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A nursing instructor is preparing a class about cephalosporins for a group of nursing students. When describing progression from first-generation to fourth-generation cephalosporins, which of the following would the instructor include as the result? Select all that apply.
- A. An increase in the sensitivity of gram-negative microorganisms
- B. A decrease in the sensitivity of gram-negative microorganisms
- C. An increase in the sensitivity of gram-positive microorganisms
- D. A decrease in the sensitivity of gram-positive microorganisms
- E. An increase in the sensitivity of viral microorganisms
Correct Answer: A,D
Rationale: In general, progression from first-generation to fourth-generation cephalosporins shows an increase in the sensitivity of gram-negative microorganisms and a decrease in the sensitivity of gram-positive microorganisms.
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A patient who has been on penicillin therapy for several days has developed inflamed oral mucous membranes and swelling in the tongue and the gums. The primary health care provider has diagnosed it as a fungal superinfection of the oral cavity resulting in impaired oral mucous membranes. Which of the following interventions should the nurse perform?
- A. Inspect mouth and gums regularly.
- B. Instruct patient to avoid brushing teeth.
- C. Offer patient a liquid diet.
- D. Instruct the patient to gargle every 2 hours.
Correct Answer: A
Rationale: The nurse should regularly inspect the patient's mouth and gums to assess the patient's progress. The nurse should instruct the patient to use a soft-bristled toothbrush. The patient need not follow a liquid diet; a nonirritating soft diet can be recommended. Gargling every 2 hours may not help relieve the symptoms and may even aggravate the existing condition.
After teaching a group of students about antibacterial drugs that disrupt the bacterial cell wall, the instructor determines that the teaching was successful when the students identify which of the following as an example of a carbapenem? Select all that apply.
- A. Vancomycin
- B. Imipenem-cilastatin
- C. Meropenem
- D. Aztreonam
- E. Ceftriaxone
Correct Answer: B,C
Rationale: Carbapenems include imipenem-cilastatin and meropenem. Vancomycin and aztreonam are classified as miscellaneous drugs that disrupt the bacterial cell wall. Ceftriaxone is a third-generation cephalosporin.
A 26-year-old female patient with a skin infection has been prescribed 400 mg ampicillin to be taken orally. Which of the following instructions should the nurse include in the patient teaching plan?
- A. If a dosage is missed, increase the next dosage to meet the daily quota.
- B. Ampicillin will reduce the effectiveness of birth control pills.
- C. Take drug on an empty stomach, an hour before or 2 hours after meals.
- D. Avoid use of skin care products, like moisturizers, when on penicillin therapy.
Correct Answer: B
Rationale: Ampicillin (also penicillin V) reduces the effectiveness of birth control pills. Increasing a dosage to compensate for a missed dosage should not be done. The patient should adhere to the prescribed regimen as strictly as possible. Ampicillin and penicillin V may be taken without regard to meals. The patient need not avoid use of skin care products when on penicillin therapy.
A nurse suspects that a client who is receiving a cephalosporin and has ingested alcohol may be experiencing a disulfiram-like reaction based on assessment of which of the following? Select all that apply.
- A. Flushing
- B. Respiratory difficulty
- C. Hypertension
- D. Vomiting
- E. Sweating
Correct Answer: A,B,D,E
Rationale: Flushing, throbbing in the head and neck, respiratory difficulty, vomiting, sweating, chest pain, and hypotension are symptoms a nurse might observe in a client having a disulfiram-like reaction with administration of a cephalosporin and alcohol.
A patient undergoing penicillin therapy shows improvement and states that he is feeling better. Which of the following interventions is the nurse most likely to perform in such a situation?
- A. Instruct patient to increase dietary intake.
- B. Inform the primary health provider immediately.
- C. Record assessments on patient's chart.
- D. Inquire about any previous drug allergies.
Correct Answer: C
Rationale: When the patient declares that he is feeling better and is also showing improved health, it should be recorded on the patient's chart. If the condition of the patient has improved, the patient will show an increased appetite, but there is no need to instruct the patient to increase dietary intake. The primary health provider need not be informed about the condition immediately unless the patient shows signs of deterioration or complications. The nurse should inquire about previous drug allergies before the start of therapy.