Pharmacology chapter 85
A patient develops flushing, rash, and pruritus during an IV infusion of vancomycin (Vancocin). Which action should a nurse take? A) Reduce the infusion rate. B) Administer diphenhydramine (Benadryl). C) Change the IV tubing. D) Check the patency of the IV.
A When vancomycin is infused too rapidly, histamine release may cause the patient to develop hypotension accompanied by flushing and warmth of the neck and face; this phenomenon is called red man syndrome. Diphenhydramine is not necessary if the infusion is administered slowly over at least 60 minutes. Changing the IV tubing would not help the symptoms. The patency of the IV needs to be checked before the administration is started.
Which statements about vancomycin (Vancocin) does the nurse identify as true? (Select all that apply.) A) Vancomycin is the most widely used antibiotic in U.S. hospitals. B) Vancomycin is effective in the treatment of Clostridium difficile infection. C) Vancomycin is effective in the treatment of MRSA infections. D) Patients who are allergic to penicillin are also allergic to vancomycin. E) The major toxicity of vancomycin therapy is liver failure.
A,B,C Patients who are allergic to penicillin are able to take vancomycin. The major toxicity of vancomycin therapy is kidney failure. The other three statements are true.
Which instructions will the nurse include when teaching a patient about cephalosporin therapy? (Select all that apply.) A) "Notify your healthcare provider if you develop diarrhea." B) "Take aspirin if you develop a headache." C) "Notify your healthcare provider if you develop a rash." D) "Cephalosporins may not be taken with food." E) "Do not take cephalosporins if you have lactose intolerance."
A,C Cephalosporins may enhance bleeding tendencies, so drugs such as aspirin that may promote bleeding should be avoided. Cephalosporins may be taken with food, and they are safe to take if a patient has lactose intolerance. Severe diarrhea should be reported, because it may indicate the development of C. difficile infection. Any indication of an allergic reaction, including a rash, should be reported to the healthcare provider.
Before administering a cephalosporin to a patient, it is most important for the nurse to assess the patient for an allergy history to what? A) Soy products B) Peanuts C) Penicillins D) Opioids
C The cephalosporins are beta-lactam antibiotics similar in structure and actions to the penicillins. They are contraindicated in patients with a history of severe allergic reactions to penicillins. The use of soy products, peanuts, and opioids is unrelated to cephalosporins.
A patient is receiving vancomycin (Vancocin). The nurse identifies what as the most common toxic effect of vancomycin therapy? A) Ototoxicity B) Hepatotoxicity C) Renal toxicity D) Cardiac toxicity
C The most common toxic effect of vancomycin (Vancocin) therapy is renal toxicity. Although ototoxicity may occur, it is rare. The liver and heart are not affected when vancomycin is used.
It is most important for the nurse to assess a patient receiving a cephalosporin for the development of which manifestation of antibiotic-associated pseudomembranous colitis (AAPMC)? A) Rigidity B) Ileus C) Ascites D) Diarrhea
D AAPMC, which is manifested initially by diarrhea and abdominal cramping, especially may develop with the use of broad-spectrum cephalosporins. Rigidity, ileus, and ascites are unrelated to cephalosporin use.
A patient who is receiving vancomycin (Vancocin) IV for a methicillin-resistant Staphylococcus aureus (MRSA) infection asks a nurse, "Why can't I take this medicine in a pill?" Which response should the nurse make? A) "The prescription could be changed, because vancomycin comes in two forms." B) "You're allergic to penicillin, and this is the only way this medication can be given." C) "It will cause too much loss of appetite and nausea if given in the oral form." D) "It is more effective by IV, because the pill form will stay in the digestive tract."
D Because of its chemical size and weight, vancomycin is absorbed poorly in the gastrointestinal (GI) tract and is given parenterally for most infections. It is used for serious infections caused by organisms such as MRSA and in patients with susceptible organisms allergic to penicillins. Oral administration is used only for infections of the intestine. It is not associated with loss of appetite or nausea.
The cephalosporins are beta-lactam antibiotics similar in structure and actions to the penicillins. They are contraindicated in patients with a history of severe allergic reactions to penicillins. The use of soy products, peanuts, and opioids is unrelated to cephalosporins. A) High blood pressure B) Cardiotoxicity C) Red man syndrome D) Seizures
D Imipenem can reduce blood levels of valproate, a drug used to control seizures, and breakthrough seizures have occurred. If possible, combined use of imipenem and valproate should be avoided. If no other antibiotic will suffice, supplemental antiseizure therapy should be considered. The other responses are not associated with use of imipenem and valproate.