Ch 21 Drug Therapy With Macrolides and Miscellaneous Anti-Infective Agents

The nurse should monitor the client for which common side effects of erythromycin therapy?

Headache and fever

Urticaria and ophthalmic drainage

Nausea, vomiting, and diarrhea

Shortness of breath and sore throat

Nausea, vomiting, and diarrhea

A client received erythromycin before dental surgery. The client has a past history of a cardiac surgery. The rest of the client's history is unremarkable. What does the nurse teach the client about this medication?

"You are receiving this medication to prevent infection that may affect your heart."

"You need this medication to decrease the extraction pain of surgery."

"You cannot receive other antibiotics because of your cardiac history."

"This medication will help them remove your tooth easier."

"You are receiving this medication to prevent infection that may affect your heart."

A client has been prescribed metronidazole for treatment of Giardia. What instruction is most important for the nurse to give to this client?

Do not smoke while taking this medication.

Do not drink alcohol while taking this medication.

Regularly use sunscreen products while taking this medication.

Do not eat dairy foods while taking this medication.

Do not drink alcohol while taking this medication.

A client with an upper respiratory infection has been prescribed macrolides. Which changes during an ongoing assessment would lead the nurse to notify the health care provider? Select all that apply.

drop in blood pressure

increase in respiratory rate

sudden increase in temperature

regular urine output

pulse rate within usual parameters

drop in blood pressure

increase in respiratory rate

sudden increase in temperature

A client developed a pressure area on the hip that has become infected. If the wound culture reveals methicillin-resistant Staphylococcus aureus, which medication would the nurse expect to be prescribed?

metronidazole

penicillin

vancomycin

erythromycin

vancomycin

Linezolid can be used to treat which of the following infections? Select all that apply.

Community-acquired pneumonia (CAP)

Vancomycin-resistant Enterococcus faecium (VREF)

Methicillin-resistant Staphylococcus aureus (MRSA)

Acute otitis media

Nosocomial pneumonia

Community-acquired pneumonia (CAP)

Vancomycin-resistant Enterococcus faecium (VREF)

Methicillin-resistant Staphylococcus aureus (MRSA)

Nosocomial pneumonia

A common reaction associated with the intravenous administration of vancomycin is "red man syndrome." What is the cause of red man syndrome?

Pseudomembranous colitis

Histamine release

Hypotension

Hypertension

Histamine Release

Rifaximin (Xifaxan) is effective to treat traveler's diarrhea from which of the following organisms?

Escherichia coli

Shigella

Salmonella

Campylobacter jejuni

Escherichia coli

Which statement is true concerning macrolides?

Macrolides are bactericidal or bacteriostatic.

Macrolides are not absorbed well in body tissues.

Macrolides are not absorbed in body fluids.

Macrolides cannot kill gram-positive bacteria.

Macrolides are bactericidal or bacteriostatic.

A health care provider is deciding what medication to prescribe for a client with an upper respiratory infection. What principles guide the provider's decision? Select all that apply.

Medication cost

Resistance of the bacteria

Other drugs the client is taking daily

The client's ability to tolerate the drug

Available in generic formulation

Resistance of the bacteria

Other drugs the client is taking daily

The client's ability to tolerate the drug

The nurse is caring for a client who is receiving IV vancomycin. The nurse infuses the medication at the prescribed rate to prevent what from occurring?

Gray syndrome

Red man syndrome

Serotonin syndrome

Cushing's syndrome

red man syndrome

A client prescribed rifaximin for diarrhea has developed frank bleeding in the stool. What intervention should the nurse anticipate being implemented to best ensure client safety?

increasing the dose of rifaximin

changing to a different antibiotic

supplementing the antibiotic with vitamin K

changing to parenteral administration of rifaximin

changing to a different antibiotic

A client comes to the clinic for a follow-up visit. The nurse notes a sunburn-like appearance to the client's skin. The client's history reveals the use of ciprofloxacin. The nurse interprets which adverse effect regarding this finding?

photosensitivity

superinfection

pseudomembranous colitis

anaphylactic reaction

photosensitivity

The nurse is preparing to administer IV vancomycin to a client for the treatment of a systemic infection. How long would the nurse expect the infusion to run?

30 minutes

3 to 4 hours

1 to 2 hours

2 to 4 hours

1 to 2 hours

A nurse is required to administer an anti-infective drug to a patient. The nurse knows that which of the following tests need to be conducted before administering the first dose of an anti-infective drug to the patient?

Stool tests

Culture tests

Urinalysis

Ulcer tests

Culture tests

A patient is required to be administered vancomycin for treatment of an abdominal abscess. What should the nurse ensure when monitoring the IV infusion of vancomycin in the patient when caring for him?

Observe for signs of headache.

Report increase in the urinary output.

Administer each dose over 60 minutes.

Report an increase in blood pressure.

Administer each dose over 60 minutes.

Which of the following drugs are considered to be macrolides? Choose all that apply.

linezolid (Zyvox)

erythromycin

clarithromycin (Biaxin)

metronidazole (Flagyl)

azithromycin (Zithromax)

erythromycin

azithromycin (Zithromax)

clarithromycin (Biaxin)

Which of the following are examples of miscellaneous antibacterials? Choose all that apply.

Clindamycin hydrochloride (Cleocin)

Erythromycin

Metronidazole (Flagyl)

Linezolid (Zyvox)

Vancomycin (Vancocin)

Linezolid (Zyvox)

Metronidazole (Flagyl)

Vancomycin (Vancocin)

Clindamycin hydrochloride (Cleocin)

The nursing instructor is discussing the administration of azithromycin, a macrolide, with her clinical group. The instructor asks her students to identify the medication that will decrease the effects of azithromycin when administered concurrently. Which of the following medications would the students identify?

Beta-adrenergic blockers

Calcium-channel blockers

Antidepressants

Antacids

Antacids

A nurse is caring for a client with severe and life-threatening pseudomembranous colitis caused by C. difficile. Which drug would the nurse expect the client's provider to order?

Oral vancomycin

Tigecycline

Linezolid

Daptomycin

Oral vancomycin

*A patient on your unit has bacterial colitis and is being treated with oral vancomycin. Why is vancomycin given orally, rather than intravenously, in the treatment of bacterial colitis?

The oral version of the drug acts within the bowel lumen.

Fewer pathogens are resistant to the oral version of the drug than to the IV version.

The oral version of the drug is easier to administer.

The oral version of the drug limits the release of histamines.*

The oral version of the drug acts within the bowel lumen.

The nurse is assessing a patient taking clarithromycin (Biaxin XL). Which symptom exhibited by the patient requires immediate intervention?

Nausea

Dyspepsia

Vomiting

Headache

Vomiting

A male client presents to the emergency department with an abdominal dehiscence. He states he had a hernia repair 18 days earlier, and the health care provider removed his wound staples 5 days ago. The client states that the dehiscence occurred when he lifted a box this morning for his wife. The wound is red, and there is evidence of foul-smelling drainage. The wound is cultured, and an anaerobic bacterium is identified. The nurse understands that the provider orders metronidazole because it is effective against which type of organism?

All gram-negative bacteria

All gram-positive bacteria

Staphylococcus

Anaerobic bacteria

Anaerobic bacteria

A client presents to the health care provider's office with a skin infection on the forearm. The infection is resistant to over-the-counter antibiotics. After receiving the culture and sensitivity results, the provider orders tigecycline. The nurse knows that this client has what illness?

Clostridium difficile

VRE

MRSA

VREF

MRSA

A client develops antibiotic-induced colitis. The symptoms have worsened within the past 72 hours. The nurse expects the health care provider to order what medication, which is considered the initial drug of choice?

Bismuth subsalicylate

Psyllium

Metronidazole

Loperamide

Metronidazole

*In antibiotic-associated colitis, stopping the causative drug is the initial treatment. If symptoms do not improve within 3 or 4 days, oral metronidazole or vancomycin is given for 7 to 10 days.*

A client has been prescribed metronidazole for treatment of Giardia. What instruction is most important for the nurse to give to this client?

Do not smoke while taking this medication.

Do not drink alcohol while taking this medication.

Regularly use sunscreen products while taking this medication.

Do not eat dairy foods while taking this medication.

Do not drink alcohol while taking this medication.

*The nurse is caring for a client who has been diagnosed with trichomoniasis. What medication would the nurse anticipate being prescribed?

clindamycin

metronidazole

rifaximin

penicillin*

metronidazole

A client developed a pressure area on the hip that has become infected. If the wound culture reveals methicillin-resistant Staphylococcus aureus, which medication would the nurse expect to be prescribed?

vancomycin

metronidazole

erythromycin

penicillin

vancomycin

An 82-year-old client, who lives alone and has occasional memory lapses, is being seen by the home health nurse. In reviewing the client's medication, the nurse discovers that the client was recently prescribed azithromycin for urethritis. What characteristic of this drug makes it an appropriate choice for this client?

Zithromax is associated with very few drug-drug interactions.

It is taken only once a day.

The half-life of the drug is 3 to 7 hours.

The drug usually achieves results in only a 3-day course.

It is taken only once a day.

Your patient is receiving a miscellaneous antibacterial to treat an infection. Which of the following goals would be appropriate to include in your plan of care? Select all that apply.

The patient will experience an increase in signs and symptoms of the infection being treated.

The patient will take or receive miscellaneous antimicrobials accurately, for the prescribed length of time.

The patient will verbalize and practice measures to prevent recurrent infection.

The patient will be monitored regularly for therapeutic and adverse drug effects.

The patient will take or receive miscellaneous antimicrobials accurately, for the prescribed length of time.

The patient will be monitored regularly for therapeutic and adverse drug effects.

The patient will verbalize and practice measures to prevent recurrent infection.

The nurse should monitor the client for which common side effects of erythromycin therapy?

Shortness of breath and sore throat

Urticaria and ophthalmic drainage

Nausea, vomiting, and diarrhea

Headache and fever

Nausea, vomiting, and diarrhea

For a client diagnosed with methicillin-resistant Staphylococcus aureus (MRSA), which medication would be most effective?

A third-generation cephalosporin

A first-generation cephalosporin

An oxazolidinone

A penicillin

An oxazolidinone

*Linezolid (Zyvox) is an oxazolidinone and very effective against MRSA. MRSA, by definition, is resistant to penicillins. MRSA is also resistant to almost all cephalosporins, which function very similarly to penicillins.*

A client is taking clindamycin for an infectious process and presents to the health care provider's office with symptoms of dehydration. The nurse understands that the client is experiencing what adverse reaction from the administration of clindamycin?

Diaphoresis

Diarrhea

Diuresis

Dysphasia

Diarrhea

A client has been prescribed daptomycin for treatment of an infection. What instruction is most important for the nurse to tell this client?

"Expect that this medication may cause bloody diarrhea."

"Tell the health care provider immediately if you develop any muscle pain."

"Take a laxative every day to prevent becoming constipated."

"Maintain a clear liquid diet while on the medication to prevent nausea."

"Tell the health care provider immediately if you develop any muscle pain."

The nurse is caring for a client who is receiving erythromycin. What assessment finding suggests that the client is experiencing an adverse effect of the drug?

The client's systolic blood pressure is approximately 20 mm Hg below the norm.

The client is uncharacteristically euphoric.

The client was incontinent of urine during the night.

The client slept poorly due to a dry cough.

The client is uncharacteristically euphoric.

Common, potentially serious, adverse effects of antibiotic drugs include:

Skin rash

Constipation

Hypopnea

Pain

Skin rash

A patient has been administered linezolid. The patient is fond of eating chocolates and coffee, both of which contain tyramine. What should the nurse inform the patient about the risk involved when linezolid interacts with foods containing tyramine?

Causes drowsiness.

Causes nausea.

Causes severe hypertension.

Causes nervousness.

Causes severe hypertension.

John, 34 years old, is being treated with clindamycin for osteomyelitis of his tibia following an open fracture 3 months ago. The nurse is teaching John how to properly administer the medication at home and the side effects that he needs to report to the health care provider. Which would be the best instruction to give John?

Call the provider if you have nausea after taking the medication.

Notify the provider if you have any blood in your stool or diarrhea.

Contact the provider if you are having headaches or visual changes.

Contact the provider's office if you have abdominal distention.

Notify the provider if you have any blood in your stool or diarrhea.

Quinupristin-dalfopristin (Synercid) belongs to a class of antimicrobials referred to as streptogramins. Which of the following describes this drug? Choose all that apply.

Prevention or treatment of anaerobic bacterial infections

Treatment of C. difficile infections associated with pseudomembranous colitis

Used for serious or life-threatening infections associated with VREF bacteremia

Indicated for skin infections caused by S. aureus or group A streptococcus

Active antimicrobials that affect bacterial ribosomes to decrease protein synthesis

Active antimicrobials that affect bacterial ribosomes to decrease protein synthesis

Indicated for skin infections caused by S. aureus or group A streptococcus

Used for serious or life-threatening infections associated with VREF bacteremia

You are a pediatric nurse caring for a child receiving erythromycin ethylsuccinate. The recommended dose for this drug is 30 mg/kg/day. The child weighs 20 kg, and the medication is to be administered q8h. How much medication should this child receive per dose?

125 mg

75 mg

175 mg

200 mg

200 mg

Which client should not receive erythromycin as ordered at 8 a.m.?

The client taking a beta blocker

The client who is 60 years old

The client with an upper respiratory infection

The client with elevated liver enzymes

The client with elevated liver enzymes

*A client has an upper respiratory infection and is allergic to penicillin. What medication does the nurse expect will be ordered?

Cephalosporin

Ancef

Ampicillin

Erythromycin*

Erythromycin

*A macrolide can be given safely to a client who is allergic to penicillin. Ampicillin, Ancef, and cephalosporins cannot be given because of the risk of cross-sensitivity.*

After teaching a client who is prescribed oral erythromycin, the nurse determines that the teaching was successful when the client states which of the following?

"I need to take the medicine with a meal so I don't get an upset stomach."

"I might have some bloody diarrhea after using this medicine."

"I should drink a full 8-oz glass of water when I take the medicine."

"I only need to take one pill every day for this medicine to work."

"I should drink a full 8-oz glass of water when I take the medicine."

A female client's medical history includes type 2 diabetes, CVA, dysphasia, and chronic renal failure. She develops an infectious process. The health care provider orders erythromycin. Based on the client's medical history, why is erythromycin the drug of choice?

It is metabolized in the kidneys.

It is metabolized in the liver.

It is excreted into the GI tract.

It is excreted into the bloodstream.

It is metabolized in the liver.

A patient has been admitted to the intensive care unit with signs and symptoms of sepsis and preliminary results of the patient's initial blood cultures reveal the presence of methicillin-resistant Staphylococcus aureus (MRSA). This finding is an indication for treatment with

ciprofloxacin.

daptomycin.

polymyxin B.

levofloxacin.

daptomycin.

The pharmacology instructor is discussing macrolides with the nursing class. For what condition does the instructor identify IV erythromycin as the drug of choice?

Acne

Legionnaire's disease

Urinary tract infection

Bacterial endocarditis

Legionnaire's disease

What information will the nurse teach the client being switched to azithromycin from erythromycin?

"This drug is in a different class of antibiotics and will work better."

"This drug causes more diarrhea."

"This drug is used with only younger clients."

"This drug has enhanced antibacterial activity."

"This drug has enhanced antibacterial activity."

The nurse has cared for an increasing number of clients who have antibiotic resistance. What principles should the nurse and the other members of the care team follow in order to prevent antibiotic resistance? Select all that apply.

Treat infections with tetracyclines or penicillins whenever possible.

Avoid the use of broad-spectrum antibacterial drugs when treating trivial or viral infections.

Use narrow-spectrum agents if they are thought to be effective.

Teach clients not to save antibiotics for self-medication in the future.

Perform culture and sensitivity testing immediately after starting a course of antibiotics.

Avoid the use of broad-spectrum antibacterial drugs when treating trivial or viral infections.

Use narrow-spectrum agents if they are thought to be effective.

Teach clients not to save antibiotics for self-medication in the future.

An 87-year-old resident of a long-term care facility has been prescribed oral clindamycin for the treatment of an infected pressure ulcer. The care providers at the facility should be instructed to monitor the resident closely for what potential adverse effect of clindamycin?

Diarrhea

Altered cognition

Respiratory depression

Hematuria

Diarrhea

The nurse realizes that vancomycin is a powerful drug and can treat serious gram-positive infections that do not respond to treatment with other anti-infectives. Serious adverse effects classic for vancomycin include which of the following? (Select all that apply.)

nephrotoxicity

increased risk for hyperglycemia

ototoxicity

increased risk for bleeding

nephrotoxicity

ototoxicity

A client returns from a vacation with traveler's diarrhea. The nurse understands that what is the treatment of choice?

Rifampin

Relafen

Rifaximin

Robaxin

Rifaximin

A client diagnosed with Chlamydia is allergic to penicillin. What medication could be used as a substitute for penicillin in this situation?

chloramphenicol

erythromycin

doxycycline

tetracycline

erythromycin

A nursing student is learning about the new drug linezolid (Zyvox) and the different adverse reactions associated with it. The student lists which as the most serious adverse reactions caused by linezolid? Select all that apply.

pseudomembranous colitis

insomnia

nausea

thrombocytopenia

headache

thrombocytopenia

pseudomembranous colitis

A newborn presents with a distended abdomen, shallow and irregular respirations, and cyanosis. The nurse recognizes this as gray syndrome as a result of administration of which antibiotic?

Ofloxacin (Floxin)

Vancomycin (Vancocin)

Telithromycin (Ketek)

Chloramphenicol (Chloromycetin)

Chloramphenicol (Chloromycetin)

A client is given linezolid for a diagnosis of VREF. The drug will be administered for a period that extends beyond 2 weeks. Which laboratory test would the nurse expect the health care provider to order on a regular basis because of the length of administration of the drug?

Potassium

Serum albumin

Electrolytes

Complete blood count

Complete blood count

A client with a history of valvular heart disease reports having had a "bad reaction" after receiving penicillin in the past. Prior to a scheduled dental procedure, the client is likely to be prescribed what drug?

vancomycin

metronidazole

erythromycin

clindamycin

erythromycin

A client is diagnosed with VRE, and the health care provider orders chloramphenicol. The nurse should monitor the client for the development of which side effect?

Dizziness

Blood dyscrasias

Nausea

Vomiting

Blood dyscrasias

A client with an infected ulcer on the foot has been prescribed daptomycin. What action should the nurse ensure has been taken to determine that the drug will be effective in treating the infection?

Determine whether the client has a known allergy to any lipopeptide class drug

Educate the client of the need to report any muscle pain immediately.

Obtain a culture of the client's infection.

Assess whether the client is being treated for hypercholesterolemia.

Obtain a culture of the client's infection.

The parent of a child diagnosed with meningococcal meningitis asks the nurse why the health care provider didn't prescribe treatment with chloramphenicol. How would the nurse respond?

"Chloramphenicol is not an antibiotic."

"Chloramphenicol isn't used unless there is no adequate substitute drug available."

"Chloramphenicol is contraindicated in children."

"Chloramphenicol isn't effective in the treatment of this disease."

"Chloramphenicol isn't used unless there is no adequate substitute drug available."

A client should be educated to limit consumption of which of the following foods to prevent the risk of severe hypertension when taking linezolid ? Select all that apply.

Broccoli

Prunes

Alcohol

Aged cheese

Pepperoni

Alcohol

Aged cheese

Pepperoni

A nurse is caring for a 25-year-old patient who has been prescribed daptomycin to treat a skin infection. Which of the following adverse effects of daptomycin should the nurse monitor when caring for the patient?

Constipation

Insomnia

Headache

Fever

Constipation

What is an advantage of daptomycin over other antibiotic therapy?

Daptomycin can be given orally twice a day, which makes the drug effective for outpatient therapy.

Daptomycin works by binding to the protein within the cell, causing cell death.

Daptomycin is effective at treating Gram-negative infections.

Daptomycin has less antibiotic resistance than other drugs used to treat against Gram-positive bacteria.

Daptomycin has less antibiotic resistance than other drugs used to treat against Gram-positive bacteria.

Your patient is receiving a macrolide, ketolide, or miscellaneous antibacterial to treat an infection. Which of the following evaluations would be appropriate to include in your plan of care? Select all that apply.

Interview and observe for improvement in the infection being treated.

Interview and observe for increased discussion regarding antihypertensive medications.

Interview and observe for increased discussion regarding anti-anginal medications.

Interview and observe for adverse drug effects.

Interview and observe for improvement in the infection being treated.

Interview and observe for adverse drug effects.

Which of the following would a nurse identify as the prototype lincosamide drug?

Lincomycin

Clarithromycin

Clindamycin

Erythromycin

Clindamycin

Because linezolid is a weak monoamine oxidase (MAO) inhibitor, clients should avoid foods high in tyramine content, such as what foods? (Select all that apply.)

Milk

Tap beers

Chicken

Red wine

Aged cheeses

Aged cheeses

Red wine

Tap beers

What medication could be prescribed orally to treat a sinus infection in a client needing an abbreviated therapy plan?

erythromycin

clarithromycin

tetracycline

azithromycin

azithromycin

Your client has been diagnosed with intermittent colitis. You know that the following antibiotic is contraindicated for use in this client:

Tetracycline.

Bactrim.

Doxycycline.

Clindamycin.

Clindamycin.

Which client should be assessed further before receiving azithromycin (Zithromax) as ordered?

The client who has an elevated white blood cell count (WBC)

The client who has abdominal discomfort

The client who is nauseous

The client who is taking digoxin

The client who is taking digoxin

Which of the following would a nurse identify as the prototype lincosamide drug?

Erythromycin

Clindamycin

Lincomycin

Clarithromycin

Clindamycin