Module 11

What is specific to macrolides?

do not give IM-to painful use NSAIDS,-ibprophen avoid acetaphemine and tynol

Nystatin routes

•oral, topical •Can be a powder used in skin folds •Ointment used on skin or vaginally •Oral swish and swallow

.Health Care Associated Infection

infection acquired while client is hospitalized or seen at a clinic recently. Many are due to drug-resistant bacteria -1 of top 10 leading causes of death in the US

What do bacteriostatic drugs do?

inhibit growth of bacteria

What is action of cephalosporins?

interfere with bacterial cell wall synthesis. the cell wall weakens, swells, bursts, and dies due to increased pressure inside the cell

What is the treatment for a mild allergic reaction? (rash,hives, pruritus)

is antihistamine such as diphenhydramine

What do bactericidal drugs do?

kill bacteria

Quinolones (Fluoroquinolones) examples

levofloxacin, moxifloxacin, and ciprofloxacin

What does MRSA stand for?

methicillin resistant staph aureus

Can MRSA be treated with penicillin's?

no, it is resistant to penicillin

Cross-resistance

occur when antibiotics have similar actions (PCN and Ceph)

What do we do to help with the superinefection?

probitoics yogurt OTC probitoics buttermilk

What are we looking at the evaluate if the antiinfected was effective

the fever goes away CBC and WBC-decreases wound looking more clear

What is special about the newer cephalosporin's, like cefepime, or ceftaroline?

the newer the more bacteria they can treat and the stronger the mechanism of action

Nystatin ointment use

wash affected area with mild soap and warm water, dry well, apply ointment

Nystatin powder use

wash skin folds with mild soap and warm water; dry well; apply powder

How do you treat red neck or red man syndrome?

you treat this by slowing down the IV rate. It is not an allergic reaction. 500 mg should be diluted in 100 mL; 1 gram should be diluted in 200 mL. Give over 60-90 minutes

Patient teaching Macrolides?

•*Advise client to take full regimen. •Take azithromycin 1 hour before or 2 hours after meals with full glass of water. •Teach to report adverse reaction •*Teach to report superinfection •*Tell patient to report onset of loose stools or diarrhea. CDAD should be ruled out.

Patient teaching for tetracyclines?

•*Avoid sunlight and wear sun block. •Advise to check expiration date on bottle, out of date tetracycline can be toxic •*Inform female patients not to become pregnant while taking drug as can cause teratogenic effects. •Take complete course of antibiotic •*Use back up birth control as this medication decreases effectiveness of oral contraceptives •*Teach patient to avoid milk products, iron, and antacids.

patient teaching for sulfonamides?

•*Encourage patient to drink several quarts of fluid daily while on sulfonamides. •*Advise pregnant women to avoid sulfonamides in the last 3 months of pregnancy •*Direct patient to report bruising or bleeding. •*Warn patient to wear sunglasses, avoid direct sunlight and use sun block and wear protective clothing to decrease risk of photosensitive reactions.

patient teaching for Aminoglycosides

•*Encourage patient to increase fluid intake •*Inform patient to report tinnitus or decreased urine output *Use sun block and protective clothing during sun exposure

implementation for Macrolides?

•*Monitor liver enzymes and signs of liver damage (jaundice). •Dilute IV in appropriate amount of solution as indicated. •*Administer antacids 2 hours before or 2 hours after macrolides. •*Give azithromycin 1 hour before or 2 hours after meals with full glass of water.

General Adverse Reactions of Antibiotics

•Allergy or hypersensitivity •Superinfection •Organ toxicity

Penicillin Contraindications

•Allergy to penicillin, asthma, pseudomembranous colitis, ulcerative colitis and inflammatory bowel disease •Use caution in patients with renal impairment

Assessments for penicillin

•Assess for allergy to PCN •Assess laboratory results, especially liver enzymes. •Assess drug history-oral contraceptives(to help prevent those surprise souvenirs) , anticoagulants, tetracyclines. •Assess BUN and Creatinine (especially in older adults). If renal function decline (Increase in Creatinine and BUN) dose should be decreased. •Record urine output, if <30 mL/hr, the drug or dose may need to be changed (renal function is declined) •*Obtain culture and sensitivity before drugs are given.

Assessments prior to administering tetracyclines?

•Assess lab values for renal or liver impairment •Obtain medication history and dietary history (antacids and dairy should be avoided while on this medication) •*Obtain sample for culture.

Penicillins structure and action

•Beta-lactam ring: interferes with bacterial cell-wall synthesis by inhibiting the bacterial enzyme that is necessary for cell division and cellular synthesis.

HAART Goal

•CD4 count Greater than 200 cells/ mm ³ If CD4 count less than 200, opportunistic infections are common Ideally, CD4 count should be greater than 500 cells/ mm³ •Viral load •Less than 50 copies/mL (undetectable) •CDC says "undetectable have effectively no risk of transmitting infection"

•Highly Active Antiretroviral Therapy (HAART)

•Combinations of antiretroviral drugs •Increases survival rates •Decreases disease symptoms •Prevents opportunistic infections •Expensive •Requires patient to be 90% adherent or greater

Penicillin drug interactions

•Decrease effects of oral contraceptives •Increases bleeding with anticoagulants •Decrease effect with tetracycline and erythromycin •Additive effects with aminoglycosides

Metronidazole action

•Disrupts DNA and protein synthesis (bactericidal, amoebicidal and trichomonacidal)

•Broad spectrum

•Effective against gram + and gram - •Examples: tetracycline, cephalosporin are frequently used to treat infections when the offending microorganism has NOT been identified by culture and sensitivity(C&S).

What are the symptoms of disulfiram-like reaction with alcohol?

•Flushing •Throbbing headache, visual disturbances •Confusion •Dyspnea •Tachycardia •Syncope •Circulatory collapse

Macrolides adverse effects

•GI distress- A/N/V/D, tinnitus, ototoxicity, Hearing loss, superinfection, hepatotoxicity, Stevens-Johnson Syndrome

Cephalosporins adverse effects?

•GI disturbances, A/N/V/D, rash/pruritis, superinfections, angioedema, Stevens-Johnson Syndrome, pancytopenia Nephrotoxicity (with patient's with preexisting renal disorder

Penicillin adverse effects

•GI disturbances, N/V/D, superinfections, thrombocytopenia, Stevens-Johnson Syndrome

Adverse effects of Metronidazole

•Headache, dizziness, A/N/V/D, Urine Discoloration, SJS, peripheral neuropathy

Acyclovir Indications

•Herpes simplex-1 and 2 •Herpes zoster (shingles)

nursing implementation for Aminoglycosides

•If giving aminoglycosides with beta lactams (PCN and cephalosporins) give the beta lactam antibiotic first. •*Monitor intake and output (output should be greater than 600 ml/day), monitor BUN and creatinine levels in order to identify nephrotoxicity. •*Monitor hearing and balance (aminoglycosides can cause ototoxicity) •For IV, dilute in 50-200 mL of D5W and infuse over 30-60 minutes •*Check therapeutic drug ranges. Gentamicin peak levels should be 4-10 mcg/mL and trough should be 1-2 mcg/mL.

Macrolides drug interactions

•Increase effect of digoxin and warfarin •Decrease effect of penicillin's and clindamycin

Drug interactions of Vancomycin

•Increased risk of nephrotoxicity if taken with loop diuretics •Dimenhydrinate can mask ototoxicity

Implementation for cephalosporins?

•Infuse all IV cephalosporins over 30 minutes to prevent pain and irritation (phlebitis). Do not administer concurrently with calcium salts •*Observe for allergic reactions and have epinephrine on hand

Aminoglycosides action

•Inhibit bacterial protein synthesis •Gram − •Bactericidal

Action of Vancomycin

•Inhibits cell wall synthesis •Treats gram + •Bactericidal

Tetracyclines action:

•Inhibits protein synthesis •Bacteriostatic or bactericidal •Broad spectrum

Quinolones (Fluoroquinolones) action

•Interfere with enzyme DNA gyrase •Broad spectrum with bactericidal

implementation for penicillin's

•Monitor for bleeding( can elevate PT/INR, especially if pt is on anticoagulants) •*Monitor closely during first and second dose for allergic reaction •*Have epinephrine available •Increase fluids. •Check for superinfection. •Warn patient that PCN injections may sting. •Reconstitute with correct diluent.

Adverse effects of Vancomycin

•Red neck or red man syndrome •Occurs when IV too rapid •Severe hypotension •Red flushing of face, neck, chest, extremities •GI distress: N/V, thrombophlebitis to injection site, ototoxicity (temporary hearing loss and/or loss of balance), CDAD •Nephrotoxicity (permanent damage to kidneys),Stevens-Johnson syndrome

Patient teaching for cephalosporins?

•Report signs of superinfection •*Advise patient to ingest buttermilk, yogurt or acidophilus supplement to prevent superinfection •Instruct to take the complete course of medication, even when symptoms of infection have ceased. •*Instruct to drink adequate fluids •May take with food to help decrease GI disturbances

Oseltamivir

•Routes: PO •Indications: Influenza A and B •Must be started within 48 hours of onset of symptoms

HIV and HAART •WHO and CDC have identified stages:

•Stage 1: asymptomatic •Stage 2: early, general symptoms of disease •Stage 3: moderate symptoms •Stage 4: severe symptoms, often leading to death

Aminoglycosides examples

•Streptomycin, gentamicin, kanamycin, tobramycin

Tetracyclines food interactions

•Tetracyclines interact with milk products

Sulfonamides examples:

•Trimethoprim-Sulfamethoxazole (Bactrim)

Usually single antibiotic use will successfully treat bacterial infection Use combo's when:

•it's a severe infection that persists and is of unknown origin •Unsuccessfully treated with several single abx's

A 79-year-old patient is receiving a quinolone as treatment for a complicated incision infection. The nurse will monitor for which adverse effect that is associated with these drugs? a. Neuralgia b. Double vision c. Hypotension d. Tendonitis and tendon rupture

D

A patient has been taking antitubercular therapy for 3 months. The nurse will assess for what findings that indicate a therapeutic response to the drug therapy? a. The chronic cough is gone. b. There are two consecutive negative purified protein derivative (PPD) results over 2 months. c. There is increased tolerance to the medication therapy, and there are fewer reports of adverse effects. d. There is a decrease in symptoms of tuberculosis along with improved chest x-rays and sputum cultures.

D

The nurse is reviewing the medication orders for a patient who will be receiving gentamicin therapy. Which other medication or medication class, if ordered, would be a potential interaction concern? a. Calcium channel blockers b. Phenytoin c. Proton pump inhibitors d. Loop diuretics

D

The nurse will question the use of a fluoroquinolone antibiotic in a patient already prescribed which medication? A. Furosemide B. Omeprazole C. Metoprolol D. Amiodarone

D

Which adverse effect can result if tetracycline is administered to children younger than 8 years of age? A. Drug-induced neurotoxicity B. Delayed growth development C. Gastrointestinal (GI) and rectal bleeding D. Permanent discoloration of the teeth

D

Which is a complication of vancomycin IV infusions? A. Angioedema B. Neurotoxicity C. Cardiomyopathy D. Red man syndrome

D

Which teaching by the nurse has highest priority for the client taking azithromycin? A. Instruct the client to use sunblock and protective clothing during sun exposure. B. Instruct the client to store the drug out of light and extreme heat. C. Inform parents that children younger than 8 years should not take the drug, to avoid tooth discoloration. D. Instruct the client to report any loose stools or diarrhea.

D

patient newly diagnosed with tuberculosis (TB) has been taking antitubercular drugs for 1 week calls the clinic and is very upset. He says, "My urine is dark orange! What's wrong with me?" Which response by the nurse is correct? a. "You will need to stop the medication, and it will go away." b. "It's possible that the TB is worse. Please come in to the clinic to be checked." c. "This is not what we usually see with these drugs. Please come in to the clinic to be checked." d. "This is an expected side effect of the medicine. Let's review what to expect."

D

The nurse is administering levofloxacin to a patient with a severe infection. What issues are included in the black box warning for this classification of drugs? SELECT ALL THAT APPLY

Achilles tendon rupture CNS effects Exacerbation of myasthenia gravis Peripheral neuropathy

Cephalosporins drug interactions

It is important to note the risk of nephrotoxicity with loop diuretics and that there is increased chance of bleeding with anticoagulants. The crystallization part is also important. It is imperative we do not administer cephalosporins in the same IV line as calcium salts, as is found in TPN and LR. In adult patients and older pediatric patients, we can administer in the same line as long as we stop the infusion of the calcium containing product and "adequately flush the line with a compatible solution." This would mean that we place the infusion pump on hold, flush the line with saline (minimum of 10 mL, but may need more depending on length of IV tubing we are trying to flush), administer the cephalosporin, flush the line with saline again(minimum of 10 mL).

Natural or inherent resistance

Occurs without previous exposure to antibacterial drug

How fast should we administer IV cephalosporins?

Over 30 min, can cause phlebitis

Macrolides are commonly used for what?

PCN allergies

Macrolides examples

Erythromycin, Clarithromycin, Azithromycin Last name is the THROMYCIN, although, some of the newer macrolide antibiotics only have the mycin as their last name. Mycin is a common last name for antibiotics, so it doesn't necessarily help us identify that it is a macrolide antibiotic

12 - True or False The therapeutic level of phenytoin is 20-40 mcg/dL. True False

False

13 - True or False Grapefruit juice can be consumed with carbamazepine. True False

False

22 - True or False PCN and cephalosporins have the same half-life and dosing schedules. 20 sec True False

False

23 - True or False Beta-lactamase inhibitors can be used alone or in combination with PCN. 20 sec True False

False

34 - True or False The black box warning for fluoroquinolones is that QT prolongation can occur. 20 sec True False

False

40 - True or False Amphotericin B is a relatively safe anti-fungal medication. 20 sec True False

False

50 - True or False Stopping antidepressants abruptly does not pose a risk to the patient. 20 sec True False

False

Tetracyclines uses?

Fights Helicobacter pylori Treats acne (oral, topical)

What are some of the adverse effects that is true of all antibiotics?

GI distress -d/v/a superinfection-CDAD organ toxicity-kidsneys,liver,ears/ nephron,otot,heptatic Allergies

Tetracyclines example?

Doxycycline end in "cycline"

What is the treatment for severe allergic reactions?(Bronchospasm, laryngeal edema, Vascular collapse, cardiac arrest)

Treatment for severe is epinephrine, bronchodilator, corticosteroid (IV methylprednisolone) and antihistamine (IV diphenhydramine

14 - True or False A CBC should be drawn with carbamazepine because it can cause thrombocytopenia and neutropenia. True False

True

21 - True or False Sulfonamides can be used to treat urinary tract infections. 20 sec True False

True

44 - True or False Therapeutic lithium range is 0.5-1.5 mEq/L 20 sec True False

True

47 - True or False St. John's Wort is contraindicated with SSRI's and SNRI's because it increases the chance of serotonin syndrome. 20 sec True False

True

49 - True or False Most of the antipsychotics, typical and atypical, can cause weight gain that can lead to metabolic syndrome. 20 sec True False

True

A client is taking piperacillin- tazobactam (Zosyn). Which nursing interventions are most appropriate for this drug? (Select all that apply.) A. Usually given with an aminoglycoside. B. Send specimen to lab for C&S before antibiotic therapy is started. C. Instruct client to take entire prescribed drug. D. Instruct client to restrict fluid intake. E. Monitor for symptoms of superinfection

B C E

Community-associate infection

acquired by a person who has not recently (in past year) been hospitalized

What is it important for the nurse to monitor when administering cephalosporins?

allergic reactions to cephalosporins in patients who are allergic to penicillin-1 and 2nd generation

What are some common things to know about sulfonamides

avoid the sun-skin reactions/photosenetivity cause crystal uria-drink a lot of water 2-3 liters make good urine-at least 1200 stomatitis-mouth sores

What can we add to a penicillin to help with the beta-lactamase problem?

beta-lactamase inhibitors

The nurse would teach a patient prescribed metronidazole to avoid ingestion of which drink? A. Milk B. Wine C. Coffee D. Orange juice

B

Which nursing diagnosis is appropriate for a patient who has started aminoglycoside therapy? a. Constipation b. Risk for injury (renal damage) c. Disturbed body image related to gynecomastia d. Imbalanced nutrition, less than body requirements, related to nausea

B

What conditions are considered contradictions for use of antifungal medications? (Select all that apply.) A. Heart failure B. Liver failure C. Kidney failure D. Pancreatic failure E. Respiratory failure

B,D

The nurse is administering one of the lipid formulations of amphotericin B. When giving this drug, which concept is important to remember? a. The lipid formulations may be given in oral form. b. The doses are much lower than the doses of the older drugs. c. The lipid formulations are associated with fewer adverse effects than the older drugs. d. There is no difference in cost between the newer and older forms.

C

The nurse is reviewing the medication history of a patient who will be taking a sulfonamide antibiotic. During sulfonamide therapy, a significant drug interaction may occur with which of these drugs or drug classes? (Select all that apply.) a. Opioids b. Oral contraceptives c. Sulfonylureas d. Antihistamines e. Phenytoin (Dilantin) f. Warfarin (Coumadin)

B C E F

The nurse would assess a patient for nephrotoxicity and ototoxicity when administering which antimicrobial? A. Cefazolin B. Clindamycin C. Gentamicin D. Erythromycin

C

What information would the nurse provide to a patient prescribed rifampin? A. Oral contraception is the preferred method of birth control when using rifampin. B. The patient will only need to take this medication for the prescribed 14-day period. C. A nonharmful adverse effect of this medication is red-orange discoloration of urine, sweat, tears, skin, salvia, and feces. D. Peripheral neuropathy is an expected side effect, and the patient should report any numbness or tingling of the extremities.

C

What is the PRIORITY intervention for the nurse to complete before administration of intravenous (IV) amphotericin B? A. Assess for nausea and vomiting. B. Monitor for cardiac dysrhythmias. C. Check for premedication prescriptions. D. Monitor IV site for signs of phlebitis.

C

When a patient is on aminoglycoside therapy, the nurse will monitor the patient for which indicators of potential toxicity? a. Fever b. White blood cell count of 8000 cells/mm3 c. Tinnitus and dizziness d. Decreased blood urea nitrogen (BUN) levels

C

Which information would the nurse include in discharge teaching for a patient prescribed doxycycline? A. "Keep the remainder of the medication in case of recurrence." B. "Take the medication until you have no fever and feel better." C. "Apply sunscreen or wear protective clothing when outdoors." D. "Take the medication with milk to minimize gastrointestinal upset."

C

A patient is being treated for oral candidiasis. Which medication will the nurse anticipate administering? A. Oseltamivir B. Nystatin C. Amantadine D. Griseofulvin

B

. A patient has oral candida albicans infection with throat involvement. The nurse is teaching the patient about taking their prescribed swish and swallow medication. What statement made by the patient indicates a need for additional teaching?

"I will drink some water directly after swallowing the nystatin to help with the bad flavor in my mouth."

What is the first name of cephalosporins?

"cef, or ceph"

Macrolides route

***Do NOT administer IM because to painful Give slowly IV to prevent pain (phlebitis)

The nurse is providing education to a patient prescribed an antibiotic. What are some general teaching points to remember with any antibiotic? SELECT ALL THAT APPLY

-Take the entire course of the prescribed antibiotic. -Increase fluids to help with excretion of the antibiotic -Taking an antibiotic puts you at risk for a super infection so eat yogurt or drink buttermilk to help re-establish your normal flora -: Organ toxicity is a common adverse effect of antibiotics, knowing the signs of the specific organ toxicity is important to prevent long term organ damage.

A young-adult, female patient is to start a tetracycline antibiotic for treatment of acne. What teaching points should the nurse include in the education provided to this patient? SELECT ALL THAT APPLY

-This medication can make oral contraceptives less effective and some other form of birth-control is recommended to prevent pregnancy. - Tetracycline antibiotics can cause birth defects in developing fetuses. - Complete the full course of therapy, as prescribed. -Take on an empty stomach with a full glass of water, either 1 hour before meals or 2 hours after meals. -: Avoid sunlight and wear sun block and protective clothing because this drug can increase the chance of severe sunburns, also known as, a photosensitive reaction.

Resistance to antibacterial drugs

1.Natural or inherent resistance 2.Acquired resistance 3.Cross-resistance 4.Community-associate infection 5.Health Care Associated Infection

Antibiotic misuse increases antibiotic resistance (50% of patient receive abx inappropriately).

1.Overprescribing of antibiotics 2.Not taking the full course of drug therapy

Which one of the generations of cephalosporins can be used to treat methicillin resistant Staphylococcus Aureus (MRSA)?

5th generation of cephalosporin's is the only current cephalosporin effective in treating MRSA.

15 - Quiz What are the 4 types of EPS? 20 sec A. Pseodoparkinsonism, acute dystonia, akithisia, tardive dyskinesia B. Acute dystonia, akithisia, cardiotoxicity, hypertensive crisis C. Psedoparkinsonism, serotonin syndrome, NMS, tardive dyskinesia D. Tardive dyskinesia, acute dystonia, nystagmus, gingival hyperplasia

A

2 - Quiz What is a common adverse effects of valproic acid? A. Hepatotoxity B. Sedation C. Gingival hyperplasia D. Drug tolerance

A

26 - Quiz A female patient of child-bearing age is prescribed PCN. What education should the nurse provide? 20 sec A. Oral contraceptives are not as effective while on PCN B. Fluid intake does not need to be increased while on PCN C. PCN should never be taken while pregnant D. GI upset is not likely with the PCN antibiotics.

A

35 - Quiz What teaching should the nurse include for a patient with diabetes prescribed ciprofloxacin? 20 sec A. Check your blood sugar more often B. You will need to decrease your insulin doses to half the normal amount C. You will need to double your insulin doses D. There is not impact on blood glucose when on ciprofloxacin

A

42 - Quiz Why are diuretics a common drug interaction with lithium? 30 sec A. They cause sodium depletion. B. They lower the blood pressure. C. They cause potassium depletion. D. They increase blood sugar.

A

48 - Quiz What signs and symptoms would the nurse associate with serotonin syndrome? 30 sec A. Fever, tremors, shivering B. Tremors, shivering, upward eye movement C. Blood pressure fluctuations, seizures, fever D. Shuffling gate, stooped posture, tremors

A

8 - Quiz The nurse is to administer a cephalosporin IV to a neonate. What information would cause the nurse the most concern? A. TPN infusion is prescribed B. Blood glucose has been low 2 times in 48 hours C. Mother is allergic to PCN D. Urine output is 1.5 ml/kg /hour

A

A patient is receiving aminoglycoside therapy and will be receiving a beta-lactam antibiotic as well. The patient asks why two antibiotics have been ordered. What is the nurse's best response? a. "The combined effect of both antibiotics is greater than each of them alone." b. "One antibiotic is not strong enough to fight the infection." c. "We have not yet isolated the bacteria, so the two antibiotics are given to cover a wide range of microorganisms." d. "We can give a reduced amount of each one if we give them together."

A

A patient visits the health care provider for treatment of tinea pedis (athlete's foot). Which medication would the nurse instruct the patient to use to treat this condition? A. Terbinafine B. Voriconazole C. Caspofungin D. Amphotericin B

A

During an intravenous (IV) infusion of amphotericin B, a patient develops tingling and numbness in his toes and fingers. What will the nurse do first? a. Discontinue the infusion immediately. b. Reduce the infusion rate gradually until the adverse effects subside. c. Administer the medication by rapid IV infusion to reduce these effects. d. Nothing; these are expected side effects of this medication.

A

During drug therapy for pneumonia, a female patient develops a vaginal superinfection. The nurse explains that this infection is caused by: a. large doses of antibiotics that kill normal flora. b. the infection spreading from her lungs to the new site of infection. c. resistance of the pneumonia-causing bacteria to the drugs. d. an allergic reaction to the antibiotics

A

The nurse would question a prescription for voriconazole if the patient was taking which medication? A. Quinidine B. Prednisone C. Captopril D. Clindamycin

A

The patient's culture has grown gram-positive cocci, and the health care provider prescribes two different antibiotics, one of which is gentamicin. To treat this type of infection, which type of antibiotic is typically prescribed together with gentamicin? A. Penicillin B. Cephalosporin C. Fluoroquinolone D. Aminoglycoside

A

What is assessment data would be collected for a patient prior to administering prescribed antibiotic therapy? A. Allergies B. Immunizations C. History of seizures D. Cardiac dysrhythmias

A

When administering a nonsteroidal antiinflammatory drug and a penicillin drug together, the displacement of the penicillin antibiotic from the protein-binding sites will result in which effect? A. Increased free drug in blood B. Decreased free drug in blood C. No change in free drug in blood D. Absence of free drug in the blood

A

When reviewing the medication orders for a patient who is taking penicillin, the nurse notes that the patient is also taking the oral anticoagulant warfarin (Coumadin). What possible effect may occur as the result of an interaction between these drugs? a. The penicillin will cause an enhanced anticoagulant effect of the warfarin. b. The penicillin will cause the anticoagulant effect of the warfarin to decrease. c. The warfarin will reduce the anti-infective action of the penicillin. d. The warfarin will increase the effectiveness of the penicillin.

A

Bacterial resistance to antibiotics can occur with which situations? (Select all that apply.) A. Patients stop taking an antibiotic when they feel better. B. Antibiotics that are prescribed to treat a viral infection C. Taking an antibiotic and an antiviral medication at the same time D. Microorganisms arriving from foreign countries and overseas ports E. Antibiotics that are prescribed according to culture and sensitivity reports

A B

When providing instructions to patients on use of antibiotics, which instructions would the nurse include in the teaching? (Select all that apply.) A. Complete the entire course of therapy. B. Increase fluid intake up to 3000 mL/day. C. Wash your hands before and after preparing food. D. Notify the provider of any possible reactions that occur. E. Save unused medication in a cool dry place for later use.

A B C D

During antibiotic therapy, the nurse will monitor closely for signs and symptoms of a hypersensitivity reaction. Which of these assessment findings may be an indication of a hypersensitivity reaction? (Select all that apply.) a. Wheezing b. Diarrhea c. Shortness of breath d. Swelling of the tongue e. Itching f. Black, hairy tongue

A C D E

The nurse is administering vancomycin to a client. Which nursing interventions are appropriate? Monitor the client for _______. (Select all that apply) A. adequate hearing B. appropriate IV rate C.pseudomembranous colitis D. Stevens-Johnson syndrome E. hypotension and tachycardia F. redness of the face, neck, and chest

A B C D E F

For a patient receiving an intravenous (IV) infusion of gentamicin, the nurse would monitor which laboratory values? A. Hematocrit and hemoglobin B. Blood urea nitrogen (BUN) and creatinine C. Prothrombin time and partial thromboplastin time D. Serum glutamic-oxaloacetic transaminase and alanine transaminase

B

If a patient is taking fluconazole (Diflucan) with an oral anticoagulant, the nurse will monitor for which possible interaction? a. Reduced action of oral anticoagulants b. Increased effects of oral anticoagulants c. Hypokalemia d. Decreased effectiveness of the antifungal drug

B

Which are important for the nurse to monitor in a patient receiving an antifungal medication? (Select all that apply.) A. Creatinine B. Daily weights C. Mental status D. Intake and output E. Blood urea nitrogen

A,B,D,C

Which types of antiviral drugs are used to treat HIV infection? (Select all that apply.) A. Fusion inhibitors B. Protease inhibitors C. Neuraminidase inhibitors D. Reverse transcriptase inhibitors E. Nonnucleoside reverse transcriptase inhibitors

A,B,D,E

The nurse has provided education to a patient about fungal skin infections. Further patient teaching is necessary when the patient tells the nurse they were prescribed antifungals for which condition? A. Thrush B. Impetigo C. Athlete's foot D. Vaginal yeast infection

B

11 - Quiz What patient education should be done with phenytoin? A. Avoid flossing teeth due to gingival tenterness B. Brush and floss your teeth twice daily C. Go to the dentist once per year D. If you want to have a baby, stop the phenytoin immediately

B

31 - Quiz When a patient wants to take an antacid with antibiotics, what is the appropriate teaching? 20 sec A. You cannot take an antacid while presribed antibiotics B. You should take the antacid 1-2 hours after the antibiotic C. You must take the antacid with the antibiotic to help the GI distress D. You should take the antacid 1 hour before the antibiotic

B

43 - Quiz What dietary teaching is important with lithium therapy? 30 sec A. Restrict potassium intake B. Increase sodium intake C. Increase caffeine intake D. Restrict fluid intake

B

51 - Quiz Match the below symptoms with either positive or negative symptoms of schizophrenia. 60 sec A. Positive= 1,2,3,5 &6; Negative= 4,7&8 B. Positive= 1,2,5,6&7; Negative=3,4&8 C. Positive=2,4,7&8; Negative=1,3,5&6 D. Positive=3,4,5,6&7; 1,2&8

B

6 - Quiz What is a common life-threatening adverse effect of all antidepressants? A. Hypertensive Crisis B. Suicide C. Serotonin Syndrome D. EPS

B

A new vaccination, Zostavax, has been approved to prevent the development of what condition in adults older than the age of 50 years? A. Influenza A B. Herpes zoster C. Avian influenza D. Herpes simplex

B

The nurse is providing patient teaching for a patient who is starting antitubercular drug therapy. Which of these statements should be included? (Select all that apply.) a. "Take the medications until the symptoms disappear." b. "Take the medications at the same time every day." c. "You will be considered contagious during most of the illness and must take precautions to avoid spreading the disease." d. "Stop taking the medications if you have severe adverse effects." e. "Avoid alcoholic beverages while on this therapy." f. "If you notice reddish-brown or reddish-orange urine, stop taking the drug and contact your doctor right away." g. "If you experience a burning or tingling in your fingers or toes, report it to your prescriber immediately." h. "Oral contraceptives may not work while you are taking these drugs, so you will have to use another form of birth control."

B, E, G, H

1 - Quiz What currently prescribed drug can have an interaction with aminoglycosides? A. Propranolol B. Morphine C. Ibuprofen D. Metformin

C

19 - Quiz What can contribute to antibiotic resistance? 20 sec A. Taking the entire course of antibiotics B. Bacteria just are resistant to antibiotics C. Overprescribing of antibiotics D. Eating meat that from animals not treated with antibiotics

C

20 - Quiz What teaching is important with sulfonamides? 20 sec A. Limit sun exposure to 4 hours per day B. Only urinate when your bladder feels full C. Drink at least 2 liters of fluid every day D. Sulfonamides have very few adverse effects

C

24 - Quiz What should the nurse assess for in a patient taking a PCN and warfarin? 20 sec A. Decreased INR level B. Increased infection C. Signs of bleeding D. Increased platelet count

C

25 - Quiz What should the nurse assess for in a patient taking a PCN and warfarin? 20 sec A. Decreased INR level B. Increased infection C. Signs of bleeding D. Increased platelet count

C

28 - Quiz A pt is prescribed ceftriaxone. What concurrently prescribed medication would concern the nurse? 20 sec A. Metoprolol B. Metformin C. Furosemide D. Atorvastatin

C

29 - Quiz Who should not take tetracycline antibiotics 20 sec A. Women of childbearing age B. People with sexually transmitted infections C. Children under 8 years old D. People prescribed digoxin

C

37 - Quiz How fast should vancomycin be administered when given intravenously? 20 sec A. Over 30 minutes B. Over 2- 6 hours C. Over 60-90 minutes D. Over a minimum of 15 minutes

C

4 - Quiz What are the general adverse reactions of antibiotics? A. Nausea, vomiting, and diarrhea B. Steven's Johnson Syndrome and nephrotoxicity C. Allergy, superinfection, and organ toxicity D. Clostridium Difficile and Candida albicans,

C

41 - Quiz What teaching with the nurse provide with nystatin swish and swallow? 20 sec A. Do not shake the bottle as it will damage the medication B. Drink water after taking the swish and swallow to help it reach the stomach C. Swish the medication around your mouth, coating all surfaces, then swallow D. You must never gargle this drug as it can cause esophageal obstructions

C

What is the only cephalosporin that can treat MRSA?

Ceftaroline

What can Metronidazole be used for?

Can be used for CDAD, although, not as effective as vancomycin or fidaxomicin. It is used for vaginal infections like bacterial vaginosis, and it is also used as an antiprotozoal

is a very strong drug used for treatment of MRSA. It can also used for CDAD and the oral form is preferred for CDAD because it is more efficacious .

Vancomycin

52 - Quiz The nurse is administering scheduled antipsychotics orally. What action should be implemented to ensure patient safety? 30 sec A. Ask the patient to open their mouth and stick out tongue after giving dose B. Leave the pill cup at the bedside if the patient is not ready to take dose C. Crush up the extended release tablets to prevent "cheeking" D. Contact the prescriber for an injectable form of the medication

A

During therapy with amphotericin B, the nurse will monitor the patient for known adverse effects that would be reflected by which laboratory result? a. Serum potassium level of 2.7 mEq/L b. Serum potassium level of 5.8 mEq/L c. White blood cell count of 7000 cells/mm3 d. Platelet count of 300,000/ microliter

A

How is the effectiveness of antiviral drugs administered to treat HIV infection assessed and evaluated? A. Viral load B. Megakaryocytes C. Lymphocyte counts D. Red blood cell counts

A

The nurse is administering intravenous acyclovir (Zovirax) to a patient with a viral infection. Which administration technique is correct? a. Infuse intravenous acyclovir slowly, over at least 1 hour. b. Infuse intravenous acyclovir by rapid bolus. c. Refrigerate intravenous acyclovir. d. Restrict oral fluids during intravenous acyclovir therapy

A

The nurse is planning care for a patient prescribed once-daily IV gentamicin therapy. When would the nurse schedule a trough drug level to be drawn? A. 12 hours after completing the antibiotic infusion B. 18 hours after completing the antibiotic infusion C. 30 minutes after beginning the antibiotic infusion D. 60 minutes after beginning the antibiotic infusion

A

The nurse is providing teaching to a patient taking an oral tetracycline antibiotic. Which statement by the nurse is correct? a. "Avoid direct sunlight and tanning beds while on this medication." b. "Milk and cheese products result in increased levels of tetracycline." c. "Antacids taken with the medication help to reduce gastrointestinal distress." d. "Take the medication until you are feeling better."

A

The nurse is reviewing the sputum culture results of a patient with pneumonia and notes that the patient has a gram-positive infection. Which generation of cephalosporin is most appropriate for this type of infection? a. First generation b. Second generation c. Third generation d. Fourth generation

A

When planning care for a patient receiving a sulfonamide antibiotic, it is important for the nurse to perform which intervention? A. Encourage fluid intake of 2000 to 3000 mL/day. B. Avoid direct sun exposure and tanning beds. C. Take the medication with dairy products such as milk or yogurt. D. Advise the patient to report any tinnitus to the health care provider

A

Which is a higher priority for the nurse who is teaching the client taking Trimethoprim-sulfamethoxazole (TMP-SMZ)? • A. Encourage an increase in fluid intake. B. Report signs of ototoxicity (e.g., tinnitus, deafness). C. Teach the client that individuals taking this drug are not affected by sun exposure. D. Advise the client to take this drug with dairy products or antacids to protect the stomach.

A

The nurse is administering intravenous vancomycin (Vancocin) to a patient who has had gastrointestinal surgery. Which nursing measures are appropriate? (Select all that apply.) a. Monitoring serum creatinine levels b. Restricting fluids while the patient is on this medication c. Warning the patient that a flushed feeling or facial itching may occur d. Instructing the patient to report dizziness or a feeling of fullness in the ears e. Reporting a trough drug level of 11 mcg/mL and holding the drug f. Reporting a trough drug level of 24 mcg/mL and holding the drug

A C D F

A patient will be receiving nitrofurantoin (Macrodantin) treatment for a urinary tract infection. The nurse is reviewing the patient's history and will question the nitrofurantoin order if which disorder is present in the history? (Select all that apply.) a. Liver disease b. Coronary artery disease c. Hyperthyroidism d. Type 1 diabetes mellitus e. Chronic renal disease

A E

patient is in the HIV clinic for a follow-up appointment. He has been on antiretroviral therapy for HIV for more than 3 years. The nurse will assess for which potential adverse effects of long-term antiretroviral therapy? (Select all that apply.) a. Lipodystrophy b. Liver damage c. Kaposi's sarcoma d. Osteoporosis e. Type 2 diabetes

A, B, D, E

A patient who is diagnosed with genital herpes is taking topical acyclovir. The nurse will provide which teaching for this patient? (Select all that apply.) a. "Be sure to wash your hands thoroughly before and after applying this medicine." b. "Apply this ointment until the lesion stops hurting." c. "Use a clean glove when applying this ointment." d. "If your partner develops these lesions, then he can also use the medication." e. "You will need to avoid touching the area around your eyes." f. "You will have to practice abstinence when these lesions are active."

A, C, E, F

Before administration of any antiviral medication, what nursing assessments and/or interventions would be performed? (Select all that apply.) A. Baseline vital signs B. History of medication use C. Head-to-toe physical assessment D. Documentation of known allergies E. Monitor for medication adverse effects

A,B,C,D

A nurse is educating students on viral transmission. What routes does the nurse include in the teaching of how viruses enter the body? (Select all that apply.) A. Through an animal bite B. Transplacentally from mother to infant C. Inhalation through the respiratory tract D. Localized allergic reaction to medication E. Ingestion via the gastrointestinal (GI) tract

A,B,C,E

. A patient is prescribed metronidazole for an infection. The nurse is providing education to the patient prior to discharge. What information should the nurse include in the discharge instructions?

Avoid alcohol, including alcohol hand gel, while on this medication to prevent a known interaction

A patient is taking nystatin (Mycostatin) oral lozenges to treat an oral candidiasis infection resulting from inhaled corticosteroid therapy for asthma. Which instruction by the nurse is appropriate? a. "Chew the lozenges until they are completely dissolved." b. "Let the lozenge dissolve slowly and completely in your mouth without chewing it." c. "Rinse your mouth with water before taking the inhaler." d. "Rinse your mouth with mouthwash after taking the inhaler."

B

A patient who has undergone a lung transplant has contracted cytomegalovirus (CMV) retinitis. The nurse expects which drug to be ordered for this patient? a. Acyclovir (Zovirax) b. Ganciclovir (Cytovene) c. Ribavirin (Virazole) d. Amantadine (Symmetrel)

B

A patient who is prescribed metronidazole for a gynecologic infection provides the nurse with a list of medications that are routinely taken. Which medication would lead the nurse to question the prescription for Flagyl? A. Ibuprofen B. Lithium C. Levothyroxine D. Multivitamin

B

A patient will be having oral surgery and has received an antibiotic to take for 1 week before the surgery. The nurse knows that this is an example of which type of therapy? a. Empiric b. Prophylactic c. Definitive d. Resistance

B

A patient with a severe fungal infection has orders for voriconazole (Vfend). The nurse is reviewing the patient's medical record and would be concerned if which assessment finding is noted? a. Decreased breath sounds in the lower lobes b. History of cardiac dysrhythmias c. History of type 2 diabetes d. Potassium level of 4.0 mEq/L

B

During antibiotic therapy, the nurse will assess the patient for a condition that may occur because of the disruption of normal flora. The nurse knows this as what condition? A. Organ toxicity B. Superinfection C. Hypersensitivity D. Allergic reaction

B

The nurse is obtaining a medication history from a patient diagnosed with genital herpes. Which drug would the nurse expect this patient to be prescribed? A. Ribavirin B. Acyclovir C. Zidovudine D. Amantadine

B

The nurse is preparing to administer morning medications to a patient who has been newly diagnosed with tuberculosis. The patient asks, "Why do I have to take so many different drugs?" Which response by the nurse is correct? a. "Your prescriber hopes that at least one of these drugs will work to fight the tuberculosis." b. "Taking multiple drugs reduces the chance that the tuberculosis will become drug resistant." c. "Using more than one drug can help to reduce side effects." d. "Using multiple drugs enhances the effect of each drug."

B

The nurse is providing counseling to a woman who is HIV positive and has just discovered that she is pregnant. Which anti-HIV drug is given to HIV-infected pregnant women to prevent transmission of the virus to the infant? a. Acyclovir (Zovirax) b. Zidovudine (Retrovir) c. Ribavirin (Virazole) d. Foscarnet (Foscavir)

B

When performing discharge teaching for a patient prescribed oral linezolid to treat methicillin-resistant Staphylococcus aureus (MRSA), the nurse would emphasize which important information? A. Stop the drug as soon as you feel better. B. Avoid ingestion of foods containing tyramine. C. Report any occurrence of constipation or facial flushing. D. Take the drug with an antacid to avoid gastrointestinal (GI) upset.

B

Which nursing intervention is a high priority for the client who is taking cefepime? A. Wait until culture results are received before initiating antibiotic. B. Monitor the client for signs and symptoms of a superinfection. C. Administer IV cephalosporins over 2 hours to prevent phlebitis. D. Instruct the client to take the drug for 5 days only.

B

Which patient statement regarding a diagnosis of HIV infection indicates further teaching is needed for the patient? A. "I must take these medications exactly as prescribed for the rest of my life." B. "I don't need to use condoms as long as I take my medication as prescribed." C. "I will notify my health care provider immediately if I bruise or bleed more easily than normal." D. "I should remain upright for 30 minutes after taking my zidovudine to prevent esophageal ulceration."

B

The nurse is administering an amphotericin B infusion. Which actions by the nurse are appropriate? (Select all that apply.) a. Administering the medication by rapid IV infusion b. Discontinuing the drug immediately if the patient develops tingling and numbness in the extremities c. If adverse effects occur, reducing the IV rate gradually until they subside d. Using an infusion pump for IV therapy e. Monitoring the IV site for signs of phlebitis and infiltration f. Administering premedication for fever and nausea g. Knowing that the intravenous solution for amphotericin B will be cloudy h. Knowing that muscle twitching may indicate hypokalemia

B, D, E, F

46 - Quiz What information is important for the nurse to teach about MAOI's? 30 sec A. Increase intake of sodium while on MAOI's B. Stop these medications immediately if side effects occur C. Avoid foods that contain tyramine D. Take other antidepressants in addition to the MAOI's

C

5 - Quiz What is a common adverse effect of phenobarbitol? A. Gingival hyperplasia B. Increased focus C. Sedation D. Gastric ulcers

C

53 - Quiz What teaching should the nurse provide to the parent of a child prescribed methylphenidate? 20 sec A. Administer after meals to prevent GI irritation B. Give before bed because of the sedative effects. C. Methylphenidate causes growth suppression and weight loss D. Your child can still have caffeine while taking this drug

C

9 - Quiz What statement by the patient indicates a need for additional education about lorazepam? 30 sec A. "I must stop drinking coffee and colas."​ B. "I must stop drinking alcoholic beverages."​ C. "I can stop this drug after 3 weeks if I feel better."​ D. "I should not become pregnant while taking this drug."

C

A patient has a urinary tract infection. The nurse knows that which class of drugs is especially useful for such infections? a. Macrolides b. Carbapenems c. Sulfonamides d. Tetracyclines

C

A patient has received a prescription for a 2-week course of antifungal suppositories for a vaginal yeast infection. She asks the nurse if there is an alternative to this medication, saying, "I don't want to do this for 2 weeks!" Which is a possibility in this situation? a. A single dose of a vaginal antifungal cream. b. A one-time infusion of amphotericin B. c. A single dose of a fluconazole (Diflucan) oral tablet. d. There is no better alternative to the suppositories.

C

A patient is infected by invasive aspergillosis, and the medical history reveals that the patient has not been able to tolerate several antifungal drugs. The nurse anticipates an order for which medication to treat this infection? a. Fluconazole (Diflucan) b. Micafungin (Mycamine) c. Caspofungin (Cancidas) d. Nystatin (Mycostatin)

C

A patient is receiving cidofovir (Vistide) as part of treatment for a viral infection, and the nurse is preparing to administer probenecid, which is also ordered. Which is the rationale for administering probenecid along with the cidofovir treatment? a. Probenecid has a synergistic effect when given with cidofovir, thus making the antiviral medication more effective. b. The probenecid also prevents replication of the virus. c. Concurrent drug therapy with probenecid reduces the nephrotoxicity of the cidofovir. d. The probenecid reduces the adverse gastrointestinal effects of the cidofovir

C

A patient is receiving his third intravenous dose of a penicillin drug. He calls the nurse to report that he is feeling "anxious" and is having trouble breathing. What will the nurse do first? a. Notify the prescriber. b. Take the patient's vital signs. c. Stop the antibiotic infusion. d. Check for allergies.

C

A patient who has been hospitalized for 2 weeks has developed a pressure ulcer that contains multidrug-resistant Staphylococcus aureus (MRSA). Which drug would the nurse expect to be chosen for therapy? a. Metronidazole (Flagyl) b. Ciprofloxacin (Cipro) c. Vancomycin (Vancocin) d. Tobramycin (Nebcin)

C

A patient who has been taking isoniazid (INH) has a new prescription for pyridoxine. She is wondering why she needs this medication. The nurse explains that pyridoxine is often given concurrently with the isoniazid to prevent which condition? a. Hair loss b. Renal failure c. Peripheral neuropathy d. Heart failure

C

A patient who has started drug therapy for tuberculosis wants to know how long he will be on the medications. Which response by the nurse is correct? a. "Drug therapy will last until the symptoms have stopped." b. "Drug therapy will continue until the tuberculosis develops resistance." c. "You should expect to take these drugs for as long as 24 months." d. "You will be on this drug therapy for the rest of your life."

C

A patient who is allergic to penicillin is at increased risk for an allergy to which drug? A. Erythromycin B. Gentamicin C. Cefazolin sodium D. Demeclocycline

C

A patient who is diagnosed with shingles is taking topical acyclovir, and the nurse is providing instructions about adverse effects. The nurse will discuss which adverse effects of topical acyclovir therapy? a. Insomnia and nervousness b. Temporary swelling and rash c. Burning when applied d. This medication has no adverse effects

C

A patient with a long-term intravenous catheter is going home. The nurse knows that if he is allergic to seafood, which antiseptic agent is contraindicated? a. Chlorhexidine gluconate (Hibiclens) b. Hydrogen peroxide c. Povidone-iodine (Betadine) d. Isopropyl alcohol

C

A young adult calls the clinic to ask for a prescription for "that new flu drug." He says he has had the flu for almost 4 days and just heard about a drug that can reduce the symptoms. What is the nurse's best response to his request? a. "Now that you've had the flu, you will need a booster vaccination, not the antiviral drug." b. "We will need to do a blood test to verify that you actually have the flu." c. "Drug therapy should be started within 2 days of symptom onset, not 4 days." d. "We'll get you a prescription. As long as you start treatment within the next 24 hours, the drug should be effective."

C

In an effort to prevent superinfections of the GI tract such as Clostridium difficile, the nurse will instruct patients to eat which foods? A. Multigrain wheat bread B. Raw fruits and vegetables C. Cultured dairy products such as yogurt D. Low-fat meats such as chicken and pork

C

The nurse checks the patient's laboratory work prior to administering a dose of vancomycin (Vancocin) and finds that the trough vancomycin level is 24 mcg/mL. What will the nurse do next? a. Administer the vancomycin as ordered. b. Hold the drug, and administer 4 hours later. c. Hold the drug, and notify the prescriber. d. Repeat the test to verify results.

C

The nurse is counseling a woman who will be starting rifampin (Rifadin) as part of antitubercular therapy. The patient is currently taking oral contraceptives. Which statement is true regarding rifampin therapy for this patient? a. Women have a high risk for thrombophlebitis while on this drug. b. A higher dose of rifampin will be necessary because of the contraceptive c. Oral contraceptives are less effective while the patient is taking rifampin. d. The incidence of adverse effects is greater if the two drugs are taken together

C

The nurse is monitoring a patient who has been on antibiotic therapy for 2 weeks. Today the patient tells the nurse that he has had watery diarrhea since the day before and is having abdominal cramps. His oral temperature is 101° F (38.3° C). Based on these findings, which conclusion will the nurse draw? a. The patient's original infection has not responded to the antibiotic therapy. b. The patient is showing typical adverse effects of antibiotic therapy. c. The patient needs to be tested for Clostridium difficile infection. d. The patient will need to take a different antibiotic.

C

The nurse is monitoring for therapeutic results of antibiotic therapy in a patient with an infection. Which laboratory value would indicate therapeutic effectiveness of this therapy? a. Increased red blood cell count b. Increased hemoglobin level c. Decreased white blood cell count d. Decreased platelet count

C

The nurse is reviewing the medication administration record of a patient who is taking isoniazid (INH). Which drug or drug class has a significant drug interaction with isoniazid? a. Pyridoxine (vitamin B6) b. Penicillins c. Phenytoin (Dilantin) d. Benzodiazepines

C

To assess for the dose-limiting toxicity of ganciclovir, the nurse will monitor which laboratory test result? A. Blood urea nitrogen B. Liver function tests C. Complete blood count (CBC) D. Creatine phosphokinase

C

When monitoring patients on antitubercular drug therapy, the nurse knows that which drug may cause a decrease in visual acuity? a. Rifampin (Rifadin) b. Isoniazid (INH) c. Ethambutol (Myambutol) d. Streptomycin

C

When providing health promotion teaching at a senior citizen center, the nurse would include information about which medication used to decrease the duration of influenza virus types A and B? A. Indinavir B. Enfuvirtide C. Oseltamivir D. Ganciclovir

C

When reviewing the allergy history of a patient, the nurse notes that the patient is allergic to penicillin. Based on this finding, the nurse would question an order for which class of antibiotics? a. Tetracyclines b. Sulfonamides c. Cephalosporins d. Quinolones

C

Which antifungal drug can be given intravenously to treat severe yeast infections as well can be prescribed as a one-time oral dose to treat vaginal yeast infections? A. Voriconazole B. Nystatin C. Fluconazole D. Caspofungin

C

Which patient statement indicates to the nurse that the patient understands the discharge teaching for ethambutol? A. "Constipation will be a problem, so I will increase the fiber in my diet." B. "Dizziness and drowsiness are common adverse effects with this drug." C. "I will need to have my vision checked periodically while I am taking this drug." D. "This medication may cause my bodily secretions to turn red-orange-brown."

C

Which statement best describes health care-associated infections? A. They develop in more than 15% of hospitalized patients. B. The infection develops in response to various antibiotics. C. The infection was not incubating at the time of admission. D. Patients are admitted to the hospital with an infectious disease.

C

A patient has taken several doses of intravenous gentamicin for a severe infection and is scheduled for another dose this morning. The patient is unsteady while walking to the bathroom this morning and complains of having some trouble hearing the nurse. The nurse notes that this is new behavior from what was shared in shift report. What action should the nurse implement

Contact the health care provider and request trough level before giving the scheduled dose Since gentamicin is an aminoglycoside and can cause organ toxicity to the ears and the kidneys, the nurse should contact the health care provider to ask for a trough level in order to determine if these symptoms are related to toxic levels of the aminoglycosides.

10 - Quiz What is the first drug used to treat status epilepticus? A. Phenobarbitol B. Phenytoin C. Midazolam D. Lorezepam

D

33 - Quiz A pt is prescribed gentamicin. What assessment would be concerning to the nurse? 20 sec A. Urine output of 1000 mL per day B. The patient hears the nurse speaking clearly C. Urine is clear, light yellow and aromatic D. The patient is unsteady on their feet and struggles with balance

D

45 - Quiz A patient is prescribed fluoxetine for depression. What information will the nurse include when teaching the patient? 20 sec A. The medication takes effect in only 1 week.​ B. The medication should be taken with grapefruit juice.​ C. The medication increases libido. D. The medication may cause headaches and insomnia.

D

A patient has been diagnosed with carbapenemase-resistant Enterobacteriaceae (CRE). The nurse expects to see orders for which drug? a. Dapsone (Cubicin), a miscellaneous antibiotic b. Ciprofloxacin (Cipro), a quinolone c. Linezolid (Zyvox), an oxazolidinone d. Colistimethate sodium (Coly-Mycin), a polypeptide antibiotic

D

A patient is admitted with a fever of 102.8° F (39.3° C), origin unknown. Assessment reveals cloudy, foul-smelling urine that is dark amber in color. Orders have just been written to obtain stat urine and blood cultures and to administer an antibiotic intravenously. The nurse will complete these orders in which sequence? a. Blood culture, antibiotic dose, urine culture b. Urine culture, antibiotic dose, blood culture c. Antibiotic dose, blood and urine cultures d. Blood and urine cultures, antibiotic dose

D

A patient prescribed azithromycin expresses concern regarding GI upset that was experienced when previously prescribed an erythromycin antibiotic. What is the nurse's best response? A. "Take an over-the-counter antiemetic to lessen the nausea." B. "Stop taking the drug if you experience heartburn and diarrhea." C. "I will call the health care provider and request a different antibiotic." D. "This drug is like erythromycin with less gastrointestinal adverse effects."

D

A patient who is HIV- positive has been receiving medication therapy that includes zidovudine (Retrovir). However, the prescriber has decided to stop the zidovudine because of its dose-limiting adverse effect. Which of these conditions is the dose-limiting adverse effect of zidovudine therapy? a. Retinitis b. Renal toxicity c. Hepatotoxicity d. Bone marrow suppression

D

A patient with a known heart condition is prescribed an antibiotic before a dental procedure. What type of antibiotic therapy is this considered? A. Empiric B. Definitive C. Supportive D. Prophylactic

D

An infant has been hospitalized with a severe lung infection caused by the respiratory syncytial virus (RSV) and will be receiving medication via the inhalation route. The nurse expects which drug to be used? a. Acyclovir (Zovirax) b. Ganciclovir (Cytovene) c. Amantadine (Symmetrel) d. Ribavirin (Virazole)

D

Before discharge, the nurse is reviewing a patient's prescribed medication regimen for tuberculosis (TB). The patient asks the nurse why pyridoxine has been prescribed while continuing to take isoniazid to treat TB. What is the nurse's appropriate response? A. "Multidrug therapy is necessary to prevent the occurrence of resistant bacteria." B. "You really should not be on that drug. I will check with the health care provider." C. "Pyridoxine is another antitubercular drug that will work synergistically with the isoniazid." D. "Pyridoxine will help prevent numbness, and tingling that can occur secondary to the isoniazid."

D

During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and decreased appetite. Which statement is the nurse's best advice to the patient? a. "Take it with cheese and crackers or yogurt." b. "Take each dose with a glass of milk." c. "Take an antacid with each dose as needed." d. "Drink a full glass of water with each dose."

D

Medications used to treat HIV infections are more specifically classified as what type of drugs? A. Antiviral B. Antifungal C. Antiparasitic D. Antiretroviral

D

The most significant drug interactions with use of antivirals occur when antivirals are administered via which route? A. Rectally B. Topically C. Optically D. Intravenously

D

The nurse anticipates a prescription for vitamin supplementation for a patient who is receiving isoniazid therapy. What vitamin supplement is usually prescribed with isoniazid? A. Folate B. Calcium C. Vitamin E D. Vitamin B6

D

The nurse is administering a vancomycin (Vancocin) infusion. Which measure is appropriate for the nurse to implement in order to reduce complications that may occur with this drug's administration? a. Monitoring blood pressure for hypertension during the infusion b. Discontinuing the drug immediately if red man syndrome occurs c. Restricting fluids during vancomycin therapy d. Infusing the drug over at least 1 hour

D

The nurse is discussing adverse effects of antitubercular drugs with a patient who has active tuberculosis. Which potential adverse effect of antitubercular drug therapy should the patient report to the prescriber? a. Gastrointestinal upset b. Headache and nervousness c. Reddish-orange urine and stool d. Numbness and tingling of extremities

D

The nurse is preparing an infusion of amphotericin B for a patient who has a severe fungal infection. Which intervention is appropriate regarding the potential adverse effects of amphotericin B? a. Discontinuing the infusion immediately if fever, chills, or nausea occur b. Gradually increasing the infusion rate until the expected adverse effects occur c. If fever, chills, or nausea occur during the infusion, administering medications to treat the symptoms d. Before beginning the infusion, administering an antipyretic and an antiemetic drug

D

The nurse is preparing to use an antiseptic. Which statement is correct regarding how antiseptics differ from disinfectants? a. Antiseptics are used to sterilize surgical equipment. b. Disinfectants are used as preoperative skin preparation. c. Antiseptics are used only on living tissue to kill microorganisms. d. Disinfectants are used only on nonliving objects to destroy organisms

D

The nurse is reviewing instructions for vaginal antifungal drugs with a patient. Which statement by the nurse is an appropriate instruction regarding these drugs? a. "The medication can be stopped when your symptoms are relieved." b. "Discontinue this medication if menstruation begins." c. "Daily douching is part of the treatment for vaginal fungal infections." d. "Abstain from sexual intercourse until the treatment has been completed and the infection has resolved."

D

The nurse providing care to patient with a fungal infection is aware that which drugs is known for the most number of possible adverse effects? A. Fluconazole B. Ketoconazole C. Griseofulvin D. Amphotericin B

D

The nurse will assess the patient for which potential contraindication to antitubercular therapy? a. Glaucoma b. Anemia c. Heart failure d. Hepatic impairment

D

Which instruction would the nurse include for a patient prescribed rifampin and isoniazid prophylactically secondary to TB exposure? A. Advise that these drugs will only need to be taken for 7 to 10 days. B. Remind that sunscreen is not needed during outdoor activities. C. Explain that isoniazid may decrease blood serum glucose in susceptible people. D. Emphasize that oral contraceptives become ineffective when given with rifampin.

D

patient is taking a combination of antiviral drugs as treatment for early stages of a viral infection. While discussing the drug therapy, the patient asks the nurse if the drugs will kill the virus. When answering, the nurse keeps in mind which fact about antiviral drugs? a. They are given for palliative reasons only. b. They will be effective as long as the patient is not exposed to the virus again. c. They can be given in large enough doses to eradicate the virus without harming the body's healthy cells. d. They may also kill healthy cells while killing viruses.

D

When assessing for adverse effects to Rifamate (combination isoniazid and rifampin), the nurse would monitor which laboratory values? (Select all that apply.) A. Cholesterol B. Uric acid levels C. Sputum cultures D. Liver function tests E. Complete blood cell count

D, E

A patient is receiving vancomycin and experiences a sudden drop in blood pressure and increase in heart rate. The nurse also notes that the patient is red on their face, neck and chest. What is the best action by the nurse?

Decrease the rate of infusion as this is a known reaction to rapid vancomycin infusions

16 - True or False Fluphenazine deconoate and haloperidol deconoate can be given by intravenous route. 20 sec True False

False

18 - True or False Buspirone is taken as needed for anxiety. 20 sec True False

False

27 - True or False Cephalosporins always cause an allergic reaction in patient's with a history of PCN allergy. 20 sec True False

False

3 - True or False Due to adverse effects of amitriptyline, it should be given first thing in the morning. True False

False

32 - True or False Macrolides can be given orally, intramuscularly, intravenously, and topically. 20 sec True False

False

7 - True or False Sudden onset of watery stools and abdominal cramping is an expected adverse effect of antibiotics and is not concerning. True False

False

What can happen if we administer cephalosporins with calcium salts?

It is imperative we do not administer cephalosporins in the same IV line as calcium salts, as is found in TPN and LR. In adult patients and older pediatric patients, we can administer in the same line as long as we stop the infusion of the calcium containing product and "adequately flush the line with a compatible solution." This would mean that we place the infusion pump on hold, flush the line with saline (minimum of 10 mL, but may need more depending on length of IV tubing we are trying to flush), administer the cephalosporin, flush the line with saline again(minimum of 10 mL). Neonates cannot have IV cephalosporins if they need treatment with TPN or LR (calcium salts). Autopsy has revealed crystalline material in the lungs and kidneys of neonates receiving cephalosporins and TPN.

A patient with tuberculosis will be starting on isoniazid, rifampin, and kanamycin for the initial phase of treatment. What education should the nurse provide this patient? SELECT ALL THAT APPLY

Rifampin can cause discoloration of body fluids, which can stain clothing and soft contact lenses. - Isoniazid and rifampin can cause liver damage, avoid acetaminophen and alcohol while on these medications. -: Kanamycin can cause kidney and ear toxicity, therefore, report decrease urine output or hearing or balance disturbances. - Because isoniazid depletes vitamin B6, peripheral neuropathy can occur, and any numbness or tingling should be reported. -Take the medications exactly as prescribed to help prevent multi-drug resistant tuberculosis

Because of the risk of nephrotoxicity and ototoxicity, serum levels of vancomycin should be monitored periodically in therapy. Report high levels to the doctor in order to prevent permanent damage. How can we prevent this?

The trough should be checked every 3-4 dose. If you do not see an order for a trough and it has been greater than 4 doses, you should request a trough level to be drawn. Ideal trough values are between 10-20 mcg/mL.

17 - True or False Risperidone can cause gynecomastia. 20 sec True False

True

30 - True or False A culture should be obtained before initiating any antibiotics. 20 sec True False

True

36 - True or False Vancomycin is the drug of choice for MRSA infections. 20 sec True False

True

38 - True or False Alcohol use with metronidazole can cause a disulfiram-like reaction. 20 sec True False

True

39 - True or False Acyclovir is commonly used to treat herpes zoster. 20 sec True False

True

A patient is receiving acyclovir by intravenous route for herpes zoster infection. What action should the nurse implement to help prevent phlebitis?

When administering IV acyclovir, the best way to prevent phlebitis is to infuse over 1 hour, on an infusion controlled device or infusion pump (IV pump). Diluting to 1 liter is not necessary. Normally, 60-150 mL will be used for the infusion, depending on the dose prescribed. Administer infusion slowly, over 60 minutes

acquired resistance to antimicrobial drugs

caused by prior exposure to antibacterial (Staph and PCN) MRSA (resistant to all PCN and most cephalosporins)

What would be the general teaching for antibiotic?

don't stop until the course is finish use alternate birthcontrol drink plenty of water don't share with family members take it at the same time at the prescribed intervals

Drugs interactions that are important to remember for cephalosporins?

loop diuretics-nephrotoxicity

Quinolones (Fluoroquinolones) implementation

•*Monitor intake and output. Urine output should be at least 750 mL. Pt should increase intake to >2000 mL/day to prevent crystalluria. •Administer oral doses 2 hours before or after antacids and iron products to aid in absorption. •For IV levofloxacin, administer over 60 minutes •*Check for signs of superinfection •*Monitor blood sugar in diabetic patients on oral hypoglycemic agents. •*Monitor Theophylline levels when taken concurrently with fluroquinolones, can increase theophylline levels. *Monitor heart rate and rhythm, especially in patients with cardiac history or on other medications that can cause QT prolongation

Quinolones (Fluoroquinolones) patient teaching

•*Teach patient to drink 2000 mL per day. •Encourage sun block •Encourage patient to report tinnitus, rash and very rare tendon rupture.

Aminoglycosides adverse effects

•A/N/V/D, photosensitivity, tinnitus, ototoxicity, nephrotoxicity, peripheral neuropathy

Antibiotic combinations:

•Additive: effect is sum of the two antibiotics •Potentiative: one potentiates effect of other •Antagonistic: if one bactericidal and one bacteriostatic, desired effect is diminished

implementation of Sulfonamides?

•Administer sulfonamides with a full glass of water. Extra fluid can help prevent crystalluria and kidney stone formation •*Fluid intake should be at least 2000 ml/day. Urine output should be at least 1200 mL/day *Observe for hematologic reactions that may lead to life-threatening anemias. Early signs are sore through, purpura, and decreasing white blood cell and platelet counts.

Implementation for tetracyclines?

•Administer tetracycline 1 hour before or 2 hours after meals for best absorption •Monitor labs for renal or liver impairment •Monitor urine output (<30 ml/hr indicates renal impairment) •*Do not administer to pregnant women or children under the age of 8.

Quinolones (Fluoroquinolones) contraindications

•Allergy to quinolones, severe renal disease, myasthenia gravis, pregnancy and breast feeding •Use caution in: Seizure disorders, renal dysfunction, children <14, older adults, cardiac dysrhythmias

Macrolides contraindications

•Allergy, bradycardia, hypokalemia, hypomagnesemia •Use caution in hepatic dysfunction, lactation and renal dysfunction

Contradictions of cephalosporin?

•Allergy, gallbladder disease, pseudomembranous colitis The contraindication of gallbladder disease is for active gallbladder disease-meaning the patient still has their gallbladder and they have stones or it does not work well. Cephalosporins can cause calcium crystal stones of the gallbladder which could cause acute gallbladder symptoms and could even rupture of the gallbladder. If the gallbladder is removed, we no longer have to worry about it rupturing or having stones form within the gallbladder.

Tetracyclines contraindications?

•Allergy, pregnancy, severe hepatic or renal disease •Use caution in renal and hepatic dysfunction, hypokalemia, bradycardia, breastfeeding

Assessment for cephalosporins

•Assess for allergy to cephalosporins or penicillins •Assess and record urine output (<30 mL/ hr indicates renal impairment) •Assess baseline liver enzymes(AST/ALT) and renal function (BUN and creatinine) •Assess drug History: loop diuretics, anticoagulants •*Culture the infected area prior to starting antibiotics

Assessment for Sulfonamides?

•Assess renal function by checking urine output,(?600 mL/day) BUN, and creatinine •Obtain medical history from patient. Contraindicated in patient with severe renal disease or liver disease •Assess for hypersensitivity to sulfonamides. •Assess baseline CBC as blood dyscrasias may occur. *Obtain culture and sensitivity before drugs are given

assessment for aminoglycosides

•Assess urine output (<30 mL/hr indicate renal impairment) •Assess laboratory results to determine renal and liver function. •Obtain medical history on renal or hearing disorders •Obtain specimen for culture and sensitivity

Assessment for Macrolides

•Assess vital signs and urine output (<30 mL/hr shows renal impairment) •Check liver function (AST, ALT) •Obtain drug history: increases effect of digoxin and warfarin, decreased effects of pcn and clindamycin •*Check culture and sensitivity (C&S) before therapy.

Quinolones (Fluoroquinolones) drug interactions

•Increase effects of oral hypoglycemics and theophylline •Decreased absorption with antacids

Aminoglycosides drug interactions

•Increased nephrotoxicity with NSAIDS, Cephalosporins, loop diuretics, and vancomycin •Increased ototoxicity with Loop diuretics

Sulfonamides actions?

•Inhibit bacterial synthesis of folic acid •Bacteriostatic •Fights gram - bacteria •Proteus, Klebsiella, E. coli, Chlamydia

What are the most common ways that antibiotics work to stop the growth of bacteria or kill bacteria?

•Interference with the bacterial cell wall synthesis •Interference with protein synthesis •Interference with replication RNA and DNA •Antimetabolite action that disrupts the metabolic reactions inside the bacterial cell

Nystatin oral swish and swallow

•It comes in a suspension, so shake it first •Have the patient swish the medicine around mouth thoroughly, coating all areas •If throat is involved, have the patient gargle before they swallow the medication •Do not drink for 30 minutes after, to allow medication to remain in contact with oral mucosa.

Amphotericin B adverse effects

•Many adverse effects •Cardiac dysrhythmias •Hypokalemia and hypomagnesemia

•Allergy or hypersensitivity:

•May be a mild allergic reaction(rash, hives, pruritus) •May be severe allergy such as anaphylactic shock (Bronchospasm, laryngeal edema, Vascular collapse, cardiac arrest)

•Organ toxicity (which organ is effected depends on the antibiotic being used) These are the common toxicities associated with various antibiotics

•Nephrotoxicity •Hepatotoxicity •Ototoxicity

Amphotericin B treatment

•Patient often premedicated •Acetaminophen •Antiemetics •Antihistamines •Corticosteroids

Tetracyclines adverse effects?

•Photosensitivity (avoid sun), GI distress: N/V/D, CDAD, superinfection, hepatotoxicity, nephrotoxicity, •Discoloration of permanent teeth •Do not give to children younger than 8 years

Amphotericin B

•Potent antifungal and dangerous •Administered IV in ICU •Slow infusion of 2-6 hours

•Narrow spectrum

•Primarily effective against one bacteria type. EITHER gram negative bacteria OR gram positive bacteria, not BOTH •Examples: penicillin, erythromycin

Quinolones (Fluoroquinolones) adverse effects

•Rash, tinnitus, photosensitivity, GI distress; N/V/D, superinfection(CDAD), Nephrotoxicity/Crystalluria •QT prolongation → torsade's de points→ sudden cardiac arrest •BLACK BOX WARNING: •Rare Achilles' tendon rupture, CNS effects, exacerbation of myasthenia gravis, and peripheral neuropathy can occur

Quinolones (Fluoroquinolones) assessments

•Record vital signs and intake and urine output •Assess laboratory results to determine renal function •Obtain drug and diet history: antacids decrease absorption. Increase the effects of oral hypoglycemics •*Obtain specimen for culture and sensitivity

Acyclovir routes and administration

•Routes: oral, topical, IV •IV is most often used for shingles •Give IV slowly and watch for phlebitis

Sulfonamides adverse effects?

•Stomatitis, photosensitivity, crystalluria, CDAD, blood dyscrasias, Steven's Johnson Syndrome

•Superinfection

•Superinfection •Secondary infection that occurs when normal flora killed •Common sites: mouth, skin, respiratory tract, vagina, intestines •Usually occurs when treated more than 1 week •More common with broad spectrum antibiotics •Examples: Thrush (oral candidiasis) or Clostridium difficile Associated Diarrhea-CDAD(bacteria in intestines, overgrowth causes severe diarrhea) •Treatment depends on organism: thrush treated with nystatin and C. Diff is treated with anti-bacterial's such as vancomycin and fidaxomicin (which is a macrolide antibiotic)

patient teaching for penicillin

•Take the entire prescribed amount, complete the full course of antibiotic •Advise patient who is allergic to PCN to wear a medical alert bracelet •Increase fluid intake •*Advise female patients of childbearing age to use additional form of birth control while taking PCN •*Advise to take with food to avoid gastric irritation