Pharmacology Prep U: Chapter 9: Antibiotics

A client who routinely takes antacids has been prescribed tetracycline. The nurse explains to the client that there is an increased risk of which effect related to this combination? A. Increased risk of bleeding B. Increased action of neuromuscular blocking drugs C. Increased profound respiratory depression D. Decreased absorption of tetracycline

D. Decreased absorption of tetracycline Interaction of antacids with a tetracycline drug causes decreased absorption of tetracycline. Increased action of neuromuscular blocking drugs and increased profound respiratory depression are the result of interaction between neuromuscular blocking drugs and tetracyclines. Increased risk of bleeding is a result of interaction between anticoagulants and tetracyclines.

A client has been prescribed ciprofloxacin after being diagnosed with a sinus infection. What medication should the client avoid taking concurrently with ciprofloxacin? A. Antacids B. Calcium channel blockers C. Beta-adrenergic blockers D. Diuretics

A. Antacids Clients should space out ciprofloxacin administration 4 to 6 hours with any of the following: antacids, multivitamins, sucralfate, or other products containing calcium, iron, or zinc. Absorption of ciprofloxacin may be impaired when these substances are administered together with ciprofloxacin, resulting in a decreased antibiotic effect. None of the other options present a barrier to ciprofloxacin absorption.

The client has been taking levofloxacin IV since admission 12 hours ago for a urinary tract infection. The nurse assesses the client's temperature at 99.8ºF. What is the nurse's best response? A. Continue to monitor vital signs. B. Notify the health care provider. C. Administer an extra dose of levofloxacin. D. Administer an antipyretic.

A. Continue to monitor vital signs. The provider should be notified if the client's temperature is greater than 101ºF. The nurse cannot discontinue or administer additional doses without a provider's order. The body's normal defense to infection is an elevated temp until it reaches 101 degrees. Only then would an antipyretic be given if ordered.

A client diagnosed with tuberculosis was prescribed antitubercular therapy but stopped after 1 month because of difficulty with the medication scheduling. As a result, secondary drugs are being prescribed. Which nursing diagnosis would the nurse identify? A. Ineffective Self-Health Management B. Imbalanced Nutrition: Less Than Body Requirements C. Ineffective Coping D. Impaired Comfort

A. Ineffective Self-Health Management Difficulties with scheduling most likely led to the client not adhering to the treatment plan. As a result, the nursing diagnosis of Ineffective Self-Health Management would be most appropriate. Although nutrition can be affected, there is no indication that this is the problem. Although the client may have difficulty coping with the disease, there is no indication that this is a problem. The client may experience discomfort related to the adverse effects of the drug; however, there is no indication that this is an issue.

Cephalosporins are structurally and chemically related to which classes of antibiotics? A. Penicillins B. Fluoroquinolones C. Aminoglycosides D. Tetracyclines

A. Penicillins Cephalosporins are structurally and chemically related to penicillins.

After administering sulfonamides to a client, the nurse observes the client has developed a fever, cough, and muscular aches, as well as lesions in the form of red wheals on the neck and the mouth. The nurse interprets these findings as indicating which possible adverse reaction? A. Stevens-Johnson syndrome (SJS) B. Anaphylactic shock C. Thrombocytopenia D. Leukopenia

A. Stevens-Johnson syndrome (SJS) Clients with Stevens-Johnson syndrome (SJS) may report fever, cough, muscular aches and pains, and headache. Additional signs include lesions on the neck and mouth. Lesions are not symptoms of leukopenia or anaphylactic shock. A client with thrombocytopenia develops bruises on the skin but not lesions in the form of red wheals.

The nurse is caring for a 6-year-old child who has pyelonephritis. The use of what group of antibiotics would be contraindicated due to the client's age? A. Tetracyclines B. Penicillins C. Cephalosporins D. Aminoglycosides

A. Tetracyclines Tetracyclines can potentially damage developing teeth and bones and thus should be used cautiously or avoided in children under the age of 8 years. Penicillins are safe to give to children and commonly used. Cephalosporins are safe to administer to pediatric clients. Aminoglycosides would not be administered to children lightly, but they can be administered when the benefits outweigh the risks, such as an infection that is resistant to other drugs.

After teaching a group of nursing students about the indications for use of antibacterial drugs that disrupt the bacterial cell wall, the instructor determines that the teaching was successful when the group identifies which medication as commonly prescribed to a victim after a sexual assault for infection prophylaxis? A. cephalosporin B. aminopenicillin C. carbapenem D. penicillin/beta-lactamase inhibitor combination

A. cephalosporin Following a sexual assault, a cephalosporin is commonly prescribed as prophylaxis treatment. Aminopenicillins are not the protocol drug of choice for sexual assault infection prophylaxis. Carbapenems inhibit synthesis of the bacterial cell wall and cause the death of susceptible cells; they are not used prophylactically. Penicillin/beta-lactamase inhibitor combinations are used to prolong the presence of antibiotic in the system and inhibit the enzymes that are produced by the bacteria.

Tetracyclines should not be used in children younger than 8 years of age because of their effects on: A. teeth and bones. B. kidneys. C. blood. D. liver.

A. teeth and bones. Tetracyclines should not be used in children younger than 8 years of age because of their effects on teeth and bones.

A 26-year-old female client with a skin infection has been prescribed 400 mg ampicillin to be taken orally. Which instruction should the nurse include in the client teaching plan? A. If a dosage is missed, increase the next dosage to meet the daily quota. B. Ampicillin will reduce the effectiveness of birth control pills. C. Take drug on an empty stomach, an hour before or 2 hours after meals. D. Avoid use of skin care products, like moisturizers, when on penicillin therapy.

B. Ampicillin will reduce the effectiveness of birth control pills. Ampicillin (also penicillin V) reduces the effectiveness of birth control pills. Increasing a dosage to compensate for a missed dosage should not be done. The client should adhere to the prescribed regimen as strictly as possible. Ampicillin and penicillin V may be taken without regard to meals. The client need not avoid use of skin care products when on penicillin therapy.

Antibiotic drugs are commonly used in the pediatric population. Why would the tetracyclines be contraindicated in children younger than 8 years of age? A. Children younger than 2 months of age have not been evaluated B. Because weight-bearing joints have been impaired in young animals given the drugs C. Because of the drugs effects on teeth and bone D. Liver and kidney function need to be monitored when it is given to neonates and infants.

C. Because of the drugs effects on teeth and bone Use tetracyclines with caution in children younger than 8 years of age because they can potentially damage developing bones and teeth; and in patients with hepatic or renal dysfunction because they are concentrated in the bile and excreted in the urine.Fluoroquinolones (e.g., ciprofloxacin [Cipro]) are generally contraindicated for use in children (<18 years of age) because weight-bearing joints have been impaired in young animals given the drugs. Clindamycin (Dalacin C) warrants monitoring liver and kidney function when it is given to neonates and infants. Trimethoprim-sulfamethoxazole (Nu-Cotrimox) is used in children, although children younger than 2 months of age have not been evaluated.

The nurse is giving discharge instructions to a woman who will be taking amoxicillin for treatment of acute otitis media. The nurse teaches the client that which symptom indicates the development of a superinfection and should be reported to the physician? A. Nausea B. Abdominal pain C. Vaginal itching and discharge D. Swelling and itching of the throat

C. Vaginal itching and discharge A vaginal infection in a client who is taking amoxicillin is an example of a superinfection. The nausea and abdominal pain are adverse effects of the medication, and swelling and itching of the throat are an example of possible allergy to the drug.

A client is prescribed penicillin V orally for a strep throat. What is the mechanism of action of this medication? A. It inhibits protein synthesis. B. It lowers the pH of cellular contents. C. It causes mutations. D. It inhibits cell wall synthesis.

D. It inhibits cell wall synthesis. Beta-lactam antibacterial drugs inhibit synthesis of bacterial cell walls by binding to proteins in bacterial cell membranes. Penicillin V does not inhibit protein synthesis. Penicillin V does not inhibit protein synthesis, cause mutations, or lower the pH of a bacterium's cellular contents.

A nurse is required to administer a parenteral form of penicillin to a client. Which intervention would be most appropriate for the nurse to do when preparing penicillin in parenteral form? A. Extract penicillin from vial and then reconstitute. B. Save excess antibiotic after reconstitution for later use. C. Use any available diluent for reconstitution. D. Shake the vial well to distribute the drug evenly.

D. Shake the vial well to distribute the drug evenly. When preparing a parenteral form of penicillin, the nurse should shake the vial thoroughly before withdrawing the drug to ensure its even distribution in the solution. Penicillins in powder or crystalline form must be reconstituted before being withdrawn from the vial. Excess antibiotic after reconstitution should never be saved, as the drug loses its potency when stored. Reconstitution should be done only with the diluent prescribed on the manufacturer's label.

A client is prescribed rifampin. What information should the nurse include in the client's medication education? A. When taking it with warfarin, an increased anticoagulant effect occurs. B. It decreases hepatic enzymes and decreases metabolism of drugs. C. It has an increased serum half-life, so it is more effective than rifabutin. D. The urine, tears, sweat, and other body fluids will be a discolored red-orange.

D. The urine, tears, sweat, and other body fluids will be a discolored red-orange. The client's urine, tears, sweat, and other body fluids will be a discolored red-orange. This adverse effect is harmless, but the client should be instructed on this adverse effect. The administration of this medication with warfarin will decrease the anticoagulant effect. The medication increases hepatic cytochrome P-450 3A4 enzyme and decreases serum concentrations. The serum half-life of rifampin is shorter than that of the medication rifabutin.