Chapter 38: Antibiotics part 1

The patient has been started on a medication regimen that includes sulfamethoxazole/trimethoprim. The nurse notes that the source of the patient's infection has been determined to be viral in origin. What is the nurse's highest priority action? Administer the medication as ordered by the provider. Ensure that the information is documented in the chart. Contact the health care provider to discuss the medication. Ask the patient if he knows how he contracted the infection.

Contact the health care provider to discuss the medication. The health care provider should be contacted regarding the ordering of sulfamethoxazole/trimethoprim for this patient because it has not been shown to be effective in treating viral infections.

A patient is prescribed sulfamethoxazole/trimethoprim (co-trimoxazole) for the treatment of a urinary tract infection. Which biochemical parameter does the nurse assess before administering the drug? Liver enzymes Red blood cell count Creatinine clearance Uric acid baseline level

Red blood cell count Sulfamethoxazole/trimethoprim (co-trimoxazole) is a sulfonamide antibiotic. Sulfonamide antibiotics may cause anemia in the patient. Therefore the patient's red blood cell count should be assessed before beginning sulfonamide therapy to check the possibility of drug-related anemia. Sulfamethoxazole/trimethoprim (co-trimoxazole) does not affect liver enzymes, creatinine levels, or uric acid levels. Therefore these need not be checked before the administration of sulfamethoxazole/trimethoprim (co-trimoxazole).

What are the adverse effects of sulfonamide antibiotics? Polyuria Urticaria Pancreatitis Constipation Hepatotoxicity

Urticaria Pancreatitis Hepatotoxicity Urticaria, pancreatitis, and hepatotoxicity are the side effects of sulfonamide antibiotics. Sulfonamide antibiotics do not cause polyuria. They cause crystalluria. Sulfonamide antibiotics do not cause constipation; they may cause diarrhea

The nurse works in a medical-surgical unit. Which patients should the nurse monitor for atypical signs of infection? A 30-year-old patient with fractured tibia A 78-year-old patient with urinary incontinence A 40-year-old patient with coronary artery disease A 35-year-old patient who underwent a renal transplant A 55-year-old patient who received radiation therapy for lung cancer

A 78-year-old patient with urinary incontinence A 35-year-old patient who underwent a renal transplant A 55-year-old patient who received radiation therapy for lung cancer Infections usually manifest as fever, chills, sweat, pain, weakness, redness, and swelling. These manifestations indicate that the immune system is actively responding against invading microorganisms. People with dysfunctional immune systems may not be able to mount an immune response and may lack the typical signs and symptoms of infection. The 78-year-old patient with urinary incontinence may have lowered immune function due to age and may not manifest the typical signs and symptoms of infection. The 35-year-old patient who underwent a renal transplant will be receiving immunosuppressant drugs and will have compromised immune function. The 55-year-old patient who received radiation therapy for lung cancer may have reduced immune function and may not manifest the usual signs of infection. The 30-year-old patient with fractured tibia and the 40-year-old patient with coronary artery disease may have functional immune systems and typical signs of infection.

A patient with pain and urinary tract infection develops fever, chills, and sores on the tongue. In the chart, the nurse finds an allergy to sulfonamides. Which drug does the nurse suspect is responsible for the patient's reaction? Celecoxib Glimepiride Furosemide Hydrochlorothiazide

Celecoxib Celecoxib is a COX-2 selective nonsteroidal antiinflammatory drug that helps in the treatment of acute pain. This drug contains sulfonamide moiety and, hence, should be avoided in patients with sulfonamide allergy. Glimepiride helps control elevated blood sugar levels in patients with diabetes, and it is safe for patients with sulfonamide allergy. Diuretics such as furosemide and hydrochlorothiazide are safe for patients with sulfonamide allergy.

The nurse is assessing a patient who has developed watery diarrhea. After checking the patient's history, the nurse finds that the patient was recently treated with antibiotics. Which further testing might be needed in this patient? Sputum test Acinetobacter test Clostridium difficile test Culture and sensitivity test

Clostridium difficile test If the patient was previously treated with antibiotics and developed watery diarrhea, then the patient needs to be tested for Clostridium difficile infection. If the result of this test is positive, then the patient needs to be treated for a serious superinfection. Infections with C. difficile are increasingly becoming resistant to standard therapy. Watery diarrhea is a common symptom of C. difficile infection.

A patient receiving antibiotics for chronic tonsillitis has been experiencing abdominal pain and cramps associated with frequent watery stools. Which infection does the nurse suspect? Klebsiella infection Clostridium infection Acinetobacter infection Enterococcus infection

Clostridium infection Antibiotic-associated diarrhea may be a result of superinfection due to the use of antibiotics in the treatment of tonsillitis. Here, the antibiotics disrupt the gut flora growth and promote Clostridium difficile growth. C. difficile infection is associated with watery diarrhea, abdominal pain, and fever. Klebsiella, Acinetobacter, and Enterococcus are common pathogens that lead to health care-associated infections such as pneumonia and urinary tract infections.

A patient is prescribed amoxicillin for Helicobacter pylori infection. During the follow-up visit, the nurse observes that the patient is wheezing and has difficulty breathing, swelling of the throat, and dizziness. The nurse also notes a drop in blood pressure and a weak pulse. Which medicine does the nurse expect to be included in the patient's treatment plan to manage the patient's current symptoms? Ranitidine Epinephrine Tetracycline Azithromycin

Epinephrine is a penicillin antibiotic. The assessment findings make it evident that the patient has a penicillin anaphylactic reaction. Difficulty breathing, wheezing, swelling of the throat or tongue, and dizziness are the symptoms of a penicillin anaphylactic reaction. In this condition, epinephrine should be administered to the patient immediately to block the action of penicillin. Ranitidine is an antacid; it helps relieve acidity but is not helpful in treating the anaphylactic reaction. Tetracycline and azithromycin are antibiotics and helpful to treat antibacterial infection, but are not effective in the treatment of penicillin anaphylactic reaction.

The nurse is performing a follow-up assessment of a patient who was prescribed a week's worth of antibiotics for gastroenteritis. Which signs and symptoms in the patient may indicate the need for referral to the primary health care provider? Jaundice Mild nausea Excessive fatigue Elevated temperature Occasional loose stools

Jaundice Excessive fatigue Elevated temperature Antibiotics are prescribed for a certain period. The nurse should monitor the patient for effectiveness of the therapy. The presence of jaundice indicates that the antibiotic is affecting liver function, and this needs to be reported to the primary health care provider. Excessive fatigue and an elevated body temperature indicate the persistence of infection, and the treatment needs to be revised. Mild nausea and occasional loose stools are the minor side effects of antibiotics and do not need to be reported to the primary health care provider.

Which medication may result in ineffectiveness of penicillin V potassium? Ibuprofen Rifampin Probenecid Methotrexate

Rifampin Rifampin and penicillin V potassium cause a drug-drug interaction. Rifampin inhibits the efficacy of penicillin and results in poor action of penicillin. Due to this drug-drug interaction, symptoms are persistent after the administration of penicillin V potassium. Ibuprofen interacts with penicillin V potassium, which results in increased levels of active penicillin for therapeutic action. Methotrexate interacts with penicillin V potassium and increases the methotrexate level in the body due to decreased renal elimination of methotrexate. Probenecid and penicillin V potassium interact and prolong the effects of penicillin V potassium.

The nurse advises a patient to use sunscreen and wear a hat to avoid the sun between 10:00 AM and 4.00 PM. Which group of antibiotics is the patient most likely using? Penicillins Sulfonamide First-generation cephalosporins Second-generation cephalosporins

Sulfonamide Sulfonamides, including cotrimoxazole and tetracyclines (especially demeclocycline), are more likely than other antibiotics to cause photosensitivity during their use. Photosensitivity is induced by exposure to sunlight during sulfonamide drug therapy. So the nurse advises the patient to use sunscreen and wear a hat.Allergic reactions to penicillins occur in 0.7% to 4% of treatment courses. The most common reactions are urticaria, pruritus, and angioedema. The safety profiles, contraindications, and pregnancy ratings of cephalosporins are similar to those of penicillins. The most commonly reported adverse effects are mild diarrhea, abdominal cramps, rash, pruritus, redness, and edema. No photosensitivity is seen here.

Which antibiotic may cause hemolysis in a patient who has glucose-6-phosphate dehydrogenase (G6PD) deficiency? Penicillin Quinolone Tetracycline Sulfonamide

Sulfonamide G6PD deficiency is an inherited disorder in which the red blood cells are partially or completely deficient in the enzyme G6PD. It is an enzyme that is required in the metabolism of glucose. Sulfonamide antibiotics may cause hemolysis in a patient who has G6PD deficiency. Penicillin antibiotics, quinolone antibiotics, and tetracycline antibiotics do not cause hemolysis in patients who have G6PD deficiency.

When instructing a patient about antibiotic therapy, the nurse explains that which condition occurs when the normal flora are disturbed during antibiotic therapy? Organ toxicity Superinfection Hypersensitivity Rebound toxicity

Superinfection Antibiotic therapy can destroy the normal flora of the body, which typically inhibit the overgrowth of fungi and yeast. When the normal flora are decreased, these organisms can overgrow and cause infections. Organ toxicity, hypersensitivity, and rebound toxicity are not a disturbance in the normal flora associated with antibiotic therapy.

What is the principal indication for sulfamethoxazole-trimethoprim (SMZ-TMP)? Meningeal infection Bacterial pneumonia Bacterial endocarditis Urinary tract infection

Urinary tract infection The primary indication for sulfonamide therapy is urinary tract infection because these drugs achieve high concentrations in the kidneys. The combination of these two drugs allows for a synergistic antibacterial effect. Further, sulfonamides are indicated in the treatment of infections with Escherichia coli, Klebsiella, Proteus vulgaris and Proteus mirabilis, Staphylococcus aureus, Pneumocystis jirovecii, and Stenotrophomonas maltophilia. Extended-spectrum penicillins are used to treat many health care-associated infections, including pneumonia. Ceftriaxone is administered in meningeal infection. Amoxicillin is used as a dental prophylaxis for bacterial endocarditis.

Which instruction will the nurse include in the discharge teaching for a patient receiving tetracycline? "Take the medication until you feel better." "Use sunscreen and protective clothing when outdoors." "Keep the remainder of the medication in case of recurrence." "Take the medication with food or milk to minimize gastrointestinal upset."

Use sunscreen and protective clothing when outdoors." Photosensitivity is a common side effect of tetracycline. Exposure to the sun can cause severe burns. The medication should not be taken with milk and should be completely finished.

The nurse is caring for a patient who is taking antibiotics. The patient reports flushing, itching, hives, anxiety, and throat and tongue swelling. The nurse finds that the patient has a rapid, irregular pulse. Which condition may the patient have as a result of taking the antibiotic? Tolerance to the antibiotic drugs An allergic anaphylactic reaction Clostridium difficile bacterial infection Glucose-6-phosphate dehydrogenase deficiency

An allergic anaphylactic reaction

Which medication may sometimes be overlooked when considering penicillin allergies in patients? Amoxicillin (Amoxil) Ampicillin (Totacillin) Penicillin V potassium (V-Cillin K) Piperacillin/tazobactam (Zosyn)

Piperacillin/tazobactam (Zosyn)The brand name of Zosyn does not have the suffix "-cillin."

The nurse is caring for a patient who is being treated for acne. The nurse anticipates that the health care provider is most likely to treat the patient using which medication? Polymyxin Tobramycin Tetracycline Vancomycin

Tetracycline is considered a drug of choice for the treatment of acne rather than vancomycin, tobramycin, and polymyxin, which are not used in the treatment of acne.

The patient has been prescribed sulfamethoxazole/trimethoprim. The nurse notes that the patient has a history of kidney stones. What is the highest priority instruction for the nurse to give to the patient? "Take the medication on a full stomach." "Take the medication on an empty stomach." "Take the medication with a full glass of fluid." "Take the medication at regularly spaced intervals."

"Take the medication with a full glass of fluid." Of the instructions provided, the only one that would affect the prevention of kidney stones is to take the medication with a full glass of fluid. Sulfamethoxazole/trimethoprim may be taken with or without food. Although the medication should be taken at regularly spaced intervals, this will not have an impact on the development of kidney stones.

A patient with type 2 diabetes mellitus is started on sulfamethoxazole/trimethoprim. Which nursing intervention is a priority for this patient? Assess blood sugar. Monitor platelet count. Assess hemoglobin and hematocrit. Take blood pressure every 4 hours.

Assess blood sugar. Sulfamethoxazole/trimethoprim increases the hypoglycemic response when taken with sulfonylureas (oral hypoglycemic agents). The nurse should assess blood sugar and determine what oral hypoglycemic the patient is taking.

A patient has been prescribed sulfamethoxazole/trimethoprim (Bactrim). What is the nurse's primary intervention for this patient? Instruct the patient to increase fluid intake. Instruct the patient to take the medication for 14 days. Assess the patient's urine before and after treatment. Ensure the patient does not eat anything when taking the medication.

Instruct the patient to increase fluid intake.

How does superinfection occur in a patient? When the serum level of an antibiotic is too high When the patient has a gram-positive bacterial infection When the patient has a gram-negative bacterial infection When the antibiotic eliminates the normal bacterial flora

When the antibiotic eliminates the normal bacterial flora Superinfection can occur when antibiotics completely eliminate the normal bacterial flora. When these bacteria or fungi are killed by antibiotics, then other bacteria or fungi cause infection, which is known as superinfection. When the serum level of the antibiotic is too high, it causes a toxic reaction. Gram-positive and gram-negative bacterial infections do not cause superinfection.

A patient is prescribed demeclocycline for the treatment of a respiratory infection. What instruction does the nurse give to the patient to ensure safe and effective administration of the drug? "Avoid eating high-protein foods." "Avoid eating high-calorie foods." "Avoid eating low-carbohydrate foods." "Avoid the consumption of dairy products.

Avoid the consumption of dairy products. Food-drug interaction occurs between demeclocycline and dairy products, which results in decreased gastrointestinal absorption of demeclocycline.

The nurse anticipates that a patient with which of the following infections would be prescribed meropenem? Cellulitis Pneumonia Tooth abscess Bacterial meningitis

Bacterial meningitis Meropenem is used to treat susceptible intraabdominal infections like complicated appendicitis and peritonitis. Because it can cross the blood-brain barrier, meropenem 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 patient is prescribed demeclocycline for the treatment of a respiratory infection. What instruction does the nurse give to the patient to ensure safe and effective administration of the drug? "Avoid eating high-protein foods." "Avoid eating high-calorie foods." "Avoid eating low-carbohydrate foods." "Avoid the consumption of dairy products."

"Avoid the consumption of dairy products." Food-drug interaction occurs between demeclocycline and dairy products, which results in decreased gastrointestinal absorption of demeclocycline. If the gastrointestinal absorption of demeclocycline is decreased, it may not have therapeutic effects, so the nurse should instruct the patient to avoid consumption of dairy products. Because demeclocycline does not cause any interaction with high-protein foods, low-carbohydrate foods, or high-calorie foods, the patient can consume such items.

A 22-year-old female patient is prescribed amoxicillin. Which is the most important intervention for this patient? Obtain a baseline complete blood count. Assess if the patient is on oral contraceptives. Inform the patient about possible superinfections. Instruct the patient to not take the medication before meals.

Assess if the patient is on oral contraceptives The nurse needs to assess whether or not the patient is on oral contraceptives and whether or not the patient is sexually active. Long-term use of antibiotics can cause blood dyscrasias, but a baseline complete blood count is not indicated.

A patient has been on sulfonamides for urinary tract infections. The nurse assesses the patient and finds bruises on the legs and arms. What is the nurse's best action? Tell the patient to be more careful. Assess the patient's platelet counts. Administer vitamin K to the patient. Ask the patient if someone is abusing her.

Assess the patient's platelet counts. Blood disorders such as hemolytic anemia, aplastic anemia, and low white blood cell and platelet counts could result from prolonged use and high dosages.

Oral sulfamethoxazole/trimethoprim is prescribed for a patient and is being administered four times a day. What is the nurse's best action? Instruct the patient about potential constipation. Schedule the medication before meals and at bedtime. Instruct the patient not to drink milk with the medication. Call the provider to discuss changing the frequency of the dose.

Call the provider to discuss changing the frequency of the dose. The patient should receive sulfamethoxazole/trimethoprim twice a day. The nurse should call the health care provider to clarify this order. The medication should not be scheduled four times a day, is not expected to cause constipation, and should not have an interaction with milk.

The nurse is caring for a postoperative patient. Which antibiotic is used for prophylaxis against infection in surgical patients? Cefazolin Cefoxitin Cefepime Ceftriaxon

Cefazolin First-generation cephalosporins, such as cefazolin, are used as prophylaxis against infection in surgical patients. First-generation agents are preferred to second- and third-generation cephalosporins for surgical prophylaxis because they are as effective as the newer drugs, are less expensive, and have a narrower antimicrobial spectrum. Cefoxitin is a second-generation cephalosporin, ceftriaxone is a third-generation cephalosporin, and cefepime is a fourth-generation cephalosporin.

The nurse is caring for a patient who has a urinary tract infection and is being treated with sulfamethoxazole/trimethoprim (SMZ-TMP). Which findings does the nurse report to the primary health care provider to prevent complications? . Diarrhea Yellowish eyes Blood in the urine Shortness of breath Change in the color of the sputum

Diarrhea Blood in the urine Shortness of breath Sulfamethoxazole/trimethoprim (SMZ-TMP) is a sulfonamide antibiotic. The nurse should monitor the patient for diarrhea, blood in the urine, and shortness of breath. These symptoms indicate an adverse reaction to the drug. Hepatotoxicity is a possibility with sulfonamides.

A patient is diagnosed with a respiratory infection caused by staphylococci. Which penicillinase-resistant drug may be included in the prescription? Ampicillin Penicillin G Amoxicillin Dicloxacillin

Dicloxacillin penicillinase-resistant drug are antibiotics that are able to resist breakdown by the penicillin-destroying enzyme (penicillinase). These enzymes are commonly produced by bacteria such as staphylococci. Amoxicillin and ampicillin are aminopenicillin drugs. Penicillin G is an example of a natural penicillin. Dicloxacillin is a penicillinase-resistant drug.

A patient who enjoys drinking socially has been prescribed cefotetan. The nurse explains to the patient that alcohol should be avoided for how long? No avoidance of alcohol is warranted During drug therapy and for 3 days afterward During drug therapy and for 7 days afterward During drug therapy and for 14 days afterward

During drug therapy and for 3 days afterward Alcohol is not recommended with cefamandole, cefoperazone, or cefotetan. An increase in acetaldehyde in the blood may result, producing a disulfiram-type reaction (e.g., stomach pain, nausea, vomiting, headaches, low blood pressure, tachycardia, respiratory difficulties, increased sweating, or flushing of the face). Patients should avoid alcoholic beverages, medications containing alcohol, or intravenous alcohol solutions during the administration of these drugs and for 3 days afterward.

When planning care for a patient receiving a sulfonamide antibiotic, which is a primary intervention? Force fluids to at least 2000 mL/day. Encourage liquids that produce acidic urine. Encourage a diet that causes an alkaline ash. Insert a Foley catheter for accurate input and output measurement.

Force fluids to at least 2000 mL/day. Forcing fluids will help prevent crystallization in the urine and kidney stone formation associated with sulfonamide antibiotics, regardless of the type of fluid consumed. Consuming a specific type of diet will not decrease the risk of crystallization.

Which antibiotics are safest for the nurse to administer to children? Macrolides Quinolones Tetracyclines Sulfonamides

Macrolides Macrolide antibiotics are safe for children because they do not produce severe side effects. Quinolone, tetracycline, and sulfonamide antibiotics are not safe for children. Quinolone antibiotics have adverse effects on bone or cartilage development in children. Tetracycline antibiotics adversely affect the development of teeth or bones in children. Sulfonamide antibiotics displace bilirubin from albumin and precipitate kernicterus (hyperbilirubinemia) in children.

The nurse is observing a few patients. Which patient does the nurse suspect to be most prone to health care-associated infection? Patient A: osteonecrosis of the knee Patient B: history of hypertension for 2 years Patient C: stage 4, severe chronic renal insufficiency, on dialysis Patient D: hip replacement 6 months ago

Patient C: stage 4, severe chronic renal insufficiency, on dialysis Health care-associated infections (HAIs) are most common among patients in critical care, dialysis, oncology, transplant, and burn units because of the reliance on various devices such as mechanical ventilators, catheters, intravenous infusion lines, and dialysis equipment. Patient C, with fourth-stage chronic renal failure, is on dialysis and is therefore more prone to HAIs. The patients with osteonecrosis of the knee, hypertension, and who underwent joint replacement are less prone to HAIs.

The nurse is performing a follow-up assessment of a patient who was prescribed tetracycline 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 coadminister iron supplements?" "Did you take the drug with a full glass of water?" "Did you take the prescribed dosage of the drug?"

"Did you take the drug with food?" Tetracycline 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 because the patient reports taking the medications as prescribed.

A nursing student asks the nursing instructor about the mechanism of bacteriostatic action of tetracycline. Which answer by the nursing instructor is correct? "Tetracycline blocks RNA synthesis." "Tetracycline binds to magnesium ions." "Tetracycline inhibits protein synthesis." "Tetracycline degrades the bacterial cell wall."

"Tetracycline inhibits protein synthesis." Tetracyclines are bacteriostatic drugs that inhibit bacterial protein synthesis by binding to the 30S bacterial ribosome. The antibiotic rifamycin blocks synthesis of RNA from a DNA template. When administered with magnesium, tetracyclines bind to the magnesium and the therapeutic action of the tetracycline is reduced; magnesium binding has no role in the bacteriostatic action of tetracycline. Tetracycline does not break down bacterial cell walls; penicillin does.

The patient has been ordered azithromycin and asks the nurse why the medication does not have to be taken as often as other antibiotics that have previously been ordered. What is the nurse's best response? "You'll need to ask your health care provider questions like that." "I'll call the pharmacy and ask about the chemical makeup of the drug." "This is a much more effective drug than what you received previously." "This drug has a longer duration of action than some of the other antibiotics."

"This drug has a longer duration of action than some of the other antibiotics." Azithromycin is one of the newer macrolide antibiotics. It has a longer duration of action, as well as fewer and less severe gastrointestinal side effects than erythromycin. The other responses do not address the patient's question, which was why azithromycin does not have to be taken as often.

What is the elimination half-life of amoxicillin? 6 to 8 hours 1 to 2 hours 0.5 to 1 hour 1 to 1.5 hours

1 to 1.5 hours is a commonly prescribed aminopenicillin. The elimination half-life of amoxicillin is 1 to 1.5 hours. The duration of action is 6 to 8 hours. The peak effect of amoxicillin occurs 1 to 2 hours after administration. The onset of action is 0.5 to 1 hour.

A patient who is about to undergo an open cholecystectomy is administered intravenous ceftriaxone. What antibiotic treatment is the patient most likely getting? Empiric Definitive Prophylactic Colonization

Prophylactic A prophylactic antibiotic treatment is administered before the actual onset of an infection. Surgery places a patient at a major risk for infection. Therefore antibiotic treatment given before surgery is a prophylactic treatment against infection. Empiric treatment is given before the causative organism is identified for infection. Definitive treatment is provided when the causative organism is known and the antibiotic treatment is focused on the causative organism. Colonization refers to the residing bacteria on the skin or other body parts

A nursing student asks the nursing instructor about the mechanism of bacteriostatic action of tetracycline. Which answer by the nursing instructor is correct? "Tetracycline blocks RNA synthesis." "Tetracycline binds to magnesium ions." "Tetracycline inhibits protein synthesis." "Tetracycline degrades the bacterial cell wall."

Tetracycline inhibits protein synthesis." Tetracyclines are bacteriostatic drugs that inhibit bacterial protein synthesis by binding to the 30S bacterial ribosome. The antibiotic rifamycin blocks synthesis of RNA from a DNA template. When administered with magnesium, tetracyclines bind to the magnesium and the therapeutic action of the tetracycline is reduced; magnesium binding has no role in the bacteriostatic action of tetracycline. Tetracycline does not break down bacterial cell walls; penicillin does.

A patient is prescribed sulfadiazine. After checking the patient's history, the nurse finds that the patient has glucose-6-phosphate dehydrogenase (G6PD) deficiency. What will the nurse do in this situation? The nurse requests testing for Clostridium difficile. The nurse requests culture and sensitivity testing for the patient. The nurse anticipates administering sulfadiazine in a higher dose to the patient. The nurse contacts the primary health care provider before administration of the drug.

The nurse contacts the primary health care provider before administration of the drug. Sulfadiazine belongs to the class of sulfonamides. The administration of sulfonamides to a patient with G6PD deficiency may result in hemolysis, or destruction of red blood cells. Therefore the nurse should inform the primary health care provider before administration of the drug. Culture and sensitivity testing is helpful to optimize drug selection in individual cases, but it does not help to reduce the risk of hemolysis. Clostridium difficile infection testing is required when the patient has symptoms such as watery diarrhea, abdominal pain, and fever. The nurse does not find these symptoms in this patient; therefore this test is not needed. The nurse should not administer sulfadiazine in higher doses to the patient because this may result in severe complications.

A patient is administered cefotetan for a urinary tract infection. After 2 days, the patient complains of stomach cramps, nausea, vomiting, excessive sweating, itching, and headache. The patient also has decreased blood pressure. What does the nurse interpret from the assessment? The patient had taken ranitidine in addition to the cefotetan. The patient had taken probenecid in addition to the cefotetan. The patient had taken methotrexate in addition to the cefotetan. The patient had taken ethanol (alcohol) in addition to the cefotetan.

The patient had taken ethanol (alcohol) in addition to the cefotetan. Cefotetan is a second gen. cephalosporin antibiotic. Combining ethanol (alcohol) and cefotetan causes a drug-drug interaction. If the patient drinks alcoholic beverages within 72 hours of taking cefotetan, it causes a disulfiram-like reaction. Stomach cramps, nausea, vomiting, excessive sweating, itching, headache, and hypotension are symptoms of a disulfiram-like reaction. Ranitidine interacts with cefotetan and decreases the effectiveness of cefotetan. Probenecid interacts with cefotetan and increases cephalosporin levels in the body. Methotrexate does not cause any interaction with cefotetan. Methotrexate interacts with penicillin and decreases its renal elimination. As a result, methotrexate levels in the body are increased.

A patient with a respiratory infection is treated with doxycycline. At the follow-up visit, the nurse finds that the signs and symptoms of infection have not subsided. Which patient action might have caused a reduction in the therapeutic effect of the drug? The patient took the medication with salt crackers. The patient refrained from going out in the sunlight. The patient took the medication with a glass of milk. The patient refrained from taking antacids along with the medication.

The patient took the medication with a glass of milk. Doxycycline is a tetracycline antibiotic. The absorption of the medication may be reduced if it binds with calcium, magnesium, or iron. Therefore the patient should stay away from dairy products, antacids, and iron supplements when taking this medication. Taking medications with salt crackers helps to reduce gastrointestinal irritation. Direct exposure to sunlight may cause photosensitivity reaction, but does not reduce the drug efficacy. Antacids should be avoided with the medication because they can reduce its efficacy.

A patient has a serious intraabdominal infection. Which antibiotic will the nurse expect to administer to this patient as empiric therapy? Ampicillin Penicillin V potassium Ticarcillin-clavulanic acid Amoxicillin-clavulanic acid

Ticarcillin-clavulanic acid Ticarcillin with clavulanic acid has one of the broadest antimicrobial spectra of all penicillins. This antibiotic is indicated as empiric therapy for this patient until the results of the culture and sensitivity are available. Ticarcillin-clavulanic acid is an extended-spectrum penicillin and a generation beyond the aminopenicillins. Ampicillin and amoxicillin-clavulanic acid are aminopenicillins. Penicillin V potassium is one of the natural penicillins.

The nurse is assessing a patient who is prescribed sulfamethoxazole/trimethoprim (SMZ-TMP) for the treatment of shigellosis enteritis. The nurse instructs the patient to increase fluid intake up to 3000 mL per day. What is the reason behind this? To prevent hypotension in the patient To prevent drug-related crystalluria in the patient To prevent mucosal irritation and dryness of the mouth To maintain the fluid and electrolyte balance in the body

To prevent drug-related crystalluria in the patient Sulfamethoxazole/trimethoprim (SMZ-TMP) is a sulfonamide antibiotic, which may cause crystalluria in the patient. Therefore the nurse instructs the patient to increase fluid intake up to 3000 mL per day to prevent drug-related crystalluria. Sulfamethoxazole/trimethoprim (SMZ-TMP) does not cause fluid loss; therefore it does not cause hypotension. Sulfamethoxazole/trimethoprim (SMZ-TMP) does not cause mucosal irritation, dryness of the mouth, or electrolyte imbalance.

The nurse should question the prescription of tetracycline for which patient? A 6-year old patient with Haemophilus influenza A 40-year-old patient diagnosed with rickettsia A 60-year-old patient with a history of hypertension A 45-year-old patient with a history of diabetes mellitus

A 6-year old patient with Haemophilus influenza Tetracycline is contraindicated in children younger than 8 years old because it can cause permanent discoloration of the teeth. Additionally, increasing tetracycline resistance to Haemophilus influenza is a concern. Tetracycline is used to treat rickettsia. Tetracycline is not contraindicated for patients diagnosed with diabetes mellitus or hypertension.

While instructing a patient about antibiotic therapy, the nurse explains to the patient that bacterial resistance to antibiotics can occur when what happens? Antibiotics are taken with water or juice. Antibiotics are prescribed to treat a viral infection. Antibiotics are taken with ascorbic acid (vitamin C). Patients stop taking an antibiotic after they feel better. Antibiotics are prescribed according to culture and sensitivity reports. Eugene on target

Antibiotics are prescribed to treat a viral infection. Patients stop taking an antibiotic after they feel better. 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. Antibiotics taken with water or vitamin C does not contribute to bacterial resistance. Acidic fluids, like juices, may nullify the antibacterial action of oral penicillin, but do not cause bacterial resistance.

A nursing instructor is discussing tigecycline therapy with a group of nursing students. Which statement is the nursing instructor most likely to make? "Avoid administering tigecycline to a 7-year-old with Lyme disease." "Avoid administering tigecycline to a 37-year-old with acne vulgaris." "Avoid administering tigecycline to a 37-year-old with granuloma inguinale." "Avoid administering tigecycline to a 17-year-old with Helicobacter pylori infection."

Avoid administering tigecycline to a 7-year-old with Lyme disease." Tetracyclines such as tigecycline 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.

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

Clavulanic acid Clavulanic acid is a beta-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

What term describes antibiotic therapy tailored to treat an identified organism? Empirical therapy Antiseptic therapy Definitive therapy Preventive therapy

Definitive therapy Definitive therapy is tailored to treat a specific pathogen. This helps avoid unnecessary use of broad-spectrum antibiotics, which contributes to resistance. In empirical therapy, the health care provider selects the antibiotic that best kills the microorganism known to be the most common cause of an infection. Antiseptic therapy inhibits growth but does not kill the microorganism. In preventive therapy, the antibiotic drug provides prophylaxis.

The patient has been diagnosed with Legionnaires' disease. Which drug does the nurse anticipate the provider will order? Aztreonam Lincomycin Daptomycin Erythromycin

Erythromycin Macrolides, such as erythromycin, are effective against Legionella (one species of that causes Legionnaires' disease).

A patient who is on long-term antibiotic therapy complains of watery diarrhea and abdominal pain. Further assessment reveals that the patient's body temperature is 39° C. Which medication does the nurse expect will be prescribed by the health care provider? Fidaxomicin Sulfasalazine Azithromycin Demeclocycline

Fidaxomicin Watery diarrhea, abdominal pain, and fever in the patient who is on long-term antibiotic therapy indicate pseudomembranous colitis, or Clostridium difficile infection. Fidaxomicin is a newer macrolide antibiotic indicated for C. difficile-associated diarrhea. Sulfasalazine is a sulfonamide used for the treatment of ulcerative colitis and rheumatoid arthritis. Azithromycin is a macrolide antibiotic useful in the prevention and treatment of Mycobacterium avium-intracellulare complex infection, responsible for causing superinfections such as pseudomembranous colitis. Demeclocycline is useful for treating gastrointestinal, genitourinary, skin, and respiratory infections.

The nurse is caring for a patient who has been prescribed cefazolin sodium. Which nursing assessment is the priority? Cardiac assessment Neurologic assessment History of immunizations History, including allergies

History, including allergies Antibiotic allergy is one of the most common drug allergies. These allergies also have the potential to cause severe anaphylaxis and death and, therefore, have more importance than assessing cardiac or neurologic function or the history of immunizations.

How does penicillin work to destroy bacteria? It interferes with cell wall synthesis. It binds irreversibly to the cell wall. It interrupts bacterial DNA processes. It interrupts bacterial RNA processes.

It interferes with cell wall synthesis. Penicillin inhibits transpeptidases and activates autolysins. This disrupts the synthesis of the cell wall and promotes active destruction of the cell wall. These combined actions result in cell lysis and death. Penicillin irreversibly inactivates a key enzyme in bacterial cell wall synthesis, but it does not bind irreversibly to the cell wall. Penicillin does not interrupt bacterial DNA or RNA processes to destroy bacteria.

A patient is prescribed azithromycin for the treatment of a respiratory tract infection. Which parameters need to be assessed in the patient to ensure safe drug administration? . Skin turgor Visual acuity Liver function Baseline hearing status Baseline cardiac function

Liver function Baseline hearing status Baseline cardiac function azithromycin is a macrolide antibiotic. Liver function is assessed in the patient because macrolide antibiotics may cause hepatotoxicity and jaundice. The patient's baseline hearing status should be assessed because the treatment may induce hearing loss and tinnitus. The patient's baseline cardiac function should be assessed because macrolide antibiotics may lead to palpitations, chest pain, and electrocardiogram changes in the patient. Macrolide antibiotics do not affect skin turgor or visual acuity; therefore these parameters need not be assessed.

A patient is prescribed cefuroxime for a respiratory tract infection. Which drug allergy, if present in the patient's medical history, may indicate the need for change of prescription? Aztreonam Imipenem/cilastatin Penicillin V potassium Sulfamethoxazole/trimethoprim

Penicillin V potassium Cefuroxime is a cephalosporin antibiotic that has a cross-interaction with penicillin antibiotics. A patient who developed allergic reactions with penicillin may develop an allergic reaction to cephalosporin as well. Therefore the prescription needs to be changed. Aztreonam is a monobactam antibiotic and does not manifest a cross-reaction with cephalosporin. Imipenem/cilastatin is a semisynthetic carbapenem antibiotic and does not interact with cephalosporin. Sulfamethoxazole/trimethoprim is a sulfa drug and does not have cross-reaction with cephalosporin.

Which class of penicillin antibiotics is known as antistaphylococcal penicillins? Aminopenicillins Natural penicillins Extended-spectrum drugs Penicillinase-resistant penicillins

Penicillinase-resistant drugs are known as antistaphylococcal penicillins. These include cloxacillin, dicloxacillin, nafcillin, and oxacillin. 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.

The patient has been diagnosed with ulcerative colitis. The nurse recognizes that which medication may be ordered to treat this condition? Aztreonam Amoxicillin Sulfasalazine Sulfamethoxazole/trimethoprim

Sulfasalazine Sulfasalazine is the drug of choice for treatment of ulcerative colitis. Aztreonam, amoxicillin, and sulfamethoxazole/trimethoprim are not indicated for the treatment of ulcerative colitis. p. 604

The nurse is assessing a patient who is prescribed sulfamethoxazole/trimethoprim (co-trimoxazole). What instruction does the nurse give to the patient before the administration of sulfamethoxazole/trimethoprim (co-trimoxazole)? "Eat more high-protein foods." "Avoid eating high-calorie foods." "Avoid consumption of dairy products." "Use any method other than oral contraception for birth control."

Use any method other than oral contraception for birth control." co-trimoxazol) is a sulfonamide antibiotic. Sulfonamide antibiotics reduce the efficacy of oral contraceptives, which may result in unintended pregnancy. Therefore the nurse should instruct the patient to switch over to another method of contraception to prevent unwanted pregnancy.

Which of the following drugs is contraindicated for a patient who is receiving erythromycin therapy? Warfarin Digoxin Tetracyclines Estrogen-containing contraceptives

Warfarin Taking warfarin with erythromycin therapy may result in decreased warfarin metabolism and excretion, thereby leading to an increased risk of bleeding or hemorrhage. Digoxin, tetracyclines, and estrogen-containing contraceptives do not interact with erythromycin.

Which over-the-counter drugs will the nurse advise a patient to avoid while the patient is taking doxycycline?

Calcium citrate Magnesium citrate The nurse should instruct the patient taking any tetracycline, such as doxycycline, to avoid products containing calcium, magnesium, or aluminum. Tetracycline binds to the metallic ions and thus reduces the therapeutic effectiveness of the antibiotic. The phenomenon is called metallic chelation. Calcium citrate is a vitamin D supplement. Magnesium citrate is a laxative. These are both over-the-counter drugs. Acetaminophen and naproxen sodium may be indicated for patients who also take tetracycline. Potassium chloride is a prescription drug. Potassium administration is not a concern with doxycycline administration.

The nurse advises a patient to use sunscreen and wear a hat to avoid the sun between 10:00 AM and 4.00 PM. Which group of antibiotics is the patient most likely using? Penicillins Sulfonamide First-generation cephalosporins Second-generation cephalosporins

Sulfonamide Sulfonamides, including cotrimoxazole and tetracyclines (especially demeclocycline), are more likely than other antibiotics to cause photosensitivity during their use. Photosensitivity is induced by exposure to sunlight during sulfonamide drug therapy. So the nurse advises the patient to use sunscreen and wear a hat. Allergic reactions to penicillins occur in 0.7% to 4% of treatment courses. The most common reactions are urticaria, pruritus, and angioedema. The safety profiles, contraindications, and pregnancy ratings of cephalosporins are similar to those of penicillins. The most commonly reported adverse effects are mild diarrhea, abdominal cramps, rash, pruritus, redness, and edema. No photosensitivity is seen here.