Ch 7 Antibacterial Drugs that Disrupt the Bacterial Cell Wall

The nurse is obtaining a medication history of a 48-year-old patient with an ear infection who is to receive penicillin therapy. The patient reports taking a beta-adrenergic blocker for his hypertension. The nurse would identify that this patient is at increased risk for which of the following if penicillin is administered? A) Anaphylactic shock B) Higher blood pressure C) Excess bleeding D) Heart attack

A Feedback: Combining penicillins with beta-adrenergic blocking drugs increases the risk of anaphylactic shock. Beta-adrenergic blocking drugs are used to control blood pressure and heart problems, but combining them with penicillins does not increase the risk of high blood pressure or heart attack. Risk of bleeding is maximized if penicillins are combined with anticoagulants.

After taking penicillin as prescribed, a patient shows signs of diarrhea and informs the nurse that there is blood in his stools. Which of the following interventions should the nurse do next? A) Contact primary health provider immediately. B) Have the patient consume yogurt with his next meal. C) Decrease fiber content in diet. D) Continue with prescribed regimen.

A Feedback: If diarrhea is suspected, the nurse should notify the primary health care provider immediately. The nurse should wait for the primary health care provider's instructions before continuing with the prescribed regimen. Yogurt or buttermilk may help prevent fungal superinfections, but they will not help alleviate the patient's condition at this stage. Changes in the diet are not recommended unless instructed by the primary health care provider.

A nurse needs to administer a cephalosporin to a patient. The patient informs the nurse that he is allergic to penicillin. Which action by the nurse would be most appropriate? A) Inform the primary health care provider. B) Obtain the patient's occupational history. C) Administer an antipyretic drug. D) Obtain specimens for kidney function tests.

A Feedback: Patients with a history of an allergy to penicillin may also be allergic to cephalosporin, so the nurse needs to inform the primary health care provider before the first dose of the drug is given. An antipyretic drug is administered when there is an increase in the body temperature of a patient receiving cephalosporin. Liver and kidney function tests may be ordered by the primary health care provider, not the nurse. Occupational history should be obtained before administration of any drug, irrespective of the patient's allergies.

A nurse suspects that a client receiving oral penicillin therapy is developing pseudomembranous colitis based on assessment of which of the following? A) Bloody diarrhea B) Pruritus C) Chills D) Hives

A Feedback: Pseudomembranous colitis is a severe, life-threatening form of diarrhea that occurs when normal flora of the bowel is eliminated and replaced with C. difficile (C. diff) bacteria. It is manifested by bloody diarrhea. Pruritus and hives would suggest an allergic reaction. Chills could indicate a wide range of problems.

A nurse is caring for a patient who is receiving penicillin. The nurse would assess for which of the following as a common adverse reaction? A) Inflammation of the tongue and mouth B) Impaired oral mucous membranes C) Severe hypotension D) Sudden loss of consciousness

A Feedback: 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 the adverse effects are 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 would suggest a possible fungal superinfection in the oral cavity, whereas severe hypotension and sudden loss of consciousness are signs of anaphylactic shock; these are not common adverse effects of penicillin and require immediate medical attention.

A patient who has been on penicillin therapy for several days has developed inflamed oral mucous membranes and swelling in the tongue and the gums. The primary health care provider has diagnosed it as a fungal superinfection of the oral cavity resulting in impaired oral mucous membranes. Which of the following interventions should the nurse perform? A) Inspect mouth and gums regularly. B) Instruct patient to avoid brushing teeth. C) Offer patient a liquid diet. D) Instruct the patient to gargle every 2 hours.

A Feedback: The nurse should regularly inspect the patient's mouth and gums to assess the patient's progress. The nurse should instruct the patient to use a soft-bristled toothbrush. The patient need not follow a liquid diet; a nonirritating soft diet can be recommended. Gargling every 2 hours may not help relieve the symptoms and may even aggravate the existing condition.

Which of the following should be included in the nurse's preadministration assessment prior to administering a penicillin to a client? Select all that apply. A) Allergy history B) Medical history C) Medication history D) Blood glucose levels E) Current symptoms

A, B, C, E Feedback: An allergy history, medical and surgical history, medication history, and the current symptoms of the infection should be included in the nurse's preadministration assessment prior to a client receiving a penicillin.

A client is prescribed penicillin therapy to treat an infection. Which of the following would the nurse include in the teaching plan for the client to reduce her risk of fungal superinfections? Select all that apply. A) "Yogurt can sometimes help." B) "Try drinking some buttermilk." C) "You could take Acidophilus capsules." D) "Rinse your mouth daily with an alcohol-based mouthwash." E) "Use a soft-bristle toothbrush when brushing."

A, B, C, E Feedback: The nurse can recommend that, if the diet permits, yogurt, buttermilk, or Acidophilus capsules may be taken to reduce the risk of fungal superinfection. Also, brushing with a soft-bristle toothbrush and frequent mouth care with a nonirritating solution can be helpful.

A nurse is monitoring a client who is receiving penicillin. The nurse would assess the client for which of the following common GI tract adverse reactions? Select all that apply. A) Glossitis B) Stomatitis C) Esophagitis D) Diarrhea E) Gastritis

A, B, D, E Feedback: 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.

A nurse suspects that a client who is receiving a cephalosporin and has ingested alcohol may be experiencing a disulfiram-like reaction based on assessment of which of the following? Select all that apply. A) Flushing B) Respiratory difficulty C) Hypertension D) Vomiting E) Sweating

A, B, D, E Feedback: Flushing, throbbing in the head and neck, respiratory difficulty, vomiting, sweating, chest pain, and hypotension are symptoms a nurse might observe in a client having a disulfiram-like reaction with administration of a cephalosporin and alcohol.

A client develops a mild skin irritation while receiving penicillin therapy. Which of the following would the nurse advise the client to avoid? Select all that apply. A) Harsh soaps B) Perfumed lotions C) Antipyretic creams D) Rubbing the irritating area E) Wearing rough or irritating clothing

A, B, D, E Feedback: When skin irritation is present during the administration of penicillin, the nurse should advise the client to avoid harsh soaps, perfumed lotions, rubbing the irritated area, or wearing rough or irritating clothing.

A group of nursing students are reviewing information about administering penicillins. The students demonstrate an understanding of the information when they identify which drugs as being given without regard to meals? Select all that apply. A) Amoxicillin (Amoxil) B) Ampicillin (Principen) C) Penicillin V (Veetids) D) Amoxicillin/clavulanate (Augmentin) E) Carbenicillin indanyl (Geocillin)

A, C Feedback: Amoxicillin and penicillin V can be administered without regard to meals, unlike the rest of the penicillins, such as ampicillin, amoxicillin/clavulanate, or carbenicillin indanyl, which should be given on an empty stomach.

A group of nursing students are reviewing the different groups of penicillins. The students demonstrate understanding when they identify which of the following as an example of a penicillinase-resistant penicillin? Select all that apply. A) Dicloxacillin B) Penicillin G C) Nafcillin D) Oxacillin E) Ampicillin

A, C, D Feedback: Dicloxacillin, nafcillin, and oxacillin are examples of penicillinase-resistant penicillins. Penicillin G is an example of a natural penicillin. Ampicillin is an example of an aminopenicillin.

A nurse is preparing to administer penicillin therapy. The nurse would expect to administer penicillins cautiously to clients with which of the following? Select all that apply. A) History of allergies B) Diabetes C) Asthma D) Bleeding disorders E) Hypertension

A, C, D Feedback: Penicillins should be used cautiously in clients with renal disease, asthma, bleeding disorders, GI disease, pregnancy or lactation, and a history of allergies.

A nurse is preparing to administer a prescribed cephalosporin by injection. Which of the following would be most important for the nurse to keep in mind? Select all that apply. A) Thrombophlebitis can occur when cephalosporins are given IV. B) Phlebitis can occur when cephalosporins are given IM. C) Pain can occur when cephalosporins are given IM. D) Tenderness can occur when cephalosporins are given IM. E) Swelling can occur when cephalosporins are given IM.

A, C, D, E Feedback: Administration route reactions include pain, tenderness, and inflammation at the injection site when cephalosporins are given IM, and phlebitis and thrombophlebitis along the vein may occur when cephalosporins are given IV.

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

A, C, D, E Feedback: An ongoing assessment is important in evaluating the client's response to therapy, such as a decrease in temperature, relief of symptoms caused by the infection, an increase in appetite, and a change in the appearance and amount of drainage.

A nursing instructor is preparing a class about cephalosporins for a group of nursing students. When describing progression from first-generation to fourth-generation cephalosporins, which of the following would the instructor include as the result? Select all that apply. A) An increase in the sensitivity of gram-negative microorganisms B) A decrease in the sensitivity of gram-negative microorganisms C) An increase in the sensitivity of gram-positive microorganisms D) A decrease in the sensitivity of gram-positive microorganisms E) An increase in the sensitivity of viral microorganisms

A, D Feedback: In general, progression from first-generation to fourth-generation cephalosporins shows an increase in the sensitivity of gram-negative microorganisms and a decrease in the sensitivity of gram-positive microorganisms.

A 26-year-old female patient with a skin infection has been prescribed 400 mg ampicillin to be taken orally. Which of the following instructions should the nurse include in the patient teaching plan? A) If a dosage is missed, increase the next dosage to meet the daily quota. B) Ampicillin will reduce the effectiveness of birth control pills. C) Take drug on an empty stomach, an hour before or 2 hours after meals. D) Avoid use of skin care products, like moisturizers, when on penicillin therapy.

B Feedback: Ampicillin (also penicillin V) reduces the effectiveness of birth control pills. Increasing a dosage to compensate for a missed dosage should not be done. The patient should adhere to the prescribed regimen as strictly as possible. Ampicillin and penicillin V may be taken without regard to meals. The patient need not avoid use of skin care products when on penicillin therapy.

A 75-year-old patient with a history of renal impairment is admitted to the primary health care center with a UTI and has been prescribed a cephalosporin. Which of the following interventions is most important for the nurse to perform when caring for this patient? A) Monitoring fluid intake B) Monitoring blood creatinine levels C) Testing for occult blood D) Testing for increased glucose levels

B Feedback: An elderly patient is more susceptible to the nephrotoxic effects of the cephalosporins. Since renal impairment is present, it is important for the nurse to closely monitor the patient's blood creatinine levels. The nurse should conduct a test for occult blood if blood and mucus occur in the stool and monitor the fluid intake if there is a decrease in urine output. The nurse does not need to monitor for increased glucose levels unless the patient has a history of diabetes.

A nurse is conducting an in-service training program for a group of nurses about antibacterial drugs such as penicillins and cephalosporins. During the question-and-answer period, the audience asks for examples of conditions that can be treated by cephalosporins. Which of the following would the nurse include in the response? A) Hemolysis B) Urinary tract infections C) Nausea and diarrhea D) Jaundice

B Feedback: Cephalosporins are used to treat respiratory infections, otitis media, urinary tract infections, and bone and joint infections, and prophylactically to treat infections that may result from a sexual assault. 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 cephalosporin therapy.

While the nurse is obtaining a drug history from a patient, the patient tells the nurse that he is allergic to penicillins and has also experienced a rash when he took a cephalosporin. The nurse interprets this information as indicating which of the following? A) Hypersensitivity B) Cross-sensitivity C) Anaphylactoid reaction D) Anaphylaxis

B Feedback: Once an individual is allergic to one penicillin, he or she is usually allergic to all of the penicillins. Those allergic to penicillin also have a higher incidence of allergy to the cephalosporins. Allergy to drugs in the same or related groups is called cross-sensitivity. Hypersensitivity is an allergic reaction to one substance. Anaphylactoid reaction is an unusual or exaggerated allergic reaction. Anaphylaxis or anaphylactic shock is a severe form of hypersensitivity that occurs immediately and can be fatal.

A patient receiving penicillin therapy tells the nurse that she feels like her mouth is irritated and that she has a sore throat. Inspection reveals a red, swollen tongue with ulcerations. The nurse suspects a fungal superinfection and identifies which nursing diagnosis as most appropriate for this patient? A) Impaired Comfort B) Impaired Oral Mucous Membranes C) Deficient Knowledge D) Inadequate Nutrition: Less Than Body Requirements

B Feedback: The assessment suggests a fungal superinfection, which would lead to the nursing diagnosis of Impaired Oral Mucous Membranes. Although Impaired Comfort may be appropriate, Impaired Oral Mucous Membranes is more specific. There is no evidence of lack of knowledge or problems with nutrition. However, if the superinfection is not addressed, the patient may experience difficulty eating due to the irritation and discomfort.

The nurse is providing care to a patient who is receiving an aminoglycoside for a wound infection. The patient is also ordered to receive a cephalosporin. The nurse would carefully assess the patient for which of the following? A) Nausea B) Nephrotoxicity C) Increased bleeding D) Respiratory difficulty

B Feedback: 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. The risk for respiratory difficulty and a disulfiram-like reaction increases if alcohol is consumed within 72 hours after administration of certain cephalosporins.

After teaching a group of students about antibacterial drugs that disrupt the bacterial cell wall, the instructor determines that the teaching was successful when the students identify which of the following as an example of a carbapenem? Select all that apply. A) Vancomycin B) Imipenem-cilastatin C) Meropenem D) Aztreonam E) Ceftriaxone

B, C Feedback: Carbapenems include imipenem-cilastatin and meropenem. Vancomycin and aztreonam are classified as miscellaneous drugs that disrupt the bacterial cell wall. Ceftriaxone is a third-generation cephalosporin.

A nurse is reviewing the laboratory test results of a client receiving penicillin therapy. Which of the following would the nurse identify as indicating an adverse hematologic reaction? Select all that apply. A) Pancytopenia B) Anemia C) Thrombocytopenia D) Leukopenia E) Hemoglobulinemia

B, C, D Feedback: Nurses should monitor blood counts of clients taking penicillins for the following hematopoietic changes: anemia, thrombocytopenia, leucopenia, and bone marrow suppression.

While administering vancomycin IV to a patient, the nurse suspects that the patient is developing red-man syndrome based on assessment of which of the following? Select all that apply. A) Headache B) Throbbing neck pain C) Chills D) Erythema of the neck and back E) Difficulty breathing

B, C, D Feedback: Red-man syndrome is manifested by a decrease in blood pressure, occurrence of throbbing neck or back pain, fever, chills, paresthesias, and erythema of the neck and back. Headache is unrelated to this syndrome. Difficulty breathing might suggest an anaphylactic reaction.

After teaching a group of nursing students about penicillins, the instructor determines that the teaching was successful when the students identify which of the following as a group? Select all that apply. A) Synthetic penicillins B) Natural penicillins C) Penicillinase-resistant penicillins D) Aminopenicillins E) Extended-spectrum penicillins

B, C, D, E Feedback: Penicillins are categorized into four groups including the natural penicillins, penicillinase-resistant penicillins, aminopenicillins, and extended-spectrum penicillins.

After teaching a group of nursing students about the different generations of cephalosporins, the instructor determines that the teaching was successful when the students identify which of the following as an example of a first-generation cephalosporin? Select all that apply. A) Cefepime (Maxipime) B) Cefazolin (Ancef) C) Cefoxitin (Mefoxin) D) Cephalexin (Keflex) E) Cefaclor (Raniclor)

B, D Feedback: Cefazolin and cephalexin are examples of first-generation cephalosporins. Cefoxitin and cefaclor are examples of second-generation cephalosporins. Cefepime is an example of a fourth-generation cephalosporin.

A nurse is teaching a patient about the common adverse reactions that can occur with his prescribed therapy with cephalosporins. The nurse determines that the teaching was successful when the patient identifies which of the following? Select all that apply. A) Drowsiness B) Headache C) Constipation D) Heartburn E) Vomiting

B, D, E Feedback: Common adverse reactions to cephalosporins include nausea, vomiting, diarrhea, headache, dizziness, malaise, heartburn, and fever.

A patient undergoing penicillin therapy shows improvement and states that he is feeling better. Which of the following interventions is the nurse most likely to perform in such a situation? A) Instruct patient to increase dietary intake. B) Inform the primary health provider immediately. C) Record assessments on patient's chart. D) Inquire about any previous drug allergies.

C Feedback: When the patient declares that he is feeling better and is also showing improved health, it should be recorded on the patient's chart. If the condition of the patient has improved, the patient will show an increased appetite, but there is no need to instruct the patient to increase dietary intake. The primary health provider need not be informed about the condition immediately unless the patient shows signs of deterioration or complications. The nurse should inquire about previous drug allergies before the start of therapy.

A group of students are reviewing information about the different penicillins. The students demonstrate understanding of the information when they identify which of the following as an example of a beta-lactamase inhibitor? Select all that apply. A) Piperacillin B) Amoxicillin C) Tazobactam D) Sulbactam E) Clavulanic acid

C, D, E Feedback: Examples of beta-lactamase inhibitors are clavulanic acid, sulbactam, and tazobactam. Amoxicillin is an example of an aminopenicillin. Piperacillin is an example of an extended-spectrum penicillin.

Before administering the first dose to the client, which assessment should the nurse perform as part of the preadministration assessment? A) Review of renal and hepatic function tests B) Inspection of patient's stools C) Evaluation of patient's lifestyle and diet D) General history of patient's health

D Feedback: 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 if the patient has diarrhea. It is not required to evaluate the patient's lifestyle and diet as part of the preadministration assessment for the first dose. Renal and hepatic function tests may be performed at intervals during penicillin therapy, usually not before it.

A patient is ordered to receive vancomycin IV. When administering the drug, the nurse would infuse the drug over which time frame? A) 15 minutes B) 30 minutes C) 45 minutes D) 60 minutes

D Feedback: Each IV dose of vancomycin is infused over 60 minutes. Too rapid an infusion may result in a sudden and profound fall in blood pressure and shock.

The nurse administers cefuroxime to a patient at least 1 hour before meals, as prescribed. However, the patient experiences GI upset. Which of the following would be most appropriate for the nurse to do? A) Administer an antacid. B) Lower the dosage. C) Discontinue the drug. D) Administer the drug with food.

D Feedback: If the patient experiences GI upset, the nurse can administer cefuroxime with food. A decrease in the dosage is suggested in a patient with renal impairment. A change in dosage, discontinuation of the drug, or use of an antacid is recommended only if prescribed by the physician.

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

D Feedback: When preparing a parenteral form of penicillin, the nurse should shake the vial thoroughly before withdrawing the drug to ensure its even distribution in the solution. Penicillins in powder or crystalline form must be reconstituted before being withdrawn from the vial. Excess antibiotic after reconstitution should never be saved, as the drug loses its potency when stored. Reconstitution should be done only with the diluent prescribed on the manufacturer's label.