CH7: Antibacterial Drugs that disrupt the bacterial cell wall
A 64-year-old client is admitted to your unit with exacerbation of chronic heart failure and pneumonia and started on cefixime. On the third hospital day, you are assessing the client and note white patches in his mouth, and he is complaining of diarrhea. What would be the most likely reason for these symptoms? The client is experiencing a reaction caused from his heart medications and the antibiotic therapy. The client is having an allergic reaction to the medication. The client's immune system is not working properly because of the antibiotic therapy. The client has developed a superinfection because the antibiotic has destroyed the normal bacterial flora in his body.
30 minutes Explanation: Anaphylaxis induced by injectable penicillins typically occurs within 30 minutes of administration.
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? Dairy products Tyramine Carbonated beverages Alcohol
Alcohol Explanation: 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 foods containing tyramine would not cause this reaction.
Beta-lactam antibiotics, such as penicillins and cephalosporins, fight infection by inhibiting development of the causative bacteria. What specific component development do these drugs affect? Cell division DNA replication Cell wall synthesis Protein synthesis
Cell wall synthesis Explanation: Beta-lactam antibacterial drugs inhibit synthesis of bacterial cell walls by binding to proteins in bacterial cell membranes. This binding produces a defective cell wall that allows intracellular contents to leak out. These do no affect DNA replication or cell division.
An older adult is to receive a low dose of a cephalosporin for an infection. When realizing that this client has age-related diminished renal function, what intervention should the nurse implement? Monitor blood creatinine levels. Initiate monitoring of intake and output. Hold the drug for lab work. Notify the prescribing provider.
Monitor blood creatinine levels. Explanation: The older adult is more susceptible to the nephrotoxic effects of the cephalosporins, particularly if renal function is already diminished because of the aging process or a disease. With renal impairment, a lower dose can be given and monitoring creatinine levels is indicated. Refusing to give the drug is not necessary nor is immediately notifying the prescriber. Monitoring intake and output will not effectively monitor of nephrotoxicity.
Cephalosporins are structurally and chemically related to which classes of antibiotics? Penicillins Aminoglycosides Fluoroquinolones Tetracyclines
Penicillins Explanation: Cephalosporins are structurally and chemically related to penicillins.
The nursing instructor is teaching students about the uses of cephalosporins. Teaching has been effective when students identify which diseases treated successfully with cephalosporins? Select all that apply. bond/joint infections sexually transmitted diseases gastrointestinal tract infections otitis media respiratory infections
respiratory infections otitis media bond/joint infections gastrointestinal tract infections Explanation: Cephalosporins are used to treat infections caused by bacteria, such as respiratory infections, otitis media, bone/joint infections, and gastrointestinal tract infections. Sexually transmitted infections are normally treated by penicillins and other anti-infectives.
The client is receiving keflex 1000 mg/day. The nurse properly identifies this drug as a: second-generation cephalosporin. fourth-generation cephalosporin. first-generation cephalosporin. third-generation cephalosporin.
Cefadroxil Explanation: Cefadroxil (Duricef) is a first-generation cephalosporin. Administration of cephalosporins or carbapenems should be avoided in individuals with life-threatening allergic reactions to penicillin. Lactulose reduces blood ammonia by resident intestinal bacteria. It is not contraindicated in the event of penicillin anaphylaxis. Ketoconazole is an antifungal and does not possess cross-sensitivity to penicillin. Kanamycin is an aminoglycoside and does not possess cross-sensitivity to penicillin.
The nurse is preparing a teaching plan for a client who is prescribed ceftriaxone. What should the nurse identify as common adverse effects associated with this drug? Diarrhea and nausea Headache and dizziness Superinfections and phlebitis Lethargy and paresthesias
Diarrhea and nausea Explanation: The most common adverse effects associated with ceftriaxone, a cephalosporin, include those affecting the GI tract, such as nausea, vomiting, diarrhea, abdominal pain, and flatulence. Headache, dizziness, lethargy, and paresthesias can occur as well as superinfections and phlebitis (with IV administration), but these are not the most common.
The nurse is administering penicillin to a client who has strep throat. Which of the following statements accurately describe the action of penicillin? It is metabolized in the liver It has many side effects, especially in large doses It is not effective against gram-negative organisms It is effective against gram-positive organisms
It is effective against gram-positive organisms Explanation: Penicillin is most effective against gram-positive organisms, such as streptococci, staphylococci, and pneumococci. It is also active against some gram-negative organisms, such as gonococci and meningococci, and against the organisms that cause syphilis. It is relatively free of side effects, even in larger doses, and is excreted rapidly in the urine.
Some combination antibacterial drugs consist of a penicillin and a beta-lactamase inhibitor. What is the primary purpose of a beta-lactamase inhibitor in one of these drugs? It acts as antiviral agent. It protects the penicillin. It suppresses any allergic reaction. It is the main antibacterial component.
It protects the penicillin. Explanation: By binding with and inactivating the beta-lactamase enzymes produced by many bacteria, the beta-lactamase inhibitor protects the penicillin from destruction by the enzymes and extends the penicillin's spectrum of antimicrobial activity. By themselves, beta-lactamase inhibitors have little antibacterial activity. The combination drugs, however, may be effective in infections caused by bacteria that are resistant to a beta-lactam antibiotic alone.
A young adult has been receiving Keflex P.O. for the last 5 days to treat a respiratory infection. The nurse is concerned when the client reports urinating only once in the last 16 hours. What should the nurse consider as the cause? Superinfection Systemic dehydration Nephrotoxicity Steven-Johnson syndrome
Nephrotoxicity Explanation: Nephrotoxicity may develop from administration of cephalosporins. An early sign of this adverse reaction is decreased urine output. The nurse should measure and record fluid intake and output and notify the primary healthcare provider if output is less than 500 ml/day. Decreased urine output is not a sign of Steven-Johnson syndrome. It also is not indicative of a superinfection. There is no indication of dehydration existing.
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. with meals at regular intervals upon rising in the am around the clock at bedtime
at regular intervals around the clock Explanation: Clients should aim to take penicillins at even intervals, preferably around the clock. These drugs are not normally taken with food.
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? stop the infusion and administer a bolus of normal saline report the rash to the primary health care provider attempt to differentiate a hypersensitivity reaction from a nonallergic ampicillin rash immediately apply a topical corticosteroid to the affected region
attempt to differentiate a hypersensitivity reaction from a nonallergic ampicillin rash Explanation: 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 concentration of any drug in the body is referred to as which of the following? percentage degree ratio blood level
blood level Explanation: The concentration of any drug in the body is referred to as the blood level. An inadequate concentration (or inadequate blood level) of penicillin may produce bacteriostatic activity, which may or may not control the infection.
The health care provider is selecting an antibiotic for a client with a known penicillin allergy. The provider knows that cephalosporins are a poor choice for this client because cephalosporins: are ineffective in clients who are allergic to penicillins. can cause allergic reactions in clients who are allergic to penicillins. can cause kidney damage in clients who are allergic to penicillins. are derived from penicillin.
can cause allergic reactions in clients who are allergic to penicillins. Explanation: Clients who are allergic to penicillins may also be allergic to cephalosporins. Although this cross-allergenicity (allergy to a drug of another class with similar chemical structure) is rare, cephalosporins are not typically administered to clients who have had life-threatening allergic reactions to a penicillin.
Penicillins are most effective when used to treat what type of microorganisms? gram-negative bacilli gram-positive bacteria gram-negative bacteria fungal infections
gram-positive bacteria Explanation: 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. This information makes the remaining options incorrect. Bacilli are a type of bacteria.
The client is admitted to the acute care facility with acute septicemia and has orders to receive gentamicin and ampicillin IV. The nurse is performing an admission assessment that includes a complete nursing history. What information provided by the client would indicate the need to consult the healthcare provider before administering the ordered medication? takes high-dose furosemide daily allergy to peanuts and peanut products had prostate surgery 3 months ago history of hypothyroidism
takes high-dose furosemide daily Explanation: Aminoglycosides should be avoided if the client takes a potent diuretic because of the increased risk of ototoxicity, nephrotoxicity, and neurotoxicity. Learning the client takes a potent diuretic would indicate the need to consult with the healthcare provider before administering gentamicin. Prostate surgery, hypothyroidism, and an allergy to peanuts would not preclude administration of these medications and would not indicate a need to consult with the provider.
A 4-year-old client being discharged from the hospital is ordered an oral-suspension cephalosporin. When the nurse instructs the mother to store the bottle in the refrigerator, the mother asks, "Why does that matter?" The nurse's best response would be which? 1) "Storing this drug at room temperature will cause it to thicken and harden." 2) "It's important to follow what the directions say." 3) "The refrigerator is convenient and a way to track the medicine's whereabouts." 4) "Drugs that require refrigeration lose potency if kept at room temperature."
"Drugs that require refrigeration lose potency if kept at room temperature." Explanation: Refrigeration will ensure that the drug does not lose its potency as it will if kept at room temperature. It is imperative that the nurse relays this rationale to the client's mother so she understands the importance of following the directions for storage of the medication. It will not thicken and harden, just lose potency. Mothers usually keep track of medications for their children as they do not want any harm to come to them.
The nurse is giving instructions to a client who is being discharged home with a prescription for Augmentin. The nurse informs the client that the best time to take this medication is: first thing in the morning. with meals. 1 hour before meals and 2 hours after a meal. at bedtime.
1 hour before meals and 2 hours after a meal. Explanation: When taking penicillin of any kind, the drug should be administered at least 1 hour before or 2 hours after a meal.
Which cephalosporins have been implicated in disulfiram-like reactions with alcohol? (Select all that apply) Cefamandole Cefotetan Cefoperazone Cephalexin Cefuroxime
Cefamandole Cefoperazone Cefotetan Explanation: Cefamandole, cefoperazone, and cefotetan have been implicated in disulfiram-like reactions with alcohol.
The nurse is caring for a client whose prescribed course of cefaclor will soon be completed. What health education should the nurse provide to the client? "You might develop a mild fever when you finish your antibiotics, but that doesn't mean your infection has returned." "Remember to have your required blood work drawn in 48 hours." "Make sure to avoid drinking any alcohol for the next three days." "It's possible that your urine might be pink-tinged for the next little while, but that's expected and it will resolve."
"Make sure to avoid drinking any alcohol for the next three days." Explanation: To avoid a disulfiram-like reaction when alcohol and cephalosporins are used together, the client should avoid consuming alcoholic beverages for at least 72 hours after completing the drug course. Pink-tinged urine is not expected and a fever would be clinically significant. There is not normally any need for follow-up blood work.
Penicillin would NOT be indicated for which of the following clients? A client with gram-negative bacteria allergic to tetracycline A client with gram-negative bacteria allergic to penicillin A client with a mixture of gram-positive and gram-negative bacteria A client with gram-negative bacterial infection allergic to sulfa
A client with gram-negative bacteria allergic to penicillin Explanation: Contraindications include hypersensitivity or allergic reactions to any penicillin preparation. An allergic reaction to one penicillin means the client is allergic to all members of the penicillin class. The potential for cross-allergenicity with cephalosporins exists, although recent data suggest that the incidence is less than 1%, lower than previously thought. Administration of cephalosporins should be avoided in individuals with life-threatening allergic reactions to penicillin (anaphylaxis, laryngeal swelling angiedema, or hives).
A client diagnosed with infective endocarditis would be most effectively treated with which medication? Oxacillin Dicloxacillin Ampicillin Nafcillin
Ampicillin Explanation: Health care providers use ampicillin in the treatment or prophylaxis of infective endocarditis. Ampicillin is effective against bacterial infections. Dicloxacillin, nafcillin, and oxacillin are typically used to treat methicillin-resistant Staphylococcus aureus.
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? Kanamycin Cefadroxil Lactulose Ketoconazole
Cefadroxil Explanation: Cefadroxil is a cephalosporin. Administration of cephalosporins or carbapenems should be avoided if possible in people with life-threatening allergic reactions to penicillin. Lactulose reduces blood ammonia by resident intestinal bacteria. It is not contraindicated in the event of penicillin anaphylaxis. Ketoconazole is an antifungal and does not possess cross-sensitivity to penicillin. Kanamycin is an aminoglycoside and does not possess cross-sensitivity to penicillin.
Natural penicillins have been available since 1941 to treat infections. What problem has developed since 1941? Enzymes have become involved in bacterial cell wall synthesis. Drug-resistant strains of microorganisms have developed. Penicillins now can inhibit cell wall synthesis. Cell wall synthesis can now destroy the cell.
Drug-resistant strains of microorganisms have developed. Explanation: Because natural penicillins have been used for many years, drug-resistant strains of microorganisms have developed, making the natural penicillins less effective than some newer antibiotics. Enzymes known as PBPs are involved in bacterial cell wall synthesis and cell division. Interference with these processes inhibits cell wall synthesis, causing rapid destruction of the cell.
A client taking a cephalosporin for a respiratory infection informs the nurse that her tongue feels funny and has white patches on it. She asks the nurse what could be wrong. The nurse informs the client that she has developed which? Adverse drug reaction Complication from the respiratory problem Poor dental hygiene Fungal superinfection
Fungal superinfection Explanation: A fungal superinfection commonly occurs in the mouth, vagina, and anogenital areas. Common signs of an oral fungal infection are creamy, white, lace-like patches on the tongue, mouth, or throat. The other options are not appropriate choices as the causes for these signs and symptoms.
What potential adverse reaction is most likely to develop during cefazolin therapy? Gastrointestinal upset Dry skin and pruritus Drowsiness Orthostatic hypotension
Gastrointestinal upset Explanation: Adverse effects to cefazolin and the other cephalosporins are similar to those of most other antibiotics: abdominal pain, diarrhea, gastritis, nausea, and vomiting because of its effect on the gastrointestinal lining. Integumentary, neurological, and blood pressure changes are atypical.
A nurse correctly identifies which as contraindications and precautions when administering cephalosporins? Select all that apply. History of allergy to penicillin, cephalosporins, or both Pregnancy Bleeding disorder Hepatic impairment Renal disease Diabetes
History of allergy to penicillin, cephalosporins, or both Hepatic impairment Bleeding disorder Renal disease Pregnancy Explanation: The nurse should not administer cephalosporins if the client has a history of allergies to them or to penicillin. Cephalosporins should be used cautiously in clients with renal disease, hepatic impairment, bleeding disorder, and pregnancy. Diabetes is not a contraindication for using cephalosporins.
A 34-year-old female client is taking oral cephradine, a first-generation cephalosporin, at regular intervals with a 2-hour gap before meals. The client reports gastrointestinal distress. The nurse will encourage the client to do which? Change the drug dosage. Drink plenty of fluids. Avoid dairy products Take the drug with food.
Take the drug with food. Explanation: Oral forms of cephradine are best taken with food to reduce GI distress. Drinking plenty of fluids will help maintain the fluid balance but will not deter cephradine absorption in the body. Altering the drug dosage would not have any effect if the client takes the medication on an empty stomach. The IV route is recommended only if the client cannot retain the oral form of the drug and could not be self-administered.
A client is taking penicillin for an upper respiratory infection. The client calls the office after 2 days of therapy reporting nausea and abdominal pain. Which would be the best instruction for the nurse to give the client? 1) Stop the medication immediately and go to the emergency room; these could be signs of a life-threatening reaction. 2) Stop the medication and the health care provider will order you a different antibiotic. 3) Continue to take the medication as prescribed; these are expected side effects from the medication. 4) These are normal side effects, but if they increase in severity or frequency, you need to contact the office again.
These are normal side effects, but if they increase in severity or frequency, you need to contact the office again. Explanation: The client is having an adverse effect from the medication, which is not life threatening. The best advice to the client would be to continue to take the medication as prescribed and report any worsening of the symptoms. The most serious adverse effect of penicillin G is allergic reaction: rash, fever, and wheezing, and possibly anaphylaxis and death. More common adverse effects of penicillin therapy involve the GI tract: nausea, vomiting, diarrhea, abdominal pain, glossitis, stomatitis, gastritis, sore mouth, and furry tongue. These effects are primarily related to the loss of normal flora (naturally occurring bacteria in the body) and subsequent opportunistic infections.
The nurse is caring for a 23-year-old female client who uses oral contraceptives and has been prescribed ampicillin for treatment of a respiratory infection. What information is most important for the nurse to share with this client? Do not take your oral contraceptives while you are taking this medication. Taking this antibiotic with your oral contraceptives will cause an increased chance of bleeding. Your menstrual cycle will have a heavier flow while on this medication. Use a type of barrier birth control while you are taking this antibiotic.
Use a type of barrier birth control while you are taking this antibiotic. Explanation: Clients taking oral contraceptives should be encouraged to use a barrier type of birth control during penicillin therapy; the penicillin will cause a decreased effectiveness of the contraceptive agent. The client should not be told to stop taking the oral contraceptive. This will not cause a heavier menses. The interaction between oral contraceptives and ampicillin will not cause an increased chance of bleeding, as that interaction is between large doses of penicillins and anticoagulants.
After teaching a group of nursing students about the action of penicillins, the instructor determines that the teaching was effective when the students identify natural penicillins as exerting which type of effect on microorganisms? fungicidal bacteriostatic bactericidal fungistatic
bactericidal Explanation: Natural penicillins exert a bactericidal effect on bacteria. Because penicillin targets bacterial cells, it is of no value to treat fungal infections as it is neither fungicidal nor fungistatic. Since it targets the bacterial cell wall to destroy the bacteria, it does not inhibit growth as in bacteriostatic.
What event triggers the development of a superinfection? 1) bone marrow suppression triggered by antibiotic treatment 2) complete establishment of the infection prior to initiation of antibiotic therapy 3) unforeseen interactions between the antibiotic and other prescribed medications 4) proliferation of antibiotic-resistant microorganisms
proliferation of antibiotic-resistant microorganisms Explanation: 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.
A client is administered a third-generation cephalosporin. The broad-spectrum agents like cephalosporins are most effective in treating which type of microorganism? Gram positive Gram negative Fungi Virus
Gram negative Explanation: Cephalosporins are broad-spectrum agents with activity against both gram-positive and gram-negative bacteria. But they are, in general, less active against gram-positive organisms and more active against gram-negative ones. Cephalosporins are not effective against fungi or viruses.
A male client who has undergone surgery of the urinary tract is administered cephalosporins to prevent infections. When assessing the client on the day after the surgery, the nurse notices that he has an elevated temperature. Which nursing intervention would be most appropriate in this case? Inform the primary health care provider. Administer a higher dosage of the drug. Record the client's fluid intake. Discontinue use of the drug.
Inform the primary health care provider. Explanation: The nurse should immediately report an increase in the client's body temperature to the primary health care provider. The nurse should consult the provider before increasing, decreasing, or discontinuing the dosage. The nurse should measure and record the fluid intake if there is a decrease in the urine output.
Cephalosporins might interfere with the accuracy of which test? HIV test A1C test cholesterol test ketone urine test
ketone urine test Explanation: Clients with diabetes who use urine ketone testing for determining diabetes medication dosing and who are prescribed cephalosporins need to be aware that this drug may interfere with the accurate test results. Cephalosporins do not interfere with blood testing such as with HIV, cholesterol, or A1C.
Penicillins may trigger an anaphylactic reaction in some clients. Within what period following injection of a penicillin is anaphylaxis most likely to occur? 15 minutes 30 minutes 10 minutes 45 minutes
30 minutes Explanation: Anaphylaxis induced by injectable penicillins typically occurs within 30 minutes of administration.
A male client who has undergone surgery of the urinary tract is administered cephalosporins to prevent infections. When assessing the client on the day after the surgery, the nurse notices that he has an elevated temperature. Which nursing intervention would be most appropriate in this case? Discontinue use of the drug. Record the client's fluid intake. Inform the primary health care provider. Administer a higher dosage of the drug.
Inform the primary health care provider. Explanation: The nurse should immediately report an increase in the client's body temperature to the primary health care provider. The nurse should consult the provider before increasing, decreasing, or discontinuing the dosage. The nurse should measure and record the fluid intake if there is a decrease in the urine output.
Michael, 25 years old, has had mitral valve regurgitation since age four, after having rheumatic fever. Michael is planning to go to his dentist to have his teeth cleaned. Because of Michael's history he will need to take antibiotics in conjunction with this procedure to prevent bacteremia. Which class of antibiotics will Michael most likely receive if he has no allergies? Cephalosporin Vancomycin Tetracycline Penicillin
Penicillin Explanation: Penicillin G may also be used as prophylaxis in special patient populations to prevent bacterial endocarditis prior to procedures likely to produce temporary bacteremia, such as dental procedures. These patients include those with prosthetic heart valves, mitral valve prolapse, most congenital heart diseases, and acquired valvular heart disease. It may also be used as prophylaxis in patients with recurrent rheumatic fever or rheumatic heart disease.
A 36-year-old client with a history of rheumatic fever is scheduled for dental surgery. The primary care provider orders this client to take penicillin for 3 days before and for 3 days after surgery. This is a case of which type of therapy? Prophylaxis Tertiary Secondary Primary
Prophylaxis Explanation: Providers often prescribe penicillin as prophylaxis (prevention) against a potential secondary bacterial infection when a client has a viral infection; however, penicillin also can be prescribed as prophylaxis for a potential infection in high-risk clients, such as those with a history of rheumatic fever. Penicillin is taken several hours or in some cases several days before and after an operative procedure, such as dental, oral, or upper respiratory tract procedures, that can result in bacteria entering the bloodstream. Primary, secondary, and tertiary are terms used for type of care clients receive.
A 64-year-old client is admitted to your unit with exacerbation of chronic heart failure and pneumonia and started on cefixime. On the third hospital day, you are assessing the client and note white patches in his mouth, and he is complaining of diarrhea. What would be the most likely reason for these symptoms? The client is experiencing a reaction caused from his heart medications and the antibiotic therapy. The client is having an allergic reaction to the medication. The client's immune system is not working properly because of the antibiotic therapy. The client has developed a superinfection because the antibiotic has destroyed the normal bacterial flora in his body.
The client has developed a superinfection because the antibiotic has destroyed the normal bacterial flora in his body. Explanation: Superinfections are also common with cephalosporin use. As with the penicillins, this adverse effect is related to the normal flora having been destroyed. Antibiotic therapy helps the body's natural immune system work to fight infections. Some heart medications may interact with antibiotics, but there is not enough information in the question to draw this conclusion.
