Chapter 18: Drug Therapy With Beta-Lactam Antibacterial Agents

Penicillins and cephalosporins are used cautiously in neonates due to what factor?

Immature kidney function Explanation: 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.

Penicillins are utilized in the treatment of which of the following bacterial infections? (Select all that apply)

Meningitis Syphilis Intra-abdominal infections Upper respiratory tract infections

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 Explanation: The most common adverse reactions that are caused due to cephalosporin administration include nausea, vomiting, and diarrhea. Cephalosporin does not cause hypotension, chest pain, or excessive tearing; hypotension and chest pain are some of the adverse reactions of disulfiram.

Which of the following are examples of beta-lactamase inhibitors? Select all that apply.

Tazobactam Sulbactam Clavulanic acid Explanation: Examples of beta-lactamase inhibitors are clavulanic acid, sulbactam, and tazobactam.

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. This drug is not indicated in the treatment of chlamydial infections, endocarditis, or encephalitis.

What event triggers the development of a superinfection?

proliferation of antibiotic-resistant microorganisms Explanation: Superinfection is an infection after the occurrence of a previous infection, typically caused by microorganisms that are resistant to the antibiotics used earlier. None of the other options accurately describe this condition as it is associated with antibiotic-resistant microorganisms.

A client has been diagnosed with a sinus infection, and the client has been given a prescription for amoxicillin. What teaching point should the nurse make for the client?

"Take your medication every 8 hours, as it's been prescribed." Explanation: Amoxicillin is almost always given q8h. This necessitates a bedtime dose for most clients, and the drug has no diuretic effect. Extreme or longstanding fatigue should be reported, but this is unlikely to be an adverse effect of the medication.

Your client receives IV vancomycin every 12 hours. You know that this infusion should run over:

1 to 2 hours. Explanation: 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.

Which of the following should be included in the nurse's pre-administration assessment prior to a client receiving a cephalosporin? Select all that apply.

Allergy history Medical history Medication history Current symptoms Explanation: An allergy history, medical and surgical history, medication history, and the current symptoms of the infection should be included in the nurse's pre-administration assessment prior to a client receiving a cephalosporin.

In general, progression from first-generation cephalosporins to fourth-generations results in which of the following? Select all that apply.

An increase in sensitivity of gram-negative microorganisms. A decrease in the sensitivity of gram-positive microorganisms. Explanation: In general, progression from first-generation cephalosporins to fourth-generations shows an increase in sensitivity of gram-negative microorganisms and a decrease in the sensitivity of gram-positive microorganisms.

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. Explanation: 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.

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 Explanation: Penicillin is most effective against gram-positive organisms, such as streptococci, staphylococci, and pneumococci. It is also active against some gram-negative organisms, such as gonococci and meningococci, and against the organisms that cause syphilis. It is relatively free of side effects, even in larger doses, and is excreted rapidly in the urine.

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. Explanation: 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. Refusing to give the drug is not necessary nor is immediately notifying the prescriber. Monitoring intake and output will not effectively monitor of nephrotoxicity.

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. Explanation: 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. The nurse should conduct a test for occult blood if blood and mucus occur in the stool and monitor the fluid intake if there is a decrease in urine output. The nurse does not need to monitor for increased glucose levels unless the patient has a history of diabetes.

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 Explanation: 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. Decreased urine output is not a sign of Steven-Johnson syndrome. It also is not indicative of a superinfection. There is no indication of dehydration existing.

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 Explanation: 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.

A client is receiving a cephalosporin and an aminoglycoside as combination therapy. What assessment should the nurse prioritize?

Serum BUN and creatinine levels Explanation: The nurse would need to assess renal function indicated by serum BUN and creatinine levels because combining cephalosporins with aminoglycosides increases the client's risk for renal toxicity. Coagulation studies would be important if the client was receiving a cephalosporin with an oral anticoagulant because there is an increased risk for bleeding. Combining cephalosporins with alcohol could result in a disulfiram-like reaction. Assessing the client's complete blood count would not be directly indicated by the combination of cephalosporins and aminoglycosides.

A client receiving the first dose of IV ampicillin asks the nurse to evaluate a rash on the torso. What should be the nurse's initial response to the client's rash?

attempt to differentiate a hypersensitivity reaction from a nonallergic ampicillin rash Explanation: The nurse carefully assesses the characteristics of a rash, if present. It is necessary to distinguish, if possible, a hypersensitivity reaction from a nonallergic ampicillin rash. Corticosteroids are not indicated, and the infusion does not necessarily need to be stopped. The rash should be reported only after the initial assessment is completed.

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 Explanation: Natural penicillins exert a bactericidal effect on bacteria. Because penicillin targets bacterial cells, it is of no value to treat fungal infections as it is neither fungicidal nor fungistatic. Since it targets the bacterial cell wall to destroy the bacteria, it does not inhibit growth as in bacteriostatic.

The nurse has administered the first dose of a client's newly-prescribed antibiotic. What assessment finding should the nurse interpret as adverse effect that suggests a more serious concern?

rash to the face and trunk Explanation: A rash poses no threat in and of itself but suggests the possibility of drug intolerance or hypersensitivity. A modest decrease in blood pressure or level of consciousness would be less clinically significant. The nurse must address the client's pain, but this is unlikely to be a consequence of antibiotic use.

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. Explanation: The nurse should instruct the parents to administer penicillin V exactly as prescribed at regular intervals. Penicillin V should be taken on an empty stomach 1 hour before or 2 hours after a meal with a glass of water. Penicillin V should not be taken with meals because food may affect the absorption of the drug. Penicillin V is easy to administer in the home setting; it does not need to be given IV under the supervision of a home health nurse.

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 Explanation: Beta-lactam antibacterial drugs inhibit synthesis of bacterial cell walls by binding to proteins in bacterial cell membranes. This binding produces a defective cell wall that allows intracellular contents to leak out. These do no affect DNA replication or cell division.

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

a skin test. Explanation: In the rare instance in which penicillin is considered essential, a skin test may be helpful in assessing hypersensitivity.