Ch 8

It would be most important for a nurse to monitor which of the following patients for ototoxicity while on gentamicin therapy?

A 25-year-old male who has a hearing impairment Explanation: Patients with a history of hearing impairment and 8th cranial nerve impairment have an elevated risk of ototoxicity. Gentamicin may aggravate muscle weakness in patients with Parkinson disease. The drug is contraindicated during pregnancy and lactation, so the therapy would be discontinued in those patients.

A patient received erythromycin before dental surgery. The patient has a past history of a cardiac surgery. The rest of the patient's history is unremarkable. What does the nurse teach the patient about this medication?

"You are receiving this medication to prevent the growth of bacteria in your heart." Explanation: The patient with a prior history of a heart defect is at risk for bacteria growing in the area of the defect. The patient should receive prophylactic antibiotics with any surgery or invasive procedure. The medication does not decrease pain, nor does it make it easier to remove a tooth. Other antibiotics are sometimes given as well as a macrolide.

Which of the following would be the priority assessment when preparing to administer amikacin to a patient?

Renal function Explanation: Amikacin is an aminoglycoside that may cause renal toxicity. Assessing renal function would be a priority. Although the drug can affect the GI tract leading to nausea, vomiting, diarrhea, and weight loss, which could lead to problems with nutrition, and cause numbness, tingling and weakness, assessment of GI function, nutritional status, and muscle strength would be considered lower priority assessments.

A healthcare provider is deciding what medication to prescribe for the patient with an upper respiratory infection. What principles guide the provider's decision?

• Resistance of the bacteria • Other drugs the patient is taking daily • The patient's ability to tolerate the drug Explanation: The healthcare provider needs to consider if the medication will kill the bacteria. The physician also needs to think about the other medications the patient is taking, because some drugs have many interactions. Tolerance also needs to be considered, because the patient may develop nausea, vomiting, and diarrhea from the antibiotic. How early the patient goes to bed and how often the patient wants to take pills are not usually factors in the decision.

The client is taking spectinomycin and calls the clinic complaining of insomnia. What is the nurse's best response to this client?

"This is a common adverse reaction to the medication and should go away when you finish the prescription." Explanation: Insomnia is one of the common adverse reactions to miscellaneous drugs that inhibit protein synthesis. Spectinomycin is one of these drugs. Though it may be permissible to use a prescribed or OTC sleeping aid, the nurse's best answer is to explain that this is an adverse effect and should go away once therapy has stopped. It is not a sign of an impending stroke.

A 15-year-old female patient is receiving tetracycline for the treatment of severe acne. When providing patient education to this patient, the nurse includes which of the following points for the patient?

"When taking tetracycline, wear extra sun block." Explanation: While GI symptoms are most common with tetracyclines, photosensitivity is another adverse reaction that can occur. Lab work is not required for daily dosing of this medication. Tetracycline can be taken orally, and the patient is not required to remain hospitalized.

The nurse is administering telithromycin (Ketek) to a child with Streptococcus pneumoniae infection. What nursing intervention is implemented when administering this medication?

Administer the medication with or without food Explanation: When administering telithromycin, food does not affect the absorption of the medication. The administration of the medication with grapefruit juice may increase the plasma concentration and cause adverse effects. Telithromycin can cause an elongation of the QT interval; thus, the dose should not be increased. The administration of telithromycin and lovastatin can cause an increase in the QT interval.

A client who has been on long-term sulfonamide therapy has developed both anemia and leukopenia. The nurse knows that this combination of problems is known as what disorder?

Aplastic anemia Explanation: Aplastic anemia is a blood disorder caused by damage to the bone marrow. It results in a marked reduction in the number of red blood cells (anemia) and white blood cells (leukopenia). Thrombocytopenia is a reduction in platelet levels, crystalluria is the formation of crystals in the urine, and anorexia is a loss of appetite.

A 25-year-old female patient 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 patient before beginning the medication?

Asking the patient 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.

The nurse receives a call from a client who is taking clindamycin (Cleocin) and is complaining of a burning feeling when she swallows. The nurse knows that the client has developed which adverse reaction related to this medication?

Esophagitis Explanation: The client is complaining of esophagitis (an inflammation of the esophagus) that may be seen in clients taking clindamycin. The pain is in the client's throat, thus it is not gastritis. It also does not describe nausea. Peptic ulcer is not a common adverse reaction to clindamycin.

Mr. Thiessen is a 60-year-old man whose bacteremia is being treated with intravenous gentamicin. After 4 days of treatment, the care team is pleased with the improvement in Mr. Thiessen's condition and the effect of the drug treatment on his blood cultures. During morning care, he has told the nurse that he is having ringing in his ears and woke up this morning with a pounding headache. How should the nurse respond to this patient's complaints?

Hold the next scheduled dose of gentamicin until the physician has been consulted. Explanation: To avoid permanent ototoxic damage, gentamicin should be withdrawn at the first sign of tinnitus or persistent headache. This supersedes the modification of the patient's care plan and slowing down the infusion of the drug does not mitigate the potential for ototoxic effects.

The nurse is preparing to administer gentamicin (Garamycin) to a patient when he suddenly complains of diminished hearing. What action should the nurse take based on this statement?

Hold the dosage and notify the physician of the alteration in hearing Explanation: Aminoglycosides accumulate in high concentrations in the inner ear, damaging sensory cells in the cochlea and vestibular apparatus. The medication should be held and alteration in hearing reported to the physician. The administration of the medication will only cause more damage to the cochlea and vestibular apparatus. Holding the medication and documenting the information in the nurses' will not allow for a new antiinfective to be administered and for the hearing to be assessed.

The nurse is preparing to administer a sulfonamide to a client who is a Type 2 diabetic taking an oral hypoglycemic agent. The nurse will monitor the client for what reaction?

Hypoglycemia Correct Explanation: Diabetic clients who take a sulfonamide may experience a hypoglycemic reaction because the sulfonamides may inhibit the hepatic metabolism of the oral hypoglycemic drugs tolbutamide and chlorpropamide. The nurse would not expect to see increased bruising or an elevated temperature, which may be a reaction related to bone marrow suppression.

Your 85-year-old client has been diagnosed with a drug-resistant urinary tract infection. She has been started on a regimen of aminoglycosides. She expresses concern about adverse reactions she has read about, including nephrotoxicity. When providing client education about the medication, you would include which of the following statements?

If nephrotoxicity occurs, it is usually reversible if the drug is stopped. Correct Explanation: In addition to the preceding recommendations, guidelines to decrease the incidence and severity of adverse effects include the following: Give the drug for no longer than 10 days unless necessary for the treatment of certain infections. Patients are most at risk when high doses are given for prolonged periods. Changes in renal function tests that indicate nephrotoxicity may not occur until the patient has received an aminoglycoside for several days. If nephrotoxicity occurs, it is usually reversible if the drug is stopped.

Your client is 32 weeks pregnant. She has just been diagnosed with a urinary tract infection. You know that tetracycline is contraindicated for her because:

It can cause a life-threatening toxicity for the fetus. Explanation: Systemic sulfonamides are contraindicated during late pregnancy, lactation, and in children younger than 2 months of age. If a fetus or young infant receives a sulfonamide by placental transfer, in breast milk, or by direct administration, the drug displaces bilirubin from binding sites on albumin. As a result, bilirubin may accumulate in the bloodstream (hyperbilirubinemia) and central nervous system (kernicterus) and cause life-threatening toxicity.

You are administering erythromycin to one of your patients. For what common side effects should you monitor the patient?

Nausea, vomiting, and diarrhea Explanation: Gastrointestinal problems (e.g., nausea, vomiting, and diarrhea) are common side effects of erythromycin and other macrolides.

You are providing discharge teaching to a patient who is being sent home on tetracycline (Sumycin) PO. What should the instructions include?

The need to take the drug on an empty stomach. Correct Explanation: Tetracycline should be taken on an empty stomach 1 hour before or 2 hours after meals with a full 8 ounces of water to ensure full absorption. Tetracycline is usually taken at least every 12 hours. Checking the pulse and holding the dose if below 60 is an action specific to the use of cardiac glycosides.

When administering aminoglycosides, the nurse must be aware of which of the following adverse reactions?

Ototoxicity and nephrotoxicity Explanation: After parenteral administration, aminoglycosides are widely distributed in extracellular fluid and reach therapeutic levels in blood, urine, bone, inflamed joints, and pleural and ascitic fluids. They accumulate in high concentrations in the proximal renal tubules of the kidney leading to acute tubular necrosis. This damage to the kidney is termed nephrotoxicity. They also accumulate in high concentrations in the inner ear, damaging sensory cells in the cochlea and the vestibular apparatus. This damage to the inner ear is termed ototoxicity.

You are caring for a patient who the physician suspects may be infected with an antibiotic-resistant pathogen. What course of action is best used to determine whether this type of pathogen is present?

Performing culture and susceptibility tests Explanation: Before prescribing an antibiotic, the physician should review culture and susceptibility reports and local susceptibility patterns to determine if an antibiotic-resistant pathogen is present in the patient.

The nurse is teaching a patient about his prescription for a macrolide antibiotic. What should the nurse teach the patient to report?

Recurring symptoms of infection Explanation: Patients taking antibiotics should be instructed to report symptoms of infection that recur or develop during therapy. Such symptoms can indicate ineffective therapy or development of a new infection with antibiotic-resistant bacteria or fungi.

You are a critical care nurse caring for a patient taking aminoglycosides. Which of the following should you monitor closely to determine whether dosage adjustment is required?

Renal function Correct Explanation: Aminoglycosides are nephrotoxic. Renal function should be monitored to determine whether dosage should be adjusted, particularly in patients with existing renal dysfunction.

A patient with a gram-negative infection is being treated with an aminoglycoside. What system should the nurse expect to be tested daily while on this medication?

Renal system Explanation: Renal function should be tested daily because aminoglycosides depend on the kidney for excretion and if the GFR is abnormal it may be toxic to the kidney. The results of the renal function testing could change the daily dosage. Aminoglycosides do not usually adversely affect respiratory, hepatic, or musculoskeletal function; although baseline data concerning these systems is always needed.

You are speaking to a 62-year-old female patient who has been started on sulfisoxazole, a sulfonamide antibiotic. You should teach this patient to contact the physician if she experiences what adverse effect associated with the drug?

Skin rash or itching Explanation: Patients taking sulfonamides should be instructed to contact the prescribing physician if they experience skin rash or itching. These symptoms may indicate a sulfonamide-induced allergic reaction and the need to change or stop the drug.

A nurse has administered an antibiotic intravenously to a patient. The nurse observes signs of tenderness, pain, and redness at the needle site. What nursing intervention should the nurse perform immediately?

Stop the infusion and restart the IV in another vein Correct Explanation: If signs of tenderness, pain, and redness are observed at the needle site, the nurse should restart the IV on another vein. Changing the needle will not help to reduce the symptoms. The nurse should not apply a cold compress or massage the area when the IV is in progress.

Which category of antimicrobial agents is used chiefly because of low cost and effectiveness in treating common bacterial infections?

Sulfonamides Correct Explanation: Sulfonamides (commonly called sulfa drugs) are used as antimicrobial agents, chiefly because of their low cost and effectiveness in treating common bacterial infections. They are bacteriostatic agents, requiring normal body processes to eradicate infection. Although the sulfa drugs are very effective, newer and more effective antibiotics with fewer side effects and faster rates of action are replacing them.

A 30-year-old client with chills and fever is diagnosed with septicemia. The client has been prescribed an aminoglycoside antibiotic. Which of the following information should the nurse include in client teaching?

Take full dose of the antibiotic prescribed Explanation: The client should be instructed to take the full prescribed dose of the antibiotic, even though the symptoms subside. Antibiotic-resistant strains of pathogens may develop if less than the prescribed dose is taken. An overdose of medication can cause various side effects. Thus, the client should never discontinue or increase the dosage of any medication without consultation with the healthcare provider.

Which of the following is true in regards to the oral administration of tetracyclines?

Tetracyclines should be administered with a full glass of water. Explanation: Tetracyclines should always be administered with a full glass of water and on an empty stomach (except minocycline and tigecycline may be taken with food).

Which patient should be assessed further before receiving azithromycin (Zithromax) as ordered?

The patient who is taking digoxin Explanation: When a patient is given azithromycin, digoxin serum levels can increase. The patient taking digoxin should be assessed and a different antibiotic administered, if possible. It is expected that patients with an infection will have an elevated WBC. GI complaints that are mild are typical reactions to the medication.

Which patient should not receive erythromycin as ordered at 8 a.m.?

The patient with elevated liver enzymes Correct Explanation: The medication is metabolized by the liver and excreted in the bile. The patient with elevated liver enzymes will not be able to tolerate this medication. There is a risk it will build up in the system. The other situations are not contraindications for taking erythromycin

The physician considers prescribing an oral tetracycline for a patient suspected of having a urinary tract infection. What action needs to be completed before the medication can be prescribed?

The physician should order culture and susceptibility studies. Explanation: Culture and susceptibility studies are needed before tetracycline therapy is started, because many strains of organisms are either drug resistant or vary greatly in drug susceptibility. Teaching the patient about proper storage and adverse effects, including photosensitivity, are appropriate after the medication is ordered. There is no cross-allergenicity with penicillin, so prescribing a tetracycline does not require assessment penicillin hypersensitivity.

Your client is scheduled to undergo major abdominal surgery. A preoperative order for neomycin has been given. Neomycin is used preoperatively for the following reason

To suppress intestinal bacteria. Correct Explanation: Neomycin and kanamycin may be given before bowel surgery to suppress intestinal bacteria. Neomycin and kanamycin may be given before bowel surgery and to treat hepatic coma. In hepatic coma, intestinal bacteria produce ammonia, which enters the bloodstream and causes encephalopathy. Drug therapy to suppress intestinal bacteria decreases ammonia production.

A patient's risk for ototoxicity, nephrotoxicity, and neurotoxicity increases dramatically if he receives an aminoglycoside in conjunction with a potent diuretic.

True

A patient has been prescribed oral tetracycline. The nurse will instruct the patient to take the drug You selected: with milk or fruit juice.

on an empty stomach 1 hour before or 2 hours after taking any meals or other drugs. 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.

A patient 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 patient 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 patient has been admitted to the critical care unit with a diagnosis of peritonitis that has necessitated treatment with gentamicin. As a result, the care team should be cautious when concurrently administering other medications that may cause

ototoxicity or nephrotoxicity. Correct Explanation: Because of the potential for nephrotoxicity and ototoxicity that is associated with gentamicin, other medications that may lead to these same adverse effects must be used with caution. Gentamicin does not typically affect immune function, ICP, or hematopoiesis.

The nurse is caring for a client on sulfonamide who has developed a fever, cough, and headache. What signs/symptoms would alert the nurse to the possible development of Stevens-Johnson syndrome? Select all that apply.

• Blister on the lip • Red wheal on the neck Correct Explanation: Clients with SJS (Stevens-Johnson syndrome) may complain of fever, cough, muscular aches and pains, and headaches, which may be symptoms of other disorders. The development of red wheals or blisters on the face, mouth, lips, neck, or other extremities suggest that SJS has developed. Brittle fingernails, alopecia, and numbness of the mouth are not suggestive of SJS.

Aminoglycosides are poorly absorbed from the GI tract; they are useful in treating which of the following? (Select all that apply)

• Hepatic coma • Prevention of abdominal infection from bowel surgery Explanation: Aminoglycosides are poorly absorbed from the GI tract making them useful in treating hepatic coma and preventing abdominal infection from bowel surgery.

After teaching a patient who is receiving doxycycline about the drug, the nurse determines that the teaching was successful when the patient states which of the following?

"I need to wear protective clothing when I'm out in the sun." Explanation: Photosensitivity is possible so the patient should use sunscreen and wear protective clothing when outdoors. Fluids should be increased to promote drug excretion. Ice chips or sugarless candy would be appropriate for combating a sore mouth. The drug should be taken on empty stomach 1 hour before or 2 hours after meals; antacids should not be taken with the drug because they can affect absorption.

You are the clinic nurse responsible for teaching a patient about his new prescription for doxycycline. Which of the following instructions should you include in your teaching?

"Limit your exposure to the sun." Explanation: Tetracyclines increase sensitivity to sunlight, placing the patient at increased risk of sunburn. Antacids can decrease the effects of tetracyclines

A patient has been prescribed doxycycline (Vibramycin). Which of the following teaching instructions is important with this medication?

Avoid sun exposure Correct Explanation: The administration of doxycycline increases photosensitivity, which is a common side effect. Avoidance of sexual activity is not taught. The medication should not be administered with an antacid; the administration of an antacid will result in diminished absorption of the medication. The doxycycline tablets should not be chewed.

A 32-year-old female patient is admitted to the floor with a superinfection. Her orders read tigecycline (Tygacil) 100 mg IV followed by 50 mg IV every 12 hours infused over 30 to 60 minutes for five days. What would be important for the nurse to educate this patient about?

Contraceptives Explanation: Many antibiotics interfere with the effectiveness of oral contraceptives and unplanned pregnancies can occur. Women should be advised to use a barrier form of contraceptives when taking this drug. There are no known serious drug-drug interactions with analgesics, antihistamines, or decongestants.

The nurse is assessing a patient receiving erythromycin (E-mycin) for an infection. What assessment finding requires immediate action by the nurse?

Diarrhea Explanation: Diarrhea could be an indication that the patient has developed pseudomembranous colitis or antibiotic-associated colitis. The patient can become dehydrated and might need to receive medication to stop the colitis. The nurse needs to assess a stool sample to validate. Nausea, stomach pain, and headache can all be treated and are not dose-limiting side effects.

A nurse is caring for a 6-year old child with a severe case of typhoid fever. The patient was mistakenly administered tetracycline, which can cause adverse reactions. Which of the following could be a permanent effect in the child?

Discoloration of the teeth Explanation: Tetracyclines cause permanent yellow-gray-brown discoloration of the teeth in children less than 9 years of age. Epigastric distress is not a permanent effect of the drug. Abdominal pain or cramping and visual disturbances are adverse reactions of macrolides.

You are the clinic nurse providing health teaching to a patient who has been prescribed doxycycline (Doxycin). You know that health teaching for this patient should include what instructions? You selected: Stay out of the sun.

Encourage the patient to apply sunscreen and wear clothing to protect exposed skin from skin rashes and sunburn associated with photosensitivity reactions. You would not teach the patient to avoid sexual activity, take an antacid, or chew tablets completely.

A patient is allergic to penicillin and has been diagnosed with a genitourinary infection caused by Chlamydia trachomatis. Which of the following medications will be administered?

Erythromycin (Ery-Tab) Explanation: A patient who is diagnosed with a genitourinary infection that is caused by trachomatis and who is allergic to penicillin should be administered erythromycin (Ery-Tab). Acamprosate calcium is administered as a substance abuse deterrent, not in place of penicillin. Atazanavir (Reyataz) is an antiviral agent that is used to treat HIV infection, not Chlamydia trachomatis. Flumazenil is a benzodiazepine antagonist and not used for Chlamydia trachomatis.

The nurse is caring for a 62-year-old patient who has orders to receive genatmicin (Garamycin). The patient complains of difficulty hearing. What should the nurse do?

Hold the dose and notify the physician immediately. Explanation: Aminoglycosides are contraindicated in the following conditions: known allergy to any of the aminoglycosides; renal or hepatic disease that could be exacerbated by toxic aminoglycoside effects and that could interfere with drug metabolism and excretion, leading to higher toxicity; pre-existing hearing loss, which could be intensified by toxic drug effects on the auditory nerve. Ototoxicity should be reported and the drug should be stopped. You would not administer the dose and then call the physician, administer the dose and report information to oncoming nurse, or administer the dose and document the finding in the nurse's notes.

The nurse is caring for a 62-year-old patient who has been prescribed gentamicin. The patient complains of difficulty hearing. What should the nurse do?

Hold the dose and notify the physician immediately. Explanation: Nurses should monitor patients for signs of aminoglycoside-induced ototoxicity. Since there is a possibility of reversing the condition (or at least arresting it) by discontinuing or reducing dosage of the drugs, the nurse should immediately contact the physician and hold the dose until receiving additional guidance.

The nurse is preparing to administer daptomycin and asks the client to confirm that he has no known allergies. The client replies that he just remembered that he once developed a rash when taking a drug but he doesn't remember which drug it was. What is the nurse's best action?

Hold the medication and contact the health care provider. Correct Explanation: When administering an antibacterial such as daptomycin, the nurse should obtain a thorough allergy history. If the client has a history of a drug allergy and has not told the health care provider, do not administer the first dose of the drug. Immediately contact the provider to discuss the situation. Though it would be helpful if the client knew the drug that caused the rash, showing him pictures to identify it is not the best action at this time. Administering half the dose is not within the nurse's scope of practice.

Macrolides must be used with caution in clients who have which of the following conditions?

Liver dysfunction Explanation: All macrolides should be used with caution in clients with liver dysfunction. Pre-existing liver disease is a contraindication.

Which statement is true concerning macrolides?

Macrolides are bacteriocidal or bacteriostatic. Explanation: Macrolides are absorbed well in body tissues and fluids and kill gram-positive bacteria. Depending on the concentration in the body, they can be bacteriocidal or bacteriostatic

You are the clinic nurse providing health teaching to a patient who has been prescribed doxycycline (Doxycin). You know that health teaching for this patient should include what instructions?

Stay out of the sun. Explanation: Encourage the patient to apply sunscreen and wear clothing to protect exposed skin from skin rashes and sunburn associated with photosensitivity reactions. You would not teach the patient to avoid sexual activity, take an antacid, or chew tablets completely.