Prep U/ Qs - Chapter 9: Antibiotics
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." Explanation: Superinfections are caused when the antibiotic destroys the normal flora within the body and a secondary infection occurs. The infection is caused by a different bacterial or fungal infection.
A young child has been brought to the clinic with signs and symptoms that are consistent with otitis externa. What assessment question should the nurse ask to address the etiology of this health problem?
"Has your child been swimming a lot lately?" Explanation: Otitis externa in children is often attributable to moisture in the ear, often because of swimming. Poor hygiene, interaction with animals, and lack of immunizations are not likely to be relevant factors.
A client scheduled for a bowel resection is to receive neomycin sulfate by mouth. The client asks the nurse the purpose of this medication. What is the most appropriate response the nurse can provide to the client?
"The administration will decrease the growth of intestinal bacteria." Explanation: Neomycin can be given before bowel surgery to suppress intestinal bacterial growth. Neomycin when administered orally is poorly absorbed in the GI tract and so exerts local bactericide effect there. The administration of neomycin will not prevent renal damage or ototoxicity but can actually increase the risk. It will also not affect the risk of airborne contamination since is focused on local effects in the GI tract.
A client diagnosed with tuberculosis (TB) has begun multidrug therapy. The client has asked the nurse why it is necessary to take several different drugs. How should the nurse respond to the client's question?
"The use of multiple drugs prevents the development of drug-resistant TB." Explanation: Use of multiple drugs to treat TB is necessary to prevent the development of drug-resistant TB. This approach to treatment is not necessitated by delays in testing, questionable diagnostic results, or the need to hasten the course of treatment.
The client has been taking a fluoroquinolone and now reports that he has a white patch in his mouth. What is the best response of the nurse?
"You may be experiencing an additional infection. I will discuss this with your health care provider." Explanation: A burning sensation of the mouth or throat may be an indication of a superinfection. It is important the nurse notify the provider. The nurse should not minimize the client's concerns or cause panic.
A client is prescribed isoniazid and rifampin for the treatment of active tuberculosis (TB). The client's medication education should stress that initial symptom improvement is likely to take how long?
2 to 3 weeks Explanation: Therapeutic effects are usually apparent within the first 2 to 3 weeks of drug therapy for active TB. This information makes the other options incorrect.
A client is caring for an 8-year-old child who weighs 30 kg. The health care provider orders gentamicin IM for the client. The recommended dosage range is 2-2.5 mg/kg q8h. What is the maximum amount of gentamicin the client will receive in a day?
225 mg Explanation: Each dose is limited to 75 mg of gentamicin (30 kg × 2.5 mg/kg = 75 mg). Since three doses will be administered daily (i.e., q8h, or "every 8 hours"), the client will receive a maximum total dose of 225 mg per day.
The nurse would contact the physician if ciprofloxacin was prescribed for which client diagnosed with a urinary tract infection?
A 13-year-old client Explanation: Ciprofloxacin should be avoided in children and adolescents under the age of 18 unless the urinary tract infection is extremely severe. Ciprofloxacin may be used in other age groups.
The nurse would contact the physician for which client if gentamicin is ordered for clarification?
A 52-year-old male with an infection of his AV fistula graft Explanation: The nurse would question the order of gentamicin for the 52-year-old male with an infection of his fistula graft. The man has a fistula for dialysis. The most frequently reported adverse effects associated with gentamicin therapy are ototoxicity and nephrotoxicity. Endocarditis, pyelonepritis and PID are not adverse effects of gentamicin.
The health care provider has ordered penicillin V for a client. What should the nurse instruct the client to take with the medication?
A full glass of water Explanation: Clients should be instructed to take each dose of an oral penicillin with a full glass of water. Orange juice and other fluids can destroy these drugs.
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 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. Antifungals are effective in the resolution of fungus infections. Aminopenicillin agents are not effective in treating gram-negative microorganisms. A GABA analog is used to treat pain related to neuropathy.
A client diagnosed with infective endocarditis would be most effectively treated with which medication?
Ampicillin Explanation: Health care providers use ampicillin in the treatment or prophylaxis of infective endocarditis. Ampicillin is effective against bacterial infections. Dicloxacillin, nafcillin, and oxacillin are typically used to treat methicillin-resistant Staphylococcus aureus.
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?
Avoid the consumption of alcohol. Explanation: The nurse should instruct the patient to avoid the consumption of alcohol since alcoholism compounds patient's difficulties and complicates the general condition of the patient's gastrointestinal tract. The nurse should instruct the patient to take the prescribed dose of Ethambutol without regard to food and to take the prescribed Pyrazinamide along with food. The nurse should instruct the patient to avoid doubling the dose in case the earlier dose was missed.
A client is diagnosed with VRE, and the health care provider orders chloramphenicol. The nurse should monitor the client for the development of which side effect?
Blood dyscrasias Explanation: Chloramphenicol (Chloromycetin) is rarely used due to the possible development of serious and fatal blood dyscrasias with its use. It is effective against some strains of VRE.
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?
Blood urea nitrogen (BUN) Explanation: When administering demeclocycline, it is important to monitor the client's BUN. Increases in the BUN are secondary to antianabolic effects. Bilirubin levels would only be important in the presence of liver toxicity. A D-dimer test is a blood test that measures a substance that is released when a blood clot breaks up. Health care providers prescribe the d-dimer test, along with other lab tests and imaging scans, to help check for blood-clotting problems. Mean corpuscular volume (MCV) laboratory test, as part of a standard complete blood count (CBC), is used along with other RBC indices (MCH and MCHC) to help classify the cause of anemia based on red cell morphology. Neither a D-dimer nor MCV values are relevant to this situation.
A client receiving ofloxacin reports diarrhea. Which stool tests are used for clients who are receiving ofloxacin and then develop diarrhea? Select all that apply.
C. difficile test Occult blood test Explanation: If diarrhea develops from use of fluoroquinolones, a nurse knows that two addition stool tests are necessary. One stool sample will test for C. difficile, which is an overgrowth of the Clostridium difficile microorganism. The other stool test, occult blood test, is a test for blood in the stool. Serum drug levels are not indicated for diarrhea. Culture and sensitivity of the stool is not used for a diarrhea diagnosis. Bacteria stool test is used for infections related to traveler's diarrhea and not indicated for this client.
A client has a history of a life-threatening anaphylactic reaction to penicillin G. Which medication should not be administered to this client?
Cefadroxil Explanation: Cefadroxil (Duricef) is a first-generation cephalosporin. Administration of cephalosporins or carbapenems should be avoided in individuals with life-threatening allergic reactions to penicillin. Lactulose reduces blood ammonia by resident intestinal bacteria. It is not contraindicated in the event of penicillin anaphylaxis. Ketoconazole is an antifungal and does not possess cross-sensitivity to penicillin. Kanamycin is an aminoglycoside and does not possess cross-sensitivity to penicillin.
Which is an example of a first generation cephalosporin?
Cefadroxil Explanation: Cefadroxil is an example of first-generation cephalosporins. Cefprozil, cefoxitin, and cefaclor are examples of second-generation cephalosporins.
After teaching a group of students about carbapenems, the instructor determines the need for additional teaching when the students identify what as an example?
Cefuroxime Explanation: Cefuroxime is a cephalosporin. Doripenem, imipenem-cilastatin, and ertapenem are carbapenems.
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 Explanation: Beta-lactam antibacterial drugs inhibit synthesis of bacterial cell walls by binding to proteins in bacterial cell membranes. This binding produces a defective cell wall that allows intracellular contents to leak out. These do no affect DNA replication or cell division.
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 Explanation: The ketolide telithromycin is approved only for community-acquired pneumonia.
An older adult client, diagnosed with community-acquired pneumonia, has been prescribed aztreonam. What action should the nurse perform before administering the first dose?
Confirm the client's allergy status. Explanation: As with all antibiotics, it is important to assess the client's allergy status prior to drug administration. This is especially important before the initial dose. An IV bolus is unnecessary, and discoloration of urine is not expected. MRSA testing is not relevant to aztreonam administration.
The client has been taking levofloxacin IV since admission 12 hours ago for a urinary tract infection. The nurse assesses the client's temperature at 99.8ºF. What is the nurse's best response?
Continue to monitor vital signs. Explanation: The provider should be notified if the client's temperature is greater than 101ºF. The nurse cannot discontinue or administer additional doses without a provider's order. The body's normal defense to infection is an elevated temp until it reaches 101 degrees. Only then would an antipyretic be given if ordered.
A female client is admitted to the critical care unit with sepsis related to a contaminated central line. The health care provider orders intravenous beta-lactam antimicrobials. The client's current laboratory report reflects renal impairment. What would the nurse expect the provider to do?
Decrease the drug dose. Explanation: Beta-lactam antimicrobials are commonly used in critical care units to treat pneumonia, bloodstream infections, wound infections, and other infections. Renal, hepatic, and other organ functions should be monitored in critically ill clients, and drug dosages should be reduced when indicated.
A client is taking clindamycin for an infectious process and presents to the health care provider's office with symptoms of dehydration. The nurse understands that the client is experiencing what adverse reaction from the administration of clindamycin?
Diarrhea Explanation: Clindamycin belongs to the lincosamide class of antimicrobials, similar to macrolides in its mechanism of action and antimicrobial spectrum. A life-threatening adverse effect of clindamycin is the development of pseudomembranous colitis.
The nurse is caring for a client diagnosed with Legionnaires disease. What medication would the nurse expect the health care provider to prescribe?
Erythromycin Explanation: Erythromycin is the prototype macrolide used to treat Legionnaires disease. Loxapine hydrochloride is an antipsychotic agent. Meclizine is used to treat nausea and dizziness. Pravastatin is used to treat hypercholesterolemia.
A client taking Bactrim DS one tablet twice daily for 14 days should be counseled about which of the following adverse reactions? Select all that apply.
Explanation: A client should be advised about potential adverse reactions that can occur while taking a sulfonamide. These adverse reactions include nausea, vomiting, anorexia, stomatitis, chills, fever, crystalluria, and photosensitivity.
A nurse is caring for a client who is receiving cephalosporin. Which histories will a nurse obtain as part of the preadministration assessment? Select all that apply.
Explanation: Before the nurse administers the first dose of a cephalosporin, it is important to obtain a general health history. The health history includes an allergy history, a history of all medical and surgical treatments, a drug history, and the current symptoms of the infection. A client's family and occupational history do not have any implications on cephalosporin therapy.
A nurse monitoring a client taking penicillin should be aware of the common GI tract adverse reactions, including which of the following? Select all that apply.
Glossitis Stomatitis Diarrhea Gastritis Explanation: A nurse monitoring a client taking penicillin should be aware of the common GI tract adverse reactions, including glossitis, stomatitis, gastritis, nausea, vomiting, diarrhea, and abdominal pain.
The pharmacology instructor is discussing antimicrobials with the nursing class. What would the instructor tell the students is the mechanism of action of some antimicrobials?
Inhibiting cell wall synthesis Explanation: Some antibiotics inhibit bacterial cell wall synthesis or activation of enzymes that disrupt bacterial cell walls. Therefore, Options A, B, and D are incorrect.
A female client's medical history includes type 2 diabetes, CVA, dysphasia, and chronic renal failure. She develops an infectious process. The health care provider orders erythromycin. Based on the client's medical history, why is erythromycin the drug of choice?
It is metabolized in the liver. Explanation: Erythromycin is generally considered safe. Because it is metabolized in the liver and excreted in bile, it may be an alternative in clients with impaired renal function.
A client is receiving rifampin and isoniazid in combination for treatment of tuberculosis. What would the nurse need to monitor closely?
Liver function studies Explanation: When rifampin and isoniazid are used in combination, the possibility of toxic liver reactions increases, requiring close monitoring. Urine culture would not need to be monitored. Audiometric studies would be monitored for clients receiving ototoxic drugs such as aminoglycosides. Although pulmonary function studies may be indicated to evaluate the client's respiratory function, these would not be as important as monitoring liver function studies.
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. Explanation: The nurse should monitor for the appearance of adverse reactions in the patient during ongoing assessment of the treatment. The nurse should monitor vital signs of the patient every four hours and not every 24 hours when the patient is hospitalized. The nurse should assess the patient's history of contacts as part of the pre-administration assessment and not as part of the ongoing assessment. DOT can only be used by the nurse to administer antitubercular drugs when the patient is at home, at his place of employment, or in school. DOT is not used when the patient is hospitalized.
The nurse should monitor the client for which common side effects of erythromycin therapy?
Nausea, vomiting, and diarrhea Explanation: Gastrointestinal problems (e.g., nausea, vomiting, and diarrhea) are common side effects of erythromycin and other macrolides. Headache, fever, ophthalmic drainage, urticaria, shortness of breath and sore throat are no common side effects.
Which of the following should a nurse carefully monitor in a patient who has been administered cephalosporin as well as aminoglycosides for a wound infection?
Nephrotoxicity Explanation: When cephalosporin is administered with aminoglycosides, it increases the risk for nephrotoxicity and should be closely monitored. Nausea is an adverse reaction of cephalosporins in patients with gastrointestinal tract infection. The risk of bleeding increases when cephalosporin is administered with oral anticoagulants. Risk for respiratory difficulty increases if alcohol is consumed within 72 hours after certain cephalosporin administration.
While administering aminoglycosides to clients, the nurse must be aware of what toxicities that can result from their use? (Select all that apply.)
Nephrotoxicity Ototoxicity Neurotoxicity
When preparing to administer a fluoroquinolone, the nurse understands that the majority of drugs belonging to this class are administered by which route?
Oral Explanation: Most fluoroquinolones are administered orally; levofloxacin and moxifloxacin may also be given intravenously.
A client has been prescribed lomefloxacin (Maxaquin) for a respiratory infection. What must the nurse closely monitor for in this client?
Photosensitivity Explanation: Lomefloxacin may induce serious photosensitivity reactions and should be discontinued at the first sign of rash, redness, or burning sensation on the skin. The drug is not associated with the development of psychosis, anemia, or increased ICP.
A middle-aged patient has been prescribed tetracycline as part of his Prevpac for the treatment of H. pylori. The patient has a history of atrial fibrillation which is being treated with digitalis drugs. Given his history and current medications, the patient is at risk for which of the following conditions?
Risk of toxicity Explanation: When digitalis drugs interact with tetracyclines, the patient is at a risk for toxicity. Respiratory depression is an effect observed when neuromuscular-blocking drugs interact with lincosamides. Increase in serum levels is observed when digoxin interacts with macrolides. Increase in serum theophylline level occurs when theophylline interacts with macrolides.
The nurse will notify the health care provider immediately if the client taking amoxicillin for otitis media is also taking what medication?
Tetracycline for acne Explanation: Tetracycline, if taken with amoxicillin, inhibits the action of amoxicillin.
A nurse is assigned to care for a client with tuberculosis who has been prescribed rifampin. What should the nurse confirm to be sure that rifampin is not contraindicated in the client?
The client does not have renal impairment. Explanation: The nurse should ensure that the client does not have renal impairment because rifampin is contraindicated in clients with this condition. Pyrazinamide and not rifampin is contraindicated in clients with severe hepatic damage, diabetes mellitus, and acute gout.
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 Explanation: Jaundice and edema suggest liver dysfunction, which the nurse should promptly report. Each of the other changes in status warrant the nurse's thoughtful attention and relevant interventions but none requires immediate input from the client's care provider.
Chest radiography and sputum sample microscopy have confirmed a diagnosis of TB in a 40-year-old man who has a history of type 1 diabetes and who currently has a diabetic foot ulcer. How should the nurse account for this patient's health status when planning care during INH treatment?
The patient will require vigilant monitoring of blood glucose levels. Explanation: INH treatment constitutes a risk for hyperglycemia and close monitoring of blood glucose levels is thus indicated. This patient's history will not likely impact the chosen route for the drug and insulin therapy can be safely continued. The patient will be vulnerable to other infections for the foreseeable future, but he will not likely be immunocompromised to the degree that positive-pressure isolation is required.
A patient is to begin taking tobramycin (Nebcin) for a nosocomial infection. Which of the following assessments should the nurse prioritize?
The peak and trough blood levels Explanation: Peak and trough levels should be closely monitored with serious infections being treated with tobramycin. The patient's blood pressure, diet, weight, and other medications would be important to know and necessary for the plan of care, but are secondary to serum levels.
A client asks why three medications are prescribed to treat his tuberculosis. The nurse informs the client of which reasons?
To prevent resistance Explanation: The CDC recommends multi-drug therapy to slow the development of bacterial resistance. It does not shorten therapy, prevent allergic reactions, or prevent adverse reactions.
A health care center is conducting a seminar on cephalosporins drugs. During the question-and-answer period, the audience wants examples of conditions that can be treated by cephalosporins. Which of the following infections should the nurse state as examples?
Urinary tract infections Explanation: Cephalosporins are used to treat urinary tract infections, skin infections, and hospital-acquired pneumonias. Cephalosporins are not used to treat hemolysis or jaundice. Nausea and diarrhea are some of the adverse reactions that can occur when a patient is on cephalosporins therapy.
Fluoroquinolones are primarily used to treat which of the following infections? Select all that apply.
Urinary tract infections Sexually transmitted infections Bone and joint infections Skin infections Explanation: Fluoroquinolones are primarily used to treat lower respiratory tract infections, bone and joint infections, urinary tract infections, skin infections, sexually transmitted infections, and some infections of the eye and ear.
The nurse is giving discharge instructions to a woman who will be taking amoxicillin for treatment of acute otitis media. The nurse teaches the client that which symptom indicates the development of a superinfection and should be reported to the physician?
Vaginal itching and discharge Explanation: A vaginal infection in a client who is taking amoxicillin is an example of a superinfection. The nausea and abdominal pain are adverse effects of the medication, and swelling and itching of the throat are an example of possible allergy to the drug.
After several rounds of treatment for TB over past several years, a male client continues to test positive for active TB, a fact that the care team attributes to the client's nonadherence to treatment. The client's most recent diagnostic workup reveals that he now has multidrug resistant TB. The nurse should anticipate that the client may require treatment with:
a fluoroquinolone. Explanation: The fluoroquinolones are used for multidrug-resistant TB, although they are not FDA approved for this indication. Penicillin, clindamycin, lincomycin, and macrolide antibiotics are not used in the treatment of TB.
In the rare instance in which penicillin is considered essential, hypersensitivity can be assessed by administering:
a skin test. Explanation: In the rare instance in which penicillin is considered essential, a skin test may be helpful in assessing hypersensitivity.
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?
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. Changing the route or supplementing with vitamin K will not aid in treatment.
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 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.
After teaching a group of students about the indications for use for aminoglycosides, the instructor determines that the teaching was successful when the students identify which type of infection as a primary indication?
gram-negative infections Explanation: Aminoglycosides are used primarily in the treatment of infections caused by gram-negative microorganisms. Aminoglycosides are not effective on gram-positive bacteria. Since aminoglycosides are antibacterial, they are not effective on fungal or viral infections.
The client has been prescribed a fluoroquinolone. The nurse knows that nursing interventions for clients taking fluoroquinolones include which?
increase fluid intake. Explanation: Clients taking fluoroquinolones should increase their fluid intake. Sodium ingestion is not affected.
When considering known adverse reactions to gentamicin therapy, the nurse should focus assessment of what body structure?
inner ears Explanation: Gentamicin reaches higher concentrations in the kidneys and inner ears than in other body tissues; this is a major factor in nephrotoxicity and ototoxicity. This situation requires focused assessment of the inner ears and kidney function. The increased concentration does occur in any of the other proposed locations.
A female client is being treated for Mycoplasma pneumoniae pneumonia. She is allergic to penicillin and is being given azithromycin (Zithromax) in capsule form. The nurse will inform the client that she will need to take the capsule
on an empty stomach. Explanation: Because the absorption of azithromycin capsules is decreased in the presence of food, azithromycin capsules should be taken on an empty stomach rather than after a meal. Unlike azithromycin capsules, azithromycin tablets have an increased absorption when given with a meal with high fat content and may be given with or without food.
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 Explanation: Anaphylactic reactions, although possible after oral administration, occur more commonly after parenteral administration. Penicillins are neither administered topically nor transdermally.
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 Explanation: Shortness of breath is suggestive of a hypersensitivity reaction and would likely warrant discontinuation of the drug. Nausea, reflux, and headache should each be addressed, but none likely necessitates discontinuation of drug therapy.
A client has been treated several times for a recurring ear infection with ofloxacin. The nurse instructs the client to look for side effects from the prolonged use of the antibiotic and informs the client that this is known as:
superinfection. Explanation: Prolonged use of otic preparations containing an antibiotic may result in a superinfection (an overgrowth of bacterial or fungal microorganisms not affected by the antibiotic being administered).
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. Explanation: Beta-lactam antibacterial drugs inhibit synthesis of bacterial cell walls by binding to proteins in bacterial cell membranes. Penicillin V does not inhibit protein synthesis. Penicillin V does not inhibit protein synthesis, cause mutations, or lower the pH of a bacterium's cellular contents.
Drugs that destroy bacteria are known as which type of drug?
Correct response: bactericidal Explanation: Drugs that destroy bacteria are known as bactericidal. Drugs that slow or retard the multiplication of bacteria are known as bacteriostatic. Bacteriostationary keeps the bacteria in place, and bacteriophage uses enzymatic substances to destroy the bacteria.
A client is diagnosed with a gram-negative infection and is prescribed an aminoglycoside. What is the action of an aminoglycoside?
It blocks protein synthesis of the cell wall. Explanation: Aminoglycosides penetrate the cell walls of susceptible bacteria and bind irreversibly to 30S ribosomes, intracellular structures that synthesize proteins. Actions associated with aminoglycosides do not include blocking DNA replication, destroying cell wall structure, or increasing white blood cells.
Which of the following drugs would be classified as an aminoglycoside?
Gentamicin Explanation: Gentamicin is classified as an aminoglycoside. Levofloxacin is a fluoroquinolone; clarithromycin is a macrolide; and cefaclor is a cephalosporin.
Tetracyclines should not be used in children younger than 8 years of age because of their effects on:
teeth and bones. Explanation: Tetracyclines should not be used in children younger than 8 years of age because of their effects on teeth and bones.
A client has been on sulfonamide therapy for the last six weeks. What client report may cause the health care provider to discontinue the sulfonamide?
10 lb weight loss Explanation: GI side effects with sulfonamide therapy may be mild, such as decreased appetite, inability to eat spicy foods (due to stomatitis), or loose stools for two days. But the drug may need to be discontinued for more serious problems such as pronounced weight loss.
The nurse prepares to administer gentamicin intravenous every 8 hours to an older adult client. Which interventions should the nurse provide to decrease the risk for nephrotoxicity and ototoxicity? Select all that apply.
Explanation: The trough or lowest drug concentration is obtained before administering the next scheduled dose, and the nurse would report a level above 2 mcg/mL. The peak of the drug occurs 30 minutes after the 30-minute infusion has ended. The nurse would report levels above 10 to 12 mcg/mL. When the drug levels are elevated, ototoxicity and nephrotoxicity are more likely to occur. The nurse would test cranial nerve VIII for hearing and any presence of vertigo (dizziness) or tinnitus (ringing in the ears) at baseline and periodically during therapy and report changes immediately to the prescriber. The estimated creatinine clearance provides information about the glomerular filtration rate and the kidney's ability to excrete the drug properly. The blood urea nitrogen (BUN) level reflects hydration. The client must be hydrated before beginning therapy and during to help prevent nephrotoxicity. The nurse would provide adequate hydration of 2 to 3 L with noncaffeinated fluids to help flush out the drug's metabolites to prevent nephrotoxicity.
Your client is currently taking aminoglycosides. You know that this type of medication is used in all of the following microorganisms, EXCEPT:
Gram-positive cocci. Explanation: Many hospital-acquired infections are caused by gram-positive cocci and gram-negative organisms. The major clinical use of parenteral aminoglycosides is to treat serious systemic infections caused by gram-negative microorganisms such as Pseudomonas and Proteus species, Escherichia coli, Klebsiella, Enterobacter, and Serratia species.
A nurse is caring for a patient who is being administered penicillin. What are the common adverse reactions to penicillin a nurse should assess for?
Inflammation of the tongue and mouth Explanation: Some of the common adverse effects of penicillin are glossitis (inflammation of the tongue), stomatitis (inflammation of the mouth), and gastritis (inflammation of the stomach). Unless severe, the drug may be continued as prescribed and the nurse would intervene to help the patient manage the common adverse reactions. Impaired oral mucous membranes are signs of a fungal superinfection in the oral cavity, whereas severe hypotension and sudden loss of consciousness are signs of an anaphylactic shock; these are not common adverse effects of penicillin and require immediate medical attention.
Your client is being treated for streptococcal pharyngitis and is NPO. The health care provider has ordered penicillin G to be given IM. The client wants to know why the medication cannot be taken via an oral route. Which is the best response from the nurse?
It is inactivated by gastric acid, therefore it is only given by injection Explanation: Penicillin G is not effective orally because it is inactivated by gastric acid. Several preparations of penicillin G are available for IV and IM administration. The other choices would not be a reason for giving penicillin G parenterally.
When discussing cephalosporins with the nursing class, the pharmacology instructor explains that this classification of drug is primarily excreted through which organ?
Kidney Explanation: The cephalosporins are primarily metabolized in the liver and excreted in the urine. These drugs cross the placenta and enter breast milk. They are not excreted through the lungs, the liver, or the skin.
Which of the following medications is contraindicated in children?
Levofloxacin Explanation: Fluoroquinolones are contraindicated in clients who are younger than 18 years of age.
The nurse knows that tuberculosis (TB) is an infectious disease seen around the world and in many cases due to overcrowding. The nurse would be aware of this condition if the lab reports showed which bacteria?
Mycobacterium tuberculosis Explanation: TB is an infectious disease caused by the Mycobacterium tuberculosis bacterium. The pathogen is also referred to as the tubercle bacillus.
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. Explanation: The nurse should be careful to rotate injection sites when administering frequent parenteral injections. At the time of each injection, the nurse inspects previous injection sites for signs of swelling, redness, and tenderness. The nurse should monitor any signs of liver dysfunction monthly in patients who are being administered antitubercular drugs. The nurse should ensure that pyridoxine, and not streptomycin, is administered to the patient to promote nutrition, but this is only administered if the patient has been living in impoverished conditions and is malnourished. The nurse should monitor patient's vital signs every four hours and not once every morning.
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 Explanation: Tetracyclines should be used with caution in children younger than age 8 years because the drugs can potentially damage developing teeth and bones. They do not affect hearing or vision. They are excreted in the urine, so caution is necessary if the client has underlying renal dysfunction; however, this is not the main reason for avoiding use in children.
A client is prescribed rifampin. What information should the nurse include in the client's medication education?
The urine, tears, sweat, and other body fluids will be a discolored red-orange. Explanation: The client's urine, tears, sweat, and other body fluids will be a discolored red-orange. This adverse effect is harmless, but the client should be instructed on this adverse effect. The administration of this medication with warfarin will decrease the anticoagulant effect. The medication increases hepatic cytochrome P-450 3A4 enzyme and decreases serum concentrations. The serum half-life of rifampin is shorter than that of the medication rifabutin.
Penicillins are most effective when used to treat what type of microorganisms?
gram-positive bacteria Explanation: Clinical indications for use of penicillins include bacterial infections caused by susceptible microorganisms. As a class, penicillins usually are more effective in infections caused by gram-positive bacteria than those caused by gram-negative bacteria. However, their clinical uses vary significantly according to the subgroup or individual drug and microbial patterns of resistance. This information makes the remaining options incorrect. Bacilli are a type of bacteria.
The nurse is preparing to administer vancomycin intravenously (IV) to a client. In preparation, the nurse dilutes the medication into 0.9% NaCl for what reason?
minimize the adverse reactions related to histamine release Explanation: When administering IV vancomycin, the nurse dilutes 500-mg doses in 100 mL and 1-g doses in 200 mL of 0.9% NaCl or 5% dextrose injection and infuses it over at least 60 minutes. This process is intended to minimize an adverse effect related to histamine release, characterized by hypotension, flushing, and skin rash. None of the other options accurately describe the reasoning for the proposed intervention.
A patient is receiving cefazolin in combination with anticoagulants. To minimize the adverse effects during therapy, the nurse will
monitor the patient for bleeding gums. Explanation: The nurse should monitor for bleeding gums when the drug is administered in combination with anticoagulants, because patients who receive oral anticoagulants may experience increased bleeding. Administering the medication with small amounts of food and fluids should help minimize adverse effects of GI distress that occur under normal circumstances. Monitoring the site of injection and continuing therapy until 2 days after the symptoms have resolved would represent good general nursing practice.
A nurse is reviewing the medical record of a client who is prescribed tetracycline. Which drug, if found being used by the client, would alert the nurse to the need for a decreased dosage of that drug?
warfarin Explanation: The concomitant use of tetracycline with warfarin, an anticoagulant, increases the risk of bleeding, necessitating a reduction in the dosage of warfarin. Vancomycin is used in specific cases of bacterial and resistant infections. Atorvastatin is for hyperlipidemia, and losartan is an antihypertensive. Tetracycline has no drug interaction with these drugs.
What drug belongs to the group of carbapenems?
Primaxin Explanation: The group consists of three drugs: Imipenem-cilastatin (Primaxin), Meropenem (Merrem), and Ertapenem (Invanz). Gemifloxacin is a Fluoroquinolones, Cefuroxime is a second-generation cephalosporin, and demeclocycline is a tetracycline.
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." Explanation: Clients taking fluoroquinolones should increase, not limit, their fluid intake. It is important that the client take all of the prescribed antibiotics and understand adverse reactions, such as abdominal pain. Difficulty breathing may indicate hypersensitivity and is an emergency.
The nurse is educating a client diagnosed with a urinary tract infection about the prescribed trimethoprim-sulfamethoxazole (TMP-SMZ). The client has a history of type 2 diabetes and currently takes a sulfonylurea. Which statement made by the client establishes the need for further clarification?
"The drug will not affect the herbal supplement, ginseng that I take." Explanation: The nurse needs to clarify the statement that the client made in regard to continuing the ginseng because the interaction with TMP-SMZ will result in increasing the effect of the bacteriostatic drug. The other statements are correct. TMP-SMZ interacts with sulfonylurea drug leading to hypoglycemia, so close monitoring of blood sugars is warranted. The drug needs to be taken before or after a meal with at least 8 ounces of water to help prevent crystalluria. The client should take at least 2 to 3 L of noncaffeinated fluids each day to properly hydrate and flush kidneys of wastes. The drug may lead to a serious life-threatening condition, Stevens-Johnson syndrome, which has a sudden development of a flat red rash that forms blisters in the center and areas of peeling skin. The client should stop the drug immediately and notify the prescriber of any rash.
A client is receiving gentamicin to treat meningitis. The health care provider has ordered a peak serum level be drawn in association with the 07:00 dose, which will finish infusing at 07:30. When should the peak serum level be drawn?
08:00 Explanation: With conventional dosing, it is necessary to take gentamicin peak levels 30 minutes after the end of a 30-minute IV infusion. Thus, 08:00 is the optimal peak time to assess the serum level of gentamicin. None of the other options would provide that assessment.
A nurse is preparing to give a client an initial dose of a penicillin preparation. What should the first action be for the nurse?
Ask the client if there is a history allergy to a penicillin. Explanation: Before giving the initial dose of any penicillin preparation, ask the client if he or she has ever taken penicillin and, if so, whether an allergic reaction occurred. If the client is believed to be hypersensitive and the penicillin is considered essential, a skin test can help assess the degree of hypersensitivity; the provider can use the results of the test to determine whether and how to administer a penicillin to the client. Although penicillin is a common source of drug-induced anaphylaxis, not all anaphylaxis is caused by drugs.
A 25-year-old female client 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 client before beginning the medication?
Asking the client if she is pregnant Explanation: Tetracyclines, such as doxycycline, are contraindicated in pregnant women and in children under 8 years of age. In the fetus and young children, the drug can inhibit bone growth and the development of enamel in the teeth.
A public health nurse interacts with many members of the community who are at risk for sexually transmitted infections (STIs). The nurse should anticipate the use of tetracycline in a client who is diagnosed with what STI?
Chlamydia Explanation: The action of tetracycline makes it effective for treating Mycoplasma, Chlamydia, and Rickettsia. It is not efficacious in the treatment of trichomoniasis, HPV, or vaginitis.
A client who takes anticoagulants for atrial fibrillation is diagnosed with a severe infection and is ordered levofloxacin (Levaquin). The nurse is aware that taking these two drugs requires frequent assessment for which of the following?
Correct response: Decreased clotting Explanation: The combination of anticoagulants and fluoroquinolones put the client at risk for increased bleeding, or decreased clotting. There is no effect on the absorption of the antibiotic.
A female client is prescribed rifampin as part of her antitubercular regimen. She also takes oral contraceptives. The nurse is aware that this combination of medications can produce what effect?
Correct response: Pregnancy Explanation: The rifamycins (rifampin, rifabutin, rifapentine) induce cytochrome P450 drug metabolizing enzymes and therefore accelerate the metabolism and decrease the effectiveness of many drugs. Rifampin is the strongest inducer and may decrease the effects of angiotensin-converting enzyme (ACE) inhibitors, anticoagulants, antiarrhythmics, some antifungals (e.g., fluconazole), anti-HIV protease inhibitors (e.g., amprenavir, indinavir), anti-HIV NNRTIs (e.g., efavirenz, nevirapine), benzodiazepines, beta-blockers, corticosteroids, cyclosporine, digoxin, and diltiazem, as well as estrogens and oral contraceptives.
What should the pre-administration assessment of any antitubercular drug include?(Select all that apply.)
Culture and sensitivity testing Complete blood count Family and contacts history Radiographic studies Medication history Explanation: Pre-administration assessment of any antitubercular drug should include culture and sensitivity testing, complete blood count, radiographic studies, medication history, and a family and contacts history for those with active TB.
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. Explanation: Clients taking penicillins should take oral doses with a full glass of water to ensure sufficient hydration while taking the medication. The drugs should otherwise be taken on an empty stomach. Tapering is unnecessary, and it is not advised to take the drug with diphenhydramine in an effort to reduce the allergy risk.
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 Explanation: 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 client being treated for cellulitis with a cephalosporin asks what the essential difference is between generations of this medication. The nurse should respond to the client's question based on what fact?
Each successive generation is more effective against gram-negative microorganisms. Explanation: Cephalosporins are grouped into generations by their antimicrobial properties. Each newer generation of cephalosporins has significantly greater gram-negative antimicrobial properties than the preceding generation, with decreased activity against gram-positive organisms. None of the remaining options accurately describe the concept of generations associated with medications.
The nurse should advise clients that which of the following are adverse reactions that may occur with the administration of tetracyclines? Select all that apply.
Explanation: The nurse should advise clients nausea, vomiting, diarrhea, epigastric distress, stomatitis, sore throat, skin rashes, and photosensitivity are adverse reactions that may occur with the administration of tetracyclines.
A student asks the pharmacology instructor if there is a way to increase the benefits and decrease the risks of antibiotic therapy. What would be an appropriate response by the instructor?
It is important to use antibiotics cautiously and to teach clients to complete the full course of an antibiotic prescription. Explanation: To prevent or contain the growing threat of drug-resistant strains of bacteria, it is very important to use antibiotics cautiously, to complete the full course of an antibiotic prescription, and to avoid saving antibiotics for self-medication in the future. A client and family teaching program should address these issues, as well as the proper dosing procedure for the drug (even if the client feels better) and the importance of keeping a record of any reactions to antibiotics. Thus, taking drugs not prescribed for the particular illness tends to maximize risks and minimize benefits. Also, if the infection is viral, antibacterial drugs are ineffective and should not be used.
A client taking isoniazid is worried about the side effects/adverse reactions. The nurse tells the client that a common adverse reaction of isoniazid is which of the following?
Jaundice Explanation: Jaundice is an adverse reaction related to isoniazid therapy. Insomnia, joint pain, and myalgia are not related to isoniazid therapy.
A client is prescribed isoniazid (INH) for a diagnosis of tuberculosis. Which adverse effect will result in discontinuation of the medication?
Jaundice Explanation: Potentially serious adverse effects of INH include hepatotoxicity. Hepatotoxicity may be manifested by symptoms of hepatitis (e.g., anorexia, nausea, fatigue, malaise, jaundice) or elevated liver enzymes. The nurse reports their development to the health care provider promptly to prevent possible liver failure and death. Weight gain, fever, and arthralgia are not the most known adverse effects of INH.
A patient with a throat infection has been recommended penicillin therapy by the primary health care provider. Before administering the first dose of penicillin to the patient, which interventions should the nurse perform as part of the pre-administration assessment?
Obtain patient's general health history. Explanation: Before administering the first dose of penicillin, the nurse should obtain and review the patient's general health history, including any allergy history, a history of all medical and surgical treatments, a drug history, and the current symptoms of the infection. The patient's stool is examined only after penicillin has been administered and the patient has diarrhea. It is not required to evaluate the patient's lifestyle and diet as part of the pre-administration assessment for the first dose. Renal and hepatic function tests may be performed at intervals during penicillin therapy, usually not before it. Reference:
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 Explanation: Penicillin G may also be used as prophylaxis in special patient populations to prevent bacterial endocarditis prior to procedures likely to produce temporary bacteremia, such as dental procedures. These patients include those with prosthetic heart valves, mitral valve prolapse, most congenital heart diseases, and acquired valvular heart disease. It may also be used as prophylaxis in patients with recurrent rheumatic fever or rheumatic heart disease.
The health care provider suspects a client may be infected with an antibiotic-resistant pathogen. The nurse caring for this client knows that what course of action is best used to determine whether this type of pathogen is present?
Perform culture and susceptibility tests. Explanation: Before prescribing an antibiotic, the health care provider should review culture and susceptibility reports and local susceptibility patterns to determine if an antibiotic-resistant pathogen is present in the client. Complete blood counts and electrolyte values are standard procedure lab tests. Spinal fluid checks are performed to detect anomalies such as meningitis.
A client who underwent abdominal surgery 6 weeks ago is diagnosed with VREF. The nurse expects the physician to order which medication?
Quinupristin-dalfopristin Explanation: Quinupristin-dalfopristin belongs to the streptogramin class of antibiotics. It is indicated for VREF and MSSA.
The nurse is aware that sulfonamide therapy is used cautiously in older adults because of decreased function of what organ system?
Renal Explanation: Sulfonamides should be administered with great caution in the older adult because of age-related, decreased renal function. Though hepatic function may diminish related to age, it is not a caution to sulfonamide therapy. The same is true for pancreatic and splenic function.
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?
Renal disease Explanation: The use of cephalosporins is restricted if the patient has a history of allergies to cephalosporins or penicillins, renal disease, hepatic impairment, bleeding disorder, or pregnancy. Aplastic anemia, headaches, and abdominal cramps are some of the adverse reactions that can be caused by use of cephalosporins.
A patient who was administered cephalosporins has developed a skin rash. The nursing assistant is scared and thinks that this is a serious reaction. The nurse tells him that this is a mild reaction. Which of the following should the nurse mention as the symptoms of serious hypersensitivity reaction?
Renal dysfunction Explanation: Renal dysfunction is one of the life-threatening hypersensitivity reactions that can occur with administration of the cephalosporins. Mild hypersensitivity reactions include pruritus, urticaria, and skin rashes; these can be controlled with appropriate nursing interventions.
A client, being treated in the intensive care unit, has been diagnosed with ventilator-associated pneumonia. Culture and sensitivity testing of the client's sputum indicates that erythromycin is a treatment option. Which nursing assessment is most appropriate to rule out contraindications for this medication therapy?
Review lab results to confirm normal liver function. Explanation: Erythromycin is seldom used in critical care settings, partly because broader-spectrum bactericidal drugs are usually needed in critically ill clients and partly because it inhibits liver metabolism and slows elimination of several other drugs. Erythromycin is not nephrotoxic. The drug is administered orally, and GI upset does not contraindicate use.
A group of students are reviewing information about drugs used to treat tuberculosis. The students demonstrate understanding of the material when they identify which drug as a first-line treatment option?
Rifampin Explanation: Rifampin, along with isoniazid, pyrazinamide, ethambutol, streptomycin, and rifapentine, are considered first-line agents for treating tuberculosis. Kanamycin, ciprofloxacin, and capreomycin are second-line agents.
A nurse is caring for a patient undergoing the second phase of standard TB treatment. The nurse knows that which of the following combinations of drugs need to be administered to the client?
Rifampin and isoniazid Explanation: The nurse knows that a combination of Rifampin and isoniazid drugs should be used during the second phase of standard treatment. Isoniazid, rifampin, and pyrazinamide are not used together as combination drugs in the second phase of standard treatment. Dapsone is used for leprosy and cannot be used in combination with isoniazid or any other drug for TB.
A 7-year-old child has been taking tetracycline for a bacterial infection. The nurse will be sure to inform the parents that this drug could cause
staining of permanent teeth. Explanation: Tetracycline is an example of a drug that can adversely affect a body system during a phase of child development. If administered to a child between the ages of 4 months and 8 years, it can stain the child's permanent teeth. Discolored urine, deep muscle pain, and sleep deprivation are not associated with tetracycline.
Common, potentially serious, adverse effects of antibiotic drugs include:
Skin rash Explanation: Examine skin for any rash or lesions, examine injection sites for abscess formation, and note respiratory status—including rate, depth, and adventitious sounds to provide a baseline for determining adverse reactions. Report nausea, vomiting, diarrhea, skin rash, recurrence of symptoms for which the antibiotic drug was prescribed, or signs of new infection (e.g., fever, cough, sore mouth, drainage). These problems may indicate adverse effects of the drug, lack of therapeutic response to the drug, or another infection. Pain, constipation, and hypopnea are not common adverse effects of antibiotic drugs.
The nurse is caring for a client who is taking tetracycline for Rocky Mountain spotted fever. The nurse notices that the client has developed painful mouth ulcers. The nurse knows that the client has developed what adverse reaction to the medication?
Stomatitis Explanation: Stomatitis is the development of ulcers in the mucous membranes of the oral cavity. It is an adverse reaction seen in clients taking tetracycline. Epigastric distress is another adverse reaction but is an inflammation of the stomach. A hypersensitivity reaction is usually seen as hives or wheals on the skin, and tetracycline is used in the treatment of acne.
The client has been taking her antibiotic for five days. She tells the nurse that she is now experiencing vaginal itching and discharge. The nurse suspects what has occurred?
The client has developed a superinfection. Explanation: The client is experiencing a vaginal yeast superinfection related to the use of antibiotics. Adverse reactions include nausea, diarrhea, abdominal pain, headache and photosensitivity. This is not indicative of an STI in this scenario.
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 need to consistently take the prescribed drugs in order to cure TB Explanation: Consistent adherence to treatment is imperative to ensure successful treatment of TB. Nonadherence leads to resistance and unsuccessful treatment, not increased adverse effects. Nonadherence has no relationship with matching dosage with signs and symptoms. Antivirals are ineffective against TB.
A client with a diagnosis of human immunodeficiency virus (HIV) has just been diagnosed with Mycobacterium avium complex (MAC) disease. The nurse should anticipate including what information when educating the client regarding the prescribed therapy? Select all that apply.
There is a once-daily dose of clarithromycin. A 600-mg dose of azithromycin will be prescribed. The therapy may include a prescription for rifabutin. Explanation: Treatment of MAC begins with once-daily administration of clarithromycin 500 mg and azithromycin 600 mg. Therapy may also involve ethambutol and rifabutin. Ethambutol is preferable because its use is associated with a lower relapse rate.
A client has been prescribed INH therapy for the treatment of latent tuberculosis. The client has a history of hypertension. The nurse teaches the client not to eat dairy products, bananas, or consume caffeine. What is the best explanation the nurse can give the client?
These foods can cause an unsafe increase in blood pressure. Explanation: Clients should refrain from the excessive intake of foods rich in tyramine and foods containing histamine. Tyramine-rich foods include cheese and dairy products, beef or chicken liver, beer and ale, red wine, avocados, bananas, figs, raisins, caffeine, and chocolates. Because most people consume these food items, the diet is difficult to maintain. Although the reaction is not as severe as with clients taking monoamine oxidase inhibitors, the client may experience hypertension. On the other hand, histamine-rich foods include tuna, brine, and yeast extract. The client may experience headache, palpitations, sweating, hypotension, flushing, diarrhea, or itching.
A client newly diagnosed with syphilis is allergic to penicillin. What medication should this client be prescribed?
tetracycline Explanation: Tetracycline may be effective in treating syphilis when penicillin cannot be given. If the client is allergic to penicillin, it is likely they are also allergic to amoxicillin. Tetracycline hydrochloride is prescribed to treat urinary tract infections (UTIs), while phenazopyridine hydrochloride is used to manage the pain associated with UTIs.
A 10-year-old client is diagnosed with acute otitis media. What does the nurse anticipate the health care provider will prescribe?
amoxicillin Explanation: Amoxicillin is the drug of choice for a client with acute otitis media. Ciprofloxacin is prescribed for necrotizing otitis external. Ibuprofen is over the counter and does not require a prescription; although it can be used for pain associated with acute otitis media, it will not treat the infection. Neomycin-polymyxin B is used for external otitis media.
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. Explanation: Clients who are allergic to penicillins may also be allergic to cephalosporins. Although this cross-allergenicity (allergy to a drug of another class with similar chemical structure) is rare, cephalosporins are not typically administered to clients who have had life-threatening allergic reactions to a penicillin.
A client with a gram-negative bacterial infection has been prescribed a fluoroquinolone. During the preadministration assessment, the nurse should ensure that which laboratory tests, if prescribed, are obtained before the first dose of fluoroquinolones is administered to the client?
culture and sensitivity test Explanation: The nurse should ensure that culture and sensitivity tests are done before the client receives the first dose of fluoroquinolones. The nurse should ensure that renal and hepatic function tests, urinalysis, and tests to determine blood count are conducted if the client is to be administered aminoglycosides.
A client with a history of valvular heart disease reports having had a "bad reaction" after receiving penicillin in the past. Prior to a scheduled dental procedure, the client is likely to be prescribed what drug?
erythromycin Explanation: Prophylactically, erythromycin is administered to prevent alpha-hemolytic streptococcal endocarditis before dental or other procedures in clients who have valvular heart disease and are allergic to penicillin. Clindamycin may be useful as a penicillin substitute in clients who are allergic to penicillin and who have serious streptococcal, staphylococcal, or pneumococcal infection in which the causative organism is susceptible to clindamycin (including prevention of perinatal group B streptococcal disease). None of the other options would be suitable substitutes for penicillin in this described situation.
A nurse is discussing the medication regimen for a client diagnosed with tuberculosis. The nurse tells the client that the prescriber is retreating the client due to not adhering to the treatment regimen. Which medications are used in the retreatment drug regimens? Select all that apply.
ethionamide cycloserine ciprofloxacin Explanation: Treatment fails because of inadequate initial drug treatment or noncompliance with the medication regimen. Retreatment drug regimens most often consist of ethionamide, aminosalicylic acid, cycloserine, and capreomycin. Ofloxacin and ciprofloxacin may also be used in retreatment. Rifampin, isoniazid, pyrazinamide and ethambutol are initial medications for the recommended treatment regimen of the Centers for Disease Control and Prevention.
When describing how tetracyclines treat infection, the nurse would incorporate which information into the description?
inhibiting bacterial protein synthesis Explanation: Tetracyclines treat infection by inhibiting bacterial protein synthesis. Penicillins inhibit cell wall synthesis. Tetracyclines do not inhibit DNA or the depolarization of the cell wall.
When describing the action of sulfonamides to a client, the nurse integrates understanding of the drug's action with effects exerted due to which mechanism?
inhibition of the activity of folic acid in bacterial cell metabolism Explanation: Sulfonamides exert their effects by inhibiting the activity of folic acid in bacterial cell metabolism. Sulfonamides do not inhibit DNA, RNA, or cell wall synthesis.
A nursing instructor is preparing a teaching plan for a nursing pharmacology class on the action of fluoroquinolones. Which would the instructor include?
interfering with DNA synthesis in the bacterial cell Explanation: The fluoroquinolones exert their bactericidal effect by interfering with the synthesis of bacterial DNA by not allowing the cell to reproduce. The tetracyclines are bacteriostatic and exert their effect by inhibiting bacterial protein synthesis. Penicillins act to disrupt the bacterial cell wall. The aminoglycosides exert their bactericidal effect by blocking the ribosome from reading the mRNA, a step in protein synthesis necessary for bacterial multiplication.
The nurse is assessing a client who has been prescribed treatment with isoniazid. What assessment finding would most likely necessitate contacting the health care provider to recommend discontinuing treatment?
jaundice Explanation: Jaundice is a clear indication of hepatotoxicity and would most likely warrant discontinuing treatment with isoniazid. Nausea would not likely prompt any change in treatment. Pruritus may be associated with liver damage but may also have other potential causes. Alopecia does not typically accompany isoniazid therapy.
The nurse recognizes that what drug classification increases the risk of ototoxicity and nephrotoxicity when prescribed with gentamicin?
loop diuretics Explanation: Loop diuretics given simultaneously with gentamicin increase the risk of nephrotoxicity by decreasing fluid volume, thereby increasing drug concentrations in serum and tissues. Loop diuretics may also contribute to ototoxicity. This risk is not associated with therapies that include both gentamicin and any of the other options.
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?
numbness and tingling in his feet Explanation: INH should also be given with caution to clients with diabetes mellitus, malnutrition, or alcoholism because its effects (antagonism or increased excretion) on pyridoxine (vitamin B6) can cause peripheral neuropathy in these clients. Pyridoxine may be given concurrently with INH to decrease the risk for this adverse effect. Another frequent adverse effect is peripheral neuropathy. This effect may cause paresthesias in the hands and feet. As previously mentioned, malnourished people and those with diabetes and alcoholism have a higher risk for this adverse effect.
A client has been prescribed oral tetracycline. The nurse will instruct the client to take the drug how?
on an empty stomach. Explanation: Oral preparations of tetracycline should be administered on an empty stomach 1 hour before or 2 hours after taking a meal or other drugs to maximize absorption. Tetracycline is not absorbed effectively if taken with food or dairy products. The dosage must be distributed around the clock, and not just at bedtime, to increase effectiveness.
What route of administration is most commonly used for the administration of ciprofloxacin when prescribed to an older adult client?
oral (PO) Explanation: While ciprofloxacin is typically administered by the PO or IV route, in most cases, oral administration is used. The medication is not administered by either the SQ or IM routes.
Tetracycline is often a viable treatment option when a client has an allergy to what antibiotics?
penicillins Explanation: Prescribers order tetracycline when penicillin is contraindicated to treat infections caused by Klebsiella, Neisseria gonorrhoeae, Treponema pallidum, Listeria monocytogenes, Clostridium, Bacillus anthracis, Fusobacterium fusiforme, and Actinomyces.
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 Explanation: Tenderness, pain, and redness along the vein may indicate phlebitis or thrombophlebitis. Extravasation occurs when the fluids leak into the surrounding tissue. Adverse reactions and allergic reactions do not occur at the IV site.
What event triggers the development of a superinfection?
proliferation of antibiotic-resistant microorganisms Explanation: Superinfection is an infection after the occurrence of a previous infection, typically caused by microorganisms that are resistant to the antibiotics used earlier. None of the other options accurately describe this condition as it is associated with antibiotic-resistant microorganisms.
A 19-year-old Mexican American is about to start taking ethambutol (Myambutol). Before beginning drug therapy, it would be critical for the nurse to assess the patient's
visual acuity and establish a baseline. Explanation: One of the main adverse effects of ethambutol is optic neuritis. Patients beginning ethambutol (Myambutol) therapy should have a baseline ophthalmologic examination and be closely monitored for changes in visual acuity and color discrimination. Because of its potential adverse effects on the liver, rifampin is used cautiously in patients with a history of hepatic dysfunction and in patients known to have alcoholism. If a patient is taking INH, the nurse will evaluate the patient's blood glucose level because the drug can cause endocrine changes.
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 glass of water 1 hour before or 2 hours after a meal. Explanation: The nurse should instruct the parents to administer penicillin V exactly as prescribed at regular intervals. Penicillin V should be taken on an empty stomach 1 hour before or 2 hours after a meal with a glass of water. Penicillin V should not be taken with meals because food may affect the absorption of the drug. Penicillin V is easy to administer in the home setting; it does not need to be given IV under the supervision of a home health nurse.
