Prep U, PN 125:Chapter 9: Antibiotics

The client has been prescribed a fluoroquinolone. Which statement by the client indicates additional education is needed?

"If I cover my head, I will be protected from the sun." Explanation: It is important that the client's skin is protected from a sunburn reaction while taking fluoroquinolones. The client needs to wear a wide-brimmed hat and protect the skin from sun exposure, even on a cloudy day. All other responses demonstrate understanding.

A client asks the nurse why fluid intake should be increased while taking sulfonamides. Which response by the nurse would be most appropriate?

"The fluids will help to decrease your risk for kidney stones." Explanation: With sulfonamides, the client is at risk for crystalluria and kidney stones. Increasing fluid intake helps to reduce the risk for their development. Fluids will have no effect on the development of photosensitivity or maintaining blood counts. Although fluids help to minimize the risk for dehydration, this is not the reason for increasing fluid intake with sulfonamide therapy.

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

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.

Extreme caution would be necessary with the use of gentamicin in which client?

A client who has chronic renal failure secondary to diabetes mellitus Explanation: Gentamicin is nephrotoxic, and with impaired renal function, a reduction in dosage is essential. Heart blocks, obesity, and lithium therapy do not severely complicate, or contraindicate, the use of an aminoglycoside since they are not associated with nephrotoxicity.

After teaching a group of nursing students about sulfonamides, the instructor determines that the teaching was successful when the students choose which medication as an example of a sulfonamide antibiotic?

Amoxicillin Ciprofloxacin Sulfamethoxazole/trimethoprim Clarithromycin Silver sulfadiazine Explanation: Silver sulfadiazine (Silvadene) and sulfamethoxazole/trimethoprim (Bactrim) are sulfonamide antibiotics. Amoxicillin is an aminopenicillin. Ciprofloxacin is classified as a fluoroquinolone. Clarithromycin is a macrolide.

A nurse works in a community setting and follows clients who have TB. Which clients would likely require the most follow-up from rifampin therapy?

An HIV-positive client Explanation: The nurse should pay special attention to the HIV-positive client because this client will require rifampin therapy for a longer period of time than the other clients. An HIV-positive person is immunocompromised, and it will take longer to fight the infection. This could increase the difficulty of adherence to the drug regimen. In addition, many of the drugs used to treat HIV are contraindicated in clients who take rifampin. Rifampin can be safely administered to nursing mothers, those with cancer, and people over 65 given certain conditions. However, their therapy should not be longer than normally required unless complications occur.

A 25-year-old female client who presents at the clinic with vaginal discharge and discomfort is diagnosed with chlamydia. The nurse knows that the drug of choice to treat this infection is doxycycline. What would be a priority assessment for this client before beginning the medication?

Asking the client if she is pregnant Explanation: Tetracyclines, such as doxycycline, are contraindicated in pregnant women and in children under 8 years of age. In the fetus and young children, the drug can inhibit bone growth and the development of enamel in the teeth.

After teaching a group of nursing students about the different generations of cephalosporins, the instructor determines that the teaching was successful when the students identify which of the following as an example of a first-generation cephalosporin?

Cefazolin (Ancef) Cephalexin (Keflex) Cefaclor (Raniclor) Cefepime (Maxipime) Cefoxitin (Mefoxin) Explanation: Cefazolin and cephalexin are examples of first-generation cephalosporins. Cefoxitin and cefaclor are examples of second-generation cephalosporins. Cefepime is an example of a fourth-generation cephalosporin.

A client previously experienced a severe anaphylactic reaction to penicillin G. Which medication class should not be administered to this client due to the potential for cross-sensitivity?

Cephalosporins Explanation: A contraindication to the use of a cephalosporin is a previous severe anaphylactic reaction to a penicillin. Because cephalosporins are chemically similar to penicillins, there is a risk of cross-sensitivity. This risk does not exist with regard to the other listed classes of medications.

Oral ampicillin has been ordered for a client whose urinary tract infection will be treated in a home setting. When providing antibiotic teaching to this client, the nurse should stress which instruction?

Drink a full glass of water when taking a dose of the drug. Explanation: Clients taking penicillins should take oral doses with a full glass of water to ensure sufficient hydration while taking the medication. The drugs should otherwise be taken on an empty stomach. Tapering is unnecessary, and it is not advised to take the drug with diphenhydramine in an effort to reduce the allergy risk.

The nurse is giving instructions to a client age 77 years who has been prescribed a sulfonamide for treatment of a urinary tract infection. The nurse has instructed the client to increase fluids while taking this medication. What does the nurse anticipate will be the client's greatest fear related to this instruction?

Fear of incontinence. Explanation: The older adult may be hesitant to increase fluid intake because of fear of incontinence. Fear of diarrhea, fear of skin problems and fear of allergic reaction are not related to the instruction to increase fluid. The client will not be given a PO medication if they cannot swallow unless it would be in a liquid form or administered in a way that they could tolerate it.

Which of the following drugs would be classified as an aminoglycoside?

Gentamicin Explanation: Gentamicin is classified as an aminoglycoside. Levofloxacin is a fluoroquinolone; clarithromycin is a macrolide; and cefaclor is a cephalosporin.

The nurse is performing an assessment on a 7-year-old child in the clinic. The nurse observes the child's teeth are darkly stained. What information should the nurse obtain from the parent?

Has the child taken tetracycline for treatment? Explanation: Tetracycline administered to a child between the ages of 4 months and 8 years will stain the permanent teeth.

A nurse is teaching a client about the common adverse reactions that can occur with the client's prescribed therapy with cephalosporins. The nurse determines that the teaching was successful when the client identifies which adverse reactions?

Headache Heartburn Vomiting Explanation: Common adverse reactions to cephalosporins include nausea, vomiting, diarrhea, headache, dizziness, malaise, heartburn, and fever.

A client has returned to the clinic for follow-up of an infection which is being treated with an aminoglycoside and reports ringing in the ears and dizziness. When developing this client's plan of care, which nursing diagnosis would be the priority?

Injury Risk Explanation: The development of ototoxicity would lead the nurse to identify a nursing diagnosis of Injury Risk related to the effects of ototoxicity. Although the client's ringing in the ears could cause discomfort, the priority nursing diagnosis would be Injury Risk. There is no evidence of Impaired Comfort, Altered Thought Process, or Diarrhea.

What is the rationale for not administering tetracycline to children under the age of 8 years?

It will interfere with enamel development. Explanation: Tetracyclines should not be used in children younger than 8 years because of their effects on teeth and bones. In teeth, the drugs interfere with enamel development. Without existing contraindications, tetracycline can be used in children to treat infections without increasing the risk of heart failure. The administration of tetracycline will not increase the risk of future infections in children.

The nurse is providing care to a client who is receiving an aminoglycoside and cephalosporin. Which assessment is a priority of care?

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 clients with gastrointestinal tract infection. The risk of bleeding increases when cephalosporin is administered with oral anticoagulants. The risk for respiratory difficulty and a disulfiram-like reaction increases if alcohol is consumed within 72 hours after administration of certain cephalosporins.

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 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.

A client has been diagnosed with streptococcal pharyngitis. What drug would the nurse expect to be prescribed by the health care provider?

Penicillin G Explanation: Some strains of streptococci have acquired resistance to penicillin G, although the drug is still effective in many streptococcal infections. It remains the drug of choice for the treatment of streptococcal pharyngitis; for prevention of recurrent attacks in clients who have had previous acute rheumatic fever due to group A streptococcus; and for the treatment of neurosyphilis. Aminopenicillins (e.g., amoxicillin) are the drugs of choice for prevention of bacterial endocarditis due to procedures that produce transient bacteremia. Penicillinase-resistant penicillins (e.g., dicloxacillin) are the drugs of choice for MRSA. Although first-generation cephalosporins such as cephalexin are effective against streptococci species, they are not the drugs of choice.

The health care provider suspects a client may be infected with an antibiotic-resistant pathogen. The nurse caring for this client knows that what course of action is best used to determine whether this type of pathogen is present?

Perform culture and susceptibility tests. Explanation: Before prescribing an antibiotic, the health care provider should review culture and susceptibility reports and local susceptibility patterns to determine if an antibiotic-resistant pathogen is present in the client. Complete blood counts and electrolyte values are standard procedure lab tests. Spinal fluid checks are performed to detect anomalies such as meningitis.

The nurse is caring for a client who is receiving IV vancomycin. The nurse infuses the medication at the prescribed rate to prevent what from occurring?

Red man syndrome Explanation: The nurse must be careful to infuse vancomycin at the prescribed rate to prevent the occurrence of red man syndrome. With this syndrome, the client's face and upper trunk becomes bright red, and it has led to cardiovascular collapse.

Which of the following are true of sulfonamides?

Sulfonamides are well-absorbed when given orally. Sulfonamides are excreted by the kidneys. Explanation: Sulfonamides are well-absorbed by the GI tract and are excreted by the kidneys. Sulfonamides treat both gram-positive and negative infections.

A client is being treated for urosepsis with ceftriaxone IV. What assessment finding should prompt the nurse to contact the care provider immediately?

The client has a new onset of jaundice and edema Explanation: Jaundice and edema suggest liver dysfunction, which the nurse should promptly report. Each of the other changes in status warrant the nurse's thoughtful attention and relevant interventions but none requires immediate input from the client's care provider.

A client with a complex medical history is showing signs and symptoms of sepsis. What aspect of this client's health history would rule out the safe and effective use of an aminoglycoside antibiotic?

The client has chronic renal failure Explanation: Renal failure would preclude the use of an aminoglycoside. Nonadherence must always be addressed, but this client variable is not specific to aminoglycosides. Neither latex allergies nor type 2 diabetes would necessarily rule out the use of an aminoglycoside.

A client asks why three medications are prescribed to treat his tuberculosis. The nurse informs the client of which reasons?

To prevent resistance Explanation: The CDC recommends multi-drug therapy to slow the development of bacterial resistance. It does not shorten therapy, prevent allergic reactions, or prevent adverse reactions.

A 49-year-old client is diagnosed with TB. The client has a history of alcoholism but has been sober for 3 months now. The client has been prescribed INH. What should the nurse ensure is obtained before initiating the therapy?

baseline liver function test values Explanation: For a TB client, the nurse should obtain baseline liver function test values and schedule serial liver function tests throughout therapy. In addition, a nurse should ensure a baseline A1C evaluation for clients who are diabetics, because INH may cause hyperglycemia. Clients with preexisting anemias should have a baseline complete blood count (CBC), because they are at risk for hematologic disorders. For clients with a history of seizures, perform a baseline neurologic examination. Also assess baseline visual acuity. All other assessments such as height, weight, serum glucose level, and bone mass are not applicable to INH therapy.

A client diagnosed with malaria has been prescribed treatment with sulfadiazine. The nurse should encourage the client to increase consumption of what dietary component?

fluids Explanation: When this medication is used, it is imperative that the client maintain a fluid intake that allows for an output of 1500 mL of urine in 24 hours. While the client should attempt to consume a healthy well-balanced diet, fluid intake is vitally important.

When a person is diagnosed with tuberculosis, the nurse prepares the family members to be treated prophylactically with which drug?

isoniazid Explanation: When a person is diagnosed with tuberculosis, family members may be treated prophylactically with isoniazid. Drugs used to treat the client with TB are ethambutol, pyrazinamide, and rifampin.

A client has been prescribed oral tetracycline. The nurse will instruct the client to take the drug how?

on an empty stomach. Explanation: Oral preparations of tetracycline should be administered on an empty stomach 1 hour before or 2 hours after taking a meal or other drugs to maximize absorption. Tetracycline is not absorbed effectively if taken with food or dairy products. The dosage must be distributed around the clock, and not just at bedtime, to increase effectiveness.