Antibiotics PREPU

A pregnant woman calls the clinic and asks if it is suitable to use ofloxacin otic drops that she used prior to pregnancy for a current ear infection. What would be an appropriate response from the nurse?

"Some medications are contraindicated in pregnancy, and ofloxacin is one of these medications." Rationale: Ofloxacin is an otic drug that is contraindicated during pregnancy. Using left-over medication from one illness to the next is not advised. Many otic drugs are not contraindicated during pregnancy. Not all medications that are okay for children are suitable to use during pregnancy.

A child has been diagnosed with acute otitis media. Before the child begins antibiotic treatment, what assessment should the nurse perform?

Assess the child for allergies to penicillins Rationale: Amoxicillin (Amoxil) is the preferred antibacterial agent for the treatment of acute otitis media. Because this medication is a penicillin, it is necessary to assess for allergies to these antibiotics. The child's immunization status, history of TB skin tests, and allergies to salicylates are not central to the child's care.

Drugs that destroy the bacteria are known as which of the following? (Choose one)

Bacteriocidal Rationale: Drugs that destroy the bacteria are known as bacteriocidal.

A nurse is caring for a 35-year-old male taking telithromycin. For what type of infection is this client being treated?

Community-acquired pneumonia Rationale:The ketolide telithromycin is approved only for community-acquired pneumonia.

A client who takes zinc daily is diagnosed with a severe infection and is ordered levofloxacin (Levaquin). The nurse is aware that taking these two drugs may have what affect on the antibiotic?

Decreased absorption Rationale: Antacids, iron salts and zinc can cause decreased absorption of the antibiotic. There is no affect on elimination of the antibiotic.

Tuberculosis (TB) affects only the lungs. True or false?

False Rationale: This statement is false. Although TB primarily affects the lungs, it can affect other organs, such as the kidneys, liver, spleen, and uterus.

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. Rationale: The older adult may be hesitent 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.

After teaching a group of students about aminoglycosides, the instructor determines that the teaching was successful when the group identifies which drug as the prototype for this class?

Gentamicin Rationale: Gentamicin is considered the prototype aminoglycoside.

The client has been prescribed a fluoroquinolone. The nurse knows that nursing interventions for clients taking fluoroquinolones include which of the following?

Increase fluid intake. Rationale: Clients taking fluoroquinolones should increase their fluid intake. Food ingestion is not affected.

A nurse teaching the patient with tuberculosis (TB) should include the following information about ethambutol:

It can cause optic neuritis. Rationale: One of the most severe adverse reactions to ethambutol is optic neuritis, which is a decrease in visual acuity and changes in color perception. The other options are not known adverse reactions to ethambutol.

A patient with septicemia is administered cefotaxime sodium (Claforan). How is this medication excreted?

It is excreted by the kidneys. Rationale: Cefotaxime sodium is excreted by the kidneys. Cefotaxime is not excreted by the lungs, liver, or skin.

A major concern among public health authorities is an increase in drug-resistant TB infections. Traditionally, this has been attributed to patient lack of adherence to medication regimen. New evidence indicates that:

Many drug-resistant infections are new infections, especially in those who are immunosuppressed. Rationale: When infected people receive antitubercular drugs, drug-resistant mutants are not killed or weakened by the drugs. Eventually, the majority of the TB bacilli in the body are drug-resistant. Drug-resistant strains can be spread from one person to another, and there is increasing evidence that many drug-resistant infections are new infections, especially in people whose immune systems are suppressed. Not all TB infections are drug-resistant, nor are drug-resistant infections decreasing.

A male client has been diagnosed with otitis externa. He also has a history of a perforated ear drum. What topical otic preparation does the nurse anticipate the physician ordering for this client?

Ofloxacin otic Rationale: Ofloxacin is the only otic topical preparation that can be administered if the client has a perforated ear drum.

A nurse has administered demeclocycline to a patient. Which of the following adverse reactions should the nurse closely monitor the patient for?

Photosensitivity Rationale: Demeclocycline causes photosensitivity reactions. Abdominal pain and cramping are adverse reactions of macrolides. Blood dyscrasias is an adverse reaction of lincosamides.

A young lifeguard has been prescribed moxifloxacin (Avelox). The nurse focuses education on which adverse reaction?

Photosensitivity Rationale: The lifeguard will be in the sun, and he is at risk for an exaggerated skin reaction. Nausea, diarrhea, and abdominal pain are adverse reactions, but due to the client's job, photosensitivity is the highest priority.

A group of students are reviewing information about drugs used to treat tuberculosis. The students demonstrate understanding of the material when they identify which drug as a first-line treatment option?

Rifampin Rationale: Rifampin, along with isoniazid, pyrazinamide, ethambutol, streptomycin, and rifapentine, are considered first-line agents for treating tuberculosis. Kanamycin, ciprofloxacin, and capreomycin are second-line agents.

A nurse is caring for a patient undergoing the second phase of standard TB treatment. The nurse knows that which of the following combinations of drugs need to be administered to the client?

Rifampin and isoniazid Rationale: The nurse knows that a combination of Rifampin and isoniazid drugs should be used during the second phase of standard treatment. Isoniazid, rifampin, and pyrazinamide are not used together as combination drugs in the second phase of standard treatment. Dapsone is used for leprosy and cannot be used in combination with isoniazid or any other drug for TB.

The nurse is caring for a 6 year-old child who has pyelonephritis. The use of what group of antibiotics would be contraindicated due to the client's age?

Tetracyclines Rationale: Tetracyclines can potentially damage developing teeth and bones and thus should be used cautiously or avoided in children under the age of 8 years. Penicillins are safe to give to children and commonly used. Cephalosporins are safe to administer to pediatric clients. Aminoglycosides would not be administered to children lightly, but they can be administered when the benefits outweigh the risks, such as an infection that is resistant to other drugs.

The client has been taking her antibiotic for five days. She tells the nurse that she is now experiencing vaginal itching and discharge. The nurse suspects what has occurred?

The client has developed a superinfection. Rationale: The client is experiencing a vaginal yeast superinfection related to the use of antibiotics. Adverse reactions include nausea, diarrhea, abdominal pain, headache and photosensitivity.

The nurse knows that pseudomembranous colitis is a superinfection of fluoroquinolones, especially when they are administered in high doses, because these medications have what effect in the body?

They disrupt the microbial flora of the body. Rationale: Pseudomembranous colitis is a superinfection that occurs when the antibiotic disrupts the normal flora, causing a secondary infection or superinfection.

A client asks the purpose for using three medications in combination to treat his tuberculosis. The nurse informs the client that multiple medications are given for which of the following reasons?

To prevent resistance Rationale: 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 client has a diagnosis of otitis media and has just begun antibiotic treatment. The client reports otalgia and has asked for medication. The nurse should anticipate the administration of:

acetaminophen (Tylenol). Rationale: Tylenol is the first-line analgesic for most cases of otalgia accompanying otitis. Opioids and ketorolac are not normally indicated.

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 Rationale: 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.

When administering a secondary drug to a patient with tuberculosis (TB), the nurse is treating which type of TB?

extrapulmonary TB Rationale: TB is treated with a combination of drugs. Secondary drugs are used to treat extrapulmonary TB or drug-resistant microorganisms.

A child has just returned home from a family vacation on a tropical island and is now reporting worsening tenderness in the right ear. The client is subsequently diagnosed with otitis externa. What causative factor of this infection should the nurse suspect?

frequent swimming and water sports while the child was on vacation Rationale: People whose ears are frequently exposed to moisture are more prone to the development of otitis externa. Swimming is a more likely cause of infection than pressure changes, foodborne pathogens, or impaired immunity.

A 35-year-old man is being treated with isoniazid (INH) for exposure to TB. He has the following medical history: diabetes mellitus type 2, hypertension, hyperlipidemia, and coronary artery disease. He drinks one to two glasses of wine on the weekend and smokes two packs of cigarettes per day. Which adverse reaction should the nurse alert the client to report to his physician right away?

numbness and tingling in his feet Rationale: INH should also be given with caution to clients with diabetes mellitus, malnutrition, or alcoholism because its effects (antagonism or increased excretion) on pyridoxine (vitamin B6) can cause peripheral neuropathy in these clients. Pyridoxine may be given concurrently with INH to decrease the risk for this adverse effect. Another frequent adverse effect is peripheral neuropathy. This effect may cause paresthesias in the hands and feet. As previously mentioned, malnourished people and those with diabetes and alcoholism have a higher risk for this adverse effect.

Sulfasalazine (Azulfidine) is contraindicated in people who are allergic to:

salicylates. Rationale: Sulfasalazine (Azulfidine) is contraindicated in people who are allergic to salicylates.

A patient has been treated several times for a recurring ear infection with ofloxacin. The nurse instructs the patient to look for side effects from the prolonged use of the antibiotic and informs the patient that this is known as which of the following?

superinfection Rationale: Prolonged use of otic preparations containing an antibiotic may result in a superinfection (an overgrowth of bacterial or fungal microorganisms not affected by the antibiotic being administered).

The physician has prescribed ciprofloxacin. For which patient would you contact the physician to clarify the order because the medication is contraindicated? (Select all that apply.)

• Children younger than 18 • Pregnant and lactating mothers Rationale: Children younger than 18 and pregnant and lactating mothers are most definitely contraindicated from using the drug. It can be given to older adults or even to people with hypertension with proper monitoring.

After teaching a client who is receiving doxycycline about the drug, the nurse determines that the teaching was successful when the client makes what statement?

"I need to wear protective clothing when I'm out in the sun." Rationale: Photosensitivity is possible, so the client should use sunscreen and wear protective clothing when outdoors. Fluids should be increased to promote drug excretion. Ice chips or sugarless candy would be appropriate for combating a sore mouth. The drug should be taken on empty stomach 1 hour before or 2 hours after meals; antacids should not be taken with the drug because they can affect absorption.

A nurse is teaching a client about the medication regimen surrounding fluoroquinolones. Which of the following statements made by the client would indicate the need for additional education?

"I will limit my fluid intake." Rationale: Clients taking fluoroquinilones should increase, not limit, their fluid intake. It is important that the client take all of the prescribed antibiotics and understand adverse reactions, such as abdominal pain. Difficulty breathing may indicate hypersensitivity and is an emergency.

A student nurse needs further explanation about tuberculosis (TB) when making the following statement:

"TB can be cured by antitubercular drugs." Rationale: The antitubercular drugs used to treat TB do not cure TB, but they do render the patient noninfectious to others. All the other statements are true concerning TB.

A client has been prescribed daptomycin for treatment of an infection. What instruction is most important for the nurse to tell this client?

"Tell the physician immediately if you develop any muscle pain." Rationale: The presence of muscle pain or weakness is an indication that the client is developing a severe musculoskeletal reaction, and the medication must be discontinued immediately.

A middle-aged woman with a complex social and medical history has begun multidrug treatment for TB. Which of the nurse's following assessment questions is most therapeutic?

"What kinds of routines would work best for you to make sure that you don't miss any doses of your rifampin?" Rationale: Assessments and interventions related to adherence to therapy are always a priority in the care of patients who have TB. It is necessary to address the patient's smoking, but adherence to therapy is a priority, even over this important health behavior. Addressing the views of family and friends may be inappropriate and/or unnecessary. Similarly, discussing the patient's part in the development of the disease may be counterproductive, depending on the patient's state of mind and the particular relationship between the nurse and the patient.

A 15-year-old female patient is receiving tetracycline for the treatment of severe acne. When providing patient education to this patient, the nurse includes which of the following points for the patient?

"When taking tetracycline, wear extra sun block." Rationale: While GI symptoms are most common with tetracyclines, photosensitivity is another adverse reaction that can occur. Lab work is not required for daily dosing of this medication. Tetracycline can be taken orally, and the patient is not required to remain hospitalized.

A client has just been diagnosed with TB. The client is extremely upset and is asking questions concerning the medications the client will have to take and how long to take them. What is an appropriate response by the nurse?

"You will have multidrug therapy for 6 to 24 months." Rationale: The nurse should tell the client that drug therapy for TB is based on the susceptibility of the infecting organism and the immunocompetence of the person affected. Usually clients with active or reactivated TB require multidrug therapy for 6 to 24 months. Telling the client "not to worry" and that the client needs to be calmer when discussing therapy are not therapeutic and minimize the client's concerns.

A patient is to receive rifampin. Which of the following would be most important for the nurse to include in the teaching plan for this patient?

"Your urine or sweat may become orange in color." Rationale: This drug causes body fluids to turn orange. The patient needs to be informed of this to avoid being frightened when it occurs. Any drug can cause a hypersensitivity reaction. Although this information is important, it is not the priority. GI adverse effects are common. Although this instruction would be important, it would not be the priority. Headache and dizziness are common CNS effects of the drug that do not need to be reported.

The client calls the clinic to report the he is experiencing a throbbing headache and his face is flushed. The client received cefotetan as an IV antibiotic prior to a minor surgical procedure the day before, and returned home that same day. What has this client consumed that has caused this reaction?

Alcohol Rationale: Clients who have taken certain cephalosporins such as cefotetan can develop a disulfiram-like (Antabuse) reaction if alcohol is consumed within 72 hours after administration of the drug. Dairy products, carbonated beverages, and leafy green vegetables would not cause this reaction.

A nurse is discussing targeted testing for latent tuberculosis infection (LTBI) with a group of nursing students. The nurse mentions that testing should be focused on groups considered to be at high risk for infection. Which group is considered high risk?

All the above Rationale: Factors associated with high risk for LTBI include homelessness, HIV infection, immigrating from areas with high TB rates, previous exposure to an infected individual, use of injectable drugs, pre-existing diabetes mellitus, advanced or younger age, low body weight, and use of high doses of corticosteroids.

Tuberculosis typically affects the lungs but can also involve other parts of the body. Which of the following can be affected by the disease?

All the above Rationale: Tuberculosis is an infectious disease that usually affects the lungs but may involve most parts of the body, including lymph nodes, meninges, bones, joints, kidneys, and the gastrointestinal tract.

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

An HIV-positive patient Rationale: The nurse should pay special attention to the HIV-positive patient because he will require rifampin therapy for a longer period of time than the other patients. 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 patients who take rifampin. Rifampin can be safely administered to nursing mothers, cancer patients, and people over 65 given certain conditions. However, their therapy should not be longer than normally required unless complications occur.

A patient has been prescribed doxycycline (Vibramycin). Which of the following teaching instructions is important with this medication?

Avoid sun exposure Rationale: The administration of doxycycline increases photosensitivity, which is a common side effect. Avoidance of sexual activity is not taught. The medication should not be administered with an antacid; the administration of an antacid will result in diminished absorption of the medication. The doxycycline tablets should not be chewed.

Before the selection of an aminoglycoside to treat a client's wound infection, what would the nurse expect the physician to order?

Culture and sensitivity Rationale: The choice of aminoglycoside depends on local susceptibility patterns and specific organisms causing an infection.

A nurse is required to administer an anti-infective drug to a patient. The nurse knows that which of the following tests need to be conducted before administering the first dose of an anti-infective drug to the patient?

Culture tests Rationale: The nurse should check whether culture tests are conducted before the first dose of drug is administered to the client. Ulcer tests and stool tests are not required to be conducted before administering the first dose of an anti-infective drug to the client. The nurse has to ensure that urinalysis is conducted before the administration of the drug but not specifically before the first dose of the anti-infective drug.

A patient has been prescribed a tetracycline drug for Rocky Mountain spotted fever. The patient also takes antacids. Which of the following effects is likely to occur due to an interaction between the two drugs?

Decreased absorption of tetracycline Rationale: Interaction of antacids with a tetracycline drug causes decreased absorption of tetracycline. Increased action of neuromuscular-blocking drugs and increased profound respiratory depression are the result of interaction between neuromuscular-blocking drugs and tetracyclines. Increased risk of bleeding is a result of interaction between anticoagulants and tetracyclines.

A patient is hospitalized with active tuberculosis. The patient is receiving antitubercular drug therapy and is not responding to the medications. What do you suspect the patient is suffering from?

Drug-resistant tuberculosis Rationale: A patient who is being treated with antitubercular drug therapy and is not responding to the medication regime is most likely experiencing drug-resistant tuberculosis. Human immunodeficiency virus causes tuberculosis to move more rapidly. This scenario does not provide any indication that the tuberculosis is related to the diminished patient response. The scenario does not identify methicillin- or vancomycin-resistant Staphylococcus aureus.

A nurse is caring for a patient who is being administered penicillin. What are the common adverse reactions to penicillin a nurse should assess for?

Inflammation of the tongue and mouth Rationale: 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 severe, the drug may be continued as prescribed and the nurse would intervene to help the patient manage the common adverse reactions. Impaired oral mucous membranes are signs of a fungal superinfection in the oral cavity, whereas severe hypotension and sudden loss of consciousness are signs of an anaphylactic shock; these are not common adverse effects of penicillin and require immediate medical attention.

The nursing student read about a disease called Hansen's disease, which is caused by the bacterium Mycobacterium leprae and is treated with many of the same drugs as are used for TB. The student learned that another name for Hansen's disease is what?

Leprosy Rationale: Leprosy, also referred to as Hansen's disease, is caused by the bacterium Mycobacterium leprae. Cholera is caused by the virus vibrio. The cytomegalovirus is caused by a herpes virus, and listeriosis is caused by Listeria monocytogenes.

An elderly patient comes to the clinic and informs the nurse that he feels as if his ear is clogged. He states that he frequently has to have his ears irrigated to get out the wax. He asks the nurse what causes this wax build-up. What is the nurse's best response?

Modified sweat glands in the ear canal Rationale: Cerumen, a natural product of the ear, is produced by modified sweat glands in the ear canal. Sometimes too much wax is produced, particularly in the elderly. It is found to be thicker in the elderly who should frequently be assessed for the build-up of cerumen, which can cause hearing loss.

When administering aminoglycosides, the nurse must be aware of which of the following adverse reactions?

Ototoxicity and nephrotoxicity Rationale: After parenteral administration, aminoglycosides are widely distributed in extracellular fluid and reach therapeutic levels in blood, urine, bone, inflamed joints, and pleural and ascitic fluids. They accumulate in high concentrations in the proximal renal tubules of the kidney leading to acute tubular necrosis. This damage to the kidney is termed nephrotoxicity. They also accumulate in high concentrations in the inner ear, damaging sensory cells in the cochlea and the vestibular apparatus. This damage to the inner ear is termed ototoxicity.

Cephalosporins are structurally and chemically related to which classes of antibiotics? (Choose one)

Penicillins Rationale: Cephalosporins are structurally and chemically related to penicillins.

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?

Serum BUN and creatinine levels Rationale: 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.

The drug's effect on what best reflects the major reason for avoiding the use of tetracyclines in children under 8 years of age?

Teeth Rationale: Tetracyclines should be used with caution in children younger than age 8 years because the drugs can potentially damage developing teeth and bones. They do not affect hearing or vision. They are excreted in the urine, so caution is necessary if the client has underlying renal dysfunction; however, this is not the main reason for avoiding use in children.

A client's risk for ototoxicity, nephrotoxicity, and neurotoxicity increases dramatically if he or she receives an aminoglycoside in conjunction with a potent diuretic.

True Rationale: Avoid combining aminoglycosides with potent diuretics; this increases the incidence of ototoxicity, nephrotoxicity, and neurotoxicity. Renal toxicity, which may progress to renal failure, is caused by direct drug toxicity in the glomerulus, meaning that the drug molecules cause damage (e.g., obstruction) directly to the kidney.

Medical treatment for tuberculosis (TB) consists of a combination of drugs to get the best results. This statement is:

True Rationale: Primary and secondary drugs provide the treatment for TB and are used in combination. Sensitivity testing is done to determine the most effective combination treatment, especially in areas of the country where patients may become resistant to therapy.

The nurse is giving discharge instructions to a woman who will be taking amoxicillin for treatment of acute otitis media. The nurse teaches the client that which symptom indicates the development of a superinfection and should be reported to the physician?

Vaginal itching and discharge Rationale: A vaginal infection in a client who is taking amoxicillin is an example of a superinfection. The nausea and abdominal pain are adverse effects of the medication, and swelling and itching of the throat are an example of possible allergy to the drug.

The nurse is preparing a teaching plan for a client who is receiving cephalosporins. Which of the following would the nurse identify as the most commonly occurring adverse effects?

Vomiting and diarrhea Rationale: Although headache and dizziness, superinfections, and phlebitis (with intravenous administration) can occur, the most common adverse effects of cephalosporins involve the GI tract and include vomiting, diarrhea, nausea, anorexia, abdominal pain, and flatulence.

A patient is taking rifampin (Rifadin) for active TB. When discussing this drug with the patient, the nurse should stress that

body fluids such as urine, saliva, tears, and sputum may become discolored. Rationale: Rifampin can discolor body fluids red-orange. The patient should be informed that this is an expected adverse effect and is harmless. However, wearers of soft contact lenses should be cautioned that the lenses may be permanently discolored and that hard contacts or regular glasses should be used during the therapy. Although rifampin is often well tolerated, it may cause GI disturbances such as nausea and vomiting, anorexia, flatulence, cramps, and diarrhea. Cardiac arrhythmias, seizures, and facial flushing are not typically associated with the use of this drug.

A client is prescribed cefazolin for a sinus infection. After administration of the first dose of the medication, the client reports itching. The nursing assessment reveals a rash over the client's torso; the client has a history of allergic reaction to penicillin. The client:

is experiencing an allergic reaction caused by a cross-sensitivity reaction. Rationale: Cefazolin is contraindicated in anyone with a known allergy to cephalosporins. Caution must be used in clients with renal failure and in pregnant or lactating women. Because of the structural similarities between cephalosporins and penicillins, clients who are allergic to one type of drug may experience cross-sensitivity to the other. Cephalosporin hypersensitivity occurs in 5% to 10% of clients with penicillin allergy. Clients with a history of severe allergic reactions to penicillins should not receive cephalosporins because of their increased risk for cross-sensitivity reactions.