Chapter 07: Antibacterial Drugs That Disrupt the Bacterial Cell Wall Introductory Clinical Pharmacology 12th Edition by Susan M Ford

Introductory Clinical Pharmacology 12th Edition by Susan M Ford 1. A nurse suspects that a client receiving oral penicillin therapy is developing pseudomembranous colitis based on which assessment finding? a. Bloody diarrhea b. Pruritus c. Chills d. Hives Answer: A Rationale: Pseudomembranous colitis is a severe, life-threatening form of diarrhea that occurs when normal flora of the bowel is eliminated and replaced with C. difficile (C. diff) bacteria. It is manifested by bloody diarrhea. Pruritus and hives would suggest an allergic reaction. Chills could indicate a wide range of problems. Question Format: Multiple Choice Chapter: 7 Learning Objective: 1 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 87, Diarrhea 2. After completing several days of penicillin therapy, a client presents with new reports of inflamed oral mucous membranes and tongue and gum swelling. What is a priority action in regards to this new finding? a. Inspect mouth and gums regularly. b. Instruct client to avoid brushing teeth. c. Offer client a liquid diet. d. Instruct the client to gargle every 2 hours. Answer: A Rationale: The client is presenting with signs of a fungal superinfection. The nurse should regularly inspect the client's mouth and gums to assess the client's progress. The nurse should instruct the client to use a soft-bristled toothbrush. The client does not need to 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. Question Format: Multiple Choice Chapter: 7 Learning Objective: 5 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 87, Altered Oral Mucous Membranes 3. Before administering the first dose of a penicillin to the client, which assessment should the nurse perform as part of the preadministration assessment? a. Review of renal and hepatic function tests b. Inspection of client's stools c. Evaluation of client's lifestyle and diet d. General history of client's health Answer: D Rationale: Before administering the first dose of penicillin, the nurse should obtain and review the client's general health history, including any allergy history, a history of all medical and surgical treatments, a drug history, and the current symptoms of the infection. The client's stool is examined only after penicillin has been administered if the client has diarrhea. It is not required to evaluate the client's lifestyle and diet as part of the preadministration assessment for the first dose. Renal and hepatic function tests may be performed at intervals during penicillin therapy, usually not before it. Question Format: Multiple Choice Chapter: 7 Learning Objective: 2 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 85, Preadministration Assessment 4. A 26-year-old female client with a skin infection has been prescribed 400 mg ampicillin to be taken orally. Which instruction should the nurse include in the client 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. 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 client should adhere to the prescribed regimen as strictly as possible. Ampicillin and penicillin V may be taken without regard to meals. The client need not avoid use of skin care products when on penicillin therapy. Question Format: Multiple Choice Chapter: 7 Learning Objective: 5 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Teaching/Learning Reference: p. 88, Educating the Client and Family 5. A client undergoing penicillin therapy shows improvement and confirms feeling better. Which intervention is the nurse most likely to perform in such a situation? a. Instruct client to increase dietary intake. b. Inform the primary health provider immediately. c. Record assessments on client's chart. d. Inquire about any previous drug allergies. Answer: C Rationale: When the client shows and verbally confirms improved health, it should be recorded on the client's chart. If the condition of the client has improved, the client will show an increased appetite, but there is no need to instruct the client to increase dietary intake. The primary health provider need not be informed about the condition immediately unless the client shows signs of deterioration or complications. The nurse should inquire about previous drug allergies before the start of therapy. Question Format: Multiple Choice Chapter: 7 Learning Objective: 2 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 89, Evaluation 6. After taking penicillin as prescribed, a client shows signs of diarrhea and informs the nurse that there is blood in the stools. Which intervention should the nurse do next? a. Contact primary health provider immediately. b. Have the client consume yogurt with the next meal. c. Decrease fiber content in diet. d. Continue with prescribed regimen. Answer: A Rationale: If diarrhea is suspected, the nurse should notify the primary health care provider immediately. The nurse should wait for the primary health care provider's instructions before continuing with the prescribed regimen. Yogurt or buttermilk may help prevent fungal superinfections, but they will not help alleviate the client's condition at this stage. Changes in the diet are not recommended unless instructed by the primary health care provider. Question Format: Multiple Choice Chapter: 7 Learning Objective: 2 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 87, Diarrhea 7. A nurse is caring for a client who is receiving penicillin. The nurse would assess for which common adverse reaction? a. Inflammation of the tongue and mouth b. Altered oral mucous membranes c. Severe hypotension d. Sudden loss of consciousness Answer: A Rationale: Some of the common adverse effects of penicillin are glossitis (inflammation of the tongue), stomatitis (inflammation of the mouth), and gastritis (inflammation of the stomach). Unless the adverse effects are severe, the drug may be continued as prescribed and the nurse would intervene to help the client manage the common adverse reactions. Altered oral mucous membranes would suggest a possible fungal superinfection in the oral cavity, whereas severe hypotension and sudden loss of consciousness are signs of anaphylactic shock; these are not common adverse effects of penicillin and require immediate medical attention. Question Format: Multiple Choice Chapter: 7 Learning Objective: 1 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 81, Gastrointestinal System Reactions 8. A nurse is required to administer a parenteral form of penicillin to a client. Which intervention would be most appropriate for the nurse to do when preparing penicillin in parenteral form?