ANTI INFECTIVE 15 q Flashcards
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. Cephalosporins
Allergy to penicillin may also result in hypersensitivity to cephalosporins
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. “Avoid direct sunlight and tanning beds while on this medication.”
Drug-related photosensitivity occurs when patients take tetracyclines, and it may continue for several days after therapy. Milk and cheese products result in decreased levels of tetracycline when the two are taken together. 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. The penicillin will cause an enhanced anticoagulant effect of the warfarin.
Administering penicillin reduces the vitamin K in the gut (intestines); therefore, enhanced anticoagulant effect of warfarin may occur.
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. Stop the antibiotic infusion.
Hypersensitivity reactions are characterized by wheezing; shortness of breath; swelling of the face, tongue, or hands; itching; or rash. The nurse should immediately stop the antibiotic infusion, have someone notify the prescriber, and stay with the patient to monitor the patient’s vital signs and condition. Checking for allergies should have been done before the infusion.
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. Blood and urine cultures, antibiotic dose
All culture specimens should be obtained before initiating antibiotic drug therapy; otherwise, the presence of antibiotics in the tissues may result in misleading culture and sensitivity results.
A patient tells the nurse that he is having nausea and decreased appetite during drug therapy with a tetracycline antibiotic. 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. “Drink a full glass of water with each dose.”
Oral doses should be given with at least 8 ounces of fluids and food to minimize gastrointestinal upset.
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 patient needs to be tested for Clostridium difficile infection.
Antibiotic-associated diarrhea is a common adverse effect of antibiotics. However, it becomes a serious superinfection when it causes antibiotic-associated colitis, also known as pseudomembranous colitis or simply C. difficile infection. This happens because antibiotics disrupt the normal gut flora and can cause an overgrowth of Clostridium difficile. The most common symptoms of C. difficile colitis are watery diarrhea, abdominal pain, and fever. Whenever a patient who was previously treated with antibiotics develops watery diarrhea, the patient needs to be tested for C. difficile infection. If the results are positive, the patient will need to be treated for this serious superinfection.
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. Decreased white blood cell count
Decreased white blood cell counts are an indication of reduction of infection and are a therapeutic effect of antibiotic therapy
The nurse is reviewing the culture results of a patient with an infection, and notes that the culture indicates a gram-positive organism. 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
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. Prophylactic
Prophylactic antibiotic therapy is used to prevent infection.
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. Sulfonamides
Sulfonamides achieve very high concentrations in the kidneys, through which they are eliminated. Therefore, they are often used in the treatment of urinary tract infections.
During drug therapy for pneumonia, a female patient develops a vaginal superinfection. The nurse explains that this infection is caused by which of these?
a. Large doses of antibiotics that kill normal flora.
b. The infection spreading from the 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. Large doses of antibiotics that kill normal flora.
Normally occurring bacteria are killed during antibiotic therapy, allowing other flora to take over and resulting in superinfections. The other options are incorrect.
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
Hypersensitivity reactions may be manifested by wheezing; shortness of breath; swelling of the face, tongue, or hands; itching; or rash
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. Tinnitus and dizziness
Dizziness, tinnitus, hearing loss, or a sense of fullness in the ears could indicate ototoxicity, a potentially serious toxicity in a patient.
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. Infusing the drug over at least 1 hour
Infuse the medication over at least 1 hour to reduce the occurrence of red man syndrome. Adequate hydration (at least 2 L of fluid in 24 hours) during vancomycin therapy is important for the prevention of nephrotoxicity. Hypotension may occur during the infusion, especially if it is given too rapidly.
Which problem may occur in a patient who has started aminoglycoside therapy?
a. Constipation
b. Renal damage
c. Gynecomastia
d. Leukocytosis
b. Renal damage
Patients on aminoglycoside therapy have an increased risk for nephrotoxicity.
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. Vancomycin (Vancocin)
Vancomycin is the antibiotic of choice for the treatment of MRSA
The nurse is reviewing the medication orders for a patient who will be receiving aminoglycoside 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. Loop diuretics
Concurrent use of aminoglycosides with loop diuretics increases the risk for ototoxicity.
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. Hold the drug, and notify the prescriber.
Optimal blood levels of vancomycin are a trough level of 10 to 20 mcg/mL. Measurement of peak levels is no longer routinely recommended, and only trough levels are commonly monitored. Blood samples for measurement of trough levels are drawn immediately before administration of the next dose. Because of the increase in resistant organisms, many clinicians use a trough level of 15 to 20 mcg/mL as their goal. These trough levels mean that even just before the next dose is due, when drug levels should be low, the drug levels are actually too high.
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. Tendonitis and tendon rupture
A black box warning is required by the U.S. Food and Drug Administration for all quinolones because of the increased risk for tendonitis and tendon rupture with use of the drugs. This effect is more common in elderly patients, patients with renal failure, and those receiving concurrent glucocorticoid therapy (e.g., prednisone).
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
ANS: A, C, D, F
ANS: A, C, D, F
Constant monitoring for drug-related neurotoxicity, nephrotoxicity, ototoxicity, and superinfection remains critical to patient safety. Monitor for nephrotoxicity by monitoring serum creatinine levels. Ototoxicity may be indicated if the patient experiences dizziness or a feeling of fullness in the ears, and these symptoms must be reported immediately. Vancomycin infusions may cause red man syndrome, which is characterized by flushing of the neck and face and a decrease in blood pressure. In addition, adequate hydration (at least 2 L of fluids every 24 hours unless contraindicated) is most important to prevent nephrotoxicity. Optimal trough blood levels of vancomycin are 10 to 20 mcg/mL; therefore, the drug should not be administered when there is a trough level of 24 mcg/mL.
A patient who is diagnosed with genital herpes 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. Burning when applied
Transient burning may occur with topical application of acyclovir.
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. Bone marrow suppression
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. Infuse intravenous acyclovir slowly, over at least 1 hour.
Intravenous infusions must be diluted as recommended (e.g., with 5% dextrose in water or normal saline) and infused with caution. Infusion over longer than 1 hour is suggested to avoid the renal tubular damage seen with more rapid infusions. Adequate hydration should be encouraged (unless contraindicated) during the infusion and for several hours afterward to prevent drug-related crystalluria.
