Question 1

A nurse is teaching a nursing student what is meant by &#34;generations&#34; of cephalosporins. Which statement by the student indicates understanding of the teaching?&#10;A) &#34;Cephalosporins are assigned to generations based on their relative costs to administer.&#34;&#10;B) &#34;Cephalosporins have increased activity against gram-negative bacteria with each generation.&#34;&#10;C) &#34;First-generation cephalosporins have better penetration of the cerebrospinal fluid.&#34;&#10;D) &#34;Later generations of cephalosporins have lower resistance to destruction by beta-lactamases.&#34;

Accepted Answer

With each progression from first-generation agents to fourth-generation agents, the cephalosporins show increased activity against gram-negative organisms, increased resistance to destruction by beta-lactamases, and increased ability to reach the CSF. Cost is not a definitive factor. First-generation drugs have less penetration of the CSF. Resistance to destruction by beta-lactamases increases with increasing generations.

Question 2

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. What is the nurse's priority action?

A) Apply warm packs to the arm, and infuse the medication at a slower rate.
B) Continue the infusion while elevating the arm.
C) Select an alternate intravenous site and administer the infusion more slowly.
D) Request central venous access.

Accepted Answer

These signs indicate thrombophlebitis. The nurse should select an alternative IV site and administer the infusion more slowly. The IV should not be continued in the same site, because necrosis may occur. A central line would be indicated only for long-term administration of antibiotics.

Question 3

Besides the cost of administering a given drug, which are considerations when a provider selects a cephalosporin to treat an infection? (Select all that apply.)&#10;A) Adverse effects&#10;B) Antimicrobial spectrum&#10;C) Brand name&#10;D) Manufacturer&#10;E) Pharmacokinetics

Accepted Answer

Cephalosporins tend to be more alike than different, but some differences make some preferable to others. Adverse effects, antimicrobial spectrum, and drug pharmacokinetics affect a prescriber's decision to select one drug over another. The agent's brand name and manufacturer should not have anything to do with drug selection.

Question 4

A patient receiving a cephalosporin develops a secondary intestinal infection caused by Clostridium difficile. What is an appropriate treatment for this patient?&#10;A) Adding an antibiotic, such as vancomycin (Vancocin), to the patient's regimen&#10;B) Discontinuing the cephalosporin and beginning metronidazole (Flagyl)&#10;C) Discontinuing all antibiotics and providing fluid replacement&#10;D) Increasing the dose of the cephalosporin and providing isolation measures

Accepted Answer

Patients who develop C. difficile infection (CDI) as a result of taking cephalosporins or other antibiotics need to stop taking the antibiotic in question and begin taking either metronidazole or vancomycin. Adding one of these antibiotics without withdrawing the cephalosporin is not indicated. CDI must be treated with an appropriate antibiotic, so stopping all antibiotics is incorrect. Increasing the cephalosporin dose would only aggravate the CDI.

Question 5

The nurse is caring for a patient who is receiving vancomycin (Vancocin). The nurse notes that the patient is experiencing flushing, rash, pruritus, and urticaria. The patient's heart rate is 120 beats per minute, and the blood pressure is 92/57 mm Hg. The nurse understands that these findings are consistent with:

A) allergic reaction.
B) red man syndrome.
C) rhabdomyolysis.
D) Stevens-Johnson syndrome.

Accepted Answer

Rapid infusion of vancomycin can cause flushing, rash, pruritus, urticaria, tachycardia, and hypotension, a collection of symptoms known as red man syndrome. Rhabdomyolysis is not associated with the administration of vancomycin. The patient's symptoms may seem to indicate an allergic reaction, but this is specifically red man syndrome. The symptoms are not those of Stevens-Johnson syndrome, which manifests as blisters or sores (or both) on the lips and mucous membranes after exposure to the sun.

Question 6

A patient is to undergo orthopedic surgery, and the prescriber will order a cephalosporin to be given preoperatively as prophylaxis against infection. The nurse expects the provider to order which cephalosporin?

A) First-generation cephalosporin
B) Second-generation cephalosporin
C) Third-generation cephalosporin
D) Fourth-generation cephalosporin

Accepted Answer

First-generation cephalosporins are widely used for prophylaxis against infection in surgical patients, because they are as effective, less expensive, and have a narrower antimicrobial spectrum than second-, third-, and fourth-generation cephalosporins.

Question 7

A provider has ordered ceftriaxone 4 gm once daily for a patient with renal impairment. What will the nurse do?&#10;A) Administer the medication as prescribed.&#10;B) Contact the provider to ask about giving the drug in divided doses.&#10;C) Discuss increasing the interval between doses with the provider.&#10;D) Discuss reducing the dose with the provider.

Accepted Answer

Unlike other cephalosporins, ceftriaxone is eliminated largely by the liver, so dosage reduction is unnecessary in patients with renal impairment. Giving the drug in divided doses, increasing the interval between doses, and reducing the dose are not necessary.

Question 8

A patient will be discharged home to complete treatment with intravenous cefotetan with the assistance of a home nurse. The home care nurse will include which instruction when teaching the patient about this drug treatment?

A) Abstain from alcohol consumption during therapy.
B) Avoid dairy products while taking this drug.
C) Take an antihistamine if a rash occurs.
D) Use nonsteroidal anti-inflammatory drugs (NSAIDs), not acetaminophen, for pain.

Accepted Answer

Four cephalosporins, including cefotetan, can induce a state of alcohol intolerance and cause a disulfiram-like reaction when alcohol is consumed; therefore, patients should be advised to avoid alcohol. It is not necessary to avoid dairy products. Patients who experience a rash should report this to their provider. Cefotetan can also promote bleeding, so drugs that inhibit platelet aggregation should be avoided.

Question 9

Which cephalosporin may be used to treat meningitis?&#10;A) Cefaclor&#10;B) Cefazolin&#10;C) Cefoxitin&#10;D) Cefotaxime

Accepted Answer

Cefotaxime has increased ability to reach the cerebrospinal fluid (CSF) and to treat meningitis. Cefaclor, cefazolin, and cefoxitin do not reach effective concentrations in the CSF.

Question 10

A prescriber has ordered cefoxitin for a patient who has an infection caused by a gram-negative bacteria. The nurse taking the medication history learns that the patient experienced a maculopapular rash when taking amoxicillin (Amoxil) several years earlier. What will the nurse do?

A) Administer the cefoxitin and observe for any side effects.
B) Give the cefoxitin and have epinephrine and respiratory support available.
C) Request an order for a different, nonpenicillin, noncephalosporin antibiotic.
D) Request an order to administer a skin test before giving the cefoxitin.

Accepted Answer

Because of structural similarities between penicillins (PCNs) and cephalosporins, a few patients allergic to one drug type will be allergic to the other drug type, although this is rare. For patients with mild PCN allergy, such as rash, cephalosporins can be used with minimal concern, so it is correct to administer the drug and monitor for side effects. It is unnecessary to prepare for anaphylaxis, to give another class of drug, or to administer a skin test.

Question 11

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 healthcare provider to order:

A) aztreonam (Azactam).
B) fosfomycin (Monurol).
C) trimethoprim/sulfamethoxazole (Bactrim).
D) vancomycin (Vancocin).

Accepted Answer

The answer of A patient complains of burning on urination...

Deck 85: Drugs That Weaken the Bacterial Cell Wall 2: F Cephalosporins, Carbapenems, Vancomycin, Telavancin, Aztreonam, Teicoplanin, and Fosfomycin