Macrolides NCLEX REVIEW

The nurse should question the *prescription of tetracycline for which patient?*

* A 6-year old patient with Haemophilus influenzae* [Tetracycline is contraindicated in children younger than 8 years because it can cause permanent discoloration of the teeth. Tetracycline is not contraindicated for patients diagnosed with diabetes mellitus or hypertension. Tetracycline is used to treat rickettsiae]

A patient who is being treated for a *neuromuscular disease* has been ordered* telithromycin (Ketek).* *What is the nurse's highest priority action?*

* Notify the health care provider* [Use of telithromycin (Ketek) can worsen symptoms of myasthenia gravis. The health care provider should be notified]

The patient has been diagnosed with *Legionnaires' disease* Which drug does *the nurse anticipate the provider will order?*

*Erythromycin (E-Mycin) * [The drug of choice for treatment of Legionnaires' disease is erythromycin (E-Mycin)]

A patient has been ordered *telithromycin (Ketek) as well as simvastatin (Zocor)*. *What is the nurse's best action?*

*Hold the medication and call the health care provider* [Telithromycin should not be taken with simvastatin owing to the risk of serious side effects. Separating the medications by 6 hours or taking the medication with milk or food will not lessen the risk of side effects. The nurse should not administer these medications]

The patient taking intravenous *Gentamicin (Garamycin)* has *elevated blood urea nitrogen (BUN*).* What is the nurse's best course of action?*

*Hold the medication* [Gentamicin (Garamycin) has a high potential for nephrotoxicity and is thus contraindicated in patients with elevated renal function tests such as BUN and creatinine. The nurse should hold the medication and call the health care provider. Increasing fluids will not decrease the patient's BUN]

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?*

*Tetracycline * [Tetracycline is considered to be a drug of choice for the treatment of acne rather than the other medications listed]

Case Study: D.T., 72-years-old, presents to the emergency department from a long-term acute care facility (LTAC) with com-plaints of fever, shaking chills, flank pain, and burning on urination. Vital signs are temperature 100.3° F, heart rate 94 beats/min, respiratory rate 16 breaths/min, and blood pressure 102/70 mm Hg. D.T.'s medical history includes adult-onset diabetes and cerebrovascular accident with residual left-sided weakness. Current drugs include glyburide, warfarin, and a daily multivitamin. D.T. is allergic to all cephalosporins. D.T. is diagnosed with an E. coli urinary tract infection and was prescribed oral trimethoprim-sulfamethoxazole (TMP-SMZ). 1. What is the mechanism of action and standard dos-age for oral TMP-SMZ? 2. What will the nurse discuss with the client and/or caregivers regarding the plan of care as it relates to TMP-SMZ? 3. For what adverse reactions will the nurse monitor?

1. TMP-SMZ is a sulfonamide that is bacteriostatic. Trimethoprim and sulfamethoxazole inhibit the bacterial synthesis of folic acid, which is required for bacterial growth. The standard oral dosage is 160 mg of TMP/800 mg of SMZ q12h. 2. Client and/or caregiver teaching will include the need for adequate fluid intake to maintain a urine output of more than 600 mL/d to prevent crystalluria. The drug should be taken on an empty stomach. The nurse will educate on the potential side effects of anorexia, nausea, vomiting, diarrhea, and abdominal pain. Other side effects include head-ache, fatigue, vertigo, and insomnia. The client should be advised to ask for help when getting out of bed or ambulating because of the potential for vertigo and risk of falling. Other plan of care instructions includes teaching to monitor for any rash or bruises, and if observed to notify the provider. TMP-SMZ can increase the effects of warfarin. The blood glucose level should be monitored more closely because of increased risk for hypoglycemia. 3. The nurse will need to be aware of the potential for increased effects of anticoagulation, such as bruising and bleeding, because of the interaction be-tween warfarin and TMP-SMZ. There is also a potential for increased hypoglycemic effects of glyburide. The nurse will need to carefully monitor lab work, including BUN and creatinine levels for renal function as well as liver panel (AST, ALT, ALP). The nurse will also need to monitor for life-threatening adverse effects, including electrolyte imbalances (hyperkalemia, hyponatremia, hypoglycemia), seizures, angioedema, anemias, leukopenia, pseudomembranous colitis, and Stevens-Johnson syndrome (erythema multiforme major). Stevens-Johnson syndrome is characterized by fe-ver, malaise, joint pain, and skin lesions. Severe cases can be life-threatening and may require in-tensive care hospitalization and the use of immunoglobulins.

What are the three interactions of aminoglycosides?

Coumadin, pencillin, and loop diuretics

Which class of drug would increase the risk of nephrotoxicity in a client taking ceftriaxone? a. Angiotensin-converting enzyme (ACE) inhibitor b. Antidysrhythmic c. Loop diuretic d. Nonsteroidal antiinflammatory drug (NSAID)

c. Loop diuretics, such as furosemide, can cause nephrotoxicity when taken concomitantly with ceftriaxone. Other class of drugs that can cause nephrotoxicity include intravenous calcium salts. ACE-I, antidysrhythmics, and NSAIDs are not implicated in causing nephrotoxicity when taken with ceftriaxone.

The nurse is caring for *multiple patients receiving antibiotics*. Which patient will the nurse assess first?

*The patient who is taking vancomycin (Vancocin) with furosemide (Lasix) * [The risk of ototoxicity with vancomycin is increased for patients taking furosemide. The nurse should assess this patient first. A patient who has started antibiotic therapy would be expected to have a fever. Gastric upset is common with this antibiotic. Telithromycin is recommended for patients 18 years and older]

*The patient has been ordered azithromycin (Zithromax)* 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?*

*This drug has a longer duration of action than some of the other antibiotics* [Azithromycin (Zithromax) 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]

A patient prescribed *azithromycin (Zithromax)*expresses concern regarding *gastrointestinal upset experienced when taking erythromycin*. *What will the nurse tell this patient?*

*This drug is like erythromycin but has less severe gastrointestinal side effects* [Azithromycin (Zithromax) 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]

Which instruction will the nurse include in the discharge *teaching for a patient receiving tetracycline?*

*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]

Which of the following is the exact order of the infection chain? 1.Susceptible host 2.Portal of entry 3.Portal of exit 4.Etiologic agent 5.Reservoir 6.Mode of transmission

A) 1, 2, 3, 4, 5, 6 B) 5, 4, 2, 3, 6, 1 C) 4, 5, 3, 6, 2, 1 D) 6, 5, 4, 3, 2, 1 Question 42 Explanation: C where the chain of infection starts. The source will first proliferate on a reservoir and will need a portal of exit to be able to transmit itself using a portal of entry to a susceptible host.

Several clients are admitted to an adult medical unit. The nurse would ensure airborne precautions for a client with which of the following medical conditions?

A) A diagnosis of AIDS and cytomegalovirus B) A positive PPD with an abnormal chest x-ray C) A tentative diagnosis of viral pneumonia D) Advanced carcinoma of the lung Question 3 Explanation: B The client who must be placed in airborne precautions is the client with a positive PPD (purified protein derivative) who has a positive x-ray for a suspicious tuberculin lesion.

Jayson, 1 year old child has a staph skin infection. Her brother has also developed the same infection. Which behavior by the children is most likely to have caused the transmission of the organism?

A) Bathing together. B) Coughing on each other. C) Sharing pacifiers. D) Eating off the same plate. Question 16 Explanation: A Direct contact is the mode of transmission for staphylococcus. Staph is not spread by coughing. Staph is not spread through oral secretions. Direct contact is required. Staph is not spread through oral secretions.

The nurse is administering augmentin to her patient with a sinus infection. Which is the best way for her to insure that she is giving it to the right patient?

A) Call the patient by name B) Read the name of the patient on the patient's door C) Check the patient's wristband D) Check the patient's room number on the unit census list Question 4 Explanation: C The correct way to identify a patient before giving a medication is to check the name on the medication administration record with the patient's identification band. The nurse should also ask the patient to state their name. The name on the door or the census list are not sufficient proof of identification. Calling the patient by name is not as effective as having the patient state their name; patients may not hear well or understand what the nurse is saying, and may respond to a name which is not their own.

Markee, A 15 year old high school student asked you. What is the mode of transmission of Lyme disease. You correctly answered him that Lyme disease is transmitted via

A) Direct contact transmission B) Vehicle borne transmission C) Air borne transmission D) Vector borne transmission Question 43 Explanation: D Lyme's disease is caused by borrelia burgdorferi and is transmitted via a tick bite.

Considered as the WEAKEST LINK in the chain of infection that nurses can manipulate to prevent spread of infection and diseases

A) Etiologic/Infectious agent B) Portal of Entry C) Susceptible host D) Mode of transmission Question 41 Explanation: D Mode of transmission is the weakest link in the chain of infection. It is easily manipulated by the nurses using the tiers of prevention, either by instituting transmission based precautions, universal precaution or isolation techniques.

A child with measles developed fever and general weakness after being exposed to another child with rubella. In what stage of infectious process does this child belongs?

A) Incubation period B) Prodromal period C) Illness period D Convalescent period Answer: B

The third period of infectious processes characterized by development of specific signs and symptoms

A) Incubation period B) Prodromal period C) Illness period D) Convalescent period Question 38 Explanation: C In incubation period, the disease has been introduced to the body but no sign and symptom appear because the pathogen is not yet strong enough to cause it and may still need to multiply. The second period is called prodromal period where appearance of non-specific signs and symptoms sets in. Illness period is characterized by appearance of specific signs and symptoms. Acme is the peak of an illness while convalescent period is characterized by the abatement of the disease or its gradual dissipation.

A 50 year old mailman carried a mail with anthrax powder in it. A minute after exposure, he still hasn't developed any signs and symptoms of anthrax. In what stage of infectious process does this man belongs?

A) Incubation period B) Prodromal period C) Illness period D)Convalescent period Question 40 Explanation: A Anthrax can have an incubation period of hours to seven (7) days with an average of 48 (hours). Since the question stated exposure, we can assume that the mailman is in the incubation phase.

A child is admitted to the pediatric unit with a diagnosis of suspected meningococcal meningitis. Which of the following nursing measures should the nurse do FIRST?

A) Institute seizure precautions B) Assess neurologic status C) Place in respiratory isolation D) Assess vital signs Question 1 Explanation: C The initial therapeutic management of acute bacterial meningitis includes isolation precautions, initiation of antimicrobial therapy and maintenance of optimum hydration. Nurses should take necessary precautions to protect themselves and others from possible infection.

The ability of the infectious agent to cause a disease primarily depends on all of the following except

A) Pathogenicity B) Virulence C) Invasiveness D) Non Specificity Question 44 Explanation: D To be able to cause a disease, a pathogen should have a target organ and should be specific to these organs to cause an infection.

A client is diagnosed with methicillin resistant staphylococcus aureus pneumonia. What type of isolation is MOST appropriate for this client?

A) Reverse isolation B) Respiratory isolation C) Standard precautions D) Contact isolation Question 2 Explanation: D Contact or Body Substance Isolation (BSI) involves the use of barrier protection (e.g. gloves, mask, gown, or protective eyewear as appropriate) whenever direct contact with any body fluid is expected. When determining the type of isolation to use, one must consider the mode of transmission. The hands of personnel continues to be the principal mode of transmission for methicillin resistant staphylococcus aureus (MRSA). Because the organism is limited to the sputum in this example, precautions are taken if contact with the patient's sputum is expected. A private room and BSI, along with good hand washing techniques, are the best defense against the spread of MRSA pneumonia.

The nurse is administering an antibiotic to her pediatric patient. She checks the patient's armband and verifies the correct medication by checking the physician's order, medication kardex, and vial. Which of the following is not considered one of the five "rights" of drug administration?

A) Right dose B) Right route C) Right frequency D) Right time Question 10 Explanation: C The five rights of medication administration are right drug, right dose, right route, right time, right patient. Frequency is not included.

Refers to the degree of resistance the potential host has against a certain pathogen

A) Susceptibility B) Immunity C) Virulence E) Etiology Question 10 Explanation: A Immunity is the absolute resistance to a pathogen considering that person has an intact immunity. Susceptibility is the degree of resistance or how well would the individual combat the pathogens and repel infection or invasion of these disease causing organisms. A susceptible person is someone who has a very low degree of resistance to combat pathogens. An immune person is someone that can easily repel specific pathogens.

A group of symptoms that sums up or constitute a disease collection of these symptoms that occurs together and has a pattern that characterizes a certain disease.

A) Syndrome B) Symptoms C)Signs D) Etiology Question 11 Explanation: A Symptoms are individual manifestation of a certain disease (i.e., tics in Tourette syndrome) but a symptom alone is not enough to diagnose the patient as other diseases may have the symptom manifestation. Syndrome, on the other hand, means collection of these symptoms that occurs together and has a pattern that characterizes a certain disease.

The most important instructions a nurse can give a patient regarding the use of the antibiotic ampicillin prescribed for her are to

A) call the physician if she has any breathing difficulties B) take it with meals so it doesn't cause an upset stomach C) take all of the medication prescribed even if the symptoms stop sooner D) not share the pills with anyone else Question 5 Explanation: C Frequently patients do not complete an entire course of antibiotic therapy, and the bacteria are not destroyed.

James Perez, a nurse on a geriatric floor, is administering a dose of digoxin to one of his patients. The woman asks why she takes a different pill than her niece, who also has heart trouble. James replies that as people get older, liver and kidney function decline, and if the dose is as high as her niece's, the drug will tend to:

A) have a shorter half-life. B) accumulate. C) have decreased distribution. D) have increased absorption. Question 3 Explanation: B The decreased circulation to the kidney and reduced liver function tend to allow drugs to accumulate and have toxic effects.

The cell and Coombs classification system categorizes allergic reactions and is useful in describing and classifying patient reactions to drugs. Type I reactions are immediate hypersensitivity reactions and are mediated by:

A) immunoglobulin E (IgE) B) immunoglobulin G (IgG) C) immunoglobulin A (IgA) D) immunoglobulin M (IgM) Question 7 Explanation: A IgE, the least common serum immunoglobulin (Ig) binds very tightly to receptors on basophils and mast cells and is involved in allergic reactions. Binding of the allergen to the IgE on the cells results in the release of various pharmacological mediators that result in allergic symptoms. IgG is the major Ig (75 percent of serum Ig is IgG). Most versatile Ig because it is capable of carrying out all of the functions of Ig molecules. IgG is the only class of Ig that crosses the placenta. It is an opsonin, a substance that enhances phagocytosis. IgA, the second most common serum Ig is found in secretions (tears, saliva, colostrum, and mucus). It is important in local (mucosal) immunity. IgM, the third most common serum Ig, is the first Ig to be made by the fetus and the first Ig to be made by a virgin B cell when it is stimulated by antigen. IgM antibodies are very efficient in leading to the lysis of microorganisms

The physician orders penicillin for a patient with streptococcal pharyngitis. The nurse administers the drug as ordered, and the patient has an allergic reaction. The nurse checks the medication order sheet and finds that the patient is allergic to penicillin. Legal responsibility for the error is:

A) only the nurse's—she should have checked the allergies before administering the medication. B) only the physician's—she gave the order, the nurse is obligated to follow it. C) only the pharmacist's—he should alert the floor to possible allergic reactions. D) the pharmacist, physician, and nurse are all liable for the mistake Question 2 Explanation: D The physician, nurse, and pharmacist all are licensed professionals and share responsibility for errors.

A client with histoplasmosis has an order for ketoconazole (Nizoral). The nurse teaches the client to do which of the following while taking this medication?

A) take the medication on an empty stomach B) take the medication with an antacid C) avoid exposure to sunlight D) limit alcohol to 2 ounces per day Question 12 Explanation: C The client should be taught that ketoconazole is an antifungal medication. It should be taken with food or milk. Antacids should be avoided for 2 hours after it is taken because gastric acid is needed to activate the medication. The client should avoid concurrent use of alcohol, because the medication is hepatotoxic. The client should also avoid exposure to sunlight, because the medication increases photosensitivity.

The nursery nurse is putting erythromycin ointment in the newborn's eyes to prevent infection. She places it in the following area of the eye

A) under the eyelid B) on the cornea C) in the lower conjunctival sac D) by the optic disc Question 1 Explanation: The ointment is placed in the lower conjunctival sac so it will not scratch the eye itself and will get well distributed.

Jessie, a young man with newly diagnosed acquired immune deficiency syndrome (AIDS) is being discharged from the hospital. The nurse knows that teaching regarding prevention of AIDS transmission has been effective when the client:

A) verbalizes the role of sexual activity in spread of the disorder. B) states he will make arrangements to drop his college classes. C) acknowledges the need to avoid all contact sports. D) says he will avoid close contact with his three-year-old niece. Question 17 Explanation: A HIV is spread through direct contact with body fluids such as blood and through sexual intercourse. Casual contact with other people does not pose a risk of transmission of HIV. Unless the client is feeling very ill, there is no need for him to drop his college classes. Contact sports are not contraindicated unless there is a significant chance of bleeding and direct contact with others. Casual contact with other people does not pose a risk of transmission of HIV . There is no need to limit casual contact with children.

A nurse is monitoring patient compliance with the diabetes mellitus treatment regimen. What value indicates compliance with the regimen?

HbA1C of 4%-6%. This is the best indicator of average blood glucose levels for the past 120 days.

A clinic nurse is preparing to administer a Penicillin IM injection to a client who has never taken the medication before. What should be included in the plan of care?

Instruct the client to sit in the clinic for 30 minutes after the injection. (to ensure prompt treatment if anaphylaxis occurs)

Which drug is often used when a patient has a penicillin allergy?

Macrolides (erythromycin, azithromycin)

How should the nurse monitor trough and peak levels in a patient receiving aminoglycosides (gentamicin, streptomycin, neomycin)?

Peak levels: 30 mins after adminstration of infusion Trough levels: 1 hr before next scheduled dose

Which drug inactivates aminoglycosides when mixed in the same IV?

Pencillin

During administration of vancomycin (Vancocin) IV, the nurse notices the client's neck and face becoming flushed. What action should the nurse take first?

Slow the rate of infusion

A nurse is taking care of a client prescribed omeprazole (Prilosex). What information should the nurse provide regarding administration of this medication?

Take medication in the morning before breakfast

Which drug causes a medication interaction when taken with milk, antacids, and magnesium containing products?

Tetracyclines

A nurse is caring for a client with a history of rheumatoid arthritis who is receiving methotrexate (Rheumatrex). What should be included in client education?

The CBC will be monitored. (Bone marrow suppression is a common side effect of using methotrexate for long term therapy of RA.)

A nurse is to administer morphine sulfate 10 mg intramuscular (IM) to an adult client for post-operative pain. Which injection site is the most appropriate?

Ventrogluteal (This site is a deep site, situated away from the major nerves and blood vessels. This site is preferred for medications (such as antibiotics) that are larger in volume, more viscous, and irritating for adults, children, and infants. This site is safe for all clients with large muscle development.)

Which intervention(s) will the nurse implement in a client with bronchitis who is receiving TMP-SMZ and lisinopril? (Select all that apply) a. Encourage fluids. b. Monitor urinary output. c. Observe for undesired side effects. d. Assess lung sounds. e. Administer laxatives.

a, b, c, d. To prevent crystallization in the urine, fluids should be encouraged. Urine output should be carefully monitored since this medication is excreted in the urine. Undesired side effects are possible and include abdominal pain, nausea, vomiting, diarrhea, and anorexia. A desired effect of TMP-SMZ will be resolution of the bronchitis as evidenced by de-creased coughing and clear lung sounds.

Which drug(s), if prescribed for a client taking oral doxycycline, will the nurse question? (Select all that apply) a. Prenatal vitamins b. Antacids c. Warfarin d. Morphine e. Omeprazole

a, b, c, e. Iron, which is found in prenatal vitamins and antacids prevent absorption of doxycycline. Studies have shown that the effects of warfarin may be increased by taking doxycycline, placing the client at higher risk for bleeding. Cautious use should be exercised in a client taking doxycycline and a proton pump inhibitor like omeprazole. There are no known interactions with doxycycline and morphine.

Which information will the nurse include in the teaching for a client taking tetracycline for a respiratory tract infection? (Select all that apply) a. Outdated tetracycline breaks down into toxic by-products and must be discarded. b. Observe for superinfection like vaginitis. c. Avoid tetracycline during first and third trimesters of pregnancy. d. Anticipate urinary urgency. e. Wear sunscreen and limit outdoor exposure during peak daylight hours.

a, b, c, e. Outdated drugs of any kind should be dis-carded; however, tetracycline will break down into toxic by-products so it must be assured it is discarded. Superinfections, which occur when normal bacteria are destroyed, are common with the use of antibiotics. Tetracycline should not be taken during the first and third trimesters of pregnancy because of possible teratogenic effects. Tetracycline increases photosensitivity and sunscreen should be used when exposed to sun or limit sun exposure. Tetracycline does not cause urinary urgency.

Which finding will the nurse routinely monitor for in a client receiving gentamicin? (Select all that apply) a. Hearing loss b. Color and clarity of urine c. AST/ALT d. Blood glucose e. Visual acuity

a, b, c. Because gentamicin can cause hepatotoxicity, liver enzymes (AST and ALT) need to be monitored for signs of liver failure. Gentamicin can also be nephrotoxic; therefore measurement of the characteristics of urine is necessary. Ototoxicity can occur with gentamicin, causing hearing loss. Gentamicin usually does not affect vision.

A client is started on ceftazidime. Which nursing intervention(s) will the nurse perform? (Select all that apply) a. Obtain a culture. b. Administer IV dose over 20 minutes every day. c. Assess for allergic reaction. d. Monitor urine output. e. Restrict oral fluid intake.

a, c, d Ideally, culture and sensitivity should be obtained before starting antibiotics. Allergic reactions are a possibility with any antibiotic. Because cephalosporins are eliminated in the urine, monitoring for adequate urine output is important. Ceftazidime is administered q8-12h, not daily. Fluid intake is encouraged since the drug is excreted in urine.

Which laboratory test is most likely influenced by doxycycline? a. Serum potassium b. Serum calcium c. Platelets d. Hemoglobin and hematocrit

a. Common side effect of doxycycline is gastrointestinal distress, which includes nausea, vomiting, and diarrhea. These side effects could cause a decrease in serum potassium due to potassium loss. Serum calcium, platelets, and hemoglobin/hematocrit are not commonly affected.

For which bacteria is quinupristin-dalfopristin appropriate for life-threatening infection? a. Vancomycin-resistant Enterococcus faecium b. Escherichia coli c. Proteus mirabilis d. Klebsiella pneumoniae

a. Life-threatening infection caused by vancomycin-resistant Enterococcus faecium (VREF) is appropriate to use quinupristin-dalfopristin, a combination drug containing two streptogramin antibacterials. Other bacteria the drug is appropriate for includes Staphylococcus aureus and Streptococcus pyogenes.

A client is concerned about some weight loss while on ceftriaxone. Which information can the nurse tell the client regarding side effects of ceftriaxone? a. Loss of appetite is a common side effect. b. Gastrointestinal bleeding may occur frequently. c. Ceftriaxone causes nutrient absorption problems. d. The client will eat more when the infection is cured.

a. Loss of appetite, diarrhea, nausea, and vomiting are common side effects of cephalosporins, such as ceftriaxone. These side effects could cause weight loss. The nurse should encourage the client that when the antibiotic is completed, appetite will resume, and weight loss will stop. It is possible that GI bleeding can occur, but the client is concerned about weight loss, not bleeding. Ceftriaxone is administered IM or IV, not orally; therefore absorption problem is not a concern. It is possible the client will begin to eat more and regain weight as her illness is cured; however, the antibiotic is what is causing the side effects, not the illness.

Which amount is the maintenance dose for sulfasalazine in the treatment of an inflammatory bowel disease, such as ulcerative colitis? a. 500 mg q6h b. 1000 mg q6h c. 1250 mg per day d. 1500 mg per day

a. The maintenance dose for sulfasalazine is 500 mg every 6 hours, with a maximum dose of 4 g/day. While 1000 mg every 6 hours are within the maximum dose, it is not the best answer. 1250 mg/d and 1500 mg/d are too small of a dose.

A client is scheduled to receive ceftriaxone for an infection due to Klebsiella. Which teaching will the nurse provide to the client about this drug? a. It is given intramuscularly (IM) or intravenously (IV). b. There is no cross-reaction to penicillins. c. Ceftriaxone is safe to take with anticoagulants. d. There is no effect on lab values.

a. The nurse will teach the client that ceftriaxone is given via IM or IV. It is not given orally. About 10% of population who has hypersensitivity to penicillin has cross-reaction to cephalosporin, such as ceftriaxone. Ceftriaxone, when taken concomitantly with anticoagulants, increases risk of bleed-ing. Ceftriaxone can increase liver enzymes and international normalized ratio (INR).

a patient is taking azithromycin (Zithromax). which nursing interventions would the nurse plan to implement for this patient (select all apply)? a. monitor periodic liver function tests b. dilute with 50mL of D5W for IV administration c. instruct the patient to report any hearing loss d. instruct patient to report evidence of superinfection e. teach to take oral drug 1 hour ac or 2 hours pc f. advise to avoid antacids from 2 hours prior to 2 hours after administration

a. monitor periodic liver function test c. instruct the patient to report any hearing loss d. instruc patinet to report evidence of superinfection e. teach to take oral drug 1 hour ac or 2 hours pc

which nursing intervention(s) should the nurse consider for the patient taking ciprofloxacin (Cipro) (select all that apply)? a. obtain culture before drug administration b. tell patient to avoid taking Cipro with antacids c. monitor patient for tinnitus d. encourage fluids to prevent crystalluria e. infuse IV Cipro over 60 minutes f. monitor blood glucose, because Cipro can decrease effect of oral hypoglycemia

a. obtain culter before drug administration b. tell patient to avoid Cipro with antacids c. monitor patient for tinnitus d. encourage fluids to prevent crystalluria e. infuse IV Cipro over 60 minutes

which instruction will the nurse include when teaching a patient about gentamicin (select all that apply)? a. patient should report any hearing loss b. patient should use sunscreen c. IV gentamicin will be given over 20 minutes d. patient will be monitored for mouth ulcers and vaginitis e. peak levels will be drawn 30 minutes before IV dose f. patient should increase fluid intake

a. patient shoudl report any hearing loss b. patient hsoudl use sunscreen d. patient will be monitored for mouth ulcers and vaginitis f. patient should increase fluid intake

the nurse enters a patients room to find that his heart rate is 120, his BP is 70/50 and his red blotching of his face and neck. vancomycin (vancocin) is running IVPB. the nurse believes that this patient is experiencing a severe advers effect called "red man syndrome." what action will the nurse take? a. stop the infusion and call the lab b. reduce the infusion to 10mg/min c. encourage the patient to drink more oral fluids up to 2L/day d. report onset of Stevens-Johnson syndrome to the health care provider

a. stop the infusion and call the lab

a patient is receiving tetracycline (Vibramycin). which advice should the nurse include when teaching this patient about tetracycline? a. take sunscreen precautions when at the beach b. take an antacid with the drug to prevent severe GI distress c. obtain frequent hearing tests for early detection of hearing loss d. obtain frequent eye checkups for early detection of retinal damage

a. take sunscreen precautions when at the beach

Which specific nursing intervention(s) would the nurse implement for a client taking doxycycline for chlamydia? (Select all that apply) a. Restricting fluids b. Storing the drug away from light c. Ordering renal and liver profiles d. Obtaining a specimen for culture and sensitivity e. Advising the patient to use additional contraceptives when taking this drug

b, c, d, e. Drugs in the tetracycline family should be stored away from light to prevent breakdown. Cautious use is recommended in clients with renal and/ or liver disease. Baseline levels should be assessed and reevaluated as needed. Because of mutations within the strains of various sexually transmitted infections, a culture and sensitivity should be obtained before starting treatment. It is also possible that various sexually transmitted infections could be present at the same time, and it would be beneficial to the client if the most effective antibiotic is prescribed for each. Tetracyclines may make oral contraceptives less effective, so additional contraceptive use is recommended.

A recent postpartum client was prescribed TMP-SMZ for urinary tract infection (UTI). Which important question(s) will the nurse ask? (Select all that apply) a. "What kind of juice do you like to drink?" b. "Are you breastfeeding?" c. "Are you allergic to any medications?" d. "Do you have a history of kidney stones?" e. "What drugs do you take regularly?"

b, c, d, e. TMP-SMZ is contraindicated while breast-feeding. It is possible that there is cross-sensitivity between sulfonamides, so it is important to determine if the client is allergic to any other antibiotics. There are a variety of etiologies for kidney stones; however, crystallization of the urine may occur with sulfonamides, which can lead to kidney stone formation. Some clients are more prone to kidney stones than others. TMP-SMZ has a variety of interactions with several drugs, including warfarin, oral hypoglycemic agents, ACE inhibitors, digoxin, phenytoin, and potassium-sparing diuretics.

The nurse assesses a client who is taking gentamicin. Which assessment finding(s) should be cause for serious concern? (Select all that apply) a. Nausea b. Ototoxicity c. Headache d. Photosensitivity e. Elevated renal function tests

b, e. Ototoxicity is a serious adverse effect of gentamicin. Elevated renal function tests may indicate a decrease in renal function, which increases the risk of nephrotoxicity. Nausea, headache, and photosensitivity may be side effects; however, they are usually not considered serious.

A trough level is obtained in a client receiving daptomycin. Which trough level will the nurse know is appropriate? a. 5 mcg/mL by the second dose b. 5.9 mcg/mL by the third dose c. 6 mg/mL by the third dose d. 6.5 mg/mL by the fourth dose

b. A trough of 5.9 mcg/mL is usually achieved by the third dose. The units are in mcg/mL, not mg/ mL.

Which statement by a parent indicates more discharge teaching is necessary for care of a 5-year-old child who has been prescribed dicloxacillin for otitis media? a. "Abdominal pain can be a side effect." b. "She needs to drink plenty of orange juice with this medication." c. "My child must take all of the drug until it is gone." d. "If my child develops a rash, I should bring her back to the doctor."

b. Acidic fruits or juices, such as orange juice, may make dicloxacillin less effective. Abdominal pain is a possible side effect. The entire course of anti-biotics must be completed to prevent the develop-ment of resistance. Rashes can be associated with dicloxacillin but may also be an indication of an allergic reaction. The client would need to be evaluated for other indications of an allergic reaction, such as difficulty breathing or hives.

A client with renal dysfunction and Staphylococcus aureus infection is prescribed cefprozil monohydrate. Which dose indicates the maximum amount the nurse will anticipate? a. 250 mg/d b. 500 mg/d c. 750 mg/d d. 1 g/d

b. Cefprozil monohydrate is given for skin infections. The usual dosage range for adults is 250 to 500 mg/d, with a maximum dose of 1 g/d. Clients with CrCl <30 mL/min, adjust dose by half; there-fore, the maximum dose would be 500 mg/d.

A client is taking gentamicin intravenously for a postsurgical infection at 9:00 am and 9:00 pm. Which time is most correct for the nurse to check drug peak level? a. 9:15 am b. 10:00 am c. 9:15 pm d. 10:30 pm

b. Peak blood levels are drawn 45-60 minutes after a drug has been administered. Gentamicin is administered intravenously over 30 to 60 minutes. Therefore, peak drug level should be checked at 10:00 am or 10:00 pm. Gentamicin will still be infusing at 9:15 am and 9:15 pm. 10:30 pm is over 60 minutes after drug has completed infusing.

Which mechanism of action is correct about penicillin V potassium? a. Alteration in membrane permeability b. Inhibition of cell-wall synthesis c. Inhibition of protein synthesis d. Interference with cellular metabolism

b. Penicillin's betalactam ring structure inhibits bacterial cell-wall synthesis. Penicillins, including penicillin V, can be both bacteriostatic and bactericidal. Amphotericin B and polymyxin alter membrane permeability. Aminoglycosides and tetracyclines are some drugs that inhibit protein synthesis. Sulfonamides and trimethoprim are some antibiotics that interferes with cellular metabolism.

The trough level that the nurse drew for a client taking gentamicin is 3.5 mcg/mL. Which action would be taken by the nurse? a. Administer the medication at the correct time. b. Hold the drug and contact the health care provider. c. Repeat the trough level after the next dose of medication. d. Give the client diphenhydramine to decrease the risk of a reaction.

b. The correct trough level for gentamicin is less than 1 to 2 mcg/mL. The health care provider should be contacted before administering the dose because it is elevated, which can cause an adverse reaction such as nephrotoxicity. The drug should not be administered because of high trough level. Diphenhydramine can decrease risk of reaction, but the client is not having a reaction; instead the trough level indicates toxicity.

15. Which dose is the usual adult dose of TMP-SMZ? a. 160 mg TMP/800 mg SMZ q6h b. 160 mg TMP/800 mg SMZ q12h c. 40 mg TMP/60 mg SMZ q6h d. 40 mg TMP/60 mg SMZ q12h

b. The usual adult dose of TMP-SMZ is 160 mg TMP/800 mg SMZ every 12 hr. Its half-life is 6 to 12 hrs; thus must be administered twice a day.

A client has been prescribed doxycycline. Which statement(s) by the client indicate(s) that the nurse needs to provide more discharge teaching? (Select all that apply) a. "It is best if I take this with meals." b. "I should drink milk." c. "I have to take this drug on an empty stomach." d. "I should wait a half-hour after meals to take the medication." e. "I cannot eat eggs when I take this drug."

c, d, e. Doxycycline should be taken with meals or milk for improved absorption. There are no restrictions regarding eggs.

An adult client has been prescribed cefaclor for otitis media. Which order will the nurse question? a. Immediate release (IR), 250 mg q8h b. Immediate release (IR), 500 mg q8h c. Immediate release (IR), 750 mg q8h d. Extended release (ER), 500 mg q12h

c. A dose of IR 750 mg every 8 hours would be too much. The standard dose for adults is 250-500 mg q8h for immediate release or 500 mg q12h for extended release.

The nurse is performing a morning assessment on a client who is receiving gentamicin. The client reports tinnitus all night. Which information is correct about gentamicin and tinnitus? a. Only low-pitched sounds are affected by gentamicin. b. Tinnitus is a sign of gentamicin allergy. c. Ototoxicity is caused by damage to cranial nerve VIII. d. Only female clients have ringing in their ears.

c. Aminoglycosides, such as gentamicin, can cause tinnitus, ringing of the ears. Tinnitus is a high-pitch sound due to damage to cranial nerve VIII. Other side effects are pruritus and muscle cramps. Tinnitus is not related to allergy or gender.

A client, who is allergic to dextromethorphan, is diagnosed with strep throat and is prescribed amoxicillin/clavulanate potassium. The client takes oral contraceptives, vitamin C, and fexofenadine. Which instruction will the nurse include in the discharge teaching regarding amoxicillin/clavulanate potassium? a. "Increase calcium intake." b. "Wear sunscreen at all times." c. "Use an alternate method of birth control." d. "Stop the fexofenadine."

c. Antibiotics, especially penicillins, may make oral contraceptives less effective, so an alternate method of birth control should be utilized. The cli-ent does not need to increase dietary calcium or stop fexofenadine. While some antibiotics can increase photosensitivity, wearing sunscreen at all times is not necessary. Sunscreens should be worn when being exposed to sun is likely.

A nurse is administering morning drugs to several clients. Which client will the nurse be concerned about in administering amoxicillin? a. A child with skin infection b. A pregnant client c. A client with asthma d. A client with diabetes

c. Caution is advised in administering amoxicillin to clients with asthma. Use in pediatric clients and diabetic clients are not contraindicated. Amoxicillin is generally safe during pregnancy.

The client has been prescribed azithromycin for an upper respiratory tract infection. Which statement by the client indicates understanding of drug's side effects? a. "I need to stay out of the sun or wear sunscreen." b. "I have to take it on an empty stomach to prevent nausea." c. "If my eyes get red and itchy, I shouldn't wear my contacts." d. "I cannot take anything for pain if I get a head-ache."

c. Conjunctivitis is a possible side effect of azithromycin. If this occurs, the client should not wear contact lenses. Photosensitivity is not a side effect of this drug. Taking azithromycin with food may help prevent nausea. If a headache occurs as a side effect, drugs such as ibuprofen or acetaminophen are not contraindicated.

For which reason are sulfonamides not classified as antibiotics? a. They do not inhibit cell-wall growth. b. They are only bacteriostatic, not bactericidal. c. They were not obtained from biological sources. d. They are only effective against viruses and fungi.

c. Sulfonamides are not obtained from biological sources. They are bacteriostatic and depending on the dose, can be bacteriostatic. They are effective against bacteria, not viruses and fungi.

The client has developed vaginal discharge since beginning gentamicin. Which cause does the nurse suspect may have occurred? a. The client has been exposed to other infectious agents. b. The client is experiencing an allergic reaction. c. A superinfection has developed. d. A drug-drug interaction is taking place.

c. Superinfection or secondary infection, such as vaginitis, can occur resulting from antibacterial therapy. The client could have been exposed to other infectious agents, but since the client has been on antibiotics, a superinfection is most likely. An allergic reaction is a hypersensitivity and would most likely manifest itself as rash, swelling, or respiratory difficulty. A drug-drug interaction is not able to be determined since the client is on one drug.

A young client is admitted to the intensive care unit with a severe lower respiratory tract infection and is started on aztreonam. Which dose of aztreonam will the nurse anticipate administering? a. 500 mg q8h b. 500 mg q6h c. 1500 mg q8h d. 2000 mg daily

c. The appropriate dose for aztreonam would be 1500 mg q8h. The range for an adult dose is 1 to 2 g q8h to q12h, with a maximum dose of 8 g/d. The amount and frequency of drugs should be considered to obtain therapeutic response and a steady state. 500 mg q8h is too low of a dose to achieve therapeutic response. 500 mg q6h is too low of a dose. 2000 mg daily will result in low serum level.

The nurse is noting the urine output has decreased to 500 mL/day in an older adult client receiving vancomycin. Which action would be best by the nurse? a. Increase the client's oral fluid intake. b. Increase the rate on client's intravenous fluid. c. Contact the health care provider. d. Document this in the client's chart.

c. The best action by the nurse is to contact the health care provider. Vancomycin is nephrotoxic, and a decrease in urine output can be an early indication of renal damage. Decreasing renal function is also a part of normal aging, putting an older adult client at higher risk for renal failure. While increas-ng fluids (orally and intravenously) can improve renal output, it is not the best action. Every assessment, such as decreased urine output, should be documented, but it is not the best answer.

A client, who recently completed five days of antibiotics, presents to the clinic with complaints of severe vaginal itching and discharge. Which mechanism will the nurse recognize as a possible cause of vaginal itching and discharge? a. Poor hygiene b. Hypersensitivity c. Kidney infection d. Superinfection

d. Superinfection is a secondary infection caused by the disturbance of the normal microbial flora during antibiotic therapy. Common signs and symptoms of superinfection include vaginal itching and discharge due to fungal overgrowth. While poor hygiene can cause infection, the client has been taking antibiotics. It is less likely the infection is due to poor hygiene. Hypersensitivity reactions usually include rash and difficulty breathing, not infection. Kidney infection is usually exhibited with dysuria and hematuria, not vaginal itching.

A client has been started on TMP-SMZ for otitis. The nurse will advise the client about which side effect? a. Confusion b. Constipation c. Fever d. Insomnia

d. Insomnia is a common side effect from TMP-SMZ. Other side effects include anorexia, nausea, vomiting, diarrhea, depression, and headache, among others. Confusion, constipation, and fever are not common.

A client has sustained partial-thickness and full-thickness burns over 20% of the body. Which drug would be useful for this client? a. Sulfadiazine b. Sulfasalazine c. Sulfacetamide sodium d. Silver sulfadiazine

d. Silver sulfadiazine and mafenide are sulfonamides that are available in cream form to treat burns. Sulfadiazine is used for prophylactic treatment in clients with rheumatic fever. Sulfasalazine is used to treat irritable bowel disease, such as ulcerative colitis. Sulfacetamide sodium is for ophthalmic disorders.

Which category of drugs is known to increase the serum levels of cefotetan? a. Antacids b. Laxatives c. Opioids d. Uricosurics

d. Uricosurics, such as probenecid, compete for renal tubular clearance which can decrease the excretion of cefotetan. Intravenous calcium salts are contraindicated when taking some cephalosporin; they can deposit crystals in the lungs and kidneys. They do not increase serum levels of cefotetan. Laxatives do not increase levels of cephalosporins. Opioid solutions that contain alcohol can have a disulfiram-like reactions if coadministered with cefotetan; it does not increase the serum levels of cefotetan.

a patient is taking levofloxacin (Levaquin). which does the nurse know to be true regarding this drug? a. administer IV only b. may cause hypertension c. classified as an aminoglycoside d. an adverse effect is dysrhythmia

d. an adverse effect is dysrhythmia

for which serious adverse effect should the nurse closely monitor a patient who is taking lincosamides? a. seizures b. ototoxicity c. hepatotoxicity d. pseudomembranous colitis

d. pseudomembranous colitis

What adverse effects is a concern with aminoglycosides (gentamicin)?

otoxocity, nephrotoxicity, and hypersensitivity