Ch. 19 prep U

Which of the following drugs is likely to be administered as a first-line treatment for anthrax exposure?

Ciprofloxacin

A 75-year-old male client is diagnosed with an infection. He is currently being treated for type 2 diabetes, hypertension, benign prostatic hypertrophy, and chronic congestive heart failure. If the health care provider orders a fluoroquinolone to treat the infection, the nurse understands that what adverse effects can occur in this client?

Hypoglycemia and hyperglycemia. Fluoroquinolones are associated with hyperglycemia and hypoglycemia, and older clients may be more at risk for these glucose disturbances.

The pharmacology instructor is discussing ways to decrease adverse effects on clients taking aminoglycosides. Which would the instructor include?

Keeping the client well hydrated

Which of the following are examples of fluoroquinolones? Select all that apply.

Levofloxacin (Levaquin) Ciprofloxacin (Cipro)

The client has been prescribed a drug that must be taken on an empty stomach. The nurse knows that to administer a medication on an empty stomach, it is given in which way?

One hour prior to a meal or two hours after the meal

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

Ototoxicity and nephrotoxicity. 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.

A client is prescribed ciprofloxacin for a urinary tract infection. The nurse is preparing to teach the client about the medication. What must the nurse include in the education plan?

Take precautions to prevent photosensitivity.

Aminoglycosides must be used cautiously in children as in adults. Dosage must be accurately calculated according to which factors?

Weight and renal function

Prior to administering fluoroquinolones, it is most important for the nurse to assess for which finding or condition?

allergies.

A client with a gram-negative bacterial infection has been prescribed a fluoroquinolone. During the preadministration assessment, the nurse should ensure that which laboratory tests, if prescribed, are obtained before the first dose of fluoroquinolones is administered to the client?

culture and sensitivity test

What route of administration is most commonly used for the administration of ciprofloxacin when prescribed to an older adult client?

oral (PO)

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

take the vitamins at least 2 hours before or after taking ciprofloxacin. 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.

The nurse should monitor a client for which finding when aminoglycosides are administered concomitantly with furosemide? Select all that apply.

tinnitus vertigo Furosemide is a loop diuretic. Therefore, the nurse should be especially careful to monitor clients for ototoxicity (tinnitus, dizziness, roaring in the ears, vertigo, and mild to severe hearing loss) when aminoglycosides are used concomitantly with furosemide. Proteinuria and hematuria are seen with nephrotoxicity and are serious adverse reactions of aminoglycosides alone. Numbness is seen in neurotoxicity.

Levofloxacin 750 mg IV is ordered for a client with a urinary tract infection. The medication is to mixed yielding 250 mg/15 mL. How many mL should be drawn up in the syringe?

45

Which of the following classes of antibiotics is a direct inhibitor of DNA synthesis in bacteria?

Fluoroquinolones. Fluoroquinolones directly affect DNA synthesis in bacteria. Macrolides and ketolides inhibit bacterial protein synthesis. Penicillins interfere with cell wall synthesis.

You are preparing to discharge a patient who is taking ciprofloxacin. What guidance would you offer this patient to prevent crystalluria?

"Drink at least 2 liters of fluids per day." Crystalluria is a potential side effect of taking fluoroquinolones such as ciprofloxacin. Patients should be instructed to drink two to three quarts of fluids each day to decrease the risk of developing the condition. Although the nurse should instruct the patient to take the medication as prescribed and to avoid antacids, which can decrease absorption of the medication, neither measure will prevent crystalluria.

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

30 minutes after the drug has finished infusing. Blood for peak levels of gentamicin is drawn 30 minutes after the completion of a 30-minute intravenous (IV) administration or immediately after a 60-minute IV administration and 45 to 60 minutes after intramuscular (IM) administration. Blood for trough levels is drawn just before the next dose.

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

Culture and sensitivity

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

The ICU nurse is caring for a patient who is receiving a fluoroquinolone. The nurse knows that which of the following decreases absorption of the fluoroquinolone if given concomitantly?

Enteral feedings

The nursing student correctly identifies the class of drugs that exerts their bactericidal effect by interfering with the synthesis of bacterial DNA, thus preventing cell reproduction and leading to death of the bacteria, as which of the following groups?

Fluoroquinolones. The fluoroquinolones exert their bactericidal effect by interfering with the synthesis of bacterial DNA. This interference prevents cell reproduction, leading to death of the bacteria. Penicillins work by inhibiting the bacterial cell activitites including cell wall synthesis, DNA or RNA synthesis, and protein synthesis. The sulfonamides are bacteriostatic and work by inhibiting the activity of folic acid in bacterial cell metabolism. Finally the cephalosporins have a beta-lactam ring and target the bacterial cell wall, making it defective and unstable.

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

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

Gentamicin

A client in the critical care unit is receiving aminoglycosides for an infectious process. What does the nurse need to monitor?

Liver function tests. Because critically ill clients are at high risk for development of nephrotoxicity and ototoxicity with aminoglycosides, guidelines for safe drug use should be strictly followed. Renal function should be monitored to assess for needed dosage reductions in clients with renal dysfunction who are receiving aminoglycosides or fluoroquinolones. Because fluoroquinolones may be hepatotoxic, hepatic function should be monitored during therapy.

When preparing to administer a fluoroquinolone, the nurse understands that the majority of drugs belonging to this class are administered by which route?

Oral. Most fluoroquinolones are administered orally; levofloxacin and moxifloxacin may also be given intravenously.

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

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.

A local Bioterrorism Medical Team is learning about germ warfare. The team is instructed that a fluoroquinolone may be used to prevent an outbreak of anthrax. What fluoroquinolone would most likely be used?

Ciprofloxacin (Cipro). Ciprofloxacin (Cipro) is the most widely used fluoroquinolone and is indicated for the prevention of anthrax infection. Gemifloxacin and sparfloxacin are most useful in treating acute episodes of chronic bronchitis and community-acquired pneumonia. Norfloxacin is recommended only for certain urinary tract infections.

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?

Peak and trough serum levels

A young lifeguard has been prescribed moxifloxacin (Avelox). The nurse understands that the focus on education would be which adverse reaction?

Photosensitivity

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

"I will only drink enough water to swallow the drug." 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 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?

225 mg

A client with a severe infection has an order for IV gentamicin and IV penicillin. How will the nurse administer these medications?

Administer the gentamicin IV and wait 1 hour and administer the penicillin. Gentamicin and penicillin should never be administered in the same syringe or the same solution. When both antibiotics are prescribed for the client, they must be administered at separate times using Y tubing.

You are writing a plan of care for a patient taking an oral fluoroquinolone. What would be an appropriate intervention to include in this plan?

Avoid concomitant use of nephrotoxic drugs.

The nurse instructs the client who is taking oral ciprofloxacin to avoid which food while taking this medication?

Cheese. Clients taking oral ciprofloxacin should avoid calcium-containing foods while taking this medication.

Clients at increased risk for adverse reactions to either aminoglycosides or fluoroquinolones include all of the following EXCEPT:

Clients with anemia. Identify patients at high risk for adverse effects (eg, neonates, older adults, patients with renal impairment, patients with disease processes or drug therapies that impair blood circulation and renal function).

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

Fluoroquinolones. 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.

Once-daily aminoglycoside (ODA) dosing has replaced multiple daily dosing in many patients. What is the rationale behind ODA dosing?

Higher efficacy with less nephrotoxicty.

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?

Hold the next scheduled dose of gentamicin until the health care provider has been consulted. 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.

Which of the following medications is contraindicated in children?

Levofloxacin. Fluoroquinolones are contraindicated in clients who are younger than 18 years of age.

The nurse is preparing to administer amikacin to a client with a complicated Staphylococcus aureus infection. What assessment should the nurse prioritize?

Renal function. 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.

A client with a gram-negative infection is being treated with an aminoglycoside. What system should the nurse expect to be tested daily while on this medication?

Renal system. Renal function should be tested daily because aminoglycosides depend on the kidney for excretion and if the GFR is abnormal it may be toxic to the kidney. The results of the renal function testing could change the daily dosage. Aminoglycosides do not usually adversely affect respiratory, hepatic, or musculoskeletal function; although baseline data concerning these systems is always needed.

A 72-year-old client has been prescribed ciprofloxacin. What instruction for home care has the highest priority?

Take this medication with extra fluid. Ciprofloxacin in the older adult should be taken with extra fluid to prevent the development of crystalluria. It may be taken with food or on an empty stomach, and it should not be taken with an antacid.

Your client is scheduled to undergo major abdominal surgery. A preoperative order for neomycin has been given. Neomycin is used preoperatively for the following reason:

To suppress intestinal bacteria.

The nurse should advise the client to avoid taking which medication at the same time as a fluoroquinolone?

antacids. The client should not take antacids or drugs containing iron or zinc at the same time as taking a fluoroquinolone because these drugs will decrease the absorption of the fluoroquinolones. There are no listed contraindications of giving fluoroquinolones with antihypertensives, antidiabetic agents, or oral contraceptives.

When describing the action of fluoroquinolones to treat infection to a group of nursing students, which action would the instructor most likely include?

bactericidal

When administering a fluoroquinolone intravenously, the nurse should check the vital signs at which frequency?

every 4 hours

A 54-year-old woman with a history of osteoporosis has been prescribed ciprofloxacin for recurrent cystitis. Because of the patient's history, the nurse would be sure to discuss with the woman the use of

food containing iron or calcium.Patients who take ciprofloxacin should avoid taking the drug with food that contains iron, calcium, magnesium, and other cations because the presence of these elements may reduce the bioavailability of ciprofloxacin.

After teaching a group of students about the indications for use for aminoglycosides, the instructor determines that the teaching was successful when the students identify which type of infection as a primary indication?

gram-negative infections

A nursing instructor is preparing a teaching plan for a nursing pharmacology class on the action of fluoroquinolones. Which action would the instructor most likely include?

interfering with DNA synthesis in the bacterial cell

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?

metronidazole. Metronidazole is not an example of a fluoroquinolone. Ciprofloxacin is an example of a fluoroquinolone. Levofloxacin is an example of a fluoroquinolone. Gemifloxacin is an example of a fluoroquinolone.

A client is prescribed ciprofloxacin 500 mg PO twice a day. When would the nurse most likely administer the drug?

twice daily PO, 2 hours after the meal.

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 best response?

Continue to monitor vital signs.

Fluoroquinolones, such as norfloxacin (Noroxin), are commonly prescribed antibiotics given to treat which of the following?

Urinary tract infections

The client has been taking a fluoroquinolone and now reports that he has a white patch in his mouth. What is the best response of the nurse?

"You may be experiencing an additional infection. I will discuss this with your health care provider." A burning sensation of the mouth or throat may be an indication of a superinfection. It is important the nurse notify the provider. The nurse should not minimize the client's concerns or cause panic

An 85-year-old client has been diagnosed with a drug-resistant urinary tract infection. The client has been started on a regimen of aminoglycosides. The client is concerned about adverse reactions such as nephrotoxicity. When providing client education about the medication, the nurse would state:

If nephrotoxicity occurs, it is usually reversible if the drug is stopped.

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

increase fluid intake.

It would be most important for a nurse to monitor which client for ototoxicity while on gentamicin therapy?

A 25-year-old male who has a hearing impairment. Clients with a history of hearing impairment and 8th cranial nerve impairment have an elevated risk of ototoxicity. Gentamicin may aggravate muscle weakness in those with Parkinson disease. The drug is contraindicated during pregnancy and lactation, so the therapy would be discontinued in those clients.

A male client is concerned that he cannot afford to have his wife's community-acquired pneumonia (CAP) treated in the hospital. He has limited health insurance, and the cost of intravenous antibiotic therapy is prohibitive. According to the American College of Chest Physicians' position statement, where will the client's wife be treated?

In the home using oral drugs

A client is being given a prescription for ciprofloxacin (Cipro) to treat a urinary tract infection. The nurse should warn the client about which of the following common adverse reactions? (Select all that apply.)

Nausea Headache Dizziness

A male client is NPO as a consequence of a cerebrovascular accident sustained 3 years ago. His care is managed at home by his wife, and he receives all medications via gastrostomy tube. The health care provider orders a fluoroquinolone for the client to treat an infection. The nurse would instruct the client's wife to administer the medication in what way?

On an empty stomach. Fluoroquinolones are usually infused IV in critically ill clients. However, administration orally or by GI tube (e.g., nasogastric, gastrostomy, jejunostomy) may be feasible in some clients. Concomitant administration of antacids or enteral feedings decreases absorption.

The health care provider orders an aminoglycoside for a ventilator-dependent client who is admitted to the critical care unit. The client's current diagnoses include respiratory arrest, type 2 diabetes, hepatitis C, and chronic obstructive pulmonary disease. Which statement indicates the risk of using this class of medication in this client?

Risk for hepatic impairment is not significant, because the drug is excreted through the

A 30-year-old woman who is in the first trimester of pregnancy has presented to her primary care provider with a 4-day history of a reddened, itchy left eye that is crusted with purulent exudate. The clinician suspects a bacterial, rather than viral, etiology. How will the client's pregnancy affect the potential use of ciprofloxacin to treat her conjunctivitis?

The use of ciprofloxacin is contraindicated in pregnancy.