Ch9 - Focus on Nursing Pharmacology 6e Instructor Test Bank PDF

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Focus on Nursing Pharmacology 6e
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Chapter 9- Antibiotics

A 32-year-old female patient is admitted to the floor with a superinfection. Her orders read tigecycline (Tygacil) 100 mg IV followed by 50 mg IV every 12 hours infused over 1. 30 to 60 minutes for 5 days. What would be important for the nurse to educate this patient about? A) Analgesics B) Antihistamines C) Contraceptives D) Decongestants Ans:

C

Feedback: Many antibiotics interfere with the effectiveness of oral contraceptives and unplanned pregnancies can occur. Women should be advised to use a barrier form of contraceptives when taking this drug. No known serious drug drug interactions involve analgesics, antihistamines, or decongestants. A patient with a gram-negative infection is being treated with an aminoglycoside. What 2.

system should the nurse expect to monitor closely while the patient is taking this medication? Respiratory system

A)

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B) Ophthalmic system C) Renal system D) Musculoskeletal system Ans:

C

Feedback: Renal function should be tested daily because aminoglycosides depend on the kidney for excretion and if the glomerular filtration rate (GFR) is abnormal it may be toxic to the kidney. The results of the renal function testing could change the daily dosage. Aminoglycosides do not usually adversely affect respiratory, hepatic, or musculoskeletal function, although baseline data concerning these systems is always needed. 3. How would the nurse describe selective toxicity? A)

Selective toxicity interferes with a biochemical reaction common to many different organisms.

B)

Selective toxicity will decrease invading bacteria by interfering with the pathogens’ ability to reproduce.

C)

Selective toxicity will eliminate bacteria by interrupting protein synthesis and damaging the pathogen’s cell wall.

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D)

Selective toxicity is the ability of the drug to kill foreign cells without causing harm to one’s own body cells.

Ans:

D

Feedback:

The choice of antibiotics in a clinical situation is determined by assessing which drug will affect the causative organism and lead to the fewest adverse effects. Selective toxicity is the ability of the drug to kill foreign cells without causing harm to the human body cells. How the antibiotic works to kill bacteria varies by drug type and may reduce the ability to reproduce, damage the cell wall, or interfere with a biochemical reaction, but this is a description of how the antibiotic works and does not describe selective toxicity A local bioterrorism medical team is learning about germ warfare. The team is instructed 4.

that a fluoroquinolone may be used to prevent an outbreak of anthrax infection. What fluoroquinolone would the nurse be most likely to administer for this purpose?

A) Ciprofloxacin (Cipro) B) Gemifloxacin (Factive) C) Norfloxacin (Noroxin) D) Sparfloxacin (Zagam) Ans:

A

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Feedback: Ciprofloxacin (Cipro) is the most widely used fluoroquinolone and is indicated for the prevention of anthrax infection. Gemifloxacin and sparfloxacin are most useful in treating acute episodes of chronic bronchitis and community-acquired pneumonia. Norfloxacin is recommended only for certain types of urinary tract infections. A clinic nurse is caring for a 66-pound child who has acute otitis media. The physician 5.

has ordered ceftibuten (Cedax) 9 mg/kg per day PO for 10 days. The drug comes in an oral suspension of 90 mg/5 mL. How many mL will the nurse administer?

A) 5 mL B) 10 mL C) 15 mL D) 20 mL Ans:

C

Feedback:

First, using the formula: 2.2 lb/1 kg = 66 lb/X kg, determine the child’s weight in kg (66/2.2 = 30 kg). Next, determine the desired dose by using the formula: amount of prescribed drug times weight in kg (9 mg/kg times 30 kg = 270 mg). To determine the volume of medication to administer, use the formula: amount of drug available/volume available = amount of drug prescribed/volume to administer (90 mg/5 mL = 270 mg/X

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mL, 90mg/(X) = 1,350 mg/mL, X = 15 mL). A 78-year-old woman, who lives alone and is forgetful, is being seen by her home health nurse. In reviewing the patient’s medication, the nurse discovers that the patient is taking 6.

Azithromycin (Zithromax) for urethritis. Why would this be a good choice of antibiotics for this patient?

A) The half-life of the drug is 3 to 7 hours. B) It is taken only once a day. C) It has very few adverse effects. D) It can be given without consideration to drug drug interactions. Ans:

B

Feedback:

Given that the patient is  forgetful and lives alone, a daily dose would likely promote improved compliance. Azithromycin can be administered once daily because the half-life is 68 hours. Azithromycin is associated with GI adverse effects and can cause pseudomembranous colitis; neurological symptoms can occur as well. Azithromycin (Zithromax) may adversely interact with cardiac glycosides, oral anticoagulants, theophyllines, carbamazepine, and corticosteroids to name a few agents.

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7.

A 12-year-old patient with a complicated skin infection has been admitted to the pediatric unit. The physician has ordered Ertapenem (Invanz). What is the nursing priority?

A) Transcribe the order to the medication administration record (MAR). B) Perform hand hygiene before preparing the medication. C) Assess the patient’s renal and hepatic functions. D) Question the order by calling the physician who prescribed it. Ans:

D

Feedback: The nurse should call the physician and question the order Because this drug is not recommended for children younger than 18 years of age. Following clarification of the order, the drug would be transcribed and listed in the MAR. The nurse would then wash her hands before preparing the drug for administration. Assessment of renal and hepatic function is good practice before administering any medication but is not the nursing priority. 8.

A 22-year-old female is diagnosed with mycobacterial tuberculosis. The physician orders rifampin (Rifadin) 600 mg PO daily. What should the nurse question the patient about?

A) Her diet B) Sun exposure

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C) Type of exercise she does D) Use of contact lenses Ans:

D

Feedback: Some antimycobacterial drugs can cause discoloration of body fluids. The orange tinged discoloration can cause permanent stain to contact lenses. The patient should avoid wearing them while on the antimycobacterial therapy. With antimycobacterial drugs there is not a concern is warranted about photosensitivity or exercise. However, due to the GI adverse effects, the nurse may want to discuss an appropriate diet if the patient experiences GI upset after beginning treatment. 9.

The nurse is providing discharge teaching to a patient who is being sent home on oral tetracycline (Sumycin). What instructions should the nurse include?

A) Take the medication only once a day. B) Check pulse rate and hold the drug if lower than 60 beats per minute (bpm). C) Take the drug on an empty stomach. D) Take the medication with 2 ounces of water. Ans:

C

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Feedback: Tetracycline should be taken on an empty stomach 1 hour before or 2 hours after meals with a full 8 ounces of water to ensure full absorption. Tetracycline is usually taken at least once every 12 hours. Checking the pulse and holding the dose if below 60 bpm is an action specific to the use of cardiac glycosides. 10.

A 28-year-old patient has been prescribed penicillin for the first time. What nursing diagnosis would be most appropriate for this patient?

A) Acute pain related to gastrointestinal (GI) effects of the drug B) Deficient knowledge regarding drug therapy C)

Imbalance nutrition: less than body requirements related to multiple GI effects of the drug

D) Constipation Ans:

B

Feedback: Because this is the first time the patient has taken penicillin, she is likely to have limited knowledge about the drug. She may not understand the importance of taking the medication as ordered to increase effectiveness of the drug or to report adverse effects. because the patient has not started the drug yet, there is no way to know what adverse effects, if any, she will experience. Only if she develops acute pain related to GI effects of the drug would this be appropriate. If GI symptoms develop it may lead to imbalanced nutrition, but that remains to be seen. No indication about constipation exists.

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The pharmacology instructor is discussing antimicrobials with the nursing class. What 11.

would the instructor tell the students about the mechanism of action of antimicrobials? (Select all that apply).

A) Preventing cell division B) Causing cell death C) Inhibiting cell wall synthesis D) Causing leakage of cell wall allowing fluid to leak in E) Inhibiting synthesis of ribonucleic acid (RNA) Ans:

A, B, C

Feedback:

Sites of cellular action of carbapenems, ketolides, lincosamides, aztreonam, penicillins, sulfonamides, tetracyclines, and antimycobacterials. Carbapenems, ketolides, and lincosamides change protein function and prevent cell division or cause cell death. Aztreonam alters cell membranes to allow leakage of intracellular substances and causes cell death; it does not cause leakage of fluid into the cell. Penicillins prevent bacteria from building their cells during division. Sulfonamides inhibit folic acid synthesis for RNA and deoxyribonucleic acid production but does not inhibit RNA synthesis The nurse is preparing to contact the physician for an antibiotic order for the patient’s 12.

infection. What information will the nurse be prepared to provide for the physician to

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choose the proper antibiotic? A) First day of infection symptoms B) Culture and sensitivity test results C) The patient’s intake and output for past 2 days D) Results of complete blood count with differential Ans:

B

Feedback: Antibiotics are best selected based on culture results that identify the type of organism causing the infection and sensitivity testing that shows what antibiotics are most effective in eliminating the bacteria. First day of symptoms of infection is likely already known if culture and sensitivity testing has been performed. Although measurement of intake and output is one indicator of renal function, a blood urea nitrogen test and assessment of creatinine levels would be better ways of assessing renal function, which will be used to determine dose of medication but not for selection of the correct antibiotic. The white blood cell count and differential would indicate the possibility of an infection but are not needed in choosing the proper antibiotic. A nursing student asks the pharmacology instructor for ways to minimize the emergence 13.

of drug-resistant microbial agents. What would be an appropriate response by the instructor? (Select all that apply.)

A)

Avoid the use of broad-spectrum antibacterial drugs when treating trivial or viral infections.

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B) Use narrow-spectrum agents if they are thought to be effective. C) Do not use vancomycin unnecessarily. D) Prescribe antibiotics when the patient believes they are warranted. E) Start the antibiotics, do culture and sensitivity tests, and provide patient education. Ans:

A, B, C

Feedback: To prevent or contain the growing threat of drug-resistant strains of bacteria, it is very important to use antibiotics cautiously, to complete the full course of an antibiotic prescription, and to avoid saving antibiotics for self-medication in the future. You would not give antibiotics every time the patient wants them, nor would you do a culture and sensitivity test after starting antibiotics. Therefore, Options D and E are incorrect. A student asks the pharmacology instructor if there is a way to increase the benefits and 14.

decrease the risks of antibiotic therapy. What would be an appropriate response by the instructor?

A)

Taking drugs not prescribed for the particular illness tends to maximize risks and minimize benefits.

B)

Never use antibiotics in combination with other prescriptions or in combination with other antibiotics.

C)

Maximize antibiotic drug therapy by administering the full dose when the patient has a fever.

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D)

Use antibiotics cautiously and teach patients to complete the full course of an antibiotic prescription.

Ans:

D

Feedback: To prevent or contain the growing threat of drug-resistant strains of bacteria, it is very important to use antibiotics cautiously, to complete the full course of an antibiotic prescription, and to avoid saving antibiotics for self-medication in the future. A patient and family teaching program should address these issues, as well as the proper dosing procedure for the drug (even if the patient feels better) and the importance of keeping a record of any reactions to antibiotics. Thus, taking drugs not prescribed for the particular illness tends to maximize risks and minimize benefits. Also, if the infection is viral, antibacterial drugs are ineffective and should not be used. 15.

What is the priority reason for the nurse to consider questioning an order for tetracycline in a child younger than 8 years of age?

A) Children younger than 8 years of age cannot take tetracyclines. B) Weight-bearing joints have been impaired in young animals given the drugs. C)

Tetracyclines can damage developing teeth and bone in children younger than 8 years of age.

D)

Liver and kidney function may be damaged when it is given to children under 8 years of age.

Ans:

C

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Feedback: Use tetracyclines with caution in children younger than 8 years of age because they can potentially damage developing bones and teeth. Although the drug does not cause damage to liver and kidneys, it may be contraindicated in patients with hepatic or renal dysfunction because it is concentrated in the bile and excreted in the urine. Fluoroquinolones, not tetracyclines, are generally contraindicated for use in children (i.e., those younger than 18 years of age) because weight-bearing joints have been impaired in young animals given the drugs. Clindamycin (Dalacin C) warrants monitoring hepatic and renal function when it is given to neonates and infants. Trimethoprim sulfamethoxazole (Nu-Cotrimox) is used in children, although children younger than 2 months of age have not been evaluated. Children under 8 years of age can take tetracycline, but it should be used with caution. 16.

After administering an antibiotic, the nurse assesses the patient for what common, potentially serious, adverse effect?

A) Rash B) Pain C) Constipation D) Hypopnea Ans:

A

Feedback:

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Examine skin for any rash or lesions, examine injection sites for abscess formation, and note respiratory status including rate, depth, and adventitious sounds to provide a baseline for indications of an allergic or adverse response to the drug. Report nausea, vomiting, diarrhea, rash, recurrence of symptoms for which the antibiotic drug was prescribed, or signs of new infection (e.g., fever, cough, sore mouth, drainage). These problems may indicate adverse effects of the drug, lack of therapeutic response to the drug, or another infection. Pain, constipation, and hypopnea are not common adverse effects of antibiotic drugs. 17.

The nurse is caring for a 62-year-old patient who is receiving IV gentamicin (Garamycin). The patient complains of difficulty hearing. What should the nurse do?

A) Hold the dose and notify the physician immediately. B) Administer the dose and speak in a louder voice when talking to the patient. C) Administer the dose and report this information to the oncoming nurse. D) Administer the dose and document the finding in the nurse’s notes. Ans:

A

Feedback: Aminoglycosides are contraindicated in the following conditions: known allergy to any of the aminoglycosides; renal or hepatic disease that could be exacerbated by toxic aminoglycoside effects and that could interfere with drug metabolism and excretion, leading to higher toxicity; preexisting hearing loss, which could be intensified by toxic drug-related adverse effects on the auditory nerve. Ototoxicity should be reported and the

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drug should be stopped. You would not administer the dose and then call the physician, administer the dose and report information to oncoming nurse, or administer the dose and document the finding in the nurse’s notes because each additional dose administered could potentially worsen hearing loss. The nurse is providing patient teaching before discharging a patient home. The patient is 18.

taking ciprofloxacin (Cipro). What would the nurse teach this patient is the best way to prevent crystalluria caused by ciprofloxacin (Cipro)?

A) Eliminate red meat and seafood from the diet. B) Encourage at least 2 liters of fluid per day. C) Avoid caffeine and alcohol. D) Spend time in the sun each day to optimize vitamin D levels. Ans:

B

Feedback: Provide the following patient teaching: Avoid driving or operating dangerous machinery because dizziness, lethargy, and ataxia may occur; try to drink a lot of fluids and maintain nutrition (very important), even though nausea, vomiting, and diarrhea may occur. There is no need to eliminate red meat, seafood, caffeine, or alcohol from the diet, although alcohol may increase the risk of GI irritation. Patients should be taught to avoid the sun due to possible photosensitivity. The nurse is caring for a child weighing 30 kg. The physician orders gentamicin 19.

(Garamycin) 100 mg tid for the patient. The recommended dosage range is 6 to 7.5

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mg/kg/day. What action should the nurse take? A) Administer the medication and assess hearing frequently. B) Question the physician about the frequency of administration. C) Question the physician about the dosage of the medication. D) Administer the medication and assess renal function frequently. Ans:

C

Feedback: The dosage is outside the recommended dosage range at 10 mg/kg/day so the nurse should question the dosage before administering the medication. It is appropriate to administer gentamicin tid to pediatric patients so there would be no need to question frequency of dosage. The drug should not be administered until the correct dosage is ordered so there is no need to assess hearing or renal function. 20.

The nurse is caring for a patient with a gram-positive infection. What antibiotic would be most effective in treating this infection?

A) Cefaclor (Ceclor) B) Cefoxitin (generic) C) Cefotaxime (Claforan)

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D) Cefazolin (Zolicef) Ans:

A

Feedback: First-generation cephalosporins are largely effective against gram-positive bacteria and include cefadroxil (generic), cefazolin (Zolicef), and cephalexin (Keflex). Second-and third-generation cephalosporins are less effective against gram-positive bacteria. Cefoxitin (generic) is a second-generation cephalosporin and cefotaxime (Claforan) and cefazolin (Zolicef) are third-generation cephalosporins. 21.

What severe reaction would the nurse assess for if it were necessary to administer trimethoprim/sulfamethoxazole (TMP/SMX) to an older adult?
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