Chapter 9 PrepU
A client has been on an antibiotic for two weeks for treatment of an infection. The client asks the nurse why a superinfection has been caused by this medication. What is the nurse's best response?
"Antibiotics can disrupt the normal bacteria in your body, causing another infection to occur."
A 5-year-old child has been brought to the clinic with signs and symptoms that are consistent with otitis externa. What assessment question is most likely to address the etiology of this health problem?
"Has he been swimming a lot in the last little while?"
Which statement by a client taking a sulfonamide requires further instruction?
"I will make sure to use extra sunscreen when I go to the tanning booth."
Which of the following are examples of fluoroquinolones? Select all that apply.
-Ciprofloxacin (Cipro) -Levofloxacin (Levaquin)
Levofloxacin 750 mg IV is ordered for a client with a urinary tract infection. The medication is mixed in a syringe for an IV pump as a solution of 250 mg/15 mL. How many mL should be in the syringe?
45mL
A nurse works in a community setting and follows patients who have TB. Which of the following patients would likely require the most follow-up from rifampin therapy?
An HIV-positive patient
A 25-year-old female patient who presents at the clinic with vaginal discharge and discomfort is diagnosed with chlamydia. The nurse knows that the drug of choice to treat this infection is doxycycline. What would be a priority assessment for this patient before beginning the medication?
Asking the patient if she is pregnant
Which of the following would a nurse identify as being classified as a macrolide?
Azithromycin
Beta-lactam antibiotics, such as penicillins and cephalosporins, fight infection by inhibiting development of the causative bacteria. What specific component of bacterial development do these drugs affect?
Cell wall synthesis
A nurse is caring for a 35-year-old male taking telithromycin. For what type of infection is this client being treated?
Community-acquired pneumonia
A female client is admitted to the critical care unit with sepsis related to a contaminated central line. The physician orders intravenous beta-lactam antimicrobials. The client's current laboratory report reflects renal impairment. What would the nurse expect the physician to do?
Decrease the drug dose.
A patient has been prescribed a tetracycline drug for Rocky Mountain spotted fever. The patient also takes antacids. Which of the following effects is likely to occur due to an interaction between the two drugs?
Decreased absorption of tetracycline
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
The nurse should advise the client which of the following in regards to the administration of fluoroquinolones?
Do not take antacids while taking fluoroquinolones
A client is diagnosed with an infectious process that is sensitive to penicillin. The client is allergic to penicillin, so the physician orders a drug with a similar antibacterial spectrum. The nurse anticipates that the physician will order what antibiotic?
Erythromycin
A patient is admitted to the emergency room with a diagnosis of Legionnaire's disease and is placed on isolation. Which of the following medications is the drug of choice for Legionnaire's disease?
Erythromycin (Ery-Tab)
A patient is administered a third-generation cephalosporin. Which of the following organisms are cephalosporins most effective in treating?
Gram-negative
A patient has just been diagnosed with tuberculosis (TB). The nurse can expect to start the patient on which of the following drugs for the initial phase of treatment?
INH, rifampin, pyrazinamide, ethambutol
Daptomycin belongs to the lipopeptide class of antibiotics that kills gram-positive bacteria. What is the mechanism of action for this antibiotic?
Inhibition of synthesis of bacterial proteins
Which of the following represents the mechanism of action of fluoroquinolones?
Interference with the synthesis of bacterial DNA.
A female client's medical history includes type 2 diabetes, CVA, dysphasia, and chronic renal failure. She develops an infectious process. The physician orders erythromycin. Based on the client's medical history, why is erythromycin the drug of choice?
It is metabolized in the liver.
A patient is administered isoniazid (INH) for latent tuberculosis. Which of the following factors will result in discontinuation of the medication?
Jaundice
A client is receiving rifampin and isoniazid in combination for treatment of tuberculosis. What would the nurse need to monitor closely?
Liver function studies
A client in the critical care unit is receiving aminoglycosides for an infectious process. What does the nurse need to monitor?
Liver function tests
A 72-year-old patient with TB is undergoing standard treatment in a health care facility. Which of the following nursing interventions should the nurse perform during ongoing assessment of the treatment?
Monitor for appearance of adverse reactions.
The nurse is administering erythromycin to a patient. For what common side effects should the nurse monitor the patient?
Nausea, vomiting, and diarrhea
The nurse is assisting in the admission of a client with a suspected urinary tract infection. The health care provider has written the following orders: acetaminophen 500 mg PO for elevated temperature; urinalysis for culture and sensitivity; sulfasalazine (Azulfidine) 500 mg PO four times daily; and force fluids to 3 L/day. Which order will the nurse complete first?
Obtain urine for culture and sensitivity.
When administering aminoglycosides, the nurse must be aware of which of the following adverse reactions?
Ototoxicity and nephrotoxicity
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
A nurse is caring for a client who the physician suspects may be infected with an antibiotic-resistant pathogen. What course of action is best used to determine whether this type of pathogen is present?
Perform culture and susceptibility tests.
A nurse is caring for a patient who has a serious infection. The patient is being treated with combination therapy of a cefazolin and an aminoglycoside. The nurse will be sure to monitor which of the following?
Serum BUN and creatinine levels
The nurse understands that which of the following is the highest priority when teaching about antitubercular medications?
Taking medications as prescribed
The drug's effect on what best reflects the major reason for avoiding the use of tetracyclines in children under 8 years of age?
Teeth
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?
Tetracyclines
Which statement is true in regards to the oral administration of tetracyclines?
Tetracyclines should be administered with a full glass of water.
A client asks the purpose for using three medications in combination to treat his tuberculosis. The nurse informs the client that multiple medications are given for which of the following reasons?
To prevent resistance
A child has just returned home from a family vacation on a tropical island and is now reporting worsening tenderness in the right ear. The client is subsequently diagnosed with otitis externa. What causative factor of this infection should the nurse suspect?
frequent swimming and water sports while the child was on vacation
A 35-year-old man is being treated with isoniazid (INH) for exposure to TB. He has the following medical history: diabetes mellitus type 2, hypertension, hyperlipidemia, and coronary artery disease. He drinks one to two glasses of wine on the weekend and smokes two packs of cigarettes per day. Which adverse reaction should the nurse alert the client to report to his physician right away?
numbness and tingling in his feet
A client is receiving levofloxacin (Levaquin) IV. During an infusion, the client reports pain and the nurse notes a reddened area along the vein. What does the nurse suspect?
phlebitis
A nurse is speaking to a 62-year-old female client who has been started on sulfisoxazole, a sulfonamide antibiotic. The nurse should teach this client to contact the physician if the client experiences what adverse effect associated with the drug?
skin rash or itching
A client has been prescribed INH for the treatment of tuberculosis. The nurse teaches the client about dietary restrictions while taking this medication. What is the most important instruction to give the client about dietary restrictions?
"Do not drink beer or red wine while taking this medication because a serious adverse reaction can occur."
A client is being given a prescription for ciprofloxacin (Cipro) to treat a urinary tract infection. The nurse should warn the client about which of the following common adverse reactions? (Select all that apply.)
-Headache -Nausea -Dizziness
Which of the following are teaching points the nurse can use to increase client compliance in tubercular drug treatment programs? Select all that apply.
-Reinforce that short-term treatment is ineffective. -Arrange for direct observation therapy with the client and family. -Review the drug therapy regimen, including the prescribed drug, doses, and frequency of administration. -Instruct client about possible adverse reactions and the need to notify prescriber should any occur
The physician has ordered penicillin V for a patient. What should the nurse instruct to take with the medication?
A full glass of water
Drugs that slow or retard the multiplication of bacteria are known as which of the following?
Bacteriostatic
A male client is admitted to the unit with Pseudomonas aeruginosa sepsis. The physician orders aminoglycoside to be given concomitantly with penicillin intravenously. How would the nurse administer these drugs?
By administering the drug in separate IV bags
A client who takes zinc daily is diagnosed with a severe infection and is ordered levofloxacin (Levaquin). The nurse is aware that taking these two drugs may have what affect on the antibiotic?
Decreased absorption
The nurse is giving instructions to a client age 77 years who has been prescribed a sulfonamide for treatment of a urinary tract infection. The nurse has instructed the client to increase fluids while taking this medication. What does the nurse anticipate will be the client's greatest fear related to this instruction?
Fear of incontinence.
A 75-year-old patient with a history of renal impairment is admitted to the primary health care center with a UTI and has been prescribed a cephalosporin. Which of the following interventions is most important for the nurse to perform when caring for this patient?
Monitoring blood creatinine levels.
Natural penicillins exert what types of effects on microorganisms?
Bactericidal
Your client is being treated for streptococcal pharyngitis and is NPO. Her health care provider has ordered Penicillin G to be given IM. She wants to know why she cannot take her medications via an oral route. Your best response is:
Penicillin G is inactivated by gastric acid, therefore it is only given IM or IV.