Ch 18 PrepU Beta-Lactam Antibacterial Agents

The parent of an 8-year-old asks the nurse why it seems amoxicillin is so often prescribed when the child needs an antibiotic. What is the nurse's best response? "Amoxicillin is effective and has a less offensive taste than many antibiotics." "Amoxicillin is better absorbed than many other antibiotics and it's highly effective." "Amoxicillin has the benefit of once-daily dosing, which is easier for both parents and children." "Amoxicillin is an inexpensive antibiotic, so clients are more likely to follow through with treatment."

"Amoxicillin is better absorbed than many other antibiotics and it's highly effective."

A client has been diagnosed with a sinus infection, and the client has been given a prescription for amoxicillin. What teaching point should the nurse make for the client? "Make sure you tell your prescriber if you're feeling particularly tired." "Take your medication every 8 hours, as it's been prescribed." "Avoid taking the medication right before bed so it doesn't cause frequent trips to the bathroom." "This might cause crystals in your urine, so drink plenty of fluids."

"Take your medication every 8 hours, as it's been prescribed."

Your client receives IV vancomycin every 12 hours. You know that this infusion should run over: 3 to 4 hours. 2 to 4 hours. 30 minutes. 1 to 2 hours.

1 to 2 hours *For systemic infections, vancomycin is given IV and reaches therapeutic plasma levels within 1 hour after infusion. It is very important to give IV infusions slowly, over 1 to 2 hours, to avoid an adverse reaction characterized by hypotension, flushing, and skin rash. This reaction, sometimes called "red man syndrome," is attributed to histamine release.*

A client has been started on Augmentin 250 mg P.O. every 12 hr. It is supplied in 500-mg tablets. How much will the nurse give at each dose? 1 tablet 1/2 tablet 2 tablets 3/4 tablet

1/2 tablet

A clinic nurse is caring for a 66-pound child who has acute otitis media. The health care provider has ordered ceftibuten 9mg/kg per day PO for 10 days. The drug comes in an oral suspension of 90 mg/5 mL. Which dose will the nurse administer? 20 mL 10 mL 5 mL 15 mL

15 ml

A client has been prescribed 500 mg of amoxicillin and potassium clavulanate acid (Augmentin) every 12 hours. The available drug is in the form of a 125-mg tablet. To meet the recommended dose, the nurse will administer _______ tablets each time.

4

A health care provider prescribes a client 3.375 g piperacillin sodium and tazobactam (Zosyn) every six hours. After reconstitution, the concentration of the drug is 2.25 g/50 mL. Which quantity of the reconstituted solution should the nurse administer to the client? 60 mL 65 mL 70 mL 75 mL

75ml

Penicillin would NOT be indicated for which of the following clients? A client with gram-negative bacterial infection allergic to sulfa A client with gram-negative bacteria allergic to penicillin A client with a mixture of gram-positive and gram-negative bacteria A client with gram-negative bacteria allergic to tetracycline

A client with gram-negative bacteria allergic to penicillin

When learning about the different classes of cephalosporins, the nurse correctly identifies which of the following statements? Cephalosporins are completely different chemically from penicillin. Cephalosporins are limited in treating many types of bacteria. A first-generation cephalosporin is more useful than a third-generation cephalosporin against gram-positive microorganisms. Cephalosporins are divided into three different groups.

A first-generation cephalosporin is more useful than a third-generation cephalosporin against gram-positive microorganisms.

The nurse administers cefuroxime to a client at least one hour before meals, as prescribed. However, the client experiences a GI upset. Which is an appropriate nursing intervention in this case? Administer an antacid. Lower the dosage. Discontinue the drug. Administer the drug with food.

Administer the drug with food.

Which of the following should be included in the nurse's pre-administration assessment prior to a client receiving a cephalosporin? Select all that apply. Current symptoms Medication history Allergy history Medical history Blood glucose

Allergy history Medical history Medication history Current symptoms

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. Ask the client if there is a history of anaphylaxis. Ask the client if the client wears a MedicAlert bracelet. Ask the health care provider to order a skin test to assess for hypersensitivity to penicillin.

Ask the client if there is a history allergy to a penicillin.

Culture and sensitivity testing of a client's urine sample reveals a bacterium that is susceptible to cephalosporins. What medication would be most likely for the nurse to administer? Cefaclor Imipenem-cilastatin Ciprofloxacin Neomycin

Cefaclor

Which is an example of a first generation cephalosporin? Cefprozil Cefoxitin Cefaclor Cefadroxil

Cefadroxil

Beta-lactam antibiotics, such as penicillins and cephalosporins, fight infection by inhibiting development of the causative bacteria. What specific component development do these drugs affect? DNA replication Cell division Cell wall synthesis Protein synthesis

Cell wall synthesis

Prior to administration of the first dose of ampicillin, the nurse questions the client about her drug history. What condition that developed with a previous dose of this medication would contraindicate the use of it again? Cholestatic jaundice Vaginal yeast infection Diarrhea Nausea

Cholestatic jaundice

A client has been diagnosed with an infected postoperative wound, and cultures reveal methicillin-resistant S. aureus (MRSA). The client is currently receiving cephalosporins IV based on previous in vitro testing that indicated susceptibility. What is the nurse's best response to this new assessment datum? Contact the health care provider to request that lab cultures be repeated. Continue administering cephalosporin. Contact the health care provider to discontinue cephalosporin. Contact the health care provider as medication should be changed to IV ampicillin.

Contact the health care provider to discontinue cephalosporin.

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? Lethargy and paresthesias Diarrhea and nausea Superinfections and phlebitis Headache and dizziness

Diarrhea and nausea

The nurse is providing discharge education to a client who is leaving with a prescription for PO ampicillin. What should the nurse teach the client? Appearance of a rash is common and does not indicate an allergic reaction. Discoloration of the tongue may occur but will subside when the drug is discontinued. Even if it seems like the infection is worsening, the drug is still working. Yeast infections are unlikely to occur with this medication because it is narrow spectrum.

Discoloration of the tongue may occur but will subside when the drug is discontinued.

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? The generations represent the order in which the drugs should be utilized clinically. Each generation of cephalosporins has a different mechanism of action. Each successive generation is more effective against gram-negative microorganisms. The generations of cephalosporins represent formulations that produce fewer side effects.

Each successive generation is more effective against gram-negative microorganisms.

Which of the following is true of fourth-generation cephalosporins? (Select all that apply) Fourth-generation cephalosporins have a shorter duration of resistance to beta-lactamase Fourth-generation cephalosporins have a narrower spectrum of action Fourth-generation cephalosporins have a longer duration of resistance to beta-lactamase Fourth-generation cephalosporins have a broader spectrum of action Fourth-generation cephalosporins have the ability to treat viral infections

Fourth-generation cephalosporins have a longer duration of resistance to beta-lactamase Fourth-generation cephalosporins have a broader spectrum of action

Penicillins are more effective when used on infections caused by what organism? Gram-positive bacteria Gram-negative viruses Gram-negative bacteria Fungi

Gram-positive bacteria

Common adverse reactions to cephalosporins include which of the following? Select all that apply. Drowsiness Headache Constipation Heartburn Vomiting

Headache Heartburn Vomiting

Penicillins and cephalosporins are used cautiously in neonates due to what factor? Immature liver function Immature immune function Immature kidney function Immature pancreatic function

Immature kidney function

The pharmacology instructor is explaining combination drugs to the nursing class. The instructor tells the students that the combination of a beta-lactamase inhibitor and a penicillin produces what effect? It extends the spectrum of antibacterial activity of the penicillin. It reduces the likelihood of anaphylaxis in clients who are hypersensitive to penicillins. It reduces the side effects of high-dose penicillin. It increases the absorption of the penicillin.

It extends the spectrum of antibacterial activity of the penicillin.

The nurse is administering penicillin to a client who has strep throat. Which of the following statements accurately describe the action of penicillin? It is effective against gram-positive organisms It is not effective against gram-negative organisms It has many side effects, especially in large doses It is metabolized in the liver

It is effective against gram-positive organisms

Probenecid is sometimes given concurrently with penicillins. What effect does probenecid have when given with a penicillin? It increases the excretion of penicillin. It maintains high serum levels of penicillin. It breaks down the bacterial cell wall. It prevents anaphylactic reaction.

It maintains high serum levels of penicillin.

Some combination antibacterial drugs consist of a penicillin and a beta-lactamase inhibitor. What is the primary purpose of a beta-lactamase inhibitor in one of these drugs? It is the main antibacterial component. It protects the penicillin. It acts as antiviral agent. It suppresses any allergic reaction.

It protects the penicillin. *By binding with and inactivating the beta-lactamase enzymes produced by many bacteria, the beta-lactamase inhibitor protects the penicillin from destruction by the enzymes and extends the penicillin's spectrum of antimicrobial activity. By themselves, beta-lactamase inhibitors have little antibacterial activity. The combination drugs, however, may be effective in infections caused by bacteria that are resistant to a beta-lactam antibiotic alone.*

A male client is placed on an IV regimen of aztreonam. The nurse would expect the health care provider to order which laboratory test? Liver function Serum albumin CBC Hematocrit

Liver function

An older adult is to receive a low dose of a cephalosporin for an infection. When realizing that this client has age-related diminished renal function, what intervention should the nurse implement? Hold the drug for lab work. Monitor blood creatinine levels. Notify the prescribing provider. Initiate monitoring of intake and output.

Monitor blood creatinine levels. *The older adult is more susceptible to the nephrotoxic effects of the cephalosporins, particularly if renal function is already diminished because of the aging process or a disease. With renal impairment, a lower dose can be given and monitoring creatinine levels is indicated.*

Which would be considered a penicillinase-resistant antibiotic? Carbenicillin Amoxicillin Ticarcillin Nafcillin

Nafcillin

A 40-year-old is being treated for an ear infection with a cephalosporin. Which adverse reactions should the nurse monitor for in the client? Nausea Chest pain Excessive tearing Hypotension

Nausea

A young adult has been receiving Keflex P.O. for the last 5 days to treat a respiratory infection. The nurse is concerned when the client reports urinating only once in the last 16 hours. What should the nurse consider as the cause? Steven-Johnson syndrome Nephrotoxicity Superinfection Systemic dehydration

Nephrotoxicity

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? Nausea Nephrotoxicity Increased bleeding Respiratory difficulty

Nephrotoxicity

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? Perform renal and hepatic function tests. Obtain patient's general health history. Inspect patient's stools. Evaluate the patient's lifestyle and diet.

Obtain patient's general health history.

An instructor is describing an antibiotic that is resistant to the enzyme penicillinase. What would the nurse identify as an example? Oxacillin Penicillin V Amoxicillin Ticarcillin

Oxacillin

The nurse is caring for a client diagnosed with syphilis. The client has no known drug allergies. Which medication can the nurse expect to be ordered for this client? Sulfonamide ACE inhibitor Penicillin Calcium-channel blocker

Penicillin

The nurse is observing a graduate nurse administering medications. The other nurse would intervene if the graduate nurse attempted to give what medication intravenously? Ampicillin Oxacillin Penicillin G benzathine Ampicillin-sulbactam

Penicillin G benzathine

Cephalosporins are structurally and chemically related to which classes of antibiotics?

Penicillins

Which classifications of antibacterials are considered beta-lactam antibiotics? (Select all that apply.) Penicillins Cephalosporins Monobactams Sulfonamides Fluoroquinolones

Penicillins Cephalosporins Monobactams

During ongoing assessment of a client receiving amoxicillin (Amoxil), the nurse should monitor the client for which of the following? Select all that apply. Relief of symptoms Development of a rash Increase in appetite Change in appearance or amount of drainage Decrease in temperature

Relief of symptoms Increase in appetite Change in appearance or amount of drainage Decrease in temperature

A client is receiving a cephalosporin and an aminoglycoside as combination therapy. What assessment should the nurse prioritize? Serum BUN and creatinine levels Coagulation studies Signs of disulfiram-like reaction Complete blood count

Serum BUN and creatinine levels *The nurse would need to assess renal function indicated by serum BUN and creatinine levels because combining cephalosporins with aminoglycosides increases the client's risk for renal toxicity*

A nurse is required to administer a parenteral form of penicillin to a patient. Which of the following interventions should a nurse perform when preparing penicillin in parenteral form? Extract penicillin from vial and then reconstitute. Shake the vial well to distribute the drug evenly. Save excess antibiotic after reconstitution for later use. Use any available diluent for reconstitution.

Shake the vial well to distribute the drug evenly.

A 34-year-old female client is taking oral cephradine, a first-generation cephalosporin, at regular intervals with a 2-hour gap before meals. The client reports gastrointestinal distress. The nurse will encourage the client to do which? Drink plenty of fluids. Change the drug dosage. Take the drug with food. Avoid dairy products

Take the drug with food.

A client is taking penicillin for an upper respiratory infection. The client calls the office after 2 days of therapy reporting nausea and abdominal pain. Which would be the best instruction for the nurse to give the client? These are normal side effects, but if they increase in severity or frequency, you need to contact the office again. Stop the medication and the health care provider will order you a different antibiotic. Stop the medication immediately and go to the emergency room; these could be signs of a life-threatening reaction. Continue to take the medication as prescribed; these are expected side effects from the medication.

These are normal side effects, but if they increase in severity or frequency, you need to contact the office again.

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? Hemolysis Urinary tract infections Nausea and diarrhea Jaundice

Urinary tract infections

The nurse is caring for a 23-year-old female client who uses oral contraceptives and has been prescribed ampicillin for treatment of a respiratory infection. What information is most important for the nurse to share with this client? Use a type of barrier birth control while you are taking this antibiotic. Do not take your oral contraceptives while you are taking this medication. Your menstrual cycle will have a heavier flow while on this medication. Taking this antibiotic with your oral contraceptives will cause an increased chance of bleeding.

Use a type of barrier birth control while you are taking this antibiotic.

The nurse is administering cefazolin to a client. What adverse reactions should the nurse recognize as being the most problematic for this client? (Select all that apply.) Diarrhea Vomiting Vaginal yeast infection Gastritis Facial edema

Vaginal yeast infection Facial edema *The most important adverse effects for the nurse to observe for in a client receiving cefazolin or any other cephalosporin are superinfections and hypersensitivity reactions demonstrated by the yeast infection and the facial edema.*

The medical chart of a newly admitted client notes a penicillin allergy, yet the physician has just written an order for an antibiotic in the same drug family after reviewing the client's wound culture and sensitivity. How should the nurse respond to this situation? Withhold the medication until the potential drug allergy has been addressed by the care team. Administer the medication and increase the frequency of assessments in the hours that follow. Substitute an antibiotic with similar action, but one that is from a different drug family. Discuss the severity, signs, and symptoms of the drug allergy with the client in order to ascertain the risks of administration.

Withhold the medication until the potential drug allergy has been addressed by the care team.

In the rare instance in which penicillin is considered essential, hypersensitivity can be assessed by administering: the medication by the intravenous route only. a loading dose of the medication. a skin test. the medication in a controlled environment.

a skin test.

A client being treated with an oral penicillin should be encouraged to administer the medication on which schedule to best achieve a therapeutic effect? Select all that apply. at regular intervals at bedtime around the clock upon rising in the am with meals

at regular intervals around the clock

After teaching a group of nursing students about the indications for use of antibacterial drugs that disrupt the bacterial cell wall, the instructor determines that the teaching was successful when the group identifies which medication as commonly prescribed to a victim after a sexual assault for infection prophylaxis? cephalosporin aminopenicillin carbapenem penicillin/beta-lactamase inhibitor combination

cephalosporin

A client is scheduled for a bowel resection. During the perioperative period, which type of medication should the nurse anticipate the client will be given? penicillins sulfonamides cephalosporins antivirals

cephalosporins

The client is receiving keflex 1000 mg/day. The nurse properly identifies this drug as a: third-generation cephalosporin. fourth-generation cephalosporin. first-generation cephalosporin. second-generation cephalosporin.

first-generation cephalosporin.

The nurse is justified in suspecting that a client who recently completed a course of ceftaroline may have been treated for what health problem? methicillin-resistant Staphylococcus aureus (MRSA) infection chlamydial infection encephalitis endocarditis

methicillin-resistant Staphylococcus aureus (MRSA) infection

The nursing instructor is teaching the students about different gastrointestinal adverse reactions to penicillin. What other reactions may occur with this medications administration? (Select all that apply.) pain at the injection site phlebitis depression irritation at the vein hyperglycemia

pain at the injection site irritation at the vein phlebitis

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 oral topical transdermal

parenteral

What event triggers the development of a superinfection? proliferation of antibiotic-resistant microorganisms bone marrow suppression triggered by antibiotic treatment complete establishment of the infection prior to initiation of antibiotic therapy unforeseen interactions between the antibiotic and other prescribed medications

proliferation of antibiotic-resistant microorganisms

The nurse is reviewing the medication history of a client who is prescribed penicillin therapy. Use of which medication would alert the nurse to the possibility of the client's increased risk for an anaphylactic reaction? verapamil propranolol losartan benazepril

propranolol *The concomitant use of penicillins with beta-adrenergic blocking drugs, such as propranolol, may increase the risk for an anaphylactic reaction*

A nurse is assessing a client who is receiving vancomycin intravenously. While the drug is being administered, the client reports a throbbing sensation in the neck and back and paresthesias. The client's blood pressure has dropped and the neck and back are erythematous. The nurse suspects which adverse finding? pseudomembranous colitis red man syndrome Stevens-Johnson syndrome (SJS) toxic epidermal necrosis

red man syndrome

The nurse is caring for a client who has been prescribed imipenem-cilastatin. For which condition is this usually prescribed? septicemia acne vulgaris sinusitis otitis media

septicemia

The client is admitted to the acute care facility with acute septicemia and has orders to receive gentamicin and ampicillin IV. The nurse is performing an admission assessment that includes a complete nursing history. What information provided by the client would indicate the need to consult the healthcare provider before administering the ordered medication? history of hypothyroidism allergy to peanuts and peanut products takes high-dose furosemide daily had prostate surgery 3 months ago

takes high-dose furosemide daily

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. immediately before or with a meal. intravenously with the assistance of a home health nurse. with a sip of water 1 hour before mealtime.

with a glass of water 1 hour before or 2 hours after a meal.

A 13-year-old male patient has been prescribed oral cefuroxime. The patient's parents should ensure that he takes the medication on an empty stomach. with food. immediately upon awakening. between meals.

with food