Course Point Module 4 (Pharm)
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." Explanation: 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.
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." 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.
To maximize the prevention of an incisional infection, when will the nurse administer the prophylactic antibiotic therapy prescribed for a surgical client?
1 hour prior to the first planned skin incision Explanation: When used perioperatively, cephalosporins should be given within 60 minutes before the first skin incision is made so the drug has time to reach therapeutic serum and tissue concentrations. It is not done as part of the surgical prep since that timing is not as specific.
For what client would a broad-spectrum antibiotic be most appropriate?
A client who has symptoms of infection but whose culture and sensitivity results are not yet available Explanation: Broad-spectrum antibiotics are often used to treat infections while awaiting the results of culture and sensitivity testing. The presence of a fever with no other signs of infection would not be an indication for the use of broad-spectrum antibiotics. Narrow-spectrum antibiotics are generally preferred when the causative microorganism of an infection is known. Advanced age is not an indication for broad-spectrum antibiotic use.
A patient 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 Explanation: Hepatotoxicity and nephrotoxicity are important adverse effects of isoniazid and rifampin. The ALT/AST will assess liver function. The hematocrit and hemoglobin associated with the oxygen-carrying capacity of the blood. A complete blood count with differential measures the levels of red blood cells, white blood cells, platelet levels, hemoglobin, and hematocrit. Many times, it is prescribed as a screening test as an anemia check or detection of infections. A urine culture is a method to grow and identify bacteria that may be in the urine. The sensitivity test helps caregivers pick the best medicine to treat the infection.
A nurse works in a community setting and follows clients who have TB. Which clients would likely require the most follow-up from rifampin therapy?
An HIV-positive client Explanation: The nurse should pay special attention to the HIV-positive client because this client will require rifampin therapy for a longer period of time than the other clients. An HIV-positive person is immunocompromised, and it will take longer to fight the infection. This could increase the difficulty of adherence to the drug regimen. In addition, many of the drugs used to treat HIV are contraindicated in clients who take rifampin. Rifampin can be safely administered to nursing mothers, those with cancer, and people over 65 given certain conditions. However, their therapy should not be longer than normally required unless complications occur.
What would be categorized as an anti-infective agent?
Anthelmintics Explanation: Anthelmintics are a type of anti-infective agent used for infections caused by worms. Anticoagulants are agents that affect blood clotting. Anticonvulsants are agents that help to control seizures. Anticholinergics are agents that block the action of acetylcholine.
A client has been taking antibiotics at home for the treatment of a respiratory infection for the past 6 days, and there is no evident improvement in the infection. Which nursing assessment is most appropriate?
Assess the client's adherence to the medication regimen. Explanation: Nonadherence to antibiotic therapy can result in a continuation or exacerbation of the infection. Poor hygiene is a risk factor for the development of infection but is less likely to perpetuate an existing infection that is being treated appropriately with antibiotics. Herbs may be contraindicated but are unlikely to negate the therapeutic effects of an antibiotic. The nurse should gauge the client's understanding of the illness, but this does not have a bearing on the client's lack of improvement.
A client is admitted to the hospital with elevated temperature, chills, cough, and fatigue. The health care provider orders a chest x-ray, which indicates pneumonia. The blood cultures also come back positive for a Gram-negative bacillus. The provider orders two antibiotics to be given to the client, one for Gram-negative organisms and one for Gram-positive organisms. Why does the provider not prescribe just one antibiotic for both types of bacteria?
Broad-spectrum antibiotics can cause antibiotic resistance. Explanation: All antimicrobials have the ability to promote the emergence of drug-resistant microbes. However, resistance is more likely to occur in organisms exposed to broad-spectrum drugs. Although the use of antimicrobials promotes the potential for drug resistance to occur, they do not directly cause the resistance.
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 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.
A client with an upper respiratory tract infection was prescribed roxithromycin, an antibiotic. To what should the nurse tell the client that irregular administration of this medication could lead?
Development of drug resistance Explanation: When there is irregular or indiscriminate use of antibiotics, certain pathogens may mutate or build a tolerance to the drug. The antibiotic then becomes ineffective against that organism. Irregular use does not affect the absorption or elimination of the drug or increase chances of serious adverse events of the antibiotic.
The nurse is giving instructions to a client age 77 years who has been prescribed a sulfonamide for treatment of a urinary tract infection. The nurse has instructed the client to increase fluids while taking this medication. What does the nurse anticipate will be the client's greatest fear related to this instruction?
Fear of incontinence. Explanation: The older adult may be hesitant to increase fluid intake because of fear of incontinence. Fear of diarrhea, fear of skin problems and fear of allergic reaction are not related to the instruction to increase fluid. The client will not be given a PO medication if they cannot swallow unless it would be in a liquid form or administered in a way that they could tolerate it.
A client diagnosed with tuberculosis was prescribed antitubercular therapy but stopped after 1 month because of difficulty with the medication scheduling. As a result, secondary drugs are being prescribed. Which nursing diagnosis would the nurse most likely identify?
Ineffective Self-Health Management Explanation: Difficulties with scheduling most likely led to the client not adhering to the treatment plan. As a result, the nursing diagnosis of Ineffective Self-Health Management would be most appropriate. Although nutrition can be affected, there is no indication that this is the problem. Although the client may have difficulty coping with the disease, there is no indication that this is a problem. The client may experience discomfort related to the adverse effects of the drug; however, there is no indication that this is an issue.
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 Explanation: Some of the common adverse effects of penicillin are glossitis (inflammation of the tongue), stomatitis (inflammation of the mouth), and gastritis (inflammation of the stomach). Unless severe, the drug may be continued as prescribed and the nurse would intervene to help the patient manage the common adverse reactions. Impaired oral mucous membranes are signs of a fungal superinfection in the oral cavity, whereas severe hypotension and sudden loss of consciousness are signs of an anaphylactic shock; these are not common adverse effects of penicillin and require immediate medical attention.
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. Explanation: Beta-lactam antibacterial drugs inhibit synthesis of bacterial cell walls by binding to proteins in bacterial cell membranes. Penicillin V does not inhibit protein synthesis. Penicillin V does not inhibit protein synthesis, cause mutations, or lower the pH of a bacterium's cellular contents.
The nurse is preparing to administer a drug that is bactericidal. The nurse should explain what characteristic of this drug?
It will directly cause the death of pathogenic cells . Explanation: Bactericidal refers to a highly aggressive drug that causes cell death. An anti-infective with a narrow spectrum of activity is selective in its action so that it is effective against only a few microorganisms with a very specific metabolic pathway or enzyme. Bacteriostatic refers to a drug's effectiveness in interfering with a cell's ability to reproduce or divide. Broad-spectrum activity refers to effectiveness against a wide variety of pathogens.
The nurse is preparing to administer an anti-infective agent that is prescribed for an older adult. The nurse should prioritize what action?
Monitor the client closely for signs of adverse effects Explanation: The older adult is more susceptible to severe adverse effects. For this reason, close monitoring is necessary and is a priority over education that addresses culture testing and the mechanism of action. Increased fluid intake is often beneficial, but close monitoring for adverse effects is a higher priority.
The nurse is assisting in the admission of a client with a suspected urinary tract infection and an oral temperature of 100.9 degrees ferenheit. 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. Explanation: A culture and sensitivity is obtained to determine which bacteria is growing in the urine, and which antibiotic the bacteria is sensitive to. It must be performed prior to any antibiotic being given to the client so that the test will be accurate. Most acetaminophen orders are for elevated temperature at or above 101.
To ensure that the most appropriate drug is being used to treat a pathogen, which would need to be done first?
Obtaining sensitivity testing Explanation: Performing sensitivity testing on cultured microbes is important to evaluate the bacteria and determine which drugs are capable of controlling the particular organism. Once the sensitivity testing is completed, then the decision for the drug can be made. Combination therapy is used when appropriate after culture and when sensitivity testing has been completed. Checking client allergies also would be done after sensitivity testing but before administering the drug. The bactericidal effects of a drug may or may not play a role in the selection of the drug.
The nurse should advise clients that which of the following are adverse reactions that may occur with the administration of tetracyclines? Select all that apply.
Photosensitivity Diarrhea Stomatitis Explanation: The nurse should advise clients nausea, vomiting, diarrhea, epigastric distress, stomatitis, sore throat, skin rashes, and photosensitivity are adverse reactions that may occur with the administration of tetracyclines.
A patient diagnosed with TB is undergoing treatment. The nurse knows that which of the following preventive therapies will avoid the spreading of TB?
Prophylactic therapy Explanation: Prophylactic therapy will prevent or avoid the spreading of TB. Long-term treatment does not prevent the spreading of TB, though it may eventually cure or reduce the intensity of the disease. Directly Observed Therapy (DOT) is used to administer drugs two to three times weekly. Using DOT will not prevent the TB from spreading. Usually, short-term therapy is of no value in treating TB. Short-term therapy will also not prevent the disease from spreading.
A nurse is caring for a patient who has a serious infection. The patient is being treated with combination therapy of a cefazolin and an aminoglycoside. The nurse will be sure to monitor which of the following?
Serum BUN and creatinine levels Explanation: Patients receiving combination therapy of a cefazolin and an aminoglycoside will need to be monitored for nephrotoxicity and therefore would need serum BUN and creatinine levels done. Serum sodium and potassium levels as well as aspartate aminotransferase should be monitored when receiving sodium penicillin G. PT and PTT should be monitored when a patient is receiving aztreonam, a monobactam antibiotic.
The nurse understands that which is the highest priority when teaching about antitubercular medications?
Taking medications as prescribed Explanation: For medications to be effective, it is most important that the nurse reinforce to the client that medications should be taken as prescribed and there should be no missed doses. Eating a well balanced diet, keeping hydrated and monitoring sputum are not medication priorities.
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. Explanation: The client is experiencing a vaginal yeast superinfection related to the use of antibiotics. Adverse reactions include nausea, diarrhea, abdominal pain, headache and photosensitivity. This is not indicative of an STI in this scenario.
When describing an anti-infective agent with a narrow spectrum of activity, what would the nurse include?
The drug is selective in its action on organisms. Explanation: An anti-infective with a narrow spectrum of activity is selective in its action; thus, it is effective against only a few microorganisms with a very specific metabolic pathway or enzyme. Broad-spectrum activity refers to effectiveness against a wide variety of pathogens. Bactericidal refers to a highly aggressive drug that causes cell death. Bacteriostatic refers to a drug's effectiveness in interfering with a cell's ability to reproduce or divide.
A client is prescribed rifampin. What information should the nurse include in the client's medication education?
The urine, tears, sweat, and other body fluids will be a discolored red-orange. Explanation: The client's urine, tears, sweat, and other body fluids will be a discolored red-orange. This adverse effect is harmless, but the client should be instructed on this adverse effect. The administration of this medication with warfarin will decrease the anticoagulant effect. The medication increases hepatic cytochrome P-450 3A4 enzyme and decreases serum concentrations. The serum half-life of rifampin is shorter than that of the medication rifabutin.
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. Explanation: Pseudomembranous colitis is a superinfection that occurs when the antibiotic disrupts the normal flora, causing a secondary infection or superinfection.
Culture and susceptibility tests are performed prior to the prescription of antimicrobial drugs. What is the specific purpose of the culture?
To identify the organism causing the infection Explanation: Culture identifies the infection's causative organism. Susceptibility tests determine which drugs are likely to be effective against the organism.
A nurse is asked to explain the difference between community-acquired infections and nosocomial infections. What response best describes the difference?
Usually, community-acquired infections are less severe and easier to treat since nosocomial infections often occur in people whose immunity is impaired. Explanation: Infections are often categorized as community-acquired or nosocomial. Because the microbial environments differ, the two types of infections often have different causes and require different antimicrobial treatment. Generally, community-acquired infections are less severe and easier to treat, although antibiotic-resistant strains are increasing (e.g., methicillin-resistant Staphylococcus aureus [MRSA]). Nosocomial infections may be more severe and difficult to manage because they often result from drug-resistant microorganisms and occur in people whose immunity is impaired. Drug-resistant strains of staphylococci, Pseudomonas, and Proteus are common causes of nosocomial infections.
Aminogylcoside antibiotics tend to collect in the eighth cranial nerve. The nurse would anticipate that which clinical manifestation may occur from the cranial nerve involvement?
Vertigo Explanation: The aminoglycosides antibiotics collect in the eighth cranial nerve and can cause dizziness, vertigo, and loss of hearing.
When providing health education to a client prescribed isoniazid, the nurse should emphasize the need to avoid what element?
alcohol Explanation: Alcohol increases the risk of hepatotoxicity even if alcohol use is stopped during isoniazid therapy. There is no therapeutic reason for clients taking isoniazid to avoid sunlight, dairy products, or purines.
The nurse should advise the client to avoid taking which medication at the same time as a fluoroquinolone?
antacids Explanation: 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.
Drugs that destroy bacteria are known as which type of drug?
bacteriocidal Explanation: Drugs that destroy bacteria are known as bactericidal. Drugs that slow or retard the multiplication of bacteria are known as bacteriostatic. Bacteriostationary keeps the bacteria in place, and bacteriophage uses enzymatic substances to destroy the bacteria.
After teaching a group of nursing students about the different classes of drugs, the instructor determines that the teaching was successful when the students identify drugs that slow or retard the multiplication of bacteria as which types of medication?
bacteriostatic Explanation: Drugs that slow or retard the multiplication of bacteria are known as bacteriostatic. Drugs that destroy the bacteria are referred to as bactericidal. Bacteriostationary keeps the bacteria in place, and bacteriophage uses enzymatic substances to destroy the bacteria.
Administration of what type of antibiotic by the nurse would be most likely to cause a superinfection?
broad spectrum Explanation: One offshoot of the use of anti-infectives, especially broad-spectrum anti-infectives, is destruction of the normal flora, allowing opportunistic pathogens to invade tissue and cause a superinfection. Narrow-spectrum anti-infectives are less likely to kill normal flora, although it is not impossible. A drug may be bactericidal, meaning it kills the pathogen; or bacteriostatic, meaning it prevents reproduction of the pathogen, but this is not related to superinfections.
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 Explanation: Because of its very limited systemic absorption (97% eliminated in feces), health care providers cannot use rifaximin to treat systemic infections, including infections due to invasive strains of E. coli. Therefore, diarrhea occurring with fever or bloody stools requires treatment with alternative agents.
A client is diagnosed with an infection. What would the nurse anticipate being used to determine the best drug to treat the infection?
culture and sensitivity (C&S) Explanation: C&S testing helps to identify the best drug for eradicating the bacterial infection. The white blood cell count will indicate the presence of infection but not what drug to treat it with. A tissue biopsy will determine a tissue type. An x-ray will only give visual views of structures in the body.
A client, hospitalized with active tuberculosis, is receiving antitubercular drug therapy. When it becomes apparent that the client is not responding to the medications, what condition will the primary health care provider identify as a possible cause?
drug-resistant tuberculosis. Explanation: A client who is being treated with antitubercular drug therapy and is not responding to the medication regime is most likely experiencing drug-resistant tuberculosis. Human immunodeficiency virus causes tuberculosis to move more rapidly. This scenario does not provide any indication that the tuberculosis is related to the diminished client response. The scenario does not identify methicillin-resistant or vancomycin-resistant Staphylococcus aureus.
The client has received the first dose of oral Cipro. The client reports shortness of breath. The nurse suspects which with this finding?
hypersensitivity reaction. Explanation: Shortness of breath after the first dose of medication could indicate a hypersensitivity reaction. It is important that the nurse intervenes immediately. A hypersensitivity reaction is not an expected, undesired effect of the medication. It is not an anaphylactic reaction at this point but can lead to it.
A client is receiving aminoglycoside therapy. The nurse would be alert for:
kidney dysfunction. Explanation: Kidney dysfunction (i.e., nephrotoxicity) is associated with aminoglycosides. Hallucinations are not associated with the use of aminoglycosides. Lethargy is not associated with aminoglycoside therapy. Loss of vision is more commonly associated with neurotoxic agents such as chloroquine. Hearing loss is a possibility with aminoglycosides.
What intervention is necessary for the nurse to perform prior to initiating prescribed antibiotic therapy?
obtaining a specimen for culture and sensitivity Explanation: It is good practice to collect specimens (e.g., sputum, urine) for culture and Gram's stain before giving the first dose an antibiotic. Fluid intake and medication education may take place after the therapy is initiated, while antidiarrheal medication is administered if the client demonstrates signs/symptoms of GI distress.
A client with burns has developed a wound infection. This client is experiencing what type of wound infection?
opportunistic infection Explanation: Opportunistic infections are likely to occur in people with severe burns, cancer, human immunodeficiency virus, and indwelling catheters and are often caused by drug-resistant microorganisms, are usually serious, and may be life threatening. The client may be at risk for a fungal, nosocomial, or food-borne infection, but the risk for all infections is high due to the client's opportunistic nature of the burn.
The client is taking an antibiotic for a urinary tract infection. The client asks how the antibiotic interferes with the growth of bacteria. The nurse explains that the antibiotic has the ability to suppress or kill an infecting microbe without injury to the host. This is referred to as:
selective toxicity. Explanation: An important principle of antimicrobial therapy is selective toxicity, which is the ability to suppress or kill an infecting microbe without injury to the host. Selective toxicity is achievable because the drug accumulates in a microbe at a higher level than in human cells; the drug has a specific action on cellular structures or biochemical processes that are unique to the microbe; or an action of a drug on biochemical processes is more harmful to the microbe than to host cells.
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. Explanation: Prolonged use of otic preparations containing an antibiotic may result in a superinfection (an overgrowth of bacterial or fungal microorganisms not affected by the antibiotic being administered).
Some anti-infective medications are more powerful when given in combination. This means that they are:
synergistic. Explanation: Synergistic drugs are drugs which are more powerful when given in combination.
A critically ill client has developed a fever of 38.9°C, and blood cultures have been drawn and sent to the laboratory for culture and sensitivity testing. Determination of the culture will give the care team what information?
the exact identity of the infectious microorganism Explanation: Culture identifies the causative microorganism. It does not necessarily indicate the presence of antibiotic resistance. The origin or location of the infection may often been indirectly determined by the culture, but this is not always the case.
An immunocompromised patient in a critical care setting has developed a respiratory infection that has been attributed to methicillin-resistant Staphylococcus aureus (MRSA). The nurse should anticipate that the patient will require treatment with
vancomycin. Explanation: Vancomycin is the drug of choice to manage infections caused by MRSA. MRSA is resistant to all of the antistaphylococcic penicillins, as well as to ciprofloxacin and clindamycin.
A pregnant woman calls the clinic and asks if it is suitable to use ofloxacin otic drops that she used prior to pregnancy for a current ear infection. What would be an appropriate response from the nurse?
"The effects of ofloxacin in pregnancy are not known, so the drug should not be used while pregnant." Explanation: The otic drugs are used with caution during pregnancy and lactation. The pregnancy category of most of these drugs is unknown when they are used as otic drugs for this reason, ofloxacin is an otic drug that is contraindicated during pregnancy. Using left-over medication from one illness to the next is not advised. Many otic drugs are not contraindicated during pregnancy. Not all medications that are okay for children are suitable to use during pregnancy.
A female client comes to the clinic reporting vaginal discharge with itching. When obtaining the client's medication history, what would the nurse consider as significant?
broad spectrum anti-infective for recent infection Explanation: The use of broad-spectrum anti-infectives may result in superinfections, which are infections occurring when opportunistic pathogens kept in check by normal flora invade the tissues. The client report of vaginal discharge with itching suggests a superinfection. Bronchodilator therapy, oral contraceptives, and multivitamins would be unrelated to the client's current issue.
A nurse is instructing a client on the antibiotic regimen for the treatment of pneumonia. Which statement is most important to share with client?
Complete the entire prescription of medication. Explanation: Interruption or inadequate antimicrobial treatment of infections may also contribute to the emergences of antibiotic resistant organisms. The administration of an antibiotic with orange juice is not recommended in all instances. The medication does not need to be supplemented with multivitamins. Antibiotics need not be administered with dairy products.
Bacitracin (Baciguent) interferes with the cell wall synthesis of which type of bacteria?
Staphylococcal Explanation: Bacitracin is an antibiotic that interferes with the cell wall synthesis of susceptible staphylococcal bacteria.
Tetracyclines should not be used in children younger than 8 years of age because of their effects on:
teeth and bones. Explanation: Tetracyclines should not be used in children younger than 8 years of age because of their effects on teeth and bones.
What is a major factor that influences whether an individual will acquire an infection?
the person's ability to defend against the would-be invaders Explanation: The human body and the environment contain many microorganisms, most of which do not cause disease and live in a state of balance with the human host. When the balance is upset and infection occurs, characteristics of the infecting microorganism and the adequacy of host defense mechanisms are major factors in the severity of the infection and the person's ability to recover. Conditions that impair defense mechanisms increase the incidence and severity of infections and impede recovery. In addition, use of antimicrobial drugs may lead to serious infections caused by drug-resistant microorganisms.
A nurse is caring for a client who is hospitalized for pneumonia. The nurse reviews the electronic health record and evaluates that the microbiology data does not support the use of the broad spectrum antibiotic. Which statement is the nurse's best response to the provider about the results?
"The microbiology data is identifying another antibiotic appropriate for the client." Explanation: Laboratory tests used to definitively identify causative organisms and to determine susceptibility to antibiotics usually require 48 to 72 hours, so the prescriber usually initiates treatment with an antimicrobial drug that is likely to be effective. The nurse should communicate with the prescriber about the change so that a correction can be made as soon as possible. Telling the prescriber to review the microbiology report is incorrect. The basis of prescribing the antibiotic should be on the identifying bacteria's culture and sensitivity. Referring the prescriber to the charge nurse is inappropriate as it is the nurse's responsibility to discuss with the prescriber the client's care.
The hospital nurse is caring for a group of adult clients. For which client should the nurse most likely administer prophylactic anti-infectives?
A client with colorectal cancer who is pre-operative for a bowel resection Explanation: Abdominal surgery is a common indication for antibiotic prophylaxis, since these surgeries present a significant risk for infection. For this reason, a pre-operative client would be more likely to need prophylaxis than a client who has had an MI, a client with renal failure or a client with an electrolyte imbalance.
For what client would the use of prophylactic anti-infective be most appropriate?
A pre-surgical client who has an artificial heart valve Explanation: A client with valve replacement is especially prone to the development of subacute bacterial endocarditis because of the vulnerability of their heart valves; prophylactic antibiotic therapy as a precaution. None of the other listed clients has particular indications for the use of prophylactic anti-infectives.
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 Explanation: Streptomycin can cause nephrotoxicity. The nurse would be monitoring the BUN and creatinine levels. Amylase and lipase are related to liver function. Streptomycin does not affect the electrolytes or blood cell counts.
A female client is admitted to the critical care unit with sepsis related to a contaminated central line. The health care provider orders intravenous beta-lactam antimicrobials. The client's current laboratory report reflects renal impairment. What would the nurse expect the provider to do?
Decrease the drug dose. Explanation: Beta-lactam antimicrobials are commonly used in critical care units to treat pneumonia, bloodstream infections, wound infections, and other infections. Renal, hepatic, and other organ functions should be monitored in critically ill clients, and drug dosages should be reduced when indicated.
A patient has been prescribed a tetracycline drug for Rocky Mountain spotted fever. The patient also takes antacids. Which of the following effects is likely to occur due to an interaction between the two drugs?
Decreased absorption of tetracycline Explanation: Interaction of antacids with a tetracycline drug causes decreased absorption of tetracycline. Increased action of neuromuscular-blocking drugs and increased profound respiratory depression are the result of interaction between neuromuscular-blocking drugs and tetracyclines. Increased risk of bleeding is a result of interaction between anticoagulants and tetracyclines.
A nurse is caring for a 6-year old child with a severe case of typhoid fever. The client was mistakenly administered tetracycline, which can cause adverse reactions. What could be a permanent effect in the child?
Discoloration of the teeth Explanation: Tetracyclines cause permanent yellow-gray-brown discoloration of the teeth in children less than 9 years of age. Epigastric distress is not a permanent effect of the drug. Abdominal pain or cramping and visual disturbances are adverse reactions of macrolides.
Which of the following should a nurse carefully monitor in a patient who has been administered cephalosporin as well as aminoglycosides for a wound infection?
Nephrotoxicity Explanation: When cephalosporin is administered with aminoglycosides, it increases the risk for nephrotoxicity and should be closely monitored. Nausea is an adverse reaction of cephalosporins in patients with gastrointestinal tract infection. The risk of bleeding increases when cephalosporin is administered with oral anticoagulants. Risk for respiratory difficulty increases if alcohol is consumed within 72 hours after certain cephalosporin administration.
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. Explanation: The nurse should be careful to rotate injection sites when administering frequent parenteral injections. At the time of each injection, the nurse inspects previous injection sites for signs of swelling, redness, and tenderness. The nurse should monitor any signs of liver dysfunction monthly in patients who are being administered antitubercular drugs. The nurse should ensure that pyridoxine, and not streptomycin, is administered to the patient to promote nutrition, but this is only administered if the patient has been living in impoverished conditions and is malnourished. The nurse should monitor patient's vital signs every four hours and not once every morning.
The nurse is assessing a client who has recently been given the first dose of a new anti-infective. What finding should lead the nurse to suspect that the client is experiencing a hypersensitivity reaction?
The client has a facial and trunk rash. Explanation: Rash suggests a hypersensitivity reaction. Vertigo may suggest a neurotoxic adverse effect. Diarrhea may occur over time as a result of gastrointestinal adverse effects. A blood pressure that is slightly elevated is not suggestive of hypersensitivity.
What assessment finding may be attributable to an adverse effect of erythromycin?
The client is uncharacteristically euphoric. Explanation: It is important to assess the client's psychosocial responses that are adverse effects of erythromycin, such as crying, laughing, and altered thought processes. Dry cough, incontinence, and hypotension are not associated with the use of erythromycin.
A medical nurse on a night shift is reviewing a client's medication administration record for the following day. The nurse notes that a combination antimicrobial drug is prescribed. What is implied by the fact that the client has been prescribed a combination drug?
The client may have an infection caused by multiple microorganisms. Explanation: Indications for combination therapy may include infections caused by multiple microorganisms. A fungal or protozoal infection is not implied, and the client may or may not have a history of recurrent infections. Intolerance of single antibiotics is not normally an indication for combination therapy.
A nurse has questioned why a client's health care provider has prescribed a narrow-spectrum antibiotic rather than a broad-spectrum drug in the treatment of an infection. Which facts provide the best rationale for the use of narrow-spectrum antibiotics whenever possible?
The use of broad-spectrum antibiotics can create a risk for a superinfection. Explanation: The benefit of a narrow-spectrum antimicrobial agent is that it limits the potential for adverse effects, such as superinfection. In a superinfection, an antibiotic suppresses all susceptible microbes, including the body's natural flora, which may keep other microbes in check. In the absence of these bacteria, nonsusceptible microbes can proliferate. Narrow-spectrum antibiotics do not lack demonstrated efficacy and they do not necessarily require a shorter duration of treatment. All antimicrobial drugs have the potential to impact subsequent C&S testing.
A client's risk for ototoxicity, nephrotoxicity, and neurotoxicity increases dramatically if he or she receives an aminoglycoside in conjunction with a potent diuretic.
True Explanation: Avoid combining aminoglycosides with potent diuretics; this increases the incidence of ototoxicity, nephrotoxicity, and neurotoxicity. Renal toxicity, which may progress to renal failure, is caused by direct drug toxicity in the glomerulus, meaning that the drug molecules cause damage (e.g., obstruction) directly to the kidney.
Which client would be at risk of developing an infection? Select all that apply.
a client with an impaired immune system a client experiencing diarrhea chronically an elderly client who has one chronic disease Explanation: Many factors impair the host defense mechanisms and predispose a person to infection by disease-producing microorganisms. These include breaks in the skin and mucous membranes, impaired blood supply, neutropenia and other blood disorders, malnutrition, poor personal hygiene, suppression of normal bacterial flora by antimicrobial drugs, diabetes mellitus and other chronic diseases, and advanced age. A client who has chronic diarrhea can experience malnutrition. A client who performs daily care and a client who takes nutritional supplements are not at risk for infection.
When caring for infants and the elderly who are in need of an antimicrobial agent, the nurse is aware that when compared with doses for young and middle-aged adults, these clients may require:
a lower dose. Explanation: Infants and the elderly are the populations most vulnerable to drug toxicity. In the infant, the liver and kidneys are still immature and may have difficulty metabolizing or excreting the drug, which results in accumulation. The same process in the elderly is related to the age of their liver and kidneys, which may no longer be functioning at an optimal level. Prescribers may request lower doses of antimicrobial agents for these two populations to minimize the risk for toxicity. The frequency is important in antimicrobial therapy and would not be decreased
A client comes to the clinic reporting mouth sores that appear consistent with an oral yeast infection. The nurse should question the client about recent use of:
antibiotics. Explanation: The client is exhibiting signs of a superinfection, which can occur with the use of antibiotics. Superinfections are not associated with oral contraceptives, multivitamins, or anticoagulants.
A group of students are reviewing information about anti-infective agents. The students demonstrate a need for additional review when they identify what as an anti-infective agent?
anticoagulant Explanation: An anticoagulant interferes with blood clotting and is not an anti-infective agent. Antibiotics, anthelmintics, antiprotozoals, antivirals, and antifungals are all anti-infective agents.
A drug that does not actually cause the death of a cell but does interfere with its ability to reproduce is said to be:
bacteriostatic. Explanation: A drug that is bacteriostatic does not kill the cell but interferes with its ability to reproduce. Bactericidal drugs cause the death of the cell. Drug resistance is the ability of a pathogen to adapt and no longer be susceptible to an anti-infective. Bacteriostatic activity can be found in both broad- and narrow-spectrum anti-infectives.
A 9-year-old client has been admitted to the pediatric unit after being diagnosed with pertussis. The pediatric nurse is processing the client's admission orders and notes that IV demeclocycline has been prescribed. After beginning this treatment, the nurse should confirm the results of what laboratory test?
blood urea nitrogen (BUN) Explanation: When administering demeclocycline, it is important to monitor the client's BUN. Increases in the BUN are secondary to antianabolic effects. Bilirubin levels would only be important in the presence of liver toxicity. A d-dimer test is a blood test that measures a substance that is released when a blood clot breaks up. Health Care Providers prescribe the d-dimer test, along with other lab tests and imaging scans, to help check for blood-clotting problems. Mean corpuscular volume (MCV) laboratory test, as part of a standard complete blood count (CBC), is used along with other RBC indices (MCH and MCHC) to help classify the cause of anemia based on red cell morphology. Neither a d-dimer nor MCV values are relevant to this situation.
A client is allergic to penicillin and has been diagnosed with a genitourinary infection caused by Chlamydia trachomatis. Which medication will most likely be administered?
erythromycin Explanation: A client who is diagnosed with a genitourinary infection that is caused by trachomatis and who is allergic to penicillin should be administered erythromycin since there is no known cross-reaction. Acamprosate calcium is administered as a substance abuse deterrent, not in place of penicillin. Atazanavir is an antiviral agent that is used to treat HIV infection, not Chlamydia trachomatis. Flumazenil is a benzodiazepine antagonist and not used for Chlamydia trachomatis.
What potential adverse reaction is most likely to develop during cefazolin therapy?
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 group of nursing students are learning about the factors that underlie recent increases in the incidence and prevalence of antibiotic-resistant microorganisms. What factor is known to contribute to antibiotic resistance?
overuse of antibiotics Explanation: Antibiotic overuse can contribute to antibiotic resistance. Resistance is not typically attributable to increased age of clients, increased population density, or the use of ineffective antibiotics.
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 Explanation: Clients taking sulfonamides should be instructed to contact the prescriber if they experience skin rash or itching. These symptoms may indicate a sulfonamide-induced allergic reaction and the need to change or stop the drug.
What occurs when the normal flora is destroyed by the use of anti-infectives?
superinfection Destruction of the normal flora by anti-infectives commonly leads to superinfection, an infection that occurs when opportunistic pathogens that were kept in check by the normal bacteria have the opportunity to invade the tissues. Neurotoxicity involves damage or interference with the function of nerve tissue, usually in areas where drugs tend to accumulate in high concentrations. Hypersensitivity or allergic reactions result from antibody formation. Resistance refers to the ability over time to adapt to an antibiotic and produce cells that are no longer affected by a particular drug.
Successful treatment with bacteriostatic antibiotics depends upon:
the ability of the host's immune system to eliminate the inhibited bacteria and an adequate duration of drug therapy. Explanation: Successful treatment with bacteriostatic antibiotics depends on the ability of the host's immune system to eliminate the inhibited bacteria and an adequate duration of drug therapy. Stopping an antibiotic prematurely can result in rapid resumption of bacterial growth.
A client has been diagnosed with osteomyelitis and has been prescribed clindamycin, a narrow spectrum antibiotic. When planning this client's care, the nurse should understand that:
the microorganism causing the infection is likely known. Explanation: Narrow spectrum antibiotics are appropriate when the identity of the microorganism is known or strongly suspected. This is unrelated to the client's immune function. Broad spectrum drugs are not necessarily trialed before using narrow spectrum drugs. The risk of adverse effects is not the determining factor.
