Pharmacology Midterm
The nurse is caring for a client who is taking methotrexate for rheumatoid arthritis and will be taking a sulfonamide for a urinary tract infection. What laboratory results will be most important for the nurse to monitor?
Complete blood count
The client admitted to the hospital is ordered sulfasalazine 500 mg QID. The drug comes from the pharmacy in 1000-mg capsules. What is the best action by the nurse?
Contact the pharmacist
The nurse instructs a client on sulfonamide therapy to drink a full glass of water when taking the medication and to also drink at least 8 large glasses of water each day until therapy is finished. The nurse is trying to prevent which complication associated with sulfonamide therapy?
Crystalluria
An 87-year-old resident of a long-term care facility has been prescribed oral clindamycin for the treatment of an infected pressure ulcer. The care providers at the facility should be instructed to monitor the resident closely for what potential adverse effect of clindamycin?
Diarrhea
The nurse is caring for a client who is on sulfonamide therapy and monitors the client for which common side effects? (Select all that apply.)
Diarrhea Nausea Photosensitivity
The nurse is preparing a teaching plan for a client who is prescribed ceftriaxone. What should the nurse identify as common adverse effects associated with this drug?
Diarrhea and nausea
The nurse is providing discharge education to a client who is leaving with a prescription for PO ampicillin. What should the nurse teach the client?
Discoloration of the tongue may occur but will subside when the drug is discontinued.
The male client who had surgery 3 days ago is discharged home after completing his perioperative regimen of cefotetan. A few hours after being home, he drinks a beer. Approximately 5 hours later, the client becomes flushed and nauseated, reports throbbing in the head and neck, begins to sweat, and becomes hypotensive. The client is <b>most</b> likely experiencing what reaction?
Disulfiram-like
Oral ampicillin has been ordered for a client whose urinary tract infection will be treated in a home setting. When providing antibiotic teaching to this client, the nurse should stress which instruction?
Drink a full glass of water when taking a dose of the drug.
Natural penicillins have been available since 1941 to treat infections. What problem has developed since 1941?
Drug-resistant strains of microorganisms have developed.
A client being treated for cellulitis with a cephalosporin asks what the essential difference is between generations of this medication. The nurse should respond to the client's question based on what fact?
Each successive generation is more effective against gram-negative microorganisms.
A 32-year-old female client has been diagnosed with a superinfection and has been prescribed tigecycline. What is a priority nursing action?
Educate the client about the need to supplement oral contraceptives with another form of birth control.
A client has an upper respiratory infection and is allergic to penicillin. What medication does the nurse expect will be ordered?
Erythromycin
Which of the following classes of penicillins are used to treat Pseudomonas? (Choose one)
Extended spectrum penicillins
The nurse is taking a pharmacolgy course to increase her knowledge about how medications work. When studying the different types of penicillins, the nurse learns that only one group destroys the bacteria pseudomonas. It is which group?
Extended-spectrum penicillins
Some clients stop taking their prescribed sulfonamide once symptoms disappear. What should the nurse tell the client when first teaching about this medication to prevent the early discontinuation of the drug?
Failure to complete a course of therapy may result in a recurrence of the infection.
A client taking a cephalosporin for a respiratory infection informs the nurse that her tongue feels funny and has white patches on it. She asks the nurse what could be wrong. The nurse informs the client that she has developed which?
Fungal superinfection
Which of the following herbs has some evidence that supports its use to treat diarrhea caused by bacteria or intestinal parasites? (Choose one)
Goldenseal
The nurse is performing an assessment on a 7-year-old child in the clinic. The nurse observes the child's teeth are darkly stained. What information should the nurse obtain from the parent?
Has the child taken tetracycline for treatment?
A client, diagnosed with peptic ulcer disease, has been prescribed clarithromycin. Which organism is this medication used to treat?
Helicobacter pylori
The nurse is caring for a neonate of a mother who took a sulfonamide during the last weeks of pregnancy. For which condition will the nurse monitor the neonate? Select all that apply.
Hemolytic anemia Jaundice
The nurse is preparing to administer a sulfonamide to a client who is a Type 2 diabetic taking an oral hypoglycemic agent. The nurse will monitor the client for what reaction?
Hypoglycemia
A male client with diabetes who controls his disease with an oral agent and diet has been hospitalized with a urinary tract infection. The physician has ordered sulfasalazine 500 mg QID. What should the nurse closely monitor for in this client?
Hypoglycemic reaction
A client receiving Rocephen IV for an infection continues to run a temperature. It becomes elevated 24 hours after the client begins drug therapy. Which would be a priority nursing diagnosis for this client?
Impaired comfort
Which nursing diagnoses would receive high priority for a burn client on sulfonamide therapy?
Impaired skin integrity
The nurse understands that bacterial resistance can result when certain bacteria produce penicillinase. What does penicillinase do?
Inactivates penicillin
A cardiac client is receiving Rocephin 1 gram IV every 12 hours postoperatively. He is currently on Diovan and Plavix. What should the nurse be concerned about with this client?
Increased risk for bleeding
Which reaction should a nurse assess for in a client who could develop a fungal superinfection in the oral cavity after being administered penicillin?
Inflamed mucous membranes
The nurse knows that sulfonamides are chosen to treat ulcerative colitis because of what action?
Inflammation is decreased because of interaction with intestinal bacteria.
A male client who has undergone surgery of the urinary tract is administered cephalosporins to prevent infections. When assessing the client on the day after the surgery, the nurse notices that he has an elevated temperature. Which nursing intervention would be most appropriate in this case?
Inform the primary health care provider.
The nursing student is studying about sulfonamides and learns that their which is their mode of action?
Inhibit the activity of folic acid in bacterial cell metabolism
A client with a urinary tract infection is being treated with a sulfonamide antibiotic. The nurse should recognize that pathogens are being eradiated by what means?
Inhibition of folic acid synthesis
A nurse is caring for a client who is receiving penicillin therapy. The client has been reporting diarrhea-like symptoms, and the nurse suspects a bacterial superinfection. Which interventions would be most appropriate?
Inspect stools to confirm diarrhea.
The nurse learns that a 7-year-old child has been prescribed tetracyclines several times in recent years. What assessment should the nurse prioritize?
Inspect the client's teeth.
A nurse is caring for a client with crystalluria. When caring for the client, which intervention would the nurse include in the plan of care to prevent more stones from forming?
Instruct the client to increase fluid intake to 2000 mL.
The pharmacology instructor is explaining combination drugs to the nursing class.The instructor tells the students that the combination of a beta-lactamase inhibitor and a penicillin produces what effect?
It extends the spectrum of antibacterial activity of the penicillin.
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.
The nurse is administering penicillin to a client who has strep throat. Which of the following statements accurately describe the action of penicillin?
It is effective against gram-positive organisms
Some combination antibacterial drugs consist of a penicillin and a beta-lactamase inhibitor. What is the primary purpose of a beta-lactamase inhibitor in one of these drugs?
It protects the penicillin.
The pharmacology instructor is discussing ways to decrease adverse effects on clients taking aminoglycosides. Which would the instructor include?
Keeping the clent well hydrated
In which condition present in the client should macrolides be used with caution?
Liver dysfunction
A client has been admitted for treatment of a burn on the left arm. Which sulfonamides are most likely to be prescribed to treat this condition? Select all that apply.
Mafenide (Sulfamylon) Silver sulfadiazine (Silvadene)
The nurse is teaching the client who has just been placed on sulfasalazine about its potential adverse reactions. One common reaction the nurse should definitely include in teaching is which?
May cause the skin and urine to turn orange-yellow
An older adult is to receive a low dose of a cephalosporin for an infection. When realizing that this client has age-related diminished renal function, what intervention should the nurse implement?
Monitor blood creatinine levels.
A 40-year-old is being treated for an ear infection with a cephalosporin. Which adverse reactions should the nurse monitor for in the client?
Nausea
The nurse informs a client of which are the most common adverse effect of sulfonamide therapy?
Nausea
A nursing student is learning about sulfonamides in pharmacology class. The student correctly identifies some of the gastrointestinal system's adverse reactions as which? (Select all that apply.)
Nausea Vomiting Anorexia Stomatitis
A nurse is helping with the discharge of a 92-year-old female client who has been hospitalized for a serious upper urinary tract infection. The client will continue taking SMZ-TMP at home. She is to be discharged into her daughter's care. The nurse will instruct the daughter to watch for which common adverse effect(s) of the drug?
Nausea and vomiting
The nurse should monitor the client for which common side effects of erythromycin therapy?
Nausea, vomiting, and diarrhea
A young adult has been receiving Keflex P.O. for the last 5 days to treat a respiratory infection. The nurse is concerned when the client reports urinating only once in the last 16 hours. What should the nurse consider as the cause?
Nephrotoxicity
John, 34 years old, is being treated with clindamycin for osteomyelitis of his tibia following an open fracture 3 months ago. The nurse is teaching John how to properly administer the medication at home and the side effects that he needs to report to the health care provider. Which would be the best instruction to give John?
Notify the provider if you have any blood in your stool or diarrhea.
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.
The nurse is caring for a 44-year-old client who takes furosemide (Lasix) on a daily basis. The physician has ordered ceftrixone (Rocephin) now for an infection. The nurse expects that the healthcare provider will do what with the dosage of ceftrixone (Rocephin) for this client?
Order a decreased dosage.
When administering aminoglycosides, the nurse must be aware of which of the following adverse reactions?
Ototoxicity and nephrotoxicity
Anaphylactic shock occurs more commonly after which route of administration? (Choose one)
Parenteral
Michael, 25 years old, has had mitral valve regurgitation since age four, after having rheumatic fever. Michael is planning to go to his dentist to have his teeth cleaned. Because of Michael's history he will need to take antibiotics in conjunction with this procedure to prevent bacteremia. Which class of antibiotics will Michael most likely receive if he has no allergies?
Penicillin
The nurse is caring for a client diagnosed with syphilis. The client has no known drug allergies. Which medication can the nurse expect to be ordered for this client?
Penicillin
Your client has been diagnosed with streptococcal pharyngitis. Which of the following would you anticipate being ordered?
Penicillin G
Cephalosporins are structurally and chemically related to which classes of antibiotics?
Penicillins
Clients with which of the following conditions should not be administered cefprozil (Cefzil) oral suspension because it contains phenylalanine? (Choose one)
Phenylketonuria
The nurse is preparing to administer nafcillin intravenously (IV) to a client. What is the most common reaction related to this method of administration?
Phlebitis
A 36-year-old client with a history of rheumatic fever is scheduled for dental surgery. The primary care provider orders this client to take penicillin for 3 days before and for 3 days after surgery. This is a case of which type of therapy?
Prophylaxis
Aminoglycosides fight infection by interfering with what process within the causative bacterium?
Protein synthesis
The nurse is caring for a child weighing 30 kg. The healthcare provider orders gentamicin 100 mg IV three times per day. The recommended dosage range is 6 to 7.5 mg/kg/day. What action should the nurse take?
Question the prescriber about the dosage of the medication.
The nurse is teaching a client about his prescription for a macrolide antibiotic. What should the nurse teach the client to report?
Recurring symptoms of infection
The nurse is aware that sulfonamide therapy is used cautiously in older adults because of decreased function of what organ system?
Renal
A client is started on sulfamethoxazole-trimethoprim (Bactrim) for a urinary infection. What adverse effect should the nurse assess with this client?
Renal damage
The nurse is preparing to administer amikacin to a client with a complicated Staphylococcus aureus infection. What assessment should the nurse prioritize?
Renal function
A health care provider is deciding what medication to prescribe for a client with an upper respiratory infection. What principles guide the provider's decision? Select all that apply.
Resistance of the bacteria Other drugs the client is taking daily The client's ability to tolerate the drug
A 55-year-old woman has recently begun treatment for a UTI with SMZ-TMP. When planning this client's care, what nursing diagnosis should the nurse prioritize?
Risk for Impaired Tissue Integrity related to drug-induced photosensitivity
A client is given sulfasalazine to treat ulcerative colitis. The client begins to complain of flu-like symptoms including fever, cough, headache, and muscle aches and pains. The nurse notices red wheals on the client's face and neck. The nurse suspects which adverse effect?
Stevens-Johnson syndrome (SJS)
The nurse is caring for a client who is taking tetracycline for Rocky Mountain spotted fever. The nurse notices that the client has developed painful mouth ulcers. The nurse knows that the client has developed what adverse reaction to the medication?
Stomatitis
The nursing student studying pharmacology identifies correctly which classes of drugs to be the first to effectively treat infections?
Sulfonamides
Which category of antimicrobial agents is used chiefly because of low cost and effectiveness in treating common bacterial infections?
Sulfonamides
A 34-year-old female client is taking oral cephradine, a first-generation cephalosporin, at regular intervals with a 2-hour gap before meals. The client reports gastrointestinal distress. The nurse will encourage the client to do which?
Take the drug with food.
Your client has been diagnosed with syphilis. He states that he is allergic to penicillin. You would anticipate which of the following drugs being prescribed for his treatment?
Tetracycline
Which statement is true in regards to the oral administration of tetracyclines?
Tetracyclines should be administered with a full glass of water.
The nurse working in the burn unit is preparing to change client's dressing for the first time. What should the nurse tell the client before changing the dressing and applying the ordered mafenide (sulfamylon) ointment?
That stinging or burning may be felt during and after application of the ointment
While discussing drug combinations, including the beta-lactamase inhibitor combinations, the pharmacology instructor explains their mechanisms of action. What benefit is derived from combining a beta-lactamase inhibitor with a penicillin?
The beta-lactamase inhibitor protects the penicillin.
A hospital client has been prescribed IV ceftriaxone, a cephalosporin antibiotic. What assessment finding related to drug therapy would be of greatest concern to the nurse?
The client develops jaundice
A client is being treated for urosepsis with ceftriaxone IV. What assessment finding should prompt the nurse to contact the care provider immediately?
The client has a new onset of jaundice and edema
A client with a complex medical history is showing signs and symptoms of sepsis. What aspect of this client's health history would rule out the safe and effective use of an aminoglycoside antibiotic?
The client has chronic renal failure
A 64-year-old client is admitted to your unit with exacerbation of chronic heart failure and pneumonia and started on cefixime. On the third hospital day, you are assessing the client and note white patches in his mouth, and he is complaining of diarrhea. What would be the most likely reason for these symptoms?
The client has developed a superinfection because the antibiotic has destroyed the normal bacterial flora in his body.
The nurse is admitting a client with a urinary tract infection who has been prescribed sulfadiazine. What information obtained in the admission process would cause the nurse to contact the health care provider immediately?
The client is currently taking warfarin (Coumadin).
An older adult client responded well to inclient treatment with a third-generation cephalosporin. After being largely symptom free for 48 hours, the client has developed a fever of 38.6°C and an elevated white cell count. What phenomenon may account for this client's current clinical presentation?
The client may be infected with microorganisms that were resistant to the cephalosporin.
Which client should be assessed further before receiving azithromycin (Zithromax) as ordered?
The client who is taking digoxin
The nurse is caring for the following clients and is aware that sulfonamides should be used cautiously in which client?
The client with asthma
Which client should not receive erythromycin as ordered at 8 a.m.?
The client with elevated liver enzymes
The health care provider considers prescribing an oral tetracycline for a client suspected of having a urinary tract infection. What action needs to be completed before the medication can be prescribed?
The health care provider should order culture and susceptibility studies.
A client is taking penicillin for an upper respiratory infection. The client calls the office after 2 days of therapy reporting nausea and abdominal pain. Which would be the best instruction for the nurse to give the client?
These are normal side effects, but if they increase in severity or frequency, you need to contact the office again.
The client who has been on long-term sulfonamide therapy begins begins to demonstrate symptoms associated with side affects of the therapy. The nurse knows that these symptoms are related to which complication associated with sulfonamide therapy?
Thrombocytopenia
The nursing instructor is teaching the nursing students about serious hematologic adverse reactions that can occur with prolonged sulfonamide therapy. Which of the following should be included? (Select all that apply.)
Thrombocytopenia Leukopenia Aplastic anemia
Your client is scheduled to undergo major abdominal surgery. A preoperative order for neomycin has been given. Neomycin is used preoperatively for the following reason:
To suppress intestinal bacteria.
The nurse is caring for a client taking sulfonamides. The nurse observes sloughing of the skin and mucous membranes. The nurse suspects which hypersensitivity reaction?
Toxic epidermal necrolysis
The nurse is caring for a client with a urinary tract infection caused by Escherichia coli and expects the health care provider to order which sulfonamide?
Trimethoprim (TMP) and sulfamethoxazole (SMZ)
The nurse is caring for a client who has been prescribed a sulfonamide but does not have an infection. The nurse is aware that the medication has been prescribed to treat what condition?
Ulcerative Colitis
Nursing students are learning that sulfonamides work on both gram-negative and gram-positive bacteria. Some infections that this class of drugs treats include which? Select all that apply.
Urinary tract infections Ulcerative colitis Acute otitis media Second- and third-degree burns
The nurse is caring for a client receiving sulfonamides. The nurse will notify the health care provider if which changes are noted in the client's urine output? Select all that apply.
Urine output is decreased. Crystals are present in the urine.
The nurse is caring for a client who is taking a sulfonamide and notices that the client has developed itchy hives. After contacting the health care provider, what term will the nurse use to describe the client's symptoms?
Urticaria
When teaching clients abput taking a sulfonamide, the nurse should include various types of hypersensitivity (allergic) reactions that can occur. Which do these include? (Select all that apply.)
Urticaria Pruritis Generalized skin eruptions Stevens-Johnson syndrome
The nurse is caring for a 23-year-old female client who uses oral contraceptives and has been prescribed ampicillin for treatment of a respiratory infection. What information is most important for the nurse to share with this client?
Use a type of barrier birth control while you are taking this antibiotic.
The nursing instructor is teaching about a new emerging bacteria that has both natural and acquired resistance and that affects the severely ill, immunocomprimised clients in intensive care, transplant, and some cancer treatment units. This is which?
VRE
The nursing instructor is teaching about anti-infectives and informs students that viruses have been difficult to treat in the past. He indicates the reason for this to be which of the following?
Viruses have the ability to change because they use DNA and RNA of other cells.
The nursing student is caring for a client with ulcerative colitis. The student asks the instructor why the client is taking a sulfonamide. What should the instructor tell the student?
When sulfonamides interact with intestinal bacteria, they help to inhibit the inflammatory process.
The client has a severe infection in the leg from a boating accident. A diagnosis has been made of the presence of MRSA. MRSA can best be defined as which?
a bacteria resistant to antibiotics
Which client has the highest risk of developing ototoxicity secondary to gentamicin?
a man who has required repeated courses of gentamicin over the past several months
A disulfiram-like reaction may occur if which substance is consumed within 72 hours after administration of certain cephalosporins?
alcohol
A nurse is caring for a client who is receiving cephalosporin. Which histories will a nurse obtain as part of the preadministration assessment? Select all that apply.
allergy history surgical treatment history drug history
A group of students are separating the various penicillins into their groups. Which drug will the students indicate as an example of an aminopenicillin?
amoxicillin
A client diagnosed with infective endocarditis would be most effectively treated with which medication?
ampicillin
A client has just received a first dose of intravenous nafcillin when he immediately begins to have difficulty breathing and loses consciousness. The nurse takes the client's vital signs: blood pressure is 88/50 with a pulse oxygenation of 88%.What should the nurse suspect?
anaphylactic reaction
Sulfonamides are classified as which type of medication?
antibacterial
After teaching a group of nursing students about the action of penicillins, the instructor determines that the teaching was effective when the students identify natural penicillins as exerting which type of effect on microorganisms?
bactericidal
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
The action of sulfonamides is classified as which type of medication?
bacteriostatic
The concentration of any drug in the body is referred to as which of the following?
blood level
A 67-year-old client with a history of chronic illness is receiving penicillin therapy. The client's age and health history indicate an increased susceptibility to pseudomembranous colitis. The nurse would be alert for which finding? Select all that apply.
bloody diarrhea rectal bleeding
When describing the ways in which microbes enter the body to a group of nursing students, which ways would the instructor include? Select all that apply.
breathing ingestion mucous membrane contact break in the skin
The primary health care provider has prescribed mafenide for a client with second-degree burns. The nurse would be alert for which effect as the most frequent adverse reaction associated with the topical application of mafenide on the affected area?
burning sensation during application
The health care provider is selecting an antibiotic for a client with a known penicillin allergy. The provider knows that cephalosporins are a poor choice for this client because cephalosporins:
can cause allergic reactions in clients who are allergic to penicillins.
A client previously experienced an anaphylactic reaction to penicillin G. Which medication should not be administered to this client due to the potential for cross-sensitivity?
cefadroxil
A client being prepared for surgery has been prescribed prophylactic antibiotics. What medication would the nurse anticipate being prescribed?
cefazolin
Which drug is a first-generation cephalosporin used as a surgical prophylaxis?
cefazolin
When reviewing an older client's most recent laboratory values, which finding may contraindicate the use of tetracycline?
creatinine of 2.8 mg/dL (247.52 µmol/L) (high)
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)
A nurse is preparing to administer a client's first scheduled dose of tetracycline. The nurse should first ensure that the client has not recently eaten what type of foods?
dairy products
Because of neuromuscular blocking effects in clients receiving gentamicin, the LPN would report which of the following findings to the health care provider?
decrease in respiratory rate and rhythm
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
A client reports having had a "bad reaction" the last time receiving penicillin. Prior to a scheduled dental procedure, the client is likely to be prescribed what drug?
erythromycin
The nurse receives a call from a client who is taking clindamycin (Cleocin). The client reports a burning feeling when swallowing. The nurse knows that the client has developed which adverse reaction related to this medication?
esophagitis
The nurse expects to apply mafenide (Sulfamylon) to the skin of a client with a burn how many times each day?
every 12 hours
The client is receiving keflex 1000 mg/day. The nurse properly identifies this drug as
first-generation cephalosporin.
The client is receiving keflex 1000 mg/day. The nurse properly identifies this drug as a
first-generation cephalosporin.
A client diagnosed with malaria has been prescribed treatment with sulfadiazine. The nurse should encourage the client to increase consumption of what dietary component?
fluids
What potential adverse reaction is most likely to develop during cefazolin therapy?
gastrointestinal upset
Penicillins are most effective when used to treat what type of microorganisms?
gram-positive bacteria
What preexisting condition would cause the nurse to question a prescription for the administration of intramuscular (IM) imipenem-cilastatin?
history of atrioventricular block
When describing how tetracyclines treat infection, the nurse would incorporate which information into the description?
inhibiting bacterial protein synthesis
When describing the action of sulfonamides to a client, the nurse integrates understanding of the drug's action with effects exerted due to which mechanism?
inhibition of the activity of folic acid in bacterial cell metabolism
When considering known adverse reactions to gentamicin therapy, the nurse should focus assessment of what body structure?
inner ears
A 66-year-old woman with a history of recurrent urinary tract infections has been admitted to the hospital with a diagnosis of pyelonephritis. The client began treatment 36 hours ago with intravenous gentamicin and is being monitored closely. The nurse is aware that the therapeutic effect of the client's drug regimen is primarily a result of:
interference with bacterial reproduction.
The nurse in the neonatal intensive care unit is caring for a premature newborn who is being administered sulfonamides. The newborn's bilirubin comes back abnormally high. What is the greatest concern for the nurse if this continues to rise?
kernicterus
Cephalosporins might interfere with the accuracy of which test?
ketone urine test
The nursing instructor is teaching about the many adverse reactions to penicillin, including some of the hematopoietic changes that can occur. Which of the following should the instructor include when reviewing blood cell changes? (Select all that apply.)
leukopenia bone marrow depression anemia thrombocytopenia
The nurse is justified in suspecting that a client who recently completed a course of ceftaroline may have been treated for what health problem?
methicillin-resistant Staphylococcus aureus (MRSA) infection
Cultures reveal methicillin-susceptible Staphylococcus aureus in a client's postoperative wound. What medication should the nurse anticipate being prescribed for this client? Select all that apply.
nafcillin oxacillin dicloxacillin
A nurse is conducting an in-service education program for a group of nurses. When describing the action of the various classes of penicillins, which class would the nurse identify as having the narrowest spectrum of activity?
natural penicillins
A client has been prescribed oral tetracycline. The nurse will instruct the client to take the drug how?
on an empty stomach.
A 25-year-old woman is being treated with penicillin G as prophylaxis to prevent bacterial endocarditis prior to a dental procedure. The nurse should question the client concerning her the use of:
oral contraceptives.
The nurse has encouraged a client prescribed oral amoxicillin to take this medication with fluids but with the exception of what beverage?
orange juice
A nurse monitors a client closely for anaphylactic reactions secondary to penicillin therapy. The nurse understands that this occurs more commonly after which route of administration?
parenteral
Which medication should be administered as prophylaxis for rheumatic fever?
penicillin G
What event triggers the development of a superinfection?
proliferation of antibiotic-resistant microorganisms
The nurse is reviewing the medication history of a client who is prescribed penicillin therapy. Use of which medication would alert the nurse to the possibility of the client's increased risk for an anaphylactic reaction?
propranolol
The nurse knows that superinfections are a concern for clients who have been taking oral penicillins. Which is one of the more common superinfections?
pseudomembranous colitis
The nurse has administered the first dose of a client's newly-prescribed antibiotic. What assessment finding should the nurse interpret as adverse effect that suggests a more serious concern?
rash to the face and trunk
A nurse is assessing a client who is receiving vancomycin intravenously. While the drug is being administered, the client reports a throbbing sensation in the neck and back and paresthesias. The client's blood pressure has dropped and the neck and back are erythematous. The nurse suspects which adverse finding?
red man syndrome
The nurse is aware that drug resistance has significantly increased. Client education must be reinforced so that complete regimens of medications are taken. In which situation would one expect to find an issue with drug resistance?
residents in a long-term care facility
A nurse is speaking to a 62-year-old female client who has been started on sulfisoxazole, a sulfonamide antibiotic. The nurse should teach this client to contact the health care provider if the client experiences what adverse effect associated with the drug?
skin rash or itching
A 7-year-old child has been taking tetracycline for a bacterial infection. The nurse will be sure to inform the parents that this drug could cause
staining of permanent teeth.
A client who has been on long-term geocillin therapy for repeated urinary tract infections (UTIs), reports severe abdominal cramping. The client also states that he has been having bloody diarrhea and rectal bleeding. What should the nurse suspect?
superinfection
The client is admitted to the acute care facility with acute septicemia and has orders to receive gentamicin and ampicillin IV. The nurse is performing an admission assessment that includes a complete nursing history. What information provided by the client would indicate the need to consult the healthcare provider before administering the ordered medication?
takes high-dose furosemide daily
A client newly diagnosed with syphilis is allergic to penicillin. What medication should this client be prescribed?
tetracycline
When conducting health education for a client prescribed an oral penicillin for an infection caused by gram-negative bacilli, the nurse should emphasize which instructions?
the need to take the medication on an empty stomach
A client, who sustained a burn from a gas grill, has been prescribed a sulfonamide to prevent a burn infection. What route is preferred in the prevention of a burn infection?
topical
A client with a deep wound producing large amounts of purulent drainage is prescribed an antibiotic. The nurse should express concern about the potential effectiveness of the treatment if which medication is prescribed?
trimethoprim-sulfamethoxazole
The client has completed a course of sulfonamide therapy and the nurse knows that continued inspection of the skin is required for how long after the end of treatment?
two weeks
What medical diagnosis is often treated with sulfasalazine therapy? Select all that apply.
ulcerative colitis
A client with a gram-negative infection is being treated with an aminoglycoside. What assessment should the nurse prioritize during treatment?
urine output and BUN and creatinine levels
The nurse is caring for a client who is receiving amikacin for the treatment of a serious Staphylococcus aureus infection. What assessment should the nurse prioritize?
urine output and creatinine clearance
A nurse is reviewing the medical record of a client who is prescribed tetracycline. Which drug, if found being used by the client, would alert the nurse to the need for a decreased dosage of that drug?
warfarin
Which action would the nurse suggest to a client to reduce the risk of photosensitivity from sulfonamide therapy? Select all that apply.
wearing sunglasses wearing protective clothing using sunscreen
A 4-year-old client being discharged from the hospital is ordered an oral-suspension cephalosporin. When the nurse instructs the mother to store the bottle in the refrigerator, the mother asks, "Why does that matter?" The nurse's best response would be which?
"Drugs that require refrigeration lose potency if kept at room temperature."
A client with a urinary tract infection has been advised that cranberries, cranberry juice, and extra fluids may assist in relieving symptoms. What statement by the client would indicate a need for further instruction?
"I don't like cranberries so I will take a cranberry capsule."
A nurse is teaching a client how to apply a topical sulfonamide to a burn. Which statement by the client would indicate that the teaching was effective?
"I will apply it in a very thin layer over the area."
Which statement by a client taking a sulfonamide requires further instruction?
"I will make sure to use extra sunscreen when I go to the tanning booth."
The nurse is preparing to administer a sulfonamide to a client when the client states, "I woke up this morning with a lot of sores in my mouth." What is the nurse's next best action?
"I'm going to contact your health care provider before I administer your medication."
The nurse is applying silver sulfadiazine (Silvadene) to a client's burn when the client states, "Every time you put that on me it burns." What is the nurse's best response?
"I'm sorry that it hurts, but many clients report a burning sensation when this medication is applied."
A 74-year-old man with a history of prostatitis has been prescribed SMZ-TMP for the treatment of a urinary tract infection. Which teaching point should the nurse include in client education?
"If you can, try to take your pill on an empty stomach."
Which statement should the nurse include in the medication instructions for an older adult prescribed tetracycline?
"Increase your fluids to 2 L or more per day to prevent renal crystals."
A professional female cyclist has been prescribed SMZ-TMP for chronic urethritis. She has informed the nurse that she has a cross-country race in 2 days. Which would be an appropriate response by the nurse?
"It would not be a good idea to be outside while taking this medication because of possible photosensitivity occurring."
The nurse is caring for a client whose prescribed course of cefaclor will soon be completed. What health education should the nurse provide to the client?
"Make sure to avoid drinking any alcohol for the next three days."
A client has been diagnosed with a sinus infection, and the client has been given a prescription for amoxicillin. What teaching point should the nurse make for the client?
"Take your medication every 8 hours, as it's been prescribed."
A client scheduled for a bowel resection is to receive neomycin sulfate by mouth. The client asks the nurse the purpose of this medication. What is the most appropriate response the nurse can provide to the client?
"The administration will decrease the growth of intestinal bacteria."
What information will the nurse teach the client being switched to azithromycin from erythromycin?
"This drug has enhanced antibacterial activity."
The nurse is preparing to discharge a client who has been prescribed telithromycin. The client understands the unique adverse effect associated with this drug when the client makes which statement?
"This drug may cause visual disturbances so I won't drive until I am finished with the medication."
An adult client prescribed trimethoprim-sulfamethoxazole should receive what information concerning potential adverse effects?
"This drug might make your stomach a bit upset, so let me know if you experience that."
Mr. Martin has been prescribed SMZ-TMP for a urinary tract infection. Mr. Martin has a history of hypertension, allergic reactions to furosemide, and smoking (1 pack of cigarettes per day). Two days after starting therapy, Mr. Martin develops an itchy rash on the trunk of his body. How would you explain to Mr. Martin what has occurred?
"You are having an allergic reaction to the medication and need to stop taking it immediately."
A postoperative client is ordered Keflex 250 mg every 6 hours for 5 days. How much Keflex will the client receive in a 24-hour period?
1 Gram
The nurse is giving instructions to a client who is being discharged home with a prescription for augmentin. The nurse informs the client that the best time to take this medication is:
1 hour before meals and 2 hours after a meal.
The nurse knows that the normal recommended time to administer a sulfonamide to a client is at which time?
1 hour before or 2 hours after meals
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
A client has been started on augmentin 250 mg P.O. every 12 hr. It is supplied in 500-mg tablets. How much will the nurse give at each dose?
1/2 tab
The nurse would question the use of sulfonamide therapy in which client? (Select all that apply.)
18-month-old female client breastfeeding client 32 years of age
A client's prescription reads that the client should receive cefaclor 250 mg orally q 8 hr. The drug is available in the form of a 125-mg tablet. How many tablets should the nurse administer in order to meet the recommended dose and at what time intervals?
2 tablets every 8 hours
A client has been recommended 1500 mg of sulfasalazine oral suspension every 24 hours. The available drug is in the form of a 500 mg tablet. To meet the recommended dose, the nurse will administer _______ tablets each day.
3
Penicillins may trigger an anaphylactic reaction in some clients. Within what period following injection of a penicillin is anaphylaxis most likely to occur?
30 mins
A client has been prescribed 200 mg of cefpodoxime every 12 hours. On hand are 25-milligram tablets. To meet the prescribed dose, the nurse administers ___________ tablets at each dosage.
8
A client has been prescribed 4 gm of sulfamethoxazole-trimethoprim tablets per day. The available drug is in the form of 500 mg. To meet the recommended dose, the nurse will administer _______ tablets each day.
8
The nurse is caring for four clients on a medical floor. For which client would the nurse suspect the health care provider might order a sulfonamide?
A 35-year-old woman with a urinary tract infection and a history of ulcerative colitis
The nurse is caring for a client who takes hydantoin (Dilantin) every day to prevent seizures. The health care provider has ordered a sulfonamide to treat a urinary tract infection. What does the nurse expect to occur in relation to these drugs?
A change from the sulfonamide to another antibiotic
Penicillin would NOT be indicated for which of the following clients?
A client with gram-negative bacteria allergic to penicillin
A client on cephalosporin therapy is prescribed cefazolin for a sinus infection. After administration of the first dose of the cefazolin, the client reports itching. The nursing assessment reveals a rash over the client's torso. What is the most likely cause of the itching?
A cross-sensitivity reaction.
Beta-lactam antibacterial drugs, such as penicillins and cephalosporins, combat infection by binding to proteins in bacterial cell membranes. What does this binding produce?
A defective cell wall
When learning about the different classes of cephalosporins, the nurse correctly identifies which of the following statements?
A first-generation cephalosporin is more useful than a third-generation cephalosporin against gram-positive microorganisms.
The client calls the clinic to report the he is experiencing a throbbing headache and his face is flushed. The client received cefotetan as an IV antibiotic prior to a minor surgical procedure the day before, and returned home that same day. What has this client consumed that has caused this reaction?
Alcohol
The nurse is caring for a client who has developed leukopenia a result of long term sulfonamide therapy. What is the most important nursing intervention in light of this client's condition?
All individuals in contact with the client must perform frequent hand hygiene.
A client developed a nosocomial (hospital-acquired), gram-negative infection when hospitalized. What is considered the antibiotic of choice for this type of infection?
Aminoglycosides
A nurse is caring for an adult client diagnosed with bacterial sinusitis. The nurse has cautioned the client against taking prescribed oral erythromycin together with antacids. What is the basis of this instruction?
Antacids decrease the absorption of the drug.
What are sulfonamides classified as?
Antibacterial
A client who has been on long-term sulfonamide therapy has developed low red blood cell counts and leukopenia. The nurse knows that this combination of problems is known as what disorder?
Aplastic anemia
A nurse is preparing to give a client an initial dose of a penicillin preparation. What should the first action be for the nurse?
Ask the client if there is a history allergy to a penicillin
A 25-year-old female client who presents at the clinic with vaginal discharge and discomfort is diagnosed with chlamydia. The nurse knows that the drug of choice to treat this infection is doxycycline. What would be a priority assessment for this client before beginning the medication?
Asking the client if she is pregnant
Which of the following would a nurse identify as being classified as a macrolide?
Azithromycin
The nurse is caring for a client on sulfonamide who has developed a fever, cough, and headache. What signs/symptoms would alert the nurse to the possible development of Stevens-Johnson syndrome? Select all that apply.
Blister on the lip Red wheal on the neck
The pharmacology instructor is teaching about sulfonamides and informs the students that these drugs are used to control infections caused by which bacteria?
Both gram positive and gram negative
The nurse informs the client that most common bacterial superinfections are developed where?
Bowel
The nurse is caring for a client who has been on sulfonamide therapy for six months. What signs or symptoms would the nurse report to the health care provider immediately?
Bruises
The nurse is applying mafenide (Sulfamylon) to a client's burned skin. The nurse knows which adverse reactions may occur with this medication? Select all that apply.
Burning sensation Itching Rash
The nurse understands that the most frequent adverse reaction seen with the topical application of a sulfonamide is which of the following?
Burning sensation or pain
Place the following cephalosporins in the proper sequence beginning with first generation cephalosporins up to fourth generation cephalosporins.
Cefazolin Cefuroxime Cefotaxime Cefepime
What symptoms should lead the nurse to suspect that a client receiving a cefuroxime ingested alcohol during treatment? Select all that apply.
Chest pain Throbbing headache Dyspnea
A client has been on sulfonamide therapy for the last six weeks. What client report may cause the health care provider to discontinue the sulfonamide?
10 lb weight loss
Due to the close relationship cephalosporins have with penicillins, what percentage of clients who are allergic to penicillins are also allergic to cephalosporins? (Choose one)
10%
The nursing student learning about anti-infective therapy demonstrates understanding when she defines which as "bacterial resistance"?
Ability of bacteria to inactivate or destroy the antibiotic
A client has been diagnosed with an infected postoperative wound, and cultures reveal methicillin-resistant Staphylococcus aureus (MRSA). The client is currently receiving intravenous cefarolin because in vitro testing indicates susceptibility. When considering the effectiveness of this client's treatment, what is the nurse's best action?
Administer the medication as prescribed and monitor for expected outcomes.
The nursing instructor is teaching about anti-infectives and realizes further instruction is needed when a student makes which of the following statements?
Bactericidal means they slow or retard the multiplication of bacteria.
Culture and sensitivity testing of a client's urine sample reveals a bacterium that is susceptible to cephalosporins. What medication would be most likely for the nurse to administer?
Cefaclor
A client has a history of a life-threatening anaphylactic reaction to penicillin G. Which medication should not be administered to this client?
Cefadroxil (Duricef)
A client is diagnosed with febrile neutropenia. Which medication is <b>most</b> effective in treating this client?
Cefepime hydrochloride (Maxipime)
Most cephalosporins may be taken with food except which of the following? (Choose one)
Ceftibuten (Cedax)
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
Your client is being prepared for surgery. His health care provider has indicated that he will order antibiotics as prophylaxis. Which of the following medications would you anticipate being ordered?
Cephalosporin
A client with diabetes is ordered a cephalosporin to treat a recurring infection. The client is taking insulin and reports controlling the blood glucose level by monitoring it with urine stips and adjusting doses of insulin accordingly. What instructions should the nurse tell this client?
Cephalosporin may interfere with accurate test results.
The nurse researching the use of antibiotics and learns that which classifications of antibiotics are most widely used in the hospital setting?
Cephalosporins
A public health nurse interacts with many members of the community who are at risk for sexually transmitted infections (STIs). The nurse should anticipate the use of tetracycline in a client who is diagnosed with what STI?
Chlamydia
Mr. Laird is a 49-year-old electrician who experienced severe burns on his trunk, arms, and hands in a workplace accident 2 weeks ago. Part of his current wound care regimen involves the daily application of silver sulfadiazine to his wounds. The nurses who are providing care for Mr. Laird in the burns and plastics unit of the hospital should perform what action when administering this medication?
Cleanse the wound of debris prior to applying the silver sulfadiazine
The nurse understands that some clients should not take sulfonamides. These include which clients? (Select all that apply.)
Clients with a hypersensitivity to sulfonamides Women who are lactating Children younger than 2 months
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.
Which is the drug of choice for surgical prophylaxis associated with a vaginal hysterectomy?
cefazolin sodium
Unlike penicillin, most cephalosporins can be taken with food to prevent gastric upset. Which is the only cephalosporin that the nurse would advise NOT to take with food?
ceftibuten
A client is scheduled for a bowel resection. During the perioperative period, which type of medication should the nurse anticipate the client will be given?
cephalosporins
The nurse is caring for a client with a urinary tract infection (UTI) being treated with a sulfonamide. The client asks for something to drink. Which option should the nurse give to the client?
cranberry juice
A client is administered a third-generation cephalosporin. The broad-spectrum agents like cephalosporins are most effective in treating which type of microorganism?
gram negative
After teaching a group of students about the indications for use for aminoglycosides, the instructor determines that the teaching was successful when the students identify which type of infection as a primary indication?
gram-negative infections
When administering aminoglycosides, the nurse should focus assessments on what adverse reaction? Select all that apply.
ototoxicity nephrotoxicity
A client has been admitted to the critical care unit with a diagnosis of peritonitis that has necessitated treatment with gentamicin. As a result, the care team should be cautious when concurrently administering other medications that may cause which?
ototoxicity or nephrotoxicity.
Ampicillin-sulbactam is administered to a client with Staphylococcus aureus. What type of antiinfective is ampicillin-sulbactam?
penicillin-beta-lactamase inhibitor combination
Tetracycline is often a viable treatment option when a client has an allergy to what antibiotics?
penicillins
The nurse is teaching a client about possible adverse reactions that can occur with tetracyclines. The nurse determines that the teaching was successful when the client identifies which reaction?
photosensitivity
A client is receiving Ancef 500 mg IV every 6 hours since joint surgery 3 days ago. The client reports that his arm hurts at the intravenous (IV) site. Upon examination, the nurse finds that it is red, hot to the touch and swollen. The nurse also notices a knot under the catheter insertion site. This client is exhibiting signs of which complication?
thrombophlebitis
