Chapter 7: Antibacterial Drugs That Disrupt the Bacterial Cell Wall

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 wall synthesis

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

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

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?

These are normal side effects, but if they increase in severity or frequency, you need to contact the office again.

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?

Use a type of barrier birth control while you are taking this antibiotic.

The client is receiving keflex 1000 mg/day. The nurse properly identifies this drug as a:

first-generation cephalosporin.

Penicillins are most effective when used to treat what type of microorganisms?

gram-positive bacteria

Cephalosporins might interfere with the accuracy of which test?

ketone urine test

The nurse is justified in suspecting that a client who recently completed a course of ceftaroline may have been treated for what health problem?

methicillin-resistant Staphylococcus aureus (MRSA) infection

The nurse has administered the first dose of a client's newly-prescribed antibiotic. What assessment finding should the nurse interpret as adverse effect that suggests a more serious concern?

rash to the face and trunk

A nurse is assessing a client who is receiving vancomycin intravenously. While the drug is being administered, the client reports a throbbing sensation in their neck and back and paresthesias. The client's blood pressure has dropped and their neck and back are erythematous. The nurse suspects which adverse finding?

red man syndrome

A client has been started on Augmentin 250 mg P.O. every 12 hr. It is supplied in 500-mg tablets. How much will the nurse give at each dose?

1/2 tablet

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:

1 hour before meals and 2 hours after a meal.

A client diagnosed with infective endocarditis would be most effectively treated with which medication?

Ampicillin

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?

Cefadroxil

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?

Drink a full glass of water when taking a dose of the drug.

A client with sepsis is being treated with penicillin G (aqueous) twice a day. By which route can the nurse anticipate to administer this medication? Select all that apply.

IV IM

A client is prescribed penicillin V orally for a strep throat. What is the mechanism of action of this medication?

It inhibits cell wall synthesis.

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.

A 40-year-old is being treated for an ear infection with a cephalosporin. Which adverse reactions should the nurse monitor for in the client?

Nausea

A client is being treated for urosepsis with ceftriaxone IV. What assessment finding should prompt the nurse to contact the care provider immediately?

The client has a new onset of jaundice and edema

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.

at regular intervals around the clock

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?

bactericidal

A group of nursing students are reviewing information about the different cephalosporins. The students demonstrate understanding of the information when they identify which medication should be administered with food to increase the absorption?

cefuroxime

A group of nursing students are reviewing information about penicillins. The students demonstrate understanding of the information when they identify the action of penicillinase as causing bacterial resistance by which mechanism?

enzymatic inactivation of the penicillin

The nursing instructor is teaching about penicillins in pharmacology class. The instructor informs her students that there are different groups of penicillins. These include which groups? Select all that apply.

natural penicillins penicillinase-resistant penicillins

A 25-year-old woman is being treated with penicillin G as prophylaxis to prevent bacterial endocarditis prior to a dental procedure. The nurse should question the client concerning her the use of:

oral contraceptives.

What event triggers the development of a superinfection?

proliferation of antibiotic-resistant microorganisms

When learning about the different classes of cephalosporins, the nurse correctly identifies which of the following statements?

A first-generation cephalosporin is more useful than a third-generation cephalosporin against gram-positive microorganisms.

Unlike penicillin, most cephalosporins can be taken with food to prevent gastric upset. Which is the only cephalosporin that the nurse would advise NOT to take with food?

ceftibuten

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?

"Make sure to avoid drinking any alcohol for the next three days."

A client has been diagnosed with a sinus infection, and the client has been given a prescription for amoxicillin. What teaching point should the nurse make for the client?

"Take your medication every 8 hours, as it's been prescribed."

A client's prescription reads that the client should receive cefaclor 250 mg orally q 8 hr. The drug is available in the form of a 125-mg tablet. How many tablets should the nurse administer in order to meet the recommended dose and at what time intervals?

2 tablets every 8 hours

Penicillins may trigger an anaphylactic reaction in some clients. Within what period following injection of a penicillin is anaphylaxis most likely to occur?

30 minutes

A client has been prescribed 200 mg of cefpodoxime every 12 hours. On hand are 25-milligram tablets. To meet the prescribed dose, the nurse administers ___________ tablets at each dosage.

8

Culture and sensitivity testing of a client's urine sample reveals a bacterium that is susceptible to cephalosporins. What medication would be most likely for the nurse to administer?

Cefaclor

Which cephalosporins have been implicated in disulfiram-like reactions with alcohol? (Select all that apply)

Cefamandole Cefoperazone Cefotetan

Which drug is a first-generation cephalosporin used as a surgical prophylaxis?

Cefazolin

The male client who had surgery 3 days ago is discharged home after completing his perioperative regimen of cefotetan. A few hours after being home, he drinks a beer. Approximately 5 hours later, the client becomes flushed and nauseated, reports throbbing in the head and neck, begins to sweat, and becomes hypotensive. The client is most likely experiencing what reaction?

Disulfiram-like

Natural penicillins have been available since 1941 to treat infections. What problem has developed since 1941?

Drug-resistant strains of microorganisms have developed.

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?

Fungal superinfection

What potential adverse reaction is most likely to develop during cefazolin therapy?

Gastrointestinal upset

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.

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 effective against gram-positive organisms

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?

Nephrotoxicity

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?

Penicillin

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?

Take the drug with food.

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 has developed a superinfection because the antibiotic has destroyed the normal bacterial flora in his body.

The nursing instructor is teaching about a new emerging bacteria that has both natural and acquired resistance and that affects the severely ill, immunocompromised clients in intensive care, transplant, and some cancer treatment units. This is which?

VRE

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:

can cause allergic reactions in clients who are allergic to penicillins.

The nurse is providing education to a client who has been prescribed oral amoxicillin. The nurse will repeat teaching related to fluid intake if the client indicates that the drug can be taken with what beverage?

orange juice

The nursing instructor is teaching the students about different gastrointestinal adverse reactions to penicillin. What other reactions may occur with this medications administration? (Select all that apply.)

pain at the injection site irritation at the vein phlebitis

A client has been admitted to the pediatric unit with blisters and sores on the face, neck, and hands. The pediatrician suspects impetigo and sends for a culture. The nurse expects the pediatrician to order a drug from which group to treat the infection?

penicillinase-resistant penicillin

The nurse knows that superinfections are a concern for clients who have been taking oral penicillins. Which is one of the more common superinfections?

pseudomembranous colitis

The nurse is aware that drug resistance has significantly increased. Client education must be reinforced so that complete regimens of medications are taken. In which situation would one expect to find an issue with drug resistance?

residents in a long-term care facility

Infections associated with which system are likely to be treated with ciprofloxacin therapy? Select all that apply.

respiratory

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