PathoPharm 1 Medications for immunity, infection, and inflammation EAQ

Which instruction would the nurse include when providing medication teaching to a client prescribed trimethoprim-sulfamethoxazole for cystitis? A. "Drink eight to ten glasses of water daily." B. "Take this medication with orange juice." C. "Take the medication with meals." D. "Take the medication until symptoms subside.

A. "Drink eight to ten glasses of water daily." Rationale: A urinary output of at least 1500 mL daily should be maintained to prevent crystalluria (crystals in the urine). Taking the medication with orange juice provides no advantage. Also, orange juice produces an alkaline ash, which results in an alkaline urine that supports the growth of bacteria. Trimethoprim-sulfamethoxazole should be taken 1 hour before meals for maximum absorption. A prescribed course of antibiotics must be completed to eliminate the infection, which can exist on a subclinical level after symptoms subside.

Which medication does the nurse expect in the prescription of a client suffering from the skin condition depicted in the image? A. Acyclovir B. Macrolides C. Ketoconazole D. Cephalosporin

A. Acyclovir Rationale: The skin condition depicted in the image is herpes zoster, which is a viral infection. Acyclovir is used in treating this condition. The macrolides are antibiotics used in situations in which there are allergic reactions to the medication. Ketoconazole is an antifungal medication that is used in the treatment of fungal infections. Cephalosporin is an antibacterial medication that is used in the treatment of bacterial infections.

Which intervention would the nurse include in the plan of care for a client admitted with herpes zoster? (Select all that apply) A. Acyclovir B. Silvadene C. Gabapentin D. Wet compresses E. Contact isolation

A. Acyclovir B. Silvadene C. Gabapentin D. Wet compresses E. Contact isolation Rationale: A client with herpes zoster would receive antiviral medications such as acyclovir. Silvadene can be applied to open vesicles. Gabapentin can be used to treat the nerve pain associated with herpes zoster. Wet compresses can be applied to the vesicles to relieve discomfort. Herpes zoster is highly contagious, and the client would be placed in contact isolation precautions.

Which medication increases the risk for upper gastrointestinal (GI) bleeding? (SATA) A. Aspirin B. Ibuprofen C. Ciprofloxacin D. Acetaminophen E. Methylprednisolone

A. Aspirin B. Ibuprofen E. Methylprednisolone Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid and ibuprofen, and corticosteroids such as methylprednisolone are known causes of medication-induced gastrointestinal (GI) bleeding by causing irritation and erosion of the gastric mucosal barrier. Ciprofloxacin, an antibiotic, has not been associated with GI bleeding. Acetaminophen is a safe alternative to NSAIDs to reduce the risk of GI bleeding.

The nurse notes an older adult's admission orders include gentamicin for the treatment of osteomyelitis. Which laboratory report would the nurse review before beginning the medication? (SATA) A. Blood urea nitrogen (BUN) and creatinine B. Electrolytes and urinalysis C. Erythrocyte count D. Blood platelet count E. Serum thyroxin levels

A. Blood urea nitrogen (BUN) and creatinine B. Electrolytes and urinalysis Rationale: Because gentamicin can increase the risk of nephrotoxicity, the nurse should assess a client's renal function before starting therapy. Dehydration can further increase the risk of nephrotoxicity; therefore, the client's

Which hormone is responsible for altered serum calcium concentrations? (Select all that apply) A. Calcitonin B. Thyroxine C. Glucocorticoids D. Growth hormone E. Parathyroid hormone

A. Calcitonin E. Parathyroid hormone Rationale: Produced by the thyroid gland, calcitonin decreases the serum calcium concentration if it increases above the normal level. Parathyroid hormones increase and stimulate bones to promote osteoclastic activity and release calcium into the blood in response to low serum calcium levels. Thyroxine increases the rate of protein synthesis in all types of tissues. Glucocorticoids regulate protein metabolism to maintain the organic matrix of bone. Growth hormone helps increase bone length and determine the amount of bone matrix formed before puberty

For which client would the nurse need to contact the health care provider based upon the client' s condition and treatment after reviewing the medication reconciliation documents of four clients? A. Client A - Condition (Enterococcus faecalis associated UTI) - Treatment: Streptomycin B. Client B - Condition: Staphylococcus epidermidis associated osteomyelitis - Treatment: Vancomycin C. Client C - Condition: Streptococcus pneumoniae associated pneumococcal pneumonia - Treatment: Cefotaxime D. Client D - Condition: Klebsiella pneumoniae associated pneumonia - Treatment: Meropenem

A. Client A Rationale: Enterococcus faecalis can cause a urinary tract infection, which is treated with penicillin G or ampicillin. E. faecalis in client A is resistant to medications such as streptomycin, vancomycin, and gentamicin and should be corrected by the nurse. All the rest are correct treatments. Staphylococcus epidermidis-associated osteomyelitis in client B can be effectively treated with vancomycin. Streptococcus pneumoniae-associated pneumococcal pneumonia in client C can be treated safely with cefotaxime and ceftriaxone. Klebsiella pneumoniae-associated pneumonia in client D is treated with meropenem.

Which assessment would the nurse perform before administering a dose of vancomycin to a client? (Select all that apply) A. Creatinine B. Trough level C. Hearing ability D. Intravenous site E. Blood urea nitrogen

A. Creatinine B. Trough level C. Hearing ability D. Intravenous site E. Blood urea nitrogen Rationale: Two major adverse effects of vancomycin are nephrotoxicity and ototoxicity. The nurse would assess the client's creatinine and blood urea nitrogen levels to determine renal function. The nurse would also assess the vancomycin trough levels to determine if the client's kidneys are clearing the medication. The nurse would assess for changes in hearing as a result of ototoxicity. Vancomycin can cause phlebitis, so the nurse would assess the intravenous site before initiating the infusion.

Which class of medication would a nurse expect to be prescribed to prevent the development of cerebral edema after a craniotomy to remove a brain tumor? A. Glucocorticoids B. Anticholinergics C. Anticonvulsants D. Antihypertensives

A. Glucocorticoids Rationale: Glucocorticoids are used for their anti-inflammatory action, which decreases the development of cerebral edema. Anticholinergics are not used to prevent cerebral edema. Anticonvulsants prevent seizure activity, not cerebral edema. Antihypertensives control hypertension, not cerebral edema.

Which assessment finding during the administration of intravenous penicillin would prompt the nurse to stop the infusion? (Select all that apply) A. Hives B. Itching C. Nausea D. Skin rash E. Shortness of breath

A. Hives B. Itching D. Skin rash E. Shortness of breath Rationale: Penicillin administration carries a high rate of allergic reaction, so the nurse monitors the client for signs of allergy. Hives, itching, skin rash, and shortness of breath are all indications of allergic reaction and warrant cessation of the infusion and contact with the health care provider. Nausea is not an indication of allergic reaction.

Which action would the nurse take to avoid red man syndrome when preparing to administer a vancomycin infusion? A. Infuse slowly. B. Change the intravenous (IV) site. C. Reduce the dosage. D. Administer vitamin K

A. Infuse slowly Rationale: Vancomycin should be infused slowly to avoid the occurrence of the reaction known as 'red man syndrome.' Changing the IV site reduces the incidence of thrombophlebitis. Reducing the dosage is done in the setting of renal dysfunction. Administration of vitamin K is done to correct an elevated prothrombin time.

Which hormones are involved in building and maintaining healthy bone tissue? (Select all that apply) A. Insulin B. Thyroxine C. Glucocorticoids D. Growth hormone E. Parathyroid hormone

A. Insulin C. Glucocorticoids D. Growth hormone Rationale: Insulin works together with growth hormone to increase bone length, which helps build and maintain healthy bone tissue. Glucocorticoids regulate protein metabolism to reduce or intensify the organic matrix of bone. Thyroxine increases the rate of protein synthesis in all types of tissues. Parathyroid hormone secretion stimulates bones to promote osteoclastic activity and release calcium into the blood when serum calcium levels are lowered.

Which adverse effect would the nurse monitor for in an infant receiving a sulfonamide? A. Kernicterus B. Gray Syndrome C. Growth suppression D. Discoloration of the teeth

A. Kernicterus Rationale: Kernicterus is a potential adverse effect of sulfonamides in infants. Gray syndrome is associated with chloramphenicol. Growth suppression can result from the use of glucocorticoids. Discoloration of the teeth is an adverse effect of tetracycline

Which substance history of a severe allergic reaction results in avoidance of the cephalosporins such as cefazolin, cefditoren, cefotetan, and ceftriaxone? (Select all that apply) A. Milk B. Aspirin C. Calcium D. Penicillin E. Strawberries

A. Milk C. Calcium D. Penicillin Rationale: Use of cephalosporins like cefazolin should be avoided in the client with a history of severe allergic reaction to penicillin because of the potential of cross-sensitivity. The cephalosporin cefditoren should not be administered to the client with a milk allergy because it contains the milk protein caseinate. Bleeding can be magnified with the use of aspirin and the use of the cephalosporins cefotetan or ceftriaxone. The cephalosporin ceftriaxone and calcium should not be administered together because they cause the formation of precipitates. Strawberry allergies do not prohibit the use of these medications.

Which action would the nurse take when a client receiving an infusion of penicillin reports having an anaphylactic reaction to penicillin in the past? (SATA) A. Notifying rapid response B. Measuring oxygen level C. Administering epinephrine D. Inserting an indwelling catheter E. Assessing the respiratory pattern

A. Notifying rapid response B. Measuring oxygen level C. Administering epinephrine D. Inserting an indwelling catheter E. Assessing the respiratory pattern Rationale: An anaphylactic reaction to penicillin can lead to cardiovascular and pulmonary collapse. If a client currently receiving penicillin reports a reaction to the medication in the past, the nurse should notify rapid response, assess the client's oxygen saturation levels, and administer oxygen. Epinephrine can be used to decrease the symptoms of an anaphylactic reaction. The nurse would insert an indwelling urinary catheter to maintain accurate intake and output. The client's respiratory rate and pattern would be monitored to determine respiratory impairment and to assess the effectiveness of the interventions.

The nurse identifies which antimicrobial medications as safe during breast-feeding? (Select all that apply) A. Penicillins B. Macrolides C. Tetracycline D. Cephalosporins E. Chloramphenicol

A. Penicillins B. Macrolides D. Cephalosporins Rationale: Penicillins, macrolides, and cephalosporins are considered safe medications during breast-feeding as they are least likely to affect the infant. Tetracycline and chloramphenicol should be avoided during breast-feeding.

Which medication may contribute to development of a peptic ulcer in a client receiving immunosuppressive therapy? A. Prednisone B. Azathioprine C. Cyclosporine D. Cyclophosphamide

A. Prednisone Rationale: Prednisone is a corticosteroid that suppresses inflammatory responses. A side effect of prednisone is the development of peptic ulcers. Azathioprine is an immunosuppressant that may cause anemia. Cyclosporine is an immunosuppressant that may cause nephrotoxicity and hypertension. Cyclophosphamide is an immunosuppressant that may cause hemorrhagic cystitis.

Which information would the nurse provide to a client diagnosed with chlamydia and prescribed doxycycline? (Select all that apply) A. Report worsening symptoms. B. Refrain from sexual relations. C. Use barrier protection devices. D. Contact partners to be tested. E. Take the entire course of antibiotics.

A. Report worsening symptoms. B. Refrain from sexual relations. D. Contact partners to be tested. E. Take the entire course of antibiotics. Rationale: The nurse would instruct clients taking doxycycline for an STI to report worsening symptoms to the health care provider as it could indicate antibiotic resistance. Clients would also be instructed to refrain from sexual relations while the infection is being treated. If they do choose to have sexual relations, they would be instructed on the importance of using barrier protection. The nurse would also instruct clients to contact their sexual partners and inform them of the need to be tested and treated for the STI. Clients should take the entire prescribed course of antibiotics to prevent recurrence of the infection.

Which action would the nurse take when a client develops a maculopapular rash on the upper extremities and audible wheezing during the administration of intravenous vancomycin? A. Stop the infusion. B. Decrease the flow rate. C. Reassess in 15 minutes. D. Notify the health care provider

A. Stop the infusion. Rationale: The first action the nurse would take is to stop the infusion immediately. The client may be experiencing an allergic reaction. Decreasing the flow rate is not an appropriate action. Infusions must be stopped if an allergic reaction is suspected. This could be an emergent situation, so reassessing in 15 minutes is not the most appropriate action. The nurse would stop the medication infusion and then notify the health care provider.

A 5-year-old child is given fluoroquinolones. Which potential adverse effect unique to pediatric clients would the nurse anticipate? A. Tendon Rupture B. Cartilage erosion C. Staining of developing teeth D. Central nervous system toxicity

A. Tendon Rupture Rationale: Fluoroquinolones may cause tendon rupture in children. Nalidixic acid can cause cartilage erosion, and tetracycline can cause staining of developing teeth. Hexachlorophene may cause central nervous system toxicity in infants.

The nurse teaches the parent of an infant prescribed nystatin for oral thrush how to prevent aggravation of the condition. Which statements by the parent indicate the need for further teaching? (Select all that apply) A. "I should rinse the infant's mouth with plain water after feeding." B. "I should boil the pacifier for at least 20 minutes on alternate days." C. "I should apply the medication at least 20 minutes before feeding." D. "I should apply the medication to the infant's oral cavity four times a day." E. "I should boil the reusable nipples for at least 5 minutes after washing.

B. "I should boil the pacifier for at least 20 minutes on alternate days." C. "I should apply the medication at least 20 minutes before feeding." E. "I should boil the reusable nipples for at least 5 minutes after washing. Rationale: Nystatin is used to treat oral thrush in infants. Boiling the pacifier for 20 minutes on alternate days is inadequate because daily boiling of the pacifier is the best way to ensure efficient sterilization and killing of pathogens. Pacifiers should be boiled daily for at least 20 minutes. Nystatin should be administered to the child after feeding, not before feeding. Reusable nipples should be boiled at least 20 minutes after washing to remove spores, which are heat-resistant. Rinsing the infant's mouth after feeding with plain water reduces the risk of infection in the infant. Nystatin should be applied four times a day to the infant's oral cavity to ensure effective medication action.

Which client receiving antibiotic therapy would the nurse identify as being at risk for Achilles tendon rupture? A. Client A (Getamicin) B. Client B (Ciprofloxacin) C. Client C (Cefazolin) D. Client D (Tobramycin)

B. Client B Rationale: Client B, prescribed ciprofloxacin, is at risk for Achilles tendon rupture as tendon rupture can occur with use of the fluoroquinolones. Client A, prescribed gentamicin, is at risk for visual and hearing problems. Client C, prescribed cefazolin, is at risk for severe watery diarrhea and mouth sores. Client D, prescribed tobramycin, is at risk for nephrotoxicity.

To which of these four assigned clients with a mouth infection would the nurse anticipate administering nystatin as an oral suspension? A. Client A (Trench mouth) B. Client B (Moniliasis) C. Client C (Cold sores) D. Client D (Parotitis)

B. Client B (Moniliasis) Rationale: Moniliasis is a fungal infection caused by Candida albicans. Nystatin is an antifungal medication used to treat fungal infections. Nystatin is the medication used to treat clients with moniliasis. A topical application of antibacterial and mouth irrigations with chlorhexidine treats those clients with trench mouth. Antiviral medications treat clients with cold sores. Adequate fluid intake and antibacterial medications treat clients with parotitis

Which medication would the nurse anticipate administering to a client who reports fever, cough, muscle aches, night sweats, and chest pain with a laboratory report indicating the presence of Coccidioides organisms in the respiratory tract? A. Oseltamivir B. Fluconazole C. Pyrazinamide D. Cephalosporin

B. Fluconazole Rationale: Coccidioides organisms cause coccidioidomycosis. The symptoms of coccidioidomycosis are fever, cough, muscle aches, night sweats, and chest pain. Fluconazole is an antifungal medication beneficial in treating coccidioidomycosis. Oseltamivir is an antiviral medication used to treat influenza. Pyrazinamide is an antitubercular medication, used to treat tuberculosis. Cephalosporin is an antibiotic and may be used in treatment of bacterial pharyngitis

Use of which medication would the nurse identify as a potential risk for hearing impairment in a child? A. Amoxicillin B. Gentamicin C. Clindamycin D. Ciprofloxacin

B. Gentamicin Rationale: Rationale Gentamicin can be ototoxic because of its effects on the eighth cranial nerve. Reactions to amoxicillin are usually allergic in nature. Impaired hearing does not occur with ciprofloxacin or with clindamycin.

Which mechanism of action applies to penicillin? A. Prevents reproduction of the pathogen B. Inhibits cell wall synthesis of the pathogen C. Inhibits nucleic acid synthesis of the pathogen D. Injures the cytoplasmic membrane of the pathogen

B. Inhibits cell wall synthesis of the pathogen Rationale: Penicillin is an antimicrobial medication that inhibits cell wall synthesis of the susceptible pathogen. Gentamicin is an antimicrobial medication that prevents the reproduction of the susceptible pathogen. Actinomycin is an antimicrobial medication that inhibits nucleic acid synthesis of the susceptible pathogen. Antifungal agents injure the cytoplasmic membrane of the susceptible pathogen.

The nurse is teaching the parent of a child prescribed a high dose of oral prednisone for asthma. Which information is critical for the nurse to include when teaching about this medication? A. It protects against infection. B. It should be stopped gradually. C. An early growth spurt may occur. D. A moon-shaped face will develop.

B. It should be stopped gradually. Rationale: Gradual weaning from prednisone is necessary to prevent adrenal insufficiency or adrenal crisis. Prednisone depresses the immune system, thereby increasing susceptibility to infection. The medication usually suppresses growth. A moon face may occur, but it is not a critical, life-threatening side effect.

Which medication would be prescribed when a client reports vaginal itching and the primary health care provider confirms that the client has candidiasis? (Select all that apply) A. Tinidazole B. Miconazole C. Fluconazole D. Clotrimazole E. Metronidazole

B. Miconazole C. Fluconazole D. Clotrimazole Rationale: Miconazole, fluconazole, and clotrimazole are used to treat candidiasis. Tinidazole is used to treat trichomoniasis. Metronidazole is used to treat bacterial vaginosis.

A pregnant client with an infection tells the nurse that they have taken tetracycline for infections in the past and prefer to take it now. Which response would the nurse give regarding the avoidance of tetracycline administration during pregnancy? A. "It affects breastfeeding adversely." B. "Tetracycline causes fetal allergies." C. "It alters the development of fetal teeth buds." D. "It increases fetal tolerance to the medication."

C. "It alters the development of fetal teeth buds." Rationale: Tetracycline has an affinity for calcium; if used during tooth bud development it may cause discoloration of teeth. Tetracycline does not adversely affect breast-feeding, cause fetal allergies to the medication, or increase fetal tolerance of the medication.

Which information would the nurse provide when administering the first dose of prednisone prescribed to a client with an exacerbation of colitis? A. "Prednisone protects you from getting an infection." B. "The medication may cause weight loss by decreasing your appetite." C. "Prednisone is not curative but does cause a suppression of the inflammatory process." D. "The medication is relatively slow in precipitating a response but is effective in reducing symptoms.

C. "Prednisone is not curative but does cause a suppression of the inflammatory process." Rationale: Prednisone inhibits phagocytosis and suppresses other clinical phenomena of inflammation; this is a symptomatic treatment that is not curative. Prednisone suppresses the immune response, which increases the potential for infection. The appetite is increased with prednisone; weight gain may result from the increased appetite or from fluid retention. Generally, the response to prednisone is rapid

A 12-year-old child recently sustained several tick bites while camping and may have Lyme disease. What is the most appropriate response when he asks what Lyme disease is? A. 'I can see that you're concerned. Tell me what you want to know.' B. 'The infection is caused by a spirochete. It can be cured with penicillin.' C. 'The tick bites gave you an infection. There is a medication that will treat it.' D. 'You sound upset. Don't worry. We have medicine that will make you better.'

C. 'The tick bites gave you an infection. There is a medication that will treat it.' Rationale: Telling the child that a tick bite caused the disease and that it is curable is a straightforward, truthful answer at a level that a 12-year-old child will comprehend. Just identifying the child's feelings disregards the fact that the child has asked a question that requires an answer. The child may not understand scientific terminology. Telling the child not to worry is demeaning and avoids answering the question.

A client with adrenal insufficiency reports feeling weak and dizzy, especially in the morning. Which physiological response would the nurse suspect is the probable cause of these symptoms? A. A lack of potassium B. Postural hypertension C. A hypoglycemic reaction D. Increased extracellular fluid volume

C. A hypoglycemic reaction Rationale: Deficiency of glucocorticoids causes hypoglycemia in the client with Addison disease (adrenal insufficiency). Clinical manifestations of hypoglycemia include nervousness; weakness; dizziness; cool, moist skin; hunger; and tremors. Hypokalemia is evidenced by nausea, vomiting, muscle weakness, and dysrhythmias. Weakness with dizziness on arising is postural hypotension, not hypertension. An increased extracellular fluid volume is evidenced by edema, increased blood pressure, and crackles.

Which medication would the nurse anticipate being prescribed for a client reporting inflammatory lesions on the face and diagnosed with an inflammatory disorder of the sebaceous glands? (SATA) A. Bacitracin B. Mupirocin C. Clindamycin D. Erythromycin E. Metronidazole

C. Clindamycin D. Erythromycin Rationale: Clindamycin and erythromycin are topical antibiotics used in the treatment of acne vulgaris, which occurs due to inflammation of the sebaceous glands. Bacitracin is an over-the-counter topical antibiotic used in the treatment of dermatological problems. Mupirocin is used in the treatment of superficial Staphylococcus infections such as impetigo. Topical metronidazole is used in the treatment of rosacea and bacterial vaginosis.

The nurse should seek clarification by the practitioner for which order? A. Discharge in AM B. Blood glucose monitoring ac and bedtime C. Erythromycin 250 mg TIW D. Dalteparin 5000 international units Sub-Q BID

C. Erythromycin 250 mg TIW Rationale: TIW, indicating three times a week, is an unacceptable abbreviation. It may be mistaken for 'three times a day' or 'twice weekly.' The abbreviation AM for in the morning is an acceptable abbreviation. The word 'discharge' must be completely spelled out instead of just 'D/C' because this may be confused with 'discontinue.' The use of ac (before meals) is an acceptable abbreviation. Bedtime must be completely spelled out instead of 'hs' because 'hs' may be confused with 'half strength' or 'every hour.' The abbreviation Sub-Q, indicating the subcutaneous route, is an acceptable abbreviation. BID, indicating twice a day, is an acceptable abbreviation. International units must be completely spelled out instead of 'IU' because it may be mistaken as a roman numeral four (IV).

Which action would the nurse take after receiving a urine culture and sensitivity report that reveals a client has vancomycin-resistant enterococcus (VRE) and after notifying the primary health care provider? A. Insert a Foley catheter. B. Initiate droplet precautions. C. Move the client to a private room. D. Use a high-efficiency particulate air (HEPA) respirator

C. Move the client to a private room. Rationale: Clients with VRE should be moved to a private room to decrease transmission to others. A Foley catheter should not be inserted because it will predispose the client to develop an additional infection. VRE has been identified in the urine, not respiratory secretions. Contact isolation should be implemented. A HEPA respirator is not required when entering the room.

After completing a week of antibiotic therapy, an infant develops oral thrush. Which medication is indicated for treatment of this condition? A. Acyclovir B. Vidarabine C. Nystatin D. Fluconazole

C. Nystatin Rationale: White, adherent patches on the tongue, palate, and inner aspects of the infant's cheeks indicate oral candidiasis (thrush). Oral candidiasis is caused by a fungus called Candida albicans. Nystatin is an antifungal agent prescribed to treat oral thrush in an infant. Acyclovir and vidarabine are antiviral agents and are not used to treat oral candidiasis in the infant. Fluconazole can effectively treat oral thrush, but its use in infants is not approved by the US Food and Drug Administration

A child recovering from a severe asthma attack is given oral prednisone 15 mg twice daily. Which intervention would be a priority for the nurse? A. Having the child rest as much as possible B. Checking the child's eosinophil count daily C. Preventing exposure of the child to infection D. Offering sips of water when administering the medication

C. Preventing exposure of the child to infection Rationale: Prednisone reduces the child's resistance to certain infectious processes and, as an anti-inflammatory medication, masks infection. The child will self-limit activity depending on respiratory status. The eosinophil count is often consistently increased in children with asthma. The child will need adequate hydration to help loosen and expel mucus.

Which action will the nurse take when it is time to administer vancomycin to a client with a continuous intravenous (IV) heparin drip? A. Stop the heparin, flush the line with normal saline, and administer the vancomycin. B. Administer the vancomycin into the heparin line using an IV piggyback set. C. Start a second IV line for the vancomycin and continue the heparin as prescribed. D. Hold the vancomycin and tell the healthcare provider that the medication is incompatible with heparin.

C. Start a second IV line for the vancomycin and continue the heparin as prescribed. Rationale: The vancomycin and heparin are incompatible in the same IV and must be administered separately. By instituting a second line for the antibiotic, heparin can continue to infuse. Both medications must run concurrently. Also, flushing the line may not eliminate remnants of the heparin, which is incompatible with vancomycin. Using a piggyback setup to administer the vancomycin into the heparin is unsafe because heparin and vancomycin are incompatible and should not be administered via the same IV line. The client has two medications prescribed, and it is the nurse's responsibility, not the health care provider's, to administer them safely.

Which initial action would the nurse take when caring for a client receiving intravenous vancomycin who reports ringing in both ears? A. Notify the primary health care provider. B. Consult an audiologist. C. Stop the infusion. D. Document the finding and continue to monitor the client

C. Stop the infusion. Rationale: The first action the nurse would take is to stop the infusion immediately. Vancomycin can cause temporary or permanent hearing loss. The nurse would stop the medication infusion and then notify the health care provider at once if a client reports any hearing problems or ringing in the ears. An audiologist may need to be consulted at a later date, but this is not the best first action. The nurse would document the findings; however, this is not the initial action.

Which explanation would the nurse provide to a client with gastric ulcer disease who asks the nurse why the health care provider has prescribed metronidazole? A. To augment the immune response B. To potentiate the effect of antacids C. To treat Helicobacter pylori infection D. To reduce hydrochloric acid secretion

C. To treat Helicobacter pylori infection Rationale: Approximately two-thirds of clients with peptic ulcer disease are found to have Helicobacter pylori infecting the mucosa and interfering with its protective function. Antibiotics do not augment the immune response, potentiate the effect of antacids, or reduce hydrochloric acid secretion.

Which client statement provides evidence that the client understands medication teaching for high-dose penicillin? A. "I should take this medication with meals." B. "This medicine may cause constipation." C. "I must avoid dairy products while taking this medicine." D. "I must increase my intake of fluids while taking this medication

D. "I must increase my intake of fluids while taking this medication Rationale: Because penicillin in high doses is nephrotoxic, keeping hydrated maintains adequate renal perfusion for medication excretion. It should be taken on an empty stomach for best absorption. It may cause diarrhea, but not constipation. Dietary restrictions are not imposed while this medication is taken.

Which client statement indicates to the nurse effective teaching regarding the administration of ciprofloxacin therapy for treatment of osteomyelitis? A. "I should go to my primary health care provider's clinic for a weekly dressing change." B. "I should stop taking the medication as soon as my symptoms begin to decrease." C. "I should not remove the soiled dressing without someone's assistance." D. "I should contact my primary health care provider if white patches appear in my mouth."

D. "I should contact my primary health care provider if white patches appear in my mouth." Rationale: Ciprofloxacin causes adverse effects like formation of whitish-yellow or curd-like lesions in the mouth and itching in the perianal area. The client's statement regarding the primary health care provider should be contacted in case of white patches in the mouth indicates effective learning. Clients should change their dressings once soiled, not weekly. The client must take the antibiotic even after the symptoms have subsided and they feel better. If the client abruptly discontinues this medication, medication resistance may develop. There are no restrictions as to who should change the dressing; the client can also change the dressing as needed

Which statement by the client indicates that the nurse's teaching was effective regarding intravenous gentamicin therapy? A. "I should drink lots of water if I am retaining urine." B. "I should use eyeglasses if I develop vision problems." C. "I should stop the medication when the symptoms have subsided." D. "I should report any hearing loss to the primary health care provider."

D. "I should report any hearing loss to the primary health care provider." Rationale: Acute osteomyelitis is treated with antibiotics such as gentamicin. Gentamicin use can cause ear toxicity; therefore, the client should report any hearing loss to the primary health care provider. Gentamicin also causes urine retention, but increasing water intake can aggravate this condition; therefore, the client should report this issue to the primary health care provider instead of increasing water consumption. Gentamicin may cause visual disturbances and should be reported to the primary health care provider; use of inappropriate eyeglasses, or use of glasses without first consulting the primary health care provider, increases the risk of falls or accidents to the patient. The client should not stop taking the medication without consulting the primary health care provider, even if the symptoms have subsided.

A prescription for 6 mg of intramuscular dexamethasone, twice a day for 2 days, is issued to a client who is 32 weeks' pregnant and having regular labor contractions. The client asks why she needs this medicine. Which reason would the nurse give the client regarding the reason the medication was prescribed? A. "It will promote sleep." B. "It may stop contractions." C. "The medication relaxes uterine muscles." D. "The medication accelerates fetal lung maturity."

D. "The medication accelerates fetal lung maturity." Rationale: Dexamethasone is a glucocorticoid that aids fetal production of surfactant, which is needed for postnatal lung expansion; it is not until 35 weeks' gestation that there is enough surfactant to confirm fetal lung maturity by way of amniocentesis. Glucocorticoids are not sedatives. Tocolytics, not glucocorticoids, may stop contractions. Tocolytics, not glucocorticoids, relax the uterine muscles.

How would the nurse reply when a client prescribed a tetracycline class medication asks why milk and antacids should be avoided before and after dosing? A. "Taking these together can lead to kidney impairment." B. "The pairing of these substances leads to tooth staining." C. "Severe diarrhea can occur when taking these substances together." D. "This can lead to decreased absorption of the medication you need."

D. "This can lead to decreased absorption of the medication you need." Rationale: Tetracyclines chelate with calcium, iron, and magnesium, so substances containing these minerals are avoided to optimize absorption of the antimicrobial. MIlk and antacid use with tertacylcines does not increase kidney impairment, tooth staining, or diarrhea.

A new mother asks the nurse administering erythromycin ophthalmic ointment to her newborn why her baby must be subjected to this procedure. Which is the best response by the nurse? A. 'It will keep your baby from going blind.' B. 'This ointment will protect your baby from bright lights.' C. 'There is a law that newborns must be given this medicine.' D. 'This antibiotic helps keep babies from contracting eye infections.'

D. 'This antibiotic helps keep babies from contracting eye infections.' Rationale: Erythromycin ophthalmic ointment is used to treat infections cause by Neisseria gonorrhoeae and Chlamydia species, which may be transmitted during birth. It is administered prophylactically. Although it will prevent the newborn from becoming blind if the infant is born with these infections, there is not enough information in the answer to help the mother understand how the ointment prevents blindness. The antibiotic ointment is not administered to protect the newborn from bright lights. Newborns are in fact required by law to receive erythromycin ophthalmic ointment, but simply stating this does not explain why it is administered.

Which prescribed medication will the nurse probably prepare educational materials for when caring for a pregnant woman with a body temperature of 103°F (39.4°C) and clinical manifestations of coccidioidomycosis? A. Doxycycline B. Ciprofloxacin C. Pyrazinamide D. Amphotericin B

D. Amphotericin B Rationale: An elevated body temperature of 103°F (39.4°C), cough, headache, muscle aches, chest pain, severe joint pain, and night sweats are symptoms of coccidioidomycosis, a fungal infection. Pregnant women can safely take amphotericin B because the medication will not affect the fetus. Doxycycline is a tetracycline that may lead to discoloration of the teeth in the newborn. Ciprofloxacin is a broad-spectrum antibiotic used to treat various bacterial infections and is ineffective with a fungal infection. Pyrazinamide is one of the first-line treatments for tuberculosis.

Which treatment strategy would benefit a client diagnosed with chlamydia? (SATA) A. Penicillin G B. Ceftriaxone C. Clotrimazole D. Doxycycline E. Azithromycin

D. Doxycycline E. Azithromycin Rationale: Doxycycline and azithromycin are used to treat chlamydia. Penicillin G is used to treat syphilis. Ceftriaxone is used to treat gonorrhea. Clotrimazole is used to treat candidiasis.

Which anti-infective agent may lead to blindness if not used correctly by the client in prescribed amounts? A. Bromfenac B. Natamycin C. Trifluridine D. Gentamicin

D. Gentamicin Rationale: Gentamicin is an anti-infective agent that can lead to blindness if not used in prescribed amounts. The nurse would instruct clients to take this only as prescribed, because bacterial and fungal eye infections may worsen rapidly and can lead to blindness if not treated adequately. Bromfenac is a nonsteroidal anti-inflammatory agent and does not lead to blindness. Natamycin is an antifungal agent, and trifluridine is a topical antiviral agent; neither cause blindness

Which medication would cause the nurse to monitor the serum creatinine and blood urea nitrogen (BUN) levels, when administered to a client receiving therapy for extensive burn wounds? A. Nitrofurantoin B. Mafenide acetate C. Silver sulfadiazine D. Gentamicin sulfate

D. Gentamicin sulfate Rationale: Gentamicin sulfate may cause nephrotoxicity in the client; therefore the nurse would monitor the client prescribed this medication for serum creatinine and BUN changes. The nurse monitors the client on nitrofurantoin for signs of allergic reactions. Mafenide acetate requires monitoring of blood gases and serum electrolyte levels. In clients who are on silver sulfadiazine, the nurse monitors the wounds for infections.

Which prescription would the nurse anticipate being written for a client experiencing vaginal discharge with a fishy odor who was diagnosed bacterial vaginosis? A. Tinidazole B. Miconazole C. Clotrimazole D. Metronidazole

D. Metronidazole Rationale: Bacterial vaginosis is a condition in which the hydrogen peroxide-producing lactobacilli are replaced with high concentrations of anaerobic bacteria. Metronidazole is an oral medication used to treat bacterial vaginosis. Tinidazole is used to treat trichomoniasis. Miconazole and clotrimazole are used to treat candidiasis.

Which medication is the first-line medication used to treat a client with mild diarrhea who is diagnosed with a Clostridium difficile infection? A. Rifaximin B. Fidaxomicin C. Vancomycin D. Metronidazole

D. Metronidazole Rationale: Metronidazole is the first-line treatment prescribed to clients with a Clostridium difficile infection. Rifaximin is used to treat traveler's diarrhea caused by Escherichia coli. Fidaxomicin is reserved for clients who are at risk for the relapse of or have recurrent Clostridium difficile infections. Vancomycin is preferred for serious Clostridium difficile infections.

Which medication used to treat bacterial vaginosis may be responsible for a client' s report of an unpleasant metallic taste, nausea, and vomiting? A. Tinidazole B. Miconazole C. Clotrimazole D. Metronidazole

D. Metronidazole Rationale: Metronidazole is used to treat bacterial vaginosis. Common side effects include an unpleasant metallic taste in the mouth, furry tongue, central nervous system reactions, and urinary tract disturbances. Tinidazole is used to treat trichomoniasis. Miconazole and clotrimazole are used to treat candidiasis.

A child is prescribed an intravenous (IV) antibiotic. Within 10 minutes of the initial infusion, the child's face and neck are flushed but the remainder of the body is unchanged. The nurse reviews the child's record. Which action would the nurse take next? A. Administer acetaminophen. B. Place the child on protective isolation. C. Increase the rate of the vancomycin infusion. D. Notify the primary health care provider after stopping the infusion

D. Notify the primary health care provider after stopping the infusion Rationale: The child is exhibiting a common vancomycin reaction called red man syndrome or red neck syndrome. Flushing usually begins in the chest area and spreads upward to the neck and face, usually during the first 15 minutes of administration. This reaction is caused by a release of histamine, which results in vasodilation. If not treated, the syndrome can lead to circulatory collapse. The appropriate response is to stop the infusion and notify the primary health care provider. The provider will usually prescribe diphenhydramine hydrochloride and then resume the vancomycin infusion. Diphenhydramine will be administered before each vancomycin dose, and the infusion will be set at a slower rate. Normal temperature is 98.6°F (37°C). It is not necessary to administer acetaminophen for a temperature below 100.4°F (38°C). The child's laboratory results indicate a bacterial infection. Protective (or reverse) isolation is not necessary. Increasing the vancomycin infusion rate will exacerbate the reaction and lead to circulatory collapse.

Which effect has resulted in the avoidance of tetracycline use in children under 8 years old? A. Birth Defects B. Allergic responses C. Severe nausea and vomiting D. Permanent tooth discoloration

D. Permanent tooth discoloration Rationale: Tetracycline use in children under the age of 8 years has been discontinued because it causes permanent tooth discoloration. Birth defects, allergic responses, and severe nausea and vomiting are not prevalent reasons for the discontinuation of tetracycline medications in children under 8 years old.

Which instruction would the nurse provide a client prescribed oral extended-release ciprofloxacin therapy for a urinary tract infection? A. Chew the medication along with food. B. Take a walk in morning sunlight. C. Stop the drug after symptoms subside. D. Refrain from taking the tablet immediately after an antacid.

D. Refrain from taking the tablet immediately after an antacid. Rationale: Ciprofloxacin is an antibiotic used in treating urinary tract infections. The nurse would instruct the client to refrain from consuming ciprofloxacin within 2 hours of taking an antacid. Most antacids contain aluminum or magnesium, which interfere with the absorption of ciprofloxacin. The client should be instructed to swallow the tablet and not chew it because chewing it negates the extended-release action of the drug. Clients on ciprofloxacin therapy should avoid sunlight because the medication increases sensitivity to sun and could result in sunburn. The prescribed medication regimen should be followed even if symptoms subside. Premature cessation of medication can lead to recurrence of infection or bacterial resistance.