Question 1

The nurse is caring for a patient who is receiving a high dose of tetracycline (Sumycin). Which laboratory values will the nurse expect to monitor while caring for this patient?

Accepted Answer

Tetracycline can cause kidney damage, hence monitoring BUN and creatinine levels is important.

Question 2

The nurse is preparing to begin a medication regimen for a patient who will receive intravenous ampicillin and gentamicin. Which is an important nursing action?

Accepted Answer

Setting up separate tubing sets for each drug labeled with the drug name and date is important to avoid cross-contamination and ensure the correct medication is being given. Administering each antibiotic to infuse over 15 to 20 minutes is also appropriate, but not as crucial as setting up separate tubing sets. Ordering serum peak and trough levels of ampicillin may be necessary, but this is a medical action rather than a nursing action. Preparing the schedule so that the drugs are given at the same time is not recommended as it increases the risk of drug interactions and adverse effects.

Question 3

The nurse is preparing to administer trimethoprim-sulfamethoxazole (TMP-SMX) to a patient who is being treated for a urinary tract infection. The nurse learns that the patient has type 2 diabetes mellitus and takes a sulfonylurea oral antidiabetic drug. The nurse will monitor this patient closely for which effect?

Accepted Answer

Sulfonylurea antidiabetic drugs can lower blood glucose levels and may potentiate the hypoglycemic effect of TMP-SMX. The nurse should monitor the patient for signs and symptoms of hypoglycemia, such as confusion, diaphoresis, and tremors. There is no indication that this medication combination would cause headaches, hypertension, or superinfection.

Question 4

A female patient who is taking trimethoprim-sulfamethoxazole (TMP-SMZ) (Bactrim, Septra) to treat a urinary tract infection reports vaginal itching and discharge. The nurse will perform which action?

Accepted Answer

Vaginal itching and discharge can indicate a possible superinfection related to the use of antibiotics. The nurse should report this to the provider for further evaluation and possible treatment. Option A is not relevant to the symptomatology reported. Option B is incorrect because vaginal itching and discharge are not normal side effects of TMP-SMZ. Option D is also incorrect because hematologic reactions are not typically associated with these symptoms.

Question 5

The nurse is preparing to give a dose of trimethoprim-sulfamethoxazole (TMP-SMX) and learns that the patient takes warfarin (Coumadin). The nurse will request an order for:

Accepted Answer

TMP-SMX can increase the anticoagulant effects of warfarin, leading to an increased risk of bleeding. Therefore, it is important to monitor the patient's coagulation studies (e.g. INR) to adjust the warfarin dose accordingly. A decreased dose of TMP-SMX or a different antibiotic may be considered, but coagulation studies should still be monitored. An increased dose of warfarin would further increase the risk of bleeding and is not appropriate.

Question 6

The nurse is preparing to give a dose of oral clindamycin (Cleocin) to a patient who is being treated for a skin infection caused by Staphylococcus aureus. The patient has had several doses of the medication and reports having nausea. Which action will the nurse take next?

Accepted Answer

BNausea is a common side effect of clindamycin, and taking the medication with a full glass of water can help minimize gastrointestinal side effects. However, if the patient's nausea is severe or persistent, it is important to hold the next dose and contact the patient's provider for further instructions, as this could indicate a more serious adverse reaction or the need for a medication adjustment.

Question 7

The nurse is caring for a patient who will begin taking doxycycline to treat an infection. The nurse should plan to give this medication:

Accepted Answer

Doxycycline should be taken with food to improve absorption and to minimize GI upset. It is also important to avoid taking it with calcium or iron supplements, as these can interfere with its absorption. Small sips of water are generally sufficient for swallowing medication. Antacids should not be taken with doxycycline, as they can decrease its absorption.

Question 8

A female patient who is allergic to penicillin will begin taking an antibiotic to treat a lower respiratory tract infection. The patient tells the nurse that she almost always develops a vaginal yeast infection when she takes antibiotics and that she will take fluconazole (Diflucan) with the antibiotic being prescribed. Which macrolide order would the nurse question for this patient?

Accepted Answer

Macrolides such as azithromycin and clarithromycin have a risk of inducing or exacerbating yeast infections, but erythromycin has been known to have a higher risk for this adverse effect. Therefore, the nurse should question the prescription of erythromycin for this patient who has a history of developing yeast infections when taking antibiotics. Fidaxomicin is not a macrolide, so it would not be a concern for this particular adverse effect.

Question 9

The nurse is preparing to administer a maintenance dose of intravenous gentamicin to an infant through an intermittent needle. The nurse notes that the infant has not had a wet diaper for several hours. The nurse will perform which action?

Accepted Answer

The infant's lack of urine output may indicate decreased renal function, which can increase the risk for toxicity with gentamicin. Therefore, the nurse should hold the dose and contact the provider to request a serum trough drug level. This will help to ensure that the infant's serum drug level is within a safe range before administering another dose. Option A is incorrect because giving extra oral fluids alone may not be enough to prevent toxicity, and administering the medication could still be harmful. Option B is incorrect because adding intravenous fluids may not be necessary if the infant's kidney function is normal, and it does not address the need to monitor serum drug levels. Option C is incorrect because obtaining a serum peak drug level is not necessary for routine monitoring and may not provide the necessary information about drug toxicity.

Question 10

The nurse is counseling a patient who will begin taking a sulfonamide drug to treat a urinary tract infection. What information will the nurse include in teaching?

Accepted Answer

Sulfonamide drugs can lead to crystalluria and kidney damage, so it is important for the patient to drink plenty of fluids to dilute the urine and prevent these complications. Option B is not recommended because antacids can decrease the absorption of sulfonamides. Option C is incorrect as sulfonamides are not recommended during pregnancy, particularly in the third trimester. Option D is also incorrect as sore throat can be a serious adverse effect and should be reported to the healthcare provider.

Question 11

The nurse is caring for a 7-year-old patient who will receive oral antibiotics. Which antibiotic order will the nurse question for this patient?

Accepted Answer

Tetracycline is contraindicated in children younger than 8 years old due to the risk of tooth discoloration and potential impact on bone growth. Therefore, the nurse should question this order for a 7-year-old patient. The other antibiotics listed are appropriate options for this age group.

Question 12

A patient who will begin taking trimethoprim-sulfamethoxazole (TMP--SMX) asks the nurse why the combination drug is necessary. The nurse will explain that the combination is used to:

Accepted Answer

TMP-SMX is a combination drug that produces a synergistic effect, meaning the two drugs work together to provide a stronger antibacterial effect than either drug could achieve alone.

Question 13

The nurse assumes care for a patient who is currently receiving a dose of intravenous vancomycin (Vancocin) infusing at 20 mg/min. The nurse notes red blotches on the patient's face, neck, and chest and assesses a blood pressure of 80/55 mm Hg. Which action will the nurse take?

Accepted Answer

The symptoms described are indicative of "Red Man Syndrome," a reaction to vancomycin that can occur when the drug is infused too quickly. Slowing the infusion rate can help alleviate these symptoms.

Question 14

The nurse is preparing to administer clarithromycin to a patient. When performing a medication history, the nurse learns that the patient takes warfarin to treat atrial fibrillation. The nurse will perform which action?

Accepted Answer

Clarithromycin can increase the effects of warfarin, so periodic serum warfarin levels are needed to monitor for potential toxicity.

Question 15

Which is a characteristic that distinguishes sulfonamides from other drugs used to treat bacterial infection?

Accepted Answer

Sulfonamides are synthetic drugs and not derived from biologic substances, unlike other antibiotics such as penicillin and tetracyclines.

Question 16

The nurse provides home-care instructions for a patient who will take a high dose of azithromycin after discharge from the hospital. Which statement by the patient indicates understanding of the teaching?

Accepted Answer

Azithromycin can interact with antacids, so they should be taken at least 2 hours before or after the medication to avoid interference with absorption.

Question 17

The nurse is reviewing a patient's chart prior to administering gentamicin (Garamycin) and notes that the last serum peak drug level was 9 mcg/mL and the last trough level was 2 mcg/mL. What action will the nurse take?

Accepted Answer

The answer of The nurse is reviewing a patient's chart...

Question 18

The nurse is caring for a 70-kg patient who is receiving gentamicin (Garamycin) 85 mg 4 times daily. The patient reports experiencing ringing in the ears. The nurse will contact the provider to discuss which of the following?

Accepted Answer

Ringing in the ears is a sign of ototoxicity, which is a potential side effect of gentamicin. Obtaining a serum drug level will help to determine if the patient's dose needs to be adjusted or if the medication needs to be discontinued altogether. Decreasing the dose or changing the dosing schedule may not address the underlying issue and could potentially worsen the ototoxicity. Ordering a hearing test may be indicated eventually, but obtaining a serum drug level should be the priority in this situation.

Question 19

The nurse is providing discharge teaching for a patient who will receive oral levofloxacin (Levaquin) to treat pneumonia. The patient takes an oral hypoglycemic medication and uses over-the-counter (OTC) antacids to treat occasional heartburn. The patient reports frequent arthritis pain and takes acetaminophen when needed. Which statement by the nurse is correct when teaching this patient?

Accepted Answer

Levofloxacin can cause hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar), so it is important for the patient to closely monitor their serum glucose levels while taking this medication. Antacids may decrease absorption of levofloxacin, so the patient should space out taking the two medications by at least two hours. NSAIDs may increase the risk of tendonitis and tendon rupture when taken with levofloxacin, so they should be avoided. Levofloxacin can be taken with or without food, but should be taken at the same time each day for maximum effectiveness. The medication guide for levofloxacin should be reviewed with the patient for additional information and precautions.

Question 20

A female patient will receive doxycycline to treat a sexually transmitted illness (STI). What information will the nurse include when teaching this patient about this medication?

Accepted Answer

Doxycycline may decrease the effectiveness of oral contraceptives, so it is important to use a backup method of contraception while taking this medication. Nausea and vomiting are common adverse effects, dairy products may interfere with absorption, and doxycycline is not teratogenic.

Quiz 26: Antibacterials

The nurse is caring for a patient who is receiving a high dose of tetracycline (Sumycin) . Which laboratory values will the nurse expect to monitor while caring for this patient?