Ch 9: Antibiotics

A client has been on an antibiotic for two weeks for treatment of an infection. The client asks the nurse why a superinfection has been caused by this medication. What is the nurse's bestresponse?

"Antibiotics can disrupt the normal bacteria in your body, causing another infection to occur."

A young child has been brought to the clinic with signs and symptoms that are consistent with otitis externa. What assessment question should the nurse ask to address the etiology of this health problem?

"Has your child been swimming a lot lately?"

The nurse educates a client about using the prescribed otic 0.5% hydrocortisone, 10,000 units polymyxin B, 4 drops QID in right ear x 10 days. Which client statements determine the need for further clarification?

"I will place the bottle tip into the ear and instill the 4 drops."

The nurse is providing education to an older adult client who has been prescribed tetracycline. Which statement should the nurse include in the teaching?

"Increase your fluids to 2 L or more per day to prevent renal crystals."

The nurse is educating a client diagnosed with a urinary tract infection about the prescribed trimethoprim-sulfamethoxazole (TMP-SMZ). The client has a history of type 2 diabetes and currently takes a sulfonylurea. Which statement made by the client establishes the need for further clarification?

"The drug will not affect the herbal supplement, ginseng that I take."

A pregnant woman calls the clinic and asks if it is suitable to use ofloxacin otic drops that she used prior to pregnancy for a current ear infection. What would be an appropriate response from the nurse?

"The effects of ofloxacin in pregnancy are not known, so the drug should not be used while pregnant."

A client diagnosed with tuberculosis (TB) has begun multidrug therapy. The client has asked the nurse why it is necessary to take several different drugs. How should the nurse respond to the client's question?

"The use of multiple drugs prevents the development of drug-resistant TB."

An older adult diagnosed with necrotizing otitis externa has been receiving IV ciprofloxacin and is now transitioning to the oral form of the drug. What health education should the nurse provide to the client?

"You can take this medication with food to reduce the chance that it will upset your stomach."

A client has just been diagnosed with TB. The client is extremely upset and is asking questions concerning the medications. What is an appropriate response by the nurse?

"You will have multidrug therapy for 6 to 24 months."

Choice of a beta-lactam antibacterial depends on which factors? (Select all that apply.)

- The organism causing the infection - Severity of the infection - Other coexisting illnesses

A client has been prescribed 2 tablets of 150 mg isoniazid every day. The available drug is in the form of a 100-mg tablet. To meet the recommended dose, the nurse will administer _______ tablets each time.

3

A client has been prescribed 4 g of sulfamethoxazole/trimethoprim tablets per day. The available drug is in the form of 500 mg. The nurse would administer how many tablets each day?

8

The nurse would contact the physician if ciprofloxacin was prescribed for which client diagnosed with a urinary tract infection?

A 13-year-old client

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

A client who has chronic renal failure secondary to diabetes mellitus

A client has been prescribed ciprofloxacin after being diagnosed with a sinus infection. What medication should the client avoid taking concurrently with ciprofloxacin?

Antacids

A nurse is caring for a patient who has an acute bacterial exacerbation of chronic bronchitis and who has been prescribed telithromycin (Ketek). Before therapy begins, the nurse will assess the patient for a history of which of the following?

Arrhythmias

A child has been diagnosed with acute otitis media. Before the child begins antibiotic treatment, what assessment should the nurse perform?

Assess the child for allergies to penicillins.

A patient with TB has been admitted to a health care facility. When providing instructions for the patient teaching related to antitubercular drugs, which instructions should the nurse provide in order to avoid complications in the patient's GI tract?

Avoid the consumption of alcohol.

A client with a positive sputum culture for TB has been started on streptomycin antitubercular therapy. Upon review of the laboratory results, the nurse notes that the client may be experiencing toxicity if which of the following results is abnormal?

BUN and creatinine

A 9-year-old client has been admitted to the pediatric unit after being diagnosed with pertussis. The pediatric nurse is processing the client's admission orders and notes that IV demeclocycline has been prescribed. After beginning this treatment, the nurse should confirm the results of what laboratory test?

Blood urea nitrogen (BUN)

A client previously experienced an anaphylactic reaction to penicillin G. Which medication should not be administered to this client due to the potential for cross-sensitivity?

Cefadroxil

Which is an example of a first generation cephalosporin?

Cefadroxil

A nurse is providing education to a client who is taking INH. The nurse is teaching the client to avoid which foods?

Cheese, dairy products, and bananas

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

A hospital client's infection is being treated with gentamicin. When reviewing the results of the client's morning laboratory results for signs of adverse effects, the nurse should pay particular attention to what laboratory value?

Creatinine clearance

A nurse is preparing to administer a client's first scheduled dose of tetracycline. The nurse should first ensure that the client has not recently eaten what type of foods?

Dairy products

A client who takes zinc daily is diagnosed with a severe infection and is ordered levofloxacin (Levaquin). The nurse is aware that taking these two drugs may have what affect on the antibiotic?

Decreased absorption

A client who takes anticoagulants for atrial fibrillation is diagnosed with a severe infection and is ordered levofloxacin (Levaquin). The nurse is aware that taking these two drugs requires frequent assessment for which of the following?

Decreased clotting

A client, hospitalized with active tuberculosis, is receiving antitubercular drug therapy. When it becomes apparent that the client is not responding to the medications, what condition will the primary health care provider identify as a possible cause?

Drug-resistant tuberculosis

The nurse is caring for a client diagnosed with Legionnaires disease. What medication would the nurse expect the health care provider to prescribe?

Erythromycin

What potential adverse reaction is most likely to develop during cefazolin therapy?

Gastrointestinal upset

After teaching a group of students about aminoglycosides, the instructor determines that the teaching was successful when the group identifies which drug as the prototype for this class?

Gentamicin

The tetracyclines are effective against a wide range of which type of organisms?

Gram-positive and gram-negative organisms

The nurse is preparing to administer a sulfonamide to a client who is a Type 2 diabetic taking an oral hypoglycemic agent. The nurse will monitor the client for what reaction?

Hypoglycemia

A client has just been diagnosed with tuberculosis (TB). The nurse can expect to start the client on which drug for the initial phase of treatment?

INH, rifampin, pyrazinamide, ethambutol

Sulfonamides are bacteriostatic against a wide range of gram-positive and gram-negative bacteria, but they are becoming less useful for what reason?

Increasing resistance

The nurse knows that sulfonamides are chosen to treat ulcerative colitis because of what action?

Inflammation is decreased because of interaction with intestinal bacteria.

A nurse is caring for a patient who is being administered penicillin. What are the common adverse reactions to penicillin a nurse should assess for?

Inflammation of the tongue and mouth

The pharmacology instructor is discussing antimicrobials with the nursing class. What would the instructor tell the students is the mechanism of action of some antimicrobials?

Inhibiting cell wall synthesis

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

Isoniazid and rifampin

A female client is diagnosed with hepatitis C as well as a urinary tract infection. The organism is sensitive to tetracycline. Why is the health care provider reluctant to order tetracycline in a client with hepatic impairment?

It slows drug elimination.

What is the rationale for not administering tetracycline to children under the age of 8 years?

It will interfere with enamel development.

A client is prescribed isoniazid (INH) for a diagnosis of tuberculosis. Which adverse effect will result in discontinuation of the medication?

Jaundice

What is a contraindication to use of a fluoroquinolone?

Lactation

Which of the following medications is contraindicated in children?

Levofloxacin

Which of the following are examples of fluoroquinolones? Select all that apply.

Levofloxacin (Levaquin) Ciprofloxacin (Cipro)

A client, prescribed clindamycin, is now reporting frequent diarrhea. How should the nurse best respond to this client?

Liaise with the client's health care provider to have the drug discontinued.

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

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.

A client is receiving aztreonam. The nurse understands that this drug is classified as which of the following?

Monobactam

The nurse knows that tuberculosis (TB) is an infectious disease seen around the world and in many cases due to overcrowding. The nurse would be aware of this condition if the lab reports showed which bacteria?

Mycobacterium tuberculosis

The nurse should monitor the client for which common side effects of erythromycin therapy?

Nausea, vomiting, and diarrhea

The nurse is assisting in the admission of a client with a suspected urinary tract infection and an oral temperature of 100.9°F. The health care provider has written the following orders: acetaminophen 500 mg PO for elevated temperature; urinalysis for culture and sensitivity; sulfasalazine (Azulfidine) 500 mg PO four times daily; and force fluids to 3 L/day. Which order will the nurse complete first?

Obtain urine for culture and sensitivity.

When preparing to administer a fluoroquinolone, the nurse understands that the majority of drugs belonging to this class are administered by which route?

Oral

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

Ototoxicity and nephrotoxicity

An instructor is describing an antibiotic that is resistant to the enzyme penicillinase. What would the nurse identify as an example?

Oxacillin

Michael, 25 years old, has had mitral valve regurgitation since age four, after having rheumatic fever. Michael is planning to go to his dentist to have his teeth cleaned. Because of Michael's history he will need to take antibiotics in conjunction with this procedure to prevent bacteremia. Which class of antibiotics will Michael most likely receive if he has no allergies?

Penicillin

A client has been prescribed lomefloxacin (Maxaquin) for a respiratory infection. What must the nurse closely monitor for in this client?

Photosensitivity

A nurse has administered demeclocycline to a patient. Which of the following adverse reactions should the nurse closely monitor the patient for?

Photosensitivity

A young lifeguard has been prescribed moxifloxacin (Avelox). The nurse understands that the focus on education would be which adverse reaction?

Photosensitivity

What drug belongs to the group of carbapenems?

Primaxin

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?

Red man syndrome

The nurse is aware that sulfonamide therapy is used cautiously in older adults because of decreased function of what organ system?

Renal

A patient who was administered cephalosporins has developed a skin rash. The nursing assistant is scared and thinks that this is a serious reaction. The nurse tells him that this is a mild reaction. Which of the following should the nurse mention as the symptoms of serious hypersensitivity reaction?

Renal dysfunction

A client in the critical care unit is receiving aminoglycosides for an infectious process. What does the nurse need to monitor?

Renal function tests

A group of students are reviewing information about drugs used to treat tuberculosis. The students demonstrate understanding of the material when they identify which drug as a first-line treatment option?

Rifampin

Common, potentially serious, adverse effects of antibiotic drugs include:

Skin rash

The nurse understands that which is the highest priority when teaching about antitubercular medications?

Taking medications as prescribed

The drug's effect on what best reflects the major reason for avoiding the use of tetracyclines in children under 8 years of age?

Teeth

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

Tetracyclines should be administered with a full glass of water.

A client with a complex medical history is showing signs and symptoms of sepsis. What aspect of this client's health history would rule out the safe and effective use of an aminoglycoside antibiotic?

The client has chronic renal failure

A client, being treated for latent tuberculosis (TB) on an out-client basis, tells the nurse, "I've been feeling pretty good lately, so I haven't actually been all that consistent with taking my drugs." Subsequent health education by the nurse should focus on what subject?

The need to consistently take the prescribed drugs in order to cure TB

Chest radiography and sputum sample microscopy have confirmed a diagnosis of TB in a 40-year-old man who has a history of type 1 diabetes and who currently has a diabetic foot ulcer. How should the nurse account for this patient's health status when planning care during INH treatment?

The patient will require vigilant monitoring of blood glucose levels.

A client is prescribed rifampin. What information should the nurse include in the client's medication education?

The urine, tears, sweat, and other body fluids will be a discolored red-orange.

The nurse knows that pseudomembranous colitis is a superinfection of fluoroquinolones, especially when they are administered in high doses, because these medications have what effect in the body?

They disrupt the normal flora of the body.

A client asks why three medications are prescribed to treat his tuberculosis. The nurse informs the client of which reasons?

To prevent resistance

A young pregnant patient with intestinal amebiasis is prescribed a tetracycline. Which can be an adverse effect of the drug?

Toxic effects to the developing fetus

A health care center is conducting a seminar on cephalosporins drugs. During the question-and-answer period, the audience wants examples of conditions that can be treated by cephalosporins. Which of the following infections should the nurse state as examples?

Urinary tract infections

The nurse is giving discharge instructions to a woman who will be taking amoxicillin for treatment of acute otitis media. The nurse teaches the client that which symptom indicates the development of a superinfection and should be reported to the physician?

Vaginal itching and discharge

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

In the rare instance in which penicillin is considered essential, hypersensitivity can be assessed by administering:

a skin test.

A 10-year-old client is diagnosed with acute otitis media. What does the nurse anticipate the health care provider will prescribe?

amoxicillin

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

A 49-year-old client is diagnosed with TB. The client has a history of alcoholism but has been sober for 3 months now. The client has been prescribed INH. What should the nurse ensure is obtained before initiating the therapy?

baseline liver function test values

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?

changing to a different antibiotic

A group of nursing students are reviewing information about penicillins. The students demonstrate understanding of the information when they identify the action of penicillinase as causing bacterial resistance by which mechanism?

enzymatic inactivation of the penicillin

Penicillins are most effective when used to treat what type of microorganisms?

gram-positive bacteria

The client has been prescribed a fluoroquinolone. The nurse knows that nursing interventions for clients taking fluoroquinolones include which?

increase fluid intake.

A nursing instructor is preparing a teaching plan for a nursing pharmacology class on the action of fluoroquinolones. Which action would the instructor most likely include?

interfering with DNA synthesis in the bacterial cell

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

A client has been prescribed oral tetracycline. The nurse will instruct the client to take the drug how?

on an empty stomach.

A client is receiving levofloxacin (Levaquin) IV. During an infusion, the client reports pain and the nurse notes a reddened area along the vein. What does the nurse suspect?

phlebitis

What event triggers the development of a superinfection?

proliferation of antibiotic-resistant microorganisms

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.

Tetracyclines should not be used in children younger than 8 years of age because of their effects on:

teeth and bones.

A student asks the pharmacology instructor to explain how beta-lactam antibiotics, such as penicillins and cephalosporins, fight bacterial infection. The instructor responds that the drugs do so by disrupting the bacterial cell wall, a process that is most effective

when the bacterial cells are dividing.

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."

After 3 weeks of drug therapy for tuberculosis (TB), a client is not showing reduction of symptoms. Repeated laboratory work shows positive cultures. What issues should the nurse consider? Select all that apply.

- Client noncompliance - Drug resistance

A client is being given a prescription for ciprofloxacin (Cipro) to treat a urinary tract infection. The nurse should warn the client about which of the following common adverse reactions? (Select all that apply.)

- Dizziness - Headache - Nausea

Culture and sensitivity testing reveals that a client's infection will respond to treatment with kanamycin. What routes of administration are available to the care team for kanamycin? Select all that apply.

- Intramuscular - Intravenous

The nurse is administering cefazolin to a client. What adverse reactions should the nurse recognize as being the most problematic for this client? (Select all that apply.)

- Vaginal yeast infection - Facial edema

A client is receiving gentamicin to treat meningitis. The health care provider has ordered a peak serum level be drawn in association with the 07:00 dose, which will finish infusing at 07:30. When should the peak serum level be drawn?

08:00

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

A patient who has been on penicillin therapy for several days has developed inflamed oral mucous membranes and swelling in the tongue and the gums. The primary health care provider has diagnosed it as a fungal superinfection of the oral cavity resulting in impaired oral mucous membranes. Which of the following interventions should the nurse perform?

Inspect mouth and gums regularly.

A 66-year-old woman with a history of recurrent urinary tract infections has been admitted to the hospital with a diagnosis of pyelonephritis. The client began treatment 36 hours ago with intravenous gentamicin and is being monitored closely. The nurse is aware that the therapeutic effect of the client's drug regimen is primarily a result of:

interference with bacterial reproduction.

When describing the action of sulfonamides to a client, the nurse integrates understanding of the drug's action with effects exerted due to which mechanism?

inhibition of the activity of folic acid in bacterial cell metabolism

The client has been taking a fluoroquinolone and now reports that he has a white patch in his mouth. What is the best response of the nurse?

"You may be experiencing an additional infection. I will discuss this with your health care provider."

A nurse is caring for a 61-year-old client whose health care provider has ordered 2200 mg of ethambutol daily. The recommended dose for ethambutol is 15-25 mg/kg/day. The client weighs 90 kg. Based on dosage calculation, the prescribed dose is:

at the high end of the recommended range.