NURS 317 Unit 7 Pharm Chapter 9 Flashcards
Place the following cephalosporins in the proper sequence beginning with first-generation cephalosporins up to fourth-generation cephalosporins.
A) Cefepime
B) Cefotaxime
C) Cefazolin
D) Cefuroxime
C) Cefazolin
Rationale:Over time, four generations of cephalosporins have been introduced, each group with its own spectrum of activity. First-generation drugs include cefadroxil, cefazolin, and cephalexin. Second-generation cephalosporins include cefaclor, cefoxitin, cefprozil, and cefuroxime. Third-generation drugs include cefdinir, cefoperazone, cefotaxime, cefpodoxime, ceftazidime, ceftibuten, ceftizoxime, and ceftriaxone. Fourth-generation cephalosporins are in development. The first drug of this group is cefepime
Culture and sensitivity testing of a client’s urine sample reveals a bacterium that is susceptible to cephalosporins. What medication would be most likely for the nurse to administer?
A) Neomycin
B) Ciprofloxacin
C) Imipenem–cilastatin
D) Cefaclor
D) Cefaclor
Rationale:Cefaclor is an example of a cephalosporin. Imipenem–cilastatin is an example of a carbapenem. Neomycin is an example of an aminoglycoside. Ciprofloxacin is an example of a fluoroquinolone
The nurse is caring for a 6-year-old child who has pyelonephritis. The use of what group of antibiotics would be contraindicated due to the client’s age?
A) Penicillins
B) Cephalosporins
C) Tetracyclines
D) Aminoglycosides
C) Tetracyclines
Rationale:Tetracyclines can potentially damage developing teeth and bones and thus should be used cautiously or avoided in children under the age of 8 years. Penicillins are safe to give to children and commonly used. Cephalosporins are safe to administer to pediatric clients. Aminoglycosides would not be administered to children lightly, but they can be administered when the benefits outweigh the risks, such as an infection that is resistant to other drugs.
A client has been diagnosed with pulmonary tuberculosis. What first-line agents should the nurse expect to administer? Select all that apply.
A) Pyrazinamide
B) Rifampin
C) Ciprofloxacin
D) Isoniazid
E) Kanamycin
A) Pyrazinamide
B) Rifampin
D) Isoniazid
Rationale:Rifampin is a first-line agent for tuberculosis. Isoniazid is a first-line agent for tuberculosis. Pyrazinamide is a first-line agent for tuberculosis. Kanamycin is considered a second-line agent for tuberculosis. Ciprofloxacin is considered a second-line agent for tuberculosis.
Today, aminoglycosides are replacing many older antibiotics due to their low risk of toxicity.
A) FALSE
B) TRUE
A) FALSE
Rationale:Aminoglycosides have potentially serious adverse effects; thus, they are being replaced by newer, less toxic drugs in the treatment of serious infections.
A client with a complex medical history is showing signs and symptoms of sepsis. What aspect of this client’s health history would rule out the safe and effective use of an aminoglycoside antibiotic?
A) The client has a history of not adhering to treatment.
B) The client has a known latex allergy.
C) The client has type 2 diabetes, controlled with oral antihyperglycemics.
D) The client has chronic renal failure.
D) The client has chronic renal failure.
Rationale:Renal failure would preclude the use of an aminoglycoside. Nonadherence must always be addressed, but this client variable is not specific to aminoglycosides. Neither latex allergies nor type 2 diabetes would necessarily rule out the use of an aminoglycoside.
A client with a urinary tract infection is being treated with a sulfonamide antibiotic. The nurse should recognize that pathogens are being eradiated by what means?
A) Prevention of biosynthesis of bacterial cell walls
B) Inhibition of cell membrane synthesis
C) Inhibition of folic acid synthesis
D) Interference with DNA enzymes necessary for bacterial growth
C) Inhibition of folic acid synthesis
Rationale:Sulfonamides inhibit the synthesis of folic acid, which is necessary for cells to grow and reproduce. Carbapenems inhibit cell membrane synthesis. Cephalosporins prevent bacteria from biosynthesizing the framework of their cell walls. Fluoroquinolones interfere with the action of DNA enzymes that are necessary for bacterial growth and reproduction.
Streptococcus pneumonia is an example of gram-negative bacteria.
A) FALSE
B) TRUE
A) FALSE
Rationale:Streptococcus pneumonia is a gram-positive bacterium.
A client who has tested positive for active tuberculosis is to receive rifampin. What is the nurse’s priority teaching point for this client?
A) “Call your doctor immediately if you experience headache or dizziness.”
B) “Avoid excessive fluid intake so that you don’t dilute your blood levels of the drug.”
C) “Expect to develop a rash for the first day or two. It will resolve spontaneously.”
D) “Your urine, tears, or sweat may become orange in color.”
D) “Your urine, tears, or sweat may become orange in color.”
Rationale:This drug causes body fluids to turn orange. The client needs to be informed of this to avoid being frightened when it occurs. A rash indicates a hypersensitivity reaction that should be addressed promptly. Headache and dizziness are common CNS effects of the drug that do not need to be immediately reported. Increased fluid intake is recommended.
A client’s risk for ototoxicity, nephrotoxicity, and neurotoxicity increases dramatically if he or she receives an aminoglycoside in conjunction with a potent diuretic.
A) FALSE
B) TRUE
B) TRUE
Rationale:Avoid combining aminoglycosides with potent diuretics; this increases the incidence of ototoxicity, nephrotoxicity, and neurotoxicity. Renal toxicity, which may progress to renal failure, is caused by direct drug toxicity in the glomerulus, meaning that the drug molecules cause damage (e.g., obstruction) directly to the kidney.
Infections of the genitourinary tract are commonly the result of gram-positive bacteria.
A) FALSE
B) TRUE
A) FALSE
Rationale:Gram-negative bacteria, usually E. coli, are frequently associated with infection of the genitourinary tract.
A client is receiving a cephalosporin and an aminoglycoside as combination therapy. What assessment should the nurse prioritize?
A) Signs of disulfiram-like reaction
B) Complete blood count
C) Coagulation studies
D) Serum BUN and creatinine levels
D) Serum BUN and creatinine levels
Rationale:The nurse would need to assess renal function indicated by serum BUN and creatinine levels because combining cephalosporins with aminoglycosides increases the client’s risk for renal toxicity. Coagulation studies would be important if the client was receiving a cephalosporin with an oral anticoagulant because there is an increased risk for bleeding. Combining cephalosporins with alcohol could result in a disulfiram-like reaction. Assessing the client’s complete blood count would not be directly indicated by the combination of cephalosporins and aminoglycosides.
