PrepU Ch21 Drug Therapy With Macrolides and Miscellaneous Anti-Infective Agents
A 79-year-old nursing home resident has been prescribed clindamycin. When the resident develops persistent diarrhea, the nurse will include what intervention to help rule out the presence of pseudomembranous colitis? a) Increase the resident's daily fluid intake. b) Request a prescription for an antidiarrheal medication. c) Eliminate dairy from the resident's diet. d) Assess the stool for the presence of blood and mucus.
d
A client developed a pressure area on the hip that has become infected. If the wound culture reveals methicillin-resistant Staphylococcus aureus, which medication would the nurse expect to be prescribed? a) metronidazole b) erythromycin c) penicillin d) vancomycin
d
A client has an upper respiratory infection and is allergic to penicillin. What medication does the nurse expect will be ordered? a) Ampicillin b) Cephalosporin c) Ancef d) Erythromycin
d
A client has been prescribed daptomycin for treatment of an infection. What instruction is most important for the nurse to tell this client? a) "Expect that this medication may cause bloody diarrhea." b) "Take a laxative every day to prevent becoming constipated." c) "Maintain a clear liquid diet while on the medication to prevent nausea." d) "Tell the health care provider immediately if you develop any muscle pain."
d
A client is given linezolid for a diagnosis of VREF. The drug will be administered for a period that extends beyond 2 weeks. Which laboratory test would the nurse expect the health care provider to order on a regular basis because of the length of administration of the drug? a) Electrolytes b) Serum albumin c) Potassium d) Complete blood count
d
A client returns from a vacation with traveler's diarrhea. The nurse understands that what is the treatment of choice? a) Relafen b) Robaxin c) Rifampin d) Rifaximin
d
A common reaction associated with the intravenous administration of vancomycin is "red man syndrome." What is the cause of red man syndrome? a) Hypotension b) Hypertension c) Pseudomembranous colitis d) Histamine release
d
A nurse is caring for a 25-year-old patient who has been prescribed daptomycin to treat a skin infection. Which of the following adverse effects of daptomycin should the nurse monitor when caring for the patient? a) Insomnia b) Fever c) Headache d) Constipation
d
Common, potentially serious, adverse effects of antibiotic drugs include: a) Skin rash b) Constipation c) Pain d) Hypopnea
a
The nurse is caring for a client who is receiving IV vancomycin. The nurse infuses the medication at the prescribed rate to prevent what from occurring? a) Red man syndrome b) Gray syndrome c) Cushing's syndrome d) Serotonin syndrome
a
Which client should be assessed further before receiving azithromycin (Zithromax) as ordered? a) The client who is taking digoxin b) The client who is nauseous c) The client who has abdominal discomfort d) The client who has an elevated white blood cell count (WBC)
a
A client develops antibiotic-induced colitis. The symptoms have worsened within the past 72 hours. The nurse expects the health care provider to order what medication, which is considered the initial drug of choice? a) Metronidazole b) Bismuth subsalicylate c) Psyllium d) Loperamide
a
A client is diagnosed with VRE, and the health care provider orders chloramphenicol. The nurse should monitor the client for the development of which side effect? a) Blood dyscrasias b) Nausea c) Dizziness d) Vomiting
a
A client is diagnosed with acute bacterial sinusitis, and the health care provider orders azithromycin. How long a course of this drug does the nurse expect the provider to order? a) 3 days b) 10 days c) 7 days d) 5 days
a
A client prescribed rifaximin for diarrhea has developed frank bleeding in the stool. What intervention should the nurse anticipate being implemented to best ensure client safety? a) changing to a different antibiotic b) changing to parenteral administration of rifaximin c) supplementing the antibiotic with vitamin K d) increasing the dose of rifaximin
a
A client who has been receiving intravenous (IV) vancomycin begins to report neck and back pain as well as feeling hot and having chills. The nurse assesses the client and notices that the neck is red. The client's temperature is 102 degrees F; BP is 86/58. This client is showing signs and symptoms of which syndrome? a) Red-man syndrome b) Cushing's syndrome c) Toxic shock syndrome d) Stevens-Johnson syndrome
a
A client with a history of valvular heart disease reports having had a "bad reaction" after receiving penicillin in the past. Prior to a scheduled dental procedure, the client is likely to be prescribed what drug? a) erythromycin b) clindamycin c) vancomycin d) metronidazole
a
A client with an infected ulcer on the foot has been prescribed daptomycin. What action should the nurse ensure has been taken to determine that the drug will be effective in treating the infection? a) Obtain a culture of the client's infection. b) Educate the client of the need to report any muscle pain immediately. c) Determine whether the client has a known allergy to any lipopeptide class drug d) Assess whether the client is being treated for hypercholesterolemia.
a
An 82-year-old client, who lives alone and has occasional memory lapses, is being seen by the home health nurse. In reviewing the client's medication, the nurse discovers that the client was recently prescribed azithromycin for urethritis. What characteristic of this drug makes it an appropriate choice for this client? a) It is taken only once a day. b) The half-life of the drug is 3 to 7 hours. c) Zithromax is associated with very few drug-drug interactions. d) The drug usually achieves results in only a 3-day course.
a
A client with-end stage renal disease has developed vancomycin-resistant enterococci (VRE). Which medications could be used to treat this client? Select all that apply. a) Daptomycin (Cubicin), a cyclic lipopeptide b) Linezolid (Zyvox), an oxazolidinone c) Chloramphenicol (Chloromycetin), an amphenicol d) Penicillin G (Pfizerpen), a penicillin e) Gentamicin (Garamycin), an aminoglycoside
a, b, c
Your patient is receiving a miscellaneous antibacterial to treat an infection. Which of the following goals would be appropriate to include in your plan of care? Select all that apply. a) The patient will be monitored regularly for therapeutic and adverse drug effects. b) The patient will take or receive miscellaneous antimicrobials accurately, for the prescribed length of time. c) The patient will experience an increase in signs and symptoms of the infection being treated. d) The patient will verbalize and practice measures to prevent recurrent infection.
a, b, d
A client with an upper respiratory infection has been prescribed macrolides. Which changes during an ongoing assessment would lead the nurse to notify the health care provider? Select all that apply. a) decrease in blood pressure b) sudden increase in temperature c) pulse rate within usual parameters d) regular urine output e) increase in respiratory rate
a, b, e
A health care provider is deciding what medication to prescribe for a client with an upper respiratory infection. What principles guide the provider's decision? Select all that apply. a) Resistance of the bacteria b) The client's ability to tolerate the drug c) Available in generic formulation d) Medication cost e) Other drugs the client is taking daily
a, b, e
A client has been prescribed metronidazole for treatment of Giardia. What instruction is most important for the nurse to give to this client? a) Do not smoke while taking this medication. b) Do not drink alcohol while taking this medication. c) Regularly use sunscreen products while taking this medication. d) Do not eat dairy foods while taking this medication.
b
A nurse is caring for a client with severe and life-threatening pseudomembranous colitis caused by C. difficile. Which drug would the nurse expect the client's provider to order? a) Tigecycline b) Oral vancomycin c) Linezolid d) Daptomycin
b
A nurse is required to administer an anti-infective drug to a patient. The nurse knows that which of the following tests need to be conducted before administering the first dose of an anti-infective drug to the patient? a) Ulcer tests b) Culture tests c) Stool tests d) Urinalysis
b
A patient has been administered linezolid. The patient is fond of eating chocolates and coffee, both of which contain tyramine. What should the nurse inform the patient about the risk involved when linezolid interacts with foods containing tyramine? a) Causes nervousness. b) Causes severe hypertension. c) Causes nausea. d) Causes drowsiness.
b
A patient is required to be administered vancomycin for treatment of an abdominal abscess. What should the nurse ensure when monitoring the IV infusion of vancomycin in the patient when caring for him? a) Report an increase in blood pressure. b) Administer each dose over 60 minutes. c) Observe for signs of headache. d) Report increase in the urinary output.
b
In which condition present in the client should macrolides be used with caution? a) Diabetes mellitus b) Liver dysfunction c) Glaucoma d) Hypertension
b
John, 34 years old, is being treated with clindamycin for osteomyelitis of his tibia following an open fracture 3 months ago. The nurse is teaching John how to properly administer the medication at home and the side effects that he needs to report to the health care provider. Which would be the best instruction to give John? a) Call the provider if you have nausea after taking the medication. b) Notify the provider if you have any blood in your stool or diarrhea. c) Contact the provider's office if you have abdominal distention. d) Contact the provider if you are having headaches or visual changes.
b
The nurse should monitor the client for which common side effects of erythromycin therapy? a) Urticaria and ophthalmic drainage b) Nausea, vomiting, and diarrhea c) Headache and fever d) Shortness of breath and sore throat
b
Which statement is true concerning macrolides? a) Macrolides cannot kill gram-positive bacteria. b) Macrolides are bactericidal or bacteriostatic. c) Macrolides are not absorbed in body fluids. d) Macrolides are not absorbed well in body tissues.
b
Which of the following drugs are considered to be macrolides? Choose all that apply. a) linezolid (Zyvox) b) azithromycin (Zithromax) c) clarithromycin (Biaxin) d) erythromycin e) metronidazole (Flagyl)
b, c, d
Metronidazole (Flagyl) can be described in which of the following ways? Please choose all that apply. a) Belongs to a class of antimicrobials referred to as streptogramins b) Used in colorectal surgery, intra-abdominal infections c) Effective against anaerobic bacteria d) Is bacteriostatic against E. faecium e) Treatment of C. difficile infections associated with pseudomembranous colitis
b, c, e
A client develops antibiotic-induced colitis. The symptoms have worsened within the past 72 hours. The nurse expects the health care provider to order what medication, which is considered the initial drug of choice? a) Bismuth subsalicylate b) Psyllium c) Metronidazole d) Loperamide
c
A client presents to the health care provider's office with a skin infection on the forearm. The infection is resistant to over-the-counter antibiotics. After receiving the culture and sensitivity results, the provider orders tigecycline. The nurse knows that this client has what illness? a) VRE b) Clostridium difficile c) MRSA d) VREF
c
A male client presents to the emergency department with an abdominal dehiscence. He states he had a hernia repair 18 days earlier, and the health care provider removed his wound staples 5 days ago. The client states that the dehiscence occurred when he lifted a box this morning for his wife. The wound is red, and there is evidence of foul-smelling drainage. The wound is cultured, and an anaerobic bacterium is identified. The nurse understands that the provider orders metronidazole because it is effective against which type of organism? a) All gram-positive bacteria b) All gram-negative bacteria c) Anaerobic bacteria d) Staphylococcus
c
Rifaximin (Xifaxan) is effective to treat traveler's diarrhea from which of the following organisms? a) Campylobacter jejuni b) Salmonella c) Escherichia coli d) Shigella
c
The nurse is preparing to administer IV vancomycin to a client for the treatment of a systemic infection. How long would the nurse expect the infusion to run? a) 3 to 4 hours b) 2 to 4 hours c) 1 to 2 hours d) 30 minutes
c
Which client should not receive erythromycin as ordered at 8 a.m.? a) The client taking a beta blocker b) The client with an upper respiratory infection c) The client with elevated liver enzymes d) The client who is 60 years old
c
You are a pediatric nurse caring for a child receiving erythromycin ethylsuccinate. The recommended dose for this drug is 30 mg/kg/day. The child weighs 20 kg, and the medication is to be administered q8h. How much medication should this child receive per dose? a) 125 mg b) 75 mg c) 200 mg d) 175 mg
c 30 mg/kg x 20 kg = 600 mg 600 mg / 3 (Q8H) = 200 mg
A patient on your unit has bacterial colitis and is being treated with oral vancomycin. Why is vancomycin given orally, rather than intravenously, in the treatment of bacterial colitis? a) The oral version of the drug is easier to administer. b) Fewer pathogens are resistant to the oral version of the drug than to the IV version. c) The oral version of the drug limits the release of histamines. d) The oral version of the drug acts within the bowel lumen.
d
A patient with acne vulgaris was administered macrolides, after which the patient developed diarrhea. What nursing intervention should the nurse perform in this case? a) Measure urine output. b) Record symptoms of infection. c) Obtain allergy history. d) Inspect stools for blood or mucus.
d
After teaching a client who is prescribed oral erythromycin, the nurse determines that the teaching was successful when the client states which of the following? a) "I might have some bloody diarrhea after using this medicine." b) "I need to take the medicine with a meal so I don't get an upset stomach." c) "I only need to take one pill every day for this medicine to work." d) "I should drink a full 8-oz glass of water when I take the medicine."
d
For a client diagnosed with methicillin-resistant Staphylococcus aureus (MRSA), which medication would be most effective? a) A first-generation cephalosporin b) A penicillin c) A third-generation cephalosporin d) An oxazolidinone
d
The nurse is caring for a client who has been diagnosed with trichomoniasis. What medication would the nurse anticipate being prescribed? a) penicillin b) clindamycin c) rifaximin d) metronidazole
d
The nursing instructor is discussing the administration of azithromycin, a macrolide, with her clinical group. The instructor asks her students to identify the medication that will decrease the effects of azithromycin when administered concurrently. Which of the following medications would the students identify? a) Antidepressants b) Beta-adrenergic blockers c) Calcium-channel blockers d) Antacids
d
What medication could be prescribed orally to treat a sinus infection in a client needing an abbreviated therapy plan? a) tetracycline b) erythromycin c) clarithromycin d) azithromycin
d
You are caring for a 60-year-old female patient who is expected to undergo extended treatment with linezolid. What lab value may require close monitoring during drug therapy? a) Blood glucose level b) Liver function c) Creatinine clearance d) Complete blood count
d
