Pharmacology

A client has recently received a diagnosis of depression and has been prescribed citalopram. The nurse is providing health education and the client states, "I'm relieved to have some medication to help with my mood, because it's my daughter's wedding next weekend and I'll be feeling better." What is the nurse's best response?

"Antidepressants will help your mood but it usually takes a few weeks to experience the benefits." Explanation: Peak benefits of SSRIs can take up to six weeks to be realized, and a client is unlikely to notice an effect within a few days. Antidepressants improve mood, not just energy and concentration.

A client is prescribed an anxiolytic agent. What would be most important for the nurse to include in the teaching?

"Be sure not to stop the drug abruptly." Explanation: Although taking the drug with meals, increasing fiber intake (to prevent constipation), and using additional measures to promote relaxation would be helpful instructions, it would be most important for the nurse to warn the client not to stop the drug abruptly. There is a risk for withdrawal if anxiolytics, both benzodiazepines and barbiturates, are stopped abruptly.

CHAPTER 55 A client has been taking fluoxetine (Prozac) for the last ten days. Today the client is reporting not feeling any better. What is the nurse's best response to this client?

"It may take another two to three weeks before the medication is completely effective." Explanation: Fluoxetine may take up to four weeks to be completely effective. It would not be appropriate for the nurse to ask the healthcare provider to change the medication, and the client has not given any indication of suicidal ideation.

A health care provider writes an order for a client to receive levothyroxine 0.2 mg, but 100-mcg tablets are supplied. The nurse would administer _________ tablets to the client.

2

The nurse is preparing to administer cefadroxil 1 g PO. The medication is supplied in 500-mg tablets. How many tablets should the nurse administer?

2

A client is receiving an SSRI. The nurse would inform the client that the full benefits of the drug may not occur for which time period?

4 weeks Explanation: It may take up to 4 weeks before the full effect of an SSRI is noted.

Which of the following would a nurse identify as being classified as a macrolide?

Azithromycin Explanation: Azithromycin is a macrolide. Gentamicin is an aminoglycoside. Doxycycline is a tetracycline. Cephalexin is a cephalosporin.

The client has been taking levofloxacin IV since admission 12 hours ago for a urinary tract infection. The nurse assesses the client's temperature at 99.8ºF. What is the nurse's best response? Administer an antipyretic. Notify the health care provider. Administer an extra dose of levofloxacin. Continue to monitor vital signs.

Continue to monitor vital signs. Explanation: The provider should be notified if the client's temperature is greater than 101ºF. The nurse cannot discontinue or administer additional doses without a provider's order. The body's normal defense to infection is an elevated temp until it reaches 101 degrees. Only then would an antipyretic be given if ordered.

Rifaximin (Xifaxan) is effective to treat traveler's diarrhea from which of the following organisms?

Escherichia coli Explanation: Rifaximin (Xifaxan) is a miscellaneous antibiotic and is used to treat E. coli. It cannot be used to treat C. jejuni. Effectiveness against Shigella and Salmonella is unknown.

A 22-year-old female patient has been prescribed erythromycin. What is essential for the nurse to assess to minimize the possible risk of undesired outcome of this therapy?

If the patient is sexually active Explanation: Erythromycin can decrease the effectiveness of contraceptives. The nurse has to first find out if the patient is sexually active; if so, then the patient needs to know about the potential decreased effectiveness of any birth control pill. Erythromycin is not given by self-injection. Irritable bowel syndrome does not affect the medication. The nurse cannot assess compliance prior to administration.

A nurse is teaching a client how to properly administer fosfomycin. The nurse determines the session is successful when the client correctly points out they will administer the drug in which manner? Ingest the drug immediately after mixing with water. Administer the drug on an empty stomach. Administer the drug every 3 hours. Dissolve the drug in 90-120 mL of hot water.

Ingest the drug immediately after mixing with water. Explanation: The nurse should instruct the client to take the drug immediately after mixing it with water. Fosfomycin, which comes in dry form, should be dissolved in 90-120 mL water, but not hot water. The nurse should instruct the client to take the drug with food to prevent gastric upset, which occurs with the administration of fosfomycin. It also comes in a 3-gram, one-dose packet.

The health care provider suspects a client may be infected with an antibiotic-resistant pathogen. The nurse caring for this client knows that what course of action is best used to determine whether this type of pathogen is present?

Perform culture and susceptibility tests. Explanation: Before prescribing an antibiotic, the health care provider should review culture and susceptibility reports and local susceptibility patterns to determine if an antibiotic-resistant pathogen is present in the client. Complete blood counts and electrolyte values are standard procedure lab tests. Spinal fluid checks are performed to detect anomalies such as meningitis.

A client with depression is prescribed venlafaxine. Which action will the nurse take when the client is unable to swallow the extended-release capsule?

Sprinkle the contents on applesauce. Explanation: Venlafaxine is a serotonin-norepinephrine reuptake inhibitor that is a standard first-line treatment for depression. The medication should be taken with food to decrease adverse gastrointestinal effects. For clients who are unable to swallow extended-release capsules, the capsule can be opened and sprinkled on applesauce and swallowed whole. The capsules and their contents should not be crushed, chewed, or dissolved in water.

A nurse is caring for a client who is prescribed multiple medications. Which clients are most likely to have adverse drug reactions?

clients who are very young or very old

The nurse understands that an admission assessment is completed to accomplish what goal?

collect data

A nurse is caring for a client who is receiving alprazolam. The nurse would be alert for which symptom as an initial adverse reaction with this drug?

headache Explanation: The nurse should assess for headache as the initial adverse reaction in the client after administering alprazolam. Heartburn and anorexia are not adverse reactions commonly observed. This medication relieves anxiety.

The nurse is caring for a client with ulcerative colitis who is taking sulfasalazine. What instruction will the nurse give this client?

"Expect your urine to turn yellow-orange." Explanation: Clients who take sulfasalazine should expect for their urine to turn yellow-orange while on the medication.

Miss Martin, a 55-year-old woman admitted with chronic obstructive pulmonary disease, is being discharged from the hospital. She is prescribed lorazepam at home for anxiety. The nurse is reviewing information with the client about this medication. Which statement by the client would indicate the need for additional teaching?

"I should take the medication first thing in the morning, every day." Explanation: Lorazepam, like other benzodiazepines, is generally well tolerated, with few adverse effects. Mild drowsiness is common but transient, occurring in the first few days of therapy and then dissipating. Ataxia and confusion may also occur, especially in older adults and in debilitated clients. Dose adjustments should be made if these effects persist.

A client is prescribed a 12.5-mg dose of metoprolol for the treatment of high blood pressure. The nurse should administer how many 25-mg tablets?

0.5

A pediatric nurse is caring for a child who weighs 42 lbs. The health care provider has ordered methylprednisolone sodium succinate (Solu-Medrol), 0.03mg/kg/day IV in normal saline. How many milligrams should the nurse prepare to give?

0.6

The health care provider has ordered 30 mg of Demerol IM for relief of a severe migraine headache. The package insert reads meperidine hydrochloride (Demerol) 50 mg/mL. How many milliliters would the nurse inject?

0.6

A client asks the nurse about drinking cranberry juice to prevent UTIs. The nurse informs the client that it is safe to use, suggesting an intake of which amount daily?

4-8 oz Explanation: Cranberry juice is safe for use as a food and for urinary tract health. The recommended dosage is 4-8 ounces of juice or 9-15 capsules (400-500 mg) per day.

An older adult client is prescribed a sedative for the treatment of insomnia. The nurse would suspect that the client is experiencing an adverse reaction to the drug based on assessment of which of the following?

Confusion Explanation: The nurse should look for signs of confusion in an older adult client when monitoring the effects of the administered drug. Headache, stress, and anxiety are causes of insomnia.

A nurse is providing discharge instructions for a client who is postoperative following inner maxillary fixation with wiring. Which of the following information should the nurse include?

Cut the wiring if emesis occurs. Inner maxillary fixation involves wiring of the teeth to support the fractured jaw by holding the jawbones together. The wires are left in place until the fracture is healed. To preserve the client's airway, the nurse should instruct the client to have wire cutters available to immediately cut wiring if emesis occurs. The client should return to the provider as soon as possible for re-wiring.

The nurse should recommend what action to a group of older adults in order to reduce their risk of recurrent urinary tract infections?

Drink 2 to 3 L of fluid daily. Explanation: Many activities are necessary to help decrease bacteria in the urinary tract (e.g., hygiene measures, proper diet, forcing fluids), to facilitate the treatment of UTIs, and help the urinary tract anti-infective be more effective. Forcing fluids increases the amount of urine that is excreted and prevents urine from sitting in the bladder. It is helpful to keep the urine acidic, not alkaline and avoid sitting in water. The importance of cleansing is to cleanse from front to back. The use of sterile wipes is not necessary.

A nurse is caring for a patient with depression. Which symptom should the nurse closely monitor for in the patient?

Extreme sadness Explanation: The nurse should monitor the patient for extreme sadness because this is a symptom of depression. Drowsiness is an adverse effect of most antidepressants. Severe headache and dilated pupils are the symptoms of hypertensive crisis.

Which of the following drugs would be classified as an aminoglycoside?

Gentamicin Explanation: Gentamicin is classified as an aminoglycoside. Levofloxacin is a fluoroquinolone; clarithromycin is a macrolide; and cefaclor is a cephalosporin.

A nurse should recognize what as a metric system unit? (Select all that apply.) Teaspoon Gram Milliliter Kilogram Dram

Gram Milliliter Kilogram

A nurse is caring for a client who is in skeletal traction following a femur fracture. The nurse finds the client has slid down toward the foot of the bed and the traction weight is resting on the floor. Which of the following actions should the nurse take?

Have the client use a trapeze to pull himself up while ensuring the weight hangs freely. The nurse should ensure that traction weight is hanging freely. The client can use an overhead trapeze bar to move up in bed, or the nurse can assist the client up, making sure to maintain proper alignment of the extremity.

A client who reports being unable to sleep is prescribed a hypnotic. The nurse explains that the insomnia may be related to which factors? Select all that apply. Change of diet Lack of activity Hospitalization Stress Chronic pain

Hospitalization Stress Chronic pain Explanation: Insomnia may be caused by lifestyle changes, such as a new job, moving to a new town, or returning to school; jet lag; chronic pain; headaches; stress; anxiety; or hospitalization. A change of diet or lack of activity is not noted to cause insomnia.

The nurse is preparing to teach a client about an anxiolytic which was recently prescribed. When discussing potential adverse reactions which instructions should the nurse prioritize? Increase fiber intake. Stop taking the drug. Increase fluid intake. Take the drug on an empty stomach. Ask to have the drug given by injection.

Increase fiber intake. Increase fluid intake. Explanation: Clients receiving an anxiolytic should be advised to increase fluid and fiber intake to address constipation. The drug should not be stopped suddenly or changed to an injectable form. Taking the drug on an empty stomach may lead to GI upset.

A patient with acne vulgaris was administered macrolides, after which the patient developed diarrhea. What nursing intervention should the nurse perform in this case?

Inspect stools for blood or mucus. Explanation: The nurse should inspect all stools for blood or mucus. Allergy history and signs of infection are obtained in the pre-administration assessment. Urine output is measured in case of renal dysfunctions.

A female client is diagnosed with hepatitis C as well as a urinary tract infection. The organism is sensitive to tetracycline. Why is the health care provider reluctant to order tetracycline in a client with hepatic impairment?

It slows drug elimination.

A nurse is preparing an in-service presentation about hypnotics. Which factor would the nurse plan to include?

Most likely administered at bedtime Explanation: A hypnotic is a drug that induces drowsiness or sleep, meaning it allows the client to fall asleep and stay asleep. Hypnotics are given at night or bedtime. A sedative is a drug that produces a relaxing, calming effect. Sedatives are usually given during daytime hours, and although they may make the client drowsy, they usually do not produce sleep.

The client has been prescribed a drug that must be taken on an empty stomach. The nurse knows that to administer a medication on an empty stomach, it is given in which way?

One hour prior to a meal or two hours after the meal Explanation: When administering medication on an empty stomach, it should be given one hour prior to a meal or two hours after the meal. The other options are inappropriate.

Following a thorough health history and assessment, a client's health care provider has diagnosed the client with depression. The nurse should anticipate that the client will likely be prescribed what classification of antidepressant?

Selective serotonin reuptake inhibitor Explanation: SSRIs are the most commonly prescribed antidepressants, due to their effectiveness and relatively low levels of adverse effects.

A client who was previously taking paroxetine is being switched to phenelzine due to a lack of response. The nurse would expect that the phenelzine will be started at which time?

Several weeks after stopping the paroxetine Explanation: Paroxetine, a SSRI, and phenelzine, an MAOI, should not be given together because of the risk for serotonin syndrome. At least 2 weeks and up to 6 weeks should be allowed between the use of the two drugs when switching from one to the other.

A patient has been prescribed oral tetracycline for the treatment of acne. Which of the following must the nurse include in the patient teaching plan?

Take the drug on an empty stomach. Explanation: Oral preparations of tetracycline should be administered on an empty stomach with a full glass of water to maximize absorption. Tetracycline is not absorbed effectively if taken with food, dairy products, or immediately after meals.

Your client was diagnosed with rheumatic heart fever. Which of the following medications would NOT be prescribed for this disease?

Tetracycline Explanation: Tetracycline does not prevent rheumatic fever. In addition, it should not be substituted for penicillin in any serious staphylococcal infection because microbial resistance commonly occurs.

A health care provider is deciding what medication to prescribe for a client with an upper respiratory infection. What principles guide the provider's decision? Select all that apply. The client's ability to tolerate the drug Other drugs the client is taking daily Medication cost Available in generic formulation Resistance of the bacteria

The client's ability to tolerate the drug Other drugs the client is taking daily Resistance of the bacteria

A patient is to begin taking tobramycin (Nebcin) for a nosocomial infection. Which of the following assessments should the nurse prioritize?

The peak and trough blood levels Explanation: Peak and trough levels should be closely monitored with serious infections being treated with tobramycin. The patient's blood pressure, diet, weight, and other medications would be important to know and necessary for the plan of care, but are secondary to serum levels.

What is the major reason that monoamine oxidase inhibitors (MAOs) are rarely used in clinical practice today?

They may cause dangerous interactions with some foods and drugs. Explanation: MAO inhibitors are rarely used in clinical practice today, mainly because they may interact with some foods and drugs to produce severe hypertension and possible heart attack or stroke. Foods that interact contain tyramine, a monoamine precursor of norepinephrine.

A nurse is caring for a client who had a fiberglass cast placed on her left arm several hours ago and now reports itching under the cast. Which of the following actions should the nurse plan to take?

Use a hair dryer on a cool setting to blow air into the cast. The nurse should provide relief for the report of itching by blowing cool air into the cast using a hair dryer on a cool setting or an empty 60-mL plunger syringe.

What statement should a nurse use to plan a client assessment for the characterizations associated with major depression?

an impaired ability to function in activities and relationships Explanation: Major depression is associated with impaired ability to function in usual activities and relationships. It is not characterized by a lack of response to reason or a deficiency of epinephrine. A lack of self-efficacy and self-advocacy may exist, but this is not a central characteristic of the illness.

The client reports using an over-the-counter (OTC) drug to treat insomnia. What classification of OTC medications is often used for this purpose?

antihistamines Explanation: People use over-the-counter medications as sleep aids; these medications include antihistamines alone or in combination with pain relievers. The other drugs lack the sedative properties.

The primary health care provider has prescribed mafenide for a client with second-degree burns. The nurse would be alert for which effect as the most frequent adverse reaction associated with the topical application of mafenide on the affected area?

burning sensation during applicationburning sensation during application Explanation: The nurse should assess for a burning sensation or pain during application of mafenide. Skin turning yellow or urine taking on an orange hue is associated with sulfasalazine, not mafenide. The risk of Stevens-Johnson syndrome is present only for sulfonamides that are taken orally, not for topical sulfonamide preparations.

Following an extensive diagnostic workup, a 20-year-old man has been diagnosed with bipolar disorder and begun lithium therapy. The nurse's priority assessment in the care of the patient is

careful monitoring of the patient's serum lithium levels. Explanation: In order to prevent the risk of lithium toxicity, it is imperative to closely monitor the patient's lithium levels, especially near the initiation of therapy. This is priority over neurological, renal, or hepatic assessments, though each may be indicated. Electrolyte deficiencies are not a common consequence of lithium therapy.

The nurse is providing health education for a client who has been prescribed a benzodiazepine. What adverse effect should the nurse discuss in the teaching?

dependence Explanation: Benzodiazepines carry a significant risk for dependence. They do not cause suicidality, personality changes, or insomnia.

A client diagnosed with Chlamydia is allergic to penicillin. What medication could be used as a substitute for penicillin in this situation?

erythromycin Explanation: Erythromycin is used as a penicillin substitute in clients who are allergic to penicillin and for prevention of rheumatic fever, gonorrhea, syphilis, pertussis, and chlamydial conjunctivitis in genitourinary infections caused by Chlamydia trachomatis and intestinal amebiasis caused by Entamoeba histolytica. None of the other options are typically used as a substitute to account for an allergy to penicillin when treating chlamydia.

In the metric system, what is the unit of weight?

gram

Because aminoglycosides are poorly absorbed from the GI tract, they are useful in treating which condition? Select all that apply. prevention of abdominal infection from bowel surgery Crohn disease otitis media hepatic coma tonsillitis

hepatic coma prevention of abdominal infection from bowel surgery

A nurse is administering a prescribed dose of chlordiazepoxide to a client. The nurse should closely assess the client for what adverse reaction?

respiratory depression Explanation: Chlordiazepoxide may have profound central nervous system (CNS) effects, including respiratory depression, and the nurse must assess accordingly. Urinary retention, ITP, and esophageal bleeding have not been noted.

A client will have bowel surgery in the morning. The health care provider orders 500 mL of GoLytly PO starting at 5 PM this evening. What would this amount be in liters?

½

A nurse is discussing the difference between rheumatoid arthritis (RA) and osteoarthritis with a newly licensed nurse. Which of the following information should the nurse include about osteoarthritis?

"Osteoarthritis can impair a joint on a single side of the body." The nurse should identify unilateral joint involvement as a finding of osteoarthritis. A client who has RA experiences symmetrical joint impairment.

A client who is receiving a benzodiazepine asks the nurse about having a dry mouth. Which suggestion would the nurse include in the teaching plan for this client?

"Sucking on hard sugarless candy might help you." Explanation: For dry mouth, the nurse should suggest sucking on hard, sugarless candies or chewing sugarless gum. Frequent sips of water would also help, but drinking 8 ounces of water every 2 hours could lead to fluid overload. Eating green leafy vegetables would help with constipation. Changing positions slowly would be appropriate if the client reported dizziness or lightheadedness.

The health care provider has ordered 35 mg of Demerol IM for relief of a severe migraine headache. The package insert reads meperidine hydrochloride (Demerol) 50 mg/mL. How many milliliters would the nurse administer?

0.7

The health care provider orders eszopiclone (Lunesta) for a male client as a treatment for intermittent insomnia. The client states that he feels the prescription works well as a sleep aid, but he is having difficulty with short-term memory loss. What is this client experiencing?

An adverse reaction Explanation: Eszopiclone (Lunesta): Adverse reactions include behavior changes such as reduced inhibition, aggression or bizarre behavior, worsening depression and suicidal ideation, hallucinations, and anterograde amnesia (short-term memory loss).

A nurse is reviewing the medical record of a client who has a prescription for probenecid to treat gout. The nurse should identify that which of the following medications can interact with probenecid?

Aspirin Aspirin can decrease the effectiveness of probenecid. The nurse should caution the client to avoid interaction between probenecid and salicylate medications.

A male client wishes to discontinue his antidepressant secondary to sexual dysfunction. What antidepressant medication may be ordered by his health care provider because it does not interfere with sexual function?

Bupropion Explanation: Bupropion does not cause orthostatic hypotension or sexual dysfunction.

A client is brought to the emergency department with suspected overdose of a benzodiazepine. Which drug should the nurse anticipate administering to counteract the effects of the overdose?

Flumazenil Explanation: Flumazenil is the antidote for benzodiazepine toxicity. Naloxone is used to reverse the effects of opioids. Naltrexone is used primarily to treat alcohol dependence and to block the effects of suspected opioids if they are being used by a person undergoing treatment for alcohol dependence. Diazepam is a benzodiazepine and would only increase the client's toxicity.

A client develops antibiotic-induced colitis. The symptoms have worsened within the past 72 hours. The nurse expects the health care provider to order what medication, which is considered the initial drug of choice?

Metronidazole Explanation: In antibiotic-associated colitis, stopping the causative drug is the initial treatment. If symptoms do not improve within 3 or 4 days, oral metronidazole or vancomycin is given for 7 to 10 days.

A patient has been prescribed daptomycin for a complicated skin infection. Which of the following will the nurse advise the patient to report immediately? Palpitations Muscle pain or tingling Nausea and vomiting Abdominal pain

Muscle pain or tingling Explanation: The nurse should teach the patient the importance of reporting diarrhea, muscle pain and tingling, and fatigue immediately because these signs and symptoms can indicate potentially severe adverse effects. Nausea and vomiting, palpitations, and abdominal pain are all adverse effects of ciprofloxacin.

Sulfonamides are commonly used to treat which of the following types of infections? Select all that apply. Acute otitis media Ulcerative colitis Upper respiratory tract infection Osteomyelitis Urinary tract infection

Ulcerative colitis Urinary tract infection Acute otitis media

A nurse is providing preoperative teaching for a client who is scheduled for total knee arthroplasty. Which of the following statements by the client should the nurse identify as understanding of the teaching?

"I should wear elastic stockings on both of my legs." The purpose of elastic stockings is to prevent venous thromboembolism, which is a common complication following orthopedic surgery. Therefore, the nurse should identify this statement as understanding of the teaching.

A nurse is caring for a client who had a below-the-knee amputation for gangrene of the right foot. The client reports sensations of burning and crushing pain in the toes of the right foot. Which of the following statements should the nurse make?

"This type of pain usually decreases over time as the limb becomes less sensitive." The nurse should recognize that the client is reporting phantom limb pain, a frequent complication following amputation. The nurse should instruct the client that the sensation should decrease over time. The nurse should recognize the pain, provide treatment, and handle the limb gently to decrease the risk of triggering pain.

A client received erythromycin before dental surgery. The client has a past history of a cardiac surgery. The rest of the client's history is unremarkable. What does the nurse teach the client about this medication?

"You are receiving this medication to prevent infection that may affect your heart." Explanation: The client with a prior history of a heart defect is at risk for bacteria growing in the area of the defect. The client should receive prophylactic antibiotics with any surgery or invasive procedure. The medication does not decrease pain, nor does it make it easier to remove a tooth. Other antibiotics are sometimes given as well as a macrolide.

A nurse is discussing the plan of care with a client who has osteomyelitis of an open wound on his heel. Which of the following information should nurse include?

"Your provider might prescribe a central catheter line for long-term antibiotic therapy." Osteomyelitis is an acute or chronic bone infection. The client will require weeks to months of IV antibiotic therapy for treatment. Therefore, the nurse should discuss the need for long-term IV access for antibiotic therapy.

The health care provider ordered 8 mg of morphine sulfate IM. Morphine sulfate is available as 10 mg in a 1-mL vial. How many milliliters will the nurse administer to this client?

0.8

The nurse is preparing to administer IV vancomycin to a client for the treatment of a systemic infection. How long would the nurse expect the infusion to run?

1 to 2 hours Explanation: For systemic infections, vancomycin is given IV and reaches therapeutic plasma levels within 1 hour after infusion. It is very important to give IV infusions slowly, over 1 to 2 hours, to avoid an adverse reaction characterized by hypotension, flushing, and skin rash. This reaction, sometimes called "red man syndrome," is attributed to histamine release.

A nurse would inform a client receiving a nonbenzodiazepine that the drug usually begins to have a diminished hypnotic effect after how long?

14 days Explanation: The nonbenzodiazepines have diminished hypnotic effects after approximately 2 weeks. Persons taking these drugs for longer than 2 weeks may have a tendency to increase the dose to produce the desired effects (e.g., sleep sedation). The lesser amount of time has not shown this effect.

A client who is prescribed a hypnotic asks the nurse, "About how long will I be taking this medication?" Which time frame would the nurse most likely include in the response?

2 weeks Explanation: Sedatives and hypnotics are best given for no more than 2 weeks and preferably for a shorter time. Sedatives and hypnotics can become less effective after they are taken for a prolonged period.

A child weighs 11 kilograms. The health care provider orders a drug as follows: 0.2 mg/kg intravenously. What dose should the nurse administer?

2.2 :Using the mg/kg method, the nurse would set up this calculation: 0.2 mg/1 kg = X mg/11 kg; Cross multiplying and solving for X: X = 0.2 × 11; X = 2.2 mg.

A client is caring for an 8-year-old child who weighs 30 kg. The health care provider orders gentamicin IM for the client. The recommended dosage range is 2-2.5 mg/kg q8h. What is the maximum amount of gentamicin the client will receive in a day?

225 mg Explanation: Each dose is limited to 75 mg of gentamicin (30 kg × 2.5 mg/kg = 75 mg). Since three doses will be administered daily (i.e., q8h, or "every 8 hours"), the client will receive a maximum total dose of 225 mg per day.

A nurse has been performing vigilant assessments of a patient who is receiving doses of intravenous gentamicin, each over 30 minutes. A blood sample for peak gentamicin levels should be drawn

30 minutes after the drug has finished infusing. Explanation: Blood for peak levels of gentamicin is drawn 30 minutes after the completion of a 30-minute intravenous (IV) administration or immediately after a 60-minute IV administration and 45 to 60 minutes after intramuscular (IM) administration. Blood for trough levels is drawn just before the next dose.

Levofloxacin 750 mg IV is ordered for a client with a urinary tract infection. The medication is to mixed yielding 250 mg/15 mL. How many mL should be drawn up in the syringe?

45 Explanation: 750/250 = 3; 3 x 15 mL = 45 mL

The nurse is preparing medication for a 30-month-old with right otitis media. The child weighs 33 pounds. The health care provider has ordered cephalexin, 50 mg/kg/day in divided doses every 8 hours. The medication concentration is 250mg/5mL. How many milliliters should the nurse give the toddler at each dose?

5

A client is receiving a maintenance dose of aminophylline, 3 mg/kg PO q 6 hr. The client weighs 50 kg. How many mg should the client receive in a 24-hour period?

600 mg

The following patients are receiving nortriptyline therapy. Which patient would the nurse most closely monitor for cardiotoxicity?

A 45-year-old man with angina pectoris Explanation: Patients with cardiovascular disease are especially sensitive to the potential cardiotoxicity of nortriptyline and need to be monitored closely. Patients with a history of seizure activity, organic brain disease, and renal dysfunction do not face as high a risk of cardiotoxicity as patients with a preexisting cardiovascular disease.

A male client is prescribed zaleplon for short-term treatment of his insomnia. He states that it only works once in a while. Upon review of his evening habits, the nurse discovers he is engaging in which behavior that may interfere with the absorption of his prescription?

A late, heavy meal before bedtime Explanation: Zaleplon is well absorbed, but bioavailability is only about 30% because of extensive presystemic or "first-pass" hepatic metabolism. Action onset is rapid and peaks in 1 hour. A high-fat, heavy meal slows absorption and may reduce the drug's effectiveness in inducing sleep.

A 35-year-old female client is recently divorced and having difficulty coping. She visits her health care provider, and he diagnoses her with situational anxiety. She is fearful that the anxiety she feels will become chronic. The nurse gives the client what information concerning situational anxiety?

A normal response to a stressful situation Explanation: Situational anxiety is a normal response to a stressful situation. It may be beneficial when it motivates the person toward constructive, problem-solving, coping activities. Symptoms may be quite severe, but they usually last only 2 to 3 weeks.

A client with a severe infection has an order for IV gentamicin and IV penicillin. How will the nurse administer these medications?

Administer the gentamicin IV and wait 1 hour and administer the penicillin. Explanation: Gentamicin and penicillin should never be administered in the same syringe or the same solution. When both antibiotics are prescribed for the client, they must be administered at separate times using Y tubing.

Venlafaxine is an antidepressant that has become more popular with adults in treating their depression. Why has it become more popular?

An extended release form is available. Explanation: Venlafaxine mildly blocks reuptake of NE, 5HT, and dopamine and has fewer adverse CNS effects than trazodone. Its popularity has increased with the introduction of an extended-release form that does away with the multiple daily doses that are required with the regular form. Venlafaxine is readily absorbed from the GI tract, extensively metabolized in the liver, and excreted in urine. Adequate studies have not been done in pregnancy and lactation, and it should be used during those times only if the benefit to the mother clearly outweighs the potential risk to the neonate. It is an oral drug, but so are most of the antidepressants It does have side effects.

A male client presents to the emergency department with an abdominal dehiscence. He states he had a hernia repair 18 days earlier, and the health care provider removed his wound staples 5 days ago. The client states that the dehiscence occurred when he lifted a box this morning for his wife. The wound is red, and there is evidence of foul-smelling drainage. The wound is cultured, and an anaerobic bacterium is identified. The nurse understands that the provider orders metronidazole because it is effective against which type of organism?

Anaerobic bacteria Explanation: Metronidazole is effective against infections with anaerobic bacteria and some protozoa.

A client experiencing depression is reluctant to start on antidepressant medication. What information should be the basis for the nurse's best response?

Antidepressant therapy may be indicated if depressive symptoms impair social relationships or work performance and occur independently of life events. Explanation: Antidepressant therapy may be indicated if depressive symptoms persist at least 2 weeks, impair social relationships or work performance, and occur independently of life events. Rest, exercise, and nutritional supplements will aid in the effectiveness of a medication regimen but may not necessarily replace it.

A male client's anxiety is interfering with his ability to perform basic activities of daily living and return to work. The nurse expects that which diagnosis will probably be made by his health care provider?

Anxiety disorder Explanation: Although there is no clear boundary between normal and abnormal anxiety, when anxiety is severe or prolonged and impairs the ability to function in usual activities of daily living, it is called an anxiety disorder.

A 79-year-old nursing home resident has been prescribed clindamycin. When the resident develops persistent diarrhea, the nurse will include what intervention to help rule out the presence of pseudomembranous colitis?

Assess the stool for the presence of blood and mucus. Explanation: Pseudomembranous colitis is inflammation (swelling, irritation) of the large intestine. In many cases, it occurs after taking antibiotics. Although pseudomembranous colitis may occur with any antibiotic, it has often been associated with clindamycin therapy. With severe and persistent diarrhea, it is critical to check the stools for white blood cells, blood, mucus, and the presence of C. difficile toxin. None of the other options are relevant to determining if pseudomembranous colitis has developed. Increasing fluids will assist in preventing dehydration related to the diarrhea. Avoiding dairy is relevant only when the diarrhea is related to lactose intolerance or some other form of absorption issue. Antidiarrheal medication, while possibly a means to minimizing the liquid stool, has no relevance to determining the cause of the diarrhea or presence of pseudomembranous colitis.

A nurse is caring for a hospitalized client with a urinary tract infection (UTI). The nurse is preparing to administer nitrofurantoin, which is a bacteriostatic antibiotic. Which statement best differentiates bacteriostatic and bactericidal medications?

Bacteriostatic medications slow or retard the multiplication of bacteria. Explanation: Bacteriostatic medications slow or retard the multiplication of bacteria and bactericidal destroys bacteria. Bactericidal medications do not improve the destruction of bacteria.

A nurse is performing medication reconciliation for a newly admitted client who has rheumatoid arthritis (RA). Which of the following medications should the nurse identify as the treatment for this condition?

Celecoxib Celecoxib is a type of NSAID, called cyclooxygenase-2 (COX-2) inhibitors, used to relieve some of the manifestations caused by RA in adults. The nurse should identify that the medication is also prescribed for osteoarthritis, spondylitis, and painful menstruation.

A group of students are reviewing information about tricyclic antidepressants and demonstrate understanding of the material when they identify which drug as also being indicated for the treatment of obsessive-compulsive disorder.

Clomipramine Explanation: Only clomipramine is indicated for the treatment of obsessive-compulsive disorder.

Which of the following are examples of supportive care the nurse can give a client taking a sedative or hypnotic drug to promote the effects of the drug? Select all that apply: Darken the client's room. Discourage caffeine intake. Provide a quiet atmosphere. Wake the client to check consciousness. Administer back rubs.

Darken the client's room. Discourage caffeine intake. Provide a quiet atmosphere. Administer back rubs. Explanation: To promote the effects of the sedative or hypnotic drug, the nurse can provide supportive care, such as back rubs, night lights or a darkened room, a quiet atmosphere, and discourage caffeine use.

A client who takes zinc daily is diagnosed with a severe infection and is ordered levofloxacin (Levaquin). The nurse is aware that taking these two drugs may have what affect on the antibiotic? Increased absorption Decreased absorption Decreased elimination Increased elimination

Decreased absorption Explanation: Antacids, iron salts and zinc can cause decreased absorption of the antibiotic. There is no affect on elimination of the antibiotic.

An 87-year-old resident of a long-term care facility has been prescribed oral clindamycin for the treatment of an infected pressure ulcer. The care providers at the facility should be instructed to monitor the resident closely for what potential adverse effect of clindamycin? Hematuria Respiratory depression Diarrhea Altered cognition

Diarrhea Explanation: The most serious adverse effect of clindamycin is pseudomembranous colitis, also known as Clostridium difficile colitis. Diarrhea, abdominal cramps, and abdominal tenderness may suggest antibiotic-associated colitis.

A nurse is assessing the medical record of a client who is prescribed tetracycline. The nurse would be alert for an increased risk of toxicity if the client is also taking which additional drug? Select all that apply. Warfarin (Coumadin) Vancomycin (Vancocin) Phenytoin (Dilantin) Digoxin (Lanoxin) Carbamazepine (Tegretol)

Digoxin (Lanoxin) Warfarin (Coumadin) Explanation: Tetracyclines may increase the risk of toxicity in clients who take digoxin for heart disease and increase the risk of bleeding in clients who take warfarin.

The nurse is providing client teaching before discharging a client home. The client is taking ciprofloxacin. What action should the nurse encourage the client to prioritize?

Drink at least 2 L of fluid per day. Explanation: Clients should be encouraged to drink a lot of fluids and maintain nutrition, even though nausea, vomiting, and diarrhea may occur. There is no need to eliminate red meat, seafood, caffeine, or alcohol from the diet, although alcohol may increase the risk of GI irritation. There is no need to minimize sodium intake.

A client has received a benzodiazepine for sedation before a diagnostic procedure. Which agent would the nurse expect the client to receive to reverse the sedative effects?

Flumazenil Explanation: Flumazenil is the antidote for benzodiazepines and is used to reverse the sedation of benzodiazepines used for diagnostic procedures. Temazepam and triazolam are benzodiazepines used as hypnotics. Promethazine is an antihistamine with sedative effects.

A nurse is caring for an elderly patient undergoing antianxiety treatment. The patient is to be administered antianxiety drugs parenterally. What precautions should be taken by the nurse?

Have resuscitative equipment ready. Explanation: The nurse should have resuscitative equipment ready because elderly patients may experience apnea and cardiac arrest during the treatment. Providing fiber-rich food and plenty of fluids is not a precautionary measure during the parenteral administration of the drug. The need for a blood transfusion would not arise during the treatment.

Which medication prescription by the health care provider will require the nurse to seek clarification?

Heparin 5,000 u SC every day

A nurse is reviewing the medical record of a female client. Which of the following findings should the nurse identify as a risk factor for osteoporosis?

History of anorexia nervosa The nurse should identify anorexia nervosa as a risk factor for osteoporosis. Inadequate protein intake can lead to a decreased bone density, increasing the risk for fractures

A nurse is preparing a teaching session for a client prescribed an antibacterial for a UTI. Which instruction should the nurse point out in the teaching session?

Increase fluid intake to at least 2000 mL/day. Explanation: The nurse should instruct the client to increase the fluid intake to at least 2000 mL/day to help remove bacteria from the genitourinary tract when caring for a client with a genitourinary tract bacterial infection. The nurse should stress the importance of continued therapy even if symptoms vanish or the client feels better after a few doses. The nurse should encourage continued increased fluid intake even if the symptoms subside. Abdominal pain is not commonly associated with genitourinary tract bacterial infections, so this instruction would not be necessary.

An 82-year-old client, who lives alone and has occasional memory lapses, is being seen by the home health nurse. In reviewing the client's medication, the nurse discovers that the client was recently prescribed azithromycin for urethritis. What characteristic of this drug makes it an appropriate choice for this client?

It is taken only once a day. Explanation: Given that the client has occasional memory lapses and lives alone, a daily dose would likely promote improved adherence. Azithromycin can be administered once daily because the half-life is 68 hours. Azithromycin may adversely interact with cardiac glycosides, oral anticoagulants, theophyllines, carbamazepine, and corticosteroids to name a few agents. The course of treatment is likely to exceed 3 days.

In which condition present in the client should macrolides be used with caution?

Liver dysfunction Explanation: All macrolides should be used with caution in clients with liver dysfunction. Pre-existing liver disease is a contraindication. Diabetes, hypertension and glaucoma are not contraindicated.

Which statement is true concerning macrolides? Macrolides are not absorbed well in body tissues. Macrolides cannot kill gram-positive bacteria. Macrolides are bactericidal or bacteriostatic. Macrolides are not absorbed in body fluids.

Macrolides are bactericidal or bacteriostatic. Explanation: Macrolides are absorbed well in body tissues and fluids and kill gram-positive bacteria. Depending on the concentration in the body, they can be bactericidal or bacteriostatic.

A patient has been prescribed lithium therapy. Which of the following signs and symptoms will the nurse tell the patient to report immediately?

Muscle twitching Explanation: Muscle twitching is an early symptom of lithium toxicity and should be reported immediately. Muscle twitching indicates that a dosage change may be needed. Increased thirst and urination are acute effects of lithium, whereas hair loss is a chronic adverse effect.

John, 34 years old, is being treated with clindamycin for osteomyelitis of his tibia following an open fracture 3 months ago. The nurse is teaching John how to properly administer the medication at home and the side effects that he needs to report to the health care provider. Which would be the best instruction to give John?

Notify the provider if you have any blood in your stool or diarrhea. Explanation: The most serious adverse effect is pseudomembranous colitis (a Black Box warning), also known as Clostridium difficile colitis. Diarrhea, abdominal cramps, and abdominal tenderness may suggest antibiotic-associated colitis. Nausea and vomiting and abdominal pain following oral administration are the most common adverse effects of clindamycin.

A nurse is caring for a client immediately following application of a plaster cast. The nurse should monitor for and report which of the following findings as an indication of compartment syndrome?

Paresthesias of the extremity The nurse should identify paresthesias as a finding of compartment syndrome. Compartment syndrome involves the compression of nerves and blood vessels in an enclosed space, leading to impaired blood flow and nerve damage. Other findings include numbness, tingling, weakness, and pain that does not respond to medication.

A 44-year-old woman has presented to her local clinic with burning and pain when voiding. In addition to prescribing an antibiotic, the clinician has recommended the use of phenazopyridine (Pyridium). What is the rationale for including phenazopyridine in this client's plan of care?

Phenazopyridine provides topical relief to many of the painful symptoms of UTIs. Explanation: Phenazopyridine (Pyridium) is used frequently for UTIs but does not itself have any antibacterial activity. It is excreted in the urine, where it exerts a topical analgesic effect. It is indicated for the symptomatic relief of pain, burning, frequency, and urgency caused by the irritation that infection produces in the urinary tract mucosa. The drug does not potentiate antibiotics or influence the pH of the urine or the function of the urethra.

After teaching a group of nursing students about possible adverse reactions associated with trazodone, the instructor determines that the teaching was successful when the students correctly choose which adverse reaction? Select all that apply. Sexual dysfunction Insomnia Priapism Diarrhea Dry mouth

Priapism Dry mouth Explanation: The following are possible adverse reactions that may occur with trazodone (an SNRI/DNRI): priapism, drowsiness, dizziness, dry mouth, nausea, vomiting, constipation, fatigue, and nervousness. Sexual dysfunction is a possible adverse reaction to paroxetine. Insomnia and diarrhea are possible adverse reactions to SSRIs.

The nurse is preparing to administer sulfadiazine to a client who is also taking warfarin. The nurse would be alert for which potential adverse effect?

Prolonged clotting times Explanation: When warfarin and sulfonamides are given concomitantly, an increase in action of the anticoagulant is seen, leading to an increase in clotting time, such as PT/INR, and an increased risk of bleeding. An increased risk of infection and a decrease in the white blood cell count would occur when a sulfonamide is given with methotrexate. The combination of warfarin and sulfonamide does not impact the effect of the antibiotic.

A client admitted for insomnia related to stress is prescribed a sedative. Which actions would the nurse include in the plan of care to promote the effectiveness of the drug?

Provide back rubs. Explanation: Back rubs are relaxing and help promote the effectiveness of the sedative. Fluids and fiber prevent constipation. Coffee and tea contain caffeine, which could interfere with the drug's effectiveness.

A nurse is preparing to administer buspirone to a client with anxiety. The nurse should question this order if which disorder is noted in the client's past history?

Psychoses Explanation: The use of buspirone is contraindicated in clients with hypersensitivity, psychoses, and acute narrow-angle glaucoma. Ethambutol is contraindicated in clients with cataracts and diabetic retinopathy. Pyrazinamide is contraindicated in clients with acute gout.

The nurse is caring for a client who is receiving IV vancomycin. The nurse infuses the medication at the prescribed rate to prevent what from occurring? Red man syndrome Gray syndrome Serotonin syndrome Cushing's syndrome

Red man syndrome Explanation: The nurse must be careful to infuse vancomycin at the prescribed rate to prevent the occurrence of red man syndrome. With this syndrome, the client's face and upper trunk becomes bright red, and it has led to cardiovascular collapse.

When administering a prescribed drug to a client, which action would be completely inappropriate? Select all that apply. Charting immediately on the MAR after drug administration Removing a drug from an unlabeled container Giving a drug that someone else prepared Crushing tablets or opening capsules without consulting the pharmacist Removing the drug's unit dose wrapper at the client's bedside

Removing a drug from an unlabeled container Giving a drug that someone else prepared Crushing tablets or opening capsules without consulting the pharmacist

The nurse is preparing to administer amikacin to a client with a complicated Staphylococcus aureus infection. What assessment should the nurse prioritize?

Renal function Explanation: Amikacin is an aminoglycoside that may cause renal toxicity. Assessing renal function would be a priority. Although the drug can affect the GI tract leading to nausea, vomiting, diarrhea, and weight loss, which could lead to problems with nutrition and cause numbness, tingling and weakness, assessment of GI function, nutritional status, and muscle strength would be considered lower-priority assessments.

After teaching a group of nursing students about antidepressants, the instructor determines that the teaching was successful when the students identify which as inhibiting the reuptake of serotonin?

Selective serotonin reuptake inhibitors Explanation: Selective serotonin reuptake inhibitors exert their effects by inhibiting reuptake of serotonin. Tricyclic antidepressants exert their effects by inhibiting reuptake of norepinephrine and serotonin. Monoamine oxidase inhibitors, classified as MAOIs, inhibit the activity of monoamine oxidase, a complex enzyme system responsible for inactivating certain neurotransmitters. Lithium is not a true antidepressant drug; it is grouped with the antidepressants because of its use in regulating the severe fluctuations of the manic phase of bipolar disorder.

A sometimes fatal syndrome, characterized by hypertensive crisis, extreme agitation progressing to delirium, and coma is known as:

Serotonin syndrome. Explanation: Serotonin syndrome, a serious and sometimes fatal reaction characterized by hypertensive crisis, hyperpyrexia, extreme agitation progressing to delirium and coma, muscle rigidity, and seizures, may occur due to combined therapy with an SSRI and an MAO inhibitor or other drugs that potentiate serotonin neurotransmission. An SSRI or SNRI and an MAO inhibitor should not be given concurrently or within 2 weeks of each other.

A 48-year-old female patient has acute pyelonephritis. Her urine pH is below 5.5, which indicates that it is acidic. Which of the following medications would serve to decrease the acidity of her urine?

Sodium bicarbonate Explanation: Giving sodium bicarbonate to a patient who has acidic urine may help reduce its acidity. The nurse could also advise the patient to drink at least 1.5 L of water daily. Dihydrofolic acid, an agent that promotes the growth of new bacteria in the urinary tract, would not help alter the urine pH. Sulfonamide and gentamicin are drugs given to patients with urinary tract infections, and are not designed to alter the pH of urine.

The nurse is providing discharge teaching to a client who is being sent home on oral tetracycline. What instructions should the nurse include?

Take the drug on an empty stomach. Explanation: Tetracycline should be taken on an empty stomach 1 hour before or 2 hours after meals with a full eight ounces of water to ensure full absorption. Tetracycline is usually taken at least once every 12 hours. Checking the pulse and holding the dose if below 60 bpm is an action specific to the use of cardiac glycosides.

The nurse is caring for a 6-year-old child who has pyelonephritis. The use of what group of antibiotics would be contraindicated due to the client's age? Aminoglycosides Cephalosporins Penicillins Tetracyclines

Tetracyclines Explanation: Tetracyclines can potentially damage developing teeth and bones and thus should be used cautiously or avoided in children under the age of 8 years. Penicillins are safe to give to children and commonly used. Cephalosporins are safe to administer to pediatric clients. Aminoglycosides would not be administered to children lightly, but they can be administered when the benefits outweigh the risks, such as an infection that is resistant to other drugs.

A client with a complex medical history is showing signs and symptoms of sepsis. What aspect of this client's health history would rule out the safe and effective use of an aminoglycoside antibiotic?

The client has chronic renal failure Explanation: Renal failure would preclude the use of an aminoglycoside. Nonadherence must always be addressed, but this client variable is not specific to aminoglycosides. Neither latex allergies nor type 2 diabetes would necessarily rule out the use of an aminoglycoside.

The nurse administers promethazine to the client before sending the client to the preoperative holding area. What outcome demonstrates therapeutic effects?

The client is conscious but drowsy. Explanation: Antihistamines (promethazine, diphenhydramine) can be very sedating in some people. They are used as preoperative medications and postoperatively to decrease the need for narcotics. The goal, however, is not to make the client unresponsive or asleep. No effect on blood pressure is intended.

To best assure client safety, what information should the nurse provide to a client whose fluoxetine therapy has been discontinued?

The dosage of the medication will be gradually reduced over a period of 6 to 8 weeks. Explanation: To avoid antidepressant discontinuation syndrome, it is essential to taper the dosage of the antidepressant and discontinue it gradually, over 6 to 8 weeks, unless severe drug toxicity, anaphylactic reaction, or another life-threatening condition is present. ECT will not avoid this syndrome. Concurrent use of an MAO inhibitor is dangerous. Avoiding stress is advisable but will not minimize the risk of injury in this situation.

A patient on your unit has bacterial colitis and is being treated with oral vancomycin. Why is vancomycin given orally, rather than intravenously, in the treatment of bacterial colitis?

The oral version of the drug acts within the bowel lumen. Explanation: For bacterial colitis, vancomycin is given orally because it is not absorbed from the GI tract and acts within the bowel lumen.

Your patient is receiving a miscellaneous antibacterial to treat an infection. Which of the following goals would be appropriate to include in your plan of care? Select all that apply. The patient will take or receive miscellaneous antimicrobials accurately, for the prescribed length of time. The patient will be monitored regularly for therapeutic and adverse drug effects. The patient will experience an increase in signs and symptoms of the infection being treated. The patient will verbalize and practice measures to prevent recurrent infection.

The patient will take or receive miscellaneous antimicrobials accurately, for the prescribed length of time. The patient will be monitored regularly for therapeutic and adverse drug effects. The patient will verbalize and practice measures to prevent recurrent infection. Explanation: The patient should experience decreased signs and symptoms of the infection being treated, not increased.

The nurse is caring for a client who has just begun to take lithium for treatment of bipolar disease. The nurse instructs the client that his lithium level will need to be monitored at what frequency?

Two or three times weekly in the morning, 12 hours after the last dose of lithium Explanation: When lithium therapy is being initiated, the serum drug concentration should be measured two or three times weekly in the morning, 12 hours after the last dose of lithium.

Vancomycin (Vancocin) is active against only gram-positive microorganisms. Which other characteristics describe this drug? Choose all that apply. Used for treatment of gonococcal exposure Used to treat anaerobic bacterial infections found in the colon during surgery Used for prophylaxis of gram-positive infections in patients who are at high risk for MRSA infections Parenteral vancomycin has been used extensively to treat methicillin-resistant S. aureus (MRSA) Can be given orally or intravenously

Used for prophylaxis of gram-positive infections in patients who are at high risk for MRSA infections Parenteral vancomycin has been used extensively to treat methicillin-resistant S. aureus (MRSA) Can be given orally or intravenously

A nurse emphasizes the need to avoid caffeine and caffeinated beverages with a client undergoing treatment for insomnia based on which known caffeine effect?

Wakefulness Explanation: Clients with insomnia should not have any caffeine intake of any kind including drinking beverages containing caffeine because it can cause wakefulness. Caffeine does not cause depression, delirium, or restlessness.

A patient undergoing treatment for insomnia is instructed by the assigned nurse not to drink beverages containing caffeine. What effect will caffeine likely have on the patient?

Wakefulness Explanation: Patients with insomnia should not drink beverages containing caffeine because it can cause wakefulness. Caffeine does not cause depression, delirium, or restlessness.

The nurse is caring for a client who has been diagnosed with bipolar disorder type II. The nurse knows that this disorder is characterized by episodes of major depression plus hypomanic episodes and occurs more frequently in what category of clients?

Women Explanation: Bipolar disorder type II is characterized by episodes of major depression plus hypomanic episodes and occurs more frequently in women.

A nurse is caring for a client who has been prescribed a monoamine oxidase inhibitor (MAOI). Which food should the nurse instruct the client to avoid?

Yogurt Explanation: The nurse should ask the client to avoid yogurt because yogurt contains tyramine, which interacts with MAOIs and causes hypertensive crisis. Milk, butter, and rice do not contain tyramine and hence can be consumed when the client is undergoing treatment with MAOIs.

A client prescribed rifaximin for diarrhea has developed frank bleeding in the stool. What intervention should the nurse anticipate being implemented to best ensure client safety?

changing to a different antibiotic Explanation: Because of its very limited systemic absorption (97% eliminated in feces), health care providers cannot use rifaximin to treat systemic infections, including infections due to invasive strains of E. coli. Therefore, diarrhea occurring with fever or bloody stools requires treatment with alternative agents. Changing the route or supplementing with vitamin K will not aid in treatment.

A 39-year-old patient who is having trouble sleeping is beginning drug treatment with zaleplon. The nurse will be sure to ask if the patient is taking:

cimetidine. Explanation: The nurse will assess for cimetidine use. Cimetidine greatly increases the level of circulating zaleplon and could cause toxic effects in the patient. Secobarbital is a barbiturate, and oxycodone and meperidine are narcotics that would not be used with lorazepam because the combinations may depress respiratory drive, create severe hypotension or bradycardia, and substantially alter level of consciousness.

A 30-year-old client is taking phenelzine 30mg PO tid. The nurse knows that at that dosage, the client will need to be carefully monitored for which?

dizziness. Explanation: The nurse will closely monitor for the adverse effects of phenelzine related to the anticholinergic effect of the drug, such as dizziness that tends to be more pronounced at dosages above 45 mg/day. Dizziness is also a sign of a phenelzine drug overdose. Constipation and dry mouth are also adverse effects, not diarrhea and increased secretions. Facial flushing is not an identified adverse effect of phenelzine.

After teaching a group of students about the indications for use for aminoglycosides, the instructor determines that the teaching was successful when the students identify which type of infection as a primary indication?

gram-negative infections Explanation: Aminoglycosides are used primarily in the treatment of infections caused by gram-negative microorganisms. Aminoglycosides are not effective on gram-positive bacteria. Since aminoglycosides are antibacterial, they are not effective on fungal or viral infections.

A nursing instructor is preparing a teaching plan for a nursing pharmacology class on the action of fluoroquinolones. Which would the instructor include? disrupting the bacterial cell wall interfering with DNA synthesis in the bacterial cell blocking ribosomal reading of mRNA interfering with protein synthesis

interfering with DNA synthesis in the bacterial cell Explanation: The fluoroquinolones exert their bactericidal effect by interfering with the synthesis of bacterial DNA by not allowing the cell to reproduce. The tetracyclines are bacteriostatic and exert their effect by inhibiting bacterial protein synthesis. Penicillins act to disrupt the bacterial cell wall. The aminoglycosides exert their bactericidal effect by blocking the ribosome from reading the mRNA, a step in protein synthesis necessary for bacterial multiplication.

The nurse recognizes that what drug classification increases the risk of ototoxicity and nephrotoxicity when prescribed with gentamicin? tricyclic antidepressants proton pump inhibitors benzodiazepines loop diuretics

loop diuretics Explanation: Loop diuretics given simultaneously with gentamicin increase the risk of nephrotoxicity by decreasing fluid volume, thereby increasing drug concentrations in serum and tissues. Loop diuretics may also contribute to ototoxicity. This risk is not associated with therapies that include both gentamicin and any of the other options.

The nurse is caring for a client who has been diagnosed with trichomoniasis. What medication would the nurse anticipate being prescribed?

metronidazole Explanation: .Metronidazole is effective against anaerobic bacteria, including gram-negative bacilli such as Bacteroides, gram-positive bacilli such as Clostridia, and some gram-positive cocci. It is also effective against protozoa that cause amebiasis, giardiasis, and trichomoniasis. None of the other options would effectively manage this infection.

A client cannot recall the name of the medication prescribed to help manage the pain associated with a urinary tract infection (UTI). What medication was likely prescribed?

phenazopyridine hydrochloride Explanation: Phenazopyridine hydrochloride is given to relieve pain associated with UTI. The remaining options are associated with managing infections.

A client prescribed fluoxetine 1 week ago presents for a scheduled follow-up appointment. What should be the focus of the client's nursing assessment to best assure client safety?

presence of suicidal ideation Explanation: It is essential to assess for suicidal thoughts or plans, especially at the beginning of selective serotonin reuptake inhibitor (SSRI) therapy or when dosages are increased or decreased. This supersedes the need to assess for concentration, cardiac function, or hypersensitivity.

The nurse is assessing a client who has been prescribed lorazepam. Which of the client's current signs and symptoms should cause the nurse to suspect that the client is experiencing withdrawal?

severe insomnia for the past several nights Explanation: Common signs and symptoms of benzodiazepine, like lorazepam, withdrawal include increased anxiety, psychomotor agitation, insomnia, irritability, headache, tremor, and palpitations. Memory lapses, unstable blood sugars, and depression are not typical.

A nurse is caring for a client who is taking a urinary anti-infectives. The nurse would need to assess this client for:

signs and symptoms of continuing UTI. Explanation: Monitor client response to the drug (resolution of UTI and relief of signs and symptoms) and repeat culture and sensitivity tests as recommended for evaluation of the effectiveness of all of these drugs. It would not be necessary to assess for discolored urine, jaundice, or flank pain.

A female client is prescribed a benzodiazepine for anxiety. She asks the nurse if she can stop the drug when she feels better. What is the nurse's best response?

"Benzodiazepines may cause physiologic dependence, and withdrawal symptoms will occur if the drug is stopped abruptly." Explanation: Benzodiazepines are widely used for anxiety and insomnia and are also used for several other indications. They have a wide margin of safety between therapeutic and toxic doses and are rarely fatal, even in overdose, unless combined with other CNS depressant drugs, such as alcohol. They are schedule IV drugs under the Controlled Substances Act. They are drugs of abuse and may cause physiologic dependence; therefore, withdrawal symptoms occur if the drugs are stopped abruptly.

The nurse is admitting a 12-year-old child to the acute care facility and notices discolored secondary teeth. The parent says they don't know why the teeth are discolored because the child is very good about brushing and flossing and sees the dentist regularly. What question should the nurse ask?

"Have they ever received tetracycline?" Explanation: The nurse would question whether the child was ever given tetracycline because this drug is commonly associated with discoloration of secondary teeth when it is administered to children who still have their primary teeth. Gentamicin, ampicillin, and cephalexin are not associated with discoloration of the teeth.

A nurse is caring for a client who is postoperative following shoulder surgery. The client has a prescription to keep the affected arm addicted. Which of the following instructions should the nurse provide the client?

"Hold your arm against the side of your body." Adduction means to position toward the midline of the body. Therefore, the nurse should provide these instructions to explain the provider's prescription.

The nurse instructs a client with depression about the drug phenelzine. Which client statements indicate that teaching has been effective? Select all that apply. "I have to limit eating chocolate." "I can use a half of a banana on my cereal." "I cannot drink coffee with this medication." "I can have wine a few days of the week." "I will not eat any aged cheese."

"I cannot drink coffee with this medication." "I will not eat any aged cheese." Explanation: Phenelzine is a monoamine oxidase inhibitor that is a third-line agent for the treatment of depression. This medication is not prescribed frequently because its interaction with some foods can produce severe hypertension. Teaching should focus on the types of foods that need to be avoided including aged cheese and coffee. Chocolate, wine, and bananas should also be completely avoided. Merely reducing their consumption is insufficient.

A nurse is teaching a client who has a new prescription for alendronate for treatment of osteoporosis. Which of the following statements by the client indicates understanding of the teaching?

"I will sit upright after taking the medication." A client taking alendronate should sit upright for 30 min after administration to prevent esophageal irritation and ulceration. Therefore, the nurse should identify this statement as indicating an understanding of the teaching.

A 70-year-old male client asks why he is receiving a lower dose of zaleplon than his son. As part of the nurse's teaching plan, which explanation will the nurse give this client?

"Older adults metabolize the drug more slowly, and half-lives are longer than in younger adults." Explanation: In older adults, most non-benzodiazepines are metabolized more slowly, and half-lives are longer than in younger adults. Exceptions are lorazepam and oxazepam, whose half-lives and dosages are the same for older adults as for younger ones. The recommended initial dose of zaleplon or zolpidem is 5 mg, one half of the initial dose recommended for younger adults. Dosages of eszopiclone should also be reduced for older adults, beginning with 1 mg initially, not to exceed 2 mg at bedtime.

A client explains to a nurse that they have been taking amitriptyline for depression, achieving a modest improvement in mood. The provider recently changed the client's medication to clomipramine. The client is confused and does not understand why their medication was changed to "the same type of drug." What is the nurse's best response?

"These drugs are similar but some clients respond better to one than the other." Explanation: Because all tricyclic antidepressants (TCAs) are similarly effective, the choice of which TCA depends on individual response to the drug and tolerance of adverse effects. A client who does not respond to one TCA may respond to another drug from this class. The nurse should avoid speculating about the rationale for the change, but it is unlikely that a difference in adverse effects motivated the change, as these are likely to be similar. Depression is multifactorial, and it is not possible to "rule out" psychological factors. Follow-up blood work is not normally necessary with TCAs.

A 28-year-old client asks his nurse how phenelzine therapy will help him. Which would be an appropriate response by the nurse?

"This therapy will improve your overall mood and increase your social activity." Explanation: The effectiveness of phenelzine is demonstrated by improved mood and increased social activity in depressed clients. Reduced severity of bipolar episodes indicates success of valproates. Increased attention levels and weight gain, though desired benefits, are not a direct result of the drug therapy.

A hospitalized client asks the nurse why the health care provider prescribed an anxiolytic medication. What is the nurse's best response?

"This type of medication is typically prescribed to treat excess anxiety that interferes with daily activities." Explanation: Drugs used to treat anxiety are called antianxiety, or anxiolytic, drugs. Long-term use of benzodiazepines, such as Xanax, can result in physical or psychological dependence. Due to the risk of dependence, benzodiazepines are used for short-term anxiety relief. Due to the risk of dependence, anxiolytics are classified as schedule IV controlled substances. Therefore, anxiolytics require a prescription. Anxiolytic drugs exert their tranquilizing effect by blocking certain neurotransmitter sites.

A patient is required to be administered vancomycin for treatment of an abdominal abscess. What should the nurse ensure when monitoring the IV infusion of vancomycin in the patient when caring for him?

Administer each dose over 60 minutes. Explanation: When caring for a client who is being administered vancomycin intravenously, the nurse should ensure that each dose is administered over 60 minutes. The nurse should monitor and report a decrease in blood pressure and not an increase. The nurse should monitor and report any decrease in urinary output and not an increase. The nurse should monitor any signs of throbbing neck pain or back pain and not for signs of headache.

The nurse interviews the family of a client hospitalized with severe depression and suicidal ideations. What assessment data is important in planning this family's plan of care? (Select all that apply.) Affect GI obstruction Physical pain Personal responsibilities Recent suicide attempts

Affect GI obstruction Recent suicide attempts Explanation: The nurse should assess for any known allergies to these drugs to avoid hypersensitivity reactions; impaired liver or kidney function, which could alter metabolism and excretion of the drug; glaucoma, benign prostatic hypertrophy, cardiac dysfunction, GI obstruction, surgery, or recent myocardial infarction, all of which could be exacerbated by the effects of the drug; and pregnancy or lactation to avoid potential adverse effects on the fetus or baby. Assess whether the client has a history of seizure disorders or a history of psychiatric problems or suicidal thoughts, or myelography within the past 24 hours or in the next 48 hours, or is taking an MAOI to avoid potentially serious adverse reactions. Assess temperature and weight; skin color and lesions; affect, orientation, and reflexes; vision; blood pressure, including orthostatic blood pressure; pulse and perfusion; respiratory rate and adventitious sounds; and bowel sounds on abdominal examination. Whether or not the client has felt physical pain recently is not important and neither are the client's personal responsibilities.

The client has been prescribed an MAO inhibitor. As the nurse teaches the client about this medication, what foods will the client be instructed to avoid?

Aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans Explanation: MAO inhibitors are rarely used in clinical practice today, mainly because they may interact with some foods and drugs to produce severe hypertension and possible heart attack or stroke. Foods that interact contain tyramine, a monoamine precursor of norepinephrine. Normally, tyramine is deactivated in the GI tract and liver so that large amounts do not reach the systemic circulation. When deactivation is blocked by MAO inhibitors, tyramine is absorbed systemically and transported to adrenergic nerve terminals, where it causes a sudden release of large amounts of norepinephrine. Foods that should be avoided include aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans.

A nurse in the emergency department is preparing to discharge a client following a Grade II (moderate) ankle sprain. Which of the following instructions should the nurse plan to give to the client?

Apply cold compresses to the extremity intermittently. Cold minimizes swelling and erythema to the affected area. Therefore, the nurse should instruct the client to apply cold compresses for no more than 20 min at a time.

A nurse is caring for a client who is postoperative following a total knee arthroplasty and is prescribed a continuous passive motion (CPM) machine and PCA. The client tells the nurse, "I am in so much pain." Which of the following actions should the nurse take first?

Ask the client to describe the characteristics of the pain. Answering this item requires application of the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with assessment or data collection. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify a provider of a change in the client's status, she must first collect adequate data from the client. Assessing or collecting additional data will provide the nurse with knowledge to make an appropriate decision. Therefore, the first action the nurse should take is to acquire further data by asking the client to describe the characteristics of the pain.

A 75-year-old client is brought to the emergency department by the family. The family relates that the client has confusion, seizures, and abnormal perception of movement. When the nurse looks at the medication that the family has brought to the ED, the nurse discovers that twice the number of tablets are missing from the vial as there should be if the prescription orders were being followed. What should the nurse suspect is wrong with this client?

Benzodiazepine toxicity Explanation: Common manifestations include increased anxiety, psychomotor agitation, insomnia, irritability, headache, tremor, and palpitations. Less common but more serious manifestations include confusion, abnormal perception of movement, depersonalization, psychosis, and seizures.

A client with a longstanding diagnosis of depression is being treated with phenelzine. The client reports the recent use of some over-the-counter flu and cold remedies and has consequently been admitted for observation and client teaching. What assessment should the nurse prioritize?

Blood pressure monitoring Explanation: The drug-drug interactions that exist with the use of monoamine oxidase inhibitors create a high risk for hypertensive crisis. Blood pressure monitoring is thus among the priority assessments. Tardive dyskinesia is not among the varied signs and symptoms that can result from drug-drug interactions with MAOIs. The nurse should certainly monitor the client's pain and oxygenation, but blood pressure monitoring is the highest priority due to the likelihood and safety risks associated with hypertensive crisis.

A nurse is preparing to administer an antidepressant that affects the neurotransmission of norepinephrine, serotonin, and dopamine. Which drug will the nurse administer?

Bupropion Explanation: Atypical antidepressants like bupropion exert their effects by affecting the neurotransmission of norepinephrine, serotonin, and dopamine. Selective serotonin reuptake inhibitors such as sertraline exert their effects by inhibiting reuptake of serotonin. Monoamine oxidase inhibitors such as phenelzine exert their effects by inhibiting the activity of monoamine oxidase. Tricyclic antidepressants such as amitriptyline exert their effects by inhibiting reuptake of norepinephrine and serotonin.

A client develops pseudomembranous colitis secondary to fluoroquinolone therapy. The nurse anticipates the bowel culture will grow which organism?

C. difficile Explanation: Pseudomembranous colitis is one type of a bacterial superinfection. This potentially life-threatening problem develops because of an overgrowth of the microorganism Clostridium difficile (C. diff) in the bowel.

A patient has been administered linezolid. The patient is fond of eating chocolates and coffee, both of which contain tyramine. What should the nurse inform the patient about the risk involved when linezolid interacts with foods containing tyramine?

Causes severe hypertension. Explanation: The nurse should inform the patient that if tyramine found in chocolates and coffee interacts with linezolid, the patient will develop an increased risk for severe hypertension. Nausea is the adverse reaction of quinupristin-dalfopristin. It is not reported to occur due to the interaction of linezolid and tyramine. Nervousness and drowsiness are not reported to be risks developed due to the interaction of linezolid and tyramine.

A nurse obtains a health history from a client who has been prescribed temazepam. Which finding would require immediate follow-up by the nurse?

Client is diagnosed with hepatitis C. Explanation: Sedatives and hypnotics should be used cautiously in lactating clients and in clients with hepatic or renal impairment, habitual alcohol use, and mental health problems. The client with hepatitis C requires immediate follow-up, because the prescribing provider may need to change the medication and/or the dose of this medication due to liver impairment. A history of a bladder infection is not a great cause of concern for renal impairment. One drink per day is not as concerning as the client diagnosed with hepatitis C, especially since the client recently quit consuming alcohol beverages. A history of miscarriage is not a contraindication for taking sedatives or hypnotics; however, the pregnant or lactating woman should not take these medications.

A client is given linezolid for a diagnosis of VREF. The drug will be administered for a period that extends beyond 2 weeks. Which laboratory test would the nurse expect the health care provider to order on a regular basis because of the length of administration of the drug?

Complete blood count Explanation: With the drug linezolid, myelosuppression (anemia, leukopenia, pancytopenia, and thrombocytopenia) is a serious adverse effect that may occur with prolonged therapy lasting longer than 2 weeks. The client's complete blood count should be monitored; if myelosuppression occurs, linezolid should be discontinued. Myelosuppression usually improves with drug discontinuation.

A nurse is caring for a 25-year-old patient who has been prescribed daptomycin to treat a skin infection. Which of the following adverse effects of daptomycin should the nurse monitor when caring for the patient?

Constipation Explanation: The nurse should monitor for constipation in the patient as an adverse reaction of daptomycin. Headache is the adverse reaction of aztreonam. Fever is the adverse reaction of vancomycin. Insomnia is the adverse reaction of linezolid.

What is an advantage of daptomycin over other antibiotic therapy?

Daptomycin has less antibiotic resistance than other drugs used to treat against Gram-positive bacteria. Explanation: Daptomycin is the only drug in a new class of antibiotics called cyclic lipopeptides. This class of antibiotics has a substantially different mechanism of action than other antibiotic drugs. Another benefit of daptomycin is its ability to retain potency against antibiotic-resistant Gram-positive bacteria. It works by binding to the bacterial membrane and interfering with the integrity of the cell wall. This disruption causes a rapid depolarization of the membrane potential that leads to inhibition of protein, DNA, and RNA synthesis and, eventually, bacterial cell death. Daptomycin also has a postantibiotic effect that lasts approximately 6 hours. Daptomycin is a once-daily IV medication.

A client is receiving lithium and informs the nurse that they are also taking antacids for heartburn. The nurse would be alert for which reaction?

Decreased effectiveness of lithium Explanation: Combining lithium with antacids may result in decreased effectiveness of lithium. This combination will not increase the risk for lithium toxicity, bipolar disorder, or psychotic symptoms. When lithium is combined with diuretics or antipsychotics, there is the increased risk for lithium toxicity. When antipsychotics and anticholinergics are combined there is the increased risk of psychotic symptoms. Lithium is used to treat the manic phase of bipolar disorder.

A client has been prescribed metronidazole for treatment of Giardia. What instruction is most important for the nurse to give to this client?

Do not drink alcohol while taking this medication. Explanation: Clients who are receiving metronidazole should not drink alcohol because the client will develop a disulfiram-type reaction if alcohol is consumed while the client is receiving metronidazole.

The nurse is preparing to administer a sulfonamide to a client who is a Type 2 diabetic taking an oral hypoglycemic agent. The nurse will monitor the client for what reaction?

Explanation: Diabetic clients who take a sulfonamide may experience a hypoglycemic reaction because the sulfonamides may inhibit the hepatic metabolism of the oral hypoglycemic drugs tolbutamide and chlorpropamide. The nurse would not expect to see increased bruising or an elevated temperature, which may be a reaction related to bone marrow suppression.

A nurse is caring for a patient with insomnia. For which type of patient should the nurse exercise caution when administering sedatives and hypnotics?

Explanation: The nurse should exercise caution while administering sedatives and hypnotics to lactating patients. Patients with heart trouble, hypertension, and gastrointestinal problems are not contraindicated in the use of sedatives and hypnotics.

The nurse is assessing a client for depression. Which symptom would the nurse prioritize?

Extreme sadness Explanation: The nurse should monitor the client for extreme sadness because this is a symptom of depression. Drowsiness is an adverse effect of most antidepressants. Severe headache and dilated pupils are symptoms of hypertensive crisis which can occur when MAOIs are combined with tyramine, tryptophan, and meperidine.

Clients taking benzodiazepines, especially older adult clients, are at high risk for which effect?

Falls Explanation: Clients taking benzodiazepines, especially older adult clients, are at high risk for falls and should be counseled on fall prevention measures. Constipation can occur at any time in an older adult due to the lack of fluid or fiber intake. Benzodiazepine use does not indicate high risk for heart failure or hepatic failure.

A nurse in the emergency department is assessing a client who was in a motor-vehicle crash 2 days ago and sustained fractures to his tibia, ulna, and several ribs. The client is now disoriented to time and place, has a SAO2 of 87%, and the nurse notes generalized petechiae on the client's skin. Which of the following complications should the nurse suspect?

Fat embolism syndrome The nurse should identify the triad of neurologic changes, petechial rash, and hypoxemia as findings of fat embolism syndrome. Risk factors include multiple fractures and fracture of a long bone. Male clients are also at greater risk. The manifestations occur when fat globules occlude small blood vessels.

Which of the following classes of antibiotics is a direct inhibitor of DNA synthesis in bacteria?

Fluoroquinolones Explanation: Fluoroquinolones directly affect DNA synthesis in bacteria. Macrolides and ketolides inhibit bacterial protein synthesis. Penicillins interfere with cell wall synthesis.

Which nursing diagnoses would receive high priority for a burn client on sulfonamide therapy? Impaired skin integrity Potential for altered nutrition Risk for ineffective regimen management Risk for body image alteration

Impaired skin integrity Explanation: The skin can become more sensitive to sunlight during sulfonamide therapy. The nurse should inspect the client's skin each shift for signs of sores or blisters, indicating a possible allergic reaction. Risk for impaired skin integrity is the diagnosis of highest priority. Furthermore, a real diagnosis should always take priority over a risk for diagnosis or potential diagnosis.

The client prescribed an antidepressant reports nausea, dry mouth, diarrhea, and loss of weight. When planning care which suggestions should the nurse include in the teaching for this client? Select all that apply. Increase fiber intake. Decrease fluid intake. Increase fluid intake. Decrease fiber intake. Chew sugarless gum.

Increase fiber intake. Increase fluid intake. Chew sugarless gum. Explanation: Malnutrition often applies due to various adverse reactions of the medication. To help with antidepressant-induced constipation, the nurse can recommend increased fluid and fiber intake, and for antidepressant-induced dry mouth the nurse can recommend good oral hygiene, frequent sips of water, sugarless gum, and hard candy. Increased fiber intake and fluid intake as well as chew sugarless gum will help improve the client's situation. Decreased fiber intake and fluid intake would further complicate the situation.

A nurse knows that promoting an optimal response to drug therapy is a desired outcome for clients on fluoroquinolones. One important action the nurse should include in the plan of care is which?

Observe the client for the first 48 hours for adverse reactions to the drug. Explanation: One of the most important actions for the nurse is to observe the client for adverse reactions, especially for the first 48 hours of therapy. It is not required to keep the client on bedrest when starting a new anti-infective, nor is it necessary to maintain a low sodium diet unless the client has another diagnosis involving dietary restrictions and I & O monitoring is performed on clients with IV's or other conditions that warrant this. The medication needs to be administered at the ordered time to maintain a constant blood level in the client.

A nurse knows that promoting an optimal response to drug therapy is a desired outcome for clients on fluoroquinolones. One important action the nurse should include in the plan of care is which?

Observe the client for the first 48 hours for adverse reactions to the drug. Explanation: One of the most important actions for the nurse is to observe the client for adverse reactions, especially for the first 48 hours of therapy. It is not required to keep the client on bedrest when starting a new anti-infective, nor is it necessary to maintain a low sodium diet unless the client has another diagnosis involving dietary restrictions and I & O monitoring is performed on clients with IV's or other conditions that warrant this. The medication needs to be administered at the ordered time to maintain a constant blood level in the client.

A client with an infected ulcer on the foot has been prescribed daptomycin. What action should the nurse ensure has been taken to determine that the drug will be effective in treating the infection?

Obtain a culture of the client's infection. Explanation: Daptomycin is a lipopeptide bactericidal agent effective only for gram-positive infections caused by S. aureus (including oxacillin-resistant strains), S. pyogenes, group B streptococci, and Enterococcus faecalis (vancomycin-susceptible strains only) found in complicated skin and skin structure infections. Prior to beginning daptomycin therapy it is necessary to culture the infection site. The results of the culture and sensitivity report will determine whether daptomycin will be effective in treating the infection. Assessment for allergies, while important, is not directed at determining therapeutic effectiveness of daptomycin. Similarly, determining whether the client is taking cholesterol lowering medications is important--concurrent use of daptomycin and statin drugs should be avoided--but that assessment is not related to drug effectiveness. Daptomycin is known to trigger muscle pain, and the risk is increased by concurrent use of statins, but there is no need to assess for this prior to administration.

A nurse is caring for a client who has a pelvic fracture. The client reports sudden shortness of breath, stabbing chest pain, and feelings of doom. The nurse should identify that the client is experiencing which of the following complications?

Pulmonary embolus Immobility following musculoskeletal trauma places the client at an increased risk for pulmonary embolus. The client might also exhibit tachycardia, chest petechiae, and have a decreased SaO2. The nurse should notify the rapid response team immediately.

A male client took zolpidem daily for 1 week with good response, then stopped the medication. Two days later, he returns to the office stating that his insomnia is worse than it ever was. The nurse is responsible for the development of a teaching plan for the client, including adverse reactions. After 1 week of regular use, which adverse reaction may occur with zolpidem?

Rebound insomnia Explanation: Adverse effects of zolpidem include daytime drowsiness, dizziness, nausea, diarrhea, and anterograde amnesia. Rebound insomnia may occur for a night or two after stopping the drug, and withdrawal symptoms may occur if it is stopped abruptly after approximately 1 week of regular use.

A nurse is assessing a client who is 24 hr postoperative following an above-the-elbow amputation. Which of the following findings should the nurse identify as the priority?

Report of muscle spasms The nurse should consider Maslow's hierarchy of needs, which includes five levels of priority. The first level consists of physiological needs; the second level consists of safety and security needs; the third level consists of love and belonging needs; the fourth level consists of personal achievement and self-esteem needs; and the fifth level consists of achieving full potential and the ability to problem solve and cope with life situations. When applying Maslow's hierarchy of needs priority-setting framework, the nurse should review physiological needs first. The nurse should then address the client's needs by following the remaining four hierarchal levels. It is important, however, for the nurse to consider all contributing client factors, as higher levels of the pyramid can compete with those at the lower levels, depending on the specific client situation. The fourth level of Maslow's hierarchy of needs includes usefulness, self-worth, and self-confidence in fulfilling self-esteem needs. Therefore, the nurse should identify the report of muscle spasms, a physiological need, as the priority client finding.

A nurse is caring for a client who is 3 days postoperative following a right total hip arthroplasty. While transferring to a chair, the client cries out in pain. The nurse should assess the client for which of the following manifestations of dislocation of the hip prosthesis?

Shortening of the right leg The nurse should monitor the client for shortening of the affected leg as an indication of dislocation of the prosthesis. Other findings include increased hip pain, inability to move the extremity, and rotation of the hip internally or externally.

A client reports taking kava for stress relief. What should the nurse teach the client about the supplement?

The Food and Drug Administration (FDA) warns that kava may cause severe liver toxicity. Explanation: The FDA issued a warning that products containing kava have been implicated in several cases of severe liver toxicity (e.g., hepatitis, cirrhosis, liver failure). It causes sedation, not stimulation. Herbs are not necessarily safer than drugs. Adverse effects of kava include impaired thinking, judgment, motor reflexes, and vision. Serious adverse effects may occur with long-term heavy use, including decreased plasma proteins, decreased platelet and lymphocyte counts, dyspnea, and pulmonary hypertension.

While reviewing a client record, the nurse sees that the client has a history of chronic insomnia. What assumption can the nurse have regarding the client?

The client has been experiencing dysfunctional sleep for more than 1 month. Explanation: Occasional sleeplessness is a normal response to many stimuli and is not usually harmful. Insomnia is said to be chronic when it lasts longer than 1 month. Insomnia has many causes, including stressors as pain, anxiety, illness, changes in lifestyle or environment, and various drugs. However, one cannot assume a specific cause based on the information provided, so the nurse has no way to know if the client is experiencing a serious illness. Normal sleep includes alternating periods of deep and light sleep cycles. The definition of chronic insomnia does not include reference to the need for pharmacologic sleep therapy.

A client diagnosed with chronic renal failure is currently taking lithium for severe depression. How will this affect the plan of care?

The dose must be markedly reduced, and plasma lithium levels must be closely monitored. Explanation: Lithium is not metabolized by the body; it is entirely excreted by the kidneys. Lower doses and close monitoring of serum levels are required in clients with renal impairment or other conditions that impair excretion.

A patient is starting on a selective serotonin reuptake inhibitor for depression. What will the nurse instruct the patient about taking the medication?

The medication should be taken once a day in the morning. Explanation: A selective serotonin reuptake inhibitor should be taken once a day in the morning unless the dosage is increased or the patient is having severe GI effects. The medication will not require 8 ounces of fluid for absorption and it should be taken for at least 4 weeks before a therapeutic effect is noted.

The client who has been on long-term sulfonamide therapy begins to demonstrate symptoms associated with side affects of the therapy. The nurse knows that these symptoms are related to which complication associated with sulfonamide therapy?

Thrombocytopenia Explanation: Hypotension, hypokalemia, and hyperglycemia are not adverse effects of sulfonamide therapy. Thrombocytopenia is a complication manifested by easy bruising and unusual bleeding after trauma to the skin or mucous membranes.

A nurse is assessing a client who is 48 hr postoperative following open reduction and internal fixation of a fractured tibia. Which of the following findings should the nurse report to the provider?

Toes cold to the touch The nurse should monitor for and report manifestations of compartment syndrome following internal fixation. Therefore, the nurse should contact the provider immediately if the client's toes are cold to the touch.

The nurse is caring for a client who has been prescribed a sulfonamide but does not have an infection. The nurse is aware that the medication has been prescribed to treat what condition?

Ulcerative Colitis Explanation: Sulfonamides are primarily prescribed for treatment of infections but they are also used to manage ulcerative colitis. Stomatitis and crystalluria are possible adverse effects of sulfonamides. Gastritis is an inflammation of the stomach and sulfonamides would not be used to treat this condition.

The nurse will notify the prescribing health care provider when which client is written a prescription for erythromycin? Select all that apply. a 25-year-old breastfeeding mother a 43-year-old in hepatic failure a 40-year-old who reports frequent heartburn a 16-year-old diagnosed with exercise-induced asthma a 75-year-old being treated for hypertension

a 25-year-old breastfeeding mother a 43-year-old in hepatic failure a 40-year-old who reports frequent heartburn Explanation: The macrolides, which include erythromycin, enter the microbial cells and reversibly bind to the 50S subunits of ribosomes, thereby inhibiting microbial protein synthesis and leading to cell death. Using erythromycin warrants caution in clients with hepatic impairment (and perhaps it should not be given at all), because it is metabolized in the liver to an active metabolite that is excreted in the bile. Women who are breastfeeding should not take erythromycin because the drug is concentrated in breast milk. This can alter the bowel flora of the infant and interfere with fever assessments. Antacids are known to decrease the effectiveness of erythromycin. There is no current research to contraindicate the use of erythromycin in clients with either asthma or hypertension.

The nurse is caring for a client taking fluoxetine for depression. Which assessment findings indicate that the medication is effective? Select all that apply. decreased anxiety reduced appetite weight loss improved sleep interest in physical activity

decreased anxiety improved sleep interest in physical activity Explanation: Selective serotonin reuptake inhibitors such as fluoxetine are the drugs of first choice in the treatment of depression. Assessment findings that indicate therapeutic effects include improved sleep, decreased anxiety, improved appetite, and interest in physical activity. Weight loss is an adverse effect from this medication.

A client with an upper respiratory infection has been prescribed macrolides. Which changes during an ongoing assessment would lead the nurse to notify the health care provider? Select all that apply. regular urine output increase in respiratory rate pulse rate within usual parameters decrease in blood pressure sudden increase in temperature

increase in respiratory rate decrease in blood pressure sudden increase in temperature Explanation: The nurse must notify the primary health care provider if there is a decrease in blood pressure, increase in respiratory rate, or sudden increase in temperature during an ongoing assessment after administration of the drug. Regular urine output or pulse rate within usual parameters need not be reported to the health care provider because these would be normal findings.

An older adult was diagnosed with depression several decades ago and has been taking tricyclic antidepressants (TCAs) ever since, with good effect. The nurse should recognize what therapeutic action of this client's medication?

inhibiting reuptake of 5HT and NE Explanation: TCAs inhibit presynaptic reuptake of the neurotransmitters 5HT and NE, which cause an accumulation of the neurotransmitters that is thought to create the antidepressant effect. Monoamine oxidase inhibitors irreversibly inhibit monoamine oxidase that breaks down norepinephrine and serotonin. Selective serotonin reuptake inhibitors block the reuptake of serotonin; gamma-aminobutyric acid inhibits nerve activity.

During assessment, a nurse asks a client about any chronic conditions that might have an impact on the client's prescribed drug therapy. What issue, if reported by the client, would alert the nurse to a possible problem?

kidney disease diagnosed 2 years ago

The nurse is caring for a client who has a sedative hypnotic ordered. The nurse should consider this drug contraindicated if the client has what disorder?

liver failure Explanation: Benzodiazepines undergo extensive hepatic metabolism. In the presence of liver disease, the metabolism of most benzodiazepines is slowed, with resultant accumulation and increased risk of adverse effects. Neurological disorders, endocrine disorders, and heart disease are not contraindications for the use of benzodiazepines.

The client tells the nurse that they have been taking oral fluoxetine 20 mg daily for the past 3 weeks and has lost 2 lb (0.9 kg) during that time due to a loss of appetite. What action should the nurse take?

reassuring the client that this is a common adverse effect with this medication Explanation: Adverse effects of fluoxetine include anorexia and weight loss. This client's weight loss is modest and would not likely necessitate a change in drug therapy. Although teaching about healthy eating is a good idea, it is more important to teach the client how to take the medication in a way that will reduce adverse effects as well as how to optimize healthy calories to maintain weight. The client should increase caloric intake, not just fluid intake. It would not be healthy to recommend exclusively increasing fat intake. The client should continue the medication to see whether therapeutic effects are obtained and adjust nutritional intake if necessary. This weight loss is not solely due to fluid loss. Multivitamins will not reduce weight loss.

A nurse is speaking to a 62-year-old female client who has been started on sulfisoxazole, a sulfonamide antibiotic. The nurse should teach this client to contact the health care provider if the client experiences what adverse effect associated with the drug?

skin rash or itching Explanation: Clients taking sulfonamides should be instructed to contact the prescriber if they experience skin rash or itching. These symptoms may indicate a sulfonamide-induced allergic reaction and the need to change or stop the drug.

A black box warning alerts health care providers to risks in young adults 18 to 24 years of age when taking antidepressant medications. Which symptoms of concern should be included?

statements or resignation and futility and a desire to die Explanation: A black box warning alerts health care providers to the increased risk of suicidal ideation in children, adolescents, and young adults 18 to 24 years of age when taking antidepressant medications. Consequently, statements alluding to a desire to die should be acted on promptly.

The nurse is providing education to a client who has been prescribed eszopiclone. What information should the nurse include?

the importance of taking the drug immediately before going to bed Explanation: People should take eszopiclone immediately prior to going to bed because of its rapid onset of action. It does not need to be taken with food and should not be combined with benzodiazepines. Regular blood work is not indicated.

A client developed a pressure area on the hip that has become infected. If the wound culture reveals methicillin-resistant Staphylococcus aureus, which medication would the nurse expect to be prescribed?

vancomycin Explanation: Vancomycin is active only against gram-positive microorganisms. It acts by inhibiting cell wall synthesis. Parenteral vancomycin has been used extensively to treat infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant staphylococcal species non-aureus (SSNA, including Staphylococcus epidermidis), and endocarditis caused by Streptococcus viridans (in clients allergic to or with infections resistant to penicillins and cephalosporins) or E. faecalis (with an aminoglycoside). None of the other options would effectively manage this infection. A

A client receiving levofloxacin tells the nurse, "I used sunscreen but it didn't help." Which response by the nurse would be most appropriate?

"Be sure to wear long sleeves and a wide-brimmed hat in addition to using sunscreen." Explanation: The fluoroquinolone drugs cause severe photosensitivity reactions. Clients may experience "sunburn" reactions even when they use sunscreen or sunblock products. Caution clients to wear cover-up clothing with long sleeves and wide-brimmed hats when outside in addition to sunblock preparations. Remind them that sunscreen needs to be applied repeatedly throughout the day or when going into water. Clients should be aware that glare during hazy or cloudy days can cause skin reactions as readily as direct sunlight on a clear day. Telling the client that they didn't apply enough or questioning the client's actual use of sunscreen is inappropriate. There is no need to change the medication because the client's report is not unusual.

You are preparing to discharge a patient who is taking ciprofloxacin. What guidance would you offer this patient to prevent crystalluria?

"Drink at least 2 liters of fluids per day." Explanation: Crystalluria is a potential side effect of taking fluoroquinolones such as ciprofloxacin. Patients should be instructed to drink two to three quarts of fluids each day to decrease the risk of developing the condition. Although the nurse should instruct the patient to take the medication as prescribed and to avoid antacids, which can decrease absorption of the medication, neither measure will prevent crystalluria.

The nurse is preparing to administer a sulfonamide to a client when the client states, "I woke up this morning with a lot of sores in my mouth." What is the nurse's next best action?

"I'm going to contact your health care provider before I administer your medication." Explanation: The nurse should withhold the medication and notify the health care provider when a client develops an adverse reaction. In this case, the client developed numerous mouth sores overnight so it must be addressed before proceeding with medication administration. The other responses do not state that the medication should be withheld.

The nurse is providing care for a client who has been prescribed a diuretic to treat hypertension. The client states that the effects of the drug are problematic, causing the client to wake up numerous times during the night to urinate. What assessment question should the nurse prioritize?

"When are you taking your medication?"

The client has been taking a fluoroquinolone and now reports that he has a white patch in his mouth. What is the best response of the nurse?

"You may be experiencing an additional infection. I will discuss this with your health care provider." Explanation: A burning sensation of the mouth or throat may be an indication of a superinfection. It is important the nurse notify the provider. The nurse should not minimize the client's concerns or cause panic.

A health care provider instructs a nurse to administer a medication to a client STAT. Which action by the nurse would be most appropriate?

Administer the drug as ordered by the health care provider

The nurse instructs the client who is taking oral ciprofloxacin to avoid which food while taking this medication?

Cheese Explanation: Clients taking oral ciprofloxacin should avoid calcium-containing foods while taking this medication.

Which of the following drugs is likely to be administered as a first-line treatment for anthrax exposure? Ciprofloxacin Tobramycin Norfloxacin Gentamicin

Ciprofloxacin Explanation: Ciprofloxacin is currently recommended as the first-line treatment for suspected anthrax.

The nurse is required to administer 4 mL of an intramuscular (IM) injection to the client. Which action would be most appropriate?

Divide the drug and give it as two separate injections

Fluoroquinolones are effective at treating which of the following types of infections? Select all that apply. Viral infections Gram-negative infections Fungal infections Gram-positive infections Parasitic infections

Gram-positive infections Gram-negative infections Explanation: Fluoroquinolones are effective in treating infections caused by gram-positive and gram-negative microorganisms.

The nurse is caring for a client who is receiving IV gentamicin and who reports difficulty hearing this morning. What should the nurse do? Make a referral for auditory testing. Administer the dose and report this information to the oncoming nurse. Administer the dose and document the finding in the client's health record. Hold the dose and notify the provider immediately.

Hold the dose and notify the provider immediately. Explanation: Aminoglycosides are contraindicated in the following conditions: known allergy to any of the aminoglycosides; renal or hepatic disease that could be exacerbated by toxic aminoglycoside effects and that could interfere with drug metabolism and excretion, leading to higher toxicity; preexisting hearing loss, which could be intensified by toxic drug-related adverse effects on the auditory nerve. Ototoxicity should be reported, and the drug should be stopped. Hearing assessment may be deemed necessary, but the priority is to hold the dose and contact the provider.

The nurse in the intensive care unit is providing care for a client who was just admitted with multiple trauma. What action should the nurse prioritize with relation to drug therapy?

Monitor the client's response to treatment closely

A nurse is beginning to apply the nursing process during a new client interaction. What activity should the nurse perform?

Obtain a medication history.

A young lifeguard has been prescribed moxifloxacin (Avelox). The nurse understands that the focus on education would be which adverse reaction?

Photosensitivity Explanation: The lifeguard will be in the sun, and he is at risk for an exaggerated skin reaction. Weakness, fatigue and muscle cramping are not know adverse reactions to this medication, therefore with the client's job, photosensitivity is the highest priority.

The nurse is caring for a child weighing 30 kg. The healthcare provider orders gentamicin 100 mg IV three times per day. The recommended dosage range is 6 to 7.5 mg/kg/day. What action should the nurse take? Administer the medication and assess hearing frequently. Administer the medication and assess renal function frequently. Question the prescriber about the frequency of administration. Question the prescriber about the dosage of the medication.

Question the prescriber about the dosage of the medication. Explanation: The dosage is outside the recommended dosage range at 10 mg/kg/day, so the nurse should question the dosage before administering the medication. It is appropriate to administer gentamicin three times per day to pediatric clients, so there would be no need to question frequency of dosage. The drug should not be administered until the correct dosage is ordered, so there is no need to assess hearing or renal function.

Which organization is responsible for the continuation of defining, explaining, classifying, and researching summary statements about health problems related to nursing?

The North American Nursing Diagnosis Association-International (NANDA)

What symptom should the nurse expect to find if the client begins to exhibit signs of ototoxicity? Tinnitus Rash Fatigue Anorexia

Tinnitus Explanation: One of the first symptoms to occur in a client who is developing ototoxicity is tinnitus or ringing in the ears. Fatigue, anorexia, and rash are other adverse effects but are not related to ototoxicity.

The nurse should notify the health care provider immediately if a client has this possible sign of serious neurotoxicity when a client is receiving an aminoglycoside. (Select all that apply.) Tremors Circumoral paresthesia Numbness or tingling of the skin (peripheral paresthesia) Muscle twitching or weakness

Tremors Circumoral paresthesia Numbness or tingling of the skin (peripheral paresthesia) Muscle twitching or weakness Explanation: The nurse should notify the provider immediately if a client has numbness or tingling of the skin, circumoral paresthesia, tremors, or muscle twitching or weakness.

"Dose desired/dose on hand = dose administered" is the formula for calculating the dose to be administered. Under which circumstances is this to be used?

When the dose desired and dose on hand are in the same system

The nurse is conducting the evaluation phase of the nursing process. The nurse should perform evaluation primarily based on what data?

Whether the client is achieving health outcomes

When considering known adverse reactions to gentamicin therapy, the nurse should focus assessment of what body structure?

inner ears Explanation: Gentamicin reaches higher concentrations in the kidneys and inner ears than in other body tissues; this is a major factor in nephrotoxicity and ototoxicity. This situation requires focused assessment of the inner ears and kidney function. The increased concentration does occur in any of the other proposed locations.

The nursing student is studying drug dosage and has learned that there are three systems of measurement associated with drug dosing. What are these systems? (Select all that apply.) metric system Mercalli system apothecary system household measurement system Avoirdupois system

metric system apothecary system household measurement system

A group of nursing students are reviewing information about fluoroquinolones. The students demonstrate a need for additional review when they identify which as an example?

metronidazole Explanation: Metronidazole is not an example of a fluoroquinolone. Ciprofloxacin is an example of a fluoroquinolone. Levofloxacin is an example of a fluoroquinolone. Gemifloxacin is an example of a fluoroquinolone.

What route of administration is most commonly used for the administration of ciprofloxacin when prescribed to an older adult client?

oral (PO) Explanation: While ciprofloxacin is typically administered by the PO or IV route, in most cases, oral administration is used. The medication is not administered by either the SQ or IM routes.

The nurse is administering a urinary tract drug that exerts a topical analgesic effect on the lining of the urinary tract. Which drug would the nurse likely administer? trimethoprim methenamine amoxicillin phenazopyridine

phenazopyridine Explanation: Phenazopyridine is a dye that exerts a topical analgesic effect on the lining of the urinary tract. Trimethoprim (TMP) is used to treat acute bacterial UTIs. Amoxicillin is used to treat acute bacterial UTIs as well as other bacterial infections. Methenamine is used to treat chronic UTIs.

A client with a gram-negative infection is being treated with an aminoglycoside. What assessment should the nurse prioritize during treatment?

urine output and BUN and creatinine levels Explanation: Renal function should be tested daily because aminoglycosides depend on the kidney for excretion and if the glomerular filtration rate (GFR) is abnormal, it may be toxic to the kidney. The results of the renal function testing could change the daily dosage. Aminoglycosides do not usually adversely affect respiratory or musculoskeletal function, although baseline data concerning these systems are always needed. Auditory effects are more likely than visual effects.

A nurse is reviewing the medical record of a client who is prescribed tetracycline. Which drug, if found being used by the client, would alert the nurse to the need for a decreased dosage of that drug?

warfarin Explanation: The concomitant use of tetracycline with warfarin, an anticoagulant, increases the risk of bleeding, necessitating a reduction in the dosage of warfarin. Vancomycin is used in specific cases of bacterial and resistant infections. Atorvastatin is for hyperlipidemia, and losartan is an antihypertensive. Tetracycline has no drug interaction with these drugs.

A client is questioning the nurse about a superinfection that developed while receiving fluoroquinolone therapy. Which response by the nurse would be most appropriate? "This happens when your original infection begins to clear." "We really don't know why this happens; it just does sometimes." "The drug disrupts your normal bacteria so it allows other organisms to grow." "Your infection was really severe, so the drug wasn't as effective as it could have been."

"The drug disrupts your normal bacteria so it allows other organisms to grow." Explanation: Antibiotics can disrupt the normal flora (nonpathogenic bacteria in the bowel), causing a secondary infection or superinfection. This new infection is "superimposed" on the original infection. The destruction of large numbers of nonpathogenic bacteria (normal flora) by the antibiotic alters the chemical environment. This allows uncontrolled growth of bacteria or fungal microorganisms that are not affected by the antibiotic being administered. It has nothing to do with the drug's effectiveness or the original infection being cleared.

A home health care nurse is assessing a client's medication during a home visit. The client is prescribed atorvastatin 10 mg daily, a change from the previous order of 20 mg daily. The client shows the nurse the medication container from the pharmacy. The label reads atorvastatin 20 mg. The nurse determines that the client is taking the correct dosage when the client states he is taking how much of the drug?

"You should be taking only 1/2 a tablet every day."

After teaching a group of nursing students about using zeros, the instructor determines that the teaching was successful when they identify which as the correct placement of a zero in a decimal?

0.75

A client has been prescribed 4 g of sulfamethoxazole/trimethoprim tablets per day. The available drug is in the form of 500 mg. The nurse would administer how many tablets each day?

8 Explanation: The required dosage is 4 g per day. Available drug is in the form of 500 mg. Therefore, eight (4000 mg/500 mg) tablets have to be administered every day.

The nurse is caring for four clients on a medical floor. For which client would the nurse suspect the health care provider might order a sulfonamide?

A 35-year-old woman with a urinary tract infection and a history of ulcerative colitis Explanation: The sulfonamides are used with caution in clients with renal impairment, hepatic impairment, or bronchial asthma. They are used to treat clients with ear infections, urinary tract infections, and ulcerative colitis. The topical sulfonamides are used to treat second- and third-degree burns.

A client is started on trimethoprim and sulfamethoxazole for a urinary tract infection. The client reports nausea, anorexia, and abdominal pain. What intervention does the nurse discuss with the client? Avoid driving and performing tasks that require alertness. Drink frequent sips of water. Call the prescriber for pain medication. Consume the medication with food.

Consume the medication with food. Explanation: The client is experiencing common adverse reactions related to the medication. Other adverse reactions include anorexia, nausea, vomiting, diarrhea, abdominal pain, or stomatitis. The client should be instructed to drink extra fluids and take the medication with food. Calling the prescriber for pain medication is not indicated. The client is not reporting an inability to stay alert.

Prior to administration of fluoroquinolones, which laboratory test should be obtained? Complete blood counts Culture and sensitivity Renal function Hepatic function

Culture and sensitivity Explanation: It is most important that culture and sensitivity tests are obtained prior to the administration of the first dose of antibiotics, so that accurate information can be obtained. Complete blood counts and hepatic and renal function tests are important but may be obtained later.

A client who routinely takes antacids has been prescribed tetracycline. The nurse explains to the client that there is an increased risk of which effect related to this combination?

Decreased absorption of tetracycline Explanation: Interaction of antacids with a tetracycline drug causes decreased absorption of tetracycline. Increased action of neuromuscular blocking drugs and increased profound respiratory depression are the result of interaction between neuromuscular blocking drugs and tetracyclines. Increased risk of bleeding is a result of interaction between anticoagulants and tetracyclines.

The nursing student correctly identifies the class of drugs that exerts their bactericidal effect by interfering with the synthesis of bacterial DNA, thus preventing cell reproduction and leading to death of the bacteria, as which of the following groups? Sulfonamides Penicillins Fluoroquinolones Cephalosporins

Fluoroquinolones Explanation: The fluoroquinolones exert their bactericidal effect by interfering with the synthesis of bacterial DNA. This interference prevents cell reproduction, leading to death of the bacteria. Penicillins work by inhibiting the bacterial cell activities including cell wall synthesis, DNA or RNA synthesis, and protein synthesis. The sulfonamides are bacteriostatic and work by inhibiting the activity of folic acid in bacterial cell metabolism. Finally the cephalosporins have a beta-lactam ring and target the bacterial cell wall, making it defective and unstable.

The health care professional has recommended sulfonamide therapy for a patient. While obtaining the patient's medical history, the nurse discovers that the patient is taking oral anticoagulants. Which of the following are the possible effects of combining sulfonamide therapy with oral anticoagulants? Patient may develop leucopenia Increased risk of an anaphylactic shock Sulfonamide therapy is rendered ineffective Increased action of the anticoagulant

Increased action of the anticoagulant Explanation: Taking sulfonamide drugs when the patient is already taking oral anticoagulants may result in increased action of the anticoagulants. Anaphylactic shock and leukopenia are some of the adverse reactions of sulfonamides, but are not associated with mixing sulfonamides and anticoagulants. Oral anticoagulants do not decrease the effectiveness of sulfonamides.

An older adult client who is hospitalized develops a UTI and is prescribed appropriate anti-infective therapy. Which action should the nurse prioritize on the ongoing assessment for this client?

Monitor the client's vital signs every 4 hours.

A male client is NPO as a consequence of a cerebrovascular accident sustained 3 years ago. His care is managed at home by his wife, and he receives all medications via gastrostomy tube. The health care provider orders a fluoroquinolone for the client to treat an infection. The nurse would instruct the client's wife to administer the medication in what way? With antacids On an empty stomach With the enteral feeding On a full stomach

On an empty stomach Explanation: Fluoroquinolones are usually infused IV in critically ill clients. However, administration orally or by GI tube (e.g., nasogastric, gastrostomy, jejunostomy) may be feasible in some clients. Concomitant administration of antacids or enteral feedings decreases absorption.

When administering aminoglycosides, the nurse must be aware of which of the following adverse reactions?

Ototoxicity and nephrotoxicity Rationale: After parenteral administration, aminoglycosides are widely distributed in extracellular fluid and reach therapeutic levels in blood, urine, bone, inflamed joints, and pleural and ascitic fluids. They accumulate in high concentrations in the proximal renal tubules of the kidney leading to acute tubular necrosis. This damage to the kidney is termed nephrotoxicity. They also accumulate in high concentrations in the inner ear, damaging sensory cells in the cochlea and the vestibular apparatus. This damage to the inner ear is termed ototoxicity.

A nurse has been instructed to administer mafenide to a patient. Which of the following adverse reactions should the nurse assess for in this patient?

Rash, itching, or other allergic reactions Explanation: The nurse should assess for allergic reactions such as rash, itching, edema, and urticaria when administering mafenide. Topical sulfonamides like mafenide do not cause crystalluria, inflammation of the mouth, or loss of appetite.

A nurse is preparing an inservice on the subject of preventing medication errors. Which actions will the nurse illustrate in the discussion? Select all that apply. Rechecking all calculations Always administering the drug before answering any of the client's questions Avoiding distractions and concentrating on only one task at a time Confirming any questionable orders Practicing the five + 1 rights of drug administration

Rechecking all calculations Avoiding distractions and concentrating on only one task at a time Confirming any questionable orders Practicing the five + 1 rights of drug administration

A middle-aged client is to receive tetracycline for treatment of H. pylori infection, as well as continue with digoxin for a history of heart disease. The nurse will be prepared to monitor the client for which potential condition? Respiratory depression Decreased effectiveness of tetracycline Risk of digoxin toxicity Prolonged clotting times

Risk of digoxin toxicity Explanation: When digoxin interacts with tetracyclines, the client is at risk for digoxin toxicity. Respiratory depression is an effect observed when neuromuscular blocking drugs interact with lincosamides. A decrease in the effectiveness of tetracycline is seen when the drug is taken with antacids, dairy products, or iron. An increased risk for bleeding with prolonged clotting times is noted when tetracycline is given with anticoagulants.

A client who takes digoxin for heart failure is also prescribed trospium. The nurse would monitor the client closely for:

Signs of digoxin toxicity Explanation: Trospium interacts with digoxin, leading to increased serum levels of digoxin. Therefore, the nurse would need to monitor the client for signs and symptoms of digoxin toxicity. Levels of trospium would not increase, so increased central nervous system effects or excess anticholinergic effects would most likely not occur. The combination of trospium and digoxin does not change the color of urine.

After teaching a group of nursing students about sulfonamides, the instructor determines that the teaching was successful when the students choose which medication as an example of a sulfonamide antibiotic? Select all that apply. Silver sulfadiazine Clarithromycin Amoxicillin Sulfamethoxazole/trimethoprim Ciprofloxacin

Silver sulfadiazine Sulfamethoxazole/trimethoprim Explanation: Silver sulfadiazine (Silvadene) and sulfamethoxazole/trimethoprim (Bactrim) are sulfonamide antibiotics. Amoxicillin is an aminopenicillin. Ciprofloxacin is classified as a fluoroquinolone. Clarithromycin is a macrolide.

The nurse should advise the client to avoid taking which medication at the same time as a fluoroquinolone? antacids antihypertensives oral contraceptives antidiabetic agents

antacids Explanation: The client should not take antacids or drugs containing iron or zinc at the same time as taking a fluoroquinolone because these drugs will decrease the absorption of the fluoroquinolones. There are no listed contraindications of giving fluoroquinolones with antihypertensives, antidiabetic agents, or oral contraceptives.

When describing the action of fluoroquinolones to treat infection to a group of nursing students, which would the instructor include?

bactericidal Explanation: The fluoroquinolones exert bactericidal effects by interfering with the synthesis of bacterial DNA. This interference prevents cell reproduction, causing death of the bacterial cell. They do not inhibit the growth as in bacteriostatic. These group of drugs are not used to treat or reduce fungal growth or infections.

A local bioterrorism medical team is responding to a possible anthrax attack. The team is instructed that a fluoroquinolone may be used to treat exposure to anthrax. The nurse should prepare to administer what antibiotic?

ciprofloxacin Explanation: Ciprofloxacin is used to treat exposure to anthrax. Gemifloxacin and sparfloxacin are most useful in treating acute episodes of chronic bronchitis and community-acquired pneumonia. Amoxicillin is a penicillin, not a fluoroquinolone.

Sulfasalazine (Azulfidine) is contraindicated in people who are allergic to:

salicylates. Explanation: Sulfasalazine (Azulfidine) is contraindicated in people who are allergic to salicylates.

A nurse is monitoring a client on sulfonamide therapy. Which finding would lead the nurse to suspect that the client is developing thrombocytopenia? difficulty breathing cough fever unusual bleeding

unusual bleeding Explanation: A person with thrombocytopenia shows visible signs of easy bruising and unusual bleeding after moderate to slight trauma to the skin. Fever can be associated with leukopenia. Cough is a common symptom associated with many other conditions. Difficulty breathing can be associated with aplastic anemia.