Pharmacology: Treatment of Infection

The client is diagnosed with a Candida infection of the mouth. How will the nurse document this finding?

Thrush is a candida infection of the mouth, often identified by small white spots on the tongue most commonly seen in newborns or clients who are immunocompromised. Ringworm is caused by tinea infection, not candida, and is usually found on the skin and not in the mouth. Fungi known as dermatophytes include tinea infections, of which candida infections are only one small subgrouping. Tinea cruris is also called jock itch and occurs in the area of the genitalia, usually as the result of perspiration from athletic activities.

Based on a physical assessment, the nurse suspects that a client was given tetracycline as a young child. What physical characteristic led the nurse to this conclusion?

Tooth color

A 49-year-old client is diagnosed with TB. The client has a history of alcoholism but has been sober for 3 months now. The client has been prescribed INH. What should the nurse ensure is obtained before initiating the therapy?

baseline liver function test values. For a TB client, the nurse should obtain baseline liver function test values and schedule serial liver function tests throughout therapy. In addition, a nurse should ensure a baseline A1C evaluation for clients who are diabetics, because INH may cause hyperglycemia. Clients with preexisting anemias should have a baseline complete blood count (CBC), because they are at risk for hematologic disorders. For clients with a history of seizures, perform a baseline neurologic examination. Also assess baseline visual acuity.

A client comes to the clinic for a follow-up visit. The nurse notes a sunburn-like appearance to the client's skin. The client's history reveals the use of ciprofloxacin. The nurse interprets which adverse effect regarding this finding?

photosensitivity Explanation:A superinfection refers to the overgrowth of bacterial or fungal microorganisms not affected by the antibiotic administered. Pseudomembranous colitis is a severe, life-threatening form of diarrhea that occurs when normal flora of the bowel is eliminated and replaced with Clostridium difficile (C. diff) bacteria. Anaphylactic reaction is a severe exaggerated allergic reaction.

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 client comes to the clinic with reports of dysuria and frequency. The nurse practitioner suspects that the client is experiencing a UTI. Before instituting anti-infective therapy, which laboratory testing would be most important?

urine culture and sensitivity

The nurse is giving instructions to the client prior to discharge. The client states that he does not like to take a lot of drugs. The nurse's best response would be what?

"Failure to complete the entire treatment may result in a return of the infection."

The nurse is giving discharge instructions to a woman who has been prescribed tetracycline and also uses oral contraceptives. What is the most important instruction the nurse will give to this client?

"You should use alternative means of contraception while you are taking tetracycline."Tetracyclines decrease the effectiveness of oral contraceptives, so the client should use alternative means of contraception while taking tetracycline.

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

The client is taking isoniazid (INH). The nurses is teaching the client the importance of understanding that INH can affect which vitamin?

B6. Isoniazid can cause a pyridoxine deficiency which leads to peripheral neuropathy. Vitamin B6 is pyridoxine.

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?

Because of the potential for nephrotoxicity and ototoxicity that is associated with gentamicin, other medications that may lead to these same adverse effects must be used with caution. Gentamicin does not typically affect immune function,ICP, or hematopoiesis.The correct answer is: Ototoxicity or nephrotoxicity

The nurse is caring for a client who is HIV positive. What laboratory test is used to determine this client's ability to fight against viral infections?

CD4The CD4 count is the laboratory test used to determine a client's ability to fight against infections in a client with HIV. A BUN measures kidney function, an AST monitors liver function, and RBCs monitor the number of red blood cells that a client has. None of these measures will give information about the client's ability to fight infection.

Unless hemodialysis is started within 48 hours, imipenem is contraindicated for clients with severe renal impairment. What laboratory measurement would indicate renal impairment?

Creatinine clearance Explanation:Dosage of imipenem should be reduced in most clients with renal impairment, and the drug is contraindicated in clients with severe renal impairment (CrCl of 5 mL/min or less) unless hemodialysis is started within 48 hours. For clients already on hemodialysis, the drug may cause seizures and should be used very cautiously, if at all.

A client has been prescribed metronidazole for treatment of Giardia. What instruction is most important for the nurse to give to this client?

Do not drink alcohol while taking this medication. Explanation: Clients who are receiving metronidazole should not drink alcohol because the client will develop a disulfiram-type reaction if alcohol is consumed while the client is receiving metronidazole.

Which drug is most commonly used orally to treat infections caused by Candida albicans?

Fluconazole (Diflucan)

A client with active AIDS is infected with a retrovirus. This virus is better known as which?

HIV

Antivirals are used to treat infections caused by viruses. In particular, acyclovir is useful to treat which infection?

Herpes Zoster Its antiviral spectrum is limited to the herpes viruses, including HSV, herpes zoster virus, Epstein-Barr virus, and CMV.

The nurse is caring for a 62-year-old who has orders to receive gentamicin . The client reports difficulty hearing. What should the nurse do?

Hold the dose and notify the physician immediately. Explanation:Nurses should monitor patients for signs of aminoglycoside-induced ototoxicity. Since there is a possibility of reversing the condition (or at least arresting it) by discontinuing or reducing dosage of the drugs, the nurse should immediately contact the physician and hold the dose until receiving additional guidance.

A nurse needs to administer a cephalosporin to a patient. The patient informs the nurse that he is allergic to penicillin. Which of the following actions is the nurse most likely to take in such a situation?

Inform the primary health care provider. Patients with a history of an allergy to penicillin may also be allergic to cephalosporin, so the nurse needs to inform the primary health care provider before the first dose of the drug is given. An antipyretic drug is administered when there is an increase in the body temperature of a patient receiving cephalosporin. Liver and kidney function tests may be ordered by the primary health care provider, not the nurse. Occupational history should be obtained before administration of any drug, irrespective of the patient's allergies.

A client being treated for tuberculosis is determined to be drug resistant. Which medications will no longer be effective in the treatment of the tuberculosis?

Isoniazid and rifampin

When discussing cephalosporins with the nursing class, the pharmacology instructor explains that this classification of drug is primarily excreted through which organ?

Kidney

The nurse should monitor the client for which common side effects of erythromycin therapy?

Nausea, vomiting, and diarrhea Explanation: Gastrointestinal problems (e.g., nausea, vomiting, and diarrhea) are common side effects of erythromycin and other macrolides. Headache, fever, opthalmic drainage, uticaria, shortness of breath and sore throat are no common side effects.

What serious adverse effect is most associated with amphotericin B?

Nephrotoxicity

The client has been prescribed a drug that must be taken on an empty stomach. The nurse knows that to administer a medication on an empty stomach, it is given in which way?

One hour prior to a meal or two hour after the meal

A nurse is caring for a client with severe and life-threatening pseudomembranous colitis caused by C. difficile. Which drug would the nurse expect the client's provider to order?

Oral vancomycin Explanation: Oral vancomycin is used to treat staphylococcal enterocolitis and pseudomembranous colitis caused by C. difficile when the colitis fails to respond to metronidazole.

Your patient is receiving a multiple-dose regimen of an aminoglycoside. On what serum drug levels will you base the patient's maintenance dose?

Peak and troughs

Cephalosporins are structurally and chemically related to which classes of antibiotics?

Penicillins

The nurse is caring for a client who is receiving IV vancomycin. The nurse infuses the medication at the prescribed rate to prevent what from occurring?

Red man syndrome Explanation: The nurse must be careful to infuse vancomycin at the prescribed rate to prevent the occurrence of red man syndrome. With this syndrome, the client's face and upper trunk becomes bright red, and it has led to cardiovascular collapse.

A client who is 32 weeks pregnant has been diagnosed with a urinary tract infection. The nurse would immediately question any prescription for a sulfonamide based on what risk?

Sulfonamides can cause a life-threatening toxicity for the fetus.Systemic sulfonamides are contraindicated during late pregnancy, lactation, and in children younger than 2 months of age. If a fetus or young infant receives a sulfonamide by placental transfer, in breast milk, or by direct administration, the drug displaces bilirubin from binding sites on albumin. As a result, bilirubin may accumulate in the bloodstream (hyperbilirubinemia) and central nervous system (kernicterus) and cause life-threatening toxicity. Sulfonamides are sometimes used in the treatment of urinary tract infections. Tetracyclines can cause tooth discoloration in young children.