PrepU Chapter 9

A nurse is teaching a client about the medication regimen surrounding fluoroquinolones. Which statement made by the client would indicate the need for additional education?

"I will only drink enough water to swallow the drug." Clients taking fluoroquinilones should increase, not limit, their fluid intake. It is important that the client take all of the prescribed antibiotics and understand adverse reactions, such as abdominal pain. Difficulty breathing may indicate hypersensitivity and is an emergency.

A client is to receive rifampin. Which would be most important for the nurse to include in the teaching plan for this client?

"Your urine or sweat may become orange in color." This drug causes body fluids to turn orange. The client needs to be informed of this to avoid being frightened when it occurs. Any drug can cause a hypersensitivity reaction. Although this information is important, it is not the priority. GI adverse effects are common. Although this instruction would be important, it would not be the priority. Headache and dizziness are common CNS effects of the drug that do not need to be reported.

Levofloxacin 750 mg IV is ordered for a client with a urinary tract infection. The medication is to mixed yielding 250 mg/15 mL. How many mL should be drawn up in the syringe?

45 mL 750/250 = 3; 3 x 15 mL = 45 mL

A public health nurse interacts with many members of the community who are at risk for sexually transmitted infections (STIs). The nurse should anticipate the use of tetracycline in a client who is diagnosed with what STI?

Chlamydia The action of tetracycline makes it effective for treating Mycoplasma, Chlamydia, and Rickettsia. It is not efficacious in the treatment of trichomoniasis, HPV, or vaginitis.

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?

Culture tests The nurse should check whether culture tests are conducted before the first dose of drug is administered to the client. Ulcer tests and stool tests are not required to be conducted before administering the first dose of an anti-infective drug to the client. The nurse has to ensure that urinalysis is conducted before the administration of the drug but not specifically before the first dose of the anti-infective drug.

A client has been prescribed ciprofloxacin IV for the treatment of cellulitis. After initiating the infusion of the client's first scheduled dose, the client develops a pronounced rash on the chest and arms. How should the nurse respond initially to this event?

Discontinue the infusion and inform the care provider promptly. Severe hypersensitivity reactions have occurred with the administration of fluoroquinolones. The nurse discontinues the antibiotic immediately if skin rash or other signs or symptoms occur. Administration of acetylcysteine or diphenhydramine is not indicated. Slowing down the rate of infusion would not address the problem as it relates to exposure to the medication. Neither the administration of acetylcysteine nor diphenhydramine is indicated initially. Acetylcysteine is prescribed to treat thick mucus lung secretions. Treatment with diphenhydramine would be ineffective if the ciprofloxacin were not first discontinued.

Oral ampicillin has been ordered for a client whose urinary tract infection will be treated in a home setting. When providing antibiotic teaching to this client, the nurse should stress which instruction?

Drink a full glass of water when taking a dose of the drug. Clients taking penicillins should take oral doses with a full glass of water to ensure sufficient hydration while taking the medication. The drugs should otherwise be taken on an empty stomach. Tapering is unnecessary, and it is not advised to take the drug with diphenhydramine in an effort to reduce the allergy risk.

Which of the following drugs would be classified as an aminoglycoside?

Gentamicin

A client diagnosed with tuberculosis was prescribed antitubercular therapy but stopped after 1 month because of difficulty with the medication scheduling. As a result, secondary drugs are being prescribed. Which nursing diagnosis would the nurse most likely identify?

Ineffective Self-Health Management Difficulties with scheduling most likely led to the client not adhering to the treatment plan. As a result, the nursing diagnosis of Ineffective Self-Health Management would be most appropriate. Although nutrition can be affected, there is no indication that this is the problem. Although the client may have difficulty coping with the disease, there is no indication that this is a problem. The client may experience discomfort related to the adverse effects of the drug; however, there is no indication that this is an issue.

A client is prescribed penicillin V orally for a strep throat. What is the mechanism of action of this medication?

It inhibits cell wall synthesis. Beta-lactam antibacterial drugs inhibit synthesis of bacterial cell walls by binding to proteins in bacterial cell membranes. Penicillin V does not inhibit protein synthesis. Penicillin V does not inhibit protein synthesis, cause mutations, or lower the pH of a bacterium's cellular contents.

When administering aminoglycosides, the nurse must be aware of which of the following adverse reactions?

Ototoxicity and nephrotoxicity After parenteral administration, aminoglycosides are widely distributed in extracellular fluid and reach therapeutic levels in blood, urine, bone, inflamed joints, and pleural and ascitic fluids. They accumulate in high concentrations in the proximal renal tubules of the kidney leading to acute tubular necrosis. This damage to the kidney is termed nephrotoxicity. They also accumulate in high concentrations in the inner ear, damaging sensory cells in the cochlea and the vestibular apparatus. This damage to the inner ear is termed ototoxicity.

Which statement is true in regards to the oral administration of tetracyclines?

Tetracyclines should be administered with a full glass of water. Tetracyclines should always be administered with a full glass of water and on an empty stomach (except minocycline and tigecycline may be taken with food).

The nurse is caring for a client who is taking a sulfonamide and notices that the client has developed itchy hives. After contacting the health care provider, what term will the nurse use to describe the client's symptoms?

Urticaria Hives or itchy wheals on the skin resulting from contact with, or ingestion of, an allergic substance is known as urticaria. Pruritis is simple itching. Toxic epidermal necrolysis is sloughing of skin and mucous membranes. Stevens-Johnson syndrome consists of fever, cough, muscular aches and pains, headache and lesions of the skin (blisters or wheals).

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

Vomiting and diarrhea Although headache and dizziness, superinfections, and phlebitis (with intravenous administration) can occur, the most common adverse effects of cephalosporins involve the GI tract and include vomiting, diarrhea, nausea, anorexia, abdominal pain, and flatulence.

Extreme caution would be necessary with the use of gentamicin in which client?

a client who has chronic renal failure secondary to diabetes mellitus Gentamicin is nephrotoxic, and with impaired renal function, a reduction in dosage is essential. Heart blocks, obesity, and lithium therapy do not severely complicate, or contraindicate, the use of an aminoglycoside since they are not associated with nephrotoxicity.

Drugs that destroy bacteria are known as which type of drug?

bacteriocidal Drugs that destroy bacteria are known as bactericidal. Drugs that slow or retard the multiplication of bacteria are known as bacteriostatic. Bacteriostationary keeps the bacteria in place, and bacteriophage uses enzymatic substances to destroy the bacteria.

A patient has been admitted to the intensive care unit with signs and symptoms of sepsis and preliminary results of the patient's initial blood cultures reveal the presence of methicillin-resistant Staphylococcus aureus (MRSA). This finding is an indication for treatment with

daptomycin. Daptomycin is FDA approved for treatment of bacteremia due to S. aureus (including MRSA). Ciprofloxacin, levofloxacin and polymyxin B are not typically used in cases of MRSA sepsis.

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.

drop in blood pressure increase in respiratory rate sudden increase in temperature The nurse must notify the primary health care provider if there is a drop in blood pressure, increase in respiratory rate, or sudden increase in temperature during an ongoing assessment after administration of the drug. Regular urine output or pulse rate within usual parameters need not be reported to the health care provider because these would be normal findings.

A client being treated for tuberculosis (TB) is determined to be drug resistant. Which medications will no longer be effective in the treatment of the tuberculosis?

isoniazid (INH) and rifampin (RIF) Isoniazid (INH) and rifampin (RIF) are used to treat tuberculosis. In multidrug resistance, the most effective drugs the client is resistant to are isoniazid and rifampin. Carbamazepine and phenytoin are used to control seizures. Dextroamphetamine and doxapram are central nervous system stimulants. Propranolol and sotalol are beta-adrenergic blocking agents.

A client has been treated several times for a recurring ear infection with ofloxacin. The nurse instructs the client to look for side effects from the prolonged use of the antibiotic and informs the client that this is known as:

superinfection Prolonged use of otic preparations containing an antibiotic may result in a superinfection (an overgrowth of bacterial or fungal microorganisms not affected by the antibiotic being administered).