Deck 49: Fluoroquinolones and Miscellaneous Antibacterials

Question 1

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:

A)encouraging the replication of the original DNA to form a new DNA strands.
B)encouraging migration of the DNA strands to opposite sides of the cell.
C)affecting the enzymes needed for DNA replication.
D)assisting the supercoil to relax and unwind.

Answer 1

affecting the enzymes needed for DNA replication.

Question 2

Which statement by a client who has received a prescription for ciprofloxacin (Cipro)indicates that further instruction by the nurse is needed?

A)"I will drink more coffee to make sure I get more fluids."
B)"I will make sure and wear sunscreen when I go outside to do my gardening."
C)"If my knees start hurting,I will call the doctor immediately."
D)"I won't take any antacids until I have finished this medication."

Answer 2

"I will drink more coffee to make sure I get more fluids."

Question 3

Fluoroquinolones are known to be effective against both gram-negative and gram-positive organisms.How is this possible?

A)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.
B)Fluoroquinolones that are effective against gram-positive organisms block the enzyme DNA gyrase,which stops relaxation of the supercoil of the DNA.
C)Fluoroquinolones that are effective against gram-negative organisms block the enzyme DNA gyrase,and those effective against gram-positive organisms block topoisomerase IV.
D)All fluoroquinolones are effective against both gram-negative and gram-positive organisms.There is no difference in the way they block bacterial DNA replication.

Answer 3

Fluoroquinolones that are effective against gram-negative organisms block the enzyme DNA gyrase,and those effective against gram-positive organisms block topoisomerase IV.

Question 4

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?

A)The development of dysrhythmias after administration of fluoroquinolones
B)The development of pathologic fractures after administration of fluoroquinolones
C)The development of insomnia after administration of fluoroquinolones
D)The development of severe phototoxicity after administration of fluoroquinolones

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:

A)relax,unwind,replicate,and migrate.
B)migrate,replicate,unwind,and relax.
C)unwind,relax,migrate,and replicate.
D)replicate,unwind,relax,and migrate.

Question 6

Many medications are developed in hopes of treating cancer.Many of these cancer drugs work by:

A)Encouraging cell replication.
B)Forming new DNA.
C)Assisting in the repair of DNA damage.
D)Substituting the drug into the DNA of the cancer cell.

Question 7

The nurse caring for a client with cancer is teaching the client about chemotherapeutic medications that affect bacterial DNA replication.Which medications should the nurse include in the teaching plan for this client?
Select all that apply.

A)Cytarabine (Cytosar-U)
B)Fluorouracil (5-FU)
C)Daunorubicin (Cerubidine)
D)Bleomycin (Blenoxane)
E)Acyclovir (Zovirax)

Question 8

The nurse is caring for a client who is taking ciprofloxacin for the treatment of acute cystitis.The nurse knows ciprofloxacin interacts with several other classes of medication and that it is important to assess the client's medication administration record for which classifications of medications?
Select all that apply.

A)Anticoagulants
B)Antacids
C)Xanthines
D)Antibiotics
E)Antivirals

Question 9

A client's urine culture has come back showing that the infecting organism is resistant to ciprofloxacin (Cipro).The client is upset,saying that this medication has worked every other time.What explanation should the nurse give to the client concerning the development of resistance?

A)"There are a number of ways that an organism can become resistant to an antibacterial.Sometimes one of the enzymes involved in bacterial DNA replication mutates so that the medication is no longer effective."
B)"You must be infected with one of the new 'superbugs.' There aren't many antibacterials that will work against it."
C)"Don't worry; the doctor will give you levofloxacin (Levaquin)to take instead of ciprofloxacin (Cipro)."
D)"There are a number of ways that an organism can become resistant to an antibacterial.It probably happened because you didn't take your medication correctly the last time you took it."

Question 10

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?

A)It inhibits the enzyme DNA polymerase necessary for DNA replication.
B)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.
C)It inhibits the relaxation of the supercoil prior to the unwinding process,which terminates replication.
D)It inhibits the unwinding of the two strands of the supercoil,thus terminating replication.

Question 11

A nursing student asks a nurse how antibacterials work.The nurse outlines the process,explaining that many antibacterials work by blocking bacterial DNA replication.The nurse knows further teaching is needed when the student states:

A)Drugs inhibit the availability of precursor bases or nucleotides."
B)Drugs can interact or bind with DNA,preventing the uncoiling or relaxation process."
C)Drugs can bind to enzymes of DNA replication,halting the formation of new DNA strands."
D)Drugs repair bacterial DNA damage."

Question 12

A client has come to the health care provider'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 woke 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:

A)"You probably had the symptoms for some time,but you didn't notice it until it became severe."
B)"The severity of your symptoms indicates a hygiene problem."
C)"Do you often have complaints of severe pain when you awaken?"
D)"The bacteria that caused your infection grow very rapidly,so it is possible you had no symptoms the night before."

Question 13

A 13-year-old client has been diagnosed with meningitis caused by Haemophilus influenzae type B.What drug is commonly prescribed to prevent this disease from occurring in individuals who had close contact with the client prior to the illness?

A)Metronidazole (Flagyl)
B)Daptomycin (Cubicin)
C)Rifampin (Rifadin)
D)Ciprofloxacin (Cipro)

Question 14

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?

A)Fluoroquinolones given as IV are very expensive,and must be switched to oral administration as soon as possible to save the client money.
B)Fluoroquinolones have equal serum drug levels with either IV or oral administration,which allows for a smooth transition from IV to oral therapy.
C)Fluoroquinolones given as an IV infusion eradicate infection quickly so that the client can be discharged.
D)Fluoroquinolones are less toxic when given orally.

Question 15

How do fluoroquinolones block bacterial DNA replication?

A)Fluoroquinolones inhibit the synthesis of precursor bases.
B)Fluoroquinolones bind to enzymes of bacterial DNA replication,blocking the relaxation and migration processes.
C)Fluoroquinolones inhibit topoisomerase I so that DNA cannot be repaired.
D)Fluoroquinolones bind with the enzyme DNA polymerase,blocking the replication of the DNA process.

Question 16

The nurse explains to a student nurse the mechanism by which resistance to fluoroquinolones occurs.The nurse knows the student requires further education when the student states:

A)Bacterial cell walls become less permeable to the fluoroquinolones."
B)Mutations to DNA helicase alter its ability to bind with fluoroquinolones."
C)Mutations to DNA gyrase alter its ability to bind with fluoroquinolones."
D)Certain bacteria have developed resistance pumps that remove fluoroquinolones from the cell."

Question 17

The nurse is caring for a client who has developed an infection that is resistant to fluoroquinolone therapy.The nurse knows that this resistance is due to which reasons?
Select all that apply.

A)A mutation to the DNA gyrase.
B)The development of resistant pumps within the bacteria.
C)The bacterial cell wall structure has become impermeable.
D)Mutations to DNA helicase alter its ability to bind with fluoroquinolones.
E)The client administered the medication improperly.

Question 18

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 student nurse answered the correctly?

A)Student B: "Medications such as fluoroquinolones do not appear to affect human DNA because human DNA is very similar to bacterial cell DNA."
B)Student D: "Human DNA is inherently healthier than bacterial DNA,so medications such as fluoroquinolones do not affect their replication."
C)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."
D)Student A: "These medications protect healthy human cells while they attempt to disrupt bacterial DNA replication."

Question 19

A client who has developed a resistance to levofloxacin (Levaquin)is concerned that getting rid of the infection will be impossible.What is the best response by the nurse to the client?

A)"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."
B)"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."
C)"The physician will switch you from levofloxacin (Levaquin)to ciprofloxacin (Cipro)."
D)"The physician will switch you to another type of antibacterial to which you haven't developed resistance."

Question 20

The health care provider has prescribed ciprofloxacin (Cipro)for four clients.For which client should the nurse contact the health care provider for further clarification?

A)A 67-year-old male who has just completed taking another antibacterial for chronic sinusitis
B)A 21-year-old female who gave birth 8 weeks ago and is still breast-feeding
C)A 49-year-old female who is experiencing "hot flashes" related to the onset of menopause
D)A 19-year-old male who plays soccer for his college team

Question 21

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?

A)Place the affected extremity in a resting position.
B)Place a warm compress on the affected muscles.
C)Encourage the client to exercise the client and work out the soreness.
D)Obtain a blood specimen for a CPK.

Question 22

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 6 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?

A)Noncompliance (antimicrobial therapy)related to therapeutic regimen
B)Diarrhea related to effects of drug therapy
C)Infection,Risk for
D)Knowledge,Deficient (infection)related to disease process,transmission,and drug therapy

Question 23

The nurse is preparing to administer a fluorquinolone medication to a client with a urinary tract infection.The nurse knows it is important to contact a health care provider immediately if which adverse effects occur?
Select all that apply.

A)Severe diarrhea containing mucous
B)Decreased urine output
C)Nausea
D)Abdominal cramping
E)Headache

Question 24

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?

A)Take a dose of antidiarrheal medication after every loose stool.
B)Do nothing until you have 8-10 loose stools per day.
C)Eat live-culture yogurt once or twice daily.
D)Limit the amount of water you drink to three glasses a day.