beta lactam antibacterial agents
The nurse is admitting a 12-year-old girl to the acute care facility and notices discolored secondary teeth. The mother says she doesn't know why the teeth are discolored because the child is very good about brushing and flossing and sees the dentist regularly. What question should the nurse ask?
"Has she ever received tetracycline?" The nurse would question whether the child was ever given tetracycline because this drug is commonly associated with discoloration of secondary teeth when it is administered to children who still have their primary teeth
A client with a complex medical history is scheduled to begin with an IV cephalosporin. After the initiation of therapy, the nurse should monitor the client for which potential adverse effect of intravenous cephalosporin therapy?
- nausea and vomiting - abdominal pain - diarrhea
Your client receives IV vancomycin every 12 hours. You know that this infusion should run over:
1 to 2 hours For systemic infections, vancomycin is given IV and reaches therapeutic plasma levels within 1 hour after infusion. It is very important to give IV infusions slowly, over 1 to 2 hours, to avoid an adverse reaction characterized by hypotension, flushing, and skin rash. This reaction, sometimes called "red man syndrome," is attributed to histamine release.
Penicillins may trigger an anaphylactic reaction in some clients. Within what period following injection of a penicillin is anaphylaxis most likely to occur?
30 minutes Anaphylaxis induced by injectable penicillins typically occurs within 30 minutes of administration.
Penicillin would NOT be indicated for which of the following clients?
A client with gram-negative bacteria allergic to penicillin Contraindications include hypersensitivity or allergic reactions to any penicillin preparation. An allergic reaction to one penicillin means the client is allergic to all members of the penicillin class
When learning about the different classes of cephalosporins, the nurse correctly identifies which of the following statements?
A first-generation cephalosporin is more useful than a third-generation cephalosporin against gram-positive microorganisms.
The nurse administers cefuroxime to a client at least one hour before meals, as prescribed. However, the client experiences a GI upset. Which is an appropriate nursing intervention in this case?
Administer the drug with food.
Which of the following should be included in the nurse's pre-administration assessment prior to a client receiving a penicillin?
Allergy history Medical history Medication history Current symptoms
A male client is admitted to the unit with Pseudomonas aeruginosa sepsis. The health care provider orders aminoglycoside to be given concomitantly with penicillin intravenously. How would the nurse administer these drugs?
By administering the drug in separate IV bags Aminoglycosides are often given concomitantly with penicillins for serious infections, such as those caused by Pseudomonas aeruginosa. The drugs should not be admixed in a syringe or in an IV solution, because the penicillin inactivates the aminoglycoside.
Culture and sensitivity testing of a client's urine sample reveals a bacterium that is susceptible to cephalosporins. What medication would be most likely for the nurse to administer?
Cefaclor
Which of the following cephalosporins' absorption is increased when administered with food?
Cefuroxime (Ceftin) Cefpodoxime (Vantin)
Prior to administration of the first dose of ampicillin, the nurse questions the client about her drug history. What condition that developed with a previous dose of this medication would contraindicate the use of it again?
Cholestatic jaundice A client who developed cholestatic jaundice with a previous use of ampicillin should not be given this medication again to prevent permanent liver damage
A female client is admitted to the critical care unit with sepsis related to a contaminated central line. The health care provider orders intravenous beta-lactam antimicrobials. The client's current laboratory report reflects renal impairment. What would the nurse expect the provider to do?
Decrease the drug dose. Beta-lactam antimicrobials are commonly used in critical care units to treat pneumonia, bloodstream infections, wound infections, and other infections. Renal, hepatic, and other organ functions should be monitored in critically ill clients, and drug dosages should be reduced when indicated.
A 28-year-old patient has been prescribed penicillin for the first time. While providing education for this patient, the nurse determines that the patient may be at high risk for noncompliance. What nursing diagnosis would be most appropriate for this patient?
Deficient knowledge regarding drug therapy Since this is the first time the patient has taken penicillin, she may have limited knowledge about the drug. She may not understand the importance of taking the medication as ordered to increase effectiveness of the drug or to report adverse effects. Knowledge will increase the compliance by being prepared for or knowing what to look for as she begins the therapy.
A client being treated for cellulitis with a cephalosporin asks what the essential difference is between generations of this medication. The nurse should respond to the client's question based on what fact?
Each successive generation is more effective against gram-negative microorganisms.
Penicillins and cephalosporins are used cautiously in neonates due to what factor?
Immature kidney function Penicillins and cephalosporins are widely used to treat infections in children and are generally safe. They should be used cautiously in neonates, because immature kidney function slows their elimination. Dosages should be based on age, weight, severity of the infection being treated, and renal function.
A male client who has undergone surgery of the urinary tract is administered cephalosporins to prevent infections. When assessing the client on the day after the surgery, the nurse notices that he has an elevated temperature. Which nursing intervention would be most appropriate in this case?
Inform the primary health care provider.
The nurse is administering penicillin to a client who has strep throat. Which of the following statements accurately describe the action of penicillin?
It is effective against gram-positive organisms
An older adult is to receive a low dose of a cephalosporin for an infection. When realizing that this client has age-related diminished renal function, what intervention should the nurse implement?
Monitor blood creatinine levels. The older adult is more susceptible to the nephrotoxic effects of the cephalosporins, particularly if renal function is already diminished because of the aging process or a disease. With renal impairment, a lower dose can be given and monitoring creatinine levels is indicated
A 75-year-old patient with a history of renal impairment is admitted to the primary health care center with a UTI and has been prescribed a cephalosporin. Which of the following interventions is most important for the nurse to perform when caring for this patient?
Monitoring blood creatinine levels An elderly patient is more susceptible to the nephrotoxic effects of the cephalosporins. Since renal impairment is present, it is important for the nurse to closely monitor the patient's blood creatinine levels.
A young adult has been receiving Keflex P.O. for the last 5 days to treat a respiratory infection. The nurse is concerned when the client reports urinating only once in the last 16 hours. What should the nurse consider as the cause?
Nephrotoxicity Nephrotoxicity may develop from administration of cephalosporins. An early sign of this adverse reaction is decreased urine output. The nurse should measure and record fluid intake and output and notify the primary healthcare provider if output is less than 500 ml/day.
Which of the following should a nurse carefully monitor in a patient who has been administered cephalosporin as well as aminoglycosides for a wound infection?
Nephrotoxicity When cephalosporin is administered with aminoglycosides, it increases the risk for nephrotoxicity and should be closely monitored. Nausea is an adverse reaction of cephalosporins in patients with gastrointestinal tract infection. The risk of bleeding increases when cephalosporin is administered with oral anticoagulants. Risk for respiratory difficulty increases if alcohol is consumed within 72 hours after certain cephalosporin administration.
Cephalosporins are structurally and chemically related to which classes of antibiotics?
Penicillins
A client is receiving a cephalosporin and an aminoglycoside as combination therapy. What assessment should the nurse prioritize?
Serum BUN and creatinine levels
A nurse is caring for a patient who has a serious infection. The patient is being treated with combination therapy of a cefazolin and an aminoglycoside. The nurse will be sure to monitor which of the following?
Serum BUN and creatinine levels Patients receiving combination therapy of a cefazolin and an aminoglycoside will need to be monitored for nephrotoxicity and therefore would need serum BUN and creatinine levels done.
A 34-year-old female client is taking oral cephradine, a first-generation cephalosporin, at regular intervals with a 2-hour gap before meals. The client reports gastrointestinal distress. The nurse will encourage the client to do which?
Take the drug with food.
The client is admitted to the acute care facility with acute septicemia and has orders to receive gentamicin and ampicillin IV. The nurse is performing an admission assessment that includes a complete nursing history. What information provided by the client would indicate the need to consult the health care provider before administering the ordered medication?
Takes high-dose furosemide (Lasix) daily Aminoglycosides should be avoided if the client takes a potent diuretic because of the increased risk of ototoxicity, nephrotoxicity, and neurotoxicity. Learning the client takes a potent diuretic would indicate the need to consult with the health care provider before administering gentamicin.
A client is taking penicillin for an upper respiratory infection. The client calls the office after 2 days of therapy reporting nausea and abdominal pain. Which would be the best instruction for the nurse to give the client?
These are normal side effects, but if they increase in severity or frequency, you need to contact the office again.
Cephalosporins are used to treat which of the following infections?
Urinary tract infections Bone infections Skin infections Nosocomial pneumonias
The nurse is caring for a 23-year-old female client who uses oral contraceptives and has been prescribed ampicillin for treatment of a respiratory infection. What information is most important for the nurse to share with this client?
Use a type of barrier birth control while you are taking this antibiotic.
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.
In the rare instance in which penicillin is considered essential, hypersensitivity can be assessed by administering:
a skin test
A client diagnosed with infective endocarditis would be most effectively treated with which medication?
ampicillin Health care providers use ampicillin in the treatment or prophylaxis of infective endocarditis. Ampicillin is effective against bacterial infections
After teaching a group of nursing students about the action of penicillins, the instructor determines that the teaching was effective when the students identify natural penicillins as exerting which type of effect on microorganisms?
bactericidal
The health care provider is selecting an antibiotic for a client with a known penicillin allergy. The provider knows that cephalosporins are a poor choice for this client because cephalosporins:
can cause allergic reactions in clients who are allergic to penicillins. Clients who are allergic to penicillins may also be allergic to cephalosporins. Although this cross-allergenicity (allergy to a drug of another class with similar chemical structure) is rare, cephalosporins are not typically administered to clients who have had life-threatening allergic reactions to a penicillin.
The nurse is preparing a teaching plan for a client who is prescribed ceftriaxone. What should the nurse identify as common adverse effects associated with this drug?
diarrhea and nausea The most common adverse effects associated with ceftriaxone, a cephalosporin, include those affecting the GI tract, such as nausea, vomiting, diarrhea, abdominal pain, and flatulence.
As a class, penicillins usually are more effective in infections caused by which type of bacteria?
gram-positive
You know that penicillins are more effective when used on what type of bacteria?
gram-positive bacteria
The mother of a 5-year-old asks the nurse why her child has oral amoxicillin prescribed so much. What rationale should the nurse give the mother?
it is better absorbed Most of the penicillins are rapidly absorbed from the GI tract, reaching peak levels in 1 hour.
A male client is placed on an IV regimen of aztreonam. The nurse would expect the health care provider to order which laboratory test?
liver function Aztreonam, imipenem, meropenem, and ertapenem may cause abnormalities in liver function test results (i.e., elevated alanine and aspartate aminotransferases
The nurse is justified in suspecting that a client who recently completed a course of ceftaroline may have been treated for what health problem?
methicillin-resistant Staphylococcus aureus (MRSA) infection Explanation: Ceftaroline is an IV cephalosporin for the treatment of community-acquired pneumonia and skin infections. It is the first cephalosporin to be considered active against resistant gram-positive organisms, such as MRSA.
A 40-year-old is being treated for an ear infection with a cephalosporin. Which adverse reactions should the nurse monitor for in the client?
nausea The most common adverse reactions that are caused due to cephalosporin administration include nausea, vomiting, and diarrhea
What event triggers the development of a superinfection?
proliferation of antibiotic-resistant microorganisms
The nurse is reviewing the medication history of a client who is prescribed penicillin therapy. Use of which medication would alert the nurse to the possibility of the client's increased risk for an anaphylactic reaction?
propranolol The concomitant use of penicillins with beta-adrenergic blocking drugs, such as propranolol, may increase the risk for an anaphylactic reaction
The nurse knows that superinfections are a concern for clients who have been taking oral penicillins. Which is one of the more common superinfections?
pseudomembranous colitis
A 7-year-old child has tonsillitis and is prescribed penicillin V, which is to be administered at home. The nurse will instruct the parents to administer the drug
with a glass of water 1 hour before or 2 hours after a meal.
The nursing instructor is teaching the students about different gastrointestinal adverse reactions to penicillin. What other reactions may occur with this medications administration?
- pain at the injection site - irritation at the vein - phlebitis
Choice of a beta-lactam antibacterial depends on which factors?
- the organism causing the infection - severity of the infection - other coexisting illnesses
A client on cephalosporin therapy is prescribed cefazolin for a sinus infection. After administration of the first dose of the cefazolin, the client reports itching. The nursing assessment reveals a rash over the client's torso. What is the most likely cause of the itching?
A cross-sensitivity reaction. Cefazolin is contraindicated in anyone with a known allergy to cephalosporins. Caution must be used in clients with renal failure and in pregnant or lactating women. Because of the structural similarities between cephalosporins and penicillins, clients who are allergic to one type of drug may experience cross-sensitivity to the other. Cephalosporin hypersensitivity occurs in 5% to 10% of clients with penicillin allergy. Clients with a history of severe allergic reactions to penicillins should not receive cephalosporins because of their increased risk for cross-sensitivity reactions.
After administering penicillin as prescribed, a patient shows signs of diarrhea and informs the nurse that there is blood in his stools. Which of the following interventions should the nurse perform?
Contact primary health provider immediately. If diarrhea is suspected, the nurse should notify the primary health care provider immediately. The nurse should wait for the primary health care provider's instructions before continuing with the prescribed regimen
Unless hemodialysis is started within 48 hours, imipenem is contraindicated for clients with severe renal impairment. What laboratory measurement would indicate renal impairment?
Creatinine clearance Dosage of imipenem should be reduced in most clients with renal impairment, and the drug is contraindicated in clients with severe renal impairment (CrCl of 5 mL/min or less) unless hemodialysis is started within 48 hours. For clients already on hemodialysis, the drug may cause seizures and should be used very cautiously, if at all.
Beta-lactam antibiotics, such as penicillins and cephalosporins, fight infection by inhibiting development of the causative bacteria. What specific component development do these drugs affect?
cell wall synthesis
After teaching a group of nursing students about the indications for use of antibacterial drugs that disrupt the bacterial cell wall, the instructor determines that the teaching was successful when the group identifies which medication as commonly prescribed to a victim after a sexual assault for infection prophylaxis?
cephalosporin
The client is receiving keflex 1000 mg/day. The nurse properly identifies this drug as a:
first-generation cephalosporin.
A nurse is required to administer a parenteral form of penicillin to a patient. Which of the following interventions should a nurse perform when preparing penicillin in parenteral form?
shake the vial well to distribute the drug evenly When preparing a parenteral form of penicillin, the nurse should shake the vial thoroughly before withdrawing the drug to ensure its even distribution in the solution. Penicillins in powder or crystalline form must be reconstituted before being withdrawn from the vial. Excess antibiotic after reconstitution should never be saved, as the drug loses its potency when stored. Reconstitution should be done only with the diluent prescribed on the manufacturer's label.
A 13-year-old male patient has been prescribed oral cefuroxime. The patient's parents should ensure that he takes the medication
with food Oral cefuroxime should be taken with food to decrease nausea and vomiting.
