Adaptive Quiz: Chapter 26, Antibacterials
Which patient is a potential candidate for antibiotic therapy involving aminoglycoside? A patient with Pseudomonas aeruginosa pneumonia A patient with a history of neuromuscular dysfunction A patient with increased serum creatinine levels A patient with elevated serum alanine aminotransferase
A patient with Pseudomonas aeruginosa pneumonia
The nurse is teaching a group of nursing students about aminoglycosides. Which statement by the nurse regarding aminoglycosides is true? "Aminoglycosides can potentiate warfarin toxicity." "Aminoglycosides can be used by lactating women." "Concurrent use with loop diuretics reduces the risk for ototoxicity." "Aminoglycosides are used alone to treat gram-positive infections."
"Aminoglycosides can potentiate warfarin toxicity." Aminoglycosides kill intestinal bacterial flora that produce vitamin K. Vitamin K plays a significant role in blood clotting. Therefore, aminoglycosides administered along with warfarin (Coumadin) may cause warfarin toxicity. Normal gut flora balances the effects of oral anticoagulants such as warfarin (Coumadin). Therefore, aminoglycosides can potentiate warfarin toxicity. Aminoglycosides cannot be used by lactating women because these drugs are present in breast milk and may cause adverse effects in the infant. Concurrent use of aminoglycosides and loop diuretics increases the risk for ototoxicity. Aminoglycosides are not used alone to treat gram-positive infections; they are given in combination with penicillin.
A nursing instructor is discussing tigecycline (Tygacil) therapy with a group of nursing students. Which statement is the nursing instructor most likely to make? "Avoid administering tigecycline (Tygacil) to a 17-year-old with Helicobacter pylori infection." "Avoid administering tigecycline (Tygacil) to a 37-year-old with acne vulgaris." "Avoid administering tigecycline (Tygacil) to a 7-year-old with Lyme disease." "Avoid administering tigecycline (Tygacil) to a 37-year-old with granuloma inguinale."
"Avoid administering tigecycline (Tygacil) to a 7-year-old with Lyme disease." Tetracyclines such as tigecycline (Tygacil) should not be given to children between 4 months and 8 years of age. They can cause discoloration of the permanent teeth and tooth enamel hypoplasia in both fetuses and children and possibly retard fetal skeletal development if taken by the mother during pregnancy. The medication can be administered to older patients per the advice of a primary health care provider. These patients may suffer from some minor adverse effects.
The nurse is performing a follow-up assessment of a patient who was prescribed tetracycline (Sumycin) for a respiratory infection. The nurse finds that the infection is still present; however, the patient reports taking the drug as prescribed. What question does the nurse ask the patient to determine the cause of drug ineffectiveness in this situation? "Did you take the drug with food?" "Did you co-administer iron supplements?" "Did you take the drug with a full glass of water?" "Did you take the prescribed dosage of the drug?"
"Did you co-administer iron supplements?" Tetracycline (Sumycin) may not be compatible with all foods and drugs. Iron, calcium, and magnesium may chelate the drug, making it unavailable for absorption. Therefore, the nurse should ask the patient about the use of iron supplements. The drug should be taken with food or with a full glass of water to avoid gastrointestinal upset. The drug, when taken as prescribed, should exhibit its therapeutic effect. The patient's history is not suggestive of nonadherence with the prescribed regimen as the patient reports taking the medications as prescribed.
A nurse is teaching a group of student nurses about the pharmacodynamics of antibacterial drugs. Which statements made by a student nurse show the need for further teaching? Select all that apply. "The ease of antibacterial drug dosing increases with the patient's adherence to the drug regimen." "The dose of an antibacterial medication once a week has been effective against eradicating pathogens." "A continuous infusion regimen of antibacterial drugs is more effective than intermittent dosing in case of severe infections." "Antibacterial drugs are used to achieve the maximum effective concentration (MEC) necessary to halt the growth of a microorganism." "The duration of time for the antibacterial drug's use varies according to the type of pathogen, site of infection, and immunocompetence of the host."
"The dose of an antibacterial medication once a week has been effective against eradicating pathogens." "Antibacterial drugs are used to achieve the maximum effective concentration (MEC) necessary to halt the growth of a microorganism." The once-daily antibacterial dose has been effective against eradicating pathogens. A weekly dose would not be effective in this regard. Antibacterial drugs are used to achieve the minimum effective concentration (MEC) to halt the growth of the microorganism. The ease of antibacterial drug dosing, administered once or twice daily, increases with the patient's adherence to the drug regimen. A continuous infusion regimen of an antibacterial drug is more effective than intermittent dosing in case of severe infections. The nurse should always remember that the duration of time for use of the antibacterial drug varies according to the type of pathogen, site of infection, and immunocompetence of the host.
What is the elimination half-life of amoxicillin (Amoxil)? 6 to 8 hours 1 to 2 hours 0.5 to 1 hour 1 to 1.5 hour
1 to 1.5 hour Amoxicillin (Amoxil) is a commonly prescribed aminopenicillin. The elimination half-life of amoxicillin (Amoxil) is 1 to 1.5 hours. The duration of the action of amoxicillin (Amoxil) is 6 to 8 hours. The peak effect of amoxicillin (Amoxil) occurs 1 to 2 hours after administration. The onset of action of amoxicillin (Amoxil) is 0.5 to 1 hour.
The nurse is setting up an intravenous infusion pump to administer a dose of vancomycin (Vancocin) to a patient. What is the proper rate that the drug should be infused? 30-60 minutes 60-90 minutes 90-120 minutes 120-150 minutes
60-90 minutes. Rapid infusion of vancomycin results in a red man syndrome, a response resulting in histamine release and chills, fever, tachycardia, pruritus, rash, or a red face, neck, upper body, back, and arms. It can be alleviated by the slow infusion of vancomycin over a 60- to 120-minute period. For this reason, the nurse should set the pump at 60 minutes. Rapid infusions at 30 minutes may also cause hypotension.
Which patient is a potential candidate for antibiotic therapy involving aminoglycoside? A patient with Pseudomonas aeruginosa pneumonia A patient with a history of neuromuscular dysfunction A patient with increased serum creatinine levels A patient with elevated serum alanine aminotransferase
A patient with Pseudomonas aeruginosa pneumonia Pseudomonas aeruginosa pneumonia, or P. aeruginosa, is susceptible to treatment with amikacin, gentamicin, or tobramycin; the patient with this infection is a suitable candidate for aminoglycosides therapy. Neuromuscular dysfunction and increased serum creatinine levels are adverse effects of aminoglycoside. Elevated serum alanine aminotransferase may indicate a liver problem; therefore, aminoglycosides therapy is contraindicated, as it may cause toxicity.
What is the mechanism of action of amphotericin B? Inhibition of protein synthesis Inhibition of cell wall synthesis Alteration in membrane permeability Interference with cellular metabolism
Alternation in membrane permeability Amphotericin B acts by altering the membrane permeability, which results in bacterial cell lysis. Drugs that act by inhibiting bacterial protein synthesis include aminoglycosides, tetracyclines, erythromycin, and lincomycin. Drugs that act by inhibiting bacterial cell wall synthesis include penicillin, cephalosporins, bacitracin, and vancomycin. Drugs that act by interfering with cellular metabolism include sulfonamides, trimethoprim, isoniazid, nalidixic acid, and rifampin.
The nurse anticipates that a patient with which of the following infections would be prescribed meropenem (Merrem)? Bacterial meningitis Cellulitis Pneumonia Tooth abscess
Bacterial meningitis Meropenem (Merrem) is used to treat susceptible intraabdominal infections like complicated appendicitis and peritonitis. Because it can cross the blood-brain barrier, meropenem (Merrem) is effective in treating bacterial meningitis. Other lactam drugs are effective for a variety of infections outside the central nervous system, such as cellulitis, pneumonia, and tooth abscess.
A nurse is caring for two patients with bacterial infections. Patient A has been prescribed amoxicillin (Amoxil), whereas patient B has been prescribed ceftriaxone (Rocephin). The nurse is concerned about possible drug interactions in these two clients. Which statement correctly depicts the side effect for which the nurse needs to watch out? Patient A is at risk for increased drug effect when taking tetracycline. Both patients are at risk for decreased drug effect when taking aspirin. Patient B is at risk for increased hepatotoxicity when taking loop diuretics. Both patients are at risk for increased bleeding when taking anticoagulants
Both patients are at risk for increased bleeding when taking anticoagulants. Amoxicillin (Amoxil) is a broad-spectrum penicillin and ceftriaxone (Rocephin) is a third-generation cephalosporin. Both amoxicillin and ceftriaxone can alter blood clotting time with the administration of large doses, so both drugs can cause increased bleeding if administered along with anticoagulants. Amoxicillin can have a decrease in effect with tetracycline. Amoxicillin can have an increased effect with aspirin; ceftriaxone has no specific interaction with aspirin. In individuals with a preexisting renal disorder, ceftriaxone increases the risk of nephrotoxicity with loop diuretics; this drug is not associated with hepatotoxicity.
Which antibiotic medication is most beneficial to a patient who has an anthrax infection? Norfloxacin (Noroxin) Ciprofloxacin (Cipro) Levofloxacin (Levaquin) Moxifloxacin (Avelox)
Ciprofloxacin (Cipro) Ciprofloxacin (Cipro) is the choice of drug for the treatment of anthrax. Norfloxacin (Noroxin) is used for the treatment of urinary tract infections and prostatitis. Levofloxacin (Levaquin) and moxifloxacin (Avelox) are more commonly used for the treatment of respiratory tract infections.
A primary health care provider prescribes a medication along with ampicillin to enhance the effectiveness of the antibiotic. Which medication will be added to enhance the effectiveness of the ampicillin? Calcium citrate Clavulanic acid Acetaminophen Carbamazepine
Clvavularic acid. Clavulanic acid is a β-lactamase inhibitor. Administered concurrently, it augments the therapeutic effect of antibiotics such as ampicillin. When ampicillin is administered by mouth, concurrent administration of calcium citrate can diminish its absorption. Acetaminophen and carbamazepine do not affect the pharmacokinetics of ampicillin.
The patient has been ordered lincomycin (Lincocin). The patient reports to the nurse that the patient has experienced reduced renal function in the past. The nurse anticipates that the health care provider will take which action? Place the medication on hold until renal function improves. Increase the original dosage of the medication. Decrease the original dosage of the medication. Continue with the medication as originally ordered
Decrease the original dosage of the medication. The most likely intervention is decreasing the dose of the medication in order to accommodate the decreased renal function. The medication would not be increased, held, or continued as originally ordered if renal function were decreased.
Which macrolide is derived from the bacteria Streptomyces erythreus? Minocyclin (Minocin) Erythromycin (E-Mycin) Clarithromycin (Biaxin) Streptomycin sulfate (Streptomycin)
Erythromycin (E-Mycin) Erythromycin (E-Mycin), a macrolide, is derived from the fungus-like bacteria Streptomyces erythreus. Minocyclin (Minocin) is a tetracycline, which is isolated from Streptomyces aureofaciens. Clarithromycin (Biaxin) is an extended macrolide group, which is a derivative of erythromycin. Streptomycin sulfate (Streptomycin) is derived from the bacterium Streptomyces griseus.
Which drugs act by inhibiting the protein synthesis of the bacteria? Select all that apply. Bacitracin (Baci-Rx) Polymyxin (Polymyxin B) Erythromycin (Erythocin) Lincomycin (Bactramycin) Penicillin G potassium (Pfizerpen)
Erythromycin (Erythocin) Lincomycin (Bactramycin) Erythromycin (Erythrocin) and lincomycin (Bactramycin) act by interfering with the steps of protein synthesis in bacteria. Bacitracin (Baci-Rx) acts by interfering with the cellular metabolism of the bacteria. Polymyxin (Polymyxin B) acts by altering bacterial membrane permeability. Penicillin G potassium (Pfizerpen) acts by inhibiting the cell wall synthesis.
Which class of antibiotics acts to inhibit the synthesis of RNA and DNA, thus stalling bacterial replication? Sulfonamides Cephalosporins Aminoglycosides Fluoroquinolones
Fluoroquinolones Fluoroquinolones act by inhibiting the synthesis of RNA and DNA by binding to nucleic acid and enzymes needed for nucleic acid synthesis. This consequently stalls bacterial replication. Sulfonamides act by interfering with the steps of metabolism within the cell. Cephalosporins act by inhibiting bacterial cell wall synthesis. Aminoglycosides act by inhibiting steps of bacterial protein synthesis.
A patient diagnosed with an upper respiratory tract infection is on phenothiazine therapy for psychotic disorder. The nurse reviews the prescription and finds that azithromycin (Zithromax) has been prescribed by the primary health care provider to treat a respiratory infection. For which complication should the nurse closely monitor the patient? Ototoxicity Hepatotoxicity Blood dyscrasias Pseudomembranous colitis
Hepatotoxicity Azithromycin (Zithromax) is the drug of choice for upper respiratory tract infections. Hepatotoxicity is a serious adverse effect of azithromycin (Zithromax) that can occur when azithromycin (Zithromax) is given in patients who are using hepatotoxic drugs such as phenothiazines. High doses of aminoglycosides cause ototoxicity. Blood dyscrasias and pseudomembranous colitis are the serious adverse effects of the medication doxycycline (Vibramycin).
A patient has been ordered telithromycin (Ketek) as well as simvastatin (Zocor). What is the nurse's best action? Hold the medication and call the health care provider. Administer the medications as prescribed. Separate the medications by 6 hours. Have the patient take the medications with food or milk
Hold the medication and call the health care provider. Telithromycin should not be taken with simvastatin owing to the risk of an increase in the medication which could cause toxicity. Separating the medications by 6 hours or taking the medication with milk or food will not lessen the risk of side effects. The nurse should not administer these medications together
A patient suffering from an upper respiratory tract infection was prescribed medication to be taken once a day for 5 days. After taking the drug, the patient complains of nausea, diarrhea, and abdominal pain. The patient also develops conjunctivitis before completing the full course. Which is a characteristic of the drug prescribed to the patient? It can cause hepatotoxicity in high doses. It is readily absorbed from the gastrointestinal (GI) tract. It should never be taken with clindamycin or lincomycin. It should not be prescribed to patients with renal insufficiency
It can cause hepatotoxicity in high doeses. The patient was prescribed azithromycin (Zithromax), which is a macrolide that is only prescribed to be taken once a day for 5 days due to its long half-life of up to 40 to 68 hours. The common side effects associated with this drug include nausea, diarrhea, and abdominal pain. It can also cause conjunctivitis as a side effect. Hepatotoxicity can occur when azithromycin (Zithromax) is taken in high doses with other hepatotoxic drugs. Clarithromycin (Biaxin) and erythromycin (E-Mycin) are readily absorbed from the GI tract, mainly by the duodenum. Azithromycin (Zithromax) is incompletely absorbed from the GI tract, and only 37% reaches systemic circulation. Because macrolides are excreted in urine in only small amounts, renal insufficiency is not a contraindication for the use of a macrolide such as azithromycin. Erythromycin (E-Mycin) should not be taken with clindamycin (Cleocin) or lincomycin (Lincocin) because these compete for receptor sites.
Which statement is true regarding ceftriaxone (Rocephin)? It has a bacteriostatic effect. It has an oral route of administration. It may decrease the levels of liver enzymes. It has a maximum child dose of 100 mg/kg/day
It has a maximum child dose of 100 mg/kg/day. The maximum dose of ceftriaxone (Rocephin) in children is 100 mg/kg/day; if the dose beyond this is administered it may lead to an overdose. Ceftriaxone (Rocephin) inhibits bacterial cell wall synthesis, causing cell death. Therefore, it is a bactericidal drug. Ceftriaxone (Rocephin) is administered through an intravenous or intramuscular route. An increase in liver enzymes is found with ceftriaxone (Rocephin).
Wich drugs inhibit bacterial growth? Select all that apply. Lincomycin (Lincocin) Levofloxacin (Levaquin) Amikacin sulfate (Amikin) Azithromycin (Zithromycin) Chloramphenicol (Chloromycetin)
Lincomycin (Lincocin) Azithromycin (Zithromycin) Chloramphenicol (Chloromycetin) Lincomycin (Lincocin), azithromycin (Zithromycin), and chloramphenicol (Chloromycetin) are bacteriostatic drugs. These drugs inhibit bacterial growth. Levofloxacin (Levaquin) and amikacin sulfate (Amikin) are bactericidal drugs. These drugs kill bacteria.
A patient is prescribed penicillin G potassium (Pfizerpen) for treating a respiratory infection. What would be the appropriate nursing interventions for this patient? Select all that apply. Monitoring for superinfection Monitoring the patient for respiratory distress Obtaining a culture and sensitivity test after starting the therapy Having availability of epinephrine to treat severe allergic reaction Advising the patient to take the medication with an empty stomach
Monitoring for superinfection Monitoring the patient for respiratory distress Having availability of epinephrine to treat severe allergic reaction When taking penicillin for a prolonged time, it may cause superinfections. Therefore, monitoring for stomatitis, which is a type of superinfection, is required. Respiratory distress is a severe allergic reaction after a first or second dose of penicillin. Epinephrine is used to treat a severe allergic reaction that may occur with the use of penicillin. A culture and sensitivity test should be obtained before starting the therapy for effective treatment. Penicillins should be taken with food to avoid gastric irritation.
The nurse is assessing a patient who is being admitted with recurrent osteomyelitis related to penicillin-G resistant Staphylococcus aureus. Which medication may be therapeutically effective in treating this infection? Nafcillin (Nallpen) Ampicillin (Principen) Aztreonam (Azactam) Carbenicillinindanyl (Geocillin)
Nafcillin (Nallpen) Nafcillin (Nallpen) is a penicillinase-resistant penicillin and is effective in treating osteomyelitis, which is a bone infection, in which the patient is resistant to penicillins. Ampicillin (Principen) is not as effective as nafcillin (Nallpen) in treating this type of infection. Aztreonam (Azactam) is similar to cephalosporin and may not be effective against penicillin-resistant bacteria. Carbenicillinindanyl (Geocillin) is not as effective as nafcillin (Nallpen) in treating osteomyelitis.
A patient is diagnosed with a penicillin-resistant staphylococcus infection. Which drug does the nurse anticipate to be prescribed by the health care provider? Amoxycillin (Amoxil) Oxacillin (Prostaphin) Ampicillin (Principen) Carbenicillinindanyl (Geocillin)
Oxacillin (Prostaphin) Oxacillin (Prostaphin) is a penicillinase-resistant penicillin and is effective in treating a penicillin-resistant staphylococcus infection. Amoxycillin (Amoxil) and ampicillin (Principen) are the broad-spectrum penicillins and are effective only against gram-negative and gram-positive bacteria. Carbenicillinindanyl (Geocillin) is extended-spectrum penicillin and is effective against Pseudomonas aeruginosa and Proteus species.
The nurse is reviewing the medical reports of four patients. Patient A is prescribed anticoagulants and amoxicillin (Amoxil). Patient B is prescribed diuretics and ceftriaxone (Rocephin). Patient C is prescribed uricosurics and cefuroxime (Ceftin). Patient D is prescribed oral contraceptives and ampicillin (Principen). Which patient is at increased risk for nephrotoxicity? Patient A Patient B Patient C Patient D
Patient B In patient B, ceftriaxone (Rocephin), when given with diuretics, undergoes drug interaction and may lead to abnormal creatinine levels resulting from nephrotoxicity. In patient A, amoxicillin (Amoxil), when given with anticoagulants may cause an increase in bleeding. In patient C, uricosuric agents may decrease the excretion of cefuroxime (Ceftin) and lead to toxicity. In patient D, oral contraceptives may decrease the effect of ampicillin (Principen).
A student nurse is learning about the uses and considerations associated with different types of penicillins. The student nurse looks at a chart that contains the medications prescribed to four different patients, the diseases they are suffering from, and the special considerations associated with each patient. Which patient does the student nurse know to have received the correct medication, based on the given information? Patient A, who has renal failure, is prescribed penicillin V potassium (Veetids) for an upper respiratory infection. PatientB, who is suffering from an electrolyte imbalance is prescribed penicillin G potassium (Pfizerpen) for an upper respiratory infection. Patient C, who is unable to swallow medication orally, is prescribed nafcillin (Nallpen) for penicillin G-resistant Staphylococcus aureus infection. Patient D, who has hypertension is prescribed carbenicillin indanyl (Geocillin) for Pseudomonas aeruginosa infection.
Patient C, who is unable to swallow medication orally, is prescribed nafcillin (Nallpen) for penicillin G-resistant Staphylococcus aureus infection. Patient C has been prescribed the correct medication. Nafcillin (Nallpen) is highly effective against penicillin G-resistant Staphylococcus aureus. It is not recommended orally due to its instability in gastric juices; it is administered intravenously or intramuscularly. Hence, the patient's inability to swallow the medication orally will not be a hindrance in this scenario. Penicillin V potassium (Veetids) is used in the treatment of upper respiratory tract infections. However, it is not recommended in renal failure. Penicillin G potassium (Pfizerpen) is used in the treatment of lower respiratory disorders. Also, the patient's electrolyte levels need to be monitored with high doses. Carbenicillin indanyl (Geocillin) is the first penicillin-like drug developed to treat infections caused by Pseudomonas aeruginosa. This drug contains large amounts of sodium, so it should be used with caution when administering it to patients with hypertension or heart failure.
While instructing a patient about antibiotic therapy, the nurse explains to the patient that bacterial resistance to antibiotics can occur when what happens? Select all that apply. Patients stop taking an antibiotic after they feel better. Antibiotics are prescribed according to culture and sensitivity reports. Antibiotics are prescribed to treat a viral infection. Antibiotics are taken with water or juice. Antibiotics are taken with ascorbic acid (vitamin C)
Patients stop taking an antibiotic after they feel better. Antibiotics are prescribed to treat a viral infection. Not completing a full course of antibiotic therapy can allow bacteria that are not killed but have been exposed to the antibiotic to adapt their physiology to become resistant to that antibiotic. The same thing can occur when bacteria are exposed to antibiotics in the environment or when antibiotics are erroneously used to treat a viral infection.
A nurse is comparing the mechanisms of action for penicillin and nystatin. Which statement is true? Both nystatin and penicillin inhibit cell-wall synthesis. Nystatin has only bactericidal effects, whereas penicillin has only bacteriostatic effects. Penicillin causes enzyme breakdown of the cell wall, whereas nystatin increases membrane permeability. Nystatin inhibits the enzyme responsible for cell-wall synthesis, whereas penicillin inhibits synthesis of nucleic acid in bacteria.
Penicillin causes enzyme breakdown of the cell wall, whereas nystatin increases membrane permeability. The mechanism of action of penicillin is the inhibition of cell-wall synthesis; this is done by causing enzyme breakdown of the cell wall. The mechanism of action of nystatin is causing an alteration in membrane permeability; this is done by increasing membrane permeability, which causes loss of cellular substances, leading to lysis of the cell. Only penicillin causes inhibition of bacterial cell-wall synthesis; nystatin causes an alteration in membrane permeability. Nystatin has both bactericidal and bacteriostatic effects, whereas penicillin has only bactericidal effects. Penicillin inhibits the enzyme responsible for the synthesis of the cell wall; neither nystatin nor penicillin inhibits the synthesis of nucleic acid in bacteria.
A nurse is comparing the mechanisms of action for penicillin and nystatin. Which statement is true? Both nystatin and penicillin inhibit cell-wall synthesis. Nystatin has only bactericidal effects, whereas penicillin has only bacteriostatic effects. Penicillin causes enzyme breakdown of the cell wall, whereas nystatin increases membrane permeability. Nystatin inhibits the enzyme responsible for cell-wall synthesis, whereas penicillin inhibits synthesis of nucleic acid in bacteria.
Penicillin causes enzyme breakdown of the cell wall, whereas nystatin increases membrane permeability. The mechanism of action of penicillin is the inhibition of cell-wall synthesis; this is done by causing enzyme breakdown of the cell wall. The mechanism of action of nystatin is causing an alteration in membrane permeability; this is done by increasing membrane permeability, which causes loss of cellular substances, leading to lysis of the cell. Only penicillin causes inhibition of bacterial cell-wall synthesis; nystatin causes an alteration in membrane permeability. Nystatin has both bactericidal and bacteriostatic effects, whereas penicillin has only bactericidal effects. Penicillin inhibits the enzyme responsible for the synthesis of the cell wall; neither nystatin nor penicillin inhibits the synthesis of nucleic acid in bacteria.
Which class of penicillin antibiotic is known as antistaphylococcal penicillin? Natural penicillins Aminopenicillins Extended-spectrum drugs Penicillinase-resistant penicillins
Penicillinase-resistant penicillins Penicillinase-resistant drugs are known as antistaphylococcal penicillins. The penicillinase-resistant penicillins are able to resist breakdown by the penicillin-destroying enzyme (penicillinase), which is commonly produced by bacteria such as staphylococci. Therefore, this class of drug is called antistaphylococcal penicillins. Natural penicillin drugs, aminopenicillin drugs, and extended-spectrum drugs are easily broken down by the penicillinase enzyme. Therefore, these drugs are not called antistaphylococcal penicillins.
While reviewing the medication chart of a patient, the nurse finds that the patient is on a combination of tetracycline (Sumycin), metronidazole (Metro), and bismuth subsalicylate (Bismatrol). Which condition does the nurse suspect in this patient? Peptic ulcer Urinary tract infection Intraabdominal infection Community-acquired pneumonia
Peptic ulcer Tetracycline (Sumycin) in combination with metronidazole (Metro) and bismuth subsalicylate (Bismatrol) is effective against a bacterium called Helicobacter pylori, which is responsible for causing peptic ulcer. Floroquinolones such as ciprofloxacin (Cipro) and norfloxacin (Noroxin) are used for urinary tract infections. Glycylcyclines such as tigecycline (Tygacil) are used for intraabdominal infections. Levofloxacin (Levaquin) is used for community-acquired pneumonia.
The nurse is caring for a patient who is on amoxicillin (Amoxil) therapy. Which parameters monitored by the nurse would be beneficial in reducing the risk of complications in the patient? Select all that apply. Platelet count Prothrombin time Alkaline phosphatase Lactat dehydrogenase Alanine aminotransferase
Platelet count Alanine aminotransferase Thrombocytopenia may occur when using amoxicillin (Amoxil); therefore the white blood cell count should be monitored. Prothrombin time should be monitored when amoxicillin is given along with anticoagulants. Liver toxicity is the serious adverse reaction of amoxicillin (Amoxil) therapy. The nurse should consider monitoring the enzymes aspartate aminotransferase and alanine aminotransferase, because an increase in serum levels of these enzymes indicate liver damage. Lactate dehydrogenase should be monitored when ceftriaxone is given with calcium salts. Alkaline phosphatase enzyme is not raised with the use of amoxicillin (Amoxil).
Which drug increases the serum amoxicillin (Amoxil) levels when used in combination? Methotrxate (Trexall) Probenecid (Benemid) Erythromycin (Erythrocin) Tetracycline (Achromycin V)
Probenecid (Benemid) Probenecid (Benemid) when taken with amoxicillin (Amoxil) increases the serum antibacterial levels by decreasing its excretion. The effect of methotrexate (Trexall) is increased when taken with amoxicillin (Amoxil). Erythromycin (Erythrocin) and tetracycline (Achromycin V) decrease the effects of amoxicillin (Amoxil).
Which action does the nurse take if a patient receiving intravenous vancomycin (Vancocin) complains of facial pruritis? Gives diphenhydramine (Benadryl) with the infusion Documents that the patient has a hypersensitivity reaction Wraps the infusion in foil to protect from light Programs the vancomycin to infuse at a slower rate
Programs the vancomycin to infuse at a slower rate The nurse infuses vancomycin over at least 1 hour, as rapid infusion can cause red man syndrome. It is indicated by flushing or itching of the face, neck, and trunk, as well as more serious problems like tachycardia and hypotension. Diphenhydramine (Benadryl) is a hypnotic drug used for treating histamine-mediated allergies, motion sickness, and promotion of sleep. Pruritus in a patient taking vancomycin is more an indication of red man syndrome than hypersensitivity. Orally disintegrating medicines are wrapped in foils which, once administered, dissolve on the patient's tongue.
Which bacterium is sensitive to gentamycin (Garamycin)? Clostridium perfringens Staphylococcus aureus Streptococcus pyogenes Pseudomonas aeruginosa
Pseudomonas aeruginosa Pseudomonas aeruginosa is sensitive to gentamycin (Garamycin). Infections caused by Clostridium perfringens are treated with glycylcyclines. Tigecycline (Tygacil) and minocycline (Minocin) are used to treat Staphylococcus aureus infections. Glycylcyclines are used to treat Streptococcus pyogenes infections.
The primary health care provider prescribes vancomycin (Vancocin) to a patient who has a streptococcal infection. What will the nurse assess in the patient to ensure safe administration of the drug? Skin integrity Renal function Blood glucose concentration Red blood cell count
Renal function Vancomycin (Vancocin) is a tricyclic glycopeptide, which causes nephrotoxicity. Therefore, the nurse should check the patient's renal function before administering vancomycin (Vancocin). Renal impairment may lead to severe toxicity. The dosing frequency of vancomycin (Vancocin) is dependent on renal function. Therefore, it is important to check the patient's renal function. Vancomycin (Vancocin) does not affect skin integrity, blood glucose concentration, or red blood cell counts; therefore, the nurse need not check these in the patient.
The nurse has just received a prescription from the primary health care provider to administer ampicillin to an 80-year-old patient. Which assessment is the nurse's priority before administering the antibiotic? Renal function Hepatic function Cross-sensitivity Total body fluid
Renal function. The most important assessment before administering ampicillin to an older adult is renal function because older adults are more sensitive to medications. Ampicillin formulations contain large amounts of sodium and/or potassium. Doses must be adjusted for patients with renal dysfunction. If the patient is hypervolemic, assessment of renal function is even more important; however, the nurse should monitor intake and output and edema with the administration of ampicillin. In addition, older adults are likely to have declining organ function, which can lead to impaired elimination of any medication. Ampicillin can be administered by way of several routes; if the patient's veins are too poor for an infusion, it can be administered by means of injection into the muscle or by mouth. Cross-sensitivity to other antibiotics is not important until ampicillin fails to eliminate the bacteria after one course of treatment. Total body fluid is a reasonable assessment before the administration of ampicillin; however, eradication of the infection may be the priority.
A patient who is on nonsteroidal antiinflammatory drug (NSAID) therapy is diagnosed with a severe lower respiratory tract infection. The primary health care provider prescribed levofloxacin (Levaquin). Which complication will the patient most likely develop? Seizures Ototoxicity Nephrotoxicity Encephalopathy
Seizures Levofloxacin (Levaquin) is the drug of choice for severe lower respiratory tract infections. Levofloxacin (Levaquin) should not be administered with NSAIDs, because it may cause central nervous system reactions such as seizures. Ototoxicity is an adverse effect of vancomycin (Vancocin). Nephrotoxicity may be seen with high doses of amphotericin B (Fungizone). Encephalopathy is an adverse effect of streptomycin sulfate (Streptomycin) and may not be seen when levoflaxacin (Levaquin) is administered along with NSAIDs.
While reviewing the blood reports of a patient who is on amikacin (Amikin) therapy, the nurse finds that the serum drug concentration is 2 mcg/mL. What further laboratory reports will the nurse check to ensure the patient's safety? Blood glucose concentration Blood platelet count Serum thyroxine concentration Serum creatinine concentration
Serum creatinine concentration Amikacin (Amikin) is an aminoglycoside antibiotic. Aminoglycosides have the potential to cause nephrotoxicity, and thus the patient's serum drug concentrations should be monitored regularly. The usual serum drug concentration of aminoglycosides is expected to be ≤1 mcg/mL (considered as safe range). Concentrations higher than this may cause adverse effects. Therefore, the nurse should check the serum creatinine concentration to evaluate proper renal function. Aminoglycosides do not affect blood glucose concentration. Therefore, the nurse need not check the patient's blood glucose concentration. Aminoglycosides do not affect platelet count. Therefore, the nurse need not check the patient's platelet count. Aminoglycosides does not affect thyroxine hormone concentration. Therefore, the nurse need not check the patient's serum thyroxine concentration.
While reviewing the blood reports of a patient who is on amikacin (Amikin) therapy, the nurse finds that the serum drug concentration is 2 mcg/mL. What further laboratory reports will the nurse check to ensure the patient's safety? Blood glucose concentration Blood platelet count Serum thyroxine concentration Serum creatinine concentration
Serum creatinine concentration. Amikacin (Amikin) is an aminoglycoside antibiotic. Aminoglycosides have the potential to cause nephrotoxicity, and thus the patient's serum drug concentrations should be monitored regularly. The usual serum drug concentration of aminoglycosides is expected to be ≤1 mcg/mL (considered as safe range). Concentrations higher than this may cause adverse effects. Therefore, the nurse should check the serum creatinine concentration to evaluate proper renal function. Aminoglycosides do not affect blood glucose concentration. Therefore, the nurse need not check the patient's blood glucose concentration. Aminoglycosides do not affect platelet count. Therefore, the nurse need not check the patient's platelet count. Aminoglycosides does not affect thyroxine hormone concentration. Therefore, the nurse need not check the patient's serum thyroxine concentration.
Which bacteria, on gram staining, retain a purple stain? Select all that apply. Escherichia coli Staphylococcus aureus Neisseria meningitides Haemophilus influenza Streptococcus pneumoniae
Staphylococcus aureus and Streptococcus pneumoniae On gram staining, gram-positive bacteria such as Staphylococcus aureus and Streptococcus pneumoniae retain a purple stain. Gram-negative bacteria such as Escherichia coli, Neisseria meningitides, and Haemophilus influenza are not stained.
Which bacterial infection is effectively treated by both tigecycline (Tygacil) and minocycline (Minocin)? Escherichia coli infection Helicobacter pylori infection Staphylococcus aureus infection Clostridium perfringens infection
Staphylococcus aureus infection Staphylococcus aureus bacterial infection is effectively treated by both tigecycline (Tygacil) and minocycline (Minocin). Escherichia coli infections can be treated by tigecycline (Tygacil). A combination of tetracycline, metronidazole, and bismuth subsalicylate is effective in treating Helicobacter pylori infection. Clostridium perfringens infection is treated by tigecycline (Tygacil).
The primary health care provider instructs a nurse to administer intravenous vancomycin (Vancocin). During infusion, the patient has excessive sweating and reports itching on the face and neck. What is the best nursing intervention in this situation? Increase the rate of infusion of vancomycin (Vancocin). Decrease the rate of infusion of vancomycin (Vancocin). Advise the patient to get their blood pressure checked. Stop the administration of the vancomycin (Vancocin) infusion.
Stop the administration of the vancomycin (Vancocin) infusion. Rapid infusion of vancomycin (Vancocin) results in red man syndrome. This syndrome is characterized by flushing and itching of the head, face, neck, and upper trunk. It is most commonly seen when the drug is infused too rapidly. Stopping the administration of the vancomycin (Vancocin) infusion is the best nursing intervention in this situation. Rapid infusions of vancomycin (Vancocin) may cause hypotension; hence the patient sweats excessively. Rapid administration of the vancomycin (Vancocin) infusion worsens the itching and hypotension. The symptoms of red man syndrome can usually be alleviated by slowing the rate of infusion of the dose to at least 1 hour, but in this situation, it is already underway, so it is best to stop the infusion. Checking the blood pressure is a secondary intervention and is done once the patient is stabilized.
The nurse is assessing a patient who has tuberculosis-associated plague. Which medication will the nurse expect the primary health care provider to prescribe? Amikacin (Amikin) Gentamicin (Garamycin) Tobramycin (Nebcin) Streptomycin (Plantomycin)
Streptomycin (Plantomycin) Streptomycin (Plantomycin) is used to treat tuberculosis; it kills the bacteria Mycobacterium tuberculosis. Streptomycin (Plantomycin) also is used to treat plague that is caused by the bacteria Yersinia pestis. Hence, to reduce the risk factors for both tuberculosis and plague, the primary health care provider prescribes streptomycin (Plantomycin), an aminoglycoside. Tuberculosis and plague are not cured by other aminoglycosides such as amikacin (Amikin), gentamicin (Garamycin), and tobramycin (Nebcin). These drugs do not affect the bacteria M. tuberculosis and Y. pestis.
A patient has been prescribed dicloxacillin (Dynapen) for the treatment of a Staphylococcus aureus infection. The nurse knows the patient is taking aspirin for headaches that occur at regular intervals. The patient is also known to drink orange juice with meals every day. What side effects might the nurse see in the patient? Select all that apply. The effect of dicloxacillin (Dynapen) will increase with aspirin. The effect of dicloxacillin (Dynapen) will decrease with orange juice. The reaction of food with dicloxacillin could lead to laryngeal edema. The reaction of the two drugs could lead to severe bronchoconstriction with stridor. The reaction of dicloxacillin (Dynapen) with orange juice will cause nausea and vomiting.
The effect of dicloxacillin (Dynapen) will increase with aspirin. The effect of dicloxacillin (Dynapen) will decrease with orange juice. Dicloxacillin (Dynapen) is a penicillinase-resistant penicillin and its effect can increase with aspirin. The effect of dicloxacillin (Dynapen) can decrease with acidic fruits or juices, like oranges or orange juice. Laryngeal edema is one of the clinical manifestations of a severe allergic reaction to penicillin; it is not associated with a reaction of dicloxacillin with food. Severe bronchoconstriction with stridor is one of the clinical manifestations of a severe allergic reaction to penicillin; it is not associated with the reaction of dicloxacillin to another drug like aspirin. Nausea and vomiting are common side effects associated with penicillins. Taking dicloxacillin with orange juice will not specifically cause nausea and vomiting.
Which class of drugs may cause a decrease in the excretion of cephalosporins? Uricosurics Aminoglycosides Oral contraceptives Potassium supplements
Uricosurics. Uricosurics when used with cephalosporins decrease the excretion of cephalosporins by increasing their reabsorption, which increases the risk of toxicity. Aminoglycosides if used in conjugation with penicillins will be rendered inactive. Effectiveness of oral contraceptives is decreased when used with amoxicillin or ampicillin but not with cephalosporins. Potassium supplements increase the serum potassium level when taken with potassium penicillin G but not with cephalosporins.
