Antibiotic Drugs

Question 1

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

Answer 1

ANS: C
Allergy to penicillin may also result in hypersensitivity to cephalosporins. Patients reporting penicillin allergy need to describe their prior allergic reaction. It is very important to document the type of reaction. The other options are incorrect.

Question 2

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.‖

Answer 2

ANS: A
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. Antacids also interfere with absorption and should not be taken with tetracycline. Counsel patients to take the entire course of prescribed antibiotic drugs, even if they feel that they are no longer ill.

Question 3

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. 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.

Answer 3

ANS: A
Administering penicillin reduces the vitamin K in the gut (intestines); therefore, enhanced anticoagulant effect of warfarin may occur. The other options are incorrect.

Question 4

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.

Answer 4

ANS: C
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.

Question 5

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

Answer 5

ANS: D
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. The other responses are incorrect.

Question 6

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.‖

Answer 6

ANS: D
Oral doses should be given with at least 8 ounces of fluids and food to minimize gastrointestinal upset. Antacids and dairy products will bind with the tetracycline and make it inactive.

Question 7

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.

Answer 7

ANS: C
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.

Question 8

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

Answer 8

ANS: C
Decreased white blood cell counts are an indication of reduction of infection and are a therapeutic effect of antibiotic therapy. The other options are incorrect.

Question 9

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

Answer 9

ANS: A
First-generation cephalosporins provide excellent coverage against gram-positive bacteria but limited coverage against gram-negative bacteria.

Question 10

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

Answer 10

ANS: B
Prophylactic antibiotic therapy is used to prevent infection. Empiric therapy involves selecting the antibiotic that can best kill the microorganisms known to be the most common causes of an infection. Definitive therapy occurs once the culture and sensitivity results are known. Resistance is not a type of antibiotic therapy.

Question 11

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

Answer 11

ANS: C
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.

Question 12

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

Answer 12

ANS: A
Normally occurring bacteria are killed during antibiotic therapy, allowing other flora to take over and resulting in superinfections. The other options are incorrect.

Question 13

The nurse is preparing to use an antiseptic. Which statement is correct regarding how antiseptics differ from disinfectants?
a. Antiseptics are used to sterilize surgical equipment.
b. Disinfectants are used as preoperative skin preparation.
c. Antiseptics are used only on living tissue to kill microorganisms.
d. Disinfectants are used only on nonliving objects to destroy organisms.

Answer 13

ANS: D
Antiseptics primarily inhibit microorganisms but do not necessarily kill them. They are applied exclusively to living tissue. Disinfectants are able to kill organisms and are used only on nonliving objects.

Question 14

A patient with a long-term intravenous catheter is going home. The nurse knows that if the patient is allergic to seafood, which antiseptic agent is contraindicated?
a. Chlorhexidine gluconate
b. Hydrogen peroxide
c. Povidone-iodine
d. Isopropyl alcohol

Answer 14

ANS: C
Iodine compounds are contraindicated in patients with allergies to seafood. The other options are incorrect.

Question 15

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

Answer 15

ANS: A, C, D, E
Hypersensitivity reactions may be manifested by wheezing; shortness of breath; swelling of the face, tongue, or hands; itching; or rash.

Question 16

The nurse is reviewing the medication history of a patient who will be taking a sulfonamide antibiotic. During sulfonamide therapy, a significant drug interaction may occur with which of these drugs or drug classes? (Select all that apply.)
a. Opioids
b. Oral contraceptives
c. Sulfonylureas
d. Antihistamines
e. Phenytoin
f. Warfarin

Answer 16

ANS: B, C, E, F
Sulfonamides may potentiate the hypoglycemic effects of sulfonylureas in diabetes treatment and the toxic effects of phenytoin. They also enhance the anticoagulant effects of warfarin, which can lead to hemorrhage. Sulfonamides may also reduce the efficacy of oral contraceptives.

Question 17

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

Answer 17

ANS: C
Dizziness, tinnitus, hearing loss, or a sense of fullness in the ears could indicate ototoxicity, a potentially serious toxicity in a patient. Nephrotoxicity is indicated by rising blood urea nitrogen and creatinine levels. Fever may be indicative of the patient‘s infection; a white blood cell count of 7000 cells/mm3 is within the normal range of 5000 to 10,000 cells/mm3.

Question 18

The nurse is administering a vancomycin 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

Answer 18

ANS: D
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.

Question 19

Which problem may occur in a patient who has started aminoglycoside therapy?
a. Constipation
b. Renal damage
c. Gynecomastia
d. Leukocytosis

Answer 19

ANS: B
Patients on aminoglycoside therapy have an increased risk for nephrotoxicity. The other options are incorrect.

Question 20

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
b. Ciprofloxacin
c. Vancomycin
d. Tobramycin

Answer 20

ANS: C
Vancomycin is the antibiotic of choice for the treatment of MRSA. The other drugs are not used for MRSA.

Question 21

A patient is receiving aminoglycoside therapy and will be receiving a beta-lactam antibiotic as well. The patient asks why two antibiotics have been ordered. What is the nurse‘s best response?
a. ―The combined effect of both antibiotics is greater than each of them alone.‖
b. ―One antibiotic is not strong enough to fight the infection.‖
c. ―We have not yet isolated the bacteria, so the two antibiotics are given to cover a wide range of microorganisms.‖
d. ―We can give a reduced amount of each one if we give them together.‖

Answer 21

ANS: A
Aminoglycosides are often used in combination with other antibiotics, such as beta-lactams or vancomycin, in the treatment of various infections because the combined effect of the two antibiotics is greater than that of either drug alone.

Question 22

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

Answer 22

ANS: D
Concurrent use of aminoglycosides with loop diuretics increases the risk for ototoxicity. The other drugs and drug classes do not cause interactions.

Question 23

The nurse checks the patient‘s laboratory work prior to administering a dose of vancomycin and finds that the trough vancomycin level is 15 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.

Answer 23

ANS: A
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.

Question 24

A patient has been diagnosed with carbapenem-resistant Enterobacteriaceae (CRE). The nurse expects to see orders for which drug?
a. Dapsone, a miscellaneous antibiotic
b. Ciprofloxacin, a quinolone
c. Linezolid, an oxazolidinone
d. Colistimethate sodium, a polypeptide antibiotic

Answer 24

ANS: D
Colistimethate sodium (Coly-Mycin), commonly referred to as colistin, is now being used again, often as one of the only drugs available to treat CRE. The other options are incorrect.

Question 25

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

Answer 25

ANS: D
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 other options are not common adverse effects.

Question 26

The nurse is administering intravenous vancomycin 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

Answer 26

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.

Question 27

A patient will be receiving nitrofurantoin treatment for a urinary tract infection. The nurse is reviewing the patient‘s history and will question the nitrofurantoin order if which disorder is present in the history? (Select all that apply.)
a. Liver disease
b. Coronary artery disease
c. Hyperthyroidism
d. Type 1 diabetes mellitus
e. Chronic renal disease

Answer 27

ANS: A, E
Nitrofurantoin is contraindicated in cases of known drug allergy and also in cases of significant renal function impairment, because the drug concentrates in the urine. Because adverse effects include hepatotoxicity, which is rare but often fatal, the nurse should also question the order if liver disease is present. The other options are not contraindications.