Deck 50: Fluoroquinolones and Miscellaneous Antibiotics

Question 1

A client asks a nurse how antibacterials work.The nurse explains that many antibacterials work by blocking bacterial DNA replication.The nurse begins to explain this process to the client.The following are all means of blocking of bacterial DNA replication except that:
1)Drugs repair bacterial DNA damage.
2)Dugs inhibit the availability of precursor bases or nucleotides.
3)Drugs can interact or bind with DNA, preventing the uncoiling or relaxation process.
4)Drugs can bind to enzymes of DNA replication, halting the formation of new DNA strands.

Answer 1

1

Question 2

How do fluoroquinolones block bacterial DNA replication?
1)Fluoroquinolones inhibit topoisomerase I so that DNA can't be repaired.
2)Fluoroquinolones inhibit the synthesis of precursor bases.
3)Fluoroquinolones bind to enzymes of bacterial DNA replication, blocking the relaxation and migration processes.
4)Fluoroquinolones bind with the enzyme DNA polymerase, blocking the replication of the DNA process.

Answer 2

3

Question 3

DNA replication is necessary for bacterial cell replication.One of the ways that antibacterials are effective is by inhibiting the DNA replication.Antibacterials often accomplish this by:
1)Affecting the enzymes needed for DNA replication.
2)Assisting the supercoil to relax and unwind.
3)Winding the supercoil tightly, breaking it apart.
4)Encouraging migration of the DNA strands to opposite sides of the cell.

Answer 3

1

Question 4

A client who has been taking ciprofloxacin (Cipro)calls the health care provider to report that he has begun having loose stools.What instructions would be most helpful to this client?
1)Drink at least one glass of buttermilk every day.
2)Limit the amount of water you drink to three glasses a day.
3)Take a dose of antidiarrheal medication after every loose stool.
4)Do nothing until you have 8-10 loose stools per day.

Question 5

A nursing instructor asks a group of students to explain the four-step process necessary for bacterial DNA replication.The student with the correct answer is the one who states that the four-step process is:
1)Migrate, replicate, unwind, and relax.
2)Relax, unwind, replicate, and migrate.
3)Unwind, relax, migrate, and replicate.
4)Replicate, unwind, relax, and migrate.

Question 6

Many medications are developed in hopes of treating cancer.Many of these cancer drugs work by:
1)Encouraging cell replication.
2)Substituting the drug into the DNA of the cancer cell.
3)Assisting in the repair of DNA damage.
4)Forming new DNA.

Question 7

Fluoroquinolones are very effective against both gram-negative and gram-positive organisms.Several of the drugs in this class have been discontinued from use.What adverse effects have caused the removal of these drugs from the market?
1)The development of pathologic fractures after administration of fluoroquinolones
2)The development of severe phototoxicity after administration of fluoroquinolones
3)The development of dysrhythmias after administration of fluoroquinolones
4)The development of insomnia after administration of fluoroquinolones

Question 8

Which of the following statements by a client who has received a prescription for ciprofloxacin (Cipro)requires further instruction by the nurse?
1)"If my knees start hurting, I will call the doctor immediately."
2)"I will drink more coffee to make sure I get more fluids."
3)"I will make sure and wear sunscreen when I go outside to do my gardening."
4)"I won't take any antacids until I have finished this medication."

Question 9

A client has been admitted to the hospital with a urinary tract infection (UTI).The physician has prescribed ciprofloxacin (Cipro)IV to be administered every 12 hours.What is the nurse's priority responsibility to this client?
1)Take a complete health history.
2)Obtain vital signs.
3)Obtain a urine specimen for culture and sensitivity.
4)Start the IV and begin the ciprofloxacin administration.

Question 10

A 13-year-old client has been diagnosed with meningitis caused by Haemophilus influenzae type B.Which of the following drugs is commonly prescribed to prevent this disease from occurring in individuals who had close contact with the client prior to her illness?
1)Ciprofloxacin (Cipro)
2)Daptomycin (Cubicin)
3)Metronidazole (Flagyl)
4)Rifampin (Rifadin)

Question 11

A 16-year-old client has been prescribed metronidazole (Flagyl)for treatment of a sexually transmitted infection.This client has been seen in the clinic four times in the last six months for the same condition.The client just wants the nurse to give her the medication so that she can go home.What would be considered the priority nursing diagnosis for this client?
1)Infection, risk for
2)Diarrhea, related to effects of drug therapy
3)Knowledge Deficit (infection), related to disease process, transmission, and drug therapy
4)Noncompliance (antimicrobial therapy)related to therapeutic regimen

Question 12

Fluoroquinolones are known to be effective against both gram-negative and gram-positive organisms.How is this possible?
1)All fluoroquinolones are effective against both gram-negative and gram-positive organisms.There is no difference in the way they block bacterial DNA replication.
2)Fluoroquinolones that are effective against gram-positive organisms block the enzyme DNA gyrase, which stops relaxation of the supercoil of the DNA.
3)Fluoroquinolones that are effective against gram-negative organisms block the enzyme topoisomerase IV, which stops the migration process of the two new strands to opposite sides of the cell.
4)Fluoroquinolones that are effective against gram-negative organisms block the enzyme DNA gyrase, and those effective against gram-positive organisms block topoisomerase IV.

Question 13

A client has come to the physician's office with symptoms of a urinary tract infection (UTI).She states that she had no symptoms when she went to bed last night but awakened this morning with severe burning with urination.A urine culture is completed and grows Escherichia coli.The client asks the nurse why these symptoms occurred so suddenly.The nurse's best response is:
1)"You probably had the symptoms for some time, but you didn't notice it until it became severe."
2)"The severity of your symptoms indicates a hygiene problem."
3)"The bacteria that caused your infection grow very rapidly, so it is possible you had no symptoms the night before."
4)"Do you often have complaints of severe pain when you awaken?"

Question 14

A client has been diagnosed with a gram-negative bacterial infection and has been prescribed a fluoroquinolone for treatment of this infection.What step of the bacterial DNA replication process is most likely being affected by the use of this medication?
1)It inhibits the relaxation of the supercoil prior to the unwinding process, which terminates replication.
2)It inhibits the unwinding of the two strands of the supercoil, thus terminating replication.
3)It inhibits the enzyme DNA polymerase necessary for DNA replication.
4)It binds to the enzyme topoisomerase IV, preventing the new DNA strands from migrating to opposite sides of the cell, thus preventing bacterial cell replication.

Question 15

During pharmacology class, a nursing professor poses the following question: "We have learned that certain medications, such as fluoroquinolones, are effective because they inhibit bacterial DNA replication.Why don't these medications cause harm to the nonbacterial cells in the body?" Which of the following student nurses answered the question correctly?
1)Student A: "These medications protect healthy human cells while they attempt to disrupt bacterial DNA replication."
2)Student B: "Medications such as fluoroquinolones do not appear to affect human DNA because human DNA is very similar to bacterial cell DNA."
3)Student C: "Medications such as fluoroquinolones don't appear to affect human DNA replication because of the difference between the enzymes needed for bacterial and human DNA replication."
4)Student D: "Human DNA is inherently healthier than bacterial DNA, so medications such as fluoroquinolones do not affect their replication."

Question 16

All of the following are mechanisms by which resistance to fluoroquinolones occurs except that:
1)Bacterial cell walls become less permeable to the fluoroquinolones.
2)Certain bacteria have developed resistance pumps that remove fluoroquinolones from the cell.
3)Mutations to DNA gyrase alter its ability to bind with fluoroquinolones.
4)Mutations to DNA helicase alter its ability to bind with fluoroquinolones.

Question 17

A client has just learned that he has developed resistance to levofloxacin (Levaquin).He is concerned that he will not be able to get rid of his infection.What is the best response by the nurse to the patient?
1)"The physician will switch you from levofloxacin (Levaquin)to ciprofloxacin (Cipro)."
2)"The physician will take you off of the levofloxacin (Levaquin)for a few days and then have you start taking it again.Then it will be effective."
3)"The physician will switch you to another type of antibacterial to which you haven't developed resistance."
4)"The physician will admit you to the hospital and put you on an IV form of levofloxacin (Levaquin).You will not be resistant to that."

Question 18

The health care provider has prescribed ciprofloxacin (Cipro)for each of the following clients.For which client should the nurse contact the health care provider for further clarification?
1)A 21-year-old female who gave birth eight weeks ago and is still breastfeeding
2)A 19-year-old male who plays soccer for his college team
3)A 49-year-old female who is experiencing "hot flashes" related to the onset of menopause
4)A 67-year-old male who has just completed taking another antibacterial for chronic sinusitis

Question 19

A client has been diagnosed with a skin infection.The infective organism has been identified as MRSA, and daptomycin (Cubicin)IV has been prescribed.If this client complains of muscle pain, what will be the priority nursing intervention?
1)Place the affected extremity in a resting position.
2)Place a warm compress on the affected muscles.
3)Obtain a blood specimen for a CPK.
4)Encourage the client to exercise the client and work out the soreness.

Question 20

A client has been hospitalized for a severe urinary tract infection (UTI).Ciprofloxacin IV (Cipro)is prescribed.Two days later, the symptoms have abated, and the client is discharged with a prescription for oral ciprofloxacin (Cipro).What characteristics of fluoroquinolones allow for this quick discharge from the hospital?
1)Fluoroquinolones are less toxic when given orally.
2)Fluoroquinolones have equal serum drug levels with either IV or oral administration, which allows for a smooth transition from IV to oral therapy.
3)Fluoroquinolones given as an IV infusion eradicate infection quickly so that the client can be discharged.
4)Fluoroquinolones given as IV are very expensive, and must be switched to oral administration as soon as possible to save the client money.