Chapter 9-Antibiotics
A client has been on an antibiotic for two weeks for treatment of an infection. The client asks the nurse why a superinfection has been caused by this medication. What is the nurse's best response?
"Antibiotics can disrupt the normal bacteria in your body, causing another infection to occur."
The health care provider is preparing to order rifampin and pyrazinamide for a female client with active tuberculosis. What question should the provider ask this client before confirming this order?
"Are you pregnant?"
A client has been prescribed INH for the treatment of tuberculosis. The nurse teaches the client about dietary restrictions while taking this medication. What is the most important instruction?
"Do not drink beer or red wine while taking this medication because a serious adverse reaction can occur."
A client diagnosed with infective endocarditis would be most effectively treated with which medication?
Ampicillin
Which of the following would a nurse identify as being classified as a macrolide?
Azithromycin
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 health care provider has prescribed ciprofloxacin. For which client would you contact the provider to clarify the order because the medication is contraindicated? (Select all that apply.)
Children younger than 18 Pregnant and lactating mothers
What should the pre-administration assessment of any antitubercular drug include?(Select all that apply.)
Culture and sensitivity testing Complete blood count Family and contacts history Radiographic studies Medication history
Clients with tuberculosis that do not respond to the primary anti-TB drugs such as INH, may need to undergo therapy using second-line defense drugs. Which medication is a second-line drug?
Cycloserine
A client is taking clindamycin for an infectious process and presents to the health care provider's office with symptoms of dehydration. The nurse understands that the client is experiencing what adverse reaction from the administration of clindamycin?
Diarrhea
The tetracyclines are effective against a wide range of which type of organisms?
Gram-positive and gram-negative organisms
Your client is currently taking aminoglycosides. You know that this type of medication is used in all of the following microorganisms, EXCEPT:
Gram-positive cocci.
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.
Cephalosporins are structurally and chemically related to which classes of antibiotics?
Penicillins
A client has been prescribed lomefloxacin (Maxaquin) for a respiratory infection. What must the nurse closely monitor for in this client?
Photosensitivity
The nurse is teaching a client about his prescription for a macrolide antibiotic. What should the nurse teach the client to report?
Recurring symptoms of infection
A client is started on sulfamethoxazole-trimethoprim for a urinary infection. What adverse effect should the nurse assess with this client?
Renal damage
Prior to and following a transurethral prostatic resection (TUPR), a 73-year-old man has been scheduled to receive a total of five intravenous doses of cefazolin. Which of the following nursing diagnoses should the nurse associate with this antibiotic therapy?
Risk for Infection related to overgrowth of nonsusceptible organisms
A client is receiving a cephalosporin and an aminoglycoside as combination therapy. What assessment should the nurse prioritize?
Serum BUN and creatinine levels
A young adult client's acne has responded well to treatment with tetracycline. However, the client has now returned to the clinic 6 weeks later with signs and symptoms of oral candidiasis. The nurse should recognize that this client's current health problem is likely attributable to which occurrence?
Superinfection following the eradication of normal oral flora
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.
A 49-year-old client is diagnosed with TB. The client has a history of alcoholism but has been sober for 3 months now. The client has been prescribed INH. What should the nurse ensure is obtained before initiating the therapy?
baseline liver function test values
A client prescribed rifaximin for diarrhea has developed frank bleeding in the stool. What intervention should the nurse anticipate being implemented to best ensure client safety?
changing to a different antibiotic
The client has been prescribed a fluoroquinolone. The nurse knows that nursing interventions for clients taking fluoroquinolones include which?
increase fluid intake.
A client comes to the clinic for a follow-up visit. The nurse notes a sunburn-like appearance to the client's skin. The client's history reveals the use of ciprofloxacin. The nurse interprets which adverse effect regarding this finding?
photosensitivity
A 7-year-old child has been taking tetracycline for a bacterial infection. The nurse will be sure to inform the parents that this drug could cause
staining of permanent teeth.
Tetracyclines should not be used in children younger than 8 years of age because of their effects on:
teeth and bones.
A client comes to the emergency department reporting a throbbing headache, nausea, vomiting, chest pain, dyspnea, vertigo, and blurred vision. The client reveals taking cefaclor for an infection. Which question would the nurse ask next?
"Have you had any alcohol to drink in the past 72 hours?"
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's upper respiratory infection is believed to be bacterial so the health care provider has prescribed amoxicillin 500 mg PO q8h. How should the nurse best interpret this prescription?
It aligns with the recommended dose, route and indication for this medication
Which of the following medications is contraindicated in children?
Levofloxacin
A client is receiving rifampin and isoniazid in combination for treatment of tuberculosis. What would the nurse need to monitor closely?
Liver function studies
The nurse is caring for a client who is on sulfonamide therapy and monitors the client for which common side effects? (Select all that apply.)
Nausea Diarrhea Photosensitivity
The nurse is caring for a client taking sulfonamides. The nurse observes sloughing of the skin and mucous membranes. The nurse suspects which hypersensitivity reaction?
Toxic epidermal necrolysis
When a person is diagnosed with tuberculosis, it is most likely that the nurse prepares the family members to be treated prophylactically with which drug?
isoniazid
A 43-year-old man has been diagnosed with active TB. He is prescribed a multiple drug therapy, including INH and rifampin. A priority assessment by the nurse will be to monitor which combination of laboratory test results?
Serum alanine transaminase, aspartate transaminase, and bilirubin
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."
Extreme caution would be necessary with the use of gentamicin in which client?
A client who has chronic renal failure secondary to diabetes mellitus
A client receiving isoniazid (INH) and rifampin has a decreased urinary output and decreased sensation in the great toes. Which laboratory values should be assessed?
ALT and AST
A patient with TB has been admitted to a health care facility. When providing instructions for the patient teaching related to antitubercular drugs, which instructions should the nurse provide in order to avoid complications in the patient's GI tract?
Avoid the consumption of alcohol.
An older adult client, diagnosed with community-acquired pneumonia, has been prescribed aztreonam. What action should the nurse perform before administering the first dose?
Confirm the client's allergy status.
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
A client is diagnosed with latent tuberculosis infection. The nurse expects that the treatment plan will include which drug?
INH
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 10-year-old client is diagnosed with acute otitis media. What does the nurse anticipate the health care provider will prescribe?
amoxicillin
The nurse should advise the client to avoid taking which medication at the same time as a fluoroquinolone?
antacids
What physical characteristic observed in an adult suggests that they were prescribed tetracycline as a child?
discoloration of the teeth
In the event of a bioterrorism attack with anthrax, the health care team should anticipate the use of which tetracycline?
doxycycline
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
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
A 75-year-old patient with a history of renal impairment is admitted to the primary health care center with a UTI and has been prescribed a cephalosporin. Which of the following interventions is most important for the nurse to perform when caring for this patient?
Monitoring blood creatinine levels.
After teaching a client who is prescribed oral erythromycin, the nurse determines that the teaching was successful when the client states which of the following?
"I should drink a full 8-oz glass of water when I take the medicine."
Which statement by a client taking a sulfonamide requires further instruction?
"I will make sure to use extra sunscreen when I go to the tanning booth."
The clinic nurse is responsible for teaching a client about a new prescription for doxycycline. The nurse should increase which instruction in the teaching?
"Limit your exposure to the sun."
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."
In general, progression from first-generation cephalosporins to fourth-generations results in which of the following? Select all that apply.
An increase in sensitivity of gram-negative microorganisms. A decrease in the sensitivity of gram-positive microorganisms.
A client with a positive sputum culture for TB has been started on streptomycin antitubercular therapy. Upon review of the laboratory results, the nurse notes that the client may be experiencing toxicity if which of the following results is abnormal?
BUN and creatinine
The ability of bacteria to produce substances that inactivate or destroy the antibiotic is known as which of the following?
Bacterial resistance
Numerous residents of a long-term care facility have developed Clostridium difficile-associated diarrhea over the past week. The nurses at this facility would anticipate that many residents would require which medication therapy?
Metronidazole
A client has a history of a life-threatening anaphylactic reaction to penicillin G. Which medication should not be administered to this client?
Cefadroxil
After teaching a group of students about carbapenems, the instructor determines the need for additional teaching when the students identify what as an example?
Cefuroxime
A client has been prescribed ciprofloxacin IV for the treatment of cellulitis. After initiating the infusion of the client's first scheduled dose, the client develops a pronounced rash on the chest and arms. How should the nurse respond initially to this event?
Discontinue the infusion and inform the health care provider promptly.
A nurse is caring for a client diagnosed with a serious gram-negative infection prescribed amikacin. Which action should the nurse prioritize while caring for this client?
Do renal tests daily
A client being treated for cellulitis with a cephalosporin asks what the essential difference is between generations of this medication. The nurse should respond to the client's question based on what fact?
Each successive generation is more effective against gram-negative microorganisms.
The nurse is caring for a client diagnosed with Legionnaires disease. What medication would the nurse expect the health care provider to prescribe?
Erythromycin
Which of the following drugs would be classified as an aminoglycoside?
Gentamicin
A nurse is caring for a patient who is being administered penicillin. What are the common adverse reactions to penicillin a nurse should assess for?
Inflammation of the tongue and mouth
A patient who has been on penicillin therapy for several days has developed inflamed oral mucous membranes and swelling in the tongue and the gums. The primary health care provider has diagnosed it as a fungal superinfection of the oral cavity resulting in impaired oral mucous membranes. Which of the following interventions should the nurse perform?
Inspect mouth and gums regularly.
A female client is diagnosed with hepatitis C as well as a urinary tract infection. The organism is sensitive to tetracycline. Why is the health care provider reluctant to order tetracycline in a client with hepatic impairment?
It slows drug elimination.
The nurse is caring for a 6-year-old girl who has been diagnosed with active tuberculosis. The physician is unlikely to prescribe which of the following drugs because its use is not recommended in children?
Levofloxacin
A client with an infected ulcer on the foot has been prescribed daptomycin. What action should the nurse ensure has been taken to determine that the drug will be effective in treating the infection?
Obtain a culture of the client's infection.
The nurse is assisting in the admission of a client with a suspected urinary tract infection and an oral temperature of 100.9°F. The health care provider has written the following orders: acetaminophen 500 mg PO for elevated temperature; urinalysis for culture and sensitivity; sulfasalazine (Azulfidine) 500 mg PO four times daily; and force fluids to 3 L/day. Which order will the nurse complete first?
Obtain urine for culture and sensitivity.
A client with a diagnosis of necrotizing otitis externa has been prescribed ciprofloxacin. What microorganism is the most likely cause of the disorder?
Pseudomonas aeruginosa
A client returns from a vacation with traveler's diarrhea. The nurse understands that what is the treatment of choice?
Rifaximin
A middle-aged patient has been prescribed tetracycline as part of his Prevpac for the treatment of H. pylori. The patient has a history of atrial fibrillation which is being treated with digitalis drugs. Given his history and current medications, the patient is at risk for which of the following conditions?
Risk of toxicity
A patient with TB is admitted to a health care facility. The nurse is required to administer an antitubercular drug through the parenteral route to this patient. Which of the following precautions should the nurse take when administering frequent parenteral injections?
Rotate injection sites for frequent parenteral injections.
A patient has been prescribed oral tetracycline for the treatment of acne. Which of the following must the nurse include in the patient teaching plan?
Take the drug on an empty stomach.
The client has been taking her antibiotic for five days. She tells the nurse that she is now experiencing vaginal itching and discharge. The nurse suspects what has occurred?
The client has developed a superinfection.
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 knows that pseudomembranous colitis is a superinfection of fluoroquinolones, especially when they are administered in high doses, because these medications have what effect in the body?
They disrupt the normal flora of the body.
The nurse is preparing a teaching plan for a client who is receiving cephalosporins. Which of the following would the nurse identify as the most commonly occurring adverse effects?
Vomiting and diarrhea
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
When describing the action of sulfonamides to a client, the nurse integrates understanding of the drug's action with effects exerted due to which mechanism?
inhibition of the activity of folic acid in bacterial cell metabolism
A client has been admitted with leprosy. The nurse completes the health history and physical examination. In addition to a thorough assessment of the skin, what other areas of the body would be important to assess? (Select all that apply.)
peripheral nerves mucosa of the gastrointestinal tract
A nursing student studying pharmacology is focusing on drugs used to treat tuberculosis (TB). This student correctly identifies the classifications of antitubercular drugs as which of the following?
primary and secondary
The nurse is reviewing the medication history of a client who is prescribed penicillin therapy. Use of which medication would alert the nurse to the possibility of the client's increased risk for an anaphylactic reaction?
propranolol
A client with a diagnosis of rhinosinusitis has been prescribed ciprofloxacin 250 mg SC b.i.d. When contacting the prescriber, the nurse should question the:
route
A nurse is speaking to a 62-year-old female client who has been started on sulfisoxazole, a sulfonamide antibiotic. The nurse should teach this client to contact the health care provider if the client experiences what adverse effect associated with the drug?
skin rash or itching
A client has been treated several times for a recurring ear infection with ofloxacin. The nurse instructs the client to look for side effects from the prolonged use of the antibiotic and informs the client that this is known as:
superinfection
