CH 18 Beta-Lactam Antibacterial Agents (E1)
cefazolin (Ancef), cephalexin (Keflex) -decent gram + -limited gram -
1st generation
cefoxitin (Mefoxin), cefuroxime (Ceftin/ Zinacef) -similar to 1st generation -slightly better gram + and gram -
2nd generation
ceftriaxone (Rocephin), ceftazidime (Fortaz) -more potent in gram - -less potent in gram + -starts treating pseudomonas -can cross the blood-brain barrier
3rd generation
cefipime (Maxipime) -broad spectrum -treats UTIs, skin infection, and pneumonia
4th generation
cefaroline (Teflaro) -broadest spectrum of all cephalosporins -only cephalosporin effective against MRSA -IV preparation only at this time
5th generation
A client diagnosed with infective endocarditis would be most effectively treated with which medication? A) dicloxacillin B) ampicillin C) nafcillin D) oxacillin
B
A client is administered a third-generation cephalosporin. The broad-spectrum agents like cephalosporins are most effective in treating which type of microorganism? A) gram positive B) gram negative C) fungi D) virus
B
Unasyn is being administered to a client with an infection caused by Staphylococcus aureus. What type of anti-infective is ampicillin-sulbactam? A) extended-spectrum antipseudomonal penicillin B) penicillin-beta-lactamase inhibitor combination C) cephalosporin D) aminopenicillin
B
Which is the drug of choice for surgical prophylaxis associated with a vaginal hysterectomy? A) cefadroxil B) cefazolin sodium C) cephalexin D) cephradine
B
A client is diagnosed with B. fragilis, an anaerobic organism resistant to most drugs. What is the drug of choice to treat this microorganism? A) cefaclor B) cefamandole nafate C) cefoxitin D) cefuroxime sodium
C
A client is to receive imipenem-cilastatin IM to treat P. aeruginosa. What should imipenem-cilastatin be mixed with prior to administering intramuscularly? A) meropenem B) gentamicin C) lidocaine D) epinephrine
C
What organ system is responsible for the excretion of cefotaxime sodium from the body? A) respiratory B) hepatic C) renal D) gastrointestinal
C
A client is prescribed aztreonam. What is the major advantage of this monobactam over the aminoglycosides in treating P. aeruginosa? A) It is a lower-cost medication. B) It is administered orally. C) It causes less GI distress. D) It has lower risk for hearing loss.
D
Which drug is a first-generation cephalosporin used as a surgical prophylaxis? A) cefotetan B) cefoxitin C ceftriaxone D) cefazolin
D
A 69-year-old responded well to inclient treatment with a third-generation cephalosporin. After being largely symptom free for 48 hours, the woman has developed a fever of 38.6°C and an elevated white cell count. What phenomenon may account for this client's current clinical presentation? A) The client may be infected with microorganisms that were resistant to the cephalosporin. B) The client may be experiencing a delayed (type IV) hypersensitivity reaction to the cephalosporin. C) The client may be developing glomerulonephritis secondary to the nephrotoxic cephalosporin. D) The cephalosporin may have initially caused leukopenia and made the client susceptible to secondary infection.
A
How does adding a beta-lactamase inhibitor agent help achieve a therapeutic effect when prescribed for otitis media? A) It extends the spectrum of antibacterial activity of penicillin. B) It extends the spectrum of the beta-lactamase inhibitor. C) It decreases the side effects of high-dose penicillin. D) It increases the absorption of the penicillin.
A
What potential adverse reaction is most likely to develop during cefazolin therapy? A) gastrointestinal upset B) dry skin and pruritus C) drowsiness D) orthostatic hypotension
A
When conducting health education for a client prescribed an oral penicillin for an infection caused by gram-negative bacilli, the nurse should emphasize which instructions? A) the need to take the medication on an empty stomach B) the fact that a mild rash frequently follows the first few doses C) the need to increase fluid intake for the duration of treatment D) the fact that the drug should be discontinued once symptoms subside
A
A client is prescribed imipenem-cilastatin for the treatment of an E. coli infection. The nurse should be aware that cilastatin is combined with the imipenem for what purpose? A) to eliminate adverse effects of imipenem administration B) to inhibit the destruction of imipenem C) to potentiate the therapeutic effects of imipenem D) to allow imipenem to cross the blood-brain barrier
B
An older adult client, diagnosed with community-acquired pneumonia, has been prescribed aztreonam. What action should the nurse perform before administering the first dose? A) Administer a 500-mL bolus of normal saline. B) Confirm the client's allergy status. C) Swab the client's nares for the presence of MRSA. D) Teach the client to expect discolored urine during treatment.
B
A nurse is assessing a client who has a severe infection and has been receiving cefotaxime for the past week. Which of the following findings indicates a potentially serious adverse reaction to this medication that the nurse should report to the provider? A) Diaphoresis B) Epistaxis C) Diarrhea D) Alopecia
C
A nurse is caring for a client who has a cerebrospinal fluid infection with gram - bacteria. Which of the following cephalosproin antibiotics should the nurse expect to administer IV to treat this infection? A) Cefaclor B) Cefazolin C) Cefepime D) Cephalexin
C
A nurse is preparing to administer a penicillin V to a client who has a streptococcal infection. The client reports difficulty swallowing tablets and doesn't "do well" with liquid or chewable medications because of the taste, even when the nurse mixes the medication with food. The nurse should request a prescription for which of the following medications? A) Fosfomycin B) Amoxicillin C) Nafcillin D) Cefaclor
C
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? A) Take the first dose together with diphenhydramine to reduce the chance of an allergic reaction. B) Take the drug immediately before a meal, unless the meal will contain large amounts of fat. C) Drink a full glass of water when taking a dose of the drug. D) Taper off the drug rather than abruptly stopping it.
C
Which antibiotic is used to treat infections caused by organisms resistant to other drugs, and is typically only used for critical patients? A) Penicillin B) Cephalosporin C) Carbapenems D) Monobactams
C
A client is prescribed penicillin V orally for a strep throat. What is the mechanism of action of this medication? A) It inhibits protein synthesis. B) It lowers the pH of cellular contents. C) It causes mutations. D) It inhibits cell wall synthesis.
D
A client previously experienced an anaphylactic reaction to penicillin G. Which medication should not be administered to this client due to the potential for cross-sensitivity? A) lactulose B) ketoconazole C) kanamycin D) cefadroxil
D
What aspect of a client's history would contraindicate imipenem-cilastatin drug therapy? A) The client has a history of type 1 diabetes mellitus. B) The client is showing signs and symptoms of fluid volume excess. C) The client's most recent creatinine level was 140 mmol/L (high). D) The client has a documented allergy to penicillin.
D
Which medication should be administered as prophylaxis for rheumatic fever? A) cyclacillin B) amoxicillin C) dicloxacillin D) penicillin G benzathine
D
