A nurse is caring for a client with asthma who is prescribed metoprolol. The nurse should monitor the client for which of the following?

Choice A reason: Ancef (ciprofloxacin) is not the correct answer for the nurse who anticipates administering a broad-spectrum antibiotic to a client diagnosed with a beta lactam resistant bacteria. Ancef is the brand name of cefazolin, which is a firstgeneration cephalosporin, a subclass of beta lactam antibiotics. Cefazolin is effective against gram-positive bacteria, but has limited activity against gram negative bacteria and anaerobes. Cefazolin is also susceptible to beta-lactamase enzymes, which are produced by some bacteria to degrade beta lactam antibiotics and confer resistance. The nurse should avoid using Ancef or any other beta lactam antibiotic for a client with a beta lactam resistant bacteria.

Choice B reason: Merrem (meropenem) is the correct answer for the nurse who anticipates administering a broad-spectrum antibiotic to a client diagnosed with a beta lactam resistant bacteria. Merrem is the brand name of meropenem, which is a carbapenem, a subclass of beta lactam antibiotics. Meropenem is effective against a wide range of bacteria, including gram-positive, gram negative, and anaerobic bacteria. Meropenem is also resistant to most beta-lactamase enzymes, except for metallo-beta-lactamase’s, which are rare and can be detected by laboratory tests. The nurse should consider using Merrem or another carbapenem for a client with a beta lactam resistant bacteria, unless they have a history of allergy or intolerance to beta lactam antibiotics .

Choice C reason: Flagyl (metronidazole) is not the correct answer for the nurse who anticipates administering a broad spectrum antibiotic to a client diagnosed with a beta lactam resistant bacteria. Flagyl is the brand name of metronidazole, which is a nitroimidazole antibiotic. Metronidazole is effective against anaerobic bacteria and some protozoa, but has no activity against aerobic bacteria. Metronidazole is not a beta lactam antibiotic, and it is not affected by beta-lactamase enzymes. However, metronidazole is not a broad spectrum antibiotic, and it is not suitable for treating infections caused by aerobic bacteria, which are more common than anaerobic bacteria. The nurse should use Flagyl only for specific indications, such as bacterial vaginosis, trichomoniasis, or Clostridioides difficile infection .

Choice D reason: Zosyn (piperacillin tazobactam) is not the correct answer for the nurse who anticipates administering a broad-spectrum antibiotic to a client diagnosed with a beta lactam resistant bacterium. Zosyn is the brand name of piperacillin tazobactam, which is a combination of penicillin, a subclass of beta lactam antibiotics, and a beta-lactamase inhibitor. Piperacillin is effective against some gram-positive and gram-negative bacteria, but it is susceptible to beta-lactamase enzymes. Tazobactam is a compound that binds to and inhibits some beta-lactamase enzymes, thereby protecting piperacillin from degradation and extending its spectrum of activity. However, piperacillin tazobactam is not effective against all types of beta-lactamase enzymes, especially those that are encoded by plasmids and can be transferred between bacteria. The nurse should not use Zosyn or any other beta lactam/beta-lactamase inhibitor combination for a client with a beta lactam resistant bacterium unless the specific type of beta-lactamase is known and susceptible to the inhibitor.

Choice A reason: "Antibiotics are administered to treat viral infections." is an incorrect statement for the nurse to make when providing teaching for a client who has a new prescription for an antibiotic. Antibiotics are medicines that fight bacterial infections in people and animals. They work by killing the bacteria or by making it hard for the bacteria to grow and multiply. Antibiotics do not work against viruses, such as those that cause colds, flu, or COVID19. Taking antibiotics when they are not needed can cause harm and increase the risk of antibiotic resistance¹.

Choice B reason: "Bloody stools are expected while taking antibiotics." is an incorrect statement for the nurse to make when providing teaching for a client who has a new prescription for an antibiotic. Bloody stools are not a normal or expected side effect of antibiotics. They can indicate a serious condition, such as intestinal bleeding, ulcerative colitis, or Clostridioides difficile infection. C. diff is a type of bacteria that can cause severe diarrhea, abdominal pain, and bloody stools. It can occur when antibiotics disrupt the normal balance of bacteria in the gut and allow C. diff to grow and produce toxins. The nurse should instruct the client to report any signs of bloody stools or severe diarrhea to the health care provider immediately.

Choice C reason: "Take the entire course of antibiotics as prescribed." is a correct statement for the nurse to make when providing teaching for a client who has a new prescription for an antibiotic. Taking the entire course of antibiotics as prescribed is important to ensure that the infection is completely treated and to prevent the bacteria from becoming resistant to the antibiotic. Stopping the antibiotic too soon or skipping doses can allow some bacteria to survive and multiply, which can cause the infection to come back or spread to other parts of the body. The nurse should also remind the client to follow the instructions on the medication label or the prescriber's order regarding the dosage, frequency, and duration of the antibiotic therapy.

Choice D reason: "Discontinue the medication when you feel better." is an incorrect statement for the nurse to make when providing teaching for a client who has a new prescription for an antibiotic. Discontinuing the medication when the client feels better is not advisable, as it can lead to incomplete treatment and antibiotic resistance. Feeling better does not mean that the infection is gone or that the bacteria are all killed. The client should continue to take the antibiotic until the end of the prescribed course, even if they have no symptoms or feel better. The nurse should also advise the client to contact the health care provider if they have any questions or concerns about the antibiotic or if they experience any side effects or allergic reactions.