Chapter 29: Penicillins and Cephalosporins Nursing School Test Banks

Chapter 29: Penicillins and Cephalosporins
Test Bank

MULTIPLE CHOICE

1. The nurse is caring for a patient who is receiving an intravenous antibiotic. The nurse notes that the provider has ordered serum drug peak and trough levels. The nurse understands that these tests are necessary for which type of drugs?
a. Drugs with a broad spectrum
b. Drugs with a narrow spectrum
c. Drugs with a broad therapeutic index
d. Drugs with a narrow therapeutic index
ANS: D
Medications with a narrow therapeutic index have a limited range between the therapeutic dose and a toxic dose. It is important to monitor these medications closely by evaluating regular serum peak and trough levels.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 401
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. The nurse is caring for a patient who is receiving an intravenous antibiotic. The patient has a serum drug trough of 1.5 mcg/mL. The normal trough for this drug is 1.7 mcg/mL to 2.2 mcg/mL. What will the nurse expect the patient to experience?
a. Inadequate drug effects
b. Increased risk for superinfection
c. Minimal adverse effects
d. Slowed onset of action
ANS: A
Low peak levels may indicate that the medication is below the therapeutic level. They do not indicate altered risk for superinfection, a decrease in adverse effects, or a slowed onset of action.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 401
TOP: NURSING PROCESS: Analysis/Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. The nurse is teaching a nursing student about the minimal effective concentration (MEC) of antibiotics. Which statement by the nursing student indicates understanding of this concept?
a. A serum drug level greater than the MEC ensures that the drug is bacteriostatic.
b. A serum drug level greater than the MEC broadens the spectrum of the drug.
c. A serum drug level greater than the MEC helps eradicate bacterial infections.
d. A serum drug level greater than the MEC increases the therapeutic index.
ANS: C
The MEC is the minimum amount of drug needed to halt the growth of a microorganism. A level greater than the MEC helps eradicate infections. Drugs at or above the MEC are usually bactericidal, not bacteriostatic. Raising the drug level does not usually broaden the spectrum or increase the therapeutic index of a drug.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 401
TOP: NURSING PROCESS: N/A
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. The nurse is caring for a patient who has recurrent urinary tract infections. The patients current infection is not responding to an antibiotic that has been used successfully several times in the past. The nurse understands that this is most likely due to
a. acquired bacterial resistance.
b. cross-resistance.
c. inherent bacterial resistance.
d. transferred resistance.
ANS: A
Acquired resistance occurs when an organism has been exposed to the antibacterial drug. Cross-resistance occurs when an organism that is resistant to one drug is also resistant to another. Inherent resistance occurs without previous exposure to the drug. Transferred resistance occurs when the resistant genes of one organism are passed to another organism.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 402
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. The nurse is preparing to administer amoxicillin (Amoxil) to a patient and learns that the patient previously experienced a rash when taking penicillin. Which action will the nurse take?
a. Administer the amoxicillin and have epinephrine available.
b. Ask the provider to order an antihistamine.
c. Contact the provider to discuss using a different antibiotic.
d. Request an order for a beta-lactamase resistant drug.
ANS: C
Patients who have previously experienced manifestations of allergy to a penicillin should not use penicillins again unless necessary. The nurse should contact the provider to discuss using another antibiotic from a different class. Epinephrine and antihistamines are useful when patients are experiencing allergic reactions, depending on severity.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 407
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. The nurse is preparing to administer an antibiotic to a patient who has been receiving the antibiotic for 2 days after a culture was obtained. The nurse notes increased erythema and swelling, and the patient has a persistent high fever of 39 C. What is the nurses next action?
a. Administer the antibiotic as ordered.
b. Contact the provider to request another culture.
c. Discuss the need to add a second antibiotic with the provider.
d. Review the sensitivity results from the patients culture.
ANS: D
The sensitivity results from the patients culture will reveal whether the organism is sensitive or resistant to a particular antibiotic. The patient is not responding to the antibiotic being given, so the antibiotic should be held and the provider notified. Another culture is not indicated. Antibiotics should be added only when indicated by the sensitivity.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 408
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. The nurse is preparing to administer the first dose of an antibiotic to a patient admitted for a urinary tract infection. Which action is most important prior to administering the antibiotic?
a. Administering a small test dose to determine whether hypersensitivity exists
b. Having epinephrine available in the event of a severe hypersensitivity reaction
c. Monitoring baseline vital signs, including temperature and blood pressure
d. Obtaining a specimen for culture and sensitivity
ANS: D
To obtain the most accurate culture, the specimen should be obtained before antibiotic therapy begins. It is important to obtain cultures when possible in order to correctly identify the organism and help determine which antibiotic will be most effective. Administering test doses to determine hypersensitivity is sometimes done when there is a strong suspicion of allergy when a particular antibiotic is needed. Epinephrine is kept close at hand when there is a strong suspicion of allergy.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 408
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. A patient is admitted to the hospital for treatment of pneumonia after complaining of high fever and shortness of breath. The patient was not able to produce sputum for a culture. The nurse will expect the patients provider to order
a. a broad-spectrum antibiotic.
b. a narrow-spectrum antibiotic.
c. multiple antibiotics.
d. the pneumococcal vaccine.
ANS: A
Broad-spectrum antibiotics are frequently used to treat infections when the offending organism has not been identified by culture and sensitivity (C&S). Narrow-spectrum antibiotics are usually effective against one type of organism and are used when the C&S indicates sensitivity to that antibiotic. The use of multiple antibiotics, unless indicated by C&S, can increase resistance. The pneumococcal vaccine is used to prevent, not treat, an infection.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 403
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. The nurse is teaching a patient who will be discharged home from the hospital to take amoxicillin (Amoxil) twice daily for 10 days. Which statement by the nurse is correct?
a. Discontinue the antibiotic when your temperature returns to normal and your symptoms have improved.
b. If diarrhea occurs, stop taking the drug immediately and contact your provider.
c. Stop taking the drug and notify your provider if you develop a rash while taking this drug.
d. You may save any unused antibiotic to use if your symptoms recur.
ANS: C
Patients who develop signs of allergy, such as rash, should notify their provider before continuing medication therapy. Patients should be counseled to continue taking their antibiotics until completion of the prescribed regimen even when they feel well. Diarrhea is an adverse effect but does not warrant cessation of the drug. Before deciding to stop taking a medication due to a side effect, encourage the patient to contact the provider first. Patients should discard any unused antibiotic.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 407
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. The nurse is preparing to administer the first dose of intravenous ceftriaxone (Rocephin) to a patient. When reviewing the patients chart, the nurse notes that the patient previously experienced a rash when taking amoxicillin. What is the nurses next action?
a. Administer the drug and observe closely for hypersensitivity reactions.
b. Ask the provider whether a cephalosporin from a different generation may be used.
c. Contact the provider to report drug hypersensitivity.
d. Notify the provider and suggest an oral cephalosporin.
ANS: A
A small percentage of patients who are allergic to penicillin could also be allergic to a cephalosporin product. Patients should be monitored closely after receiving a cephalosporin if they are allergic to penicillin. There is no difference in hypersensitivity potential between different generations or method of delivery of cephalosporins.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 410
TOP: NURSING PROCESS: Assessment/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. The nurse is preparing to give a dose of a cephalosporin medication to a patient who has been receiving the antibiotic for 2 weeks. The nurse notes ulcers on the patients tongue and buccal mucosa. Which action will the nurse take?
a. Hold the drug and notify the provider.
b. Obtain an order to culture the oral lesions.
c. Gather emergency equipment to prepare for anaphylaxis.
d. Report a possible superinfection side effect of the cephalosporin.
ANS: D
The patients symptoms may indicate a superinfection and should be reported to the physician so it can be treated; however, the drug does not need to be held. It is not necessary to culture the lesions. The symptoms do not indicate impending anaphylaxis.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 408
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. The nurse is providing teaching to a patient who will begin taking a cephalosporin to treat an infection. Which statement by the patient indicates a need for further teaching?
a. I may stop taking the medication if my symptoms clear up.
b. I should eat yogurt while taking this medication.
c. I should stop taking the drug and call my provider if I develop a rash.
d. I will not consume alcohol while taking this medication.
ANS: A
Patients should take all of an antibiotic regimen even after symptoms clear to ensure complete treatment of the infection. Patients are often advised to eat yogurt or drink buttermilk to prevent superinfection. A rash is a sign of hypersensitivity, and patients should be counseled to stop taking the drug and notify the provider if this occurs. Alcohol consumption may cause adverse effects and should be avoided by patients while they are taking cephalosporins.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 403
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

13. The nurse is caring for a patient who takes low-dose erythromycin as a prophylactic medication. The patient will begin taking cefaclor for treatment of an acute infection. The nurse should discuss this with the provider because taking both of these medications simultaneously can cause which effect?
a. Decreased effectiveness of cefaclor.
b. Increased effectiveness of cefaclor.
c. Decreased effectiveness of erythromycin.
d. Increased effectiveness of erythromycin.
ANS: A
The interaction of cefaclor and erythromycin will produce a decrease in the action of the cefaclor.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 409
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

14. A patient is receiving high doses of a cephalosporin. Which laboratory values will this patients nurse monitor closely?
a. Blood urea nitrogen (BUN), serum creatinine, and liver function tests
b. Complete blood count and electrolytes
c. Serum calcium and magnesium
d. Serum glucose and lipids
ANS: A
Cefazolin will produce an increase in the patients BUN, creatinine, AST, ALT, ALP, LDH, and bilirubin.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 409
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

15. A patient will begin taking amoxicillin. The nurse should instruct the patient to avoid which foods?
a. Green leafy vegetables
b. Beef and other red meat
c. Coffee, tea, and colas
d. Acidic fruits and juices
ANS: D
Acidic fruits and juices should be avoided while the client is being treated with amoxicillin because amoxicillin can be irritating to the stomach. Stomach irritation will be increased with the ingestion of citrus and acidic foods. Amoxicillin may also be less effective when taken with acidic fruit or juice.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 405
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

16. The patient will begin taking penicillin G procaine (Wycillin).The nurse notes that the solution is milky in color. What action will the nurse take?
a. Call the pharmacist and report the milky color.
b. Add normal saline to dilute the medication.
c. Call the physician and report the milky appearance.
d. Administer the medication as ordered by the physician.
ANS: D
Penicillin G procaine (Wycillin) has a milky appearance; therefore, the appearance should not concern the nurse.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 406
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE

1. Which actions can contribute to bacterial resistance to antibiotics? (Select all that apply.)
a. Frequent use of antibiotics
b. Giving large doses of antibiotics
c. Skipping doses
d. Taking a full course of antibiotics
e. Treating viral infections with antibiotics
ANS: A, C, E
Frequent use of antibiotics increases the exposure of bacteria to an antibiotic and results in acquired resistance. Skipping doses of an antibiotic can lead to incomplete treatment of an infection, and the remaining bacteria may develop acquired resistance. Treating viral infections with antibiotics is unnecessary and may cause acquired resistance to develop from unneeded exposure to a drug. Infections adequately treated with an antibiotic do not result in resistance.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 403
TOP: NURSING PROCESS: Assessment/Analysis
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

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