Main Drugs and practice problems from Lecture on Antimicrobials etc.
8. Myles is a 2-year-old patient who has been diagnosed with acute otitis media. He is afebrile and has not been treated with antibiotics recently. First-line treatment for his otitis media would include: 1. Azithromycin 2. Amoxicillin 3. Ceftriaxone 4. Trimethoprim/sulfamethoxazole
amoxicillin
Jaheem is a 10-year-old low-risk patient with sinusitis. Treatment for a child with sinusitis is: 1. Amoxicillin 2. Azithromycin 3. Cephalexin 4. Levofloxacin
amoxicillin
The HCP orders gentamicin (Garamycin) for a client with a postop wound infection. Which lab result should prompt the nurse to consult the prescriber about possible nephrotoxicity of this drug? A) elevated serum creatinine levels B) decreased BUN levels C) increased WBC count D) elevated serum iron leve
) elevated serum creatinine levels
he client is receiving gentamicin (Garamycin) IV for a significant infection. While the client is receiving this drug, what assessment data will the nurse gather to monitor for adverse effects? Select all that apply. A) serum creatinine B) signs of muscle weakness C) liver function studies D) urine output E) hearing and balance assessment
) serum creatinine B) signs of muscle weakness D) urine output E) hearing and balance assessments
A patient is to receive antibiotic therapy with a cephalosporin. When assessing the patient's drug history, the nurse recognizes that an allergy to which drug class may be a possible contraindication to cephalosporin therapy? a. Cardiac glycosides b. Thiazide diuretics c. Penicillins d. Macrolides
. Penicillins
During intravenous quinolone therapy in an 88-year-old patient, which potential problem is of most concern when assessing for adverse effects? a. hepatotoxicity b. rhabdomyolysis c. tendon rupture d. nephrotoxicit
c. tendon rupture
16. Tetracyclines such as minocycline are safe to use in: 1. Pregnant women 2. Adolescents 3. Patients with renal dysfunction 4. Patients with hepatic dysfunction
2. Adolescents
Myles is a 2-year-old patient who has been diagnosed with acute otitis media. He is afebrile and has not been treated with antibiotics recently. First-line treatment for his otitis media would include: 1. Azithromycin 2. Amoxicillin 3. Ceftriaxone 4. Trimethoprim/sulfamethoxazole
2. Amoxicillin
6. Sarah is a 25-year-old female who is 8 weeks pregnant and has a urinary tract infection. What would be the appropriate antibiotic to prescribe for her? 1. Ciprofloxacin (Cipro) 2. Amoxicillin (Trimox) 3. Doxycycline 4. Trimethoprim-sulfamethoxazole (Septra)
2. Amoxicillin (Trimox) (safe, pregnancy category B) doxycycline: avoided due to suppression of bone growth and teeth staining Septra: avoided, can cause jaundice in newbords Ciprofloxacin: no real long-term studies are done, cautious
12. Janet was recently treated with clindamycin for an infection. She calls the advice nurse because she is having frequent diarrhea that she thinks may have blood in it. What would be the appropriate care for her? 1. Encourage increased fluids and fiber. 2. Assess her for pseudomembranous colitis. 3. Advise her to eat yogurt daily to help restore her gut bacteria. 4. Start her on an antidiarrheal medication.
2. Assess her for pseudomembranous colitis.
12. First-line therapy for a patient with acute otitis externa (swimmer's ear) and an intact tympanic membrane includes: 1. Swim-Ear drops 2. Ciprofloxacin and hydrocortisone drops 3. Amoxicillin 4. Gentamicin ophthalmic drops
2. Ciprofloxacin and hydrocortisone drops
First-line therapy for a patient with acute otitis externa (swimmer's ear) and an intact tympanic membrane includes: 1. Swim-Ear drops 2. Ciprofloxacin and hydrocortisone drops 3. Amoxicillin 4. Gentamicin ophthalmic drops
2. Ciprofloxacin and hydrocortisone drops
The nurse determines that the client understands the use of azithromycin (Zithromax) when the client makes which statement? A) "It only needs to be taken once-daily because it last longer." B) "It causes more nausea than most other antibiotics in this classification." C) It must be taken on an empty stomach." D) "It is ineffective if taken with calcium-rich foods."
A) "It only needs to be taken once-daily because it last longer."
Nicholas is a football player who presents to clinic with athlete's foot. Patients with tinea pedis may be treated with: A) OTC miconazole cream for 4 weeks B) Oral ketoconazole for 6 weeks C) Mupirocin ointment for 2 weeks D) Nystatin cream for 2 weeks
A) OTC miconazole cream for 4 weeks
Erik presents with one golden-crusted lesion at the site of an insect bite consistent with impetigo. His parents have limited finances and request the least expensive treatment. Which medication would be the best choice for treatment? A) Mupirocin (Bactroban) B) Bacitracin and polymixin B (generic double antibiotic ointment) C) Retapamulin (Altabax) D) Oral cephalexin (Keflex)
B) Bacitracin and polymixin B (generic double antibiotic ointment)
Sally is a 16-year-old female with a urinary tract infection. She is healthy, afebrile, with no use of antibiotics in the previous 6 months and no drug allergies. An appropriate first-line antibiotic choice for her would be: 1. Azithromycin 2. Trimethoprim/sulfamethoxazole 3. Ceftriaxone 4. Levofloxacin
Azithromycin: pneumonia Bactrim~ Ceftriaxone: cephalosporin Levofloxacin
5. Jonathan has been diagnosed with strep throat and needs a prescription for an antibiotic. He says the last time he had penicillin he developed a red, blotchy rash. An appropriate antibiotic to prescribe would be: 1. Penicillin VK, because his rash does not sound like a serious rash 2. Amoxicillin 3. Cefadroxil (Duricef) 4. Azithromycin
4. Azithromycin, remember there is cross-sensitivity with penicillin and cefadroxil,cefaclor, cephalexin
Conjunctivitis in a child that is accompanied by acute otitis media is treated with: 1. Sulfacetamide 10% ophthalmic solution (Bleph-10) 2. Bacitracin/polymyxin B (Polysporin) ophthalmic drops 3. Ciprofloxacin (Ciloxan) ophthalmic drops 4. High-dose oral amoxicillin
4. High-dose oral amoxicillin (Amoxicillin is for acute otitis media)
When planning care for a client receiving a sulfonamide antibiotic, it is important for the nurse to perform which intervention? a. Encourage fluid intake of 2000 to 3000 mL/day. b. Avoid direct sun exposure and tanning beds. c. Take the medication with dairy products such as milk or yogurt. d. Advise the client to report any tinnitus to the health care provider.
A Clients should be encouraged to drink plenty of fluids (2000 to 3000 mL/24 hours) to prevent drug-related crystalluria associated with sulfonamide antibiotics.
When administering a nonsteroidal antiinflammatory drug and a penicillin drug together, the displacement of the penicillin antibiotic from the protein-binding sites will result in which effect? a. Increased free drug in blood b. Decreased free drug in blood c. No change in free drug in blood d. Absence of free drug in the blood
A Drugs that are not bound to protein are free and thus active to exert their therapeutic (or toxic, if too much free) effect.
Nicholas has been diagnosed with Type A influenza. Appropriate prescribing of oseltamivir (Tamiflu) would include: A. Starting oseltamivir within the first 48 hours of influenza symptoms B. Advising the patient he can stop the oseltamivir when his symptoms resolve C. Educating the patient that oseltamivir will cure influenza D. Prophylactic treatment of all family members
A. Starting oseltamivir within the first 48 hours of influenza symptoms
Patricia has been prescribed doxycycline for a Chlamydia infection. She is healthy and her only medication is an oral combined contraceptive. Patricia's education would include: A. Use a back-up method of birth control (condom) until her next menses B. Doxycycline may cause tendonitis and she should report any joint pain C. Her partner will need treatment if her infection doesn't clear with the doxycycline D. Doxycycline is used for one dose treatment of STIs; take the whole prescription at once
A. Use a back-up method of birth control (condom) until her next menses
Isoniazid (INH) may induce a deficiency of which vitamin? A.Vitamin B6 B.Vitamin C C.Vitamin D D.Vitamin E
A.Vitamin B6 AKA pyridoxine Given prophylactically to patients on isoniazid to prevent drug-induced neuritis. Vitamin B6 supplements may reduce the symptoms of premenstrual syndrome, and nausea and vomiting associated with pregnancy
Jacob has been diagnosed with sinusitis. He is the parent of a child in daycare. Treatment for sinusitis in an adult who has a child in daycare is: 1. Azithromycin 500 mg q day for 5 days 2. Amoxicillin-clavulanate 500 mg bid for 7 days 3. Ciprofloxacin 500 mg bid for 5 days 4. Cephalexin 500 mg qid for 5 days
Amoxicillin-clavulanate 500 mg bid for 7 day
Twenty-year-old Annie comes to the clinic complaining of copious yellow-green eye discharge. Gram stain indicates she most likely has gonococcal conjunctivitis. While awaiting the culture results, the plan of care should be: 1. None, wait for the culture results to determine the course of treatment 2. Ciprofloxacin (Ciloxan) ophthalmic drops 3. IM ceftriaxone 4. High-dose oral amoxicillin
Answer: IM ceftriaxone (severity of the disease, potential for severe eye damage) which is a cephalosporin Gonococcal is gram negative. Gram negative (and based on the results consider aminopenicillins when combined with a beta lactase inhibitor) (this is not an option) Next we go to ciprofloxacin (Ciloxan): ciprofloxacin is a fluoroquinolone (this has excellent gram negative activity and variable gram positive activity). However, I am not sure that ciprofloxin can be in the ophthalmic form? IM ceftriaxone: ceftriaxone is a 3rd generation cephalosporin. Third generation has gram negative activity and gonococcal conjunctivitis is a gram negative bacteria.
What is the brand name for amoxicillin/clavulanate
Augmentin
Samantha is 34 weeks pregnant and has been diagnosed with pneumonia. She is stable enough to be treated as an outpatient. What would be an appropriate antibiotic to prescribe? A) Levofloxacin B) Azithromycin C) Amoxicillin D) Doxycycline
Azithromycin: Yes, safe for use in pregnancy (azalide class) Levofloxacin: this is a fluoroquinolone for bronchitis, community acquired pneumonia, sinusitis, UTI (but do not give to pregnant women due to adverse effects on joints and cartilage) Amoxicillin: a type of pneumonia is naturally resistant to penicillin, this is a type of penicillinase resistant penicillin which should be avoided in later pregnancy and neonates because it may displace bilirubin from plasma proteins of newborn which causes a CNS disorder doxycycline: this another penicillinase resistant penicillin, which may cause potential CNS disorder
When prescribing metronidazole (Flagyl) to treat bacterial vaginosis, patient education would include: A. Metronidazole is safe in the first trimester of pregnancy B. Consuming alcohol in any form may cause a severe reaction C. Sexual partners need concurrent therapy D. Headaches are a sign of a serious adverse reaction and need immediate evaluation
B. Consuming alcohol in any form may cause a severe reaction
When prescribing acyclovir, patients should be educated regarding: A. High risk of developing diarrhea B. Need to drink lots of fluids during treatment C. Risk for life-threatening rash such as Stevens-Johnson D. Eccentric dosing schedule
B. Need to drink lots of fluids during treatment
To prevent the development of peripheral neuropathy in patients taking isoniazid for tuberculosis the patient is also prescribed: A. Niacin (Vitamin B3) B. Pyridoxine (Vitamin B6) C. Riboflavin (Vitamin B2) D. Thiamine (Vitamin B1)
B. Pyridoxine (Vitamin B6)
Pregnant patients who are taking isoniazid (INH) should take 25 mg/day of vitamin B6 (pyridoxine) to prevent: A.Beriberi B.Peripheral neuropathy C.Rickets D.Megaloblastic anemia
B.Peripheral neuropathy
A client who is allergic to penicillin is at increased risk for an allergy to which drug? a. Erythromycin (E-mycin) b. Gentamicin (Garamycin) c. Cefazolin sodium (Ancef) d. Demeclocycline (Declomycin)
C Clients who are allergic to penicillins have an increased risk of allergy to other beta-lactam antibiotics. The incidence of cross-reactivity between cephalosporins and penicillins is reported to be between 1% and 4%.
Which information should the nurse include in discharge teaching for a client prescribed doxycycline (Vibramycin)? a. "Keep the remainder of the medication in case of recurrence." b. "Take the medication until you have no fever and feel better." c. "Apply sunscreen or wear protective clothing when outdoors." d. "Take the medication with milk to minimize gastrointestinal upset."
C Photosensitivity is a common adverse effect of doxycycline, a tetracycline antibiotic. The client should avoid direct sun exposure and tanning bed use while taking this medication. Exposure to the sun can cause severe burns.
Pharmacogenetic testing is required by the Food and Drug Administration (FDA) prior to prescribing: A.Erythromycin B.Digoxin C.Cetuximab D.Rifampin
C. Cetuximab is an epidermal growth factor receptor (EGFR) inhibitor used for the treatment of metastatic colorectal cancer, metastatic non-small cell lung cancer and head and neck cancer.
Nicole is a 16 year old who is taking minocycline for acne. She comes to the clinic complaining of a headache. What would be the plan of care? A. Advise acetaminophen or ibuprofen as needed for headaches B. Prescribe sumatriptan (Imitrex) to be taken at the onset of the headache C. Evaluate for pseudotremor cerebri D. Assess her caffeine intake and sleep patterns
C. Evaluate for pseudotremor cerebri
Rifampin is to treat tuberculosis: Rifampin is a nonspecific CYP450 inducer that may: A.Lead to toxic levels of rifampin and must be monitored closely B.Cause toxic levels of drugs, such as oral contraceptives, when co-administered C.Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure D.Cause nonspecific changes in drug metabolism
C. Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure/// (Antimycobacterial, induces liver metabolism)
When prescribing a tetracycline or quinolone antibiotic it is critical to instruct the patient: A. Not to take their regularly prescribed medications while on these antibiotics B. Regarding the need for lots of acidic foods and juices, such as orange juice, to enhance absorption C. Not to take antacids while on these medications, as the antacid decreases absorption D. That there are no drug interactions with these antibiotics
C. Not to take antacids while on these medications, as the antacid decreases absorption should not take any antacid until at least 2 hours after tetracycline administration Aluminum hydroxide and magnesium hydroxide have a strong affinity for tetracycline and form an insoluble and inactive chelate. This interaction can reduce the bioavailability of tetracycline by 90% and result in clinical failures doxycycline (tetracycline) cipro (quinolone)
A client prescribed azithromycin (Zithromax) expresses concern regarding GI upset that was experienced when previously prescribed an erythromycin antibiotic. What is the nurse's best response? a. "Take an over-the-counter antiemetic to lessen the nausea." b. "Stop taking the drug if you experience heartburn and diarrhea." c. "I will call the health care provider and request a different antibiotic." d. "This drug is like erythromycin with less gastrointestinal adverse effects."
D Azithromycin is a newer macrolide antibiotic. It has a longer duration of action, as well as fewer and less severe GI adverse effects than erythromycin.
Nicole is a 4-year-old female with a febrile urinary tract infection. She is generally healthy and has no drug allergies. Appropriate initial therapy for her UTI would be: A) Azithromycin B) Trimethoprim/sulfamethoxazole C) Ceftriaxone D) Ciprofloxacin
Ceftriaxone, ceftriaxone is a cephalosporin Azithromycin is not used because the oral form is used for skin infections, Chlamydia, urethritis Bactrim Ceftriaxone Ciprofloxacin: not recommended in children, outdoes treat UTI, anthrax, etc and is part of the fluoroquinolone *Due to the presence of a fever it is possible this could by pyelonephritis (Ceftriaxone is used due to convenience of 24 hour dosing)
Mechanism for cephalosporin?
Cephalosporin mechanism is what? Correct answer: inhibits bacterial cell wall synthesis by binding to penicillin binding proteins and inhibiting peptidoglycan synthesis
9. Alyssa is a 15-month-old patient who has been on amoxicillin for 2 days for acute otitis media. She is still febrile and there is no change in her tympanic membrane examination. What would be the plan of care for her? 1. Continue the amoxicillin for the full 10 days. 2. Change the antibiotic to azithromycin. 3. Change the antibiotic to amoxicillin/clavulanate. 4. Change the antibiotic to trimethoprim/sulfamethoxazole.
Change the antibiotic to amoxicillin/clavulanate.
Jamie is a 24-year-old female with a UTI. She is healthy, afebrile, and her only drug allergy is sulfa. An appropriate first line antibiotic choice for her would be: 1. Azithromycin 2. Trimethoprim/sulfamethoxazole 3. Ceftriaxone 4. Ciprofloxacin
Ciprofloxacin (not bactrim because she is allergic to sulfa, not azithromycin because Ceftriaxone: skin infections, endocarditis, meningitis, gonorrhea remember quinolone like ciprofloxacin are 2nd line for UTI, however in this case the first line drugs such as: nitrofurantoin, bactrim( cannot be used) and phosphomycin are not mentioned.
The nurse identifies Zosyn as being a member of which group? a. cephalosporins b. macrolides c. penicillins d. sulfonamides
Correct answer: C Rationale: Zosyn is a penicillin. The nurse should be aware of the fact that many times, these drugs are referred to by their trade names and do not always end in "cillin," such as with Zosyn and Augmentin.
Which of the following does the nurse identify as being a concern for patients receiving tetracycline? a. tetracycline should not be administered to anyone older than age 65 years b. tetracycline has no impact on the effectiveness of oral contraceptives c. tetracycline used with warfarin decreases its effectiveness and enhances clot formation d. tetracyclines should not be administered with dairy products
Correct answer: D Rationale: Assess for significant drug interactions, including simultaneous use of antacids, antidiarrheal drugs, dairy products, calcium, enteral feedings, and iron preparations. There is concern regarding the use of these drugs in patients younger than 8 years of age because of the problem of permanent mottling and discoloration of the teeth. Tetracyclines may also decrease the effectiveness of oral contraceptives. Assess the patient taking oral anticoagulants more closely because of possible potentiation of bleeding.
A patient has a prescription for a sulfa drug as treatment for a UTI. She is also taking an oral contraceptive, an oral sulfonylurea antidiabetic drug, and phenytoin for a history of seizures. Which drug may pose a potential serious interaction with the sulfa drug? a. The oral contraceptive b. The oral antidiabetic drug c. The phenytoin d. All of these
Correct answer: D Rationale: The combination of the sulfa drug with the oral contraceptive may reduce the effectiveness of the contraceptive. The combination with the oral antidiabetic drug may potentiate the hypoglycemic effect of the sulfonylurea drug, and the combination with the phenytoin may potentiate the toxic effects of the phenytoin.
A 58-year-old man is receiving vancomycin as part of the treatment for a severe bone infection. After the infusion, he begins to experience some itching and flushing of the neck, face, and upper body. He reports no chills or difficulty breathing. The nurse should suspect a. an allergic reaction has occurred. b. an anaphylactic reaction is about to occur. c. the medication will not be effective for the bone infection. . the IV dose may have infused too quickly.
Correct answer: D Rationale: These symptoms are know as red man syndrome and may occur during or after an infusion of vancomycin. This syndrome is characterized by flushing or itching of the head, face, neck, and upper trunk area. Symptoms can usually be alleviated by slowing the rate of infusion to at least 1 hour. Red man syndrome is bothersome but usually not harmful. Rapid infusions may also cause hypotension.
Which adverse effect can result if tetracycline is administered to children younger than 8 years of age? a. Drug-induced neurotoxicity b. Delayed growth development c. Gastrointestinal (GI) and rectal bleeding d. Permanent discoloration of the teeth
D Tetracycline is contraindicated in children younger than 8 years of age because it can cause permanent discoloration of the adult teeth and tooth enamel, which are still forming in the child.
While teaching the client about taking oral tetracycline, which of the following does the nurse advise the client to do? A) Consume calcium-rich products to decrease the duration of the antibacterial effect B) Use a soft toothbrush and floss teeth gently to remove staining on teeth C) Report any ringing in the ears or dizziness D) Avoid direct exposure to sunlight and apply sun block when outdoors
D) Avoid direct exposure to sunlight and apply sun block when outdoors
Monitoring for patients who are on long-term antifungal therapy with ketoconazole includes: A. Platelet count B. BUN and creatinine C. White blood cell count D. AST, ALT, alkaline phosphatase, and bilirubin
D. AST, ALT, alkaline phosphatase, and bilirubin
Penicillin is active against what? Gram + cocci Strep Gram - cocci Gram - baccilli
Gram + cocci, Strep, and Staph
Amoxicillin has extended activity beyond penicillin to include Haemophilus influenzae Pseudomonas aeruginosa E. Coli Enterococci Proteus mirabis
Haemophilus influenzae, E.Coli Proteus mirabis
Major toxicity of isoniazid?
Hepatitis, can also cause peripheral neuropathy (especially if predisposed) give B6!
The nurse will instruct a patient who is receiving a tetracycline antibiotic to take it using which guideline? a. It should be taken with milk b. It should be taken with 8oz of water c. It should be taken 30 minutes before iron preparations are taken d. An antacid should also be taken to decrease GI discomfort
It should be taken with 8oz of water
13. Keng has chronic hepatitis that has led to mildly impaired liver function. He has an infection that would be best treated by a macrolide. Which would be the best choice for a patient with liver dysfunction? 1. Azithromycin (Zithromax) 2. Clarithromycin (Biaxin) 3. Erythromycin (E-mycin) 4. None of the above
None of the above (all can inhibit cytochrome)
Jamie is a 24-year-old female with a urinary tract infection. She is healthy, afebrile, and her only drug allergy is sulfa, which gives her a rash. An appropriate first-line antibiotic choice or her would be: 1. Azithromycin 2. Trimethoprim/sulfamethoxazole 3. Ceftriaxone 4. Ciprofloxacin
Not azithromycin because this is for skin infections, clamydia// *bactrim, phosphomycin, nitrofurantoin (first ones) since pt has a sulfa allergy cannot use bactrim. Therefore think of second lines which are quinolone like ciprofloaxin. Another one that could be used is levofloxacin (can also be used for community acquired pneumonia and sinusitis). Trimethoprim/sulfamethoxazole: cannot use because the patient is allergic to sulfa Ceftriaxone: this is prescribed if someone is allergic to sulfa drugs or fluoroquinolones answer: Ciprofloxacin (this is a fluoroquinolone) (usually the first line treatment is bactrim or nitrofurantoin; but the fluoroquinolone are the next (this resistance has been increasing and this is not recommended for children or pregnant women except for ciprofloaxin, second line therapy)
A patient who is receiving vancomycin (Vancocin) therapy should notify the nurse immediately if which effects are noted? (Select all that apply) a. Ringing in the ears b. Dizziness c.Hearing loss d.Fullness in the ears e. Nausea
Ringing in the ears b. Dizziness c.Hearing loss d.Fullness in the ears
By itself amoxicillin is vulnerable to beta-lactamase. so it is given with clavulanate.
True
The client's culture has grown gram-positive cocci, and the health care provider prescribes two different antibiotics, one of which is gentamicin (Garamycin). To treat this type of infection, which type of antibiotic is typically prescribed together with gentamicin (Garamycin)? a. Penicillin b. Cephalosporin c. Fluoroquinolone d. Aminoglycoside
a In gram-positive cocci, gentamicin is usually given in combination with a penicillin antibiotic. The other antibiotics are not typically prescribed with gentamicin for this culture result.
When administering vancomycin, the nurse knows that which of these is most important to assess before giving the medication? a. renal function b. WBC count c. liver function d. platelet count
a. renal function
A patient has been admitted to the unit with a stage IV pressure ulcer. After 2 days, the wound culture results come back positive for MRSA. The nurse knows that the drug of choice for the treatment of MRSA infections is which drug? a. vancomycin (Vancocin) b. gentamicin (Garamycin) c.ciprofloxacin (Cipro) d. colistimethate (Coly-Mycin
a. vancomycin (Vancocin)
Tetracyclines should not be prescribed to children younger than 8 years due to: A. Risk of developing cartilage problems B. Development of significant diarrhea C. Risk of kernicterus D. Adverse effects on bone growth
adverse effects on bone growth
15. If a patient is allergic to sulfonamide antibiotics, he or she will most likely have cross-sensitivity to: 1. Loop diuretics 2. Sulfonylureas 3. Thiazide diuretics 4. All of the above
all of the above
A child that may warrant "watchful waiting" instead of prescribing an antibiotic for acute otitis media includes patients who: 1. Are low risk with temperature of less than 39oC or 102.2oF 2. Have reliable parents with transportation 3. Are older than age 2 years 4. All of the above
all of the above
The treatment goals when treating urinary tract infection (UTI) include: 1. Eradication of infecting organism 2. Relief of symptoms 3. Prevention of recurrence of the UTI 4. All of the above
all of the above
4. Jaheem is a 10-year-old low-risk patient with sinusitis. Treatment for a child with sinusitis is: 1. Amoxicillin 2. Azithromycin 3. Cephalexin 4. Levofloxacin
amoxicillin
Patient Education: Gentamicin
avoid direct exposure to sunlight
A client who is prescribed metronidazole (Flagyl) for a gynecologic infection provides the nurse with a list of medications that are routinely taken. Which medication would lead the nurse to question the prescription for Flagyl? a. Ibuprofen (Advil) b. Lithium (Eskalith) c. Levothyroxine (Synthroid) d. Multivitamin (Thera-Tabs)
b Concomitant use of lithium and metronidazole may result in lithium toxicity. Thus, a client who reports taking lithium should alert the nurse to notify the health care provider because of the potential significant interaction.
For a client receiving an intravenous (IV) infusion of gentamicin (Garamycin), the nurse would monitor which laboratory values? a. Hematocrit and hemoglobin b. Blood urea nitrogen (BUN) and creatinine c. Prothrombin time and partial thromboplastin time d. Serum glutamic-oxaloacetic transaminase and alanine transaminase
b Gentamicin has a high potential for nephrotoxicity. Nephrotoxicity typically occurs in 5% to 25% of clients. Thus, the client's renal function test results for BUN and creatinine must be monitored closely throughout therapy.
When performing discharge teaching for a client prescribed oral linezolid (Zyvox) to treat methicillin-resistant Staphylococcus aureus (MRSA), the nurse should emphasize which important information? a. Stop the drug as soon as you feel better. b. Avoid ingestion of foods containing tyramine. c. Report any occurrence of constipation or facial flushing. d. Take the drug with an antacid to avoid gastrointestinal (GI) upset.
b hypertension may occur in clients consuming tyramine-containing foods such as aged cheese or wine, soy sauce, smoked meats or fish, and sauerkraut while taking linezolid. Linezolid causes diarrhea, not constipation, and should be taken with food to decrease GI distress. An antacid would interfere with absorption.
A patient is prescribed linezolid (Zyvox) to trade hospital-acquired pneumonia. It is most important for the nurse to determine if the patient is also taking which medication? a. a diuretic b. an SSRI c. a cardiac glycoside d. a thyroid replacement drug
b. an SSRI
The nurse is reviewing the drugs ordered for a patient. A drug interaction occurs between penicillins and which drugs? (Select all that apply) a.Alcohol b.Oral Contraceptives c.Digoxin d.Nonsteroidal antiinflammatory drugs e.Warfarin f.Anticonvulsants
b.Oral Contraceptives d.Nonsteroidal antiinflammatory drugs e.Warfarin
Tetracyclines have been overused, but doxycline is good. Characteristics of tetracycline (doxycline, omadacycline)?
bacteriostatic, Chlamydia, mycoplasma, but toxicities are an issue (GI irritation esp. doxycycline esophageal irritation), phototoxic, brown discoloration of the teeth, slower bone growth (do not give in children younger than 12), pregnancy category D, Avoid Milk/Dairy/Antacids/Iron preparations
The nurse should assess a client for nephrotoxicity and ototoxicity when administering which antimicrobial? a. Cefazolin (Ancef) b. Clindamycin (Cleocin) c. Gentamicin (Garamycin) d. Erythromycin
c Aminoglycoside antibiotics, including gentamicin, have a high risk for nephrotoxicity and ototoxicity.
The nurse is administering an IV amino glycoside to a patient who has had GI surgery. Which nursing measures are appropriate? (SATA) a. report a trough drug level of 0.8 mcg/mL, and hold the drug b. enforce strict fluid restriction c. monitor serum creatinine levels d. instruct the patient to report dizziness or a feeling of fullness in the ears e. warn the patient that the urine may turn darker in color
c and d monitor serum creatinine levels d. instruct the patient to report dizziness or a feeling of fullness in the ears
Quinolones are a class of antibiotics known for several significant complications. Which are possible adverse effects with these drugs? (Select all that apply.) a. Ototoxicity b. Nephrotoxicity c. Tendon rupture d. Prolongation of the QT interval e. Abnormal cartilage development in children
c, d, and e Quinolones are not used in prepubescent children because of the risk of cartilage development issues. Quinolones may also cause a cardiac effect that involves prolongation of the QT interval on the electrocardiogram. The use of these medications can result in tendonitis or ruptured tendons in adults. Nephrotoxicity and ototoxicity are not associated with quinolones.
When patients are receiving aminoglycosides, the nurse must monitor for tinnitus and dizziness, which may indicate which problem? a. Cardiotoxicity b. Hepatotoxicity c. Ototoxicity d. Nephrotoxicity
c. Ototoxicity
A patient has been admitted for treatment of an infected leg ulcer and will be started on IV linezolid. The nurse is reviewing the list of the patient's current medications. Which type of medication, if listed, would be of most concern if taken with the linezolid? a. beta blocker b. oral anticoagulant c. SSRI d. thyroid replacement hormone
c. SSRI
A newly admitted patient reports a penicillin allergy. The prescriber has ordered a second-generation cephalosporin as part of the therapy. Which nursing action is appropriate? a. call the prescriber to clarify the order because of the patient's allergy b. give the medication, and monitor for adverse effects c. ask the pharmacy to change the order to a first-generation cephalosporin d. administer the drug with a NSAID to reduce adverse effects
call the prescriber to clarify the order because of the patient's allergy
Alyssa is a 15-month-old patient who has been on amoxicillin for 2 days for acute otitis media. She is still febrile and there is no change in her tympanic membrane examination. What would be the plan of care for her? 1. Continue the amoxicillin for the full 10 days. 2. Change the antibiotic to azithromycin. 3. Change the antibiotic to amoxicillin/clavulanate. 4. Change the antibiotic to trimethoprim/sulfamethoxazole.
change the antibiotic to amoxicillin/clavulanate
10. To prevent further development of antibacterial resistance it is recommended that fluoroquinolones be reserved for treatment of: 1. Urinary tract infections in young women 2. Upper respiratory infections in adults 3. Skin and soft tissue infections in adults 4. Community-acquired pneumonia in patients with comorbidities
community acquired pneumonia in pt with comorbidities
The nurse will question the use of a fluoroquinolone antibiotic in a client already prescribed which medication? a. Furosemide (Lasix) b. Omeprazole (Prilosec) c. Metoprolol (Lopressor) d. Amiodarone (Cordarone)
d Dangerous cardiac dysrhythmias are more likely to occur when quinolones are taken by clients receiving class Ia and class III antidysrhythmic drugs such as disopyramide and amiodarone. For this reason, such drug combinations should be avoided.
Which is a complication of vancomycin IV infusions? a. Angioedema b. Neurotoxicity c. Cardiomyopathy d. Red man syndrome
d When infused too rapidly, clients receiving vancomycin may develop hypotension accompanied by flushing or itching of the head, face, neck, and upper trunk area. This phenomenon is called red man syndrome.
During therapy with an IV amino glycoside, the patient calls the nurse and says, "I'm hearing some odd sounds, like ringing, in my ears." What is the nurse's priority action at this time? a. reassure the patient that these are expected adverse effects b. reduce the rate of the IV infusion c. increase the rate of the IV infusion d. stop the infusion immediately
d. stop the infusion immediately
The client has received a prescription for tetracycline (Sumycin) for treatment of acne. The nurse will teach the client to avoid taking the tetracycline concurrently with ________.
dairy products -iron containing preparations such as multi-vitamins -antacids
During patient education regarding an oral macrolide such as erythromycin, the nurse will include which information? a. if GI upset occurs, the drug will have to be stopped b. the drug needs to be taken with an antacid to avoid GI problems c. the patient needs to take each dose with a sip of water d. the patient may take the drug with a small snack to reduce GI irritation
the patient may take the drug with a small snack to reduce GI irritation
While assessing a woman who is receiving quinolone therapy for pneumonia, the nurse notices that the patient has a history of heart problems. The nurse will monitor for which potential cardiac effect of quinolone therapy? a. bradycardia b. dysrhythmias c. tachycardia d. prolonged QT interval
dprolonged QT interval
First generation cephalosporins have (cephlaxin) has good activity against?
gram positive
2nd generation cephalosporins (cefprozil) has increased activity against gram negative bacteria such as?
haemophilus influenzae, escherichia coli
Tetracycline is an?
inhibitor of protein synthesis along with ahminoglycosides, macrolide, clindamycin, linezoid
Mechanism for penicillin
nhibits bacterial cell wall synthesis by binding to penicillin binding proteins and inhibiting peptidoglycan synthesis
When giving IV quinolones, the nurse needs to keep in mind that these drugs may have serious interactions with which drugs? a. SSRIs b. NSAIDs c. oral anticoagulants d. antihypertensives
oral anticoagulants
Third generation cephalosporins have (cefdinir and cefixime) have good activity against?
ram positive and gram negative aerobic bacteria
Cephalosporin eliminated via?
renal
Sadie is an 82-year-old patient who has herpes zoster (shingles) and would benefit from an antiviral such as valacyclovir. Prior to prescribing valacyclovir she will need assessment of: A. Complete blood count to rule out anemia B. Liver function C. Renal function D. Immunocompetence
renalfunction
Indications for cephalosporins?
respiratory tract, otitis media, sinusitis, skin, urinary tract
14. Jamie has glucose-6-phosphate dehydrogenase deficiency (G6PD) and requires an antibiotic. Which class of antibiotics should be avoided in this patient? 1. Penicillins 2. Macrolides 3. Cephalosporins 4. Sulfonamides
sulfonamides
11. Fluoroquinolones have a Black Box Warning regarding ________ even months after treatment. 1. Renal dysfunction 2. Hepatic toxicity 3. Tendon rupture 4. Development of glaucoma
tendon rupture
A teenage patient is taking a tetracycline drug as part of treatment for severe acne. When the nurse teaches this patient about drug-related precautions, which is the most important information to convey? a. when the acne clears up, the medication may be discontinues b this medication needs to be taken with antacids to reduce GI upset c. the patient needs to use sunscreen or avoid exposure to sunlight, because this drug may cause photosensitivity d. the teeth should be observed closely for signs of mottling or other color changes
the patient needs to use sunscreen or avoid exposure to sunlight, because this drug may cause photosensitivity
Sally is a 16-year-old female with a urinary tract infection. She is healthy, afebrile, with no use of antibiotics in the previous 6 months and no drug allergies. An appropriate first-line antibiotic choice for her would be: 1. Azithromycin 2. Trimethoprim/sulfamethoxazole 3. Ceftriaxone 4. Levofloxacin
trimethoprim/sulfamethoxazole
As of 2011 every antibiotic drug class has resistant organisms which influence prescribing decisions. True or False
true
Antimycobacterial drug: Isoniazid is a key drug for?
tuberculosis, inhibits mycelia acid synthesis of the cell wall, eliminates in 90 minutes w/ fast metabolizers (Eskimos, Native Americans, Asians)
