NCLEX - Penicillins and Cephalosporins

A client with otitis media is ordered to receive amoxicillin (Amoxil). The client discloses to the nurse that she is allergic to penicillin. What is the highest priority action on the part of the nurse? a. Notify the healthcare provider that the client is allergic to penicillin. b. Encourage the client to take the dose under close monitoring. c. Administer half of the amoxicillin dose under supervision. d. Report the amoxicillin order to the supervisor.

ANS: A - Any medication allergy should be reported to the healthcare provider.

Most beta-lactam antibiotics are excreted through the kidneys. The nurse should assess the clients renal function by monitoring which levels? a. Blood urea nitrogen and serum creatinine b. Creatinine phosphokinase and alkaline phosphatase c. White blood cell count and red blood cell count d. Hemoglobin and hematocrit

ANS: A - Blood urea nitrogen and creatinine levels determine renal function.

The client has been ordered Cefazolin. The nurse anticipates an increase in the clients _____ from this medication? a. BUN and serum creatinine b. serum potassium c. serum calcium d. serum white blood cells

ANS: A - Cefazolin will produce an increase in the clients BUN, creatinine, AST, ALT, ALP, LDH, and bilirubin.

A client is ordered to receive a cephalosporin to treat a bacterial infection. Regarding monitoring of the client, the highest priority action on the part of the nurse includes assessing the client for which side effects? a. Nausea, vomiting, and diarrhea b. Photophobia and phototoxicity c. Pain with urination and blood in the urine d. High fevers and sweating

ANS: A - Common side effects of cephalosporins include anorexia, nausea, vomiting, headache, dizziness, itching, and rash.

A nurse is ordered to draw blood levels for a person receiving an antibiotic. The nurse is aware that peaks and troughs of serum antibiotic levels are monitored for drugs with a: a. narrow therapeutic index. b. large therapeutic index. c. long half-life. d. short half-life.

ANS: A - Medications with a narrow therapeutic index have a limited range between the therapeutic dose and the lethal dose.

Drug concentration is important for the eradication of bacterial infection. It is desired to keep the drug dose: a. below minimum effective concentration. b. above minimum effective concentration. c. below minimum toxic level. d. above minimum toxic level.

ANS: B - Medication levels must be maintained above the MEC throughout therapy to ensure that bacterial resistance does not occur.

The client has been ordered treatment with Cefaclor as well as erythromycin. The nurse anticipates what effect from the interaction of the medications? a. Increased action of the Cefaclor b. Decreased action of the Cefaclor c. Anaphylactic reaction to the Cefaclor d. Toxic action of the Cefaclor

ANS: B - The interaction of Cefaclor and erythromycin will produce a decrease in the action of the Cefaclor.

A client who reports an allergy to penicillin is ordered to receive cephalexin (Keflex). The correct action for the nurse is to: a. administer the medication as ordered with additional fluids. b. administer the medication and carefully observe for allergic reaction. c. call the physician to change the order because of the allergy history. d. administer another antibiotic after consulting the pharmacist.

ANS: B - There is a cross-sensitivity between penicillin and cephalosporin medications. The nurse should observe for allergic reactions.

When antibacterials are prescribed for the treatment of an infection and a culture is ordered, what should happen next? a. The initial dose of the antibiotic should be given before the culture is taken. b. The culture should be taken before the initial dose of the antibiotic is given. c. The culture should be taken any time after the antibiotic therapy begins. d. The culture may be taken at any time before or during antibiotic therapy.

ANS: B - To obtain the most accurate culture, the specimen should be obtained before antibiotic therapy begins.

With continuous use of antibiotics, antibiotic resistance result because: a. bacteria are producing fewer mutations. b. the immune system has enhanced ability to fight infection. c. mutant bacteria are surviving antibiotic use. d. fewer new antibiotics have been produced.

ANS: C - Bacteria mutate if they are in contact with antibiotics for extended periods.

The client has been ordered treatment with Amoxil. The client reports to the nurse that she has developed symptoms of vaginitis. The highest priority action on the part of the nurse is to recognize this as: a. an expected side effect of the medication. b. a life-threatening reaction to the drug. c. evidence of development of a superinfection. d. evidence of an anaphylactic reaction.

ANS: C - Development of vaginitis can be evidence of development of a superinfection.

A client at an outpatient clinic is ordered to receive ampicillin (Omnipen) for an infection. Which nursing intervention related to penicillins would the nurse question? a. Verify that the client is not allergic to penicillin. b. Obtain culture before administering the first dose of medication. c. Instruct client to discontinue penicillin when temperature is normal. d. Encourage the client to increase fluid intake.

ANS: C - The entire course of the medication should be taken to ensure eradication of the infection and decreased resistance, even if the clients temperature has normalized.

A client has been receiving a cephalosporin for 20 days to treat a severe bacterial infection. The client complains of mouth pain, and the nurse assesses white patches in the clients mouth. What is the highest priority action on the part of the nurse? a. Provide mouth care with glycerin swabs. b. Encourage the client to drink more fluids. c. Notify the physician and describe symptoms. d. Administer analgesia for the mouth pain.

ANS: C - These symptoms may indicate a superinfection and should be reported to the physician.

The client has been ordered to be treated with amoxicillin. The highest priority instruction that the nurse should give the client related to diet while on the medication is to avoid: a. green leafy vegetables. b. beef and other red meat. c. coffee, tea, and colas. d. acidic fruits and juices.

ANS: D - Acidic fruits and juices should be avoided while the client is being treated with amoxicillin.

A client has relayed instructions from a physician regarding an allergy to a type of antibiotic therapy. The nurse would question which instruction? a. Wear a Medic Alert bracelet that indicates the allergy. b. Avoid all penicillin-type drugs. c. Inform all healthcare providers of the allergy. d. Restrict fluids when taking the antibiotic.

ANS: D - Fluids should be encouraged with antibiotic therapy, so such an order would need to be questioned.

A clients medication warrants peak and trough levels to be drawn. The nurse is aware that if the peak level of the drug is too high, what could occur? a. Mild side effects b. Inadequate drug action c. Slow onset of drug action d. Drug toxicity

ANS: D - High peak levels may indicate that the medication is above the toxic level.

The client has been ordered treatment with Wycillin. The nurse notes that the solution is milky in color. What is the highest priority action on the part of the nurse? a. Call the pharmacist and report the milky color. b. Add normal saline to dilute the medication. c. Call the physician and report the milky appearance. d. Administer the medication as ordered by the physician.

ANS: D - Wycillin has a milky appearance; this appearance should not concern the nurse.