A pregnant female patient with bacteriuria, suprapubic pain, urinary urgency and frequency, and a low-grade fever is allergic to sulfa, ciprofloxacin, and amoxicillin. The nurse knows that the best alternative for treating this urinary tract infection is with:
A nurse is discussing methicillin-resistant Staphylococcus aureus (MRSA) with a group of nursing students. Which statement by a student correctly identifies the basis for MRSA resistance?
"MRSA bacteria have developed PBPs with a low affinity for penicillins."
A patient has an infection caused by Pseudomonas aeruginosa. The prescriber has ordered piperacillin and amikacin, both to be given intravenously. What will the nurse do?
Make sure to administer the drugs at different times using different IV tubing.
The nurse is caring for a patient taking vancomycin (Vancocin). Upon assessment of the patient, the nurse finds that he is experiencing flushing, rash, pruritus, and urticaria. His vital signs are: P-120/minute, BP-92/97 mm Hg, T-98.9° F, and R-20/minute. The nurse understands that these findings are consistent with
"red man" syndrome.
A patient tells the nurse during the health history that the last time she received penicillin, she experienced anaphylaxis. Which of the following medications should the nurse advise the patient to avoid?
A patient who is taking doxycycline for a serious infection contacts the nurse to report anal itching. The nurse will contact the provider to discuss:
prescribing an antifungal drug to treat a suprainfection.
A nursing student asks a nurse to clarify the differences between the mechanisms of spontaneous mutation and conjugation in acquired resistance of microbes. What will the nurse say?
Spontaneous mutation leads to resistance to only one antimicrobial agent.
A patient with no known drug allergies is receiving amoxicillin (Amoxil) PO twice daily. Twenty minutes after being given a dose, the patient complains of shortness of breath. The patient's blood pressure is 100/58 mm Hg. What will the nurse do?
Contact the provider and prepare to administer epinephrine.
To prevent yellow or brown discoloration of teeth in children, tetracyclines should not be given:
to pregnant patients after the fourth month of gestation.
A child has been receiving chloramphenicol for a Neisseria meningitidis central nervous system (CNS) infection. The nurse administers the dose and subsequently notes that the child has vomited and appears dusky and gray in color. The child's abdomen is distended. What will the nurse do?
Stop the infusion immediately and notify the provider.
A patient will be discharged from the hospital with a prescription for TMP/SMZ (Bactrim). When providing teaching for this patient, the nurse will tell the patient that it will be important to:
drink 8 to 10 glasses of water each day.
A patient has a localized skin infection, which is most likely caused by a gram-positive cocci. Until the culture and sensitivity results are available, the nurse will expect the provider to order a _____-spectrum _____ agent.
A child with an upper respiratory infection caused by B. pertussis is receiving erythromycin ethylsuccinate. After 2 days of treatment, the parent asks the nurse why the child's symptoms have not improved. Which response by the nurse is correct?
"Erythromycin eliminates the bacteria that causes the infection, but not the toxin that causes the symptoms."
A nurse transcribes a new prescription for potassium penicillin G given intravenously (IV) every 8 hours and gentamicin given IV every 12 hours. Which is the best schedule for administering these drugs?
Give the penicillin at 0800, 1600, and 2400; give the gentamicin (Garamycin) at 1800 and 0600.
A patient is to begin taking doxycycline to treat a rickettsial infection. Which statement by the patient indicates a need for teaching about this drug?
"I should take this drug with food to ensure more complete absorption."
A patient recently began receiving clindamycin (Cleocin) to treat an infection. After 8 days of treatment, the patient reports having 10 to 15 watery stools per day. What will the nurse tell this patient?
The patient should stop taking the clindamycin now and contact the provider immediately.
A patient being treated with cefmetazole (Zefazone) complains of a headache. Which analgesic would be the best choice for this patient?
A patient with recurrent bacterial pneumonia is treated with an antibiotic that has worked previously but is not working to reduce symptoms in a current infection. The nurse caring for this patient understands that this is likely for which reason?
The antibiotic destroyed competing organisms that secrete substances toxic to the pathogen.
Which side effect of clindamycin (Cleocin) causes the most concern and may warrant discontinuation of the drug?
A child with otitis media has had three ear infections in the past year. The child has just completed a 10-day course of amoxicillin (Amoxil) with no improvement. The parent asks the nurse why this drug is not working, because it has worked in the past. What will the nurse tell the patient?
"The bacteria have synthesized penicillinase."
A patient with type 2 diabetes mellitus takes glipizide. The patient develops a urinary tract infection, and the prescriber orders TMP/SMZ. What will the nurse tell the patient?
The patient should check the blood glucose level more often while taking TMP/SMZ.
A patient presents to the emergency department with complaints of chills, severe flank pain, dysuria, and urinary frequency. The vital signs are temperature of 102.9° F, pulse of 92 beats per minute, respirations of 24 breaths per minute, and blood pressure of 119/58 mm Hg. The nurse would be correct to suspect that the patient shows signs and symptoms of:
A pregnant patient with fever, flank pain, and chills has a history of two previous bladder infections before getting pregnant. She is allergic to several antibiotics. She reports having taken methenamine successfully in the past. What will the nurse tell her?
"This agent is not effective against infections of the upper urinary tract."
A patient is taking erythromycin ethylsuccinate for a chlamydial infection and develops vaginal candidiasis. The prescriber orders ketoconazole to treat the suprainfection. What will the nurse do?
Contact the provider to discuss changing to a different antifungal medication.
A patient is diagnosed with periodontal disease, and the provider orders oral doxycycline (Periostat). The patient asks the purpose of the drug. What is the nurse's response?
"It inhibits collagenase to protect connective tissue in the gums."
A patient with a urinary tract infection is given a prescription for TMP/SMZ. When reviewing the drug with the patient, the nurse learns that the patient has type 1 diabetes mellitus and consumes alcohol heavily. What will the nurse do?
Contact the provider to request a different antibiotic for this patient.
A 6-week-old infant who has not yet received immunizations develops a severe cough. While awaiting nasopharyngeal culture results, the nurse will expect to administer which antibiotic?
The nurse is teaching a nursing student about the mechanism by which antimicrobial agents achieve selective toxicity. Which statement by the student indicates a need for further teaching?
"Some agents cause phagocytosis of bacterial cells."
A patient is receiving intravenous potassium penicillin G, 2 million units to be administered over 1 hour. At 1900, the nurse notes that the dose hung at 1830 has infused completely. What will the nurse do?
Request an order for serum electrolytes and cardiac monitoring.
A patient who has been taking linezolid (Zyvox) for 6 months develops vision problems. What will the nurse do?
Tell the patient that this symptom is reversible when the drug is discontinued.
The nurse understands that vancomycin (Vancocin) generally is given intravenously. In which patient would an oral route of administration be warranted?
A patient with pseudomembranous colitis
A hospitalized patient who is taking demeclocycline (Declomycin) reports increased urination, fatigue, and thirst. What will the nurse do?
Provide extra fluids and reassure the patient that these are expected side effects.
A nurse is discussing microbial resistance among sulfonamides and trimethoprim with a nursing student. Which statement by the student indicates a need for further teaching?
"Resistance to sulfonamides is less than resistance to trimethoprim."
A patient has an infection caused by Streptococcus pyogenes. The prescriber has ordered dicloxacillin PO. What will the nurse do?
Question the need for a penicillinase-resistant penicillin.
Which patient with a urinary tract infection will require hospitalization and intravenous antibiotics?
An older adult man with a low-grade fever, flank pain, and an indwelling catheter
A nurse is teaching a nursing student about dalfopristin/quinupristin (Synercid). Which statement by the student indicates an understanding of the teaching?
"Patients taking this drug should have blood tests performed frequently."
A patient with a history of renal calculi has fever, flank pain, and bacteriuria. The nurse caring for this patient understands that it is important for the provider to:
begin antibiotic therapy after urine culture and sensitivity results are available.
A patient is about to receive penicillin G for an infection that is highly sensitive to this drug. While obtaining the patient's medication history, the nurse learns that the patient experienced a rash when given amoxicillin (Amoxil) as a child 20 years earlier. What will the nurse do?
Request an order for a skin test to assess the current risk.
A patient with bronchitis is taking TMP/SMZ, 106/80 mg orally, twice daily. Before administering the third dose, the nurse notes that the patient has a widespread rash, a temperature of 103° F, and a heart rate of 100 beats per minute. The patient looks ill and reports not feeling well. What will the nurse do?
Withhold the dose and notify the provider of the symptoms.
A patient with second-degree burns is treated with silver sulfadiazine (Silvadene). A nursing student asks the nurse about the differences between silver sulfadiazine and mafenide (Sulfamylon), because the two are similar products, and both contain sulfonamides. What does the nurse tell the student about silver sulfadiazine?
It has antibacterial effects related to release of free silver.
A patient who is taking nitrofurantoin calls the nurse to report several side effects. Which side effect of this drug causes the most concern and would require discontinuation of the medication?
Tingling of the fingers
A pregnant adolescent patient asks the nurse whether she should continue to take her prescription for tetracycline (Sumycin) to clear up her acne. Which response by the nurse is correct?
"Tetracycline can be harmful to the baby's teeth and should be avoided."
A 30-year-old male patient reports having two to four urinary tract infections a year. What will the nurse expect to teach this patient?
"You will need to take a low dose of medication for 6 months to prevent infections."
A child has received amoxicillin (Amoxil) for three previous ear infections, but a current otitis media episode is not responding to treatment. The nurse caring for this child suspects that resistance to the bacterial agent has occurred by which microbial mechanism?
A nurse teaches a patient about sulfonamides. Which statement by the patient indicates a need for further teaching?
"I should stop taking this drug when my symptoms are gone."
An older male patient comes to the clinic with complaints of chills, malaise, myalgia, localized pain, dysuria, nocturia, and urinary retention. The nurse would most likely suspect that the patient has:
A patient received 500 mg of azithromycin (Zithromax) at 0800 as a first dose. What are the usual amount and time of the second dose of azithromycin?
250 mg at 0800 the next day
A patient admitted with an infected below-the-knee amputation (BKA) and heart failure (HF) is taking vancomycin (Vancocin) and furosemide (Lasix). Which of the following is the most important instruction the nurse should provide?
"Report any ringing in the ears or dizziness."
The nurse is preparing to administer intravenous doripenem (Doribax) to a patient with a severe intra-abdominal infection that developed after colon surgery. In reviewing the patient's current medications, which one would be of most concern?
Valproic acid (Depakene)
A parent asks a nurse if the provider will prescribe an antibiotic for a child who attends school with several children who have strep throat. The child is complaining of a sore throat and has a fever. What will be the nurse's response?
"Your child should come to the clinic to have a throat culture done today."
The nurse is caring for a patient on a medical-surgical unit who has a fever of unknown origin. The prescriber has ordered a broad-spectrum antibiotic. Which intervention is the priority?
Obtaining all cultures before the antibiotic is administered
A nurse is obtaining a drug history from a patient about to receive sulfadiazine. The nurse learns that the patient takes warfarin, glipizide, and a thiazide diuretic. Based on this assessment, the nurse will expect the provider to:
monitor the patient's coagulation levels.
A patient who is taking immunosuppressants develops a urinary tract infection. The causative organism is sensitive to sulfonamides and to another, more expensive antibiotic. The prescriber orders the more expensive antibiotic. The nursing student assigned to this patient asks the nurse why the more expensive antibiotic is being used. Which response by the nurse is correct?
"Sulfonamides are bacteriostatic and depend on host immunity to work."
A patient is receiving intravenous (IV) vancomycin (Vancocin). A unique complication of rapid IV infusion of vancomycin is
"red man" syndrome.
A young, nonpregnant female patient with a history of a previous urinary tract infection is experiencing dysuria, urinary urgency and frequency, and suprapubic pain of 3 days' duration. She is afebrile. A urine culture is positive for more than 100,000/mL of urine. The nurse caring for this patient knows that which treatment is most effective?
A 3-day course of trimethoprim/sulfamethoxazole (Bactrim)
Before giving methenamine (Hiprex) to a patient, it is important for the nurse to review the patient's history for evidence of which problem?
Elevated blood urea nitrogen and creatinine
A patient has a positive urine culture 1 week after completion of a 3-day course of antibiotics. The nurse anticipates that the prescriber will:
begin a 2-week course of antibiotics.
A patient complains of burning on urination and increased frequency. The patient has a history of frequent urinary tract infections (UTIs) and is going out of town in 2 days. To treat the infection quickly, the nurse would expect the health care provider to order
A patient who is receiving a final dose of intravenous (IV) cephalosporin begins to complain of pain and irritation at the infusion site. The nurse observes signs of redness at the IV insertion site and along the vein. The nurse's priority action is to
select an alternate intravenous site and administer the infusion more slowly.
A 20-year-old female patient has suprapubic discomfort, pyuria, dysuria, and bacteriuria greater than 100,000/mL of urine. Which are the most likely diagnosis and treatment?
Uncomplicated lower urinary tract infection treatable with short-course therapy
A nurse is providing teaching for a patient who will begin taking clarithromycin ER (Biaxin XL) to treat an Helicobacter pylori infection. Which statement by the patient indicates understanding of the teaching?
"I may experience distorted taste when taking this medication."
The parent of an infant with otitis media asks the nurse why the prescriber has ordered amoxicillin (Amoxil) and not ampicillin (Unasyn). What will the nurse tell the parent?
Ampicillin is not as acid stable as amoxicillin.
The nurse has been caring for a patient who has been taking antibiotics for 3 weeks. Upon assessing the patient, the nurse notices the individual has developed oral thrush. What describes the etiology of the thrush?
A pregnant patient is treated with trimethoprim/sulfamethoxazole (TMP/SMZ) (Bactrim) for a urinary tract infection at 34 weeks' gestation. A week later, the woman delivers her infant prematurely. The nurse will expect to monitor the infant for:
A nurse assisting a nursing student with medications asks the student to describe how penicillins (PCNs) work to treat bacterial infections. The student is correct in responding that penicillins:
disrupt bacterial cell wall synthesis.
An older adult patient with chronic obstructive pulmonary disease (COPD) develops bronchitis. The patient has a temperature of 39.5° C. The nurse will expect the provider to:
order empiric antibiotics while waiting for sputum culture results.
A child with an ear infection is not responding to treatment with amoxicillin (Amoxil). The nurse will expect the provider to order:
amoxicillin-clavulanic acid (Augmentin).
A patient has a viral sinus infection, and the provider tells the patient that antibiotics will not be prescribed. The patient wants to take an antibiotic and asks the nurse what possible harm could occur by taking an antibiotic. Which response by the nurse is correct?
"Even normal flora can develop resistance and transfer this to pathogens."
A nurse is caring for an African American patient who has been admitted to the unit for long-term antibiotic therapy with sulfonamides. The patient develops fever, pallor, and jaundice. The nurse would be correct to suspect that the patient has developed:
A patient with an infection caused by Pseudomonas aeruginosa is being treated with piperacillin. The nurse providing care reviews the patient's laboratory reports and notes that the patient's blood urea nitrogen and serum creatinine levels are elevated. The nurse will contact the provider to discuss:
reducing the dose of piperacillin.
A nurse is providing education about tetracycline (Sumycin). Which statement by the patient best demonstrates understanding of the administration of this medication?
"I should not take this medication with milk or other dairy products."