Karch: Ch. 9 - Antibiotics
The nurse is conducting discharge teaching to the caregiver of a 6-month-old child diagnosed with acute otitis media prescribed amoxicillin and alternating acetaminophen and ibuprofen for fever. Which statement by the caregiver establishes a need for additional teaching by the nurse? "If the fever increases after alternating acetaminophen and ibuprofen, baby aspirin may be used." "Sudden development of a rash, shortness of breath, or wheezing should be reported immediately." "The entire course of the amoxicillin should be taken as directed on the bottle and completed." "I should see an improvement in my baby in 24 hours from the time the drugs are started."
"If the fever increases after alternating acetaminophen and ibuprofen, baby aspirin may be used."
What administration instructions should the nurse provide to the parents of a 4-year-old child prescribed a neomycin-polymyxin B-hydrocortisone combination drug for otitis media in the right ear? "Put one drop into the right ear each morning." "Place two drops in the right ear each morning and then again before bedtime." "Put one to two drops in the right ear whenever your child reports pain in the right ear." "Place three drops into the right ear four times a day."
"Place three drops into the right ear four times a day."
A pregnant woman calls the clinic and asks if it is suitable to use ofloxacin otic drops that she used prior to pregnancy for a current ear infection. What would be an appropriate response from the nurse? "The effects of ofloxacin in pregnancy are not known, so the drug should not be used while pregnant." "If the infection seems the same, then you could try using the same prescription." "Otic medications are contraindicated during pregnancy. Do not take it." "Ofloxacin drops are used in children, so it is probably okay to use when pregnant."
"The effects of ofloxacin in pregnancy are not known, so the drug should not be used while pregnant."
A patient with TB has been admitted to a health care facility. When providing instructions for the patient teaching related to antitubercular drugs, which instructions should the nurse provide in order to avoid complications in the patient's GI tract? Double the dose if earlier dose is missed. Take prescribed Pyrazinamide without regard to food. Take prescribed Ethambutol with food. Avoid the consumption of alcohol.
Avoid the consumption of alcohol.
After teaching a group of students about carbapenems, the instructor determines the need for additional teaching when the students identify what as an example? Doripenem Imipenem-cilastatin Cefuroxime Ertapenem
Cefuroxime
A client is receiving ciprofloxacin for a urinary tract infection. This drug is administered IV. During the infusion, the nurse notes fluid leaking into the tissue around the IV site. What is the *best* response of the nurse? Discontinue the IV. Withdraw the cannula slightly. Reposition and retape. Elevate the extremity.
Discontinue the IV.
A client's sudden onset of respiratory distress has been attributed to Legionnaire's disease. The nurse should anticipate giving what antibiotic? Erythromycin Ciprofloxacin Tetracycline Ampicillin
Erythromycin
Which of the following drugs would be classified as an aminoglycoside? Levofloxacin Clarithromycin Gentamicin Cefaclor
Gentamicin
A client is diagnosed with latent tuberculosis infection. The nurse expects that the treatment plan will include which drug? Ethambutol Pyrazinamide INH Cyclosporine
INH
A client diagnosed with tuberculosis was prescribed antitubercular therapy but stopped after 1 month because of difficulty with the medication scheduling. As a result, secondary drugs are being prescribed. Which nursing diagnosis would the nurse most likely identify? Ineffective Self-Health Management Imbalanced Nutrition: Less Than Body Requirements Ineffective Coping Impaired Comfort
Ineffective Self-Health Management
A client is prescribed penicillin V orally for a strep throat. What is the mechanism of action of this medication? It inhibits protein synthesis. It lowers the pH of cellular contents. It causes mutations. It inhibits cell wall synthesis.
It inhibits cell wall synthesis.
What is the rationale for not administering tetracycline to children under the age of 8 years? It will not treat the infection effectively. It will increase the risk of heart failure. It will interfere with enamel development. It will increase the risk for future infections.
It will interfere with enamel development.
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. Monitor patient's vital signs every 24 hours. Assess patient's history of contacts. Use DOT to administer the drug to the patient.
Monitor for appearance of adverse reactions.
The heathcare industry is aware that tuberculosis (TB) is on the rise worldwide. Which populations is at risk for TB? Select all that apply. People living in crowded conditions People who are immunocompromised People with debilitative conditions Very young children People with HIV The elderly
People living in crowded conditions People who are immunocompromised People with debilitative conditions People with HIV
A young lifeguard has been prescribed moxifloxacin (Avelox). The nurse understands that the focus on education would be which adverse reaction? Weakness Fatigue Muscle cramping Photosensitivity
Photosensitivity
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? Gray syndrome Red man syndrome Serotonin syndrome Cushing's syndrome
Red man syndrome
A nurse is preparing the medical history report of a patient with a urinary tract infection. Which of the following conditions should the nurse identify as one in which the use of cephalosporins is restricted? Aplastic anemia Renal disease Abdominal cramps Headache
Renal disease
Prior to and following a transurethral prostatic resection (TUPR), a 73-year-old man has been scheduled to receive a total of five intravenous doses of cefazolin. Which of the following nursing diagnoses should the nurse associate with this antibiotic therapy? Risk for Seizures related to adverse drug effects Risk for Constipation related to drug effects Risk for Pain related to vascular irritation Risk for Infection related to overgrowth of nonsusceptible organisms
Risk for Infection related to overgrowth of nonsusceptible organisms
A client is prescribed ciprofloxacin for a urinary tract infection. The nurse is preparing to teach the client about the medication. What must the nurse include in the education plan? Take a missed dose, even if close to the next dose. Take precautions to prevent photosensitivity. Avoid foods high in sodium such as processed meats. Take the necessary vitamins along with the drug.
Take precautions to prevent photosensitivity.
A client asks why three medications are prescribed to treat his tuberculosis. The nurse informs the client of which reasons? To prevent adverse reactions To prevent resistance To decrease length of drug therapy To decrease allergic response of medications
To prevent resistance
The nurse should advise the client to avoid taking which medication at the same time as a fluoroquinolone? antacids antihypertensives antidiabetic agents oral contraceptives
antacids
Drugs that destroy bacteria are known as which type of drug? bacteriocidal bacteriostatic bacteriostationary bacteriophage
bacteriocidal
A 49-year-old client is diagnosed with TB. The client has a history of alcoholism but has been sober for 3 months now. The client has been prescribed INH. What should the nurse ensure is obtained before initiating the therapy? baseline bone mass determination baseline renal function values baseline serum glucose levels baseline liver function test values
baseline liver function test values
A 9-year-old client has been admitted to the pediatric unit after being diagnosed with pertussis. The pediatric nurse is processing the client's admission orders and notes that IV demeclocycline has been prescribed. After beginning this treatment, the nurse should confirm the results of what laboratory test? mean corpuscular volume (MCV) d-dimer bilirubin blood urea nitrogen (BUN)
blood urea nitrogen (BUN)
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: are ineffective in clients who are allergic to penicillins. can cause kidney damage in clients who are allergic to penicillins. are derived from penicillin. can cause allergic reactions in clients who are allergic to penicillins.
can cause allergic reactions in clients who are allergic to penicillins.
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? lactulose ketoconazole kanamycin cefadroxil
cefadroxil
A nurse is preparing to administer a client's first scheduled dose of tetracycline. The nurse should first ensure that the client has not recently eaten what type of foods? dairy products leafy green vegetables any high-fat foods acidic foods
dairy products Explanation: The combination of tetracycline with metallic ions such as aluminum, calcium, iron, or magnesium inhibits tetracycline absorption. It is important not to take tetracycline with dairy products, antacids, or iron supplements. None of other foods present significant amounts of metallic ions.
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. drop in blood pressure increase in respiratory rate sudden increase in temperature regular urine output pulse rate within usual parameters
drop in blood pressure increase in respiratory rate sudden increase in temperature
Which medication is the drug of choice for Legionnaires disease? erythromycin loxapine hydrochloride meclizine pravastatin
erythromycin
An adult male client with a diagnosis of osteomyelitis will soon begin treatment with gentamicin. Which schedule is most likely to maximize efficacy and minimize nephrotoxicity? gentamicin 500 mg IV OD at 12:00 gentamicin 250 mg PO BID at 07:30 and 19:30 gentamicin 500 mg PO TID at 08:00, 12:00, and 19:00 gentamicin 125 mg IV QID at 06:00, 12:00, 18:00, and 24:00
gentamicin 500 mg IV OD at 12:00
A nursing instructor is preparing a teaching plan for a nursing pharmacology class on the action of fluoroquinolones. Which action would the instructor most likely include? interfering with DNA synthesis in the bacterial cell interfering with protein synthesis disrupting the bacterial cell wall blocking ribosomal reading of mRNA
interfering with DNA synthesis in the bacterial cell
What event triggers the development of a superinfection? proliferation of antibiotic-resistant microorganisms bone marrow suppression triggered by antibiotic treatment the infection is well established before antibiotic treatment begins unforeseen interactions between the antibiotic and other prescribed medications
proliferation of antibiotic-resistant microorganisms
A client with a diagnosis of rhinosinusitis has been prescribed ciprofloxacin 250 mg SC b.i.d. When contacting the prescriber, the nurse should question the: route. dose. frequency. choice of drug.
route.
The nurse has administered a client's first scheduled dose of amoxicillin. What subsequent client report should prompt the nurse to seek the discontinuation of this drug? shortness of breath nausea heartburn frontal lobe headache
shortness of breath
A 7-year-old child has tonsillitis and is prescribed penicillin V, which is to be administered at home. The nurse will instruct the parents to administer the drug with a sip of water 1 hour before mealtime. immediately before or with a meal. with a glass of water 1 hour before or 2 hours after a meal. intravenously with the assistance of a home health nurse.
with a glass of water 1 hour before or 2 hours after a meal.
A nurse is teaching a client about the medication regimen surrounding fluoroquinolones. Which statement made by the client would indicate the need for additional education? "I will only drink enough water to swallow the drug." "I will take all of my antibiotics." "If I have trouble breathing, I will call 911." "I may have some abdominal pain with this medication."
"I will only drink enough water to swallow the drug."
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." "It's possible that your urine might be pink-tinged for the next little while, but that's expected and it will resolve." "You might develop a mild fever when you finish your antibiotics, but that doesn't mean your infection has returned." "Remember to have your required blood work drawn in 48 hours."
"Make sure to avoid drinking any alcohol for the next three days." Explanation: 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.
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? DNA replication Cell division Cell wall synthesis Protein synthesis
Cell wall synthesis
Your client is being prepared for surgery. His health care provider has indicated that he will order antibiotics as prophylaxis. Which of the following medications would you anticipate being ordered? Penicillin G Amoxicillin Cephalosporin Vibramycin
Cephalosporin
An older adult client, diagnosed with community-acquired pneumonia, has been prescribed aztreonam. What action should the nurse perform before administering the first dose? Administer a 500-mL bolus of normal saline. Confirm the client's allergy status. Swab the client's nares for the presence of MRSA. Teach the client to expect discolored urine during treatment.
Confirm the client's allergy status.
Which of the following clients should not be prescribed fluoroquinolones? Male 19 years of age with pneumonia Female 79 years of age with a urinary tract infection Female 12 years of age with a respiratory infection Male 54 years of age with prostatitis
Female 12 years of age with a respiratory infection Explanation: Fluoroquinolones are contraindicated in children under 18 years of age.
In which condition present in the client should macrolides be used with caution? Glaucoma Liver dysfunction Diabetes mellitus Hypertension
Liver dysfunction Explanation: All macrolides should be used with caution in clients with liver dysfunction. Pre-existing liver disease is a contraindication. Diabetes, hypertension and glaucoma are not contraindicated.
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 fluid intake. Monitoring blood creatinine levels. Testing for occult blood. Testing for increased glucose levels.
Monitoring 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? Hypotension Chest pain Nausea Excessive tearing
Nausea
The nurse should monitor the client for which common side effects of erythromycin therapy? Headache and fever Urticaria and opthalmic drainage Nausea, vomiting, and diarrhea Shortness of breath and sore throat
Nausea, vomiting, and diarrhea
When administering aminoglycosides, the nurse must be aware of which of the following adverse reactions? Liver necrosis, or hepatic failure Ototoxicity and nephrotoxicity Glaucoma and renal failure Hypoglycemia and hyperglycemia
Ototoxicity and nephrotoxicity
A patient with TB is admitted to a health care facility. The nurse is required to administer an antitubercular drug through the parenteral route to this patient. Which of the following precautions should the nurse take when administering frequent parenteral injections? Rotate injection sites for frequent parenteral injections. Monitor patient's vital signs each morning. Monitor signs of liver dysfunction weekly. Administer streptomycin to promote nutrition.
Rotate injection sites for frequent parenteral injections.
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 Penicillins Cephalosporins Aminoglycosides
Tetracyclines
Which statement is true in regards to the oral administration of tetracyclines? Tetracyclines should be administered with a full glass of water. Tetracyclines should be administered on a full stomach. Tetracyclines should only be administered in the evening. Tetracyclines should only be administered in the morning.
Tetracyclines should be administered with a full glass of water.
A 30-year-old woman who is in the first trimester of pregnancy has presented to her primary care provider with a 4-day history of a reddened, itchy left eye that is crusted with purulent exudate. The clinician suspects a bacterial, rather than viral, etiology. How will the client's pregnancy affect the potential use of ciprofloxacin to treat her conjunctivitis? Ciprofloxacin is safe to use in pregnancy and the client may use to same dose and route as a nonpregnant client. The use of ciprofloxacin is contraindicated in pregnancy. It is safe for the client to use topical ciprofloxacin but the oral route is potential teratogenic. The client will require a lower dose and longer course of ciprofloxacin than a nonpregnant, adult client.
The use of ciprofloxacin is contraindicated in pregnancy.
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? Continue to take the medication as prescribed; these are expected side effects from the medication. Stop the medication immediately and go to the emergency room; these could be signs of a life-threatening reaction. These are normal side effects, but if they increase in severity or frequency, you need to contact the office again. Stop the medication and the health care provider will order you a different antibiotic.
These are normal side effects, but if they increase in severity or frequency, you need to contact the office again.
A client is diagnosed with an infection attributable to the gram-negative microorganism Pseudomonas. Which anti-infective agent is *most* reliable in treating this microorganism? aminoglycoside antifungal aminopenicillin GABA analog
aminoglycoside Explanation: Aminoglycosides penetrate the cell walls of susceptible bacteria. As a result, the bacterial cell membrane becomes defective and cannot synthesize the proteins necessary for their function and replication. Aminoglycosides are used to treat infections caused by gram-negative microorganisms, such as Pseudomonas.
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 a different antibiotic supplementing the antibiotic with vitamin K changing to parenteral administration of rifaximin
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.
A client diagnosed with malaria has been prescribed treatment with sulfadiazine. The nurse should encourage the client to increase consumption of what dietary component? fluids proteins calories vitamin D
fluids Explanation: When this medication is used, it is imperative that the client maintain a fluid intake that allows for an output of 1500 mL of urine in 24 hours. While the client should attempt to consume a healthy well-balanced diet, fluid intake is vitally important.
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 chlamydial infection endocarditis encephalitis
methicillin-resistant Staphylococcus aureus (MRSA) infection Explanation: Ceftaroline is an IV cephalosporin for the treatment of community-acquired pneumonia and skin infections. It is the first cephalosporin to be considered active against resistant gram-positive organisms, such as MRSA. This drug is not indicated in the treatment of chlamydial infections, endocarditis, or encephalitis.
A 35-year-old man being treated with isoniazid (INH) for exposure to TB has this 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 health care provider right away? changes in his bowel elimination pattern numbness and tingling in his feet a slight decrease in his blood glucose levels a persistent cough since starting the medication
numbness and tingling in his feet
What organ system is responsible for the excretion of cefotaxime sodium from the body? respiratory hepatic renal gastrointestinal
renal
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 health care provider if the client experiences what adverse effect associated with the drug? polydipsia tachycardia skin rash or itching dizziness
skin rash or itching
A client, being treated for latent tuberculosis (TB) on an out-client basis, tells the nurse, "I've been feeling pretty good lately, so I haven't actually been all that consistent with taking my drugs." Subsequent health education by the nurse should focus on what subject? the fact that nonadherence to treatment exacerbates the risks of adverse effects the need to consistently take the prescribed drugs in order to cure TB the need to match drug dosages carefully to signs and symptoms the fact that nonadherence will necessitate the use of antiretrovirals
the need to consistently take the prescribed drugs in order to cure TB