The nurse is reviewing the culture results of a patient with an infection, and notes that the culture indicates a gram-positive organism. Which generation of cephalosporin is most appropriate for this type of infection?
Third-generation
First-generation
Fourth-generation
Second-generation
The Correct Answer is B
Choice A reason: Third-generation cephalosporins, like ceftriaxone, are effective against gram-negative bacteria and some gram-positive organisms but are not the primary choice for gram-positive infections. Their broader spectrum targets complex infections, while gram-positive organisms like Staphylococcus are better treated with first-generation cephalosporins, which are more specific.
Choice B reason: First-generation cephalosporins, like cefazolin, are most effective against gram-positive organisms, such as Staphylococcus and Streptococcus. They inhibit cell wall synthesis by binding to penicillin-binding proteins, providing excellent coverage for skin and soft tissue infections caused by gram-positive bacteria, making them the preferred choice.
Choice C reason: Fourth-generation cephalosporins, like cefepime, have a broad spectrum, including gram-negative and some gram-positive organisms. They are reserved for multidrug-resistant infections, not routine gram-positive infections, where first-generation cephalosporins are more targeted and sufficient, reducing the risk of resistance development.
Choice D reason: Second-generation cephalosporins, like cefuroxime, have balanced activity against gram-positive and gram-negative bacteria. They are less effective against gram-positive organisms compared to first-generation cephalosporins and are typically used for respiratory or mixed infections, not primarily for gram-positive infections.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Definitive therapy targets a confirmed infection with antibiotics chosen based on culture results. Prescribing antibiotics before a dental procedure for a heart condition aims to prevent infection, not treat an existing one, making this incorrect for endocarditis prophylaxis.
Choice B reason: Empiric therapy involves antibiotics for suspected infections without confirmed pathogens. Antibiotics before dental procedures in heart patients prevent endocarditis, not treat suspected infections. This is a preventive measure based on risk, not empiric treatment, making this incorrect.
Choice C reason: Supportive therapy addresses symptoms or supports other treatments, not infection prevention. Antibiotics before dental procedures in patients with heart conditions (e.g., valvular disease) prevent bacterial endocarditis, a specific prophylactic measure, not supportive care, making this an incorrect classification.
Choice D reason: Prophylactic antibiotic therapy prevents infections in high-risk patients, such as those with heart conditions (e.g., mitral valve prolapse) before dental procedures. It reduces the risk of bacterial endocarditis from transient bacteremia, aligning with guidelines for prophylaxis in susceptible individuals, making this correct.
Correct Answer is C
Explanation
Choice A reason: Amoxicillin, a penicillin antibiotic, inhibits bacterial cell wall synthesis and is commonly used for infections like otitis media. It is not associated with tendon rupture, as it lacks the mechanism affecting collagen or connective tissue. Its side effects include gastrointestinal upset and allergic reactions, not musculoskeletal issues.
Choice B reason: Clarithromycin, a macrolide antibiotic, inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit. It is used for respiratory infections but is not linked to tendon rupture. Its side effects include gastrointestinal disturbances and QT prolongation, with no known impact on tendon integrity or collagen metabolism.
Choice C reason: Ciprofloxacin, a fluoroquinolone, is associated with tendon rupture, particularly in the Achilles tendon. It may disrupt collagen synthesis and extracellular matrix integrity, increasing tendon vulnerability, especially in older adults or those on corticosteroids. This rare but serious side effect requires monitoring during therapy.
Choice D reason: Doxycycline, a tetracycline antibiotic, inhibits protein synthesis and is used for infections like acne or Lyme disease. While it can cause photosensitivity or gastrointestinal issues, it is not associated with tendon rupture. Its mechanism does not involve collagen disruption, unlike fluoroquinolones such as ciprofloxacin.
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