Pharm Ch 38 Antibiotic P1
The patient has been diagnosed with Legionnaires' disease. Which drug does the nurse anticipate the provider will order? 1. Aztreonam 2. Lincomycin 3. Daptomycin 4. Erythromycin
4. Erythromycin Macrolides, such as erythromycin, are effective against Legionella (one species of that causes Legionnaires' disease). Aztreonam, lincomycin, and daptomycin do not exert antibacterial activity against Legionella.
The nurse should question the prescription of tetracycline for which patient? 1. A 6-year old patient with Haemophilus influenza 2. A 40-year-old patient diagnosed with rickettsia 3. A 60-year-old patient with a history of hypertension 4. A 45-year-old patient with a history of diabetes mellitus
1. A 6-year old patient with Haemophilus influenza Tetracycline is contraindicated in children younger than 8 years old because it can cause permanent discoloration of the teeth. Additionally, increasing tetracycline resistance to Haemophilus influenza is a concern. Tetracycline is used to treat rickettsia. Tetracycline is not contraindicated for patients diagnosed with diabetes mellitus or hypertension.
The nurse is caring for a postoperative patient. Which antibiotic is used for prophylaxis against infection in surgical patients? 1. Cefazolin 2. Cefoxitin 3. Cefepime 4. Ceftriaxone
1. Cefazolin First-generation cephalosporins, such as cefazolin, are used as prophylaxis against infection in surgical patients. First-generation agents are preferred to second- and third-generation cephalosporins for surgical prophylaxis because they are as effective as the newer drugs, are less expensive, and have a narrower antimicrobial spectrum. Cefoxitin is a second-generation cephalosporin, ceftriaxone is a third-generation cephalosporin, and cefepime is a fourth-generation cephalosporin.
A patient with pain and urinary tract infection develops fever, chills, and sores on the tongue. In the chart, the nurse finds an allergy to sulfonamides. Which drug does the nurse suspect is responsible for the patient's reaction? 1. Celecoxib 2. Glimepiride 3. Furosemide 4. Hydrochlorothiazide
1. Celecoxib Celecoxib is a COX-2 selective nonsteroidal antiinflammatory drug that helps in the treatment of acute pain. This drug contains sulfonamide moiety and, hence, should be avoided in patients with sulfonamide allergy. Glimepiride helps control elevated blood sugar levels in patients with diabetes, and it is safe for patients with sulfonamide allergy. Diuretics such as furosemide and hydrochlorothiazide are safe for patients with sulfonamide allergy.
The nurse is caring for a patient who has a urinary tract infection and is being treated with sulfamethoxazole/trimethoprim (SMZ-TMP). Which findings does the nurse report to the primary health care provider to prevent complications? Select all that apply. 1. Diarrhea 2. Yellowish eyes 3. Blood in the urine 4. Shortness of breath 5. Change in the color of the sputum
1. Diarrhea 3. Blood in the urine 4. Shortness of breath Sulfamethoxazole/trimethoprim (SMZ-TMP) is a sulfonamide antibiotic. The nurse should monitor the patient for diarrhea, blood in the urine, and shortness of breath. These symptoms indicate an adverse reaction to the drug. Therefore the nurse should immediately notify the primary health care provider to prevent complications. Sulfonamide antibiotics do not affect oral secretions or the eyes. Changes in the color of the sputum and yellowish eyes are not symptoms associated with an adverse reaction to sulfonamide antibiotics. Changes in the color of the sputum indicate infection. Yellowish eyes are a sign of jaundice. Hepatotoxicity is a possibility with sulfonamides.
When planning care for a patient receiving a sulfonamide antibiotic, which is a primary intervention? 1. Force fluids to at least 2000 mL/day. 2. Encourage liquids that produce acidic urine. 3. Encourage a diet that causes an alkaline ash. 4. Insert a Foley catheter for accurate input and output measurement.
1. Force fluids to at least 2000 mL/day. Forcing fluids will help prevent crystallization in the urine and kidney stone formation associated with sulfonamide antibiotics, regardless of the type of fluid consumed. Consuming a specific type of diet will not decrease the risk of crystallization. It is outside the nurse's scope of practice to decide to insert a Foley catheter.
A patient has been prescribed sulfamethoxazole/trimethoprim (Bactrim). What is the nurse's primary intervention for this patient? 1. Instruct the patient to increase fluid intake. 2. Instruct the patient to take the medication for 14 days. 3. Assess the patient's urine before and after treatment. 4. Ensure the patient does not eat anything when taking the medication.
1. Instruct the patient to increase fluid intake. Increased fluid intake is highly recommended to avoid complications such as crystallization in the urine. The course of therapy is not always 14 days; the drug is not prescribed only for urinary tract infections; and the patient does not have to take the drug on an empty stomach.
How does penicillin work to destroy bacteria? 1. It interferes with cell wall synthesis. 2. It binds irreversibly to the cell wall. 3. It interrupts bacterial DNA processes. 4. It interrupts bacterial RNA processes.
1. It interferes with cell wall synthesis. Penicillin inhibits transpeptidases and activates autolysins. This disrupts the synthesis of the cell wall and promotes active destruction of the cell wall. These combined actions result in cell lysis and death. Penicillin irreversibly inactivates a key enzyme in bacterial cell wall synthesis, but it does not bind irreversibly to the cell wall. Penicillin does not interrupt bacterial DNA or RNA processes to destroy bacteria.
Which of the following drugs is contraindicated for a patient who is receiving erythromycin therapy? 1. Warfarin 2. Digoxin 3. Tetracyclines 4. Estrogen-containing contraceptives
1. Warfarin Taking warfarin with erythromycin therapy may result in decreased warfarin metabolism and excretion, thereby leading to an increased risk of bleeding or hemorrhage. Digoxin, tetracyclines, and estrogen-containing contraceptives do not interact with erythromycin.
Which instruction will the nurse include in the discharge teaching for a patient receiving tetracycline? 1. "Take the medication until you feel better." 2. "Use sunscreen and protective clothing when outdoors." 3. "Keep the remainder of the medication in case of recurrence." 4. "Take the medication with food or milk to minimize gastrointestinal upset."
2. "Use sunscreen and protective clothing when outdoors." Photosensitivity is a common side effect of tetracycline. Exposure to the sun can cause severe burns. The medication should not be taken with milk and should be completely finished.
The nurse works in a medical-surgical unit. Which patients should the nurse monitor for atypical signs of infection? Select all that apply. 1. A 30-year-old patient with fractured tibia 2. A 78-year-old patient with urinary incontinence 3. A 40-year-old patient with coronary artery disease 4. A 35-year-old patient who underwent a renal transplant 5. A 55-year-old patient who received radiation therapy for lung cancer
2. A 78-year-old patient with urinary incontinence 4. A 35-year-old patient who underwent a renal transplant 5. A 55-year-old patient who received radiation therapy for lung cancer Infections usually manifest as fever, chills, sweat, pain, weakness, redness, and swelling. These manifestations indicate that the immune system is actively responding against invading microorganisms. People with dysfunctional immune systems may not be able to mount an immune response and may lack the typical signs and symptoms of infection. The 78-year-old patient with urinary incontinence may have lowered immune function due to age and may not manifest the typical signs and symptoms of infection. The 35-year-old patient who underwent a renal transplant will be receiving immunosuppressant drugs and will have compromised immune function. The 55-year-old patient who received radiation therapy for lung cancer may have reduced immune function and may not manifest the usual signs of infection.
While instructing a patient about antibiotic therapy, the nurse explains to the patient that bacterial resistance to antibiotics can occur when what happens? Select all that apply. 1. Antibiotics are taken with water or juice. 2. Antibiotics are prescribed to treat a viral infection. 3. Antibiotics are taken with ascorbic acid (vitamin C). 4. Patients stop taking an antibiotic after they feel better. 5. Antibiotics are prescribed according to culture and sensitivity reports.
2. Antibiotics are prescribed to treat a viral infection. 4. Patients stop taking an antibiotic after they feel better. Not completing a full course of antibiotic therapy can allow bacteria that are not killed but have been exposed to the antibiotic to adapt their physiology to become resistant to that antibiotic. The same thing can occur when bacteria are exposed to antibiotics in the environment or when antibiotics are erroneously used to treat a viral infection. Antibiotics taken with water or vitamin C does not contribute to bacterial resistance. Acidic fluids, like juices, may nullify the antibacterial action of oral penicillin, but do not cause bacterial resistance.
A 22-year-old female patient is prescribed amoxicillin. Which is the most important intervention for this patient? 1. Obtain a baseline complete blood count. 2. Assess if the patient is on oral contraceptives. 3. Inform the patient about possible superinfections. 4. Instruct the patient to not take the medication before meals.
2. Assess if the patient is on oral contraceptives. This medication may decrease the effectiveness of oral contraceptives. The nurse needs to assess whether or not the patient is on oral contraceptives and whether or not the patient is sexually active. Long-term use of antibiotics can cause blood dyscrasias, but a baseline complete blood count is not indicated. Informing the patient about possible superinfections and not to take the medication before meals are not priorities.
A patient has been on sulfonamides for urinary tract infections. The nurse assesses the patient and finds bruises on the legs and arms. What is the nurse's best action? 1. Tell the patient to be more careful. 2. Assess the patient's platelet counts. 3. Administer vitamin K to the patient. 4. Ask the patient if someone is abusing her
2. Assess the patient's platelet counts. Blood disorders such as hemolytic anemia, aplastic anemia, and low white blood cell and platelet counts could result from prolonged use and high dosages. The nurse should assess the patient before assuming frequent falls, vitamin K deficiency, or potential abuse.
A patient receiving antibiotics for chronic tonsillitis has been experiencing abdominal pain and cramps associated with frequent watery stools. Which infection does the nurse suspect? 1. Klebsiella infection 2. Clostridium infection 3. Acinetobacter infection 4. Enterococcus infection
2. Clostridium infection C. difficile infection is associated with watery diarrhea, abdominal pain, and fever. Klebsiella, Acinetobacter, and Enterococcus are common pathogens that lead to health care-associated infections such as pneumonia and urinary tract infections.
A patient who enjoys drinking socially has been prescribed cefotetan. The nurse explains to the patient that alcohol should be avoided for how long? 1. No avoidance of alcohol is warranted 2. During drug therapy and for 3 days afterward 3. During drug therapy and for 7 days afterward 4. During drug therapy and for 14 days afterward
2. During drug therapy and for 3 days afterward Alcohol is not recommended with cefamandole, cefoperazone, or cefotetan. An increase in acetaldehyde in the blood may result, producing a disulfiram-type reaction (e.g., stomach pain, nausea, vomiting, headaches, low blood pressure, tachycardia, respiratory difficulties, increased sweating, or flushing of the face). Patients should avoid alcoholic beverages, medications containing alcohol, or intravenous alcohol solutions during the administration of these drugs and for 3 days afterward. Seven and 14 days after therapy is not warranted.
A patient is prescribed sulfamethoxazole/trimethoprim (co-trimoxazole) for the treatment of a urinary tract infection. Which biochemical parameter does the nurse assess before administering the drug? 1. Liver enzymes 2. Red blood cell count 3. Creatinine clearance 4. Uric acid baseline level
2. Red blood cell count Sulfamethoxazole/trimethoprim (co-trimoxazole) is a sulfonamide antibiotic. Sulfonamide antibiotics may cause anemia in the patient. Therefore the patient's red blood cell count should be assessed before beginning sulfonamide therapy to check the possibility of drug-related anemia. Sulfamethoxazole/trimethoprim (co-trimoxazole) does not affect liver enzymes, creatinine levels, or uric acid levels. Therefore these need not be checked before the administration of sulfamethoxazole/trimethoprim (co-trimoxazole).
Which medication may result in ineffectiveness of penicillin V potassium? 1. Ibuprofen 2. Rifampin 3. Probenecid 4. Methotrexate
2. Rifampin Rifampin and penicillin V potassium cause a drug-drug interaction. Rifampin inhibits the efficacy of penicillin and results in poor action of penicillin. Due to this drug-drug interaction, symptoms are persistent after the administration of penicillin V potassium. Ibuprofen interacts with penicillin V potassium, which results in increased levels of active penicillin for therapeutic action. Methotrexate interacts with penicillin V potassium and increases the methotrexate level in the body due to decreased renal elimination of methotrexate. Probenecid and penicillin V potassium interact and prolong the effects of penicillin V potassium.
The nurse advises a patient to use sunscreen and wear a hat to avoid the sun between 10:00 AM and 4.00 PM. Which group of antibiotics is the patient most likely using? 1. Penicillins 2. Sulfonamide 3. First-generation cephalosporins 4. Second-generation cephalosporins
2. Sulfonamide Sulfonamides, including cotrimoxazole and tetracyclines (especially demeclocycline), are more likely than other antibiotics to cause photosensitivity during their use. Photosensitivity is induced by exposure to sunlight during sulfonamide drug therapy. So the nurse advises the patient to use sunscreen and wear a hat. Allergic reactions to penicillins occur in 0.7% to 4% of treatment courses. The most common reactions are urticaria, pruritus, and angioedema. The safety profiles, contraindications, and pregnancy ratings of cephalosporins are similar to those of penicillins. The most commonly reported adverse effects are mild diarrhea, abdominal cramps, rash, pruritus, redness, and edema. No photosensitivity is seen here.
When instructing a patient about antibiotic therapy, the nurse explains that which condition occurs when the normal flora are disturbed during antibiotic therapy? 1. Organ toxicity 2. Superinfection 3. Hypersensitivity 4. Rebound toxicity
2. Superinfection Antibiotic therapy can destroy the normal flora of the body, which typically inhibit the overgrowth of fungi and yeast. When the normal flora are decreased, these organisms can overgrow and cause infections. Organ toxicity, hypersensitivity, and rebound toxicity are not a disturbance in the normal flora associated with antibiotic therapy.
The nurse is assessing a patient who is prescribed sulfamethoxazole/trimethoprim (SMZ-TMP) for the treatment of shigellosis enteritis. The nurse instructs the patient to increase fluid intake up to 3000 mL per day. What is the reason behind this? 1. To prevent hypotension in the patient 2. To prevent drug-related crystalluria in the patient 3. To prevent mucosal irritation and dryness of the mouth 4. To maintain the fluid and electrolyte balance in the body
2. To prevent drug-related crystalluria in the patient Sulfamethoxazole/trimethoprim (SMZ-TMP) is a sulfonamide antibiotic, which may cause crystalluria in the patient. Therefore the nurse instructs the patient to increase fluid intake up to 3000 mL per day to prevent drug-related crystalluria.
What are the adverse effects of sulfonamide antibiotics? Select all that apply. 1. Polyuria 2. Urticaria 3. Pancreatitis 4. Constipation 5. Hepatotoxicity
2. Urticaria 3. Pancreatitis 5. Hepatotoxicity Urticaria, pancreatitis, and hepatotoxicity are the side effects of sulfonamide antibiotics. Sulfonamide antibiotics do not cause polyuria. They cause crystalluria. Sulfonamide antibiotics do not cause constipation; they may cause diarrhea.
A patient is prescribed sulfamethoxazole/trimethoprim (co-trimoxazole) for a urinary tract infection. What instruction does the nurse give to the patient to prevent complications associated with sulfamethoxazole/trimethoprim (co-trimoxazole)? 1. "Limit your fluid intake." 2. "Avoid eating citrus fruits." 3. "Avoid exposure to sunlight." 4. "Limit your intake of milk products."
3. "Avoid exposure to sunlight." Sulfamethoxazole/trimethoprim (co-trimoxazole) is a sulfonamide antibiotic and may cause photosensitivity. The nurse should instruct the patient to avoid exposure to sunlight during sulfonamide therapy because it may cause a photosensitivity reaction or another type of skin reaction in the patient. The nurse instructs the patient to increase fluid intake to avoid the risk of crystalluria. Sulfonamide antibiotics do not have any interaction with milk products or citrus fruits, so these can be consumed.
The patient has been prescribed sulfamethoxazole/trimethoprim. The nurse notes that the patient has a history of kidney stones. What is the highest priority instruction for the nurse to give to the patient? 1. "Take the medication on a full stomach." 2. "Take the medication on an empty stomach." 3. "Take the medication with a full glass of fluid." 4. "Take the medication at regularly spaced intervals."
3. "Take the medication with a full glass of fluid." Of the instructions provided, the only one that would affect the prevention of kidney stones is to take the medication with a full glass of fluid. Sulfamethoxazole/trimethoprim may be taken with or without food. Although the medication should be taken at regularly spaced intervals, this will not have an impact on the development of kidney stones.
The patient has been started on a medication regimen that includes sulfamethoxazole/trimethoprim. The nurse notes that the source of the patient's infection has been determined to be viral in origin. What is the nurse's highest priority action? 1. Administer the medication as ordered by the provider. 2. Ensure that the information is documented in the chart. 3. Contact the health care provider to discuss the medication. 4. Ask the patient if he knows how he contracted the infection.
3. Contact the health care provider to discuss the medication. The health care provider should be contacted regarding the ordering of sulfamethoxazole/trimethoprim for this patient because it has not been shown to be effective in treating viral infections.
The nurse is observing a few patients. Which patient does the nurse suspect to be most prone to health care-associated infection? 1. Patient A 2. Patient B 3. Patient C 4. Patient D
3. Patient C Health care-associated infections (HAIs) are most common among patients in critical care, dialysis, oncology, transplant, and burn units because of the reliance on various devices such as mechanical ventilators, catheters, intravenous infusion lines, and dialysis equipment. Patient C, with fourth-stage chronic renal failure, is on dialysis and is therefore more prone to HAIs. The patients with osteonecrosis of the knee, hypertension, and who underwent joint replacement are less prone to HAIs.
A patient with a respiratory infection is treated with doxycycline. At the follow-up visit, the nurse finds that the signs and symptoms of infection have not subsided. Which patient action might have caused a reduction in the therapeutic effect of the drug? 1. The patient took the medication with salt crackers. 2. The patient refrained from going out in the sunlight. 3. The patient took the medication with a glass of milk. 4. The patient refrained from taking antacids along with the medication.
3. The patient took the medication with a glass of milk. Doxycycline is a tetracycline antibiotic. The absorption of the medication may be reduced if it binds with calcium, magnesium, or iron. Therefore the patient should stay away from dairy products, antacids, and iron supplements when taking this medication. Taking medications with salt crackers helps to reduce gastrointestinal irritation. Direct exposure to sunlight may cause photosensitivity reaction, but does not reduce the drug efficacy. Antacids should be avoided with the medication because they can reduce its efficacy.
A patient has a serious intraabdominal infection. Which antibiotic will the nurse expect to administer to this patient as empiric therapy? 1. Ampicillin 2. Penicillin V potassium 3. Ticarcillin-clavulanic acid 4. Amoxicillin-clavulanic acid
3. Ticarcillin-clavulanic acid Ticarcillin with clavulanic acid has one of the broadest antimicrobial spectra of all penicillins. This antibiotic is indicated as empiric therapy for this patient until the results of the culture and sensitivity are available. Ticarcillin-clavulanic acid is an extended-spectrum penicillin and a generation beyond the aminopenicillins. Ampicillin and amoxicillin-clavulanic acid are aminopenicillins. Penicillin V potassium is one of the natural penicillins.
A patient is prescribed demeclocycline for the treatment of a respiratory infection. What instruction does the nurse give to the patient to ensure safe and effective administration of the drug? 1. "Avoid eating high-protein foods." 2. "Avoid eating high-calorie foods." 3. "Avoid eating low-carbohydrate foods." 4. "Avoid the consumption of dairy products."
4. "Avoid the consumption of dairy products." Food-drug interaction occurs between demeclocycline and dairy products, which results in decreased gastrointestinal absorption of demeclocycline. If the gastrointestinal absorption of demeclocycline is decreased, it may not have therapeutic effects, so the nurse should instruct the patient to avoid consumption of dairy products. Because demeclocycline does not cause any interaction with high-protein foods, low-carbohydrate foods, or high-calorie foods, the patient can consume such items.
Oral sulfamethoxazole/trimethoprim is prescribed for a patient and is being administered four times a day. What is the nurse's best action? 1. Instruct the patient about potential constipation. 2. Schedule the medication before meals and at bedtime. 3. Instruct the patient not to drink milk with the medication. 4. Call the provider to discuss changing the frequency of the dose.
4. Call the provider to discuss changing the frequency of the dose. The patient should receive sulfamethoxazole/trimethoprim twice a day. The nurse should call the health care provider to clarify this order. The medication should not be scheduled four times a day, is not expected to cause constipation, and should not have an interaction with milk.
The nurse is caring for a patient who has been prescribed cefazolin sodium. Which nursing assessment is the priority? 1. Cardiac assessment 2. Neurologic assessment 3. History of immunizations 4. History, including allergies
4. History, including allergies Antibiotic allergy is one of the most common drug allergies. These allergies also have the potential to cause severe anaphylaxis and death and, therefore, have more importance than assessing cardiac or neurologic function or the history of immunizations.
Which class of penicillin antibiotics is known as antistaphylococcal penicillins? 1. Aminopenicillins 2. Natural penicillins 3. Extended-spectrum drugs 4. Penicillinase-resistant penicillins
4. Penicillinase-resistant penicillins Penicillinase-resistant drugs are known as antistaphylococcal penicillins. These include cloxacillin, dicloxacillin, nafcillin, and oxacillin. The penicillinase-resistant penicillins are able to resist breakdown by the penicillin-destroying enzyme (penicillinase), which is commonly produced by bacteria such as staphylococci. Therefore this class of drug is called antistaphylococcal penicillins. Natural penicillin drugs, aminopenicillin drugs, and extended-spectrum drugs are easily broken down by the penicillinase enzyme. Therefore these drugs are not called antistaphylococcal penicillins.
Which medication may sometimes be overlooked when considering penicillin allergies in patients? 1. Amoxicillin (Amoxil) 2. Ampicillin (Totacillin) 3. Penicillin V potassium (V-Cillin K) 4. Piperacillin/tazobactam (Zosyn)
4. Piperacillin/tazobactam (Zosyn) The brand name of Zosyn does not have the suffix "-cillin." For amoxicillin (Amoxil), ampicillin (Totacillin), and V potassium (V-Cillin K), "amoxil" or "-cillin" is mentioned in the brand name.
Which antibiotic may cause hemolysis in a patient who has glucose-6-phosphate dehydrogenase (G6PD) deficiency? 1. Penicillin 2. Quinolone 3. Tetracycline 4. Sulfonamide
4. Sulfonamide G6PD deficiency is an inherited disorder in which the red blood cells are partially or completely deficient in the enzyme G6PD. It is an enzyme that is required in the metabolism of glucose. Sulfonamide antibiotics may cause hemolysis in a patient who has G6PD deficiency. Penicillin antibiotics, quinolone antibiotics, and tetracycline antibiotics do not cause hemolysis in patients who have G6PD deficiency.
A patient is administered cefotetan for a urinary tract infection. After 2 days, the patient complains of stomach cramps, nausea, vomiting, excessive sweating, itching, and headache. The patient also has decreased blood pressure. What does the nurse interpret from the assessment? 1. The patient had taken ranitidine in addition to the cefotetan. 2. The patient had taken probenecid in addition to the cefotetan. 3. The patient had taken methotrexate in addition to the cefotetan. 4. The patient had taken ethanol (alcohol) in addition to the cefotetan.
4. The patient had taken ethanol (alcohol) in addition to the cefotetan. Cefotetan is a second-generation cephalosporin antibiotic. Combining ethanol (alcohol) and cefotetan causes a drug-drug interaction. If the patient drinks alcoholic beverages within 72 hours of taking cefotetan, it causes a disulfiram-like reaction. Stomach cramps, nausea, vomiting, excessive sweating, itching, headache, and hypotension are symptoms of a disulfiram-like reaction. Ranitidine interacts with cefotetan and decreases the effectiveness of cefotetan. Probenecid interacts with cefotetan and increases cephalosporin levels in the body. Methotrexate does not cause any interaction with cefotetan. Methotrexate interacts with penicillin and decreases its renal elimination. As a result, methotrexate levels in the body are increased.
What is the principal indication for sulfamethoxazole-trimethoprim (SMZ-TMP)? 1. Meningeal infection 2. Bacterial pneumonia 3. Bacterial endocarditis 4. Urinary tract infection
4. Urinary tract infection The primary indication for sulfonamide therapy is urinary tract infection because these drugs achieve high concentrations in the kidneys.