptococcus pneumonia is a gram-positive bacterium.

A client has been diagnosed with pulmonary tuberculosis. What first-line agents should the nurse expect to administer? Select all that apply. A. Isoniazid B. Cirpofloxacin C. Rifampin D. Kanamycin E. Pyrazinamide

Isoniazid, Rifampin, Pyrazinamide Rationale: Rifampin is a first-line agent for tuberculosis. Isoniazid is a first-line agent for tuberculosis. Pyrazinamide is a first-line agent for tuberculosis. Kanamycin is considered a second-line agent for tuberculosis. Ciprofloxacin is considered a second-line agent for tuberculosis.

True or false: A client's risk for ototoxicity, nephrotoxicity, and neurotoxicity increases dramatically if he or she receives an aminoglycoside in conjunction with a potent diuretic.

True Rationale: Avoid combining aminoglycosides with potent diuretics; this increases the incidence of ototoxicity, nephrotoxicity, and neurotoxicity. Renal toxicity, which may progress to renal failure, is caused by direct drug toxicity in the glomerulus, meaning that the drug molecules cause damage (e.g., obstruction) directly to the kidney.