Ch 19: Drug Therapy with Aminoglycosides and Fluoroquinolones

d) Oral Pg.

1. When preparing to administer a fluoroquinolone, the nurse understands that the majority of drugs belonging to this class are administered by which route? a) Subcutaneous b) Intramuscular c) Topical d) Oral

b)

10. A group of nursing students are reviewing information about fluoroquinolones. The students demonstrate a need for additional review when they identify which as an example? gemifloxacin metronidazole levofloxacin ciprofloxacin

d) Renal function Pg. 378 Amikacin is an aminoglycoside that may cause renal toxicity. Assessing renal function would be a priority. Although the drug can affect the GI tract leading to nausea, vomiting, diarrhea, and weight loss, which could lead to problems with nutrition and cause numbness, tingling and weakness, assessment of GI function, nutritional status, and muscle strength would be considered lower-priority assessments.

11. The nurse is preparing to administer amikacin to a client with a complicated Staphylococcus aureus infection. What assessment should the nurse prioritize? Gastrointestinal function Nutritional status Muscle strength Renal function

a) Pg. 382 The nurse will instruct the client to discontinue the drug immediately and return to the clinic. These are signs and symptoms of a potentially serious photosensitivity reaction. The nurse should never tell the client to change a dosage schedule that involves stopping and starting a drug.

12. A 23-year-old man who works in construction calls the clinic to report that he has a rash all over his body, his skin is red, and it feels like it is burning. The nurse suspects that he is having a photosensitivity reaction from Lomefloxacin (Maxaquin), which was prescribed the day before. The nurse will instruct the client to: discontinue the drug immediately and return to the clinic. decrease the dosage by half until being seen by the health care provider. stop the drug for 3 days and then continue with the prescribed schedule. continue to take the drug; the rash will eventually subside.

b) Lactation Pg. 382 Fluoroquinolones are contraindicated in patients with known allergy to any fluoroquinolone and in pregnant or lactating patients because potential effects on the fetus and infant are not known. Weight, height, and gender are not absolute contraindications to taking fluoroquinolones.

13. What is a contraindication to use of a fluoroquinolone? Gender Lactation Weight Height

c) Peak and trough levels Pg. 379 In patients receiving aminoglycosides, both peak and trough serum levels are measured to maintain therapeutic levels without excessive toxicity. For accuracy, blood samples must be drawn at the correct times and the timing of drug administration and blood sampling must be accurately documented and based on institutional recommendations.

14. Your patient is receiving a multiple-dose regimen of an aminoglycoside. On what serum drug levels will you base the patient's maintenance dose? Mean levels only Mean and trough levels Peak and trough levels Peak levels only

b) Gentamicin Pg. 376 Gentamicin is considered the prototype aminoglycoside.

15. 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? Tobramycin Gentamicin Neomycin Kanamycin

a) Crystalluria b) Azotemia c) Hematuria Pg. 382 With fluoroquinolones, reported renal effects include azotemia, crystalluria, hematuria, interstitial nephritis, nephropathy, and renal failure. Pyuria (pus in the urine) is one of the reasons a fluoroquinolone is prescribed.

16. What renal effects may occur in clients treated with fluoroquinolones? (Select all that apply.) a) Crystalluria b) Azotemia c) Hematuria d) Pyuria e) Glycosuria

a) Gentamicin Pg. 376 Gentamicin is classified as an aminoglycoside. Levofloxacin is a fluoroquinolone; clarithromycin is a macrolide; and cefaclor is a cephalosporin.

17. Which of the following drugs would be classified as an aminoglycoside? Gentamicin Levofloxacin Cefaclor Clarithromycin

c) Hold the next scheduled dose of gentamicin until the health care provider has been consulted Pg. 382 To avoid permanent ototoxic damage, gentamicin should be withdrawn at the first sign of tinnitus or persistent headache. This supersedes the modification of the client's care plan and slowing down the infusion of the drug does not mitigate the potential for ototoxic effects.

18. A 60-year-old male client with a diagnosis of bacteremia is being treated with intravenous gentamicin. After 4 days of treatment, the care team is pleased with the improvement in the client's condition and the effect of the drug treatment on his blood cultures. During morning care, the client has told the nurse that he is having ringing in his ears and woke up this morning with a pounding headache. How should the nurse respond to this client? a) Administer the next scheduled dose of gentamicin over 90 to 120 hours b) Document the client's reports and integrate them into his plan of care c) Hold the next scheduled dose of gentamicin until the health care provider has been consulted d) Continue the gentamicin as ordered and monitor the client's symptoms closely

c) 225 mg Pg. 378 Each dose is limited to 75 mg of gentamicin (30 kg × 2.5 mg/kg = 75 mg). Since three doses will be administered daily (i.e., q8h, or "every 8 hours"), the client will receive a maximum total dose of 225 mg per day.

19. A client is caring for an 8-year-old child who weighs 30 kg. The health care provider orders gentamicin IM for the client. The recommended dosage range is 2-2.5 mg/kg q8h. What is the maximum amount of gentamicin the client will receive in a day? 600 mg 180 mg 225 mg 36 mg

a) Gentamicin Pg.

2. 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? a) Gentamicin b) Kanamycin c) Tobramycin d) Neomycin

b) Pg. 379 Multiple-dose regimens (conventional dosing) of aminoglycosides must be carefully monitored with evaluation of peak and trough serum levels. Once-daily regimens are monitored with random level (12-hour) serum evaluation.

20. A male client develops a wound infection, and the health care provider orders once-daily intravenous multiple-dose regimens of aminoglycosides. What kinds of monitoring does the nurse expect the provider to order? Measurement of electrolytes every 48 hours Peak and trough serum levels A serum albumin determination every 48 hours A complete blood count every 48 hours

c) Pg. 381 Ciprofloxacin (Cipro, Ciloxan) is a fluoroquinolone, a broad-spectrum anti-infective used for UTI, acute sinusitis, bone infections, and anthrax exposure. Levofloxacin is another fluoroquinolone used for community-acquired pneumonia and UTI. It is not in the drug classifications of penicillins, tetracyclines or cephalosporins.

21. A client is prescribed ciprofloxacin for an acute sinus infection. The nurse knows that this anti-infective medication belongs to which drug category? Cephalosporins Penicillins Fluoroquinolones Tetracyclines

a) Pg. 384 The provider should be notified if the client's temperature is greater than 101ºF. The nurse cannot discontinue or administer additional doses without a provider's order. The body's normal defense to infection is an elevated temp until it reaches 101 degrees. Only then would an antipyretic be given if ordered.

22. The client has been taking levofloxacin IV since admission 12 hours ago for a urinary tract infection. The nurse assesses the client's temperature at 99.8ºF. What is the nurse's bestresponse? Continue to monitor vital signs. Administer an extra dose of levofloxacin. Notify the health care provider. Administer an antipyretic.

c) Pg. 382 Antacids, iron salts and zinc can cause decreased absorption of the antibiotic. There is no affect on elimination of the antibiotic.

23. 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? Increased absorption Decreased elimination Decreased absorption Increased elimination

d) Pg. 381 Ciprofloxacin is currently recommended as the first-line treatment for suspected anthrax.

24. Which of the following drugs is likely to be administered as a first-line treatment for anthrax exposure? Tobramycin Gentamicin Norfloxacin Ciprofloxacin

b) Pg. 382-383 If a patient taking vitamins or herbal supplements is prescribed ciprofloxacin, the nurse should advise the patient to take the vitamins at least 2 hours before or after taking ciprofloxacin. Changing or alternating the dosage must be determined by the prescriber.

25. A 45-year-old female patient is prescribed ciprofloxacin to treat a bronchial infection. A nursing assessment revealed that she started taking daily vitamin supplements about 2 years ago. To maximize the therapeutic effects of the ciprofloxacin therapy, the nurse should advise the patient to reduce the dosage of vitamin supplements. take the vitamins at least 2 hours before or after taking ciprofloxacin. alternate the dosage of ciprofloxacin and vitamin supplements. reduce the dosage of vitamin supplements and double the dosage of ciprofloxacin.

c) Pg. The nurse should notify the health care provider if a client's output is less than 750 mL/day when taking an aminoglycoside. Any amount less than 30 mL/hr indicates kidney failure. The other values are within normal expectations.

26. The nurse is assessing the urine output of a client who is receiving an aminoglycoside. The nurse should notify the health care provider if a client's output is less than how many mL/day? 1000 mL/day 1500 mL/day 750 mL/day 2000 mL/day

a) Pg. 381 While ciprofloxacin is typically administered by the PO or IV route, in most cases, oral administration is used. The medication is not administered by either the SQ or IM routes.

27. What route of administration is most commonly used for the administration of ciprofloxacin when prescribed to an older adult client? oral (PO) intramuscular (IM) subcutaneous (SQ) intravenous (IV)

d)

3. You are preparing to discharge a patient who is taking ciprofloxacin. What guidance would you offer this patient to prevent crystalluria? "Take the medication as prescribed." "Limit fluids to a couple of glasses per day." "Do not take antacids." "Drink at least 2 liters of fluids per day."

b)

4. The nurse is providing client teaching before discharging a client home. The client is taking ciprofloxacin. What action should the nurse encourage the client to prioritize? Minimize sodium intake. Drink at least 2L of fluid per day. Avoid all caffeine and alcohol. Eliminate red meat and seafood from the diet.

a) Cheese Pg.

5. The nurse instructs the client who is taking oral ciprofloxacin to avoid which food while taking this medication? Cheese Chicken Tuna Hamburger

allergies

6. Prior to administering fluoroquinolones, it is most important for the nurse to assess for which finding or condition? respiratory function. allergies. hepatic function. vital signs.

a)

7. When discussing nephrotoxicity with an older adult client prescribed gentamicin, the nurse should include what statement? "If nephrotoxicity occurs, it is usually reversible if the drug is stopped." "Clients are at a lower risk for nephrotoxicity when high doses are given for prolonged periods." "Kidney function tests will immediately reveal any decrease in function." "Gentamicin is given for no longer than 30 days unless necessary for the treatment of certain infections."

d)

8. A client with a severe infection has an order for IV gentamicin and IV penicillin. How will the nurse administer these medications? Administer the penicillin and immediately administer the gentamicin. Mix both antibiotics in an IV piggyback and administer over 1 hour. Mix the two antibiotics in one syringe and push it slowly over 5 minutes. Administer the gentamicin IV and wait 1 hour and administer the penicillin.

d)

9. A nurse has been performing vigilant assessments of a patient who is receiving doses of intravenous gentamicin, each over 30 minutes. A blood sample for peak gentamicin levels should be drawn immediately after the third intravenous dose of the drug. as soon as possible after the patient awakens in the morning. at the midpoint between scheduled doses. 30 minutes after the drug has finished infusing.