Ch. 38 & Ch. 39 Antibiotics 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
ANS: C
Allergy to penicillin may also result in hypersensitivity to cephalosporins. The other options are
incorrect
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.”
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.
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.
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.
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.
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.
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
ANS: D
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.
During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and
decreased appetite. 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.”
ANS: D
Oral doses should be given with at least 8 ounces of fluids and food to minimize gastrointestinal
upset; however, antacids and dairy products will bind with the tetracycline and make it inactive.
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.
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.
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
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.
The nurse is reviewing the sputum culture results of a patient with pneumonia and notes that the
patient has a gram-positive infection. Which generation of cephalosporin is most appropriate for
this type of infection?
a. First generation
b. Second generation
c. Third generation
d. Fourth generation
ANS: A
First-generation cephalosporins provide excellent coverage against gram-positive bacteria but
limited coverage against gram-negative bacteria.
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
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
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
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.
During drug therapy for pneumonia, a female patient develops a vaginal superinfection. The
nurse explains that this infection is caused by:
a. large doses of antibiotics that kill normal flora.
b. the infection spreading from her lungs to the new site of infection.
c. resistance of the pneumonia-causing bacteria to the drugs.
d. an allergic reaction to the antibiotics.
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.
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.
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.
A patient with a long-term intravenous catheter is going home. The nurse knows that if he is
allergic to seafood, which antiseptic agent is contraindicated?
a. Chlorhexidine gluconate (Hibiclens)
b. Hydrogen peroxide
c. Povidone-iodine (Betadine)
d. Isopropyl alcohol
ANS: C
Iodine compounds are contraindicated in patients with allergies to seafood. 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
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.
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 (Dilantin)
f. Warfarin (Coumadin)
ANS: B, C, E, F
Sulfonamides may potentiate the hypoglycemic effects of sulfonylureas in diabetes treatment, the
toxic effects of phenytoin, and the anticoagulant effects of warfarin, which can lead to
hemorrhage. Sulfonamides may also reduce the efficacy of oral contraceptives.
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
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
.
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
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.
Which nursing diagnosis is appropriate for a patient who has started aminoglycoside therapy?
a. Constipation
b. Risk for injury (renal damage)
c. Disturbed body image related to gynecomastia
d. Imbalanced nutrition, less than body requirements, related to nausea
ANS: B
Patients on aminoglycoside therapy have an increased risk for injury caused by nephrotoxicity.
The other options are incorrect.
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)
ANS: C
Vancomycin is the drug of choice for the treatment of MRSA. The other drugs are not used for
MRSA.
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.”
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.
The nurse is reviewing the medication orders for a patient who will be receiving gentamicin
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
ANS: D
Concurrent use of aminoglycosides, such as gentamicin, with loop diuretics increases the risk for
ototoxicity. The other drugs and drug classes do not cause interactions.
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.
ANS: C
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
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.
