Infection

Question 1

What is a superinfection

Answer 1

A type of resistance that results when an antibiotic kills normal flora, thus favoring the emergence of a new infection that is difficult to eliminate

Question 2

What lab tests should be completed before giving antibiotics?

Answer 2

Testing of body fluids: blood, urine, sputum, and wound drainage
Gram Stain: examine an aspirate of body fluids under a microscope to identify micro-organisms directly
Culture: aspirate is applied to a culture medium where colonies can grow

Question 3

What is Clostridium difficle (C. diff)?

Answer 3

Disruption of normal healthy bacteria in the colon, usually from antibiotics, that results in watery and bloody stool

Question 4

What are the beta-lactam antibiotics?

Answer 4

Cephalosporins, Macrolides, aminoglycosides, penicillins

Question 5

Expected Pharmacological Action

Penicillin - Amoxicillin

Answer 5

Penicillin weaken and destroy the cell wall of bacteria that are sensitive. They do this by inhibiting the enzyme necessary for cell-wall formation, which is transpeptidase. Then, they activate the enzyme that opens the cell wall during replication, which is autolysin. Both of these actions weaken the cell wall and expedite the destruction of the bacteria

Question 6

Adverse effects

Penicillin - Amoxicillin

Answer 6

GI symptoms: diarrhea, nauseas, vomiting; Rarely may cause C. Diff-superinfections (more frequent with other antibiotics than amoxicillin; superinfection with Candida albicans; Allergy to penicillin (rash, hives, wheezing and difficulty breathing)

Question 7

Nursing Interventions

Penicillin - Amoxicillin

Answer 7

Monitor for GI symptoms; Monitor and report bloody stools or long-term watery diarrhea; monitor for and report candida infections of the mouth and vagina; expect to treat candida with an antifungal infection; ask clients if they are allergic prior to administering the first dose; monitor for allergy manifestations and notify provider; for injectable penicillin (IM or IV), keep client in facility for 30 minutes after administration and monitor for allergy; prepare to treat rash/hives with antihistamines, anaphylaxis with epinephrine and respiratory support

Question 8

Interactions

Penicillin - Amoxicillin

Answer 8

Probenecid increases penicillin blood levels
Bacteriostatic agents may decrease therapeutic effects
Reduced effectiveness of oral contraceptives

Question 9

What are the differences in treatments for generations of cephalosporins

Answer 9

Cephalexin is a first-generation cephalosporin that treats infections caused by gram-positive cocci
Subsequent generations of cephalosporins (drugs from the second, to fifth generation) are more active against gram-negative bacteria; more resistant to beta-lactamase (gram-positive) bacteria; more able to penetrate cerebrospinal fluid to treat infections, such as meningitis

Question 10

Adverse Effects

Cephalosporins

Answer 10

GI symptoms: diarrhea, nausea; CDAD, which is rare, may be from superinfection; possible cross-allergy to penicillin allergy (especially for clients with a history of severe penicillin allergy); thrombophlebitis with cephalosporins infused IV; Cefotetan (Cefotan): disulfiram-like reaction if client takes with alcohol, risk for hemorrhage

Question 11

Therapeutic Uses

Monobactam - aztreonam

Answer 11

Narrow-spectrum antibiotic that treats infections caused by gram-negative aerobic bacteria; lower respiratory infections; urinary tract infections; abdominal and gynecological infections

Question 12

Contraindications/Precautions

Carbapenem - imipenem

Answer 12

Allergy to carbapenems; allergy to penicillin; allergy to cephalosporins; seizures; renal impairment

Question 13

Therapeutic Uses

Vancomycin

Answer 13

Severe infections: Methicillin-resistant staphylococcus aureus infections (MRSA); Infections in clients with an allergy to penicillin; Clostridium Difficile associated diarrhea (CDAD)

Question 14

Adverse Effects

Vancomycin

Answer 14

Renal failure secondary to nephrotoxicity; hypotension, tachycardia, and flushing of the face and trunk (“red man” syndrome) occur with rapid IV infusion; rare-ototoxicity (usually reversible); thrombophlebitis at IV site and tissue damage with IV infiltration

Question 15

Client Education

Tetracycline

Answer 15

Take with non-dairy food if GI symptoms occur; report to provider if pregnant; giving the drug to children under the age of 8 should be avoided; report jaundice, abdominal pain, or fatigue to provider; report mouth pain and difficulty chewing or swallowing; report vaginal irritation/discharge; report watery or bloody stools; wear protective clothing and wear sunscreen for exposure

Question 16

Contraindications

Tetracyclines

Answer 16

Pregnancy risk-teratogenic, children younger than 8 years old; allergy to tetracycline; exposure to ultraviolet light; serious renal or liver failure

Question 17

Interactions

Tetracyclines

Answer 17

Absorption decreased by antidiarrheals containing kaolin, supplement and antacids containing calcium, magnesium, and aluminum
Dairy products and supplements with iron or zinc decrease absorption
Tetracyclines decrease effectiveness of oral contraceptives

Question 18

Therapeutic Uses

Macrolides - erythromycin, azithromycin

Answer 18

First line treatment for: Legionnaires’ disease, Whooping cough, acute diphtheria, treatment of clients who are carriers of diphtheria, some Chlamydia infections, certain pneumonias
Treats common infections for clients who have a penicillin allergy
Ophthalmic ointment prevents eye infections in neonates

Question 19

Adverse Effects

Macrolides - erythromycin, azithromycin

Answer 19

GI symptoms: nausea, vomiting, abdominal pain, and diarrhea; cardiac symptoms: serious ventricular dysrhythmias can result in death; ototoxicity: hearing loss, vertigo, and tinnitus (able to reverse when treatment ends); Superinfection (CDAD, candidiasis)

Question 20

Client Education

Macrolides - erythromycin, azithromycin

Answer 20

Take with food if GI symptoms occur; report continuing of symptoms to provider; report palpitations and fainting spells to the provider; report hearing loss, vertigo, and tinnitus to provider; report watery or bloody diarrhea; report mouth pain with white patches on the oral mucosa, or vaginal discomfort and discharge

Question 21

Adverse Effects

Aminoglycosides - gentamicin

Answer 21

Elevated trough levels of the drug (early signs include tinnitus, headache, and vertigo) can cause ototoxicity
Nephrotoxicity (polyuria, dilute urine, protein and casts in urine, elevated BUN, creatinine)
Ataxia

Question 22

Nursing Interventions

Aminoglycosides - gentamicin

Answer 22

Monitor for and report tinnitus and other symptoms of early signs of toxicity; monitor for peak and trough levels; monitor laboratory values (BUN, creatinine, urine for protein and casts) and report elevations; evaluate of eight cranial nerve with audiometry; monitor I&O

Question 23

Client Education

Aminoglycosides - gentamicin

Answer 23

Report onset of tinnitus, headache, vertigo, or hearing loss to provider
Report an increase in the output of dilute urine to provider

Question 24

What is the suffix for fluoroquinolones?

Answer 24

-floxacin

Question 25

Interactions | Fluoroquinolones - ciprofalxin

Answer 25

Antacids, iron preparation, calcium (including dairy products), and sucralfate (Carafate) decrease oral absorption; Increase theophylline levels and the risk for CNS symptoms; Increase warfarin (Coumadin) levels; concurrent use of erythromycin, quinidine, some antipsychotics, and tricyclic antidepressants can increase the risk for torsade de pointes in those susceptible; Increase hypoglycemia occur when taken concurrently with antidiabetic medication

Question 26

Therapeutic Use | Sulfonamide - trimethoprim and sulfamethoxazole

Answer 26

Trimethoprim and sulfamethoxazole work together to treat: urinary tract infections, pneumocystis pneumonia, shigella enteritis (shigellosis, also called traveler's diarrhea), chronic bronchitis (acute phase), acute otitis media in children

Question 27

Medication Administration | Sulfonamide - trimethoprim and sulfamethoxazole

Answer 27

Available as fixed-dose combination in tablets, liquid solution, and IV form; give oral dose with 8 oz. of water; administer intermittent IV infusion slowly (over 60-90 minutes) and with recommended dilution; drink at least 1200 to 1500 mL water/day during treatment with this drug

Question 28

Interactions | Sulfonamide - trimethoprim and sulfamethoxazole

Answer 28

Alcohol use with this drug may cause a disulfiram-type reaction; may increase effects of warfarin, phenytoin, tolbutamide (and other sulfonylurea oral antidiabetic drugs); taken with methotrexate, clients may have increased immunosuppression; reduced effectiveness of oral contraceptives (use alternative contraception)

Question 29

Adverse Effects | Urinary Tract Antiseptics - nitrofurantoin

Answer 29

GI symptoms: nausea, vomiting, and diarrhea; Respiratory symptoms: acute chills/fever, cough, lasts 2 to 4 days, subacute cough, shortness of breath, lasts weeks to months and may be permanent; permanent peripheral neuropathy (commonly in clients with impaired renal function); blood cell dysfunction (anemia, including hemolytic anemia, thrombocytopenia, neutropenia); tooth staining caused by contact with liquid suspension; urine may appear brownish (harmless side effect); dizziness, drowsiness, headache, and photosensitivity; pulmonary distress

Question 30

Client Education | Urinary Tract Antiseptics - nitrofurantoin

Answer 30

Take with food or milk; report acute or subacute respiratory symptoms, such as dyspnea, fever, or cough to the provider; report numbness, tingling, and weakness of extremities; report fatigue, easy bruising, or repeated infections to provider; swallow capsules whole; dilute liquid suspension; rinse mouth after taking suspension

Question 31

Therapeutic Use | Isoniazid

Answer 31

Treatment of active TB | Treatment of latent TB (positive TB skin test; disease not yet active)

Question 32

Adverse Effects | Isoniazid

Answer 32

Liver damage, including hepatitis, liver failure (especially common in older adults and clients with alcohol use disorder); peripheral neuropathy: numbness, tingling, pain in the hands or feet (especially common in clients who have diabetes or alcohol use disorder); CNS symptoms: dizziness, ataxia, seizures, psychotic symptoms; GI symptoms: nausea, vomiting

Question 33

Nursing Interventions | Isoniazid

Answer 33

Monitor for and report GI symptoms; work with client to encourage compliance with drug regimen; monitor levels of liver enzymes throughout therapy; monitor for and report signs of liver damage; administer pyridoxine (vitamin B6) as prescribed for neuropathy; monitor for and report CNS symptoms; monitor for signs of DRESS

Question 34

What are the signs of DRESS

Answer 34

Fever, rash, lymphadenopathy, and/or facial swelling, associated with involvement of other organ systems (hepatitis, nephritis, hematologic abnormalities, myocarditis, myositis)

Question 35

Contraindications | Isoniazid

Answer 35

History of allergy to isoniazid; history of liver damage from isoniazid; severe liver damage from any cause; chronic liver disease, including hepatitis, adults older than 50; seizure disorder; renal disorders; alcohol use disorder

Question 36

Evaluation of Medication Effectiveness | Isoniazid

Answer 36

Improvement of tuberculosis manifestations (clear breath sounds, no night sweats, increased appetites, and no afternoon rises of temperature) Three negative sputum cultures for tuberculosis, usually taking 3 to 6 months to achieve

Question 37

Therapeutic Use | Rifamycin - rifampin

Answer 37

Adjunct therapy to treat TB; effective against Neisseria meningitidis (cause of meningococcal meningitis), legionella (responsible for Legionnaires disease), and staphylococcus aureus; may treat leprosy; prevents hemophilus influenza infection

Question 38

Adverse Effects | Rifamycin - rifampin

Answer 38

Liver toxicity (hepatitis); red-orange color of body fluids (urine, saliva, tears, sweat); GI symptoms (nausea, vomiting, diarrhea, cramping, abdominal pain); flushing, rash, itching

Question 39

Nursing Interventions | Rifamycin - rifampin

Answer 39

Monitor liver enzyme levels throughout therapy; monitor for and report symptoms of hepatitis; observe for presence of soft contact lenses-may become stained by tears; monitor for and report persistent GI symptoms; monitor for signs of DRESS, therapy should be stopped if symptoms appear

Question 40

Interactions | Rifamycin - rifampin

Answer 40

Decreases blood levels of oral contraceptives, warfarin (Coumadin) and several HIV drugs (protease inhibitors) Isoniazid and pyrazinamide increase risk for liver toxicity

Question 41

Therapeutic Use | Anti-infective, antiprotozoal, antiulcer - metronidazole

Answer 41

IV form treats anaerobic bacterial infections, such a colorectal. abdominal, and vaginal surgeries; oral form treats some bacterial infections which include: CDAD, bacterial vaginal infections; Oral also treats protozoal infections which include: intestinal and systemic amebiases, giardiasis, trichomoniasis in both males and females

Question 42

Client Education | Anti-infective, antiprotozoal, antiulcer - metronidazole

Answer 42

Take just before, with, or after a meal if GI symptoms occur; report severe GI symptoms to provider; report CNS symptoms to provider; do not be alarmed if darkening of urine occurs during treatment; instruct clients that they may experience a metallic taste, headache, and dizziness; advise client to avoid alcohol

Question 43

Therapeutic Use | Antimalarial - chloroquine

Answer 43

Treats chloroquine-sensitive malaria. Combination with primaquine is necessary to cure malaria caused by two of the parasites; prophylaxis for malaria in regions where chloroquine resistance is not widespread; treats amebiasis; second-line therapy to treat rheumatoid arthritis and systemic lupus erythematosus

Question 44

Adverse Effects | Antimalarial - chloroquine

Answer 44

``` Visual symptoms GI symptoms (nausea, diarrhea) ```

Question 45

Medication Administration | Antifungal - amphotericin B

Answer 45

Available for IV infusion, treatment given daily; infuse IV form at recommended dilution and rate, monitor IV site carefully for thrombophlebitis; if ordered, administer a test dose to determine how the client tolerates the drug; there is a lipid-based from available for IV use with less adverse effects, but a much more expensive formulation; Oral suspension: the client may "swish and swallow" oral suspension for oral Candida (thrush) infections, instruct the client to swish well in mouth before swallowing

Question 46

Therapeutic Use | Antiviral - acyclovir

Answer 46

IV: treats severe viral infections in clients who are immunocompromised Oral: treats symptoms of severe viral infections in clients with normal immune systems Topical: treats symptoms of viral infections such as cold sores, initial genital herpes outbreaks, and mild skin infections for clients who are immunocompromised

Question 47

Adverse Effects | Antiviral - acyclovir

Answer 47

IV: Renal toxicity; CNS toxicity (rare, client with renal impairment are at the most risk), restlessness, tremors, psychosis, seizures; thrombophlebitis at IV site; IV infiltration causes tissue damage Oral: GI symptoms (nausea, vomiting, diarrhea, headache); vertigo Topical: burning, itching at application site (usually temporary)

Question 48

Adverse Effects | Azoles - ketoconazole

Answer 48

Systemic Use: Liver toxicity; GI symptoms (nausea/vomiting, constipation, or diarrhea); drowsiness, dizziness (decreases during duration of treatment)

Question 49

Nursing Interventions | Vaccines

Answer 49

Have emergency medications and equipment on standby in case the client experiences an allergic reaction; Instruct clients to observe for complications and notify provider

Question 50

What is the timeframe to give oseltamivir (Tamiflu)

Answer 50

Within 48 hours of flu symptom onset

Question 51

Therapeutic Use | Inhaled ribavirin

Answer 51

Anti-viral drug used to treat infants and young children who have a severe lung infection caused by RSV

Question 52

Which immune cells does HIV/AIDS destroy?

Answer 52

CD4+ T cells

Question 53

Adverse Effects | Cancer

Answer 53

Bone marrow suppression, nausea/vomiting, hair loss

Question 54

Client Education | Cancer

Answer 54

Follow strict hand hygiene; avoid crowds; avoid raw or uncooked food (including fruits and vegetables that are eaten raw); report nausea