Chap 38 (exam 4) Flashcards
Antibiotics taken before exposure to an infectious organism in an effort to prevent the development of infection
Prophylactic
This class of antibiotics may cause tooth discoloration in children under age 8
Tetracycline
Anaphylactic reactions are common with this class of antibiotics
Penicillin
Antibiotics that kill bacteria
Bactericidal
There is a chance of cross-reactivity between this class of antibiotics and the class penicillin
Cephalosporin
The classification for the drug erythromycin
Macrolide
This class of antibiotics is commonly used for urinary tract infections
Sulfonamide
Antibiotics that inhibit the growth of bacteria
Bacteriostatic
An infection that occurs during antimicrobial treatment for another infection and involves overgrowth of a nonsusceptible organism
Superinfection
The nurse is reviewing the drugs ordered for a patient. A drug interaction occurs between penicilins and which drugs? Select all that apply: Alcohol Oral contraceptives Digoxin Nonsteroidal antiinflammatory drugs Warfarin Anticonvulsants
Oral contraceptives
Nonsteroidal antiinflammatory drugs
Warfarin
Which intervention is important for the nurse to perform before beginning antibiotic therapy?
Obtain a specimen for culture and sensitivity
Give with an antacid to reduce gastrointestinal (GI) upset
Monitor for adverse effects
Restrict oral fluids
Obtain a specimen for culture and sensitivity
The nurse will instruct a patient who is receiving a tetracycline antibiotic to take it using which guideline?
It needs to be taken with milk
It needs to be taken with 8 oz of water
It needs to be taken 30 minutes before iron preparations are taken
An antacid should be taken to decrease GI discomfort
It needs to be taken with 8 oz of water
A patient is to receive antibiotic therapy with a cephalosporin. When assessing the patient's drug history, the nurse recognizes that an allergy to which drug class may be a possible contrainication to cephalosporin therapy? Cardiac glycosides Thiazide diuretics Penicillins Macrolides
Penicillins
When asked about drug allergies, a patient says, “I can’t take sulfa drugs because I’m allergic to them.” Which question will the nurse ask next?
“Do you have any other drug allergies?”
“Who prescribed that drug for you?”
“How long ago did this happen?”
“What happened when you took the sulfa drug?”
“What happened when you took the sulfa drug?”
Which statement accurately describes the action of antiseptics?
They are used to kill organisms on nonliving objects
They are used to kill organisms on living tissue
They are used to sterilize equipment
They are used to inhibit the growth of organisms on living tissue
They are used to inhibit the growth of organisms on living tissue
During a class on health care-associated infections, the nurse shares several facts about these infections. Which statements about health care-associated infections are true? Select all that apply:
They are contracted in the home or community
They are contracted in a hospital or institution
They are more difficult to treat
The organisms that cause these infections are more virulent
The infection is incubating at the time of admission
They are contracted in a hospital or institution
They are more difficult to treat
The organisms that cause these infections are more virulent
A patient is receiving imipenem/ cilastatin (Primaxin) and asks the nurse, “Why does that medicine bag have two names listed? Am I receiving two drugs?” What is the best explanation for the patient?
Imipenem/ cilastatin (Primaxin) does contain 2 drugs, but one of the drugs (cilastatin) works to prevent the antibiotic (imipenem) from being destroyed by bacterial enzymes that can make the antibiotic ineffective
Mr. R., a 50-year old banker, is scheduled for a colon surgery tomorrow. The surgeon is planning to administer a prophylactic antibiotic. What drug is frequently used for this purpose, and why?
Cefoxitin (Mefoxin) is frequently used in patients undergoing abdominal surgeries because it can effectively kill intestinal bacteria, including anaerobic bacteria
Sean is a 19 year old college freshman who has been diagnosed with gonorrhea. The provider has prescribed doxycycline therapy. During the nursing assessment, Sean discusses his diet, which includes “lots of meat, milk and veggies.” Sean also tells the nurse that he jogs frequently and is a member of the tennis team.
In addition to instruction about sexually transmitted infections, what patient teaching about the medication does Sean require?
A few days late, Sean calls and complains of an upset stomach and diarrhea. What does the nurse suspect might be wrong with Sean?
Sean must not take the doxycycline with milk because that can result in a significant reduction in the absorption of the drug. Also, Sean needs to be aware that tetracyclines can cause photosensitivity; he needs to avoid direct exposure to sunlight and use sunscreen and/ or protective clothing.
The diarrhea is probably the result of alteration of the intestinal flora caused by the drug therapy.
Sandra has bronchitis and has been taking an antibiotic for 1 week. She calls the nurse and complains of severe genital itching and a whitish discharge in her vaginal area. What has happened, and what caused it?
She is experiencing a superinfection because the antibiotics she has been taking for her bronchitis have reduced the normal vaginal bacterial flora, and the yeast that is usually kept in balance by this normal flora has an opportunity to grow and cause an infection
A 78 year old patient admitted to the hospital with a stroke 2 days earlier has developed a urinary tract infection. His foley catheter is draining urine that is cloudy and dark yellowish-orange with a strong oder. He is receiving an intravenous heparin infusion and has a history of type 2 diabetes. The physician orders co-trimoxazole (Bactrim).
What will the nurse assess before giving this medication?
He needs to be assessed for renal problems and blood dyscrasias. Also, the use of co-trimoxazole is contraindicated in cases of known drug allergy to sulfonamides or chemically related drugs such as sulfonylureas (used for diabetes), thiazide and loop diuretics, and carbonic anhydrase inhibitors.
A 78 year old patient admitted to the hospital with a stroke 2 days earlier has developed a urinary tract infection. His foley catheter is draining urine that is cloudy and dark yellowish-orange with a strong oder. He is receiving an intravenous heparin infusion and has a history of type 2 diabetes. The physician orders co-trimoxazole (Bactrim).
Are there any potential drug interactions?
If he is taking a sulfonylurea for his type 2 diabetes, close monitoring ir needed, because sulfonamides can potentiate the hypoglycemic effects of sulfonylureas in patients with diabetes. In addition, although he is currently receiving intravenous heparin and not warfarin, he may be switch to oral anticoagulants soon, so keep in mind that sulfonamides can potentiate the anticoagulant effects of warfarin and lead to hemorrhage
A 78 year old patient admitted to the hospital with a stroke 2 days earlier has developed a urinary tract infection. His foley catheter is draining urine that is cloudy and dark yellowish-orange with a strong oder. He is receiving an intravenous heparin infusion and has a history of type 2 diabetes. The physician orders co-trimoxazole (Bactrim).
Why was the particular antibiotic chosen?
These antibiotics achieve very high concentrations in the kidneys, through which they are eliminated. Therefore, they are primarily used in the treatment of urinary tract infections
A 78 year old patient admitted to the hospital with a stroke 2 days earlier has developed a urinary tract infection. His foley catheter is draining urine that is cloudy and dark yellowish-orange with a strong oder. He is receiving an intravenous heparin infusion and has a history of type 2 diabetes. The physician orders co-trimoxazole (Bactrim).
Is there antibiotic bactericidal or bacteriostatic? Explain.
Sulfonamides do not actually destroy bacteria but inhibit their growth. For this reason, they are considered bacteriostatic antibiotics. Bactericidal antibiotics kill bacteria
A patient is scheduled for colorectal surgery tomorrow. He does not have sepsis, his WBC count is normal, he has no fever, and he is otherwise in good health. However, there is an order to administer an antibiotic on call before he goes to surgery. The nurse knows that the rationale for this antibiotic order is to: Provide empiric therapy Provide prophylactic therapy Treat for a superinfection Reduce the number of resistant organisms
Provide prophylactic therapy
A teenage patient is taking a tetracycline drug as part of treatment for severe acne. When the nurse teaches this patient about drug-related precautions, which is the most important information to convey?
When the acne clears up, the medication may be discontinued
This medication needs to be taken with antacids to reduce GI upset
The patient needs to use sunscreen or avoid exposure to sunlight, because this drug may cause photosensitivity
The teeth should be observed closely for signs of mottling or other color changes
The patient needs to use sunscreen or avoid exposure to sunlight, because this drug may cause photosensitivity
A newly admitted patient reports a penicillin allergy. The prescriber has ordered a second-generation cephalosporin as part if the therapy. Which nursing action is appropriate?
Call the prescriber to clarify the order because of the patient’s allergy
Give the medication, and monitor for adverse effects
Ask the pharmacy to change the order to a first-generation cephalosporin
Administer the drug with a nonsteroidal antiinflammatory drug to reduce adverse effects
Call the prescriber to clarify the order because of the patient’s allergy
During patient education regarding an oral macrolide such as erythromycin, the nurse will include which information?
If GI upset occurs, the drug will have to be stopped
The drug needs to be taken with an antacid to avoid GI problems
The patient needs to take each dose with a sip of water
The patient may take the drug with a small snack to reduce GI irritation
The patient may take the drug with a small snack to reduce GI irritation
A woman who has been taking an antibiotic for a UTI calls the nurse practitioner to complain of severe vaginal itching. She has also noticed a thick, whitish vaginal discharge. The nurse practitioner suspects that:
this is an expected response to antibiotic therapy
The UTI has become worse instead of better
A superinfection has developed
The UTI is resistant to the antibiotic
A superinfection has developed
The nurse is reviewing the order for wound care, which include use of an antiseptic. Which statements best describe the use of antiseptics? Select all that apply:
Antiseptics are appropriate for use on living tissue
Antiseptics work by sterilizing the surface of the wound
Antiseptics are applied to nonliving objects to kill microorganisms
The patient’s allergies must be assessed before using the antiseptic
Antiseptics are used to inhibit the growth of microorganisms on the would surface
Antiseptics are appropriate for use on living tissue
The patient’s allergies must be assessed before using the antiseptic
Antiseptics are used to inhibit the growth of microorganisms on the would surface
Sulfonamides mechanism of action
Compete w/ PABA for tetrahydropteroic acid synthetase, preventing bacterial synthesis of folic acid, inhibiting bacteria growth
Bacteriostatic
Antimetabolites
Sulfonamides indications
Gram positive organisms
Gram negative organisms
Sulfamthoxazole w/ trimethoprim
Co-trimoxazole
Bactrium
5:1 ratio
Oral & injectable
Duration 12 hours
Indications: UTIs, respiratory tract infections, prophylaxis & treatment of opportunistic infections in pts w/ HIV
Susceptible organisms: Enterobacter spp, E. coli, Klebsiella spp, Proteus mirabilis, Proteus vulgaris, S areus
Sulfonamides Contraindications
Drug allergy
Pregnant women
Infants younger than 2 months
