Chap 18 beta lactam/penicilin.cephalosporins

A nurse is preparing to administer the first dose of piperacillin/tazobactam to a patient in an infusion clinic. The nurse should take which of the following precautions?

1. Ask the patient about past allergic reactions to penicillins.

Which of the following classes of cephalosporins has the best activity against gram-positive organisms?

1. first-generation cephalosporins;

A cardiac surgeon orders cefazolin 1 g IV "on call" to the operating room for a patient scheduled for a heart valve replacement. The surgery is scheduled for 7:00 AM the next morning. What is the rationale for giving the antibiotic at 6:30 AM? The last dose was administered more than 8 hours ago.

2. The cefazolin must be given within 60 minutes before the first skin incision to reach therapeutic concentrations.

In acute renal failure, doses of which of the following antibiotics must be reduced?

2. cefazolin3. meropenem4. aztreonam

A client diagnosed with E. coli resistant to other drugs has been prescribed imipenem-cilastatin to be given IM. When preparing the medication for administration, what information should the nurse obtain from the client?

:Allergy to local lidocaine

Patient with a repository form of penicillin will experience

A delay in absorption

A client has been diagnosed with an infected postoperative wound, and cultures reveal methicillin-resistant Staphylococcus aureus (MRSA). The client is currently receiving intravenous ceftaroline because in vitro testing indicates susceptibility. When should the nurse do?

Administer the medication as prescribed and monitor for expected outcomes.

A client receiving the first dose of IV ampicillin asks the nurse to evaluate a rash on the torso. What should be the nurse's initial response to the client's rash?

Attempt to differentiate a hypersensitivity reaction from a nonallergic ampicillin rash;

Patient who is allergic to penicillin can have

Aztreonam

A nurse working in the neurointensive care unit is caring for a patient with a head injury who has been experiencing seizures and now has pneumonia caused by Pseudomonas aeruginosa. The physician has prescribed imipenem 1 g IV every 6 hours plus gentamicin for the pneumonia. Before administering the antibiotics, the nurse should do which of the following?

B) Remind the physician of the patient's seizures and inquire whether a different ATB might be safer

IV penicillin may result in

Cardio pulmonary arrest and death

Name a med from cephalosporins

Ceftaroline (Telfaro)

A client being prepared for surgery has been prescribed antibiotics as prophylaxis. Which medication would the nurse anticipate being ordered?

Cephalosporin;Clinical indications for the use of cephalosporins include surgical prophylaxis and treatment of infections of the respiratory tract, skin and soft tissues, bones and joints, urinary tract, brain and spinal cord, and bloodstream (septicemia

What to remember about cephalosporins

Closely related to penicillin and as a result of that cross sensitivity may occur

A client being treated for cellulitis with a cephalosporin asks the nurse what the essential difference is between generations of this medication. The nurse should respond to the client's question based on what fact?

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

What are beta lactamase

Enzymes that disrupt the beta-lactam ring/ stops the drugs How organisms gain resistance to beta- lactam antibiotics

What does the med Ceftaroline(Telfaro) do

Fights gram-positive organisms such as MRSA, VRSA, and VISA

what generation fights both gram pos and gram neg organisms and has stability against degradation of beta-lactamase enzymes

Fourth-generation cephalosporins a

What produces beta lactamase

Gram-positive and gram-negative

Patient with a large are the doses of penicillin will display what electrolyte imbalance

Hyperkalemia

For a patient taking penicillin a skin test is needed to check

Hypersensitivity

Penicillin class is more effective in

Infections caused by gram-positive bacteria

Patience with penicillin who have a renal impairment for heart failure may have what types of imbalance

Metabolic and electrolyte

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

A client with a complex medical history is scheduled to begin treatment with an IV cephalosporin. After the initiation of therapy, the nurse should monitor the client for which potential adverse effect of intravenous cephalosporin therapy? Select all that apply.

Nausea and vomiting, Diarrhea, Abdominal pain

The nurse is providing education to a client who has been prescribed oral amoxicillin. The nurse will repeat teaching related to fluid intake if the client indicates that the drug can be taken with what beverage?

Orange juice/acidic drugs

How to determine types of beta lactam antibodies

Organisms? Severity? And other factors

A client has been diagnosed with streptococcal pharyngitis. What drug would the nurse expect to be prescribed by the health care provider?

Penicillin G

Beta-Lactam antibiotics are

Penicillin, cephalosporins, carbapenems, and monobactams

The nurse initiated administration of IV cefazolin with the dose ending at 13:00. When would the nurse expect the drug to reach peak effect?

Shortly after 13:00; cefazolin works quickly IV and IM.the drug peaks at the end of IV infusion and within 1-2 hrs with IM injection

How will a client's diagnosis of liver cirrhosis affect the potential use of appropriate ampicillin therapy to treat an infected pressure ulcer?

The client can safely be treated with ampicillin;Ampicillin can be used in clients experiencing hepatic impairment, as can almost all the penicillins. No specific dosing are needed.

A woman is to receive amoxicillin-clavulanate 500 mg PO every 8 hours for bronchitis. The nurse retrieves two 250-mg tablets from the medication cart. This is incorrect for which of the following reasons?

This provides twice the intended dose of clavulanate; its a combination product of amoxicillin and betalactamase. each tablet contains an additional 125mg of claulante. So that would mean a clavulanate overdose.

A 13-year-old male patient has been prescribed oral cefuroxime. The patient's parents should ensure that he takes the medication

With food

A client receiving the first dose of IV ampicillin asks the nurse to evaluate a rash on the torso. What should be the nurse's initial response to the client's rash

attempt to differentiate a hypersensitivity reaction from a nonallergic ampicillin rash

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

monitor what labs in pt on penicillin

creatine and BUN

The nurse is preparing a teaching plan for a client who is prescribed ceftriaxone. What should the nurse identify as common adverse effects associated with this drug?

diarrhea, nausea

Give meds on

empty stomach; 1hr before or 2hrs after meals

drugs that may be used in critical illness pts

extended spectrum drugs (bactericidal drugs)

second generation cephalosprins fight

gram neg organisms

A client has been diagnosed with an infected postoperative wound, and cultures reveal methicillin-susceptible Staphylococcus aureus. What medication should the nurse anticipate being prescribed for this client? Select all that apply.

penicillin resistant drugs(antistaphylococcal) Dicloxacillin, Oxacillin, Nafcillin

In most infections with streptococci and staphylococci, what medicine is more effective

penicillins are more effective and less expensive.

The nurse knows that superinfections are a concern for clients who have been taking oral penicillins. Which is one of the more common superinfections?

pseudomembranous colitis

A nurse is assessing a client who is receiving vancomycin intravenously. While the drug is being administered, the client reports a throbbing sensation in their neck and back and paresthesias. The client's blood pressure has dropped and their neck and back are erythematous. The nurse suspects which adverse finding?

red man syndrome

Older pts considerations with penicillins

susceptible to superinfections

What generation of cephalosporins further extend the spectrum of activity against gram-negative organisms

third generation

Cephalosporin use adv effect

tx respiratory, urinary, skin infections lower dosage in renal patients contraindictation is cross-sens/allergy to penicillin

The nurse is preparing a teaching plan for a client who is receiving cephalosporins. Which of the following would the nurse identify as the most commonly occurring adverse effects?

vomiting and diarrhea