Antibiotics and Antimicrobial Agents > Pharmacology
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Showing 31 questions, Sign in for moreA nurse is preparing to administer ceftriaxone (Rocephin) to a client who has pneumonia caused by Streptococcus pneumoniae.
The nurse should recognize that ceftriaxone belongs to which generation of cephalosporins?
Explanation
Ceftriaxone belongs to the third-generation of cephalosporins.Third-generation cephalosporins have greater activity than the second-generation cephalosporins against certain gram-negative bacteria, such as Streptococcus pneumoniae.They are also more resistant to beta-lactamases, enzymes that can inactivate some cephalosporins.
Choice A is wrong because first-generation cephalosporins have less activity against gram-negative bacteria and are more susceptible to beta-lactamases.
Choice B is wrong because second-generation cephalosporins have less activity against Streptococcus pneumoniae than third-generation cephalosporins, and are also less resistant to beta-lactamases.
Choice D is wrong because fourth-generation cephalosporins have a broader spectrum of activity against gram-negative bacteria, including some that are resistant to third-generation cephalosporins, but they are not more effective against Streptococcus pneumoniae.
A nurse is caring for a client who has a severe infection and is receiving vancomycin (Vancocin).
The nurse should monitor the client for which of the following manifestations of ototoxicity?
Explanation
Vancomycin is an antibiotic that can cause ototoxicity, which is damage to the inner ear due to exposure to certain drugs.Ototoxicity can manifest as tinnitus (ringing in the ears), vertigo (dizziness), and hearing loss.Vancomycin ototoxicity is usually related to high serum levels of the drug and is more likely to occur in patients with renal impairment.Vancomycin can also potentiate the ototoxicity of other drugs, such as aminoglycosides.
Choice A is wrong because tinnitus is a possible manifestation of ototoxicity.
Choice B is wrong because vertigo is a possible manifestation of ototoxicity.
Choice C is wrong because hearing loss is a possible manifestation of ototoxicity.
A nurse is educating a client who has a respiratory infection and a new prescription for azithromycin (Zithromax).
Which of the following instructions should the nurse include? (Select all that apply).
Explanation
Choice A is wrong because azithromycin (Zithromax) should be takenwith foodto prevent stomach upset.
Choice B is correct because azithromycin can causeliver damageand the client should report any signs ofjaundiceordark urineas they may indicate liver problems.
Choice C is correct because azithromycin can interact withgrapefruit juiceand increase the risk ofside effectssuch as nausea, vomiting, diarrhea, headache and QT interval prolongation.
Choice D is correct because the client shouldcomplete the full course of therapyas prescribed to prevent bacterial resistance and recurrence of infection.
Choice E is wrong because azithromycin should be stored in arefrigeratorand discarded after 10 days if it is in a liquid form.
Which of the following antiviral medications inhibits neuraminidase enzyme?
Explanation
This is because oseltamivir is aneuraminidase inhibitor, which means it blocks the enzyme that helps the influenza virus to spread from cell to cell. By preventing the release of new virus particles, oseltamivir reduces the duration and severity of influenza infection.
Choice A is wrong becauseAcyclovir is wrong because it is anucleoside analogthat inhibits viral DNA synthesis.
It is effective against herpes simplex virus (HSV) and varicella zoster virus (VZV), but not against influenza virus.
Choice C is wrong because Efavirenz is wrong because it is a **non-nucleoside reverse transcript
Which of the following antiviral medications prevents viral fusion with host cell membrane?
Explanation
Maraviroc is aCCR5 coreceptor antagonistthat blocks the receptor site the HIV virus needs to interact with in order to enter the cell.It prevents viral fusion with host cell membrane by binding to the CCR5 receptor on CD4+ T cells and macrophages.
Choice B is wrong becauseAbacavir is wrong because it is anucleoside reverse transcriptase inhibitor (NRTI)that inhibits the enzyme reverse transcriptase, which converts viral RNA into DNA.
It does not prevent viral fusion with host cell membrane.
Choice C is wrong becauseDarunavir is wrong because it is aprotease inhibitor (PI)that inhibits the enzyme protease, which cleaves viral proteins into functional units.
It does not prevent viral fusion with host cell membrane.
Choice D is wrong becauseFosamprenavir is wrong because it is also aprotease inhibitor (PI)that inhibits the enzyme protease.
It does not prevent viral fusion with host cell membrane.
A nurse is caring for a client who has oral candidiasis and is prescribed nystatin suspension.
Which of the following actions should the nurse take?
Explanation
This is because nystatin suspension is an antifungal medication that works by coating the oral mucosa and killing the candida organisms.Swishing and swallowing the medication ensures that it reaches all the affected areas in the mouth and throat.
Choice B is wrong because administering the medication with a dropper to avoid aspiration is not necessary for a client who has oral candidiasis.
The client should be able to swish and swallow the medication without difficulty.
Choice C is wrong because diluting the medication with water before giving it to the client reduces its effectiveness and concentration.
The medication should be given undiluted for optimal results.
Choice D is wrong because giving the medication after meals to increase its effectiveness is not accurate.The medication should be given at least 30 minutes before or after meals to avoid interference with food or beverages.
A nurse is reviewing laboratory results for a client who has a fungal infection and is receiving itraconazole therapy.
Which of the following findings should alert the nurse to a potential adverse effect of this medication?
Explanation
This is because itraconazole can cause renal impairment and decreased urine output as an adverse effect.A normal serum creatinine level is 0.6 to 1.2 mg/dL for males and 0.5 to 1.1 mg/dL for females.
Choice B is wrong because decreased serum potassium level is not an adverse effect of itraconazole.Itraconazole can cause hypokalemia, which is a low level of potassium in the blood, but this is usually due to fluid retention and heart failure caused by the drug.A normal serum potassium level is 3.5 to 5.0 mEq/L.
Choice C is wrong because increased serum glucose level is not an adverse effect of itraconazole.Itraconazole can cause hyperglycemia, which is a high level of glucose in the blood, but this is usually due to diabetes mellitus or steroid use in patients taking the drug.A normal serum glucose level is 70 to 100 mg/dL.
Choice D is wrong because decreased white blood cell count is not an adverse effect of itraconazole.Itraconazole can cause leukopenia, which is a low level of white blood cells in the blood, but this is usually due to bone marrow suppression or infection in patients taking the drug.A normal white blood cell count is 4,500 to 11,000 cells/mm3.
A nurse is preparing to administer flucytosine to a client who has a systemic fungal infection.
Which of the following assessments should the nurse perform before giving this medication? (Select all that apply.).
Explanation
Flucytosine can cause bone marrow suppression and renal toxicity, so the nurse should monitor the client’s renal function tests and complete blood count before giving this medication.
These tests can help detect any signs of anemia, leukopenia, thrombocytopenia, or impaired kidney function that may require dose adjustment or discontinuation of the drug.
Choice A is wrong because flucytosine does not affect liver function significantly.Choice C is wrong because flucytosine does not cause changes in blood pressure.Choice E is wrong because flucytosine does not affect cardiac function or cause arrhythmias.
A nurse is caring for a client who has trichomoniasis and is prescribed tinidazole.
Which of the following instructions should the nurse give to the client?
Explanation
The client should avoid sexual intercourse until treatment is completed.This is because trichomoniasis is a sexually transmitted infection that can be passed between partners during penile-vaginal sex or through transmission of infected vaginal fluids or fomites among women who have sex with women. Therefore, abstaining from sex until both partners are cured can prevent reinfection and transmission.
Choice A is wrong because taking the medication with an antacid can reduce its absorption and effectiveness.Tinidazole should be taken with food to minimize gastrointestinal side effects.
Choice B is wrong because drinking plenty of fluids to prevent crystalluria is not relevant for tinidazole.
Crystalluria is a condition where crystals form in the urine, which can cause kidney stones or damage.This is a potential complication of some antibiotics, such as sulfonamides, but not tinidazole.
Choice D is wrong because chewing the tablets thoroughly before swallowing is not necessary for tinidazole.Tinidazole tablets are film-coated and can be swallowed whole with water.
Chewing the tablets may alter their release and absorption, and may also cause a bitter aftertaste.
A nurse is preparing to administer ivermectin to a client who has onchocerciasis (river blindness).
Which of the following adverse effects should the nurse monitor for in this client?
Explanation
A Mazzotti reaction is a severe inflammatory response that can occur after taking ivermectin for onchocerciasis (river blindness), a parasitic infection caused by Onchocerca volvulus.The reaction is due to the death of the microfilariae (larvae) of the parasite and can cause fever, rash, itching, joint pain, swollen lymph nodes, and eye inflammation.
Choice A is wrong because hypertension is not a common adverse effect of ivermectin.Hypotension, however, can occur in some cases.
Choice B is wrong because tinnitus is not a common adverse effect of ivermectin.Tinnitus is a ringing or buzzing sound in the ears that can be caused by various factors, such as exposure to loud noise, ear infections, or certain medications.
Choice D is wrong because Stevens-Johnson syndrome is not a common adverse effect of ivermectin.
Stevens-Johnson syndrome is a rare but serious skin reaction that can be triggered by infections or medications.
It causes blisters and peeling of the skin and mucous membranes.
A nurse is educating a group of travelers who are going to a region where malaria is endemic.
Which of the following antimalarial drugs should the nurse recommend for prophylaxis? (Select all that apply.).
Explanation
These are the antimalarial drugs that are recommended for prophylaxis by the CDC and other sources.
They are effective against the malaria parasites that are resistant to chloroquine and primaquine, which are the other two options.
Choice A is wrong because chloroquine is not effective in areas where chloroquine resistance is present, which is most of the malaria-endemic regions.
Choice B is wrong because primaquine is not used for prophylaxis, but for radical cure of vivax and ovale malaria.It also requires a test for glucose-6-phosphate dehydrogenase (G6PD) deficiency before use, as it can cause hemolysis in people with this condition.
Choice C is correct because mefloquine is a suppressive prophylactic that can be used in areas with chloroquine resistance.
A nurse is caring for a client who is receiving gentamicin, an aminoglycoside antibiotic, for a severe infection.
The nurse should monitor the client for which adverse effects of this drug? (Select all that apply.)
Explanation
Gentamicin is an aminoglycoside antibiotic that can causeototoxicity(damage to the inner ear) andnephrotoxicity(damage to the kidneys) as serious side effects. These effects may be irreversible and can occur even at therapeutic doses. Therefore, the nurse should monitor the client’s hearing, balance, urine output, and blood tests for kidney function while on this drug.
Choice C is wrong because gentamicin does not causehepatotoxicity(damage to the liver).
This is more common with other antibiotics such as isoniazid or rifampin.
Choice D is wrong because gentamicin does not causeneuromuscular blockade(paralysis of muscles).
This is more common with other aminoglycosides such as neomycin or tobramycin.
Choice E is wrong because gentamicin does not causethrombocytopenia(low platelet count).
This is more common with other drugs such as heparin or sulfonamides.
A nurse is teaching a client who has tuberculosis about the prescribed drug regimen, which includes isoniazid, rifampin, pyrazinamide, and ethambutol.
The nurse should instruct the client to report which signs or symptoms as possible adverse effects of these drugs? (Select all that apply.)
Explanation
Jaundice, vision changes and numbness in the hands or feet are possible adverse effects of the drugs used to treat tuberculosis.The nurse should instruct the client to report these signs or symptoms as they may indicate liver damage, optic neuritis or peripheral neuropathy respectively.
Choice C is wrong because hearing loss is not a common side effect of these drugs.Hearing loss may be caused by other drugs such as aminoglycosides.
Choice D is wrong because orange-colored urine is a harmless side effect of rifampin and does not need to be reported.
The nurse should inform the client about this expected change and reassure them that it is not harmful.
The normal ranges for liver function tests are:
• AST: 10-40 U/L
• ALT: 7-56 U/L
• ALP: 45-115 U/L
• Bilirubin: 0.1-1.2 mg/dL
The normal range for visual acuity is 20/20.
The normal range for sensation is intact and symmetrical in all extremities.
Which statement is true regarding narrow spectrum antibiotics?
Explanation
They are effective against a few types of organisms.Narrow spectrum antibiotics are antibiotics that work against a limited range of bacteria, usually either gram-positive or gram-negative.They are more specific and less likely to cause resistance or disrupt the normal flora.
Choice A) They are effective against gram-positive bacteria only.This is not true because some narrow spectrum antibiotics can also target gram-negative bacteria, such as aminoglycosides.
Choice B) They are effective against gram-negative bacteria only.This is not true because some narrow spectrum antibiotics can also target gram-positive bacteria, such as vancomycin.
Choice C) They are effective against one type of organism.This is too restrictive because narrow spectrum antibiotics can work against more than one type of organism, such as penicillins that target both streptococci and staphylococci.
Which term is used to describe an agent that inhibits bacterial growth but does not kill bacteria?
Explanation
A bacteriostatic agent is an agent that inhibits the growth or reproduction of bacteria, but does not kill them.
This means that the bacteria are still alive, but they cannot multiply or cause infection.
Choice A) Bactericidal is wrong because a bactericidal agent is an agent with the capability to kill bacteria.
This means that the bacteria are no longer alive or viable.
Choice C) Bacteriolytic is wrong because a bacteriolytic agent is an agent that causes the lysis or rupture of bacterial cells.
This means that the bacteria are destroyed and their contents are released.
Choice D) Bacteriophage is wrong because a bacteriophage is not an agent, but a type of virus that infects and replicates within bacteria.
This means that the bacteriophage uses the bacteria as hosts and may kill them or not depending on the type of infection.
Question 78.
The nurse is caring for a patient receiving vancomycin (Vancocin) for treatment of an infection caused by methicillin-resistant Staphylococcus aureus (MRSA).
Which assessment finding would indicate a potentially serious adverse reaction to this drug?
Explanation
These are signs ofototoxicity, a potentially serious adverse reaction to vancomycin (Vancocin) and other aminoglycosides.Ototoxicity can damage the inner ear and cause permanent hearing loss or balance problems.
Choice A is wrong because redness and itching at the infusion site are not specific to vancomycin (Vancocin) and could indicate a local irritation or an allergic reaction to any drug.
Choice B is wrong because flushing, rash, and pruritus on the face and upper torso are symptoms ofred man syndrome, a common but not serious side effect of vancomycin (Vancocin) that occurs due to rapid infusion and histamine release.Red man syndrome can be prevented by infusing the drug over at least 1 hour.
Choice C is wrong because nausea, vomiting, and abdominal cramps are not specific to vancomycin (Vancocin) and could be caused by many factors, such as infection, food poisoning, or other drugs.
Normal ranges for vancomycin (Vancocin) trough levels are 10 to 20 mcg/mL for most infections and 15 to 20 mcg/mL for serious infections such as osteomyelitis, endocarditis, or meningitis.Levels above 20 mcg/mL increase the risk of ototoxicity and nephrotoxicity.
Therefore, the nurse should monitor the patient’s trough levels regularly and report any abnormal findings to the prescriber.
The nurse is providing discharge teaching for a patient who will be taking oral linezolid (Zyvox) to treat a complicated skin infection caused by vancomycin-resistant enterococci (VRE).
Which statement by the patient indicates a need for further teaching?
Explanation
This statement indicates a need for further teaching because linezolid should be taken for the full prescribed course of treatment, even if the symptoms improve or resolve.Stopping the medication too soon can lead to bacterial resistance or recurrence of the infection.
Choice A is wrong because it is a correct statement.Linezolid can cause optic neuropathy or vision changes, so patients should report any changes in their vision to their doctor.
Choice B is wrong because it is a correct statement.
Linezolid can interact with foods that contain tyramine, such as cheese and red wine, and cause a hypertensive crisis.Patients should avoid eating foods that contain tyramine while taking linezolid and for two weeks after stopping the medication.
Choice C is wrong because it is a correct statement.Linezolid can be taken with or without food, but taking it on an empty stomach may help with absorption and effectiveness.
A nurse is administering penicillin to a client who has streptococcal pharyngitis. The nurse should monitor for which adverse effect of penicillin therapy?
Explanation
Anaphylaxis is a severe allergic reaction that can be life-threatening and requires immediate medical attention.Penicillin is one of the most common causes of anaphylaxis.Symptoms of anaphylaxis include difficulty breathing, swelling of the face, throat, or tongue, hives, itching, low blood pressure, and shock.
Choice A is wrong because hypokalemia (low potassium levels in the blood) is not a common or serious side effect of penicillin therapy.Hypokalemia can cause muscle weakness, cramps, irregular heartbeat, and fatigue.
Choice B is wrong because hyperglycemia (high blood sugar levels) is not a common or serious side effect of penicillin therapy.Hyperglycemia can cause thirst, frequent urination, blurred vision, and headaches.
Choice D is wrong because constipation is not a common or serious side effect of penicillin therapy.Constipation can cause abdominal pain, bloating, and difficulty passing stools.
A nurse is caring for a client who has tuberculosis and is prescribed rifampin, an antitubercular drug. The nurse should instruct the client about which potential side effect of rifampin?
Explanation
The nurse should instruct the client about this possibility and reassure them that it is harmless and will disappear when the medication is discontinued.
Choice B is wrong because metallic taste in mouth is not a side effect of rifampin, but of metronidazole, an antibiotic used to treat infections caused by anaerobic bacteria or protozoa.
Choice C is wrong because photosensitivity reaction is not a side effect of rifampin, but of tetracycline, an antibiotic used to treat acne and other infections.
Choice D is wrong because ototoxicity is not a side effect of rifampin, but of aminoglycosides, a class of antibiotics used to treat serious infections caused by gram-negative bacteria.
Ototoxicity can cause hearing loss or balance problems.
A nurse is teaching a client who has been prescribed tetracycline, a tetracycline antibiotic, for acne vulgaris.
Which of these instructions should the nurse include in the teaching? (Select all that apply.)
Explanation
The nurse should include these instructions in the teaching because:
• Tetracycline should be taken on an empty stomach to avoid interference with absorption.
• Dairy products should be avoided while taking this drug because they contain calcium, which can form insoluble complexes with tetracycline and reduce its effectiveness.
• Sunscreen or sun avoidance should be used while taking this drug because it can cause photosensitivity, which increases the risk of sunburn and skin damage.
• Plenty of fluids should be drunk while taking this drug because it can cause nephrotoxicity, which is damage to the kidneys.
Choice E is wrong because vaginal itching or discharge is not a common side effect of tetracycline.It may indicate a superinfection, which is a secondary infection caused by the disruption of normal flora by antibiotics.
This should be reported to the health care provider as soon as possible.
The nurse identifies which host factor as the most important when choosing an antimicrobial drug?
Explanation
This is because antibiotics act synergistically with the immune system to subdue infection, and it is critical for success that the host defenses are adequate.
Choice A is wrong becauseAge is wrong because age is a general factor that must be considered when choosing any medication, not just antimicrobials.
Choice C is wrong becauseGenetic heritage is wrong because genetic heritage is also a general factor that may affect the metabolism and excretion of medications, not the selection of antimicrobials.
Choice D is wrong becausePrevious medication reactions is wrong because previous medication reactions are also a general factor that may indicate allergies or intolerances to certain medications, not the selection of antimicrobials.
Normal ranges for immune function vary depending on the type and level of immunity measured, such as innate, adaptive, humoral or cellular immunity.Some common tests for immune function include complete blood count (CBC), immunoglobulin levels, complement levels, antibody titers and skin tests.
Normal ranges for these tests depend on the laboratory and the method used, but some examples are:
• CBC: white blood cell count 4.5-11 x 10^9/L; neutrophils 40-75%; lymphocytes 20-50%; monocytes 2-10%; eosinophils 1-6%; basophils 0-2%.
• Immunoglobulin levels: IgG 7-16 g/L; IgA 0.7-4 g/L; IgM 0.4-2.3 g/L; IgE 0-0.4 g/L.
• Complement levels: C3 0.9-1.8 g
The development of a new infection as a result of the elimination of normal flora by an antibiotic is referred to as what?
Explanation
A superinfection is defined as an infection that comes second to an initial infection and is often caused by the elimination of normal flora by an antibiotic.
Normal flora are the microorganisms that normally live in the human body and help prevent the growth of harmful pathogens.
When an antibiotic kills the normal flora, it creates an opportunity for other microorganisms to overgrow and cause a new infection.
Choice A is wrong because a resistant infection is an infection that does not respond to an antibiotic due to the presence of resistant bacteria.
Resistance can occur when bacteria mutate or acquire genes that make them able to survive the antibiotic.
Choice C is wrong because a nosocomial infection is an infection that is acquired in a hospital or health care setting.
Nosocomial infections can be caused by various factors, such as exposure to contaminated equipment, poor hygiene practices, or transmission from other patients or staff.
Choice D is wrong because an allergic reaction is an immune response to a foreign substance that is not harmful.
Allergic reactions can occur when a person is sensitive to an antibiotic or any other drug.
Symptoms of an allergic reaction may include rash, itching, swelling, or difficulty breathing.
(Select all that apply) A microbe acquires antibiotic resistance by which means?
Explanation
A microbe acquires antibiotic resistance by transferring DNA coding to other bacteria or by spontaneous mutation in the microbial genome.
These genetic changes allow the microbe to survive the effects of the antibiotic and pass on the resistance to its offspring.
ChoiceAis wrong because the host does not develop medication resistance, but the microbe does.
ChoiceBis wrong because the minimum bactericidal concentration (MBC) is the lowest concentration of an antibiotic needed to kill 99.9% of bacteria, not a mechanism of resistance.
ChoiceCis wrong because incorrect dosing does not cause ribosome mutations, but may promote the emergence of drug-resistant microbes by exposing them to suboptimal levels of the antibiotic.
Which statement is true regarding antimicrobial stewardship?
Explanation
Inappropriate antibiotic use leads to the emergence of resistance.This is a well-established fact that is supported by the CDC and other organizations.Resistance can occur when antibiotics are used unnecessarily, excessively, or incorrectly, and can lead to infections that are harder to treat and more costly.
Choice A is wrong because antibiotic guidelines in critical care do not necessarily reduce the hospital length of stay.Although some studies have suggested that adherence to pneumonia guidelines may improve outcomes in severe pneumonia, other studies have found no significant effect of antibiotic stewardship on hospital length of stay or mortality in critically ill patients.
Therefore, this statement is not universally true.
Choice C is wrong because antibiotic dosing has a significant effect on antimicrobial resistance.Optimal dosing of antibiotics can help eradicate infections, prevent relapse, and minimize the selection of resistant bacteria.Conversely, suboptimal dosing can lead to treatment failure, prolonged infection, and increased resistance.
Therefore, antibiotic dosing should be carefully adjusted according to the pharmacokinetic and pharmacodynamic properties of the drug and the patient.
Choice D is wrong because an antibiotic stewardship programme leads to a decrease in antimicrobial resistance, not an increase.An antibiotic stewardship programme is a coordinated effort to improve and measure the appropriate use of antibiotics by promoting the selection of the optimal drug regimen, dose, duration, and route of administration.Such programmes have been shown to reduce antibiotic consumption, resistance rates, adverse events, and costs in various settings.
Therefore, this statement is false.
Which antibiotics are classified as concentration-dependent antimicrobials?
Explanation
Gentamicin is an example of a concentration-dependent antimicrobial, which means that it achieves increasing bacterial kill with increasing levels of drug.The peak concentration and the area under the concentration curve (AUC) determine the efficacy of these antibiotics.Other examples of concentration-dependent antimicrobials include fluoroquinolones, daptomycin, aminoglycosides, and amphotericin
Choice A is wrong because ciprofloxacin is a fluoroquinolone, which is also a concentration-dependent antimicrobial.
Choice B is wrong because imipenem is a carbapenem, which is a type of beta-lactam antibiotic.Beta-lactams are time-dependent antimicrobials, which means that their bactericidal activity depends on the duration of the effective concentration.
Choice C is wrong because penicillin V is another type of beta-lactam antibiotic, which is also a time-dependent antimicrobial.
Choice D is wrong because metronidazole is a bactericidal agent that has both time- and concentration-dependent properties.However, it is not classified as a concentration-dependent antimicrobial according to the AMEG categorization of antibiotics in the European Union.
A nurse is preparing to administer vancomycin, a glycopeptide antibiotic, to a client with a severe infection caused by Clostridium difficile.
The nurse should select all that apply:
Explanation
Here is why:
• Choice A:Monitor the client’s serum creatinine level.
This is correct because vancomycin can cause nephrotoxicity (damage to the kidneys) and serum creatinine is a marker of kidney function.A high serum creatinine level indicates impaired kidney function and may require dose adjustment or discontinuation of vancomycin.
• Choice B:Monitor the client’s serum vancomycin level.
This is correct because vancomycin has a narrow therapeutic range, meaning that there is a small difference between the effective dose and the toxic dose.Monitoring the serum vancomycin level can help to ensure that the drug is within the therapeutic range and avoid toxicity or suboptimal efficacy.
• Choice C:Infuse the drug over at least 60 minutes.
This is correct because vancomycin can cause a hypersensitivity reaction called “red man syndrome” or “red neck syndrome”, which is characterized by flushing, itching, rash, hypotension and tachycardia.
This reaction is not an allergy but a result of histamine release due to rapid infusion of vancomycin.Infusing the drug over at least 60 minutes can reduce the risk of this reaction.
• Choice D:Observe the client for signs of ototoxicity.
This is incorrect because vancomycin is not known to cause ototoxicity (damage to the ears) in humans.Ototoxicity has been reported in animal studies and in vitro studies, but not in clinical trials or case reports involving humans.
Therefore, there is no need to monitor for signs of ototoxicity such as hearing loss, tinnitus or vertigo.
A patient has been prescribed azithromycin, a macrolide antibiotic, for a respiratory infection.
The nurse should instruct the patient to report which of the following signs or symptoms of a potential adverse effect?
Explanation
Azithromycin is a macrolide antibiotic that can cause a rare but serious side effect calledQT prolongation, which affects the electrical activity of the heart and can lead toirregular heartbeats, chest pain, and sudden cardiac death. The patient should report any signs of chest pain or palpitations to the doctor immediately.
Choice A is wrong because diarrhea is a common side effect of azithromycin that usually does not require medical attention unless it is severe or bloody.
Choice B is wrong because headache is also a common side effect of azithromycin that usually does not require medical attention unless it is severe or persistent.
Choice D is wrong because nausea is another common side effect of azithromycin that usually does not require medical attention unless it is severe or accompanied by vomiting.
A patient is receiving cefazolin, a first-generation cephalosporin, for a surgical prophylaxis.
The nurse should assess the patient for which of the following possible allergic reactions? (Select all that apply.)
Explanation
Cefazolin can cause serious or life-threatening allergic reactions in some patients, especially those with a history of penicillin allergy.The most common allergic reactions to cefazolin are immediate reactions, such as anaphylaxis, urticaria, bronchospasm, and angioedema.These reactions usually occur within one hour of the drug administration and may involve symptoms such as rash, itching, swelling, difficulty breathing, low blood pressure, and shock.Immediate reactions are mediated by immunoglobulin E (IgE) antibodies that bind to the drug and trigger the release of inflammatory mediators from mast cells and basophils.
Choice D is wrong because Stevens-Johnson syndrome is not a typical allergic reaction to cefazolin.
Stevens-Johnson syndrome is a rare and severe skin reaction that can be caused by various drugs, infections, or autoimmune diseases.
It involves blistering and peeling of the skin and mucous membranes, fever, malaise, and eye inflammation.
Stevens-Johnson syndrome is not mediated by IgE antibodies, but by other immune mechanisms that damage the skin cells.
Cefazolin is not known to cause Stevens-Johnson syndrome, although other cephalosporins have been reported to do so in rare cases.
A nurse is administering tetracycline, a broad-spectrum antibiotic, to a patient who has acne vulgaris.
The nurse should monitor the patient for which of the following adverse effects of this medication? (Select all that apply.)
Explanation
Tetracycline can causephotosensitivity, which means increased sensitivity to sunlight and risk of sunburn.It can also causesuperinfection, which means overgrowth of resistant bacteria or fungi in the mouth, intestines, or vagina.
Choice B is wrong because tetracycline can causetooth discolorationin children under 8 years old, not in adults.
Choice C is wrong because tetracycline can causehepatic impairmentonly in patients with preexisting liver disease or who take high doses for a long time.
Choice E is wrong because tetracycline can causebone marrow suppressiononly in patients with preexisting blood disorders or who take high doses for a long time.
A nurse is caring for a patient who is receiving gentamicin IV for treatment of endocarditis caused by gram-negative bacteria.
Which laboratory value should be monitored closely during gentamicin therapy?
Explanation
Gentamicin is an aminoglycoside antibiotic that can cause nephrotoxicity, which is damage to the kidneys.Serum creatinine is a measure of kidney function and should be monitored closely during gentamicin therapy. The normal range for serum creatinine is 0.6 to 1.2 mg/dL for men and 0.5 to 1.1 mg/dL for women.
Choice B is wrong because serum potassium is not affected by gentamicin.
The normal range for serum potassium is 3.5 to 5.0 mEq/L.
Choice C is wrong because serum calcium is not affected by gentamicin.
The normal range for serum calcium is 8.5 to 10.2 mg/dL.
Choice D is wrong because serum glucose is not affected by gentamicin.
The normal range for serum glucose is 70 to 110 mg/dL.
A nurse is reviewing the culture and sensitivity report of a patient who has a wound infection caused by Staphylococcus aureus.
The report indicates that the organism is sensitive to several antibiotics, including oxacillin, erythromycin, and clindamycin. Which antibiotic should be chosen for this patient? (Select all that apply.).
Explanation
Oxacillin, erythromycin and clindamycin are all antibiotics that are sensitive to Staphylococcus aureus according to the culture and sensitivity report.
This means that they can inhibit or kill the bacteria that are causing the wound infection.These antibiotics belong to different classes of drugs that have different mechanisms of action and spectrum of activity.
Choice D and E are wrong because vancomycin and linezolid are antibiotics that are usually reserved for more resistant strains of Staphylococcus aureus, such as methicillin-resistant Staphylococcus aureus (MRSA) or
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