8 Antibacterial Drugs That Interfere With Protein Synthesis

A patient is prescribed demeclocycline. The nurse would teach the patient to be alert for signs of which of the following? A) Photosensitivity B) Abdominal pain C) Cramping D) Blood dyscrasias

Ans: A Feedback: Demeclocycline causes photosensitivity reactions. Abdominal pain and cramping are adverse reactions of macrolides. Blood dyscrasias are an adverse reaction of lincosamides.

A client who is receiving statin therapy as treatment for elevated lipid levels is also prescribed daptomycin. The nurse would assess which of the following laboratory test results for changes? A) Creatine phosphokinase levels B) Blood glucose levels C) White blood cell count D) International normalized ratio

Ans: A Feedback: Myopathy with elevated creatine phosphokinase (CPK) levels may occur if daptomycin is administered with statin drugs (cholesterol reduction). Therefore, the nurse would assess CPK levels. The combination of statin therapy and daptomycin has no effect on blood glucose levels, white blood count, or international normalized ratio (INR).

A patient has been prescribed oral tetracycline for the treatment of acne. Which of the following must the nurse include in the patient teaching plan? A) Take the drug on an empty stomach. B) Take the drug along with a meal. C) Take the drug along with milk or fruit juice. D) Take the drug immediately after meals.

Ans: A Feedback: Oral preparations of tetracycline should be administered on an empty stomach with a full glass of water to maximize absorption. Tetracycline is not absorbed effectively if taken with food, with dairy products, or immediately after meals.

A patient is receiving linezolid. The patient is fond of eating chocolates and coffee, both of which contain tyramine. The nurse would instruct the patient that he is at risk for which of the following should he consume foods containing tyramine while taking linezolid? A) Severe hypertension B) Drowsiness C) Nervousness D) Nausea

Ans: A Feedback: The nurse should inform the patient that if tyramine found in chocolates and coffee interacts with linezolid, the patient will develop an increased risk for severe hypertension. Tyramine-containing foods interacting with linezolid do not cause drowsiness, nervousness, or nausea.

A patient is ordered to receive neomycin as part of the treatment plan for hepatic coma. Which of the following would be most important for the nurse to assess before administering this drug? Select all that apply. A) Ability to swallow B) Level of consciousness C) Baseline vital signs D) Pulmonary function E) Culture and sensitivity results

Ans: A, B Feedback: During the early stages of hepatic coma, various changes in the level of consciousness may be seen. At times, the patient may appear lethargic and respond poorly to commands. Because of these changes in the level of consciousness, the patient may have difficulty swallowing, and a danger of aspiration is present. If the patient appears to have difficulty taking an oral drug, the nurse should withhold the drug and contact the primary health care provider. Baseline vital signs are important but are not the priority when the patient has hepatic coma. The drug does not affect the patient's respiratory function. There is no infection; therefore, there is no need for culture and sensitivity testing.

A nurse is reviewing the medical records of several patients who are to receive antibacterial drug therapy. The nurse understands that aminoglycosides would be contraindicated in clients with which of the following conditions? Select all that apply. A) Pre-existing hearing loss B) Pregnancy C) Parkinsonism D) Diabetes E) Hyperlipidemia

Ans: A, B, C Feedback: The aminoglycosides are contraindicated in clients with pre-existing hearing loss, myasthenia gravis, and parkinsonism and during lactation and pregnancy.

A patient is to receive tetracycline therapy at home. After teaching the patient about foods to avoid when taking the drug, the nurse determines that the teaching was successful when the patient states he will avoid which of the following? Select all that apply. A) Yogurt B) Cheese C) Calcium-fortified cereals D) Citrus fruits E) Green leafy vegetables

Ans: A, B, C Feedback: The patient should avoid dairy products including yogurt, cheese, milk, cream, ice cream, ice milk, or frozen custard before or after taking tetracycline. Citrus fruits and green leafy vegetables should not be avoided.

A client is receiving gentamicin. Assessment of which of the following would lead the nurse to suspect that the client is developing nephrotoxicity? Select all that apply. A) Proteinuria B) Hematuria C) Decreased urine output D) Increased serum creatinine E) Decreased fluid intake

Ans: A, B, C, D Feedback: Proteinuria, hematuria, decreased urine output, increased serum creatinine, and increased blood nitrogen urea (BUN) are suggestive of nephrotoxicity. Decreased fluid intake would support dehydration.

1. After teaching a group of students about tetracyclines, the instructor determines that the teaching was successful when the students identify which of the following as a true statement? Select all that apply. A) Tetracyclines are broad-spectrum antibiotics. B) Tetracyclines may cause permanent discoloration of the teeth in children. C) Tetracyclines can be used when penicillins are contraindicated. D) Tetracyclines are contraindicated in children younger than 6 years. E) Tetracyclines are used to treat Rocky Mountain spotted fever.

Ans: A, B, C, E Feedback: Tetracyclines are broad-spectrum antibiotics used to treat rickettsial disease, such as Rocky Mountain spotted fever, and when the use of penicillins is contraindicated. Tetracyclines are not given to children younger than 9 years of age unless absolutely necessary because these drugs may cause permanent yellow-gray-brown discoloration of the teeth.

The nurse is completing an ongoing assessment of a client receiving erythromycin. The nurse would notify the primary health care provider immediately if assessment reveals which of the following? Select all that apply. A) Significant drop in blood pressure B) Increase in heart rate C) Decrease in temperature D) Increase in respiratory rate E) Sudden increase in temperature

Ans: A, B, D, E Feedback: During ongoing assessment of a client receiving erythromycin, the nurse should notify the primary health care provider immediately if the client has a significant drop in blood pressure, increase in heart rate, increase in respiratory rate, or sudden increase in temperature.

A nurse is preparing to administer lincomycin via IM injection. Which of the following would be most appropriate for the nurse to do? Select all that apply. A) Inspect previous injection sites. B) Rotate the injection site. C) Use the abdomen for intramuscular injections. D) Note the site used for injection in the client's chart. E) Notify the physician of any persistent localized reactions.

Ans: A, B, D, E Feedback: When giving lincomycin intramuscularly, the nurse inspects previous injection sites for signs of pain or tenderness, redness, and swelling; reports the persistence of a localized reaction to the physician; rotates the injection sites; and records the site used for injection in the client's chart.

A nurse suspects that a patient receiving an aminoglycoside is developing neurotoxicity based on assessment of which of the following? Select all that apply. A) Paresthesias B) Tingling around the mouth C) Ringing in the ears D) Vertigo E) Muscle twitching

Ans: A, B, E Feedback: Signs and symptoms of neurotoxicity include numbness, skin tingling, circumoral (around the mouth) paresthesia, peripheral paresthesia, tremors, muscle twitching, convulsions, muscle weakness, and neuromuscular blockade (acute muscular paralysis and apnea). Ringing in the ears and vertigo would suggest ototoxicity.

A patient is being discharged with a prescription for linezolid. After teaching the patient about this drug, the nurse determines that additional teaching is needed when the patient identifies that he can consume which of the following without any risks? Select all that apply. A) Alcohol B) Prunes C) Aged cheese D) Pepperoni E) Broccoli

Ans: A, C, D Feedback: When linezolid is taken with foods containing tyramine, such as aged cheese and meats, yogurt, chocolate, caffeinated beverages, and alcohol, the risk for severe hypertension increases. Prunes and broccoli pose no risk to the patient.

A nursing instructor is preparing a class on various antibacterial drugs interfering with protein synthesis, with the discussion focusing on quinupristin/dalfopristin. Which of the following medications would the instructor include as interacting with quinupristin/dalfopristin, thus increasing the risk for toxicity? Select all that apply. A) Lorazepam (Ativan) B) Quinapril (Accupril) C) Ritonavir (Norvir) D) Atorvastatin (Lipitor) E) Tacrolimus (Prograf)

Ans: A, C, D Feedback: When quinupristin/dalfopristin is prescribed, it may interact with the following drugs, increasing serum levels and thus the risk for toxicity: antiretrovirals, antineoplastic and immunosuppressant agents, calcium channel blockers, benzodiazepines, and cisapride.

A nursing instructor is preparing a teaching plan for a group of nursing students about macrolide antibacterial drugs. Which of the following would the instructor expect to include? Select all that apply. A) Macrolides are broad-spectrum antibiotics. B) Macrolides are contraindicated in clients with renal dysfunction. C) Macrolides may cause visual disturbances. D) Macrolides can be used in clients allergic to penicillins. E) Macrolides can be used to treat acne vulgaris.

Ans: A, C, D, E Feedback: Macrolides are broad-spectrum antibiotics that can be used in clients with penicillin allergies and can be used to treat acne vulgaris. Macrolides can cause visual disturbances and are contraindicated in clients with pre-existing liver disease.

A nurse is preparing to administer an aminoglycoside to a client. The nurse would be alert for the development of which of the following toxicities? Select all that apply. A) Nephrotoxicity B) Cardiotoxicity C) Ototoxicity D) Hepatotoxicity E) Neurotoxicity

Ans: A, C, E Feedback: More serious adverse reactions of aminoglycosides include nephrotoxicity, ototoxicity, and neurotoxicity. A nurse recognizing these can greatly reduce permanent damage to the client's hearing, kidneys, and nerves. Aminoglycosides are not associated with cardiotoxicity or hepatotoxicity.

A nurse is reviewing the medical record of a client who is prescribed tetracycline. The nurse would be alert for an increased risk of toxicity if the client is taking which of the following? Select all that apply. A) Digoxin (Lanoxin) B) Phenytoin (Dilantin) C) Vancomycin (Vancocin) D) Warfarin (Coumadin) E) Carbamazepine (Tegretol)

Ans: A, D Feedback: Tetracyclines may increase the risk of toxicity in clients who take digoxin for heart disease and increase the risk of bleeding in clients who take warfarin.

A group of nursing students are reviewing information about aminoglycosides. The students demonstrate understanding when they identify which of the following as an example? Select all that apply. A) Amikacin (Amikin) B) Amoxicillin (Amoxil) C) Vancomycin (Vancocin) D) Kanamycin (Kantrex) E) Azithromycin (Zithromax)

Ans: A, D Feedback: The aminoglycosides include amikacin, gentamicin, kanamycin, neomycin, streptomycin, and tobramycin. Amoxicillin is an aminopenicillin. Vancomycin is a miscellaneous agent that disrupts the bacterial cell wall. Azithromycin is classified as a macrolide.

The nurse is teaching a client about possible adverse reactions that can occur with tetracyclines. The nurse determines that the teaching was successful when the client identifies which of the following? Select all that apply. A) Photosensitivity B) Hypoglycemia C) Hypotension D) Diarrhea E) Stomatitis

Ans: A, D, E Feedback: The nurse should advise the client that nausea, vomiting, diarrhea, epigastric distress, stomatitis, sore throat, skin rashes, and photosensitivity are adverse reactions that may occur with the administration of tetracyclines.

A patient is receiving telithromycin. Based on the nurse's understanding of potential adverse reactions, the nurse would identify which nursing diagnosis as a priority? A) Ineffective Renal Tissue Perfusion B) Risk for Injury C) Diarrhea D) Risk for Impaired Skin Integrity

Ans: B Feedback: Telithromycin can cause visual disturbances such as difficulty focusing and accommodating to light. Therefore, the priority nursing diagnosis would be Risk for Injury related to these visual disturbances. Aminoglycosides can cause nephrotoxicity, leading to a nursing diagnosis of Ineffective Renal Perfusion. Although diarrhea and skin rashes can occur, these would not be a priority at this time.

A group of nursing students are reviewing information about clindamycin (Cleocin). The students demonstrate understanding of this drug when they identify that it should be used with caution in clients with which of the following? Select all that apply. A) Seizure disorder B) GI disorders C) Myasthenia gravis D) Diabetes E) Hepatic impairment

Ans: B, C, E Feedback: Clindamycin, a lincosamide, should be used cautiously in clients with a history of GI disorders, renal disease, liver impairment, or myasthenia gravis.

A nurse is reading a journal article about spectinomycin. Which of the following would the nurse expect to find as being discussed about this drug? Select all that apply. A) Spectinomycin is used to treat chlamydia infections. B) Spectinomycin is used to treat gonorrhea infections. C) Spectinomycin is chemically unrelated to aminoglycosides. D) Spectinomycin can be used in clients with penicillin allergy. E) Spectinomycin has no known significant food or drug interactions.

Ans: B, D, E Feedback: Spectinomycin is used to treat gonorrhea infections in clients who are allergic to penicillins, cephalosporins, or probenecid (Benemid). Spectinomycin is chemically related to but different from aminoglycosides. No significant drug or food interactions for spectinomycin are known.

A client is receiving iron therapy for anemia. The prescriber has ordered tetracycline as treatment for the client's infection. Which of the following would be most appropriate for the nurse to do? A) Give the drugs at the same time. B) Give the iron first, then follow with the tetracycline in 30 minutes. C) Separate administration times by 2 hours. D) Withhold the iron until the tetracycline therapy is completed.

Ans: C Feedback: Iron therapy can interfere with the absorption of tetracycline. Therefore, the nurse should give the iron 2 hours before or after administering tetracycline. The two drugs should not be given at the same time. Withholding the iron would be inappropriate.

A patient is scheduled for abdominal surgery and is ordered to receive kanamycin as part of the bowel preparation. The patient asks the nurse why he is getting this drug. Which response by the nurse would be most appropriate? A) You have an infection now and will probably have one after surgery, so this will help control it. B) We need to lower the levels of ammonia in your bloodstream to prevent problems. C) The drug helps eliminate bacteria so that your GI tract is as clean as possible for surgery. D) This is to help prevent you from developing any blood clots during and after the surgery.

Ans: C Feedback: Kanamycin and neomycin are used before surgery to reduce intestinal bacteria. It is thought that this reduces the possibility of abdominal infection that may occur after surgery on the bowel. By destroying bacteria in the gut and washing it out with laxatives or enemas, the surgical area becomes as clean as possible before the operation. The drug is not used to control an infection preoperatively. It does help to reduce blood ammonia levels with hepatic coma, but this is not the reason for its use with this patient. The drug has no effect on preventing blood clots postoperatively.

After reviewing information about lincosamide therapy, a group of nursing students demonstrate understanding of the information when they identify which of the following as a contraindication? A) Children younger than 9 years B) Patients with pre-existing liver disease C) Patients taking cisapride D) Patients with myasthenia gravis

Ans: C Feedback: Lincosamide is contraindicated in patients taking cisapride. Tetracyclines are contraindicated in children younger than 9 years of age and pregnant women. Macrolides are contraindicated in patients with pre-existing liver disease and patients with myasthenia gravis.

A client is receiving quinupristin/dalfopristin via a peripheral intravenous infusion. After the drug is administered, the nurse would flush the intravenous line with which of the following? A) Normal saline B) 0.45% sodium chloride C) Dextrose 5% and water D) Heparin

Ans: C Feedback: Quinupristin/dalfopristin is irritating to the vein. After peripheral infusion, the vein should be flushed with 5% dextrose in water (D5W), because the drug is incompatible with saline or heparin flush solutions.

A patient has been prescribed a tetracycline drug for Rocky Mountain spotted fever. The patient also takes antacids. Which of the following effects is likely to occur due to an interaction between the two drugs? A) Increased risk of bleeding B) Increased action of neuromuscular blocking drugs C) Increased profound respiratory depression D) Decreased absorption of tetracycline

Ans: D Feedback: Interaction of antacids with a tetracycline drug causes decreased absorption of tetracycline. Increased action of neuromuscular blocking drugs and increased profound respiratory depression are the result of interaction between neuromuscular blocking drugs and tetracyclines. Increased risk of bleeding is a result of interaction between anticoagulants and tetracyclines.

After teaching a group of nursing students about indications for linezolid (Zyvox), the instructor determines a need for additional teaching when the students identify which of the following as an indication? A) Community-acquired pneumonia (CAP) B) Vancomycin-resistant Enterococcus faecium (VREF) C) Methicillin-resistant Staphylococcus aureus (MRSA) D) Acute otitis media

Ans: D Feedback: Linezolid is used in the treatment of vancomycin-resistant Enterococcus faecium (VREF), health care- and community-acquired pneumonias, and skin and skin structure infections, including those caused by methicillin-resistant Staphylococcus aureus (MRSA). It is not used to treat otitis media.

A client has been receiving an aminoglycoside for several weeks and comes to the clinic complaining of ringing in his ears and some dizziness. The nurse suspects ototoxicity. When developing this client's plan of care, which nursing diagnosis would be the priority? A) Impaired Comfort B) Altered Thought Process C) Diarrhea D) Risk for Injury

Ans: D Feedback: The development of ototoxicity would lead the nurse to identify a nursing diagnosis of Risk for Injury related to the effects of ototoxicity. Although the client's ringing in the ears could cause discomfort, the priority nursing diagnosis would be Risk for Injury. There is no evidence of impaired comfort, altered thought process or diarrhea.

A middle-aged patient has been prescribed tetracycline as part of his treatment of H. pylori. The patient has a history of heart disease for which he is receiving digoxin. Given his history and current medications, the patient is at risk for which of the following conditions? A) Respiratory depression B) Decreased effectiveness of tetracycline C) Prolonged clotting times D) Risk of digoxin toxicity

Ans: D Feedback: When digoxin interacts with tetracyclines, the patient is at risk for digoxin toxicity. Respiratory depression is an effect observed when neuromuscular blocking drugs interact with lincosamides. A decrease in the effectiveness of tetracycline is seen when the drug is taken with antacids, dairy products, or iron. An increased risk for bleeding with prolonged clotting times is noted when tetracycline is given with anticoagulants.