EAQ RN 35
A student nurse is comparing the side effects and adverse reactions associated with ceftriaxone (Rocephin), amoxicillin (Amoxil), and dicloxacillin (Dynapen). Which statements made by the nurse indicate the need for further education
Amoxicillin (Amoxil) and dicloxacillin (Dynapen) are penicillins, while ceftriaxone (Rocephin) is a cephalosporin. Insomnia is a side effect of only amoxicillin (Amoxil); it is not associated with either ceftriaxone (Rocephin) or dicloxacillin (Dynapen). Edema is associated with only one of the penicillins: amoxicillin (Amoxil). It is also a side effect of the cephalosporin ceftriaxone (Rocephin). Abdominal pain and flatulence are caused by the cephalosporin ceftriaxone (Rocephin); it is also caused by one of the penicillins, dicloxacillin (Dynapen). Diarrhea is associated with both the penicillins and the cephalosporins. Pruritus is an adverse reaction associated with only the cephalosporin ceftriaxone (Rocephin).
When instructing a patient about antibiotic therapy, the nurse explains that which condition occurs when the normal flora are disturbed during antibiotic therapy Hypersensitivity Rebound toxicity Organ 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.
A patient with a history of gastric reflux is prescribed telithromycin (Ketek) therapy for community-acquired pneumonia. The patient experiences toxicity due to concomitant drug therapy. Which medication in the patient's prescription has led to this condition? Rifampin (Rifadin) Cisapride (Propulsid) Itraconazole (Onmel) Ketoconazole (Nizoral)
Cisapride (Propulsid) is used to treat gastric reflux in certain clients. Serum levels of cisapride (Propulsid) are increased with concurrent use of telithromycin (Ketek), which leads to severe hepatotoxicity. Hence, cisapride (Propulsid) is contraindicated in clients who are using telithromycin (Ketek). Serum levels of telithromycin (Ketek) are increased when used concurrently with rifampin (Rifadin), itraconazole (Onmel), and ketoconazole (Nizoral), causing minor drug interactions but not leading to hepatotoxicity.
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 is a β-lactamase inhibitor. Administered concurrently, it augments the therapeutic effect of antibiotics such as ampicillin. When ampicillin is administered by mouth, concurrent administration of calcium citrate can diminish its absorption. Acetaminophen and carbamazepine do not affect the pharmacokinetics of ampicillin.
A microbiologic culture report of a patient shows the presence of Staphylococcus aureus. Which drug does the nurse anticipate to be prescribed by the health care provider?
Dicloxacillin (Dynapen) is penicillinase-resistant penicillin and is effective in treating infections caused by gram-positive bacteria such as Staphylococcus aureus. Amoxicillin (Amoxil) and ampicillin (Principen) are broad-spectrum penicillins that are ineffective in treating Staphylococcus aureus infections, because they are readily inactivated by the betalactamase produced by these bacteria. Carbenicillinindanyl (Geocillin) belongs to the extended-spectrum penicillins, which are effective against Pseudomonas aeruginosa infections
Which drugs inhibit bacterial growth Lincomycin (Lincocin) Levofloxacin (Levaquin) Amikacin sulfate (Amikin) Azithromycin (Zithromycin) Chloramphenicol (Chloromycetin)
Lincomycin (Lincocin), azithromycin (Zithromycin), and chloramphenicol (Chloromycetin) are bacteriostatic drugs. These drugs inhibit bacterial growth. Levofloxacin (Levaquin) and amikacin sulfate (Amikin) are bactericidal drugs. These drugs kill bacteria.
Which side effect reported by the patient who is on an antibiotic therapy would be of high priority and require prompt notification to the primary health care provider? "I have difficulty in breathing." "I have trouble with digestion." "I have giddiness upon standing." "I have pain in the upper abdomen.
Respiratory distress is a serious side effect of antibiotic therapy due to anaphylaxis. It requires immediate intervention and prompt notification to the primary health care provider. Indigestion may also occur due to antibiotic therapy, but it may not require immediate intervention. Giddiness may also occur with antibiotic therapy, but it is not as important as that of an anaphylactic reaction. Abdominal pain can be treated based on its severity, but it is not of high priority and may not require immediate intervention.
Which bacterial infection is effectively treated by both tigecycline (Tygacil) and minocycline (Minocin) Escherichia coli infection Helicobacter pylori infection Staphylococcus aureus infection Clostridium perfringens infection
Staphylococcus aureus bacterial infection is effectively treated by both tigecycline (Tygacil) and minocycline (Minocin). Escherichia coli infections can be treated by tigecycline (Tygacil). A combination of tetracycline, metronidazole, and bismuth subsalicylate is effective in treating Helicobacter pylori infection. Clostridium perfringens infection is treated by tigecycline (Tygacil)
The nurse is caring for a patient who has been taking antibacterials for 2 weeks and reports symptoms consistent with oral candidiasis. What would be the cause of this condition Superinfection Cross-resistance Antibiotic resistance Nosocomial infection
Superinfection is a secondary infection that occurs when the normal flora of the gut are destroyed by the antibiotic use and lead to overgrowth of fungus. Cross-resistance occurs between the antibacterial drugs that have similar actions. Antibiotic resistance occurs when bacteria reduces or eliminates the effectiveness of the antibacterial drug. Nosocomial infection is an infection that has occurred in the hospital
A nursing instructor is discussing tigecycline (Tygacil) therapy with a group of nursing students. Which statement is the nursing instructor most likely to make? "Avoid administering tigecycline (Tygacil) to a 17-year-old with Helicobacter pylori infection." "Avoid administering tigecycline (Tygacil) to a 37-year-old with acne vulgaris." "Avoid administering tigecycline (Tygacil) to a 7-year-old with Lyme disease." "Avoid administering tigecycline (Tygacil) to a 37-year-old with granuloma inguinale."
Tetracyclines such as tigecycline (Tygacil) should not be given to children between 4 months and 8 years of age. They can cause discoloration of the permanent teeth and tooth enamel hypoplasia in both fetuses and children and possibly retard fetal skeletal development if taken by the mother during pregnancy. The medication can be administered to older patients per the advice of a primary health care provider. These patients may suffer from some minor adverse effects.
Which statement is true regarding ceftriaxone (Rocephin)? It has a bacteriostatic effect. It has an oral route of administration. It may decrease the levels of liver enzymes. It has a maximum child dose of 100 mg/kg/day
The maximum dose of ceftriaxone (Rocephin) in children is 100 mg/kg/day; if the dose beyond this is administered it may lead to an overdose. Ceftriaxone (Rocephin) inhibits bacterial cell wall synthesis, causing cell death. Therefore, it is a bactericidal drug. Ceftriaxone (Rocephin) is administered through an intravenous or intramuscular route. An increase in liver enzymes is found with ceftriaxone (Rocephin
The nurse has just received a prescription from the primary health care provider to administer ampicillin to an 80-year-old patient. Which assessment is the nurse's priority before administering the antibiotic Renal function Hepatic function Cross-sensitivity Total body fluid
The most important assessment before administering ampicillin to an older adult is renal function because older adults are more sensitive to medications. Ampicillin formulations contain large amounts of sodium and/or potassium. Doses must be adjusted for patients with renal dysfunction. If the patient is hypervolemic, assessment of renal function is even more important; however, the nurse should monitor intake and output and edema with the administration of ampicillin. In addition, older adults are likely to have declining organ function, which can lead to impaired elimination of any medication. Ampicillin can be administered by way of several routes; if the patient's veins are too poor for an infusion, it can be administered by means of injection into the muscle or by mouth. Cross-sensitivity to other antibiotics is not important until ampicillin fails to eliminate the bacteria after one course of treatment. Total body fluid is a reasonable assessment before the administration of ampicillin; however, eradication of the infection may be the priority.
The patient has been ordered lincomycin (Lincocin). The patient reports to the nurse that the patient has experienced reduced renal function in the past. The nurse anticipates that the health care provider will take which action Place the medication on hold until renal function improves. Increase the original dosage of the medication. Decrease the original dosage of the medication. Continue with the medication as originally ordered
The most likely intervention is decreasing the dose of the medication in order to accommodate the decreased renal function. The medication would not be increased, held, or continued as originally ordered if renal function were decreased
Which action does the nurse take if a patient receiving intravenous vancomycin (Vancocin) complains of facial pruritis? Gives diphenhydramine (Benadryl) with the infusion Documents that the patient has a hypersensitivity reaction Wraps the infusion in foil to protect from light Programs the vancomycin to infuse at a slower rate
The nurse infuses vancomycin over at least 1 hour, as rapid infusion can cause red man syndrome. It is indicated by flushing or itching of the face, neck, and trunk, as well as more serious problems like tachycardia and hypotension. Diphenhydramine (Benadryl) is a hypnotic drug used for treating histamine-mediated allergies, motion sickness, and promotion of sleep. Pruritus in a patient taking vancomycin is more an indication of red man syndrome than hypersensitivity. Orally disintegrating medicines are wrapped in foils which, once administered, dissolve on the patient's tongue. Test-Taking Tip: Choose the best answer for questions asking for a single answer. More than one answer may be correct, but one answer may contain more information or more important information than another
A patient suffering from an upper respiratory tract infection was prescribed medication to be taken once a day for 5 days. After taking the drug, the patient complains of nausea, diarrhea, and abdominal pain. The patient also develops conjunctivitis before completing the full course. Which is a characteristic of the drug prescribed to the patient It can cause hepatotoxicity in high doses. It is readily absorbed from the gastrointestinal (GI) tract. It should never be taken with clindamycin or lincomycin. It should not be prescribed to patients with renal insufficiency
The patient was prescribed azithromycin (Zithromax), which is a macrolide that is only prescribed to be taken once a day for 5 days due to its long half-life of up to 40 to 68 hours. The common side effects associated with this drug include nausea, diarrhea, and abdominal pain. It can also cause conjunctivitis as a side effect. Hepatotoxicity can occur when azithromycin (Zithromax) is taken in high doses with other hepatotoxic drugs. Clarithromycin (Biaxin) and erythromycin (E-Mycin) are readily absorbed from the GI tract, mainly by the duodenum. Azithromycin (Zithromax) is incompletely absorbed from the GI tract, and only 37% reaches systemic circulation. Because macrolides are excreted in urine in only small amounts, renal insufficiency is not a contraindication for the use of a macrolide such as azithromycin. Erythromycin (E-Mycin) should not be taken with clindamycin (Cleocin) or lincomycin (Lincocin) because these compete for receptor sites
The nurse is caring for a patient who is on antibiotic therapy for cardiac surgical prophylaxis. The nurse observes red blotching of the face, neck, and chest of the patient. Which medication is associated with this side effect of "red man" syndrome?
Vancomycin (Vancocin) is used in cardiac surgical prophylaxis when the patient is allergic to penicillin. Red blotching of the face, neck, and chest refers to "red man" syndrome or "red neck" syndrome. This condition occurs in the client due to rapid intravenous administration of vancomycin (Vancocin). Lincomycin (Lincocin) and clindamycin (Cleocin) may cause anaphylactic shock. Telithromycin (Ketek) may lead to an exacerbation of myasthenia gravis.
A patient is prescribed penicillin G potassium (Pfizerpen) for treating a respiratory infection. What would be the appropriate nursing interventions for this patient? multiple Monitoring for superinfection Monitoring the patient for respiratory distress Obtaining a culture and sensitivity test after starting the therapy Having availability of epinephrine to treat severe allergic reaction Advising the patient to take the medication with an empty stomach
When taking penicillin for a prolonged time, it may cause superinfections. Therefore, monitoring for stomatitis, which is a type of superinfection, is required. Respiratory distress is a severe allergic reaction after a first or second dose of penicillin. Epinephrine is used to treat a severe allergic reaction that may occur with the use of penicillin. A culture and sensitivity test should be obtained before starting the therapy for effective treatment. Penicillins should be taken with food to avoid gastric irritation. Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses.
