Abrams Chapter 18 - NCLEX
A client has been diagnosed with an infected postoperative wound, and cultures reveal methicillin-susceptible Staphylococcus aureus. What medication should the nurse anticipate being prescribed for this client? Select all that apply. A. Dicloxacillin B. Oxacillin C. Ampicillin D. Nafcillin E. Doxycycline
A. Dicloxacillin B. Oxacillin D. Nafcillin Penicillinase-resistant (antistaphylococcal) penicillins include three drugs (dicloxacillin, nafcillin, and oxacillin) that are the drugs of choice for methicillin-susceptible Staphylococcus aureus. These drugs are formulated to resist the penicillinases that inactivate other penicillins. Neither ampicillin nor doxycycline would be effective in treating this type of infection.
A client being treated for cellulitis with a cephalosporin asks the nurse what the essential difference is between generations of this medication. The nurse should respond to the client's question based on what fact? A. Each successive generation is more effective against gram-negative microorganisms. B. The generations represent the order in which the drugs should be utilized clinically. C. Each generation of cephalosporins has a different mechanism of action. D. The generations of cephalosporins represent formulations that produce fewer side effects.
A. Each successive generation is more effective against gram-negative microorganisms. Cephalosporins are grouped into generations by their antimicrobial properties. Each newer generation of cephalosporins has significantly greater gram-negative antimicrobial properties than the preceding generation, with decreased activity against gram-positive organisms. None of the remaining options accurately describe the concept of generations associated with medications
A client with a complex medical history is scheduled to begin treatment with an IV cephalosporin. After the initiation of therapy, the nurse should monitor the client for which potential adverse effect of intravenous cephalosporin therapy? Select all that apply. A. Itching B. Abdominal pain C. Oliguria D. Diarrhea E. Nausea and vomiting
B. Abdominal pain D. Diarrhea E. Nausea and vomiting Adverse effects to cefazolin and the other cephalosporins are like those of most other antibiotics: abdominal pain, diarrhea, gastritis, nausea, and vomiting. Neither oliguria nor itching is associated with adverse reactions to cephalosporin therapy.
A client diagnosed with E. coli resistant to other drugs has been prescribed imipenem-cilastatin to be given IM. When preparing the medication for administration, what information should the nurse obtain from the client? A. Allergy to sulfa drugs B. Allergy to local lidocaine C. History of rapid heart rates D. Allergy to corticosteroids
B. Allergy to local lidocaine To prepare the solution for IM injection of imipenem-cilastatin, lidocaine, a local anesthetic, is added to decrease pain. This solution is contraindicated in people allergic to this type of local anesthetic or who have severe shock or heart block.
A client receiving the first dose of IV ampicillin asks the nurse to evaluate a rash on the torso. What should be the nurse's initial response to the client's rash? A. Immediately apply a topical corticosteroid to the affected region. B. Attempt to differentiate a hypersensitivity reaction from a nonallergic ampicillin rash. C. Report the rash to the primary health care provider. D. Stop the infusion and administer a bolus of normal saline.
B. Attempt to differentiate a hypersensitivity reaction from a nonallergic ampicillin rash. The nurse carefully assesses the characteristics of a rash, if present. It is necessary to distinguish, if possible, a hypersensitivity reaction from a nonallergic ampicillin rash. Corticosteroids are not indicated, and the infusion does not necessarily need to be stopped. The rash should be reported only after the initial assessment is completed.
The nurse is providing education to a client who has been prescribed oral amoxicillin. The nurse will repeat teaching related to fluid intake if the client indicates that the drug can be taken with what beverage? A. Carbonated soda B. Orange juice C. Milk D. Green tea
B. Orange Juice Clients should not take penicillins with orange juice or any acidic beverages because these may destroy the drug. None of the other options have a negative effect on the medication.
The nurse initiated administration of IV cefazolin with the dose ending at 13:00. When would the nurse expect the drug to reach peak effect? A. Between 16:00 and 17:00 B. Shortly after 13:00 C. By 13:45 D. Between 14:00 and 15:00
B. Shortly after 13:00 Cefazolin is distributed into most body tissues and crosses the placenta. The onset of action is rapid with both IV and IM administration. The drug peaks at the end of IV infusion and within 1 to 2 hours with IM injection.
How will a client's diagnosis of liver cirrhosis affect the potential use of appropriate ampicillin therapy to treat an infected pressure ulcer? A. Cephalosporin rather than ampicillin should be prescribed. B. The client can safely be treated with ampicillin. C. The frequency of the doses is needed to reduce the risk of hepatotoxicity. D. The client should be treated with approximately half of the normal dose of penicillin.
B. The client can safely be treated with ampicillin. Ampicillin can be used in clients experiencing hepatic impairment, as can almost all the penicillins. No specific dosing are needed.
A client has been diagnosed with an infected postoperative wound, and cultures reveal methicillin-resistant S. aureus (MRSA). The client is currently receiving cephalosporins IV based on previous in vitro testing that indicated susceptibility. What is the A. Contact the health care provider to request that lab cultures be repeated. B. Contact the health care provider as medication should be changed to IV ampicillin. C. Contact the health care provider to discontinue cephalosporin. D. Continue administering cephalosporin.
C. Contact the health care provider to discontinue cephalosporin. In infections caused by MRSA, cephalosporins are not clinically effective, even if in vitro testing indicates susceptibility (except for the newest cephalosporin, ceftaroline). The health care provider will determine the need for additional tests or alternative anti-infectives.
The nurse is justified in suspecting that a client who recently completed a course of ceftaroline may have been treated for what health problem? A. Chlamydial infection B. Endocarditis C. Methicillin-resistant Staphylococcus aureus (MRSA) infection D. Encephalitis
C. Methicillin-resistant Staphylococcus aureus (MRSA) infection Ceftaroline is an IV cephalosporin for the treatment of community-acquired pneumonia and skin infections. It is the first cephalosporin to be considered active against resistant gram-positive organisms, such as MRSA. This drug is not indicated in the treatment of chlamydial infections, endocarditis, or encephalitis.
What event triggers the development of a superinfection? A. Complete establishment of the infection prior to initiation of antibiotic therapy B. Unforeseen interactions between the antibiotic and other prescribed medications C. Proliferation of antibiotic-resistant microorganisms D. Bone marrow suppression triggered by antibiotic treatment
C. Proliferation of antibiotic-resistant microorganisms Superinfection is an infection after the occurrence of a previous infection, typically caused by microorganisms that are resistant to the antibiotics used earlier. None of the other options accurately describe this condition as it is associated with antibiotic-resistant microorganisms.
To maximize the prevention of an incisional infection, when will the nurse administer the prophylactic antibiotic therapy prescribed for a surgical client? A. As part of the surgical prep B. When the client is admitted to postsurgical recovery C. The night before surgery D. 1 hour prior to the first planned skin incision
D. 1 hour prior to the first planned skin incision When used perioperatively, cephalosporins should be given within 60 minutes before the first skin incision is made so the drug has time to reach therapeutic serum and tissue concentrations. It is not done as part of the surgical prep since that timing is not as specific.
A client has been diagnosed with an infected postoperative wound, and cultures reveal methicillin-resistant Staphylococcus aureus (MRSA). The client is currently receiving intravenous ceftaroline because in vitro testing indicates susceptibility. When con A. Contact the health care provider because the medication should be changed to the oral route. B. Contact the health care provider because the medication is not known to be clinically effective. C. Monitor the client closely for signs of hepatotoxicity. D. Administer the medication as prescribed and monitor for expected outcomes.
D. Administer the medication as prescribed and monitor for expected outcomes. The nurse's responsibility in supporting prescribed medication therapy is to administer the medication as prescribed and to monitor for expected outcomes. Ceftaroline is an IV cephalosporin used for the treatment of community-acquired pneumonia and skin infections. It is the first cephalosporin to be considered active against resistant gram-positive organisms, such as MRSA, vancomycin-resistant S. aureus (VRSA), vancomycin-insensitive S. aureus (VISA), and heteroresistant VISA. Decreased renal function, not hepatic function, is a prescribing concern.
A client being treated with an oral penicillin should be encouraged to administer the medication on which schedule to best achieve a therapeutic effect? Select all that apply. A. Upon rising in the am B. At bedtime C. With meals D. At regular intervals E. Around the clock
D. At regular intervals E. Around the clock Clients should aim to take penicillins at even intervals, preferably around the clock. These drugs are not normally taken with food.
A client being prepared for surgery has been prescribed antibiotics as prophylaxis. Which medication would the nurse anticipate being ordered? A. Penicillin G B. Amoxicillin C. Doxycycline D. Cephalosporin
D. Cephalosporin Clinical indications for the use of cephalosporins include surgical prophylaxis and treatment of infections of the respiratory tract, skin and soft tissues, bones and joints, urinary tract, brain and spinal cord, and bloodstream (septicemia). In most infections with streptococci and staphylococci, penicillins are more effective and less expensive.
Penicillins are more effective when used on infections caused by what organism? A. Gram-negative bacteria B. Gram-negative viruses C. Fungi D. Gram-positive bacteria
D. Gram-positive bacteria Clinical indications for use of penicillins include bacterial infections caused by susceptible microorganisms. As a class, penicillins usually are more effective in infections caused by gram-positive bacteria than those caused by gram-negative bacteria. However, their clinical uses vary significantly according to the subgroup or individual drug and microbial patterns of resistance. Penicillins are not used to treat viral or fungal infections.
A client has been diagnosed with streptococcal pharyngitis. What drug would the nurse expect to be prescribed by the health care provider? A. Amoxicillin B. Dicloxacillin C. Cephalexin D. Penicillin G
D. Penicillin G 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.
