Nursing Pharm Ch52 Fluoroquinolones and Miscellaneous Antibacterials – Flashcards

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question
DNA replication is necessary for bacterial cell replication. One of the ways that antibacterials are effective is by inhibiting the DNA replication. Antibacterials often accomplish this by: 1. Encouraging the replication of the original DNA to form a new DNA strands. 2. Encouraging migration of the DNA strands to opposite sides of the cell. 3. Affecting the enzymes needed for DNA replication. 4. Assisting the supercoil to relax and unwind.
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3. A large number of enzymes are needed for DNA replication, and some of these enzymes are targets for antibiotics.
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A client has come to the health care provider's office with symptoms of a urinary tract infection (UTI). She states that she had no symptoms when she went to bed last night but woke this morning with severe burning with urination. A urine culture is completed and grows Escherichia coli. The client asks the nurse why these symptoms occurred so suddenly. The nurse's best response is: 1. "You probably had the symptoms for some time, but you didn't notice it until it became severe." 2. "The severity of your symptoms indicates a hygiene problem." 3. "Do you often have complaints of severe pain when you awaken?" 4. "The bacteria that caused your infection grow very rapidly, so it is possible you had no symptoms the night before."
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4. E. coli can replicate every 20 minutes, producing a billion cells in as little as 10 hours.
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A nursing instructor asks a group of students to explain the four-step process necessary for bacterial DNA replication. The student with the correct answer is the one who states that the four-step process is: 1. Relax, unwind, replicate, and migrate. 2. Migrate, replicate, unwind, and relax. 3. Unwind, relax, migrate, and replicate. 4. Replicate, unwind, relax, and migrate.
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1. The correct order of the four-step process is relax, unwind, replicate, and migrate.
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The nurse is explaining the four steps in DNA replication to a client who has developed MRSA. The nurse knows the client has understood the explanation when the client places the four steps of DNA replication in what order of occurrence? Click and drag the options below to move them up or down. Choice 1. Relax Choice 2. Unwind Choice 3. Replicate Choice 4. Migrate
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1,2,3,4. The first step in the DNA replication process is relax. The supercoil is relaxed by the enzyme DNA gyrase (also called topoisomerase II). The second step in DNA replication is unwind. After the supercoil is relaxed, the enzyme DNA helicase unwinds the two strands.: The third step in DNA replication is replicate. The enzyme DNA polymerase adds the precursor bases to replicate the original DNA and form new DNA strands. The fourth step is migrate. The two newly formed strands are interlocked until the enzyme topoisomerase IV frees them to migrate to opposite sides of the cell, where they are segregated into the two daughter cells.
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Many medications are developed in hopes of treating cancer. Many of these cancer drugs work by: 1. Encouraging cell replication. 2. Forming new DNA. 3. Assisting in the repair of DNA damage. 4. Substituting the drug into the DNA of the cancer cell.
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4. Cancer drugs can work by mimicking molecules that are mistakenly incorporated into newly formed DNA, preventing its replication.
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A nursing student asks a nurse how antibacterials work. The nurse outlines the process, explaining that many antibacterials work by blocking bacterial DNA replication. The nurse knows further teaching is needed when the student states: 1. "Drugs inhibit the availability of precursor bases or nucleotides." 2. "Drugs can interact or bind with DNA, preventing the uncoiling or relaxation process." 3. "Drugs can bind to enzymes of DNA replication, halting the formation of new DNA strands." 4. "Drugs repair bacterial DNA damage."
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4. Drugs that block bacterial DNA replication would block the repair of the DNA, not allow it.
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How do fluoroquinolones block bacterial DNA replication? 1. Fluoroquinolones inhibit the synthesis of precursor bases. 2. Fluoroquinolones bind to enzymes of bacterial DNA replication, blocking the relaxation and migration processes. 3. Fluoroquinolones inhibit topoisomerase I so that DNA cannot be repaired. 4. Fluoroquinolones bind with the enzyme DNA polymerase, blocking the replication of the DNA process.
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2. Fluoroquinolones bind to enzymes gyrase and topoisomerase, blocking the relaxation and migration processes of bacterial DNA replication.
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The nurse caring for a client with cancer is teaching the client about chemotherapeutic medications that affect bacterial DNA replication. Which medications should the nurse include in the teaching plan for this client? Select all that apply. 1. Cytarabine (Cytosar-U) 2. Fluorouracil (5-FU) 3. Daunorubicin (Cerubidine) 4. Bleomycin (Blenoxane) 5. Acyclovir (Zovirax)
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1,2,3,4. Cytarabine (Cytosar-U) is a chemotherapeutic agent that resembles nucleotides and is mistakenly incorporated into newly formed DNA strands, inhibiting replication. Fluorouracil (5-FU) is a chemotherapeutic agents that resembles nucleotides and is mistakenly incorporated into newly formed DNA strands, inhibiting replication. Daunorubicin (Cerubidine) is a highly toxic chemotherapeutic antibiotic that interacts with DNA to physically block replication. Bleomycin (Blenoxane) is a highly toxic chemotherapeutic antibiotic that interacts with DNA to physically block replication.
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A client has been diagnosed with a gram-negative bacterial infection and has been prescribed a fluoroquinolone for treatment of this infection. What step of the bacterial DNA replication process is most likely being affected by the use of this medication? 1. It inhibits the enzyme DNA polymerase necessary for DNA replication. 2. It binds to the enzyme topoisomerase IV, preventing the new DNA strands from migrating to opposite sides of the cell, thus preventing bacterial cell replication. 3. It inhibits the relaxation of the supercoil prior to the unwinding process, which terminates replication. 4. It inhibits the unwinding of the two strands of the supercoil, thus terminating replication.
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3. It is thought that fluoroquinolones fight gram-negative organisms by binding to DNA gyrase, thereby inhibiting the ability of the supercoil to relax, resulting in termination of bacterial cell replication.
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During pharmacology class, a nursing professor poses the following question: "We have learned that certain medications, such as fluoroquinolones, are effective because they inhibit bacterial DNA replication. Why don't these medications cause harm to the nonbacterial cells in the body?" Which of the following student nurses answered the question correctly? 1. Student B: "Medications such as fluoroquinolones do not appear to affect human DNA because human DNA is very similar to bacterial cell DNA." 2. Student D: "Human DNA is inherently healthier than bacterial DNA, so medications such as fluoroquinolones do not affect their replication." 3. Student C: "Medications such as fluoroquinolones don't appear to affect human DNA replication because of the difference between the enzymes needed for bacterial and human DNA replication." 4. Student A: "These medications protect healthy human cells while they attempt to disrupt bacterial DNA replication."
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3. It is thought that medications such as fluoroquinolones are very safe to use because they do not affect human DNA replication. This is because the enzymes that the medications affect in bacterial DNA replication are very different from the enzymes present in human DNA cells
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Fluoroquinolones are known to be effective against both gram-negative and gram-positive organisms. How is this possible? 1. Fluoroquinolones that are effective against gram-negative organisms block the enzyme topoisomerase IV, which stops the migration process of the two new strands to opposite sides of the cell. 2. Fluoroquinolones that are effective against gram-positive organisms block the enzyme DNA gyrase, which stops relaxation of the supercoil of the DNA. 3. Fluoroquinolones that are effective against gram-negative organisms block the enzyme DNA gyrase, and those effective against gram-positive organisms block topoisomerase IV. 4. All fluoroquinolones are effective against both gram-negative and gram-positive organisms. There is no difference in the way they block bacterial DNA replication.
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3. Fluoroquinolones attack gram-negative organisms by blocking DNA gyrase and attack gram-positive organisms by blocking topoisomerase IV.
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The nurse is caring for a client who has been prescribed a fluoroquinolone for the treatment of a respiratory infection. The nurse is explaining to the client that this class of medications affects DNA replication by inhibiting the ______ strands of DNA from migrating to the opposite sides of the cell therefore inhibiting division. Record your answer rounding to the nearest whole number.
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2. The fluoroquinolone antibiotics act on two enzymes in the DNA replication process. First, they bind to DNA gyrase, inhibiting its ability to relax the supercoiling of the bacterial DNA. When the replication enzymes reach an area still in a supercoiled state, replication terminates. A second mechanism is binding to topoisomerase IV. When this occurs, the two daughter DNA strands cannot migrate to opposite sides of the cell, and division cannot be completed
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A client's urine culture has come back showing that the infecting organism is resistant to ciprofloxacin (Cipro). The client is upset, saying that this medication has worked every other time. What explanation should the nurse give to the client concerning the development of resistance? 1. "There are a number of ways that an organism can become resistant to an antibacterial. Sometimes one of the enzymes involved in bacterial DNA replication mutates so that the medication is no longer effective." 2. "You must be infected with one of the new 'superbugs.' There aren't many antibacterials that will work against it." 3. "Don't worry; the doctor will give you levofloxacin (Levaquin) to take instead of ciprofloxacin (Cipro)." 4. "There are a number of ways that an organism can become resistant to an antibacterial. It probably happened because you didn't take your medication correctly the last time you took it."
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1. One of the ways that resistance occurs against fluoroquinolones is by a mutation to DNA gyrase, decreasing the effectiveness of the fluoroquinolone
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The nurse explains to a student nurse the mechanism by which resistance to fluoroquinolones occurs. The nurse knows the student requires further education when the student states: 1. "Bacterial cell walls become less permeable to the fluoroquinolones." 2. "Mutations to DNA helicase alter its ability to bind with fluoroquinolones." 3. "Mutations to DNA gyrase alter its ability to bind with fluoroquinolones." 4. "Certain bacteria have developed resistance pumps that remove fluoroquinolones from the cell."
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2. Fluoroquinolones do not bind with the enzyme DNA helicase. They bind with DNA gyrase, so resistance will occur from mutations to DNA gyrase.
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A client who has developed a resistance to levofloxacin (Levaquin) is concerned that getting rid of the infection will be impossible. What is the best response by the nurse to the client? 1. "The physician will admit you to the hospital and put you on an IV form of levofloxacin (Levaquin). You will not be resistant to that." 2. "The physician will take you off of the levofloxacin (Levaquin) for a few days and then have you start taking it again. Then it will be effective." 3. "The physician will switch you from levofloxacin (Levaquin) to ciprofloxacin (Cipro)." 4. "The physician will switch you to another type of antibacterial to which you haven't developed resistance."
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4. The physician will switch the client to another class of antibacterial to which the client has not developed resistance.
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The nurse is caring for a client who has developed an infection that is resistant to fluoroquinolone therapy. The nurse knows that this resistance is due to which reasons? Select all that apply. 1. A mutation to the DNA gyrase. 2. The development of resistant pumps within the bacteria. 3. The bacterial cell wall structure has become impermeable. 4. Mutations to DNA helicase alter its ability to bind with fluoroquinolones. 5. The client administered the medication improperly.
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1,2,3. Mutations to DNA gyrase can alter its ability to bind fluoroquinolones, thus rendering the drug less effective. Some bacteria have developed resistance pumps that remove fluoroquinolones from inside their cells, thus rending the drug less effective. Some bacteria have developed a cell wall structure that is less permeable to the drugs, thus rendering the drug less effective.
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A client has been hospitalized for a severe urinary tract infection (UTI). Ciprofloxacin IV (Cipro) is prescribed. Two days later, the symptoms have abated, and the client is discharged with a prescription for oral ciprofloxacin (Cipro). What characteristics of fluoroquinolones allow for this quick discharge from the hospital? 1. Fluoroquinolones given as IV are very expensive, and must be switched to oral administration as soon as possible to save the client money. 2. Fluoroquinolones have equal serum drug levels with either IV or oral administration, which allows for a smooth transition from IV to oral therapy. 3. Fluoroquinolones given as an IV infusion eradicate infection quickly so that the client can be discharged. 4. Fluoroquinolones are less toxic when given orally.
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2. The serum levels of oral and IV administration of fluoroquinolones are the same, allowing for a smooth transition from IV to oral therapy.
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Fluoroquinolones are very effective against both gram-negative and gram-positive organisms. Several of the drugs in this class have been discontinued from use. What adverse effects have caused the removal of these drugs from the market? 1. The development of dysrhythmias after administration of fluoroquinolones 2. The development of pathologic fractures after administration of fluoroquinolones 3. The development of insomnia after administration of fluoroquinolones 4. The development of severe phototoxicity after administration of fluoroquinolones
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1. Fluoroquinolones have been indicated as the cause of potentially fatal dysrhythmias after the administration of gatifloxacin and moxifloxacin. These two fluoroquinolones have been removed from the market.
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A 13-year-old client has been diagnosed with meningitis caused by Haemophilus influenzae type B. What drug is commonly prescribed to prevent this disease from occurring in individuals who had close contact with the client prior to the illness? 1. Metronidazole (Flagyl) 2. Daptomycin (Cubicin) 3. Rifampin (Rifadin) 4. Ciprofloxacin (Cipro)
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3. Rifampin is the drug of choice for prophylaxis of persons who have come in contact with clients with Haemophilus influenzae type B.
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The nurse is caring for a female client with an uncomplicated UTI that is being treated with ciprofloxacin hydrochloride (Proquin XR). The client asks the nurse how long she will need to take this medication. The nurse tells the client she will have to take the medication for _______days. *rounding to the nearest whole number*
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Answer: 3. Approved in 2005, Proquin XR contains only the hydrochloride salt and has been formulated to cause less nausea, vomiting, and diarrhea than other formulations. Proquin XR is administered for only 3 days and is only approved for uncomplicated UTI (acute cystitis).
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The nurse is administering ciprofloxacin to a client with acute cystitis. The nurse anticipates administering this drug to the client twice a day because the duration of action is ______ hours. *rounding to the nearest whole number*
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Answer: 12. The duration of action for ciprofloxacin is 12 hours; therefore, the nurse anticipates the need to administer the medication twice a day.
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The nurse is caring for a client who is taking ciprofloxacin for the treatment of acute cystitis. The nurse knows ciprofloxacin interacts with several other classes of medication and that it is important to assess the client's medication administration record for which classifications of medications? Select all that apply. 1. Anticoagulants 2. Antacids 3. Xanthines 4. Antibiotics 5. Antivirals
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1,2,3. Concurrent administration of ciprofloxacin with the anticoagulant warfarin may increase anticoagulant effects and result in bleeding due to the decreased metabolism of warfarin. Antacids may decrease the absorption of ciprofloxacin, thus causing decreased effectiveness of the antibiotic. Ciprofloxacin slows the hepatic metabolism of xanthines, including caffeine, theophylline, and theobromine. Theophylline levels may increase 15% to 30%.
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A client has been admitted to the hospital with a urinary tract infection (UTI). The health care provider has prescribed ciprofloxacin (Cipro) IV to be administered every 12 hours. What is the nurse's priority responsibility to this client? 1. Take a complete health history. 2. Start the IV and begin the ciprofloxacin administration. 3. Obtain vital signs. 4. Obtain a urine specimen for culture and sensitivity.
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4. The nurse must always obtain a culture and sensitivity before starting an antibacterial to be sure that the infecting organisms is sensitive to the antibacterial being used.
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The health care provider has prescribed ciprofloxacin (Cipro) for four clients. For which client should the nurse contact the health care provider for further clarification? 1. A 67-year-old male who has just completed taking another antibacterial for chronic sinusitis 2. A 21-year-old female who gave birth 8 weeks ago and is still breast-feeding 3. A 49-year-old female who is experiencing "hot flashes" related to the onset of menopause 4. A 19-year-old male who plays soccer for his college team
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2. Ciprofloxacin is contraindicated in clients who are pregnant or breast-feeding because the drug is secreted in breast milk, and crosses the placenta
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Which statement by a client who has received a prescription for ciprofloxacin (Cipro) indicates that further instruction by the nurse is needed? 1. "I will drink more coffee to make sure I get more fluids." 2. "I will make sure and wear sunscreen when I go outside to do my gardening." 3. "If my knees start hurting, I will call the doctor immediately." 4. "I won't take any antacids until I have finished this medication."
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1. Clients are advised to limit caffeine intake, not increase it, to decrease the chance of insomnia, nervousness, and anxiety.
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The nurse is preparing to administer a fluorquinolone medication to a client with a urinary tract infection. The nurse knows it is important to contact a health care provider immediately if which adverse effects occur? Select all that apply. 1. Severe diarrhea containing mucous 2. Decreased urine output 3. Nausea 4. Abdominal cramping 5. Headache
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1,2. Severe diarrhea, especially containing mucous, blood, or pus, should be reported immediately. Decreased urine output should be reported immediately.
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A 16-year-old client has been prescribed metronidazole (Flagyl) for treatment of a sexually transmitted infection. This client has been seen in the clinic four times in the last 6 months for the same condition. The client just wants the nurse to give her the medication so that she can go home. What would be considered the priority nursing diagnosis for this client? 1. Noncompliance (antimicrobial therapy) related to therapeutic regimen 2. Diarrhea related to effects of drug therapy 3. Risk for Infection 4. Knowledge Deficit (infection) related to disease process, transmission, and drug therapy
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4. This client is exhibiting deficient knowledge about STIs because she has her fourth infection in the last 6 months.
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A client who has been taking ciprofloxacin (Cipro) calls the health care provider to report that he has begun having loose stools. What instructions would be most helpful to this client? 1. Take a dose of antidiarrheal medication after every loose stool. 2. Do nothing until you have 8-10 loose stools per day. 3. Drink at least one glass of buttermilk every day. 4. Limit the amount of water you drink to three glasses a day.
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3. Clients are often advised to consume cultured daily products such as yogurt or buttermilk to help maintain and restore normal intestinal flora
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The nurse is explaining the four steps in DNA replication to a client who has developed MRSA. The nurse knows the client has understood the explanation when the client places the four steps of DNA replication in what order of occurrence? Click and drag the options below to move them up or down. Choice 1. Relax Choice 2. Unwind Choice 3. Replicate Choice 4. Migrate
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1,2,3,4. The first step in the DNA replication process is relax. The supercoil is relaxed by the enzyme DNA gyrase (also called topoisomerase II). The second step in DNA replication is unwind. After the supercoil is relaxed, the enzyme DNA helicase unwinds the two strands.: The third step in DNA replication is replicate. The enzyme DNA polymerase adds the precursor bases to replicate the original DNA and form new DNA strands. The fourth step is migrate. The two newly formed strands are interlocked until the enzyme topoisomerase IV frees them to migrate to opposite sides of the cell, where they are segregated into the two daughter cells.
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A client has been diagnosed with a skin infection. The infective organism has been identified as MRSA, and daptomycin (Cubicin) IV has been prescribed. If this client complains of muscle pain, what will be the priority nursing intervention? 1. Place the affected extremity in a resting position. 2. Place a warm compress on the affected muscles. 3. Encourage the client to exercise the client and work out the soreness. 4. Obtain a blood specimen for a CPK.
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4. Because myopathy is a possibly adverse effect of daptomycin, the nurse should immediately obtain a CPK for evidence of muscle damage.
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The nurse is preparing to discharge a client with a urinary tract infection (UTI) from the urgent care center. The nurse tells the client to call the health care provider is the current fever does not diminish below ____ degrees Celsius within 3 days. *rounding to one decimal place
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Answer: 37.8. Teach the client to report a fever that does not diminish below 37.8°C (100°F) or per the parameters set by the health care provider within 3 days, increasing signs and symptoms of infection, or symptoms that remain after taking the entire course of the antibacterial drug.
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