pharm 102 unit 4 Antibiotics
which tetracycline may be administered with meals? A. tetracycline B. demeclocycline C. doxycyline D. minocycline
D. minocycline Rationale: Tetracycline, demeclocycline, and doxycycline should be administered on an empty stomach. Minocycline can be administered with meals.
A patient on IV vancomycin is tired of the long infusion times and would like to have his medication administered by IV push. What education should the nurse provide regarding this request? "IV vancomycin is more effective when given slowly." "IV vancomycin cannot be given by IV push because that type of administration can cause phlebitis." "The IV Vancomycin cannot be given by IV push because that is not how it has been ordered by the health care provider." "IV push is contradicted with vancomycin because fast administration can have a toxic effect known as Red Man Syndrome."
"IV push is contradicted with vancomycin because fast administration can have a toxic effect known as Red Man Syndrome." Red Man Syndrome is a toxic effect that can occur if IV Vancomycin is given too quickly; therefore, vancomycin cannot be administered by IV push.
Anna, a 30-year-old female, is currently hospitalized post bladder surgery. She has an indwelling urine catheter. When the nurse performs the first assessment on Anna, she complains of having chills and flank pain. Her temperature is 101.8 degrees F. The nurse informs the health care provider about Anna's assessment. The nurse draws labs on Anna and amoxicillin is initiated. The nurse educates Anna about the administration and side effects of amoxicillin. The nurse teaches Anna about amoxicillin. Which statement made by Anna indicates that further teaching is required? "I should take this medication by mouth." "It is okay for me to stop taking my medicine as soon as I feel better." "I should not take this medicine if I have an allergy to penicillin or cephalosporin." "I should use another form of birth control in addition to my birth control pills when taking this medication."
"It is okay for me to stop taking my medicine as soon as I feel better." The prescribed medication should be taken as directed until the therapy course is completed. Stopping the medication early may lead to the bacteria's resistance to antibiotics in the future.
A hospitalized patient is prescribed multiple antibiotics for an infection. The patient asks why she is taking so many different types of antibiotics. What is the best response for the nurse to give? "Multi-antibiotic therapy helps delay the development of microorganism resistance." "Multi-antibiotic therapy uses fewer doses to treat an infection than single-antibiotic therapy." "Multi-antibiotic therapy helps the health care provider determine if a patient is allergic to any of the medications." "Multi-antibiotic therapy is used when the health care provider does not know what microorganism is causing the infection."
"Multi-antibiotic therapy helps delay the development of microorganism resistance." Multi-antibiotic therapy is used to help delay the development of microorganism resistance.
A patient states she is feeling better after completing half of her antibiotic therapy with no complications. What education should the nurse provide? "Save the remainder of the antibiotics for use with a future infection." "The prescription should be taken until completed even if you are feeling better." "It is advisable to discontinue use of antibiotics if all of the symptoms have resolved." "You can increase the frequency of dosing to complete the antibiotic therapy more quickly."
"The prescription should be taken until completed even if you are feeling better." The prescription should be taken until completed. This helps to prevent antibiotic resistance.
A 30-year-old female patient is prescribed amoxicillin. Which education should the nurse provide? "If you develop diarrhea, take amoxicillin with food." "Make sure to take amoxicillin on an empty stomach." "Avoid taking amoxicillin at the same time as an oral contraceptives." "Use an additional form of birth control while taking this medication."
"Use an additional form of birth control while taking this medication." Amoxicillin can decrease the effectiveness of oral contraceptives. The nurse should educate the patient to use an additional form of birth control when taking amoxicillin.
A patient is prescribed an antibiotic to treat a urinary tract infection. What statement by the patient indicates a need for further teaching? A. "I can stop the medication as soon as the symptoms have disappeared." B. "I will drink more fluids to help clear up the infection." C. "I will stop the medication and contact the doctor if I develop a rash." D. "I should immediately report vaginal itching or discharge."
A. "I can stop the medication as soon as the symptoms have disappeared." Rationale: Patients should be taught not to discontinue antibiotics prematurely, but rather to complete the entire course of therapy, even if symptoms improve or resolve. The other responses are appropriate
The patient is ordered daily divided doses of gentamycin. The patient received an intravenous dose of gentamycin at 4:00 PM. When should the nurse obtain the peak level? A. 4:30 PM B. 5:00 PM C. 5:30 PM D. 6:00 PM
A. 4:30 PM Rationale: When using divided daily doses, draw blood samples for measuring peak levels 1 hour after IM injection and 30 minutes after completing an IV infusion. When a single daily dose is used, measuring peak levels is unnecessary. Draw samples for trough levels just before the next dose (when using divided daily doses) or 1 hour before the next dose (when using a single daily dose).
Which statement about allergic reactions to penicillin does the nurse identify as true? A. Anaphylactic reactions occur more frequently with penicillins than with any other drug. B. Allergy to penicillin always increases over time. C. Benadryl is the drug of choice for anaphylaxis due to penicillin allergy. D. Patients allergic to penicillin are also allergic to vancomycin.
A. Anaphylactic reactions occur more frequently with penicillins than with any other drug. Rationale: Anaphylactic reactions occur more frequently with penicillins than with any other drug. Allergy to penicillin can decrease over time. Epinephrine is the drug of choice for anaphylaxis. Vancomycin, erythromycin, and clindamycin are effective and safe alternatives for patients with penicillin allergy.
The patient is being discharged with continued ciprofloxacin therapy. When providing discharge teaching, the nurse should advise the patient to call the healthcare provider immediately if what develops? A. Pain in the heel of the foot B. Nausea C. Diarrhea D. Headache
A. Pain in the heel of the foot Rationale: Rarely, ciprofloxacin and other fluoroquinolones have caused tendon rupture, usually of the Achilles tendon. The incidence is 1 in 10,000 or less. Because tendon injury is reversible if diagnosed early, fluoroquinolones should be discontinued at the first sign of tendon pain, swelling, or inflammation. In addition, patients should refrain from exercise until tendinitis has been ruled out.
A dialysis patient is prescribed amoxicillin. When should the nurse administer the medication? After dialysis Before dialysis During dialysis Timing of administration does not matter
After dialysis Amoxicillin is removed during dialysis. Therefore, it should be administered after dialysis.
How is the frequency of antibiotic dosing altered if a patient has renal impairment? Antibiotic dosing is less frequent. Antibiotic dosing is more frequent. Frequency of antibiotic dosing is not altered. Patients with renal impairment should not take antibiotics.
Antibiotic dosing is less frequent. Patients with renal impairment require less frequent antibiotic dosing.
Which patient should receive prophylactic antibiotic therapy? A. A patient who is to have his teeth cleaned B. A patient who is scheduled for a hysterectomy C. A patient with a white blood cell count of 8000 cells/mm3 D. A patient with a high fever without an identifiable cause
B. A patient who is scheduled for a hysterectomy Rationale: Patients who undergo a hysterectomy (and other specific surgeries) may have a decreased incidence of infection if antibiotics are administered before or during surgery. Use of prophylactic antibiotics are not indicated for the other conditions.
Which patient would most likely need intravenous antibiotic therapy to treat a urinary tract infection? A. A patient with an uncomplicated urinary tract infection caused by Escherichia coli B. A patient with pyelonephritis with symptoms of high fever, chills, and severe flank pain C. A patient with acute cystitis who complains of dysuria, frequency, and urgency D. A patient with acute bacterial prostatitis with a mild fever, chills, and nocturia
B. A patient with pyelonephritis with symptoms of high fever, chills, and severe flank pain
A patient with a history of a severe anaphylactic reaction to penicillin has an order to receive cephalosporin. What should the nurse do? A. Administer the cephalosporin as ordered. B. Contact the health care provider for a different antibiotic. C. Administer a test dose of cephalosporin to determine reactivity. D. Have an epinephrine dose available when administering the cephalosporin.
B. Contact the health care provider for a different antibiotic. Rationale: A few patients with penicillin allergy (about 1%) display cross-sensitivity to cephalosporins. If at all possible, patients with penicillin allergy should not be treated with any member of the penicillin family. Use of cephalosporins depends on the intensity of the allergic response to penicillin; if the penicillin allergy is mild, use of cephalosporins is probably safe. However, if the allergy is severe, cephalosporins should be avoided.
A patient who sustained second- and third-degree burns has been prescribed mafenide. Which statement about mafenide does the nurse identify as true? A. Use of mafenide can cause alkalosis. B. Mafenide is painful upon application. C. A blue-green to gray discoloration of the skin occurs with mafenide therapy. D. Mafenide exerts its therapeutic effect by the release of free silver.
B. Mafenide is painful upon application. Local application of mafenide is frequently painful. Mafenide is metabolized to a compound that can suppress renal excretion of acid, thereby causing acidosis. Silver sulfadiazine, another topical sulfonamide used for burn therapy, can cause a blue-green to gray skin discoloration, so facial application should be avoided. Mafenide does not cause this specific skin discoloration. Mafenide acts by the same mechanism as other sulfonamides. In contrast, the antibacterial effects of silver sulfadiazine are due primarily to the release of free silver, not to the sulfonamide portion of the molecule.
A patient is diagnosed with C. difficile infection. The nurse anticipates administering which medication? A. Daptomycin B. Metronidazole C. Rifampin D. Rifaximin
B. Metronidazole Rationale: Metronidazole is a drug of choice for C. difficile infection. Daptomycin has a unique mechanism and can rapidly kill virtually all clinically relevant gram-positive bacteria, including MRSA. Rifampin [Rifadin] is a broad-spectrum antibacterial agent used primarily for tuberculosis. However, the drug is also used against several nontuberculous infections. Rifampin is useful for treating asymptomatic carriers of Neisseria meningitidis. Rifaximin [Xifaxan] is an oral, nonabsorbable analog of rifampin used to kill bacteria in the gut.
Before administering gentamycin, it is most important for the nurse to assess the patient for a history of what? A. Hypertension B. Myasthenia gravis C. Diabetes mellitus D. Asthma
B. Myasthenia gravis Rationale: Aminoglycosides must be used with caution in patients with renal impairment, pre-existing hearing impairment, and myasthenia gravis, and in patients receiving ototoxic drugs (especially ethacrynic acid), nephrotoxic drugs (for example, amphotericin B, cephalosporins, vancomycin, cyclosporine, nonsteroidal anti-inflammatory drugs [NSAIDs]), and neuromuscular blocking agents.
A patient is prescribed cefixime. The nurse should teach the patient to immediately report any signs of what? A. Milk intolerance B. Skin rash, hives, or itching C. Constipation, nausea, or vomiting D. Headache, contusions, or seizures
B. Skin rash, hives, or itching Rationale: Hypersensitivity reactions are common with cephalosporins. Patients should be instructed to report any signs of allergy such as skin rash, itching, or hives. Cefditoren contains a milk protein and should not be prescribed for patients with a milk-protein allergy. Cefoperazone and cefotetan can promote bleeding. Diarrhea associated with antibiotic-associated pseudomembranous colitis (AAPMC)is a possible side effect with cephalosporin's
hich statement about superinfections does the nurse identify as true? A. Superinfections are more common in patients treated with narrow-spectrum drugs. B. Superinfection is defined as a new infection that appears. during the course of treatment for a primary infection. C. Superinfections are caused by viruses. D. Superinfections are easy to treat.
B. Superinfection is defined as a new infection that appears. during the course of treatment for a primary infection. Rationale: Because broad-spectrum antibiotics kill off more normal flora than do narrow-spectrum drugs, superinfections are more likely in patients receiving broad-spectrum agents. Suprainfections are caused by drug-resistant microbes; these infections are often difficult to treat.
The nurse is reviewing laboratory values from a patient who has been prescribed gentamicin. To prevent ototoxicity, it is most important for the nurse to monitor which value(s)? A. Serum creatinine and blood urea nitrogen levels B. Trough drug levels of gentamicin C. Peak drugs levels of gentamicin D. Serum alanine aminotransferase and aspartate aminotransferase levels
B. Trough drug levels of gentamicin Rationale: To minimize ototoxicity, trough levels must be sufficiently low to reduce exposure of sensitive sensory hearing cells. The risk of ototoxicity is related primarily to persistently elevated trough drug levels rather than to excessive peak levels.
A patient has been prescribed oral ciprofloxacin [Cipro] for a skin infection. When administering the medication, it is most important for the nurse to do what? A. Monitor for a decrease in the prothrombin time (PT) if the patient is also taking warfarin [Coumadin] B. Withhold antacids and milk products for 6 hours before or 2 hours afterward C. Inform the healthcare provider if the patient has a history of asthma D. Assess the skin for Stevens-Johnson syndrome
B. Withhold antacids and milk products for 6 hours before or 2 hours afterward Rationale: Absorption of ciprofloxacin can be reduced by ingestion of antacids and milk products. Ingestion of these products should occur at least 6 hours before ciprofloxacin or 2 hours afterward. Ciprofloxacin can increase the PT if the patient is also taking warfarin. Use of ciprofloxacin is contraindicated in patients with a history of myasthenia gravis. Patients taking ciprofloxacin are at risk for development of phototoxicity.
When should a culture and sensitivity test be collected? When the patient has a fever Before antibiotics are initiated After the first dose of an antibiotic After antibiotic therapy is complete
Before antibiotics are initiated
Which patient does the nurse identify as most likely to need treatment with trimethoprim/sulfamethoxazole (Bactrim) for a period of 6 months? A. A female patient with acute pyelonephritis B. A male patient with acute prostatitis C. A female patient with recurring acute urinary tract infections D. A male patient with acute cystitis
C. A female patient with recurring acute urinary tract infections
A patient is prescribed doxycycline (vibramycin). If the patient complains of gastric irritation, what should the nurse do? A. Instruct the patient to take the medication with milk B. Tell the patient to take an antacid with the medication C. Give the patient food, such as crackers or toast, with the medication D. Have the patient stop the medication immediately and contact the health care provider
C. Give the patient food, such as crackers or toast, with the medication Rationale: Tetracyclines form insoluble chelates with calcium, iron, magnesium, aluminum, and zinc; absorption is decreased. Tetracyclines should not be administered together with milk or antacids. Long-acting tetracyclines, such as doxycycline, may be taken with food; food does not affect absorption.
A patient has been prescribed ciprofloxacin for treatment of a UTI with Escherichia coli. Before administering the drug, it is most important for the nurse to assess the patient for a history of what? A. Hypertension B. Diabetes mellitus C. Myasthenia gravis D. Seasonal allergies
C. Myasthenia gravis Rationale: Ciprofloxacin and other fluoroquinolones can exacerbate muscle weakness in patients with myasthenia gravis. Accordingly, patients with a history of myasthenia gravis should not receive these drugs.
Which drug does the nurse identify as a urinary tract antiseptic? A. Ciprofloxacin B. Ceftriaxone C. Nitrofurantoin D. Ceftazidime
C. Nitrofurantoin injures bacteria by damaging DNA
Fluoroquinolones should be discontinued immediately if what happens? A. Nausea, vomiting, or diarrhea is experienced. B. Dizziness, headache, or confusion occurs. C. Tendon pain or inflammation develops. D. Theophylline is prescribed for asthma.
C. Tendon pain or inflammation develops. Rationale: Fluoroquinolones can cause tendon rupture and should be discontinued if tendon pain or inflammation develops.
A patient who takes warfarin has been prescribed sulfadiazine. When teaching the patient about this drug, which statement will the nurse include? A."If you become pregnant, it is safe to take sulfadiazine." B."You should limit your fluid intake while taking sulfadiazine." C."Avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin." D."You will most likely need to have an increase in the dose of warfarin while taking sulfadiazine."
C."Avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin." Sulfonamides can cause photosensitivity
What should patients avoid within 3 hours of taking tetracycline? Driving Lying flat Drinking grapefruit juice Consuming dairy products
Consuming dairy products
A patient is prescribed cefazolin. It is most important for the nurse to teach the patient to avoid which substance while taking cefazolin? A patient is prescribed cefazolin. It is most important for the nurse to teach the patient to avoid which substance while taking cefazolin? A. Warfarin B. Milk products C. Digitalis D. Alcohol
D. Alcohol Cefazolin and cefotetan can cause alcohol intolerance. A serious disulfiram-like reaction may occur if alcohol is consumed. Inform patients about alcohol intolerance and warn them not to drink alcoholic beverages.
It is most important for the nurse to avoid administering oral ciprofloxacin to this patient with which food? A. Bananas B. Baked chicken C. Grapefruit juice D. Milk
D. Milk Rationale: Absorption of ciprofloxacin can be reduced by compounds that contain cations. Among these are (1) aluminum- or magnesium-containing antacids, (2) iron salts, (3) zinc salts, (4) sucralfate, (5) calcium supplements, and (6) milk and other dairy products, all of which contain calcium ions. These cationic agents should be administered at least 6 hours before ciprofloxacin or 2 hours after.
A patient is prescribed vancomycin orally for antibiotic-associated pseudomembranous colitis. The nurse will monitor the patient for what? A. Leukopenia B. "Redman" syndrome C. Liverimpairment D. Ototoxicity
D. Ototoxicity Rationale:The most serious adverse effect of vancomycin is ototoxicity. "Red man" syndrome occurs only with rapid intravenous administration.
A prescriber states that a patient will need to receive penicillin intravenously. The nurse anticipates administering which drug? A. Penicillin V B. Procaine penicillin G C. Benzathine penicillin G D. Potassium penicillin G
D. Potassium penicillin G Rationale: When high blood levels are needed rapidly, penicillin can be administered IV. However, only the potassium salt should be administered by this route. Owing to poor water solubility, procaine and benzathine salts must never be administered IV. Penicillin V is administered orally.
The nurse is caring for a patient receiving intravenous gentamicin for a severe bacterial infection. Which assessment findings by the nurse indicates the patient is experiencing an adverse effect of gentamycin therapy? A. Blurred vision B. Hand tremors C. Urinary frequency D. Tinnitus
D. Tinnitus Rationale: Ototoxicity can result from accumulation of the drug in the inner ear. Early signs that should be reported include tinnitus or headache. Other major adverse effects include nephrotoxicity and neuromuscular blockade.
A patient who was taking sulfonamides develops Stevens-Johnson syndrome. Upon assessment, the nurse expects to find what? A. Hypotension B. Bronchospasm C. Temperature of 35.5º C D. Widespread skin lesions
D. Widespread skin lesions The most severe hypersensitivity response to sulfonamides is Stevens-Johnson syndrome, a rare reaction with a mortality rate of about 25%. Symptoms include widespread lesions of the skin and mucous membranes, combined with fever, malaise, and toxemia. Bronchospasm and hypotension, as well as tachycardia, are manifestations of anaphylactic reactions.
What laboratory test has a significant impact on the health care provider's choice of antibiotic regimen? Gram stain Lipid panel Chest x-ray Complete blood count (CBC)
Gram stain The Gram stain test helps to categorize bacteria. Determining if a bacteria is gram-positive or gram-negative is significant when choosing an antibiotic regimen.
What should a patient do to assist with drug excretion while taking antibiotics? Increase fluid intake Avoid dairy products Follow dosing instructions Wash the hands frequently
Increase fluid intake Patients should increase fluid intake to assist with drug excretion.
What additional effect can occur if food is taken with an antibiotic to prevent GI upset? It can lead to increased thirst. It can speed up the onset of action. It can delay absorption of the antibiotic. It can cause the antibiotic to become inactive.
It can delay absorption of the antibiotic. Taking an antibiotic with food can delay the absorption of the medication.
Which statement about amoxicillin is true? It is bactericidal. It is bacteriostatic. It is 50% protein bound. It has a half-life of 6 hours.
It is bactericidal. Amoxicillin is bactericidal. It attacks bacterial cell wall synthesis by binding to penicillin-binding proteins, causing cell lysis and death.
Why is a continuous antibiotic infusion effective in the treatment of a severe infection? It is easier to administer than intermittent doses. It has a decreased risk of severe adverse reactions. It decreases symptoms of the infection more quickly. It provides constant drug concentration and time exposure.
It provides constant drug concentration and time exposure. Continuous antibiotic infusions are more effective than intermittent doses because they provide constant drug concentration and time exposure.
What effect does a bactericidal antibiotic have on a pathogen? Kills the pathogen Inhibits the pathogen's growth Strengthens the pathogen's cell walls Assists the pathogen with replication
Kills the pathogen A bactericidal antibiotic works by killing the pathogen.
What benefit is seen with antibiotics that have longer half-lives? Less frequent dosing Quicker onset of action Less gastrointestinal (GI) upset Slower elimination from the body
Less frequent dosing Antibiotics with longer half-lives maintain higher concentrations at the bacterial binding sites. Therefore, they require less frequent dosing.
What does the abbreviation MEC stand for in discussions of antibiotics? Modified Effective Concentration Minimum Effective Concentration Maximum Effective Concentration Medication Effective Concentration
Minimum Effective Concentration Minimum Effective Concentration (MEC) is the concentration of a drug necessary to halt the growth of a microorganism.
Why is it important to record a baseline neurologic assessment before administering antibiotics? Some antibiotics have the potential for adverse CNS effects. A patient with a baseline neurologic deficit should not take antibiotics. It is part of a routine nursing assessment and should always be recorded. The nurse must determine if the patient will be able to understand and comply with antibiotic therapy.
Some antibiotics have the potential for adverse CNS effects. Some antibiotics may have adverse CNS effects. Therefore, it is important to assess the patient's neurological baseline prior to administering these medications.
If a patient on amoxicillin reports a rash, what is the first step the nurse should take? Decrease the frequency of dosing Stop administrating the medication Report the rash to the health care provider Give the medication with a full glass of water
Stop administrating the medication If any signs of medication allergy are observed or reported by the patient, the nurse should immediately stop administrating the medication.
A pregnant patient in her third trimester says that she would like to take tetracycline as an acne treatment because it has always worked for her in the past. What teaching should the nurse provide for this patient? Tetracycline is contraindicated for pregnant women. Tetracycline needs to be given in larger doses when a patient is pregnant. The patient should avoid dairy products within 3 hours of taking tetracycline. The patient should avoid ultraviolet light exposure when taking tetracycline due to the potential for a severe photosensitivity reaction.
Tetracycline is contraindicated for pregnant women. Tetracycline is contraindicated in pregnancy because it can cause tooth discoloration in the child.
Effectiveness of an antibiotic is dependent on which factor? The type of bacterial cell wall The morphology of the bacteria The Gram status of the bacteria The length of time that it remains at the bacterial cell-binding site.
The length of time that it remains at the bacterial cell-binding site. Effectiveness of an antibiotic depends on the length of time that the drug remains at the bacterial cell-binding site.
Why are microorganisms that cause health care-associated infections so difficult to treat? The microorganisms that cause health care-associated infections have changed over time. Health care associated infections are one of the top ten leading causes of death in the United States. The patient acquires the microorganism while receiving treatment for another condition in a health care facility. The microorganisms have been exposed to strong antibiotics in the past, which has made them more drug resistant and virulent.
The microorganisms have been exposed to strong antibiotics in the past, which has made them more drug resistant and virulent. The microorganisms that cause health care-associated infections are difficult to treat and are the most drug resistant microorganisms because they have been exposed to strong antibiotics in the past.
How do bacteriostatic antibiotics, which only inhibit bacterial growth, contribute to the elimination of infection? They decrease the symptoms of the infection. They achieve the minimum effective concentration. They are used in combination with bactericidal medications. They work in conjunction with the body's natural defense mechanisms.
They work in conjunction with the body's natural defense mechanisms. Bacteriostatic antibiotics work in conjunction with the body's natural defenses to cure bacterial infections.
How are most antibiotic medications eliminated from the body? Through bile Through feces Through urine Through perspiration
Through urine Most antibiotic medications are eliminated from the body as urine via the renal route.
Before administering erythromycin to a patient for an upper respiratory tract infection, it is most important for the nurse to determine if the patient is also prescribed which drug? A. guaifenesin (Guiatuss) B. hydrocodone (Vicodin) C. nitroglycerin (Tridil) D. verapamil (Calan)
d verapamil (Calan) Rationale: QT prolongation and sudden cardiac death have occurred in patients taking CYP3A4 inhibitos, such as calcium channel blockers (verapamil), azole antifungal drugs, HIV protease inhibitors and nefazodone
