Antibiotics and Antimicrobial Agents > Pharmacology
Exam Review
Nursing implications and patient education
Total Questions : 5
Showing 5 questions, Sign in for moreA nurse is preparing to administer an antimicrobial agent to a patient who has a urinary tract infection. The nurse reviews the culture and sensitivity results and notes that the microorganism is resistant to the prescribed antimicrobial agent.
What is the most appropriate action by the nurse?
Explanation
Hold the antimicrobial agent and notify the prescriber of the resistance.This is because administering an antimicrobial agent that the microorganism is resistant to will not be effective and may increase the risk of medication toxicity. The prescriber should be informed so that they can order a different antimicrobial agent that is sensitive to the microorganism.
Choice A is wrong because administering the antimicrobial agent as ordered and monitoring for therapeutic effects will not treat the urinary tract infection (UTI) and may allow the infection to spread or worsen.
Choice C is wrong because administering a different antimicrobial agent that is sensitive to the microorganism without consulting the prescriber is outside the nurse’s scope of practice and may cause adverse effects or interactions.
Choice D is wrong because administering the antimicrobial agent with another medication to enhance its activity without consulting the prescriber is also outside the nurse’s scope of practice and may not be appropriate for the type of microorganism causing the UTI.
A nurse is educating a patient about the adverse effects of antimicrobial therapy.
Which of the following statements by the patient indicate a need for further teaching? (Select all that apply.)
Explanation
The correct answer is choice D and E and they indicate a need for further teaching.
Choice D is wrong because the patient should not stop taking the medication if they develop a rash or hives, but should report it to the provider immediately, as this could indicate a serious allergic reaction.
Choice E is wrong because the patient should not take an antacid if they have stomach upset, as this could interfere with the absorption of the antimicrobial drug.
Some additional information:
• Choice A is correct because drinking plenty of fluids can help prevent kidney damage from some antimicrobial drugs, such as aminoglycosides.
• Choice B is correct because ringing in the ears or hearing loss can be signs of ototoxicity from some antimicrobial drugs, such as vancomycin.
• Choice C is correct because some antimicrobial drugs, such as tetracyclines and sulfonamides, can increase the sensitivity to sunlight and cause sunburns.
• Normal ranges for kidney function tests are blood urea nitrogen (BUN) 7 to 20 mg/dL and creatinine 0.6 to 1.2 mg/dL.
• Normal ranges for liver function tests are alanine aminotransferase (ALT) 7 to 56 units/L and aspartate aminotransferase (AST) 10 to 40 units/L.
A nurse is caring for a patient who is receiving intravenous vancomycin for a severe infection. The patient complains of itching and flushing of the face, neck, and chest.
The nurse recognizes these symptoms as indicative of what?
Explanation
A red man syndrome is a reaction to the antibiotic vancomycin that causes flushing, itching, and sometimes hypotension and tachycardia. It is not a true allergic reaction, but rather a pseudoallergic or anaphylactoid reaction caused by the release of histamine from mast cells. It is more likely to occur when vancomycin is infused rapidly or at high doses.The symptoms usually resolve with slowing or stopping the infusion, and can be prevented by premedicating with antihistamines or extending the infusion time
Choice A is wrong because an allergic reaction to vancomycin would involve IgE-mediated hypersensitivity, which can cause urticaria, angioedema, bronchospasm, and anaphylaxis.An allergic reaction would not be dependent on the infusion rate or dose of vancomycin, and would require immediate discontinuation of the drug and treatment with epinephrine and other supportive measures
Choice B is wrong because a superinfection is a secondary infection that occurs when the normal flora of the body is disrupted by antibiotics, allowing opportunistic pathogens to proliferate. Common examples of superinfections are Clostridioides difficile colitis, oral or vaginal candidiasis, and methicillin-resistant Staphylococcus aureus infections. Superinfections do not cause flushing or itching, but rather symptoms related to the site of infection, such as diarrhea, abdominal pain, oral thrush, or skin lesions.Superinfections may require treatment with different antibiotics or antifungals
Choice C is wrong because a disulfiram-like reaction is a reaction that occurs when alcohol is consumed while taking certain drugs that inhibit the enzyme acetaldehyde dehydrogenase, which is responsible for metabolizing alcohol. This leads to the accumulation of acetaldehyde, which causes nausea, vomiting, headache, flushing, palpitations, and hypotension. Vancomycin does not cause a disulfiram-like reaction, but some other antibiotics such as metronidazole and cephalosporins do.A disulfiram-like reaction can be avoided by abstaining from alcohol while taking these drugs
A nurse is administering gentamicin, an aminoglycoside antibiotic, to a patient who has a gram-negative infection.
The nurse monitors the patient’s serum creatinine level as an indicator of what?
Explanation
Gentamicin is an aminoglycoside antibiotic that can cause nephrotoxicity, which is the damage of the kidney.Gentamicin induces nephrotoxicity by inhibiting protein synthesis in renal cells that specifically causes necrosis of cells in the renal proximal tubule, resulting in acute tubular necrosis, followed by acute renal failure.The nurse monitors the patient’s serum creatinine level as an indicator of nephrotoxicity because serum creatinine reflects the glomerular filtration rate (GFR) and kidney function.
Choice A is wrong because hepatotoxicity is the damage of the liver, not the kidney.
Gentamicin is not known to cause hepatotoxicity.
Choice C is wrong because neurotoxicity is the damage of the nervous system, not the kidney.
Gentamicin can cause neurotoxicity by affecting the neuromuscular junction and causing muscle weakness or paralysis, but this is not related to serum creatinine level.
Choice D is wrong because ototoxicity is the damage of the ear, not the kidney.
Gentamicin can cause ototoxicity by damaging the hair cells in the inner ear and causing hearing loss or balance problems, but this is not related to serum creatinine level.
Normal ranges for serum creatinine are 0.6 to 1.2 mg/dL for men and 0.5 to 1.1 mg/dL for women.
A nurse is teaching a patient who has been prescribed metronidazole, a nitroimidazole antibiotic, for a bacterial infection.
The nurse instructs the patient to avoid consuming what substance while taking this medication?
Explanation
The patient should avoid consuming alcohol while taking metronidazole, a nitroimidazole antibiotic, for a bacterial infection.This is because the combination of metronidazole and alcohol can cause a reaction (often referred to as a disulfiram-like reaction) in some people that may include nausea, vomiting, flushing, fast heart beat, and stomach cramps.This reaction can be severe and even fatal.It is best to avoid alcohol while taking metronidazole and for at least 3 days after the last dose.
Choice A is wrong because grapefruit juice does not interact with metronidazole.
Choice B is wrong because dairy products do not interact with metronidazole.
Choice D is wrong because caffeine does not interact with metronidazole.
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