More Antibiotics

CH. 83 - Basic Principles of Antimicrobial Therapy

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CH. 84 - Drugs That Weaken the Bacterial Cell Wall I: Penicillins

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CH. 85 - Drugs That Weaken the Bacterial Cell Wall II: Cephalosporins, Carbapenems, Vancomycin, Telavancin, Aztreonam, Teicoplanin, and Fosfomycin

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CH. 86 - Bacteriostatic Inhibitors of Protein Synthesis: Tetracyclines, Macrolides, and Others

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CH. 87 - Aminoglycosides: Bactericidal Inhibitors of Protein Synthesis

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CH. 88 - Sulfonamides and Trimethoprim

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CH. 89 - Drug Therapy of Urinary Tract Infections

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The nurse should include which instructions when teaching a patient about tigecycline therapy? (Select all that apply.) A. "Use sunscreen when you are outside." B. "If you have diarrhea more than five times a day, notify your healthcare provider." C. "Avoid using this drug if you are pregnant." D. "Stop taking the drug if you experience nausea." E. "Stop taking the drug if you experience vomiting."

A, B, C Nausea and vomiting may occur. The patient should not stop taking the medication; rather, the healthcare provider should be notified so that an alternative plan can be discussed. The other three instructions should be included in the patient teaching.

Which statements about vancomycin (Vancocin) does the nurse identify as true? (Select all that apply.) A. Vancomycin is the most widely used antibiotic in U.S. hospitals. B. Vancomycin is effective in the treatment of Clostridium difficile infection. C. Vancomycin is effective in the treatment of MRSA infections. D. Patients who are allergic to penicillin are also allergic to vancomycin. E. The major toxicity of vancomycin therapy is liver failure.

A, B, C Patients who are allergic to penicillin are able to take vancomycin. The major toxicity of vancomycin therapy is kidney failure. The other three statements are true.

Which statements about serum drug levels does the nurse identify as true? (Select all that apply.) A. With once-daily dosing, only trough levels need to be drawn. B. Peak levels for intramuscular (IM) injections should be drawn 30 minutes after administration of the medication. C. The trough level ideally should be close to zero. D. For patients receiving once-daily doses, the sample should be drawn 2 hours before the next dose. E. For patients receiving divided doses, trough levels should be drawn 1 hour before the next dose.

A, B, D For patients receiving once-daily doses, the sample should be drawn 1 hour before the next dose. For patients receiving divided doses, trough levels should be drawn immediately before the next dose. The other three statements are true.

The nurse identifies which statements about Stevens-Johnson syndrome as true? (Select all that apply.) A. Patients with Stevens-Johnson syndrome have a mortality rate of about 25%. B. Toxemia is associated with Stevens-Johnson syndrome. C. Short-acting sulfonamides do not induce Stevens-Johnson syndrome. D. Patients with Stevens-Johnson syndrome usually are hypothermic. E. Lesions of the mucous membranes are a characteristic of Stevens-Johnson syndrome.

A, B, E Short-acting sulfonamides do induce Stevens-Johnson syndrome on rare occasions, and patients with Stevens-Johnson syndrome usually are hyperthermic. The other three statements are true.

The nurse identifies which statements about penicillins as true? (Select all that apply.) A. Penicillins are the safest antibiotics available. B. The principal adverse effect of penicillins is allergic reaction. C. A patient who is allergic to penicillin always has a cross-allergy to cephalosporins. D. A patient who is allergic to penicillin is also allergic to vancomycin, erythromycin, and clindamycin. E. Penicillins are normally eliminated rapidly by the kidneys but can accumulate to harmful levels if renal function is severely impaired.

A, B, E A patient who is allergic to penicillin has a 1% chance of also being allergic to cephalosporins. Patients who are allergic to penicillin are safely able to take vancomycin, erythromycin, and clindamycin. The other three statements are true.

The nurse identifies appropriate use of antimicrobials to prevent infection in which situations? (Select all that apply.) A. Cardiac surgery B. Recurrent urinary tract infections in women C. Anemia D. Treatment of fever of unknown origin E. Hysterectomy

A, B, E Prophylactic use of antibiotics can reduce the incidence of infection in certain kinds of surgery. Procedures in which prophylactic efficacy has been documented include cardiac surgery, peripheral vascular surgery, orthopedic surgery, and surgery on the gastrointestinal (GI) tract (stomach, duodenum, colon, rectum, and appendix). Prophylaxis is also beneficial for women undergoing a hysterectomy or an emergency cesarean section. Severe neutropenia, not anemia puts individuals at high risk of infection. In young women with recurrent urinary tract infection, prophylaxis with trimethoprim/sulfamethoxazole may be helpful. Unless the cause of a fever is a proven infection, antibiotics should not be used. Fever by itself constitutes a legitimate indication for antibiotic use only when the fever occurs in a severely immunocompromised person. Because fever may indicate infection and because infection can be lethal to immunocompromised individuals, these patients should be given antibiotics when fever occurs, even if fever is the only indication that an infection may be present.

Which medications does the nurse identify as having antibacterial properties? (Select all that apply.) A. Rifampin B. Zidovudine C. Imipenem D. Amphotericin B E. Amantadine

A, C Zidovudine and amantadine are antiviral drugs. Amphotericin B is an antifungal drug. Rifampin and imipenem are antibacterial drugs.

Which instructions will the nurse include when teaching a patient about cephalosporin therapy? (Select all that apply.) A. "Notify your healthcare provider if you develop diarrhea." B. "Take aspirin if you develop a headache." C. "Notify your healthcare provider if you develop a rash." D. "Cephalosporins may not be taken with food." E. "Do not take cephalosporins if you have lactose intolerance."

A, C Cephalosporins may enhance bleeding tendencies, so drugs such as aspirin that may promote bleeding should be avoided. Cephalosporins may be taken with food, and they are safe to take if a patient has lactose intolerance. Severe diarrhea should be reported, because it may indicate the development of C. difficile infection. Any indication of an allergic reaction, including a rash, should be reported to the healthcare provider.

Which outcomes should a nurse establish when planning care for a patient taking methenamine (Mandelamine)? (Select all that apply.) A. Maintains a urine pH of 5.5 or lower B. Consumes 3000 mL of liquid daily C. Uses an enteric-coated formulation D. Avoids sulfonamide medications E. No elevation in liver enzymes

A, C, D Under acidic conditions, methenamine makes formaldehyde, which causes bacterial cell death. Formaldehyde requires an acid urine to be released. To prevent the dose from being converted to formaldehyde in an acidic stomach, an enteric-coated formula may be used. Ingestion of large volumes of fluid dilutes methenamine and raises the urinary pH. Hepatotoxicity is not associated with methenamine (Mandelamine).

The nurse identifies which statements about frequent urinary tract reinfections as true? (Select all that apply.) A. Reinfections are considered frequent if the individual has three or more a year. B. Prophylactic therapy should continue for at least 2 months. C. If reinfection is associated with sexual intercourse, the risk can be reduced by instructing the patient to void after intercourse. D. Single-dose nitrofurantoin 50 mg taken 1 hour before intercourse has been found to reduce the rate of reinfection. E. If a symptomatic episode occurs, the standard therapy for acute cystitis should be used.

A, C, E Prophylactic therapy should continue for at least 6 months. Single-dose trimethoprim/sulfamethoxazole, taken after intercourse, has been found to reduce the risk of reinfection. The other three statements are true.

A nurse should recognize that antibiotic prophylaxis is appropriate in patients with which medical conditions? (Select all that apply.) A. Aortic valve replacement B. Ruptured appendix C. Bronchitis D. Neutropenia E. Chickenpox

A, D Antibiotic prophylaxis is appropriate and effective in certain situations. These include patients who have prosthetic valves and are at risk for bacterial endocarditis. The use of antibiotics in "dirty" surgeries, such as those for ruptured organs, is considered treatment, not prophylaxis. Severe neutropenia can put patients at risk for severe infection, and antibiotics can reduce infections but may encourage fungal invasion. Antibiotics are not prescribed preventively for bronchitis or chickenpox.

A patient is receiving local applications of mafenide (Sulfamylon) to burn areas. Before application, it is most important for the nurse to do what? A. Administer a pain medication. B. Obtain a set of vital signs. C. Auscultate the lung fields. D. Obtain a signed consent form.

A. Administer a pain medication. The sulfonamide mafenide (Sulfamylon) is used to suppress bacterial colonization in patients with burns. Local application frequently is painful. It is important to administer a pain medication before applying mafenide (Sulfamylon). Obtaining vital signs and a signed informed consent form and auscultating lung fields are not essential actions for mafenide application.

A patient is receiving penicillin G (Bicillin C-R). Which assessment should the nurse monitor as an indicator of an undesired effect? A. Cardiac rhythm B. Serum sodium level C. Lung sounds D. Red blood cell (RBC) count

A. Cardiac rhythm Penicillin G in high IV doses may cause hyperkalemia, which can result in dysrhythmias or cardiac arrest. Hypernatremia occurs with high IV doses of ticarcillin. Lung sounds and the RBC count are unrelated to the administration of penicillin G.

Both IV ampicillin/sulbactam (Unasyn) and gentamicin (Garamycin) are ordered for a patient. When administering these medications, the nurse will do what? A. Ensure that separate IV solutions are used. B. Use two different peripheral IV sites. C. Administer the gentamicin first. D. There are no necessary precautions.

A. Ensure that separate IV solutions are used. When penicillins are present in high concentrations, they interact chemically with aminoglycosides, causing inactivation of the aminoglycoside. Therefore, penicillins and aminoglycosides should not be mixed in the same IV solution. Rather, these drugs should be administered separately. Two different peripheral IV sites are not necessary. Administering the gentamicin first does not ensure separation of the two medications.

The nurse is working with a patient who has a UTI. Because patient adherence to a medication regimen is a concern, the nurse anticipates use of which medication? A. Fosfomycin B. Amoxicillin C. Cephalexin D. Trimethoprim

A. Fosfomycin When adherence is a concern, fosfomycin, which requires just one dose, is an attractive choice. As a rule, amoxicillin and cephalexin are avoided, because they are less effective than the alternatives and are less well tolerated. Trimethoprim requires a longer course of therapy than fosfomycin.

Which approach should a nurse take when administering an oral dose of levofloxacin (Levaquin)? A. Give the medication with or without food. B. Administer the drug with an oral dose of a magnesium-based antacid. C. Premedicate the patient with diphenhydramine (Benadryl). D. Administer the drug with milk products.

A. Give the medication with or without food. Levofloxacin should not be administered with milk products or antacids containing magnesium or aluminum, because this reduces absorption from the gastrointestinal (GI) tract. However, this does not happen with most foods. Premedicating with diphenhydramine is unnecessary.

Before administering an aminoglycoside, it is most important for the nurse to assess the patient for a history of what? A. Myasthenia gravis B. Asthma C. Hypertension D. Diabetes mellitus

A. Myasthenia gravis Aminoglycosides can inhibit neuromuscular transmission, causing flaccid paralysis and potentially fatal respiratory depression. These drugs should be used with extreme caution in patients with myasthenia gravis.

A patient is admitted to the hospital with a medical diagnosis of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). When taking the patient's history, a nurse recognizes which information as the most important? A. Plays a contact sport and is an athlete B. Currently resides in a long-term care facility C. Did not complete the last course of antibiotics D. Had gallbladder surgery in the previous month

A. Plays a contact sport and is an athlete CA-MRSA is transmitted by skin-to-skin contact and by contact with contaminated objects, such as sports equipment and personal items. It is seen in young, healthy people without recent exposure to healthcare facilities, which is one of the biggest risk factors for CA-MRSA. Not completing an antibiotic course is unrelated.

A patient develops flushing, rash, and pruritus during an IV infusion of vancomycin (Vancocin). Which action should a nurse take? A. Reduce the infusion rate. B. Administer diphenhydramine (Benadryl). C. Change the IV tubing. D. Check the patency of the IV.

A. Reduce the infusion rate. When vancomycin is infused too rapidly, histamine release may cause the patient to develop hypotension accompanied by flushing and warmth of the neck and face; this phenomenon is called red man syndrome. Diphenhydramine is not necessary if the infusion is administered slowly over at least 60 minutes. Changing the IV tubing would not help the symptoms. The patency of the IV needs to be checked before the administration is started.

When ceftriaxone is administered intravenously, it is most important for the nurse to avoid mixing it with what? A. Ringer's lactate B. Normal saline C. Sterile water D. D5 0.45% NS

A. Ringer's lactate Mixing ceftriaxone with calcium causes precipitates to form. Ringer's lactate contains calcium; therefore it should not be mixed with ceftriaxone. It is safe to mix normal saline, sterile water, and D5 0.45% NS with ceftriaxone.

A nurse should teach a patient to observe for which side effect when taking ampicillin (Polycillin)? A. Skin rash and loose stool B. Reddened tongue and gums C. Digit numbness and tingling D. Bruising and petechiae

A. Skin rash and loose stool Ampicillin's most common side effects are rash and diarrhea; both reactions occur more frequently with ampicillin than with any other penicillin. Reddened tongue and gums, digit numbness and tingling, and bruising and petechiae are not associated side effects of ampicillin.

A patient is receiving an aminoglycoside (tobramycin) antibiotic. A nurse asks the patient to choose daily meal selections, to which the patient responds, "Oh, dear, I don't want another IV." The nurse makes which assessment about the patient's response? A. Some hearing loss may have occurred. B. The confusion is due to the hospital stay. C. A nutrition consult most likely is needed. D. The patient has a family history of dementia.

A. Some hearing loss may have occurred. The patient's comment suggests that the person did not hear the instructions. Aminoglycoside antibiotics can cause ototoxicity. The first sign may be tinnitus (ringing in the ears), progressing to loss of high-frequency sounds. Audiometric testing is needed to detect it. Nutrition, confusion, and a family history of dementia do not address the problem of possible hearing loss associated with aminoglycosides.

The nurse identifies which drug as a short-acting tetracycline? A. Sumycin B. Declomycin C. Vibramycin D. Minocin

A. Sumycin Sumycin is a short-acting tetracycline. Declomycin is an intermediate-acting tetracycline, and Vibramycin and Minocin are long-acting tetracyclines.

Ch. 91: After completing a course of ciprofloxacin (Cipro) for a skin infection, the patient says, "I took the whole bottle of pills, but my infection hasn't gotten any better." Which additional information should the nurse recognize as most significant? A. The patient takes antacids on a daily basis. B. The medication was stored in a cool, dry area. C. The patient did not use sunscreen while taking the ciprofloxacin (Cipro). D. The patient took two doses of diphenhydramine (Benadryl) while on ciprofloxacin (Cipro) therapy.term-104

A. The patient takes antacids on a daily basis. Antacids interfere with the absorption of quinolone antibiotics, such as ciprofloxacin (Cipro), and many other drugs; therefore, this patient has not received the full dosing regimen, which is required if ciprofloxacin is to be effective against the infection. Storing the drug in a cool, dry area and using sunscreen or diphenhydramine would not disrupt the effectiveness of ciprofloxacin.

A patient who has a vancomycin-resistant enterococci (VRE) infection is receiving linezolid (Zyvox). Which laboratory result indicates that the patient is having an adverse effect? A. White blood cell (WBC) count of 1200 units/L B. Hemoglobin (Hgb) level of 18 g/dL C. Potassium level of 3.0 mEq/dL D. Glucose level of 200 mg/dL

A. White blood cell (WBC) count of 1200 units/L Linezolid can cause reversible myelosuppression, manifesting as anemia, leukopenia, or even pancytopenia. The potassium and blood glucose levels are not affected by linezolid.

Which manifestations does the nurse associate with the development of hemolytic anemia? (Select all that apply.) A. Urticaria B. Fever C. Pallor D. Jaundice E. Diarrhea

B, C, D Urticaria and diarrhea are not associated with the development of hemolytic anemia. Fever, pallor, and jaundice are associated with the development of hemolytic anemia.

A nurse is assessing the effects of antimicrobial therapy in a patient with pneumonia. The nurse should establish which outcomes when planning care? (Select all that apply.) A. Potassium level of 4 mEq/dL B. Reduction of fever C. Sterile sputum cultures D. Oxygen saturation of 98% E. Elastic skin turgor

B, C, D Antimicrobial therapy is assessed by monitoring clinical and laboratory responses. Clinical indicators of success in a patient with pneumonia may include afebrile status and resolution of an infectious infiltrate, resulting in an oxygen saturation above 95%. The disappearance of infectious organisms from post-treatment cultures also indicates resolution of infection. Potassium levels and elastic skin turgor are not assessment parameters for clinical infections, including pneumonia.

When performing a skin test for penicillin allergy, the nurse will do what? (Select all that apply.) A. Inject a tiny amount of the allergen subcutaneously. B. Observe for a local allergic response. C. Have epinephrine readily available. D. Have respiratory support readily available. E. Administer diphenhydramine (Benadryl) as the first-line agent should anaphylaxis occur.

B, C, D For a penicillin allergy skin test, a small amount of allergen is injected intradermally. The nurse observes for a local allergic reaction and has epinephrine and respiratory support readily available. Epinephrine is administered as the first-line agent should anaphylaxis occur.

Which statements about CDAD associated with clindamycin therapy does the nurse identify as true? (Select all that apply.) A. Leukopenia commonly occurs. B. It is a potentially fatal condition. C. Patients usually experience abdominal pain. D. Anticholinergics are effective in treating the diarrhea. E. Clindamycin therapy should be discontinued and vancomycin started.

B, C, E CDAD is a potentially fatal condition in which patients experience abdominal pain. If CDAD develops, clindamycin therapy should be stopped and vancomycin or metronidazole therapy started. Leukocytosis, not leukopenia, develops. Anticholinergics can make the diarrhea worse and therefore should be avoided.

A nurse assesses the history of a patient who has had multiple complicated UTIs for which risk factors? (Select all that apply.) A. Female gender, child-bearing age B. Indwelling catheter C. Prostate hypertrophy D. Fair skin tone E. Urinary tract stones

B, C, E Complicated UTIs occur in both males and females and usually are associated with some predisposing factor, such as calculi, prostatic hypertrophy, or catheters. Uncomplicated UTIs occur primarily in women of child-bearing age and are not associated with any specific predisposing factor. Fair skin tone is unrelated to UTI occurrence.

Which are examples of the improper use of antibiotic therapy? (Select all that apply.) A. Using surgical drainage as an adjunct to antibiotic therapy B. Treating a viral infection C. Basing treatment on sensitivity reports D. Treating fever in an immunodeficient patient E. Using dosing that results in a superinfection

B, E Common misuses of antibiotics include (1) treatment of a viral infection, which results in exposure of the patient to the risks of the medication without providing any benefits; and (2) improper dosing (dosing that is too high results in superinfection). The other answers are examples of the proper use of antimicrobial therapy.

Which instructions should a nurse provide to a patient who is to start taking amoxicillin/clavulanate (Augmentin)? A. "Take Augmentin once per day and only at bedtime." B. "Augmentin may be taken with food or meals." C. "Avoid taking Augmentin with grapefruit juice." D. "Use a minimal amount of liquid to swallow the Augmentin."

B. "Augmentin may be taken with food or meals." Amoxicillin/clavulanate is a broad-spectrum aminopenicillin that may be taken with meals. Most other oral penicillins must be taken with a full glass of water 1 hour before or 2 hours after meals. Taking oral penicillins only at bedtime, avoiding grapefruit juice, and taking the drug with only minimal water are not necessary.

Which instruction should a nurse include in the discharge teaching for a patient who is to start taking tetracycline (Sumycin)? A. "You may stop taking the pills when you begin to feel better." B. "Use sunscreen and protective clothing when outdoors." C. "You'll have to come back to the clinic for weekly blood work." D. "Take the medication with yogurt or milk so you won't have nausea."

B. "Use sunscreen and protective clothing when outdoors." Tetracyclines are bacteriostatic antibiotics; photosensitivity and severe sunburn are common adverse effects. A full course of antibiotics must always be taken. Blood studies are not necessary for therapeutic levels. Absorption decreases after ingestion of chelates, such as calcium and magnesium, so doses should be given 2 hours before or 2 hours after ingestion of milk products.

A nurse is administering a daily dose of tobramycin (Nebcin) at 1000. At which time should the nurse obtain the patient's blood sample to determine the trough level? A. 0800 B. 0900 C. 1130 D. 1200

B. 0900 Trough levels determine the lowest level between doses. Blood is drawn just before the next dose is administered when a divided dose is used or 1 hour before the next dose if a single daily dose is used.

When caring for a patient receiving mafenide (Sulfamylon) for treatment of a severe burn, it is most important for the nurse to monitor which laboratory value? A. Blood glucose level B. Acid-base status C. Sodium level D. Peak mafenide level

B. Acid-base status Mafenide (Sulfamylon) therapy is associated with the development of acidosis. Peak mafenide levels are not obtained. The blood glucose and sodium levels are not affected by mafenide.

Before administering trimethoprim, it is most important for the nurse to assess the patient for a history of what? A. Heart failure B. Alcoholism C. Diabetes D. Emphysema

B. Alcoholism Trimethoprim inhibits bacterial synthesis of folic acid. It is avoided in patients when folate deficiency is likely, such as in alcoholism, because bone marrow suppression may occur. Heart failure, diabetes, and emphysema are unrelated to adverse effects with trimethoprim.

Before administering intravenous (IV) penicillin, the nurse should do what? A. Flush the IV site with normal saline. B. Assess the patient for allergies. C. Review the patient's intake and output record. D. Determine the latest creatinine clearance result.

B. Assess the patient for allergies. The principal adverse effect of penicillins is allergic reaction. Penicillins are contraindicated in patients with a history of severe allergic reactions to penicillins, cephalosporins, or carbapenems. IV patency is important, as is monitoring renal function, because impairment can cause penicillins to reach toxic levels; however, these are not as important as determining allergy status.

When administering an aminoglycoside to a patient with myasthenia gravis, it is most important for the nurse to assess what? A. Deep tendon reflexes B. Breath sounds C. Eyelid movement D. Muscle strength

B. Breath sounds Aminoglycosides can inhibit neuromuscular transmission, causing potentially fatal respiratory depression. Patients with myasthenia gravis (MG) are at an increased risk. Deep tendon reflexes, eyelid movement, and muscle strength are important assessments for a patient who has MG, but they are not as important as airway and breathing ability.

The nurse identifies which host factor as the most important when choosing an antimicrobial drug? A. Age B. Competent immune function C. Genetic heritage D. Previous medication reactions

B. Competent immune function Two factors—host defenses and the site of infection—are unique to the selection of antibiotics. It is critical for success that antibiotics act synergistically with the immune system to subdue infection. Other host factors, such as age, genetic heritage, and previous drug reactions, are the same factors that must be considered when choosing any other medication.

A patient is taking nitrofurantoin (Macrodantin). Which finding should a nurse recognize as an indication that the treatment is having an undesired effect? A. Hyperpigmentation of the palms B. Dyspnea with chills C. Gum irritation with bleeding D. Scalp tenderness and thinning hair

B. Dyspnea with chills Nitrofurantoin, a urinary tract antiseptic, may induce a pulmonary reaction that manifests with dyspnea, chest pain, and chills. These symptoms, which resolve 2 to 4 days after the drug is stopped, are thought to be hypersensitivity reactions. Hyperpigmentation of the palms, gum irritation with bleeding, and scalp tenderness and thinning hair are not side effects associated with nitrofurantoin.

Most cases (more than 80%) of uncomplicated, community-acquired urinary tract infection (UTI) are caused by which bacteria? A. Klebsiella pneumoniae B. Escherichia coli C. Enterobacter spp. D. Pseudomonas spp.

B. Escherichia coli Most cases of uncomplicated, community-acquired UTI are caused by E. coli. In rare cases, other gram-negative bacilli (e.g., K. pneumoniae, Enterobacter spp., and Pseudomonas spp.) are the cause.

A patient who has acute cystitis is receiving treatment with trimethoprim/sulfamethoxazole. Which manifestation should indicate to a nurse that the patient's condition is worsening? A. Incontinence B. Flank pain C. 3+ pedal edema D. Hyperactive bowel sounds

B. Flank pain Flank pain may indicate continued infection or pyelonephritis. When acute cystitis is treated with a traditional agent of choice, such as trimethoprim/sulfamethoxazole, manifestations of dysuria, urinary urgency and frequency, suprapubic discomfort, and bacteriuria improve. Incontinence, 3+ pedal edema, and hyperactive bowel sounds are unrelated to acute cystitis.

What does the nurse identify as an adverse effect of clindamycin (Cleocin) therapy? A. Cyanosis and gray discoloration of the skin B. Frequent loose, watery stools with mucus and blood C. Reduction in all blood cells produced in the bone marrow D. Elevated bilirubin, with dark urine and jaundice

B. Frequent loose, watery stools with mucus and blood Clostridium difficile-associated diarrhea (CDAD) is the most severe toxicity associated with clindamycin and is characterized by profuse, watery stools. The cause is superinfection of the bowel with Clostridium difficile, an anaerobic gram-positive bacillus. Gray syndrome, which usually occurs in infants and those with aplastic anemia, is an adverse effect of chloramphenicol (Chloromycetin). Hepatotoxicity is associated most closely with telithromycin (Ketek).

A patient taking a sulfonamide is breast-feeding an infant. Which complication in the infant would the nurse associate with kernicterus? A. Hemolytic anemia B. Neurologic deficits C. Hepatocellular failure D. Ophthalmic infection

B. Neurologic deficits Kernicterus is a disorder in newborns caused by deposition of bilirubin in the brain, which leads to severe neurologic deficits and death. Sulfonamides promote kernicterus by displacing protein-bound bilirubin from the proteins, leaving newly freed bilirubin access to brain sites. Sulfonamides are not administered to infants under 2 years old, nor are they given to pregnant patients near term or nursing mothers. Hemolytic anemia, hepatocellular failure, and ophthalmic infection are not associated sulfonamide effects in infants.

Which cardiovascular finding does the nurse identify as a possible adverse effect of erythromycin (Ery-Tab) therapy? A. Heart rate of 52 beats per minute B. Prolonged QT interval C. Jugular vein distention D. Grade III diastolic murmur

B. Prolonged QT interval When present in high levels, erythromycin can prolong the QT interval, causing a potentially fatal ventricular dysrhythmia. It should be avoided by patients taking class IA or class III antidysrhythmic medications or others that inhibit metabolism.

A patient is taking nalidixic acid (NegGram) and experiencing photophobia and diplopia. Which instruction should a nurse provide the patient? A. Wear prescription sunglasses. B. Restrict driving temporarily. C. Wear nonskid footwear. D. Avoid daytime activities.

B. Restrict driving temporarily. Nalidixic acid (NegGram) is a second-choice medication for UTIs. It can cause visual disturbances (blurred vision, diplopia, photophobia, altered color perception). Caution with driving is needed. Prescription sunglasses and avoiding daytime activities are not necessary. Nonskid footwear does not help a visual acuity problem.

The nurse is assessing a patient who is receiving a sulfonamide for treatment of a urinary tract infection. To monitor the patient for the most severe response to sulfonamide therapy, the nurse will assess for what? A. Diarrhea B. Skin rash and lesions C. Hypertension D. Bleeding

B. Skin rash and lesions The nurse's priority is to monitor for hypersensitivity reactions. The most serious response to sulfonamide therapy is Stevens-Johnson syndrome, which manifests as symptoms of the skin and mucous membranes, lesions, fever, and malaise. In rare cases, hematologic effects occur, requiring periodic blood studies.

The development of a new infection as a result of the elimination of normal flora by an antibiotic is referred to as what? A. Resistant infection B. Superinfection C. Nosocomial infection D. Allergic reaction

B. Superinfection Antibiotic therapy can destroy the normal flora of the body, which normally would inhibit the overgrowth of fungi and yeast. When the normal flora is decreased, these organisms can overgrow and cause a new infection, or superinfection.

What is the minimum bactericidal concentration (MBC)? A. The lowest concentration of an antibiotic needed to suppress bacterial growth completely B. The lowest concentration of an antibiotic needed to reduce the number of bacterial colonies by 99.9% C. The lowest concentration of an antibiotic needed to produce effects D. The lowest dose of an antibiotic needed to eradicate bacteria

B. The lowest concentration of an antibiotic needed to reduce the number of bacterial colonies by 99.9% The MBC is the lowest concentration of drug that produces a 99.9% decline in the number of bacterial colonies (indicating bacterial kill). The lowest antibiotic concentration needed to suppress bacterial growth or to produce effects and the lowest antibiotic dose needed to eradicate bacteria are incorrect descriptions of MBC.

The nurse knows that there is an increased risk of ototoxicity in a patient receiving an aminoglycoside if which level is high? A. Concentration B. Trough C. Peak D. Dose

B. Trough When trough levels remain elevated, aminoglycosides are unable to diffuse out of inner ear cells, thus exposing the cells to the medication for an extended time. Prolonged exposure (i.e., high trough levels), rather than brief exposure to high levels, underlies cellular injury.

An antimicrobial medication that has selective toxicity has which characteristic? A. Ability to transfer DNA coding B. Ability to suppress bacterial resistance C. Ability to avoid injuring host cells D. Ability to act against a specific microbe

C. Ability to avoid injuring host cells Selective toxicity refers to an antibiotic that has the ability to injure only invading microbes, not the host. Conjugation is the process through which DNA coding for drug resistance is transferred from one bacterium to another. Antibiotics do not suppress bacterial resistance, but rather promote the emergence of drug-resistant microbes. Antibiotics that are narrow spectrum are active against only a few microbes.

When providing patient teaching for oral sulfonamide therapy, the nurse should instruct the patient to take the sulfonamide in what way? A. At mealtime, when food is available B. With soy or nonmilk products C. Between meals with a full cup of water D. On awakening before breakfast

C. Between meals with a full cup of water Oral sulfonamides should be taken on an empty stomach and with a full glass of water. To minimize the risk of renal damage, adults should maintain a daily urine output of 1200 mL. Sulfonamides should not be taken with soy or nonmilk products or food or before breakfast without liquids.

The nurse identifies which medication as posing a significant risk of causing confusion, somnolence, psychosis, and visual disturbances in elderly patients? A. Metronidazole (Flagyl) B. Rifampin (Rifadin) C. Ciprofloxacin (Cipro) D. Daptomycin (Cubicin)

C. Ciprofloxacin (Cipro) In elderly patients, ciprofloxacin (Cipro) poses a significant risk of confusion, somnolence, psychosis, and visual disturbances. Metronidazole, rifampin, and daptomycin are not associated with confusion in elderly patients.

A nurse monitors a patient who is receiving an aminoglycoside (gentamicin) for symptoms of vestibular damage. Which finding should the nurse expect the patient to have first? A. Unsteadiness B. Vertigo C. Headache D. Dizziness

C. Headache Gentamicin causes irreversible ototoxicity, which results in both impaired hearing and disruption of balance. Headache is the first sign of impending vestibular damage (balance) and may last 1 to 2 days. Unsteadiness, vertigo, and dizziness appear after headache.

A patient who is receiving cefotetan (Cefotan) has all of these medications ordered. The nurse monitors the patient for an adverse effect related to an interaction with which medication? A. Regular insulin B. Ampicillin (Polycillin) C. Naproxen (Naprosyn) D. Bisacodyl (Dulcolax)

C. Naproxen (Naprosyn) Three cephalosporins—cefmetazole (Zefazone), cefoperazone (Cefobid), and cefotetan (Cefotan)—cause bleeding tendencies. Caution should be used during concurrent use of anticoagulants and other nonsteroidal medications. Regular insulin, ampicillin, and bisacodyl are unrelated to adverse effects with cefotetan.

A patient has acquired an infection while in the hospital. The nurse identifies this type of infection as what? A. Superinfection B. Suprainfection C. Nosocomial infection D. Resistant infection

C. Nosocomial infection Nosocomial infections are acquired by patients while in the hospital. Superinfection and suprainfection are terms used to describe the emergence of drug resistance.

Before administering a cephalosporin to a patient, it is most important for the nurse to assess the patient for an allergy history to what? A. Soy products B. Peanuts C. Penicillins D. Opioids

C. Penicillins The cephalosporins are beta-lactam antibiotics similar in structure and actions to the penicillins. They are contraindicated in patients with a history of severe allergic reactions to penicillins. The use of soy products, peanuts, and opioids is unrelated to cephalosporins.

A nurse observes a red streak and palpates the vein as hard and cordlike at the intravenous (IV) site of a patient receiving cefepime (Maxipime). Which assessment should the nurse make about the IV site? A. An allergic reaction has developed to the drug solution. B. The drug has infiltrated the extravascular tissues. C. Phlebitis of the vein used for the antibiotic has developed. D. Local infection from bacterial contamination has occurred.

C. Phlebitis of the vein used for the antibiotic has developed. IV cephalosporins may cause thrombophlebitis. To minimize this, the injection site should be rotated and a dilute solution should be administered slowly. An allergic response would be shown as itching, redness, and swelling. Infiltration would show as a pale, cool, and puffy IV site. Infection would show as pus, tenderness, and redness.

A nurse removes a central line access device once the patient no longer requires intravenous (IV) antibiotics. This action is an example of which strategy to prevent antimicrobial resistance established by the Centers for Disease Control and Prevention (CDC)? A. Preventing transmission B. Proper diagnosis C. Preventing infection D. Prudent antibiotic use

C. Preventing infection The CDC's campaign to prevent the development of antimicrobial resistance in hospitals focuses on four approaches: (1) prevent infection, (2) diagnose and treat infection effectively, (3) use antimicrobials wisely, and (4) prevent transmission. Expeditious removal of invasive devices, such as IV catheters, and restricting these devices to essential use are examples of the CDC's strategy to prevent infection.

A patient is receiving vancomycin (Vancocin). The nurse identifies what as the most common toxic effect of vancomycin therapy? A. Ototoxicity B. Hepatotoxicity C. Renal toxicity D. Cardiac toxicity

C. Renal toxicity The most common toxic effect of vancomycin (Vancocin) therapy is renal toxicity. Although ototoxicity may occur, it is rare. The liver and heart are not affected when vancomycin is used.

A patient who has acquired immunodeficiency syndrome (AIDS) is receiving trimethoprim/sulfamethoxazole (Bactrim). Which response should a nurse expect if the medication is achieving the desired effect? A. Increase in CD4 T cells B. Increased appetite and weight gain C. Resolution of pneumonia D. Decrease in joint pain

C. Resolution of pneumonia Trimethoprim/sulfamethoxazole is the treatment of choice for Pneumocystis pneumonia (PCP), an infection caused by Pneumocystis jiroveci (formerly thought to be Pneumocystis carinii). PCP is an opportunistic pneumonia caused by a fungus that thrives in immunocompromised hosts. It does not increase the number of CD4 T cells, the targeted cells of the human immunodeficiency virus (HIV), nor does it affect joint pain. Increased appetite and weight gain are not therapeutic actions of trimethoprim/sulfamethoxazole.

The nurse identifies tigecycline (Tygacil) as a derivative of what? A. Penicillins B. Cephalosporins C. Tetracyclines D. Macrolides

C. Tetracyclines Tigecycline is the first representative of a new class of antibiotics, the glycyclines. It is a tetracycline derivative made to overcome drug resistance and is active against many drug-resistant strains. It has adverse effects similar to those of the tetracyclines.

An immunocompromised patient who is receiving piperacillin/tazobactam (Zosyn) develops oozing and bleeding from the gums. Which additional data should the nurse determine? A. Whether the patient has a fever above 100.5 °F B. Whether the patient reports any painful teeth C. The most recent platelet count D. The last time mouth care was given

C. The most recent platelet count Piperacillin/tazobactam (Zosyn) is an extended-spectrum penicillin used primarily for infections caused by Pseudomonas aeruginosa in immunocompromised hosts. It can cause bleeding secondary to disrupting platelet function; therefore, the platelet count may be altered. High fever, painful teeth, and mouth care do not address the patient's bleeding gums.

Which statements about ototoxicity and aminoglycosides does the nurse identify as true? (Select all that apply.) A. The risk of ototoxicity is related primarily to excessive peak levels. B. The first sign of impending cochlear damage is headache. C. The first sign of impending vestibular damage is tinnitus. D. Ototoxicity is largely irreversible. E. Use of aminoglycosides for less than 10 days is recommended to avoid ototoxicity.

D, E The risk of ototoxicity with aminoglycoside use is related primarily to excessive trough levels. The first sign of impending vestibular damage is headache. The first sign of cochlear damage is tinnitus. The other two statements are true.

A patient who is receiving vancomycin (Vancocin) IV for a methicillin-resistant Staphylococcus aureus (MRSA) infection asks a nurse, "Why can't I take this medicine in a pill?" Which response should the nurse make? A. "The prescription could be changed, because vancomycin comes in two forms." B. "You're allergic to penicillin, and this is the only way this medication can be given." C. "It will cause too much loss of appetite and nausea if given in the oral form." D. "It is more effective by IV, because the pill form will stay in the digestive tract."

D. "It is more effective by IV, because the pill form will stay in the digestive tract." Because of its chemical size and weight, vancomycin is absorbed poorly in the gastrointestinal (GI) tract and is given parenterally for most infections. It is used for serious infections caused by organisms such as MRSA and in patients with susceptible organisms allergic to penicillins. Oral administration is used only for infections of the intestine. It is not associated with loss of appetite or nausea.

Thirty minutes after receiving an intramuscular (IM) injection of penicillin G (Pfizerpen), a patient reports itching and redness at the injection site. Which action should the nurse take first? A. Elevate the lower legs. B. Place an ice pack on the site. C. Make sure the patient stays calm. D. Administer subcutaneous epinephrine.

D. Administer subcutaneous epinephrine. Itching and redness at the IM injection site indicate an allergy to penicillin. The primary treatment is epinephrine (subcutaneous, IM, or IV) plus respiratory support. Elevation, ice packs, and calming the patient are done once epinephrine has been administered.

A patient who is receiving an aminoglycoside develops flaccid paralysis and impaired breathing. Which medication does the nurse anticipate administering? A. Magnesium sulfate (Epsom salt) B. Potassium chloride (K-Dur) C. Sodium bicarbonate (Citrocarbonate) D. Calcium gluconate (Kalcinate)

D. Calcium gluconate (Kalcinate) Flaccid paralysis and impaired breathing are signs of impaired neuromuscular transmission, which may occur with aminoglycosides, especially if they are administered concurrently with a neuromuscular blocking agent. Impaired transmission can be reversed with intravenous infusion of a calcium salt (calcium gluconate). Magnesium sulfate, potassium chloride, and sodium bicarbonate do not reverse impaired neuromuscular transmission caused by aminoglycosides.

It is most important for the nurse to assess a patient receiving a cephalosporin for the development of which manifestation of antibiotic-associated pseudomembranous colitis (AAPMC)? A. Rigidity B. Ileus C. Ascites D. Diarrhea

D. Diarrhea AAPMC, which is manifested initially by diarrhea and abdominal cramping, especially may develop with the use of broad-spectrum cephalosporins. Rigidity, ileus, and ascites are unrelated to cephalosporin use.

A nurse assessing a patient who is 12 years old should associate which complication with the patient's receiving tetracycline (Sumycin) as a younger child? A. Delay in long bone growth B. Early onset of puberty C. Severe face and body acne D. Discoloration of the teeth

D. Discoloration of the teeth Tetracycline is contraindicated in children younger than 8 years of age, because it binds to calcium in developing teeth, resulting in permanent discoloration of the teeth. Delay in long bone growth, early onset of puberty, and severe face and body acne are not adverse effects associated with tetracyclines.

A patient who takes ciprofloxacin (Cipro) and runs 6 miles daily tells a nurse about heel and calf tenderness. The nurse instructs the patient to take which action? A. No action is needed, because this is a temporary but expected side effect. B. Continue the antibiotic with an anti-inflammatory medication. C. Slow the running pace and walk more. D. Discontinue the medication, because severe damage can result.

D. Discontinue the medication, because severe damage can result. Fluoroquinolones may result in tendinitis and rupture by disrupting the extracellular matrix of cartilage. Because tendon injury is reversible if diagnosed early, fluoroquinolones should be discontinued at the first sign of tendon pain or inflammation.

Which test is the most widely used method for assessing drug sensitivity? A. Minimum inhibitory concentration (MIC) B. Minimum bacterial concentration (MBC) C. Broth dilution D. Disk diffusion

D. Disk diffusion The most widely used method for assessing drug sensitivity is the disk diffusion test, also known as the Kirby-Bauer test. Through diffusion, an antibiotic-containing zone becomes established around each disk. As the bacteria proliferate, growth is inhibited around the disks that contain an antibiotic to which the bacteria are sensitive.

Which laboratory result should a nurse monitor more frequently when a patient is receiving clarithromycin (Biaxin) and warfarin (Coumadin)? A. Activated partial thromboplastin time (aPTT) B. Platelet count C. Erythrocyte sedimentation rate (ESR) D. International normalized ratio (INR)

D. International normalized ratio (INR) Clarithromycin is a macrolide similar to erythromycin and can inhibit hepatic metabolism of medications such as warfarin and theophylline. The INR is the blood test used to evaluate warfarin ranges. The aPTT is the blood test used in monitoring heparin. The platelet count and ESR are not affected by clarithromycin.

A patient is to begin taking nitrofurantoin (Macrodantin). The nurse should teach the patient that which manifestation should be the priority to report to the healthcare provider? A. Headache and drowsiness B. Brown-colored urine C. Nausea and vomiting D. Muscle weakness and tingling

D. Muscle weakness and tingling Nitrofurantoin is used in acute infections of the lower urinary tract only. Muscle weakness and tingling may indicate irreversible damage to sensory and motor nerves caused by demyelinization of nerves. Patients should be informed of these symptoms and taught to report them immediately. Gastrointestinal (GI) effects may be minimized by taking the drug with milk or food. Brown-colored urine is a harmless effect of the urinary excretion of the medication. Headache and drowsiness are less common adverse effects that are readily reversible.

Which enteral aminoglycoside would the nurse expect to be ordered preoperatively for a patient having intestinal surgery? A. Gentamicin B. Tobramycin C. Amikacin D. Neomycin

D. Neomycin In general, aminoglycosides are poorly absorbed in the gastrointestinal (GI) tract. Neomycin is given orally to suppress bowel flora before surgery of the intestine and is not used parenterally because of its high nephrotoxicity and ototoxicity. Gentamicin, tobramycin, and amikacin are administered parenterally only.

A patient who is receiving an aminoglycoside (gentamicin) has a urinalysis result with all of these findings. Which finding should a nurse associate most clearly with an adverse effect of gentamicin? A. White blood cells (WBCs) B. Glucose C. Ketones D. Protein

D. Protein Aminoglycoside-induced nephrotoxicity usually presents as acute tubular necrosis. Symptoms of concern are protein in the urine, dilute urine, and elevation of the serum creatinine and blood urea nitrogen (BUN) levels. WBCs, glucose, and ketones are not specifically related to gentamicin use.

A patient is receiving imipenem and valproate. It is most important for the nurse to monitor the patient for the development of what? A. High blood pressure B. Cardiotoxicity C. Red man syndrome D. Seizures

D. Seizures Imipenem can reduce blood levels of valproate, a drug used to control seizures, and breakthrough seizures have occurred. If possible, combined use of imipenem and valproate should be avoided. If no other antibiotic will suffice, supplemental antiseizure therapy should be considered. The other responses are not associated with use of imipenem and valproate.

A nurse should recognize that which sulfonamide, applied topically, has the greatest therapeutic benefit for burns? A. Sulfadiazine B. Trimethoprim (Trimpex) C. Sulfacetamide (Isopto Cetamide) D. Silver sulfadiazine (Silvadene)

D. Silver sulfadiazine (Silvadene) Silver sulfadiazine is a topical anti-infective agent used to treat and prevent infection in second- and third-degree burns. Its effects are due primarily to the release of free silver and not to the sulfonamide portion of the molecule. Sulfadiazine and trimethoprim are sulfonamides used systemically, not topically. Sulfacetamide is used for superficial infections of the eye.

A microbe acquires antibiotic resistance by which means? A. Development of medication resistance in the host B. Over-riding of the minimum bactericidal concentration C. Incorrect dosing, which contributes to ribosome mutations D. Transfer of DNA coding to other bacteria

D. Transfer of DNA coding to other bacteria All alterations in structure and function result from changes in the microbial genome. The microbe, not the host, becomes medication resistant. Genetic changes in a microbe result either from spontaneous mutation or from acquisition of DNA from conjugation with other bacteria. The minimum bacterial concentration (MBC) is used in testing for drug sensitivity. Incorrect dosing does not lead to microbe mutations.

The nurse identifies what as the first step in the Campaign to Prevent Antimicrobial Resistance, established in 2002 by the CDC? A. Target the pathogen B. Access the experts C. Isolate the pathogen D. Vaccinate

D. Vaccinate Although all responses are components of the Campaign to Prevent Antimicrobial Resistance, step one is vaccination.