Pharmacology Chapter 15, 16, 18

A client prescribed allopurinol denies any current symptoms of gout. What response should the nurse provide when the client asks why the medication has been prescribed? "Allopurinol is used to prevent or treat hyperuricemia, which commonly occurs with gout." "Allopurinol is not a first-line drug but can be used to cure gout." "Allopurinol promotes formation of uric acid. It is used in combination with another drug to prevent reoccurrences of the symptoms of gout." "Allopurinol is used to cure hyperuricemia, which commonly occurs with gout."

"Allopurinol is used to prevent or treat hyperuricemia, which commonly occurs with gout." Explanation: Allopurinol is used to prevent or treat (but not cure) hyperuricemia, which occurs with gout and with antineoplastic drug therapy. Allopurinol prevents formation of uric acid. The drug promotes resorption of urate deposits and prevents their further development. Allopurinol is among the first-line drugs used in the treatment of gout but does not cure the condition.

The parent of an 8-year-old asks the nurse why it seems amoxicillin is so often prescribed when the child needs an antibiotic. What is the nurse's best response? "Amoxicillin is effective and has a less offensive taste than many antibiotics." "Amoxicillin is an inexpensive antibiotic, so clients are more likely to follow through with treatment." "Amoxicillin has the benefit of once-daily dosing, which is easier for both parents and children." "Amoxicillin is better absorbed than many other antibiotics and it's highly effective."

"Amoxicillin is better absorbed than many other antibiotics and it's highly effective." Explanation: Most penicillins are rapidly absorbed from the GI tract, reaching peak levels in 1 hour. Although amoxicillin is less expensive, that fact has far less impact on choosing the proper antibiotic than the effectiveness of the drug. Most oral antibiotics for children are available in pleasant tasting syrups so taste would not be a factor. Amoxicillin must be given q8h.

Which instruction would be most important to include when teaching parents about over-the-counter (OTC) anti-inflammatory agents? "Be sure to read the label for the ingredients and dosage." "Aspirin is best for treating your child's flulike symptoms." "Refrain from using acetaminophen for the child's symptoms." "Make sure to give the drug on an empty stomach or before meals."

"Be sure to read the label for the ingredients and dosage." Explanation: Care must be taken to make sure that the child receives the correct dose of any anti-inflammatory agent. This can be a problem because many of these drugs are available in OTC pain, cold, flu, and combination products. Parents need to be taught to read the label to find out the ingredients and the dosage they are giving the child. Aspirin for flulike symptoms in children is to be avoided due to the increased risk for Reye's syndrome. Children are more susceptible to the GI and central nervous system effects of these drugs, so the drugs should be given with food or meals. Acetaminophen is the most used anti-inflammatory drug for children. However, parents need to be cautioned to avoid overdosage, which can lead to severe hepatotoxicity.

The nurse has provided client teaching for a client who will be discharged to home on an anti-infective. What statement made by the client indicates the nurse needs to provide additional teaching concerning the use of anti-infectives?

"I will stop taking the antibiotic once my symptoms have resolved." Explanation: Compliance with anti-infective therapy is a concern. Patients tend to stop taking the drugs when they begin to "feel better." A nurse should instruct the client to take the entire course of prescribed drug to ensure a sufficient period to rid the body of pathogens and to help prevent the development of resistance. Antibiotics are not prescribed for viral infections. It is important that cultures be performed before antibiotics are prescribed to determine what organism is causing the infection so that the correct drug is prescribed. Diarrhea is the most common adverse effect from anti-infectives.

The client states that he knows many people who take acetaminophen, and asks the nurse what it is used for. What is the best response by the nurse? "It is used to treat chronic pain." "It is an anti-inflammatory medication." "It is used to treat severe arthritis." "It is an aspirin substitute for pain and fever."

"It is an aspirin substitute for pain and fever." Explanation: Acetaminophen is used to treat mild to moderate pain, and fever. It has no anti-inflammatory effect and will not address pain related to severe arthritis.

A sputum sample of a postsurgical client with coarse crackles audible in the lungs has been sent for culture and sensitivity testing. What response should the nurse provide when the client asks why the sample needed to be analyzed?

"It will identify what drug will best kill this microorganism." Explanation: Once a specific microorganism is identified by laboratory culture, it is important to determine susceptibility, which is the vulnerability of the bacteria to the effects of an antibiotic. None of the other options are associated with identifying the most effective antibiotic therapy.

A client has been diagnosed with a sinus infection, and the client has been given a prescription for amoxicillin. What teaching point should the nurse make for the client? "This might cause crystals in your urine, so drink plenty of fluids." "Make sure you tell your prescriber if you're feeling particularly tired." "Take your medication every 8 hours, as it's been prescribed." "Avoid taking the medication right before bed so it doesn't cause frequent trips to the bathroom."

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

A nurse is caring for a client who is hospitalized for pneumonia. The nurse reviews the electronic health record and evaluates that the microbiology data does not support the use of the broad spectrum antibiotic. Which statement is the nurse's best response to the provider about the results? "I think you need to review the microbiology report for the client." "I have reviewed the client's record and the client does not want the antibiotic." "The microbiology data is identifying another antibiotic appropriate for the client." "The charge nurse prefers that you call her about the antibiotic coverage for the client."

"The microbiology data is identifying another antibiotic appropriate for the client." Explanation: Laboratory tests used to definitively identify causative organisms and to determine susceptibility to antibiotics usually require 48 to 72 hours, so the prescriber usually initiates treatment with an antimicrobial drug that is likely to be effective. The nurse should communicate with the prescriber about the change so that a correction can be made as soon as possible. Telling the prescriber to review the microbiology report is incorrect. The basis of prescribing the antibiotic should be on the identifying bacteria's culture and sensitivity. Referring the prescriber to the charge nurse is inappropriate as it is the nurse's responsibility to discuss with the prescriber the client's care.

After teaching a local community group about the use of OTC anti-inflammatory agents, the nurse determines that the group needs additional teaching when they state: "We can easily overdose on them if we don't follow the directions." "The drugs might interact with other drugs and cause problems." "Other signs and symptoms of an illness might not appear with these drugs." "These drugs are relatively safe since they don't have adverse effects."

"These drugs are relatively safe since they don't have adverse effects." Explanation: All anti-inflammatory drugs available OTC have adverse effects that can be dangerous if toxic levels of the drug circulate in the body. Since these drugs are available OTC, there is a potential for abuse and overdosing. In addition, these drugs block the signs and symptoms of a present illness. OTC agents, if combined with other drugs, can induce toxicity.

A client is alarmed to be prescribed celecoxib (Celebrex), stating, "I heard on TV that Celebrex causes heart attacks." How should the nurse best respond? "A final decision from the FDA on whether Celebrex is safe will be released in 2018." "This drug hasn't been definitively proven to be unsafe, so it's still available." "That was a scare that was entirely created by the media." "As long as you take your heart medications, you'll be fine."

"This drug hasn't been definitively proven to be unsafe, so it's still available." Explanation: Celecoxib remains on the market despite a 2 to 3 times increase in CV events because further research called into question these findings and the drug continues to be monitored. There is no promise of a decision in 2018. The media played a role in the public response, but did not wholly create the controversy.

The nurse admits a client with septicemia (infection in the bloodstream). The client denies any allergies, and the doctor has ordered cefuroxime based on blood culture and sensitivity testing. The client states, "I'd prefer vancomycin because I've been reading about drug-resistant bacteria and I don't want to take any chances." What is the nurse's best response? "There are some resistant infections that require vancomycin so you are right to prefer a stronger antibiotic." "I appreciate your concern but you can certainly rest assured that the health care provider ordered the right medication for your needs." "You can't believe anything you read on the internet because most of it is just someone's opinion and not fact." "Vancomycin is a powerful drug with many adverse effects and it is generally reserved for when no other drug will work."

"Vancomycin is a powerful drug with many adverse effects and it is generally reserved for when no other drug will work." Explanation: The client is right in saying that vancomycin is effective against drug-resistant bacteria but needs help to understand that he or she does not have a resistant infection as indicated by the culture and sensitivity and that use of such a powerful drug when it is not needed increases risk of developing a vancomycin-resistant infection. It is never right to tell a client "not to worry" because they have every right to participate in his or her own care and should not be patronized. Although some information on the internet may not be accurate, it would be incorrect to say it is all just someone's opinion and not fact, especially given that the client's information is accurate.

The nurse collects the past medical history of a client new to the clinic. The client reports an allergy to penicillin. What questions about the allergy should the nurse ask the client? Select all that apply. "Do others in your family have similar allergies?" "Had the medication ever been prescribed before the time when the reaction occurred?" "Were you offered alternative medications?" "What signs and symptoms were displayed with the reaction?" "How many doses were administered before the reaction occurred?"

"What signs and symptoms were displayed with the reaction?" "How many doses were administered before the reaction occurred?" "Had the medication ever been prescribed before the time when the reaction occurred?"

Aspirin increases the risk of bleeding and should generally be avoided for how many weeks before and after surgery? 1 to 2 weeks 2 to 3 weeks 6 to 8 weeks 3 to 4 weeks

1 to 2 weeks Explanation: Aspirin should generally be avoided for 1 to 2 weeks before and after surgery, because it increases the risk of bleeding. Most other NSAIDs should be discontinued approximately 3 days before surgery; nabumetone and piroxicam have long half-lives and must be discontinued approximately 1 week before surgery. NSAIDs, administered intraoperatively, have been shown to reduce postoperative pain and use of opioids after abdominal surgery.

A client has been started on Augmentin 250 mg P.O. every 12 hr. It is supplied in 500-mg tablets. How much will the nurse give at each dose? 1 tablet 1/2 tablet 3/4 tablet 2 tablets

1/2 tablet Explanation: The drug comes in 500-mg tablets and the order is for half that dose, so the nurse will give a 1/2 tablet.

The client has pain and the health care provider has ordered meloxicam 15 mg daily. It is supplied in 7.5-mg tablets. The nurse will administer how much per dose?

2 Explanation: 15 mg/7.5 mg = 2

Penicillins may trigger an anaphylactic reaction in some clients. Within what period following injection of a penicillin is anaphylaxis most likely to occur? 15 minutes 10 minutes 45 minutes 30 minutes

30 minutes Explanation: Anaphylaxis induced by injectable penicillins typically occurs within 30 minutes of administration.

A client is ordered to receive vancomycin IV. When administering the drug, the nurse would infuse the drug over which time frame? 30 minutes 60 minutes 15 minutes 45 minutes

60 minutes Explanation: Each IV dose of vancomycin is infused over 60 minutes. Too rapid an infusion may result in a sudden and profound fall in blood pressure and shock.

A health care provider prescribes a client 3.375 g piperacillin sodium and tazobactam (Zosyn) every six hours. After reconstitution, the concentration of the drug is 2.25 g/50 mL. Which quantity of the reconstituted solution should the nurse administer to the client? 65 mL 60 mL 75 mL 70 mL

75 mL Explanation: After reconstitution, the concentration of the drug is 2.25 g/50 mL. Concentration of drug per mL is 0.045 g (2.25/50). Therefore, to administer 3.375 mg piperacillin, 75 (3.375/0.045) mL of the reconstituted solution is required.

A client has been prescribed 200 mg of cefpodoxime every 12 hours. On hand are 25-milligram tablets. To meet the prescribed dose, the nurse administers ___________ tablets at each dosage. 4 8 6 10

8 Explanation: The required dosage is 200 mg, while the available tablet contains 25 mg of the drug. Therefore, 8 tablets (200 mg/25 mg) need to be administered at each dosage.

A client has been prescribed 200 mg of cefpodoxime every 12 hours. On hand are 25-milligram tablets. To meet the prescribed dose, the nurse administers ___________ tablets at each dosage. 6 4 8 10

8 Explanation: The required dosage is 200 mg, while the available tablet contains 25 mg of the drug. Therefore, 8 tablets (200 mg/25 mg) need to be administered at each dosage.

Patients are often given a daily dose of aspirin for prophylaxis of myocardial infarction (MI), transient ischemic attacks (TIA), and cerebrovascular accident (CVA). What is the recommended daily dose for this purpose?

81-325 mg Explanation: The recommended daily dose for prophylaxis of MI, TIA, and CVA is 81-325 mg. The indication stems from aspirin's ability to decrease formation of blood clots.

The nurse is monitoring several clients for the development of an opportunistic infection. The nurse understands that which client is at greatest risk? A client who received electrical burns to the lower body A client being treated for ischemic heart disease A client being treated for the exacerbation of rheumatoid arthritis A client who has just given birth vaginally to a premature infant

A client who received electrical burns to the lower body Explanation: Opportunistic infections are likely to occur in people with severe burns, cancer, human immunodeficiency virus (HIV) infection, indwelling intravenous or urinary catheters, and antibiotic or corticosteroid drug therapy. Autoimmune diseases, heart disease, and recent vaginal birth are not major risk factors for opportunistic infections.

The nurse is monitoring several clients for the development of an opportunistic infection. The nurse understands that which client is at greatest risk? A client who received electrical burns to the lower body A client being treated for the exacerbation of rheumatoid arthritis A client being treated for ischemic heart disease A client who has just given birth vaginally to a premature infant

A client who received electrical burns to the lower body Explanation: Opportunistic infections are likely to occur in people with severe burns, cancer, human immunodeficiency virus (HIV) infection, indwelling intravenous or urinary catheters, and antibiotic or corticosteroid drug therapy. Autoimmune diseases, heart disease, and recent vaginal birth are not major risk factors for opportunistic infections.

Penicillin would NOT be indicated for which of the following clients?

A client with gram-negative bacteria allergic to penicillin Explanation: Contraindications include hypersensitivity or allergic reactions to any penicillin preparation. An allergic reaction to one penicillin means the client is allergic to all members of the penicillin class. The potential for cross-allergenicity with cephalosporins exists, although recent data suggest that the incidence is less than 1%, lower than previously thought. Administration of cephalosporins should be avoided in individuals with life-threatening allergic reactions to penicillin (anaphylaxis, laryngeal swelling angiedema, or hives).

The nurse is caring for several medical clients who have infections. For which client would the administration of a broad spectrum antibiotic be most appropriate? A client with signs of infection who is awaiting the results of laboratory testing A client with pneumonia who has a confirmed allergy to penicillins A client with an infected surgical wound A client who is being treated for a urinary tract infection for the third time this year

A client with signs of infection who is awaiting the results of laboratory testing Explanation: Broad spectrum antibiotics are effective against a wide variety of microorganisms. None of the other listed clients have obvious indications for using a broad spectrum antibiotic.

When learning about the different classes of cephalosporins, the nurse correctly identifies which of the following statements? Cephalosporins are divided into three different groups. Cephalosporins are limited in treating many types of bacteria. A first-generation cephalosporin is more useful than a third-generation cephalosporin against gram-positive microorganisms. Cephalosporins are completely different chemically from penicillin.

A first-generation cephalosporin is more useful than a third-generation cephalosporin against gram-positive microorganisms. Explanation: Cephalosporins are valuable and effective in treating infections with almost all strains of bacteria also affected by penicillins, as well as some strains that have become resistant to penicillin. Cephalosporins are structurally and chemically related to penicillin. They are divided into four groups: first, second-, third-, and fourth-generation drugs. It is true that progression from first to fourth generation shows an increase in the sensitivity of gram-negative microorganisms and a decrease in the sensitivity of gram-positive microorganisms. For instance, a first-generation cephalosporin would be more useful against gram-positive microorganisms than would a third-generation cephalosporin.

Which of the following patients would the nurse determine has the highest risk of cumulative toxicity if prescribed colchicine?

A patient with hepatic disease Explanation: Colchicine is eliminated primarily through the biliary tract. Therefore, patients with hepatic disease face the highest risk for cumulative toxicity, if they were to be administered colchicine. Patients with myelosuppression are at risk for infections or bleeding. Patients undergoing radiation therapy do not face the risk of drug toxicity. Pregnant women do not face an increased risk of cumulative toxicity; however, colchicine is in pregnancy category D and should never be given in pregnancy.

For what client would the use of prophylactic anti-infective be most appropriate?

A pre-surgical client who has an artificial heart valve Explanation: A client with valve replacement is especially prone to the development of subacute bacterial endocarditis because of the vulnerability of their heart valves; prophylactic antibiotic therapy as a precaution. None of the other listed clients has particular indications for the use of prophylactic anti-infectives.

Which agent would be least appropriate to administer to a client with joint inflammation and pain? Diclofenac Ibuprofen Naproxen Acetaminophen

Acetaminophen Explanation: Acetaminophen has analgesic and antipyretic properties but does not exert an anti-inflammatory effect. Therefore, it would not be indicated for joint inflammation. Ibuprofen, naproxen, and diclofenac have anti-inflammatory properties and would be appropriate for use.

Mr. Conn, age 65, is taking probenecid for treatment of chronic gouty arthritis. When providing patient and family education, what should a nurse advise the patient to do if he misses a dose and it is almost time for the next dose? Advise the patient to undergo blood and urine tests before the next dose is taken. Advise the patient to take both the doses together or adjust the missed dose between the next two. Advise the patient to take only the second dose and ignore the missed dose. Advise the patient to stop medication and contact the health care provider immediately.

Advise the patient to take only the second dose and ignore the missed dose. Explanation: If a patient misses a dose, it should be taken as soon as possible. If it is almost time for the next dose, however, only that dose should be taken; the patient should never take double or extra doses. It is not essential to undergo blood or urine tests or stop the medication unless symptoms of any adverse effects occur.

A nurse is assessing the medical record of a client with arthritis who is to receive Celecoxib. The nurse would question this order based on which finding in the client's history? Allergy to sulfonamides Diabetic retinopathy Acute gout Cataract

Allergy to sulfonamides Explanation: Celecoxib is contraindicated among clients with allergy to sulfonamides. Ethambutol is contraindicated in clients with diabetic retinopathy and clients with cataracts. Pyrazinamide is contraindicated among clients with acute gout.

A client receiving penicillin therapy reports mouth irritation and a sore throat to the nurse. Inspection reveals a red, swollen tongue with ulcerations. The nurse suspects a fungal superinfection and prioritizes which nursing diagnosis as most appropriate for this client? Deficient Knowledge Altered Oral Mucous Membranes Altered Comfort Inadequate Nutrition: Less Than Body Requirements

Altered Oral Mucous Membranes Explanation: The assessment suggests a fungal superinfection, which would lead to the nursing diagnosis of Altered Oral Mucous Membranes. Although Altered Comfort may be appropriate, Altered Oral Mucous Membranes is more specific. There is no evidence of lack of knowledge or problems with nutrition. However, if the superinfection is not addressed, the client may experience difficulty eating due to the irritation and discomfort.

A 26-year-old female client with a skin infection has been prescribed 400 mg ampicillin to be taken orally. Which instruction should the nurse include in the client teaching plan? Take drug on an empty stomach, an hour before or 2 hours after meals. Ampicillin will reduce the effectiveness of birth control pills. If a dosage is missed, increase the next dosage to meet the daily quota. Avoid use of skin care products, like moisturizers, when on penicillin therapy.

Ampicillin will reduce the effectiveness of birth control pills. Explanation: Ampicillin (also penicillin V) reduces the effectiveness of birth control pills. Increasing a dosage to compensate for a missed dosage should not be done. The client should adhere to the prescribed regimen as strictly as possible. Ampicillin and penicillin V may be taken without regard to meals. The client need not avoid use of skin care products when on penicillin therapy.

You are working as a nurse educator in the hospital setting. Part of your responsibility includes developing a plan to prevent antibiotic resistance. What is the most important part of your plan?

An education campaign that focuses on handwashing between patients Explanation: Handwashing is one of the most effective ways to prevent antibiotic resistance, by preventing diseases from being spread from one person to an

A nurse is preparing to teach a client about aspirin. Which actions will the nurse explain to the client? Select all that apply. Analgesic Antipyretic Anti-inflammatory Anti-infective Antiviral

Analgesic Antipyretic Anti-inflammatory Aspirin is a salicylate. Salicylates are useful in pain management because of their analgesic, antipyretic, and anti-inflammatory effects. Aspirin does not have anti-infective or antiviral effects.

A nurse is examining the laboratory test results of a client receiving penicillin therapy. Which results would the nurse predict as indicating an adverse hematologic reaction? Select all that apply. Anemia Thrombocytopenia Pancytopenia Hemoglobulinemia Leukopenia

Anemia Thrombocytopenia Leukopenia Explanation: Nurses should monitor blood counts of clients taking penicillins for the following hematopoietic changes: anemia, thrombocytopenia, leukopenia, and bone marrow suppression. The client may not have all counts low which would indicate the pancytopenia. Hemoglobulinemia is an indication of low hemoglobin but not necessarily low red blood cell count.

A nurse is preparing to present information about ibuprofen at a community health promotion conference. Which actions will the nurse illustrate during the presentation? Select all that apply. Anti-inflammatory Analgesic Antipruritic Antipyretic Antibacterial

Anti-inflammatory Analgesic Antipyretic

A nurse is preparing to present information about ibuprofen at a community health promotion conference. Which actions will the nurse illustrate during the presentation? Select all that apply. Antipruritic Antibacterial Anti-inflammatory Analgesic Antipyretic

Anti-inflammatory Analgesic Antipyretic Explanation: Like the salicylates, the NSAIDS have anti-inflammatory, antipyretic, and analgesic effects. They do not exert antipruritic or antibacterial properties.

What should a nurse recognize as a property of ibuprofen/Motrin? (Select all that apply.) Anti-inflammatory Antipyretic Analgesic Antipruritic Antibacterial

Anti-inflammatory Antipyretic Analgesic

Acetaminophen is frequently used as a substitute for aspirin. What effects of aspirin are absent in acetaminophen? Antiplatelet and antipyretic effects Anti-inflammatory and antiplatelet effects Analgesic and antipyretic effects Anti-inflammatory and analgesic effects

Anti-inflammatory and antiplatelet effects Explanation: Acetaminophen is commonly used as an aspirin substitute, because it lacks aspirin's antiplatelet effects. It also lacks aspirin's anti-inflammatory effect. Acetaminophen has antipyretic and analgesic effects equal to those of aspirin.

A group of students is reviewing information about cyclooxygenase receptors. The students demonstrate understanding of the information when they identify what as an effect of COX-2 receptors? Maintenance of renal function Promotion of vascular hemostasis Provision of gastric mucosal integrity Blockage of platelet clumping

Blockage of platelet clumping Explanation: COX-2 receptors block platelet clumping. COX-1 receptors maintain renal function, provide for gastric mucosal integrity, and promote vascular hemostasis.

A client is diagnosed with bacterial pneumonia. Pending culture results, what would the nurse expect the health care provider to order? Broad-spectrum antibiotics Short-term IV antibiotic therapy Short-term oral antibiotic therapy Long-term oral antibiotic therapy

Broad-spectrum antibiotics Explanation: Bacterial pneumonia is usually treated with a broad-spectrum antibiotic until culture and susceptibility reports become available.

The pathophysiology class is learning how microorganisms develop resistance to anti-infective drugs. What is one way the students would learn that microorganisms develop resistance to anti-infective drugs? By rearranging their DNA to produce membranes that are permeable to the drug By changing the cellular membrane to allow the drug entry into the cell By producing an enzyme that stimulates the drug By altering binding sites on the membrane or ribosomes so that the drug cannot enter the cell SUBMIT ANSWER Exit quiz

By altering binding sites on the membrane or ribosomes so that the drug cannot enter the cell Explanation: Microorganisms have developed resistance by changing cellular permeability to prevent the drug from entering the cell by altering binding sites on the membranes or on ribosomes so the drug can no longer be accepted and by producing enzymes that deactivate the drug. Microorganisms have not been found to be able to rearrange their DNA to change their membrane structure

A client with controlled hypertension asks about using an over-the-counter NSAID for muscle aches. What is the best response from the nurse when describing the possible effect of mixing the two drugs? Can increase the metabolism of the antihypertensive drug Can decrease the metabolism of NSAIDs Can increase absorption of the antihypertensive drug Can decrease the effectiveness of the antihypertensive drug

Can decrease the effectiveness of the antihypertensive drug Explanation: The nurse should inform the client that taking an NSAID while on antihypertensive drug therapy decreases the effectiveness of antihypertensive drugs. Interactions of NSAIDs and antihypertensive drugs do not include increased metabolism of antihypertensive drugs, increased absorption of antihypertensive drugs, or decreased metabolism of NSAIDs

The nurse is caring for a client who is immunocompromised following a kidney transplant and who has developed an infection. When planning this client's care, the nurse should prioritize what action?

Carefully maintaining the client's isolation precautions Explanation: Even though assessment is an important aspect of nursing care, maintenance of infection control measures is a priority due to the safety risk to the client. The client should be taught about hand hygiene, but it is even more important for nurses and family members to maintain hand hygiene.

The 56-year-old client is diagnosed with osteoarthritis and reports joint pain and stiffness. Which medication would be identified as appropriate for the client to take?

Celecoxib Explanation: Celecoxib is a COX-2 inhibitor used to treat pain related to osteoarthritis. Eletriptan, sumatriptan, and ergotamine are medications used to treat migraines.

Beta-lactam antibiotics, such as penicillins and cephalosporins, fight infection by inhibiting development of the causative bacteria. What specific component development do these drugs affect? Protein synthesis DNA replication Cell division Cell wall synthesis

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

A nurse is asked to explain the difference between community-acquired infections and hospital-acquired infections. What response best describes the difference? Hospital-acquired infections are typically less severe and easier to treat because they occur in the presence of trained medical staff. Community-acquired infections are usually less severe and easier to treat since hospital-acquired infections often involve drug-resistant microorganisms. There is no epidemiological difference between the infection types; they are simply categorized as community-acquired or hospital-acquired. Only drug-resistant strains of staphylococci, Pseudomonas, and Proteus are categorized as hospital-acquired infections.

Community-acquired infections are usually less severe and easier to treat since hospital-acquired infections often involve drug-resistant microorganisms. Explanation: Infections are often categorized as community-acquired or hospital-acquired. Because the microbial environments differ, the two types of infections often have different causes and require different antimicrobial treatment. Generally, hospital-acquired infections are more severe and difficult to manage because they often result from drug-resistant microorganisms and occur in people whose immunity is impaired. A wide variety of organisms can lead to hospital-acquired infections.

The nursing instructor is discussing the signs and symptoms of infection. Which of the following is a local sign of infection? Leukocytosis. Edema Fatigue Fever

Edema Explanation: Local signs of infection include redness, heat, edema, and pain; systemic signs include fever and leukocytosis. Specific manifestations depend on the site of infection.

The nurse administers cefuroxime to a client at least 1 hour before meals, as prescribed; however, the client experiences GI upset. Which action would be most appropriate for the nurse to do? Discontinue the drug. Lower the dosage. Administer an antacid. Administer the drug with food.

Explanation: If the client experiences GI upset, the nurse can administer cefuroxime with food. A decrease in the dosage is suggested in a client with renal impairment. A change in dosage, discontinuation of the drug, or use of an antacid is recommended only if prescribed by the physician.

A 40-year-old is being treated for an ear infection with a cephalosporin. Which adverse reactions should the nurse monitor for in the client? Excessive tearing Chest pain Nausea Hypotension

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

A nurse is assessing pain in a 3-year-old child. Which of the following would be most appropriate for the nurse to use? Select all that apply. Facial expression scale Color scale Shape scale Letter scale Number scale

Facial expression scale Color scale Explanation: Color and facial expression scales are especially helpful with children who have trouble understanding or cannot tell the nurse about their pain using numbers.

A nurse is preparing to teach a client about the adverse effects of the prescribed NSAID therapy. Which system would the nurse include as being involved?

Gastrointestinal Explanation: The most common adverse reactions caused by the NSAIDs involve the GI tract, including the stomach, leading to GI bleed and/or possible ulceration. The lungs are not specifically affected by NSAIDs; however, pain associated with respiratory insults such as pneumonia can be relieved. Peripheral nerve pain can also be treated with NSAIDs. There is no injury noted to the liver or hepatobiliary system while taking NSAIDs.

Which of the following is the most important nursing action to help prevent antimicrobial resistance in health care settings? Using aseptic technique for all nursing procedures Documenting improvement or worsening of symptoms of infection Good hand-washing between each patient contact Reporting culture and sensitivity results in a timely manner

Good hand-washing between each patient contact Explanation: Antimicrobial resistance is a major concern worldwide because hospitals are most likely to harbor resistant bacteria, it is important that nurses use aseptic technique for all procedures; obtain culture specimens appropriately; communicate culture and sensitivity results in a timely manner; adhere to isolation procedures; document improvement or worsening of symptoms of infection; and most importantly, practice good hand-washing between each patient contact. Washing hands between patients will help prevent the spread of resistant bacteria.

As a class, penicillins usually are more effective in infections caused by which type of bacteria? Aerobic Anaerobic Gram-positive Gram-negative

Gram-positive Explanation: As a class, penicillins usually are more effective in infections caused by gram-positive bacteria than those caused by gram-negative bacteria.

An older adult male patient has begun treatment for gout after an extensive diagnostic workup. The nurse who is contributing to the patient's care should understand that gout is a result of what pathophysiological process? Lack of joint mobility causes impaired uric acid metabolism. Hyperuricemia causes crystals to precipitate in the synovial fluid. Excess purine intake initiates an autoimmune process that impairs joint function. Mechanical damage to the joints results in increased release of uric acid.

Hyperuricemia causes crystals to precipitate in the synovial fluid. Explanation: Gout occurs when hyperuricemia forms monosodium urate crystals. These precipitate into the synovial fluid and cause an inflammatory response. Gout does not primarily result from mechanical damage, lack of mobility, or autoimmune processes.

Penicillins and cephalosporins are used cautiously in neonates due to what factor? Immature kidney function Immature liver function Immature pancreatic function Immature immune function

Immature kidney function Explanation: Penicillins and cephalosporins are widely used to treat infections in children and are generally safe. They should be used cautiously in neonates, because immature kidney function slows their elimination. Dosages should be based on age, weight, severity of the infection being treated, and renal function.

A salicylate is contraindicated in clients who have had surgery within the past week for which reason? Increased risk for bleeding Increased risk for fluid imbalance Increased risk for allergic reaction Increased risk for toxicity

Increased risk for bleeding Explanation: Salicylates are contraindicated for clients who have had surgery within the past week because of the increased risk for bleeding. Their use in clients with an allergy to salicylates or tartrazine would increase the risk for an allergic reaction. Their use in clients with impaired renal function may increase the risk for toxicity because the drug is excreted in the urine. There is no associated risk for fluid imbalance and salicylate therapy.

A nurse is caring for a client who is receiving penicillin. The nurse would assess for what common adverse reaction? Severe hypotension Altered oral mucous membranes Sudden loss of consciousness Inflammation of the tongue and mouth

Inflammation of the tongue and mouth Explanation: Some of the common adverse effects of penicillin are glossitis (inflammation of the tongue), stomatitis (inflammation of the mouth), and gastritis (inflammation of the stomach). Unless the adverse effects are severe, the drug may be continued as prescribed and the nurse would intervene to help the client manage the common adverse reactions. Altered oral mucous membranes would suggest a possible fungal superinfection in the oral cavity, whereas severe hypotension and sudden loss of consciousness are signs of anaphylactic shock; these are not common adverse effects of penicillin and require immediate medical attention

A male client who has undergone surgery of the urinary tract is administered cephalosporins to prevent infections. When assessing the client on the day after the surgery, the nurse notices that he has an elevated temperature. Which nursing intervention would be most appropriate in this case? Administer a higher dosage of the drug. Inform the primary health care provider. Record the client's fluid intake. Discontinue use of the drug.

Inform the primary health care provider. Explanation: The nurse should immediately report an increase in the client's body temperature to the primary health care provider. The nurse should consult the provider before increasing, decreasing, or discontinuing the dosage. The nurse should measure and record the fluid intake if there is a decrease in the urine output.

The client is taking NSAIDs for pain. The nurse explains to the client that NSAIDs act by which actions? Inhibiting impulses to the brain Blocking the neuronal terminal Decreasing nerve stimulation Inhibiting the synthesis of prostaglandins

Inhibiting the synthesis of prostaglandins Explanation: NSAIDs inhibit prostaglandin synthesis by blocking the action of cyclooxygenase. This helps to block pain and inflammation.

A client is to receive penicillin. The nurse understands that this drug achieves its effect by which action? Not allowing the organism to use the substances it needs Disrupting the steps of protein synthesis Interfering with DNA synthesis Interfering with the pathogen cell wall

Interfering with the pathogen cell wall Explanation: Penicillins interfere with the biosynthesis of the pathogen cell wall. Sulfonamides, antimycobacterial drugs, and trimethoprim-sulfamethoxazole prevent the cells of the invading organism from using substances essential to their growth and development, leading to cell death. Aminoglycosides and macrolides interfere with the steps involved in protein synthesis. Fluoroquinolones interfere with DNA synthesis in the cell.

The nurse is administering penicillin to a client who has strep throat. Which of the following statements accurately describe the action of penicillin? It has many side effects, especially in large doses It is not effective against gram-negative organisms It is effective against gram-positive organisms It is metabolized in the liver

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

Probenecid is sometimes given concurrently with penicillins. What effect does probenecid have when given with a penicillin? It breaks down the bacterial cell wall. It maintains high serum levels of penicillin. It increases the excretion of penicillin. It prevents anaphylactic reaction.

It maintains high serum levels of penicillin. Explanation: Probenecid can be given concurrently with penicillins to slow the excretion of those drugs, which helps maintain high serum drug levels for longer durations.

What information about antibiotic therapy should the nurse include in a client's medication education? An aseptic internal environment only exists in young adults. Maintenance of normal bacterial flora is essential to health during the therapy. Bacteria can remain in the body for 48 to 72 hours after the completion of antibiotic therapy. The healthy human body hosts dozens of minor infections at any given time.

Maintenance of normal bacterial flora is essential to health during the therapy. Explanation: Normal flora protects the human host in a variety of ways. For example, normal bowel flora synthesizes vitamin K and vitamin B complex. The intestinal flora also plays a role in digestion. Furthermore, by competing with potential pathogens for nutrients and by preventing adhesion and growth of pathogens, beneficial microorganisms interfere with the ability of potential pathogens to cause infections. None of the other options are accurate statements regarding antibiotic therapy.

A 75-year-old patient with a history of renal impairment is admitted to the primary health care center with a UTI and has been prescribed a cephalosporin. Which of the following interventions is most important for the nurse to perform when caring for this patient? Monitoring fluid intake. Monitoring blood creatinine levels. Testing for occult blood. Testing for increased glucose levels.

Monitoring blood creatinine levels. Explanation: An elderly patient is more susceptible to the nephrotoxic effects of the cephalosporins. Since renal impairment is present, it is important for the nurse to closely monitor the patient's blood creatinine levels. The nurse should conduct a test for occult blood if blood and mucus occur in the stool and monitor the fluid intake if there is a decrease in urine output. The nurse does not need to monitor for increased glucose levels unless the patient has a history of diabetes.

After teaching a group of nursing students about penicillins, the instructor determines that the teaching was successful when the students identify which as part of a group? Select all that apply. Natural penicillins Aminopenicillins Synthetic penicillins Extended-spectrum penicillins Penicillinase-resistant penicillins

Natural penicillins Aminopenicillins Extended-spectrum penicillins Penicillinase-resistant penicillins Explanation: Penicillins are categorized into four groups including the natural penicillins, penicillinase-resistant penicillins, aminopenicillins, and extended-spectrum penicillins.

Which of the following should a nurse carefully monitor in a patient who has been administered cephalosporin as well as aminoglycosides for a wound infection? Nephrotoxicity Increased bleeding Nausea Respiratory difficulty

Nephrotoxicity Explanation: When cephalosporin is administered with aminoglycosides, it increases the risk for nephrotoxicity and should be closely monitored. Nausea is an adverse reaction of cephalosporins in patients with gastrointestinal tract infection. The risk of bleeding increases when cephalosporin is administered with oral anticoagulants. Risk for respiratory difficulty increases if alcohol is consumed within 72 hours after certain cephalosporin administration.

What information should be provided to a client diagnosed with an acetylsalicylic acid allergy? Nonaspirin form of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided. Nonsteroidal anti-inflammatory drugs (NSAIDs) should be taken for only short periods of time. It is safe to use only buffered forms of acetylsalicylic acid. Nonsteroidal anti-inflammatory drugs (NSAIDs) should always be taken with food.

Nonaspirin form of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided. Explanation: In people who have demonstrated hypersensitivity to acetylsalicylic acid, all nonaspirin NSAIDs are also contraindicated because cross-hypersensitivity reactions may occur with any drugs that inhibit prostaglandin synthesis. This makes all the other options incorrect.

To ensure that the most appropriate drug is being used to treat a pathogen, which would need to be done first? Using combination therapy Checking client allergies Obtaining sensitivity testing Evaluating the bactericidal effects

Obtaining sensitivity testing Explanation: Performing sensitivity testing on cultured microbes is important to evaluate the bacteria and determine which drugs are capable of controlling the particular organism. Once the sensitivity testing is completed, then the decision for the drug can be made. Combination therapy is used when appropriate after culture and when sensitivity testing has been completed. Checking client allergies also would be done after sensitivity testing but before administering the drug. The bactericidal effects of a drug may or may not play a role in the selection of the drug.

What conditions are salicylates are effective in managing? (Select all that apply.) Pain Fever Inflammation GI upset Infection

Pain Fever Inflammation Salicylates are effective in the management of pain, fever, and for inflammation. They are contraindicated in gastrointestinal disorders and are not indicated for infection.

A nurse is preparing to teach a client about the penicillin which has just been prescribed. With which drugs will the nurse explain that penicillin can be taken without regard to meals? Select all that apply. Carbenicillin indanyl Penicillin V Amoxicillin/clavulanate Ampicillin Amoxicillin

Penicillin V Amoxicillin Explanation: Amoxicillin and penicillin V can be administered without regard to meals, unlike the rest of the penicillins, such as ampicillin, amoxicillin/clavulanate, or carbenicillin indanyl, which should be given on an empty stomach.

A nurse is instructing a colleague on how an antimicrobial produces a therapeutic effect. What should be included in the nurse's teaching?

Penicillin interferes with synthesis of the bacteria cell wall. Explanation: The action of antimicrobials is to interfere with the normal function of the invading organism to prevent it from reproducing and to cause cell death without affecting host cells. Penicillin interferes with biosynthesis of the bacterial cell wall. Because bacteria cells have a slightly different composition than human cells, the bacteria are destroyed without interfering with the host. The first drugs used to treat systemic infections were developed in the early 20th century. Fluoroquinolones act by interfering with DNA synthesis. Sulfonamides interfere with growth and development of bacterial cells. The term selective toxicity refers to the ability to affect certain proteins or enzyme systems that are used by infecting organisms but not by human cells.

A nurse is instructing a colleague on how an antimicrobial produces a therapeutic effect. What should be included in the nurse's teaching? Selective toxicity determines the appropriate drug dosage needed. Fluoroquinolones interfere with the growth and development of the bacteria cell wall. Penicillin interferes with synthesis of the bacteria cell wall. The first drugs used to treat infections date back to the 17th century.

Penicillin interferes with synthesis of the bacteria cell wall. Explanation: The action of antimicrobials is to interfere with the normal function of the invading organism to prevent it from reproducing and to cause cell death without affecting host cells. Penicillin interferes with biosynthesis of the bacterial cell wall. Because bacteria cells have a slightly different composition than human cells, the bacteria are destroyed without interfering with the host. The first drugs used to treat systemic infections were developed in the early 20th century. Fluoroquinolones act by interfering with DNA synthesis. Sulfonamides interfere with growth and development of bacterial cells. The term selective toxicity refers to the ability to affect certain proteins or enzyme systems that are used by infecting organisms but not by human cells.

A nurse caring for a patient administered an NSAID for fever reduction records a decrease in urinary output for the patient. Which of the following should the nurse consider as a probable reason for the patient's condition? Reduced intake of fibrous food Prolonged immobility Intake of food with antacids Prolonged temperature elevation

Prolonged temperature elevation Explanation: If temperature elevation is prolonged while on NSAID therapy, hot, dry, flushed skin and a decrease in urinary output may develop; consequently, dehydration can occur. Prolonged immobility, reduced intake of fibrous food, and intake of food with antacids do not cause a decrease in urinary output.

Aspirin is not recommended for use in children. This is due to its association with which condition? gastrointestinal blockage. Reye's syndrome. growth retardation. megaloblastic anemia.

Reye's syndrome. Explanation: Aspirin is not recommended for use in children due to its association with Reye's syndrome. Aspirin is not associated with megaloblastic anemia, gastrointestinal blockage, or growth

A nurse is caring for a patient who has a serious infection. The patient is being treated with combination therapy of a cefazolin and an aminoglycoside. The nurse will be sure to monitor which of the following? Aspartate aminotransferase levels Serum sodium and potassium levels Serum BUN and creatinine levels Prothrombin time (PT) and partial thromboplastin time (PTT)

Serum BUN and creatinine levels Explanation: Patients receiving combination therapy of a cefazolin and an aminoglycoside will need to be monitored for nephrotoxicity and therefore would need serum BUN and creatinine levels done. Serum sodium and potassium levels as well as aspartate aminotransferase should be monitored when receiving sodium penicillin G. PT and PTT should be monitored when a patient is receiving aztreonam, a monobactam antibiotic.

A client is prescribed frovatriptan. Which of the following would the nurse expect to include in the client's teaching plan? Select all that apply. Used to prevent migraines Should be administered at the earliest onset of migraine symptoms Decrease the number of migraine headaches experienced No more than two doses of the drug should be used in a 24-hour period Repeat the dose every hour until symptoms subside

Should be administered at the earliest onset of migraine symptoms No more than two doses of the drug should be used in a 24-hour period

The nurse is administering an anti-infective medication that is known to lack total selective toxicity. What consequence should the nurse anticipate? Bacterial DNA will mutate. All pathogens in the body will be destroyed. The microbe's enzyme production will be slowed. Some healthy cells will be damaged.

Some healthy cells will be damaged. Explanation: When a drug does not display selective toxicity, healthy cells are damaged because the drug does not specifically target only the pathogen. Anti-infectives work by a variety of different means so one drug is not likely to kill every type of pathogen in the body. Selective toxicity does not impact enzyme production or cause mutation.

The nurse is administering an anti-infective medication that is known to lack total selective toxicity. What consequence should the nurse anticipate? The microbe's enzyme production will be slowed. All pathogens in the body will be destroyed. Bacterial DNA will mutate. Some healthy cells will be damaged.

Some healthy cells will be damaged. Explanation: When a drug does not display selective toxicity, healthy cells are damaged because the drug does not specifically target only the pathogen. Anti-infectives work by a variety of different means so one drug is not likely to kill every type of pathogen in the body. Selective toxicity does not impact enzyme production or cause mutation.

A 64-year-old client has been prescribed ibuprofen for osteoarthritis. Which adverse reaction should the client report with the use of ibuprofen? Tarry stool Nausea Flatulence Headache

Tarry stool Explanation: Serious GI events are also listed as a Black Box warning. Gastropathies are commonly associated with ibuprofen. Nausea, vomiting, diarrhea, constipation, flatulence, and abdominal pain may be representative of minor adverse effects in some clients or serious GI toxicity in others. During long-term administration, the most serious effects are peptic ulcer disease or gastritis that leads to GI bleeding or even perforation. These events can occur at any time, with or without warning.

A 65-year-old man who just had a heart attack is placed on aspirin, 81 mg daily. The nurse is explaining the purpose of this medication to the client and his wife. What would be the nurses best explanation? The aspirin is being prescribed because it will protect your heart. The aspirin is being prescribed because it reduces your risk of a second heart attack. The aspirin is being prescribed because it reduces the prostaglandins in your body. The aspirin is being prescribed to relieve the pain from the heart attack.

The aspirin is being prescribed because it reduces your risk of a second heart attack. Explanation: Because of its antiplatelet and anti-inflammatory effects, low-dose aspirin (81 mg daily) is useful in preventing or reducing the risk of transient ischemic attacks (TIAs), MI, and ischemic cerebral vascular accident (stroke). It is also indicated for clients with a previous MI, chronic or unstable angina, and those undergoing angioplasty or other revascularization procedures.

The nurse would question the health care provider who prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) for which client? The postpartum woman who had a vaginal birth The client diagnosed with peptic ulcers The client diagnosed with diabetes The client diagnosed with psoriasis

The client diagnosed with peptic ulcers Explanation: The client diagnosed with peptic ulcer disease is at risk for further GI irritation and bleeding if given NSAIDs, so the nurse would question the health care provider who ordered this drug. Clients with diabetes and psoriasis may take NSAIDs safely and the nurse would not question the order. NSAIDs are often ordered for pain control for clients following vaginal birth and this order need not to be questioned.

A client has been receiving an antibiotic for the past 36 hours for treatment of a bacterial infection, and the infection has shown no signs of improving. What does the nurse suspect is the most likely reason for a lack of improvement? The client has a viral infection, not bacterial The client's infection is resistant to the medication The client isn't taking the medication The client is allergic to this medication

The client's infection is resistant to the medication Explanation: When a client hasn't responded to an antibiotic after 24 to 36 hours, it is a possible sign that the infectious agent is resistant to the antibiotic. Though it is possible the client isn't taking the medication, or that the client's infection is viral, not bacterial, they are not the most likely reason. Lack of improvement does not signify an allergic reaction.

What is a major factor that influences whether an individual will acquire an infection? implementation of continuous antimicrobial treatment of the infection the number of effective drugs available to an antibiotic-resistant infections The person's ability to defend against invading microorganisms the infection's tendency to recur and involve simple organisms

The person's ability to defend against invading microorganisms Explanation: The human body and the environment contain many microorganisms, most of which do not cause disease and live in a state of balance with the human host. When the balance is upset and infection occurs, characteristics of the infecting microorganism and the adequacy of host defense mechanisms are major factors in the severity of the infection and the person's ability to recover. Conditions that impair defense mechanisms increase the incidence and severity of infections and impede recovery. In addition, use of antimicrobial drugs may lead to serious infections caused by drug-resistant microorganisms.

A nurse has questioned why a client's health care provider has prescribed a narrow-spectrum antibiotic rather than a broad-spectrum drug in the treatment of an infection. Which facts provide the best rationale for the use of narrow-spectrum antibiotics whenever possible? Broad-spectrum antibiotics confound the results of subsequent culture and sensitivity testing. Narrow-spectrum antibiotics normally require a shorter duration of treatment. The use of broad-spectrum antibiotics can create a risk for a superinfection. The efficacy of most narrow-spectrum antibiotics has not been proven.

The use of broad-spectrum antibiotics can create a risk for a superinfection. Explanation: The benefit of a narrow-spectrum antimicrobial agent is that it limits the potential for adverse effects, such as superinfection. In a superinfection, an antibiotic suppresses all susceptible microbes, including the body's natural flora, which may keep other microbes in check. In the absence of these bacteria, nonsusceptible microbes can proliferate. Narrow-spectrum antibiotics do not lack demonstrated efficacy and they do not necessarily require a shorter duration of treatment. All antimicrobial drugs have the potential to impact subsequent C&S testing.

What situation is an indication for combination antimicrobial drug therapy? Select all that apply. There is a probable likelihood the client will be nonadherent to treatment. The infection is hospital acquired. There is a likely emergence of drug-resistant organisms if a single drug is used. A fever is present in a client whose immune system is suppressed. The infection is caused by several different organisms.

There is a likely emergence of drug-resistant organisms if a single drug is used. A fever is present in a client whose immune system is suppressed. The infection is caused by several different organisms. The infection is hospital acquired.

Your client asks about the difference between viruses and bacterial infection. When explaining about the origin of viruses, you would include:

They are officially classified according to their structure but are more commonly described according to origin and the disorders or symptoms they produce. Explanation: Viruses are intracellular parasites that survive only in living tissues. They are officially classified according to their structure, but are more commonly described according to origin and the disorders or symptoms they produce. Human pathogens include adenoviruses, herpes viruses, and retroviruses.

The client has been prescribed one aspirin a day. The nurse understands that is prescribed for which of the following? To inhibit platelet aggregation To decrease temperature To treat osteoarthritis To decrease pain

To inhibit platelet aggregation Explanation: Daily low-dose aspirin is prescribed to inhibit platelet aggregation within the heart and brain. Aspirin for osteoarthritis and pain is usually prescribed at a higher dosage. If the client is having elevated temperatures daily, the cause would need to be investigated.

Like many other classes of drugs, anti-infective drugs can have a variety of adverse effects. What is the most common, potentially serious, adverse effect of antimicrobial drugs? Constipation Skin rash Pain Toxic effects on the kidney

Toxic effects on the kidney Explanation: The most commonly encountered adverse effects associated with the use of anti-infective agents are direct toxic effects on the kidney, gastrointestinal (GI) tract, and nervous system. Pain, constipation, and hypopnea are not common adverse effects of antimicrobial drugs.

A 60-year-old client with rheumatoid arthritis reveals to the nurse the recent use of an OTC NSAID. The nurse should point out the client is at an increased risk for developing which disorder related to the use of NSAIDs? Ulcer disease Blindness Hearing impairment CNS disorders

Ulcer disease Explanation: Age appears to increase the possibility of adverse reactions to NSAIDs. The risk of serious ulcer disease in adults older than 65 years is increased with higher doses of NSAIDs. CNS disorders, hearing impairment, and blindness are not effects associated with using NSAIDs on a long-term basis in older clients.

A nurse is conducting an in-service about antibacterial drugs such as penicillins and cephalosporins. During the question-and-answer period, the audience asks for examples of conditions that can be treated by cephalosporins. Which examples would the nurse include in the response? Jaundice Urinary tract infections Nausea and diarrhea Hemolysis

Urinary tract infections Explanation: Cephalosporins are used to treat respiratory infections, otitis media, urinary tract infections, and bone and joint infections, and prophylactically to treat infections that may result from a sexual assault. Cephalosporins are not used to treat hemolysis or jaundice. Nausea and diarrhea are some of the adverse reactions that can occur when a patient is on cephalosporin therapy.

The nurse is checking the orders for pain management for a client that had coronary surgery 24 hours ago. The nurse identifies that the client has been receiving Celebrex and a narcotic postoperatively for pain management. What is the most appropriate response of the nurse? Administer the Celebrex. Withhold the Celebrex and notify the health care provider. Administer the Celebrex and narcotic because it is his pain management regimen. Discontinue the Celebrex.

Withhold the Celebrex and notify the health care provider. Explanation: Celebrex should not be used for pain management after coronary surgery due to the risk of cardiovascular thrombosis, myocardial infarction, and stroke. The nurse should not administer the medication and should notify the provider. The nurse cannot discontinue the Celebrex without prescriptive authority.

Which client is receiving prophylactic anti-infectives? a client with metastatic lung cancer who will soon begin chemotherapy a client who has been admitted for the treatment of an infected surgical incision a client with human immunodeficiency syndrome who begins antiretroviral therapy a client who is prescribed a 3-day course of antibiotics prior to dental surgery

a client who is prescribed a 3-day course of antibiotics prior to dental surgery Explanation: In a situation where an infection is likely to occur, antibiotics can be used to prevent it. Giving antibiotics before surgery is an example of prophylaxis. Chemotherapy is the use of drugs to destroy abnormal cells, usually cancer cells; this is not prophylactic. Antiretroviral therapy and treatment of an active infection are not prophylactic.

When caring for infants and the elderly who are in need of an antimicrobial agent, the nurse is aware that when compared with doses for young and middle-aged adults, these clients may require:

a lower dose. Explanation: Infants and the elderly are the populations most vulnerable to drug toxicity. In the infant, the liver and kidneys are still immature and may have difficulty metabolizing or excreting the drug, which results in accumulation. The same process in the elderly is related to the age of their liver and kidneys, which may no longer be functioning at an optimal level. Prescribers may request lower doses of antimicrobial agents for these two populations to minimize the risk for toxicity. The frequency is important in antimicrobial therapy and would not be decreased.

In the rare instance in which penicillin is considered essential, hypersensitivity can be assessed by administering: a loading dose of the medication. a skin test. the medication by the intravenous route only. the medication in a controlled environment.

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

A nurse is assigned to care for a patient with arthritis in a health care facility. The patient has been prescribed celecoxib. Celecoxib is contraindicated in clients with: acute gout. cataract. diabetic retinopathy. allergy to sulfonamides.

allergy to sulfonamides. Explanation: Celecoxib is contraindicated among patients with allergy to sulfonamides. Ethambutol is contraindicated in patients with diabetic retinopathy and patients with cataract. Pyrazinamide is contraindicated among patients with acute gout.

How should a nurse best explain the presence of the inflammation process?

as an attempt by the body to remove the damaging agent and repair the damaged tissue Explanation: Inflammation is the normal body response to tissue damage from any source, and it may occur in any tissue or organ. The remaining options are either incorrect or incomplete descriptions of the inflammation process.

The nurse is caring for a child who weighs 30 kg. The physician orders gentamicin t.i.d. The recommended dosage range is 6 to 7.5 mg/kg/day. What should the nurse explain is the importance of giving a dosage within this recommended range? Select all that apply. avoiding toxic effects reducing the risk of drug-resistant organisms promoting lactic acid clearance eradicating the bacteria promptly protecting other clients

avoiding toxic effects reducing the risk of drug-resistant organisms protecting other clients eradicating the bacteria promptly

A client is febrile and is suspected of having a respiratory infection. A sputum culture has been collected and the results of sensitivity testing are expected within 48 hours. The nurse should anticipate that the client may: be treated with antiviral medication on a short-term basis. need to provide a follow-up sputum culture before medications can be prescribed. be immediately prescribed a broad-spectrum antibiotic. receive supportive care until an antibiotic can be prescribed in 48 hours.

be immediately prescribed a broad-spectrum antibiotic. Explanation: Broad-spectrum antibiotics are often prescribed pending sensitivity testing. There is no need to completely withhold medications until results are acquired. Antiviral medications are not used for this short-term purpose. Follow-up testing may or may not be needed.

The health care provider is selecting an antibiotic for a client with a known penicillin allergy. The provider knows that cephalosporins are a poor choice for this client because cephalosporins: can cause kidney damage in clients who are allergic to penicillins. are ineffective in clients who are allergic to penicillins. are derived from penicillin. can cause allergic reactions in clients who are allergic to penicillins.

can cause allergic reactions in clients who are allergic to penicillins. Explanation: Clients who are allergic to penicillins may also be allergic to cephalosporins. Although this cross-allergenicity (allergy to a drug of another class with similar chemical structure) is rare, cephalosporins are not typically administered to clients who have had life-threatening allergic reactions to a penicillin.

A client is scheduled for a bowel resection. During the perioperative period, which type of medication should the nurse anticipate the client will be given? penicillins antivirals sulfonamides cephalosporins

cephalosporins Explanation: Cephalosporins may be used throughout the perioperative period to prevent infection in clients having surgery on a contaminated or potentially contaminated area, such as the gastrointestinal tract or vagina. The other drug groups are not normally given during the perioperative period for bowel surgery. Antivirals are not part of the perioperative protocol for any type of surgery.

A group of nursing students are reviewing the pain-relieving action of NSAIDs. The students demonstrate understanding of the information when they identify which actions as being blocked to achieve pain relief? cyclooxygenase-1 cyclooxygenase-4 cyclooxygenase-2 cyclooxygenase-3

cyclooxygenase-2 Explanation: Blocking COX-2 is responsible for the pain-relieving effects of NSAIDs. COX-1 is an enzyme that helps to maintain the stomach lining; inhibition of COX-1 would cause unwanted gastrointestinal (GI) reactions such as stomach irritation and ulcers. The antipyretic action of aspirin may be mediated by inhibition of COX-3 in hypothalamic endothelial cells. No data are obtained on the discovery of COX-4.

A client with an infection has been prescribed metronidazole, a bactericidal antibiotic. What should the nurse determine is the therapeutic effect of the medication?

death of the microbial cells Explanation: Some anti-infectives are so active against the infective microorganisms that they actually cause the death of the cells they affect. These drugs are said to be bactericidal. Bactericidal agents do not slow DNA replication or cause mutations. Removal of dead tissue is not relevant to anti-infective therapy.

A young adult client who has no significant prior health history has been prescribed antibiotics for the first time. What nursing diagnosis would be most appropriate for this client? constipation related to increased fluid absorption acute pain related to gastrointestinal (GI) effects of the drug deficient knowledge regarding drug therapy imbalance nutrition: less than body requirements related to multiple GI effects of the drug

deficient knowledge regarding drug therapy Explanation: Because this is the first time the client has taken antibiotics, he or she is likely to have limited knowledge about the drug. The client may not understand the importance of taking the medication as ordered to increase effectiveness of the drug or to report adverse effects. Because the client has not started the drug yet, there is no way to know what adverse effects, if any, he or she will experience.

The nurse is providing health education to a client with an infection who lives in the community. What characteristic of the client's anti-infective regimen will best prevent the development of resistant strains of microbes?

ensuring that the duration of drug use is appropriate Explanation: Exposure of pathogens to an antimicrobial agent without cellular death leads to the development of resistance so it is important to limit the use of these agents to treat pathogens with a known sensitivity to the drug being used. The duration of drug use is critical to ensure that microbes are completely eliminated and not given the chance to grow and develop resistant strains. Adverse effects must be addressed, but this is not directly related to the development of resistance. Dosing frequency must be determined with the goal of enhancing the therapeutic action, but excessive frequency can cause problems with the client's adherence. Follow-up testing is not a major component of preventing resistance.

A client is admitted to the emergency department with suspect salicylism. The client's plasma salicylate level is 300 µg/mL. Which sign/symptom would the nurse expect to assess? Select all that apply. flushing asterixis headache tetany thirst

flushing headache thirst

An adult client is brought to the emergency department after deliberately overdosing on acetaminophen. The care team should prioritize interventions based on the client's risk for which adverse reaction? seizures acute GI bleed gastric perforation liver failure

liver failure Explanation: Potentially fatal hepatotoxicity is the main concern with acetaminophen overdose and is most likely with doses of 20 g or more. None of the other options are associated with acetaminophen overdosing.

The nurse administers a drug to treat Chlamydia trachomatis. The nurse is aware that this drug has no effect on any other bacteria. How should the nurse describe this characteristic of the drug? bacteriostatic narrow spectrum prophylactic qualities bactericidal

narrow spectrum Explanation: Without knowing the name of the antibiotic and how it works to treat N. gonorrhoeae, the only thing that can be said is that it is a narrow-spectrum anti-infective because it only treats one specific organism. Broad-spectrum anti-infectives treat multiple organisms. The name of the drug and how it works would need to be known to determine whether it is bactericidal or bacteriostatic.

A client is prescribed piroxicam for osteoarthritis. The nurse would assess the client for which adverse reaction? constipation dizziness nausea rash

nausea Explanation: The nurse should monitor the client being treated with piroxicam for nausea. Rash, constipation, and dizziness are adverse reactions of oxaprozin.

What intervention is most important for the nurse to perform before antibiotic therapy is initiated? obtaining a specimen for culture and sensitivity educating the client about adverse effects increasing the client's fluid intake administer an antidiarrheal to prevent gastrointestinal (GI) upset

obtaining a specimen for culture and sensitivity Explanation: It is good practice to collect specimens (e.g., sputum, urine) for culture and Gram's stain before giving the first dose of an antibiotic. Fluid intake and medication education may take place after the therapy is initiated, while antidiarrheal medication is administered if the client demonstrates signs/symptoms of GI distress.

A client is to undergo extensive dental surgery. The dentist prescribes a course of antibiotics before beginning the procedure and continuing for 5 days after the procedure. This is an example of:

prophylaxis. Explanation: In a situation where an infection is likely to occur, antibiotics can be used as a means of prophylaxis to prevent an infection before it occurs. Synergism is using two antibiotics together to improve their effectiveness. Chemotherapy is the use of drugs to kill cells. Curative treatment involves treating an actual infection to promote a cure.

A client with rheumatic disease is being prescribed salicylate therapy. The nurse should teach the client monitor himself or herself for which adverse effects? ringing in the ears increased hair growth visual changes irritation of oral mucosa

ringing in the ears Explanation: Tinnitus is associated with salicylates. The disease-modifying antirheumatic drug (DMARD) category of antimalarials may cause visual changes, GI upset, skin rash, headaches, photosensitivity, and bleaching of hair. Eighth cranial nerve damage and stomatitis are associated with gold therapy. Hirsutism is associated with corticosteroid therapy.

The nurse administering an anti-infective agent recognizes that the drug will destroy some human cells as well as pathogens because of the absence of: antigens. resistance. selective toxicity. virulence.

selective toxicity. Explanation: Although anti-infective agents target foreign organisms infecting the body of a human host, they do not possess selective toxicity, which is the ability to affect certain proteins or enzyme systems used only by the infecting organism but not by human cells. Virulence would apply to the destructive power of the infection, not the drug. Resistance is the pathogen's ability to no longer respond to specific anti-infectives. Antigens are proteins bound to the cell that help the body identify a cell as belonging (or not) in the body, and are not the cause of human cell destruction.

The client is admitted to the acute care facility with acute septicemia and has orders to receive gentamicin and ampicillin IV. The nurse is performing an admission assessment that includes a complete nursing history. What information provided by the client would indicate the need to consult the healthcare provider before administering the ordered medication? takes high-dose furosemide daily history of hypothyroidism allergy to peanuts and peanut products had prostate surgery 3 months ago

takes high-dose furosemide daily Explanation: Aminoglycosides should be avoided if the client takes a potent diuretic because of the increased risk of ototoxicity, nephrotoxicity, and neurotoxicity. Learning the client takes a potent diuretic would indicate the need to consult with the healthcare provider before administering gentamicin. Prostate surgery, hypothyroidism, and an allergy to peanuts would not preclude administration of these medications and would not indicate a need to consult with the provider.

Although the numbers and virulence of microorganisms help determine whether a person acquires an infection, another major factor is: the host's ability to defend itself against the would-be invaders. the number of effective drugs available for serious or antibiotic-resistant infections. continuous antimicrobial treatment of infections. infections that tend to recur and involve simple organisms.

the host's ability to defend itself against the would-be invaders. Explanation: The human body and the environment contain many microorganisms, most of which do not cause disease and live in a state of balance with the human host. When the balance is upset and infection occurs, characteristics of the infecting microorganism and the adequacy of host defense mechanisms are major factors in the severity of the infection and the person's ability to recover. Conditions that impair defense mechanisms increase the incidence and severity of infections and impede recovery. In addition, use of antimicrobial drugs may lead to serious infections caused by drug-resistant microorganisms.

A client has been diagnosed with osteomyelitis and has been prescribed clindamycin, a narrow spectrum antibiotic. When planning this client's care, the nurse should understand that:

the microorganism causing the infection is likely known. Explanation: Narrow spectrum antibiotics are appropriate when the identity of the microorganism is known or strongly suspected. This is unrelated to the client's immune function. Broad spectrum drugs are not necessarily trialed before using narrow spectrum drugs. The risk of adverse effects is not the determining factor.

Inappropriate use of antibiotics does all of the following except increase:

the number of available effective drugs for serious or antibiotic-resistant infections. Explanation: Antimicrobials are among the most frequently used drugs worldwide. Their success in saving lives and decreasing severity and duration of infectious diseases has encouraged their extensive use. Authorities believe that much antibiotic use involves overuse, misuse, or abuse of the drugs. That is, an antibiotic is not indicated at all or the wrong drug, dose, route, or duration is prescribed. Inappropriate use of antibiotics increases adverse drug effects, infections with drug-resistant microorganisms, and health care costs. In addition, it decreases the number of effective drugs for serious or antibiotic-resistant infections.

An immunocompromised patient in a critical care setting has developed a respiratory infection that has been attributed to methicillin-resistant Staphylococcus aureus (MRSA). The nurse should anticipate that the patient will require treatment with

vancomycin. Explanation: Vancomycin is the drug of choice to manage infections caused by MRSA. MRSA is resistant to all of the antistaphylococcal penicillins, as well as to ciprofloxacin and clindamycin.

A 7-year-old child has tonsillitis and is prescribed penicillin V, which is to be administered at home. The nurse will instruct the parents to administer the drug with a glass of water 1 hour before or 2 hours after a meal. intravenously with the assistance of a home health nurse. with a sip of water 1 hour before mealtime. immediately before or with a meal.

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