Pharm Final Quiz/Practice Questions-Antibiotics

Which instructions should a nurse provide to a patient who is to start taking amoxicillin/clavulanate [Augmentin]?

"Augmentin may be taken with food or meals." Amoxicillin/clavulanate is a broad-spectrum aminopenicillin that may be taken with meals. Most other oral penicillins must be taken with a full glass of water 1 hour before or 2 hours after meals.

A patient who is receiving vancomycin [Vancocin] IV for a methicillin-resistant Staphylococcus aureus (MRSA) infection asks a nurse, "Why can't I take this medicine in a pill?" Which response should the nurse make?

"It is more effective by IV, because the pill form will stay in the digestive tract." Because of its chemical size and weight, vancomycin is absorbed poorly in the gastrointestinal (GI) tract and is given parenterally for most infections. It is used for serious infections caused by organisms such as MRSA and in patients with susceptible organisms allergic to penicillins. Oral administration is used only for infections of the intestine.

Which instructions will the nurse include when teaching a patient about cephalosporin therapy?

"Notify your healthcare provider if you develop diarrhea.""Notify your healthcare provider if you develop a rash." Cephalosporins may enhance bleeding tendencies, so drugs such as aspirin that may promote bleeding should be avoided. Cephalosporins may be taken with food, and they are safe to take if a patient has lactose intolerance. Severe diarrhea should be reported, because it may indicate the development of C. difficile infection. Any indication of an allergic reaction, including a rash, should be reported to the healthcare provider.

Which instruction should a nurse include in the discharge teaching for a patient who is to start taking tetracycline?

"Use sunscreen and protective clothing when outdoors." Tetracyclines are bacteriostatic antibiotics; photosensitivity and severe sunburn are common adverse effects

The nurse should include which instructions when teaching a patient about tigecycline therapy?

"Use sunscreen when you are outside." "If you have diarrhea more than five times a day, notify your healthcare provider." "Avoid using this drug if you are pregnant."

The nurse understands that tetracyclines are contraindicated for which patient?

A 7 year old with acne

When administering an aminoglycoside to a patient with myasthenia gravis, it is most important for the nurse to assess what?

Breath sounds

A patient who is receiving an aminoglycoside develops flaccid paralysis and impaired breathing. Which medication does the nurse anticipate administering?

Calcium gluconate [Kalcinate]

Which of the following OTC medications should not be taken with tetracyclines?

Calcium supplements, milk products, magnesium containing laxatives, antacids containing magnesium, aluminum, or both.

A patient is receiving penicillin G [Bicillin C-R]. Which assessment should the nurse monitor as an indicator of an undesired effect?

Cardiac rhythm-Penicillin G in high IV doses may cause hyperkalemia, which can result in dysrhythmias or cardiac arrest. Hypernatremia occurs with high IV doses of ticarcillin.

What Principles must be considered in the choice of an antibiotic?

Choose the antibiotic that is specific to the infecting organism, Choose the antibiotic to which the infecting organism is the most sensitive, Choose the method of delivery to provide the best method of killing the bacteria.

It is most important for the nurse to assess a patient receiving a cephalosporin for the development of which manifestation of antibiotic-associated pseudomembranous colitis (AAPMC)?

Diarrhea. AAPMC, which is manifested initially by diarrhea and abdominal cramping, especially may develop with the use of broad-spectrum cephalosporins.

What combination of medications should the nurse question?

Erythromycin and verapamil

What does the nurse identify as an adverse effect of clindamycin [Cleocin] therapy?

Frequent loose, watery stools with mucus and blood. Clostridium difficile-associated diarrhea (CDAD) is the most severe toxicity associated with clindamycin and is characterized by profuse, watery stools. The cause is superinfection of the bowel with Clostridium difficile, an anaerobic gram-positive bacillus.

The nurse recognizes that what action may decrease the incidence of red man syndrome in a patient receiving vancomycin?

Giving the medication over at least 60 minutes.

A nurse monitors a patient who is receiving an aminoglycoside (gentamicin) for symptoms of vestibular damage. Which finding should the nurse expect the patient to have first?

Headache. Headache is the first sign of impending vestibular damage (balance) and may last 1 to 2 days. Unsteadiness, vertigo, and dizziness appear after headache.

Which laboratory result should a nurse monitor more frequently when a patient is receiving clarithromycin [Biaxin] and warfarin [Coumadin]?

International normalized ratio (INR) . Clarithromycin is a macrolide similar to erythromycin and can inhibit hepatic metabolism of medications such as warfarin and theophylline.

Which statements about CDAD associated with clindamycin therapy does the nurse identify as true?

It is a potentially fatal condition, Patients usually experience abdominal pain, Clindamycin therapy should be discontinued and vancomycin started.

A patient who is receiving ceftriaxone has all of these medications ordered. The nurse monitors the patient for an adverse effect related to an interaction with which medication?

Naproxen [Naprosyn] Three cephalosporins—cefmetazole [Zefazone], cefoperazone [Cefobid], and cefotetan [Cefotan]—cause bleeding tendencies. Caution should be used during concurrent use of anticoagulants and other nonsteroidal medications.

How does penicillin work to destroy bacteria?

PCN disrupts cell wall synthesis & promotes cell wall destruction.

Before administering a cephalosporin to a patient, it is most important for the nurse to assess the patient for an allergy history to what?

Penicillins. The cephalosporins are beta-lactam antibiotics similar in structure and actions to the penicillins. They are contraindicated in patients with a history of severe allergic reactions to penicillins.

A patient is admitted to the hospital with a medical diagnosis of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). When taking the patient's history, a nurse recognizes which information as the most important?

Plays a contact sport and is an athlete. CA-MRSA is transmitted by skin-to-skin contact and by contact with contaminated objects, such as sports equipment and personal items. It is seen in young, healthy people without recent exposure to healthcare facilities, which is one of the biggest risk factors for CA-MRSA.

Which cardiovascular finding does the nurse identify as a possible adverse effect of erythromycin [Ery-Tab] therapy?

Prolonged QT interval. When present in high levels, erythromycin can prolong the QT interval, causing a potentially fatal ventricular dysrhythmia.

A patient who is receiving an aminoglycoside (gentamicin) has a urinalysis result with all of these findings. Which finding should a nurse associate most clearly with an adverse effect of gentamicin?

Protein. Aminoglycoside-induced nephrotoxicity usually presents as acute tubular necrosis.

A patient is receiving vancomycin [Vancocin]. The nurse identifies what as the most common toxic effect of vancomycin therapy?

Renal toxicity. The most common toxic effect of vancomycin [Vancocin] therapy is renal toxicity. Although ototoxicity may occur, it is rare.

A nurse should teach a patient to observe for which side effects when taking ampicillin?

Skin rash and loose stools-Ampicillin's most common side effects are rash and diarrhea; both reactions occur more frequently with ampicillin than with any other penicillin.

A patient taking an oral cephlasporin complains of nausea. What should the nurse have the patient do to decrease the nausea?

Take the medication with food.

An immunocompromised patient who is receiving piperacillin/tazobactam [Zosyn] develops oozing and bleeding from the gums. Which additional data should the nurse determine?

The most recent platelet count. Piperacillin/tazobactam [Zosyn] is an extended-spectrum penicillin used primarily for infections caused by Pseudomonas aeruginosa in immunocompromised hosts. It can cause bleeding secondary to disrupting platelet function; therefore, the platelet count may be altered.

Which drug has the broadest antimicrobial spectrum of all the penicillins?

Ticarcillin

Headache is the first sign of impending vestibular damage (balance) and may last 1 to 2 days. Unsteadiness, vertigo, and dizziness appear after headache.

Trough

Which statements about vancomycin [Vancocin] does the nurse identify as true?

Vancomycin is the most widely used antibiotic in U.S. hospitals. Vancomycin is effective in the treatment of Clostridium difficile infection. Vancomycin is effective in the treatment of MRSA infections.

Which medications by the nurse for infections in a patient with a severe penicillin allergy?

Vancomycin, Ezithromycin, & Clindamycin

A patient who has a vancomycin-resistant enterococci (VRE) infection is receiving linezolid [Zyvox]. Which laboratory result indicates that the patient is having an adverse effect?

White blood cell (WBC) count of 1200 units/L. Linezolid can cause reversible myelosuppression, manifesting as anemia, leukopenia, or even pancytopenia.