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Chapter 38 - Antibiotics_Part 1 - Pharmacology & Nursing Process
Terms in this set (17)
A patient is receiving Augmentin (amoxicillin and clavulanic acid) liquid solution through a percutaneous endoscopic gastrostomy tube. What is the purpose of the clavulanic acid?
a. It works synergistically with the antibiotic to improve potency.
b. It inhibits the action of the enzymes produced by beta-lactamase-producing bacteria.
c. It protects the antibiotic from the harmful gastric acid secretions in the stomach.
d. It enhances the absorption of the antibiotic in the small intestine.
Correct answer: B
Rationale: The clavulanic acid works to inhibit the action of the enzymes produced by the bacteria, which would normally inactivate the antibiotic.
Which of the following does the nurse identify as being a concern for patients receiving tetracycline?
a. Tetracycline should not be administered to anyone older than age 65 years.
b. Tetracycline has no impact on the effectiveness of oral contraceptives.
c. Tetracycline used with warfarin decreases its effectiveness and enhances clot formation.
d. Tetracyclines should not be administered with dairy products.
Correct answer: D
Rationale: Assess for significant drug interactions, including simultaneous use of antacids, antidiarrheal drugs, dairy products, calcium, enteral feedings, and iron preparations. There is concern regarding the use of these drugs in patients younger than 8 years of age because of the problem of permanent mottling and discoloration of the teeth. Tetracyclines may also decrease the effectiveness of oral contraceptives. Assess the patient taking oral anticoagulants more closely because of possible potentiation of bleeding.
When completing an admission assessment, the patient states that she is allergic to sulfa drugs. What will the nurse do next?
a. Mark the allergy on her medical record.
b. Place an "allergy" armband on the patient.
c. Ask the patient for more information about the allergic reaction she had.
d. Notify the physician about the patient's allergy.
Correct answer: C
Rationale: Some patients say they are "allergic" to drugs when in fact what they experienced was a common and mild adverse effect. The nurse should clarify the patient's statements with open-ended questions.
A patient has a prescription for a sulfa drug as treatment for a UTI. She is also taking an oral contraceptive, an oral sulfonylurea antidiabetic drug, and phenytoin for a history of seizures. Which drug may pose a potential serious interaction with the sulfa drug?
a. The oral contraceptive
b. The oral antidiabetic drug
c. The phenytoin
d. All of these
Correct answer: D
Rationale: The combination of the sulfa drug with the oral contraceptive may reduce the effectiveness of the contraceptive. The combination with the oral antidiabetic drug may potentiate the hypoglycemic effect of the sulfonylurea drug, and the combination with the phenytoin may potentiate the toxic effects of the phenytoin.
The nurse identifies Zosyn as being a member of which group?
Correct answer: C
Rationale: Zosyn is a penicillin. The nurse should be aware of the fact that many times, these drugs are referred to by their trade names and do not always end in "cillin," such as with Zosyn and Augmentin.
What is the priority assessment data for a client prescribed antibiotic therapy?
b. Cardiac dysrhythmias
d. History of seizures
Antibiotic allergy is one of the most common drug allergies. An allergic reaction that occurs after administration of an antibiotic has the potential to cause severe anaphylaxis and possible death.
Which information should the nurse include in discharge teaching for a client prescribed doxycycline (Vibramycin)?
a. "Take the medication with milk to minimize gastrointestinal upset."
b. "Apply sunscreen or wear protective clothing when outdoors."
c. "Take the medication until you have no fever and feel better."
d. "Keep the remainder of the medication in case of recurrence."
Photosensitivity is a common adverse effect of doxycycline, a tetracycline antibiotic. The client should avoid direct sun exposure and tanning bed use while taking this medication. Exposure to the sun can cause severe burns.
Which adverse effect can result if tetracycline is administered to children younger than 8 years of age?
a. Delayed growth development
b. Drug-induced neurotoxicity
c. Permanent discoloration of the teeth
d. Gastrointestinal (GI) and rectal bleeding
Tetracycline is contraindicated in children younger than 8 years of age because it can cause permanent discoloration of the adult teeth and tooth enamel, which are still forming in the child.
A client who is allergic to penicillin is at increased risk for an allergy to which drug?
a. Erythromycin (E-mycin)
b. Gentamicin (Garamycin)
c. Cefazolin sodium (Ancef)
d. Demeclocycline (Declomycin)
Clients who are allergic to penicillins have an increased risk of allergy to other beta-lactam antibiotics. The incidence of cross-reactivity between cephalosporins and penicillins is reported to be between 1% and 4%.
When planning care for a client receiving a sulfonamide antibiotic, it is important for the nurse to perform which intervention?
a. Take the medication with dairy products such as milk or yogurt.
b. Advise the client to report any tinnitus to the health care provider.
c. Avoid direct sun exposure and tanning beds.
d. Encourage fluid intake of 2000 to 3000 mL/day.
Clients should be encouraged to drink plenty of fluids (2000 to 3000 mL/24 hours) to prevent drug-related crystalluria associated with sulfonamide antibiotics.
When administering a nonsteroidal antiinflammatory drug and a penicillin drug together, the displacement of the penicillin antibiotic from the protein-binding sites will result in which effect?
a. Absence of free drug in the blood
b. Increased free drug in blood
c. Decreased free drug in blood
d. No change in free drug in blood
Drugs that are not bound to protein are free and thus active to exert their therapeutic (or toxic, if too much free) effect.
During antibiotic therapy, the nurse will assess the client for a condition that may occur because of the disruption of normal flora. The nurse knows this as what condition?
c. Allergic reaction
d. Organ toxicity
Superinfections can occur when antibiotic therapy reduces or completely eliminates the normal bacterial flora of the body, which normally would inhibit the overgrowth of fungi and yeast. When the normal bacterial are flora and are reduced or completely eliminated, these organisms can overgrow and cause infections.
A client prescribed azithromycin (Zithromax) expresses concern regarding GI upset that was experienced when previously prescribed an erythromycin antibiotic. What is the nurse's best response?
a. "Take an over-the-counter antiemetic to lessen the nausea."
b. "I will call the health care provider and request a different antibiotic."
c. "Stop taking the drug if you experience heartburn and diarrhea."
d. "This drug is like erythromycin with less gastrointestinal adverse effects."
Azithromycin is a newer macrolide antibiotic. It has a longer duration of action, as well as fewer and less severe GI adverse effects than erythromycin.
In an effort to prevent superinfections of the GI tract such as Clostridium difficile, the nurse will instruct clients to eat which foods?
a. Cultured dairy products such as yogurt
b. Low-fat meats such as chicken and pork
c. Multigrain wheat bread
d. Raw fruits and vegetables
The natural flora in the GI tract may be killed off by antibiotics, leaving other bacteria such as C. difficile to overgrow. This process may be prevented through consumption of probiotics (e.g., yogurt, buttermilk, kefir).
Which statement best describes health care-associated infections?
a. The infection develops in response to various antibiotics.
b. Clients are admitted to the hospital with an infectious disease.
c. The infection was not incubating at the time of admission.
d. They develop in more than 15% of hospitalized clients.
A health care-associated infection is an infection that is acquired during the course of receiving treatment for another condition in a health care facility. The infection is not present or incubating at the time of admission; also known as a nosocomial infection.
A client with a known heart condition is prescribed an antibiotic before a dental procedure. What type of antibiotic therapy is this considered?
Prophylactic antibiotic therapy is used to prevent infections in individuals who are at high risk of development of an infection during or after a procedure. The antibiotics are given before the procedure for prophylactic treatment.
Bacterial resistance to antibiotics can occur with which situations? (Select all that apply.)
Select all that apply.
a. Antibiotics that are prescribed to treat a viral infection
b. Clients stop taking an antibiotic when they feel better.
c. Antibiotics that are prescribed according to culture and sensitivity reports
d. Microorganisms arriving from foreign countries and overseas ports
e. Taking an antibiotic and an antiviral medication at the same time
answer: a, b
Not completing a full course of antibiotic therapy can allow bacteria that are not killed but have been exposed to the antibiotic to adapt their physiology to become resistant to that antibiotic. Administering antibiotics to treat viral infections is not effective and may expose small amounts of bacteria that may be present to the antibiotic and therefore risk the development of resistance.
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