130 Unit 6

Which information should the nurse include in discharge teaching for a client prescribed doxycycline (Vibramycin)? "Take the medication with milk to minimize gastrointestinal upset." "Apply sunscreen or wear protective clothing when outdoors." "Take the medication until you have no fever and feel better." "Keep the remainder of the medication in case of recurrence."

"Apply sunscreen or wear protective clothing when outdoors." (Photosensitivity is a common adverse effect of doxycycline, a tetracycline antibiotic. The client should avoid direct sun exposure and tanning bed use while taking this medication. Exposure to the sun can cause severe burns.)

Which client statement indicates to the nurse that the client understands the discharge teaching for ethambutol (Myambutol)? "Constipation will be a problem, so I will increase the fiber in my diet." "This medication may cause my bodily secretions to turn red-orange-brown." "Dizziness and drowsiness are common adverse effects with this drug." "I will need to have my vision checked periodically while I am taking this drug."

"I will need to have my vision checked periodically while I am taking this drug." (Ethambutol can cause optic neuritis. Ophthalmologic examinations should be performed periodically to assess visual acuity.)

Before discharge, the nurse is reviewing a client's prescribed medication regimen for tuberculosis (TB). The client asks the nurse why pyridoxine (vitamin B₆) has been prescribed while continuing to take isoniazid (Nydrazid) to treat TB. What is the nurse's best response? "Pyridoxine will help prevent numbness, and tingling that can occur secondary to the isoniazid." "Pyridoxine is another antitubercular drug that will work synergistically with the isoniazid." "You really should not be on that drug. I will check with the health care provider." "Multidrug therapy is necessary to prevent the occurrence of resistant bacteria."

"Pyridoxine will help prevent numbness, and tingling that can occur secondary to the isoniazid." (Isoniazid can cause neurotoxicity. Pyridoxine, vitamin B6, is the drug of choice to prevent this adverse reaction. It is not an antiinfective drug and thus will not work to destroy the mycobacterium or prevent drug resistance.)

A client prescribed azithromycin (Zithromax) expresses concern regarding GI upset that was experienced when previously prescribed an erythromycin antibiotic. What is the nurse's best response? "Take an over-the-counter antiemetic to lessen the nausea." "I will call the health care provider and request a different antibiotic." "Stop taking the drug if you experience heartburn and diarrhea." "This drug is like erythromycin with less gastrointestinal adverse effects."

"This drug is like erythromycin with less gastrointestinal adverse effects." (Azithromycin is a newer macrolide antibiotic. It has a longer duration of action, as well as fewer and less severe GI adverse effects than erythromycin.)

A client is being discharged home with active tuberculosis. Which information does the nurse include in the discharge teaching plan? "You will not spread the disease unless you stop taking your medication." "You will not pose an increased risk of disease to the people you have been living with." "You will have to take these medications for at least 1 year." "Your sputum may turn a rust color as your condition gets better."

"You will not pose an increased risk of disease to the people you have been living with." (The nurse tells the client that he/she will not be contagious to the people he/she lives with. The people the client has been living with have already been exposed and need to be tested. They cannot become at higher risk simply because the diagnosis has now been confirmed.The client with active tuberculosis is contagious, even while taking medication. However, the risk for transmission is reduced after the infectious person has received proper drug therapy for 2 to 3 weeks, clinical improvement occurs, and acid-fast bacilli (AFB) in the sputum are reduced. The length of time for treatment is 6 months. Fluid from the pulmonary capillaries and red blood cells moving into the alveoli is a result of the inflammatory process. Rust-colored sputum is an indication that the tuberculosis is getting worse.)

The nurse is planning care for a client prescribed once-daily IV gentamicin (Garamycin) therapy. When should the nurse schedule a trough drug level to be drawn? 12 hours after completing the antibiotic infusion 30 minutes after beginning the antibiotic infusion 18 hours after completing the antibiotic infusion 60 minutes after beginning the antibiotic infusion

12 hours after completing the antibiotic infusion (Trough serum drug levels should be drawn at least 8 to 12 hours after the medication is infused.)

Which client is at greatest risk for developing an infection? A 54-year-old man with hypertension A 17-year-old girl with a fractured tibia in a cast A 65-year-old woman who had coronary bypass surgery 4 days ago A 71-year-old man in a nursing home

A 65-year-old woman who had coronary bypass surgery 4 days ago (Older clients such as the 65-year-old people with decreased vascularity to the integumentary system (from the bypass surgery) and compromised skin (surgical incision) are at risk for infection.No coexisting conditions are present for the client with hypertension to be at risk for infection. The 71-year-old client in a nursing home is not at highest risk because no coexisting conditions make this client most vulnerable to infection.)

The community health nurse is planning treatment for multi-drug resistant tuberculosis for a client who is addicted to heroin. Which action will be most effective in ensuring that the client completes treatment? Arrange for a health care worker to observe the client take the medication. Give the client written instructions about how to take prescribed medications. Have the client repeat medication names and side effects. Instruct the client about the possible consequences of nonadherence.

A client who has recently relocated to the United States from Vietnam comes to the emergency department with fatigue, lethargy, night sweats, and a low-grade fever. What is the nurse's first action? Contact the health care provider for tuberculosis (TB) medications. Perform a TB skin test. Place a respiratory mask on the client. Test all family members for TB.

What information should the nurse provide to a client prescribed rifampin (Rifadin)? Peripheral neuropathy is an expected side effect, and the patient should report any numbness or tingling of the extremities. Oral contraception is the preferred method of birth control when using rifampin. A nonharmful adverse effect of this medication is red-orange discoloration of urine, sweat, tears, skin, salvia, and feces. The patient will only need to take this medication for the prescribed 14-day period.

A nonharmful adverse effect of this medication is red-orange discoloration of urine, sweat, tears, skin, salvia, and feces. (Red-orange-brown discoloration of the skin, sweat, tears, urine, feces, sputum, saliva, and tongue as an adverse effect of the drug, but it is not harmful. Rifampin does not cause peripheral neuropathies (isoniazid does), but it does interfere with the effectiveness of oral contraceptives. All antitubercular drugs need to be taken long term to eradicate the slow-growing mycobacterium lying deep within the tissues.)

What is the priority assessment data for a client prescribed antibiotic therapy? Immunizations Cardiac dysrhythmias Allergies History of seizures

Allergies (Antibiotic allergy is one of the most common drug allergies. An allergic reaction that occurs after administration of an antibiotic has the potential to cause severe anaphylaxis and possible death.)

Which statement about why multidrug-resistant organisms and other infections are increasing in incidence is correct? Antibiotics have been given to clients for conditions that do not require antibiotics. Microorganisms are more susceptible to antibiotics today than when they were given years ago. Additional precautions are taken, along with Standard Precautions, to prevent infection. Most antibiotics are effective for infection.

Antibiotics have been given to clients for conditions that do not require antibiotics. (Antibiotics have often been prescribed for conditions that do not require them, or have been given at higher doses or for longer periods of time than needed. As a result, a number of microorganisms have become resistant to certain antibiotics.Microorganisms are more resistant to certain antibiotics. Strictly adhered-to Standard Precautions are adequate to prevent infection. Most antibiotics are not effective for every infection.)

Bacterial resistance to antibiotics can occur with which situations? (Select all that apply.) Antibiotics that are prescribed to treat a viral infection Clients stop taking an antibiotic when they feel better. Antibiotics that are prescribed according to culture and sensitivity reports Microorganisms arriving from foreign countries and overseas ports Taking an antibiotic and an antiviral medication at the same time

Antibiotics that are prescribed to treat a viral infection Clients stop taking an antibiotic when they feel better. (Not completing a full course of antibiotic therapy can allow bacteria that are not killed but have been exposed to the antibiotic to adapt their physiology to become resistant to that antibiotic. Administering antibiotics to treat viral infections is not effective and may expose small amounts of bacteria that may be present to the antibiotic and therefore risk the development of resistance.)

When performing discharge teaching for a client prescribed oral linezolid (Zyvox) to treat methicillin-resistant Staphylococcus aureus (MRSA), the nurse should emphasize which important information? Stop the drug as soon as you feel better. Take the drug with an antacid to avoid gastrointestinal (GI) upset. Report any occurrence of constipation or facial flushing. Avoid ingestion of foods containing tyramine.

Avoid ingestion of foods containing tyramine. (Hypertension may occur in clients consuming tyramine-containing foods such as aged cheese or wine, soy sauce, smoked meats or fish, and sauerkraut while taking linezolid. Linezolid causes diarrhea, not constipation, and should be taken with food to decrease GI distress. An antacid would interfere with absorption.)

For a client receiving an intravenous (IV) infusion of gentamicin (Garamycin), the nurse would monitor which laboratory values? Serum glutamic-oxaloacetic transaminase and alanine transaminase Prothrombin time and partial thromboplastin time Hematocrit and hemoglobin Blood urea nitrogen (BUN) and creatinine

Blood urea nitrogen (BUN) and creatinine (Gentamicin has a high potential for nephrotoxicity. Nephrotoxicity typically occurs in 5% to 25% of clients. Thus, the client's renal function test results for BUN and creatinine must be monitored closely throughout therapy.)

A client who is allergic to penicillin is at increased risk for an allergy to which drug? Erythromycin (E-mycin) Gentamicin (Garamycin) Cefazolin sodium (Ancef) Demeclocycline (Declomycin)

Cefazolin sodium (Ancef) (Clients who are allergic to penicillins have an increased risk of allergy to other beta-lactam antibiotics. The incidence of cross-reactivity between cephalosporins and penicillins is reported to be between 1% and 4%.)

What instruction should the nurse include for a client prescribed rifampin (Rifadin) and isoniazid (Nydrazid) prophylactically secondary to TB exposure? Remind that sunscreen is not needed during outdoor activities. Explain that isoniazid may decrease blood serum glucose in susceptible people. Emphasize that oral contraceptives become ineffective when given with rifampin. Advise that these drugs will only need to be taken for 7 to 10 days.

Emphasize that oral contraceptives become ineffective when given with rifampin. (Women taking oral contraceptives who are prescribed rifampin must be switched to another form of birth control because oral contraceptives become ineffective when given with rifampin. These medications must be taken long term because mycobacterium is slow growing. They can cause photosensitivity, necessitating the use of sunscreen. Finally, isoniazid may increase, not decrease, serum glucose levels.)

When planning care for a client receiving a sulfonamide antibiotic, it is important for the nurse to perform which intervention? Take the medication with dairy products such as milk or yogurt. Advise the client to report any tinnitus to the health care provider. Avoid direct sun exposure and tanning beds. Encourage fluid intake of 2000 to 3000 mL/day.

Encourage fluid intake of 2000 to 3000 mL/day. (Clients should be encouraged to drink plenty of fluids (2000 to 3000 mL/24 hours) to prevent drug-related crystalluria associated with sulfonamide antibiotics.)

Which is a common clinical manifestation of infectious disease? Dry and pink skin Hypothermia Decreased respiratory rate Fever

Fever (Fever (generally a temperature above 101°F [38.3°C]) is a common clinical manifestation of infection.Skin tends to be warm and moist, not dry and pink, when an infectious disease is present. Clients typically have hyperthermia (fever), not hypothermia, when an infectious disease is present, although some clients can have infection without fever. Respiratory rate typically increases, as does the heart rate, with infectious disease.)

The nurse should assess a client for nephrotoxicity and ototoxicity when administering which antimicrobial? Erythromycin Clindamycin (Cleocin) Cefazolin (Ancef) Gentamicin (Garamycin)

Gentamicin (Garamycin) (Aminoglycoside antibiotics, including gentamicin, have a high risk for nephrotoxicity and ototoxicity.)

When administering a nonsteroidal antiinflammatory drug and a penicillin drug together, the displacement of the penicillin antibiotic from the protein-binding sites will result in which effect? Absence of free drug in the blood Increased free drug in blood Decreased free drug in blood No change in free drug in blood

Increased free drug in blood (Drugs that are not bound to protein are free and thus active to exert their therapeutic (or toxic, if too much free) effect.)

A client who is prescribed metronidazole (Flagyl) for a gynecologic infection provides the nurse with a list of medications that are routinely taken. Which medication would lead the nurse to question the prescription for Flagyl? Multivitamin (Thera-Tabs) Lithium (Eskalith) Ibuprofen (Advil) Levothyroxine (Synthroid)

Lithium (Eskalith) (Concomitant use of lithium and metronidazole may result in lithium toxicity. Thus, a client who reports taking lithium should alert the nurse to notify the health care provider because of the potential significant interaction.)

When assessing for adverse effects to Rifamate (combination isoniazid and rifampin), the nurse would monitor which laboratory values? (Select all that apply.) Liver function tests Complete blood cell count Sputum cultures Uric acid levels Cholesterol

Liver function tests Complete blood cell count (Rifamate can lead to impairment of liver function as well as hematologic disorders. Assessment of sputum cultures confirms the diagnosis but is not related to adverse effects. The drug does not affect uric acid levels or cholesterol.)

The client's culture has grown gram-positive cocci, and the health care provider prescribes two different antibiotics, one of which is gentamicin (Garamycin). To treat this type of infection, which type of antibiotic is typically prescribed together with gentamicin (Garamycin)? Aminoglycoside Penicillin Fluoroquinolone Cephalosporin

Penicillin (In gram-positive cocci, gentamicin is usually given in combination with a penicillin antibiotic. The other antibiotics are not typically prescribed with gentamicin for this culture result.)

Which adverse effect can result if tetracycline is administered to children younger than 8 years of age? Delayed growth development Drug-induced neurotoxicity Permanent discoloration of the teeth Gastrointestinal (GI) and rectal bleeding

Permanent discoloration of the teeth (Tetracycline is contraindicated in children younger than 8 years of age because it can cause permanent discoloration of the adult teeth and tooth enamel, which are still forming in the child.)

A client who has recently relocated to the United States from Vietnam comes to the emergency department with fatigue, lethargy, night sweats, and a low-grade fever. What is the nurse's first action? Contact the health care provider for tuberculosis (TB) medications. Perform a TB skin test. Place a respiratory mask on the client. Test all family members for TB.

Place a respiratory mask on the client. (The nurse's first action is to place a respiratory mask on the client. The concern is that this client has a high risk for TB having recently immigrated from overseas. Client with symptoms consistent with TB should be considered infectious until the disease is ruled out.Requesting medications for TB is not appropriate until the client has been evaluated and a diagnosis has been made. Performing a TB test will be important, but this is not the top priority. Tell the client that results will not be available for at least 48 hours after the test is administered. Further testing of this client needs to be completed and a diagnosis made before family members are tested.)

Quinolones are a class of antibiotics known for several significant complications. Which are possible adverse effects with these drugs? (Select all that apply.) Prolongation of the QT interval Ototoxicity Nephrotoxicity Tendon rupture Abnormal cartilage development in children

Prolongation of the QT interval Tendon rupture Abnormal cartilage development in children (Quinolones are not used in prepubescent children because of the risk of cartilage development issues. Quinolones may also cause a cardiac effect that involves prolongation of the QT interval on the electrocardiogram. The use of these medications can result in tendonitis or ruptured tendons in adults. Nephrotoxicity and ototoxicity are not associated with quinolones.)

Which actions aid in the prevention and early detection of infection in a client at risk? Select all that apply. Inspect the skin for coolness and pallor. Promote sufficient nutritional intake. Encourage fluid intake, as appropriate. Monitor the red blood cell (RBC) count. Obtain cultures as needed. Remove unnecessary medical devices.

Promote sufficient nutritional intake. Obtain cultures as needed. Remove unnecessary medical devices. (Promoting sufficient nutritional intake helps prevent and detect early infection in at risk clients. Nutrition has a direct correlation to improvement of general health. Malnutrition, especially protein-calorie malnutrition, places clients at increased risk for infection. Blood cultures would be used to detect a possible systemic infection. Advocating for the removal of unnecessary medical devices (e.g., intravascular or urinary catheters, endotracheal tubes, synthetic implants) may also interfere with normal host defense mechanisms and may help prevent infection.Inspecting the skin does not prevent or detect systemic infections. Fluid intake is important but does not directly relate to prevention or detection of infection. Monitoring the RBC count does not prevent, nor would it detect, infection.)

The nurse notices a visitor walking into the room of a client on airborne isolation with no protective gear. What does the nurse do? Ensures that the client is wearing a mask Informs the visitor that the client cannot receive visitors at this time Provides a particulate air respirator to the visitor Provides the visitor with a surgical mask

Provides the visitor with a surgical mask (Because the visitor is entering the client's isolation environment, the visitor must wear a mask.The client typically must wear a mask only when he or she is outside of an isolation environment. Turning the visitor away is inappropriate and unnecessary. It would not be necessary for the visitor to wear an air respirator which is typically used for TB, H5N1 influenza, or SARS.)

Which is a complication of vancomycin IV infusions? Cardiomyopathy Neurotoxicity Red man syndrome Angioedema

Red man syndrome (When infused too rapidly, clients receiving vancomycin may develop hypotension accompanied by flushing or itching of the head, face, neck, and upper trunk area. This phenomenon is called red man syndrome.)

The nurse manager for a long-term care facility is in charge of implementing a plan to decrease the spread of infection within the facility. Which part of the plan is most appropriate to delegate to nursing assistants working at the facility? Evaluating each other's handwashing technique Deciding which brand of handwashing soap to use Reinforcing the need for handwashing after caring for clients Determining which clients are most likely to infect other residents

Reinforcing the need for handwashing after caring for clients (All caregivers have a responsibility to reinforce basic handwashing, including that provided for nursing assistants.A higher level of administration is required to evaluate the performance of another worker. Deciding which brand of handwashing soap to use is done at the facility level by the infection control department. Determining which clients are most likely to infect other residents requires a higher level of education for client management.)

During antibiotic therapy, the nurse will assess the client for a condition that may occur because of the disruption of normal flora. The nurse knows this as what condition? Superinfection Hypersensitivity Allergic reaction Organ toxicity

Superinfection (Superinfections can occur when antibiotic therapy reduces or completely eliminates the normal bacterial flora of the body, which normally would inhibit the overgrowth of fungi and yeast. When the normal bacterial are flora and are reduced or completely eliminated, these organisms can overgrow and cause infections.)

Which information does the nurse include when teaching a client about antibiotic therapy for infection? Take all antibiotics as prescribed, unless side effects develop. Take antibiotics until symptoms subside, and then stop taking the drugs. Take antibiotics when symptoms of infection develop. Share antibiotics with family members who develop the same infection.

Take all antibiotics as prescribed, unless side effects develop. (Antibiotics should be taken as prescribed until they are gone. Teach the client about possible side effects and allergic manifestations. The provider must be contacted immediately if any side effects develop.Antibiotics must be taken until they are gone, even if the client feels better or when symptoms of infection appear. They should be taken only by the person for whom they are prescribed and not shared with anyone else.)

Which statement best describes health care-associated infections? The infection develops in response to various antibiotics. Clients are admitted to the hospital with an infectious disease. The infection was not incubating at the time of admission. They develop in more than 15% of hospitalized clients.

The infection was not incubating at the time of admission. (A health care-associated infection is an infection that is acquired during the course of receiving treatment for another condition in a health care facility. The infection is not present or incubating at the time of admission; also known as a nosocomial infection.)

A client with tuberculosis (TB) who is homeless and has been living in shelters for the past 6 months asks the nurse why he must take so many medications. What information will the nurse provide in answering this question? Combination medication therapy is effective in eliminating cough and fever. Combination medication therapy improves adherence. Combination medication therapy has fewer side effects, particularly liver damage. The use of multiple medications destroys organisms quickly and reduces the development of drug-resistant organisms.

The use of multiple medications destroys organisms quickly and reduces the development of drug-resistant organisms. (The nurse tells the client that multiple drug regimens are able to destroy organisms as quickly as possible and reduce the emergence of drug-resistant organisms. Combination drug therapy is the most effective method for treating TB and preventing transmission.As the disease responds to treatment, the symptoms will decrease, but they are not eliminated. Combination drug therapy does not improve adherence to drug therapy. Isoniazid, rifampin, and pyrazinamide may cause liver damage.)

The nurse in the community health clinic is planning education related to tuberculosis (TB). Which of these groups will the nurse target? Select all that apply. Breast cancer survivors Those in the local prison Homeless adults Recent immigrants to the United States Those who have received bacille Calmette-Guérin (BCG) vaccine

Those in the local prison Homeless adults Recent immigrants to the United States (The groups the nurse plans to educate include those adults who live in crowded areas such as prisons and homeless shelters, and those who are recent immigrants to the USA. Other groups at higher risk for tuberculosis include those who abuse injection drugs or alcohol and those groups of lower socioeconomic status.Breast cancer survivors who are no longer undergoing immunocomprising therapy have the same risk as the general population. Receiving BCG, an immunization often given to individuals from overseas, is designed to prevent rather than cause TB. Clients who have received BCG vaccine within the last 10 years will have a positive skin test that can complicate interpretation.)

The nurse anticipates a prescription for vitamin supplementation for a client who is receiving isoniazid (Nydrazid) therapy. What vitamin supplement is usually prescribed with isoniazid? Vitamin E Calcium Vitamin B₆ Folate

Vitamin B₆ (Pyridoxine (vitamin B₆) is often given concurrently with isoniazid to prevent the adverse effect of isoniazid induced peripheral neuropathy associated with neurotoxicity.)

When providing instructions to clients on use of antibiotics, which instructions would the nurse include in the teaching? (Select all that apply.) Wash your hands before and after preparing food. Complete the entire course of therapy. Increase fluid intake up to 3000 mL/day. Save unused medication in a cool dry place for later use. Notify the provider of any possible reactions that occur.

Wash your hands before and after preparing food. Complete the entire course of therapy. Increase fluid intake up to 3000 mL/day. Notify the provider of any possible reactions that occur. (There should not be any leftover medication, but if there is, it needs to be discarded in the appropriate method. The health care provider typically only writes a prescription for the exact amount of medication needed by the client.)

The nurse would teach a client prescribed metronidazole (Flagyl) to avoid ingestion of which drink? Wine Coffee Milk Orange juice

Wine (A disulfiram-like (Antabuse) reaction may occur with concurrent ingestion of metronidazole and alcohol, leading to facial flushing, tachycardia, palpitations, nausea, and vomiting.)

The nurse is providing teaching to a patient taking an oral tetracycline antibiotic. Which statement by the nurse is correct? a. "Avoid direct sunlight and tanning beds while on this medication." b. "Milk and cheese products result in increased levels of tetracycline." c. "Antacids taken with the medication help to reduce gastrointestinal distress." d. "Take the medication until you are feeling better."

a. "Avoid direct sunlight and tanning beds while on this medication." (Drug-related photosensitivity occurs when patients take tetracyclines, and it may continue for several days after therapy. Milk and cheese products result in decreased levels of tetracycline when the two are taken together. Antacids also interfere with absorption and should not be taken with tetracycline. Counsel patients to take the entire course of prescribed antibiotic drugs, even if they feel that they are no longer ill.)

A patient is receiving aminoglycoside therapy and will be receiving a beta-lactam antibiotic as well. The patient asks why two antibiotics have been ordered. What is the nurse's best response? a. "The combined effect of both antibiotics is greater than each of them alone." b. "One antibiotic is not strong enough to fight the infection." c. "We have not yet isolated the bacteria, so the two antibiotics are given to cover a wide range of microorganisms." d. "We can give a reduced amount of each one if we give them together."

a. "The combined effect of both antibiotics is greater than each of them alone." (Aminoglycosides are often used in combination with other antibiotics, such as beta-lactams or vancomycin, in the treatment of various infections because the combined effect of the two antibiotics is greater than that of either drug alone.)

A client is being admitted with suspected tuberculosis (TB). What actions by the nurse are best? (Select all that apply.) a. Admit the client to a negative-airflow room. b. Maintain a distance of 3 feet from the client at all times. c. Order specialized masks/respirators for caregiving. d. Other than wearing gloves, no special actions are needed. e. Wash hands with chlorhexidine after providing care.

a. Admit the client to a negative-airflow room. c. Order specialized masks/respirators for caregiving. (A client with suspected TB is admitted to Airborne Precautions, which includes a negative-airflow room and special N95 or PAPR masks to be worn when providing care. A 3-foot distance is required for Droplet Precautions. Chlorhexidine is used for clients with a high risk of infection.)

A student nurse asks the nursing instructor why older adults are more prone to infection than other adults. What reasons does the nursing instructor give (Select all that apply.) a. Age-related decrease in immune function b. Decreased cough and gag reflexes c. Diminished acidity of gastric secretions d. Increased lymphocytes and antibodies e. Thinning skin that is less protective

a. Age-related decrease in immune function b. Decreased cough and gag reflexes c. Diminished acidity of gastric secretions e. Thinning skin that is less protective (Older adults have several age-related changes making them more susceptible to infection, including decreased immune function, decreased cough and gag reflex, decreased acidity of gastric secretions, thinning skin, and fewer lymphocytes and antibodies.)

A client has been hospitalized with tuberculosis (TB). The client's spouse is fearful of entering the room where the client is in isolation and refuses to visit. What action by the nurse is best? a. Ask the spouse to explain the fear of visiting in further detail. b. Inform the spouse the precautions are meant to keep other clients safe. c. Show the spouse how to follow the isolation precautions to avoid illness. d. Tell the spouse that he or she has already been exposed, so it's safe to visit.

a. Ask the spouse to explain the fear of visiting in further detail. (The nurse needs to obtain further information about the spouse's specific fears so they can be addressed. This will decrease stress and permit visitation, which will be beneficial for both client and spouse. Precautions for TB prevent transmission to all who come into contact with the client. Explaining isolation precautions and what to do when entering the room will be helpful, but this is too narrow in scope to be the best answer. Telling the spouse it's safe to visit is demeaning of the spouse's feelings.)

A nursing manager is concerned about the number of infections on the hospital unit. What action by the manager would best help prevent these infections? a. Auditing staff members' hand hygiene practices b. Ensuring clients are placed in appropriate isolation c. Establishing a policy to remove urinary catheters quickly d. Teaching staff members about infection control methods

a. Auditing staff members' hand hygiene practices (All methods will help prevent infection; however, health care workers' lack of hand hygiene is the biggest cause of healthcare-associated infections. The manager can start with a hand hygiene audit to see if this is a contributing cause.)

A client is hospitalized and on multiple antibiotics. The client develops frequent diarrhea. What action by the nurse is most important? a. Consult with the provider about obtaining stool cultures. b. Delegate frequent perianal care to unlicensed assistive personnel. c. Place the client on NPO status until the diarrhea resolves. d. Request a prescription for an anti-diarrheal medication.

a. Consult with the provider about obtaining stool cultures. (Hospitalized clients who have three or more stools a day for 2 or more days are suspected of having infection with Clostridium difficile. The nurse should inform the practitioner and request stool cultures. Frequent perianal care is important and can be delegated but is not the priority. The client does not necessarily need to be NPO; if the client is NPO, the nurse ensures he or she is getting appropriate IV fluids to prevent dehydration. Anti-diarrheal medication may or may not be appropriate, and the diarrhea serves as the portal of exit for the infection.)

A client has been diagnosed with tuberculosis (TB). What action by the nurse takes highest priority? a. Educating the client on adherence to the treatment regimen b. Encouraging the client to eat a well-balanced diet c. Informing the client about follow-up sputum cultures d. Teaching the client ways to balance rest with activity

a. Educating the client on adherence to the treatment regimen (The treatment regimen for TB ranges from 6 to 12 months, making adherence problematic for many people. The nurse should stress the absolute importance of following the treatment plan for the entire duration of prescribed therapy. The other options are appropriate topics to educate this client on but do not take priority.)

A patient will be receiving nitrofurantoin (Macrodantin) treatment for a urinary tract infection. The nurse is reviewing the patient's history and will question the nitrofurantoin order if which disorder is present in the history? (Select all that apply.) a. Liver disease b. Coronary artery disease c. Hyperthyroidism d. Type 1 diabetes mellitus e. Chronic renal disease

a. Liver disease e. Chronic renal disease (Nitrofurantoin is contraindicated in cases of known drug allergy and also in cases of significant renal function impairment, because the drug concentrates in the urine. Because adverse effects include hepatotoxicity, which is rare but often fatal, the nurse should also question the order if liver disease is present. The other options are not contraindications.)

The nurse is administering intravenous vancomycin (Vancocin) to a patient who has had gastrointestinal surgery. Which nursing measures are appropriate? (Select all that apply.) a. Monitoring serum creatinine levels b. Restricting fluids while the patient is on this medication c. Warning the patient that a flushed feeling or facial itching may occur d. Instructing the patient to report dizziness or a feeling of fullness in the ears e. Reporting a trough drug level of 11 mcg/mL and holding the drug f. Reporting a trough drug level of 24 mcg/mL and holding the drug

a. Monitoring serum creatinine levels c. Warning the patient that a flushed feeling or facial itching may occur d. Instructing the patient to report dizziness or a feeling of fullness in the ears f. Reporting a trough drug level of 24 mcg/mL and holding the drug (Constant monitoring for drug-related neurotoxicity, nephrotoxicity, ototoxicity, and superinfection remain critical to patient safety. Monitor for nephrotoxicity by monitoring serum creatinine levels. Ototoxicity may be indicated if the patient experiences dizziness or a feeling of fullness in the ears, and these symptoms must be reported immediately. Vancomycin infusions may cause red man syndrome, which is characterized by flushing of the neck and face and a decrease in blood pressure. In addition, adequate hydration (at least 2 L of fluids every 24 hours unless contraindicated) is most important to prevent nephrotoxicity. Optimal trough blood levels of vancomycin are 10 to 20 mcg/mL; therefore, the drug should not be administered when there is a trough level of 24 mcg/mL.)

A nurse is caring for a client who has methicillin-resistant Staphylococcus aureus (MRSA) infection cultured from the urine. What action by the nurse is most appropriate? a. Prepare to administer vancomycin (Vancocin). b. Strictly limit visitors to immediate family only. c. Wash hands only after taking off gloves after care. d. Wear a respirator when handling urine output.

a. Prepare to administer vancomycin (Vancocin). (Vancomycin is one of a few drugs approved to treat MRSA. The others include linezolid (Zyvox) and ceftaroline fosamil (Teflaro). Visitation does not need to be limited to immediate family only. Hand hygiene is performed before and after wearing gloves. A respirator is not needed, but if splashing is anticipated, a face shield can be used.)

When reviewing the medication orders for a patient who is taking penicillin, the nurse notes that the patient is also taking the oral anticoagulant warfarin (Coumadin). What possible effect may occur as the result of an interaction between these drugs? a. The penicillin will cause an enhanced anticoagulant effect of the warfarin. b. The penicillin will cause the anticoagulant effect of the warfarin to decrease. c. The warfarin will reduce the anti-infective action of the penicillin. d. The warfarin will increase the effectiveness of the penicillin.

a. The penicillin will cause an enhanced anticoagulant effect of the warfarin. (Administering penicillin reduces the vitamin K in the gut (intestines); therefore, enhanced anticoagulant effect of warfarin may occur. The other options are incorrect.)

During antibiotic therapy, the nurse will monitor closely for signs and symptoms of a hypersensitivity reaction. Which of these assessment findings may be an indication of a hypersensitivity reaction? (Select all that apply.) a. Wheezing b. Diarrhea c. Shortness of breath d. Swelling of the tongue e. Itching f. Black, hairy tongue

a. Wheezing c. Shortness of breath d. Swelling of the tongue e. Itching (Hypersensitivity reactions may be manifested by wheezing; shortness of breath; swelling of the face, tongue, or hands; itching; or rash.)

The nurse is providing patient teaching for a patient who is starting antitubercular drug therapy. Which of these statements should be included? (Select all that apply.) a. "Take the medications until the symptoms disappear." b. "Take the medications at the same time every day." c. "You will be considered contagious during most of the illness and must take precautions to avoid spreading the disease." d. "Stop taking the medications if you have severe adverse effects." e. "Avoid alcoholic beverages while on this therapy." f. "If you notice reddish-brown or reddish-orange urine, stop taking the drug and contact your doctor right away." g. "If you experience a burning or tingling in your fingers or toes, report it to your prescriber immediately." h. "Oral contraceptives may not work while you are taking these drugs, so you will have to use another form of birth control."

b. "Take the medications at the same time every day." e. "Avoid alcoholic beverages while on this therapy." g. "If you experience a burning or tingling in your fingers or toes, report it to your prescriber immediately." h. "Oral contraceptives may not work while you are taking these drugs, so you will have to use another form of birth control." (Medications for tuberculosis must be taken on a consistent schedule to maintain blood levels. Medication therapy for tuberculosis may last up to 24 months, long after symptoms disappear, and patients are infectious during the early part of the treatment. Compliance with antitubercular drug therapy is key, so if symptoms become severe, the prescriber should be contacted for an adjustment of the drug therapy. The medication must not be stopped. Because of potential liver toxicity, patients on this drug therapy must not drink alcohol. Discoloration of the urine is an expected adverse effect, and patients need to be warned about it beforehand. Burning or tingling in the fingers or toes may indicate that peripheral neuropathy is developing, and the prescriber needs to be notified immediately. A second form of birth control must be used because antitubercular drug therapy makes oral contraceptives ineffective.)

The nurse is preparing to administer morning medications to a patient who has been newly diagnosed with tuberculosis. The patient asks, "Why do I have to take so many different drugs?" Which response by the nurse is correct? a. "Your prescriber hopes that at least one of these drugs will work to fight the tuberculosis." b. "Taking multiple drugs reduces the chance that the tuberculosis will become drug resistant." c. "Using more than one drug can help to reduce side effects." d. "Using multiple drugs enhances the effect of each drug."

b. "Taking multiple drugs reduces the chance that the tuberculosis will become drug resistant." (The use of multiple medications reduces the possibility that the organism will become drug resistant. The other options are incorrect.)

The student nurse caring for clients understands that which factors must be present to transmit infection? (Select all that apply.) a. Colonization b. Host c. Mode of transmission d. Portal of entry e. Reservoir

b. Host c. Mode of transmission d. Portal of entry e. Reservoir (Factors that must be present in order to transmit an infection include a host with a portal of entry, a mode of transmission, and a reservoir. Colonization is not one of these factors.)

The nurse is reviewing the medication history of a patient who will be taking a sulfonamide antibiotic. During sulfonamide therapy, a significant drug interaction may occur with which of these drugs or drug classes? (Select all that apply.) a. Opioids b. Oral contraceptives c. Sulfonylureas d. Antihistamines e. Phenytoin (Dilantin) f. Warfarin (Coumadin)

b. Oral contraceptives c. Sulfonylureas e. Phenytoin (Dilantin) f. Warfarin (Coumadin) (Sulfonamides may potentiate the hypoglycemic effects of sulfonylureas in diabetes treatment, the toxic effects of phenytoin, and the anticoagulant effects of warfarin, which can lead to hemorrhage. Sulfonamides may also reduce the efficacy of oral contraceptives.)

Which nursing diagnosis is appropriate for a patient who has started aminoglycoside therapy? a. Constipation b. Risk for injury (renal damage) c. Disturbed body image related to gynecomastia d. Imbalanced nutrition, less than body requirements, related to nausea

b. Risk for injury (renal damage) (Patients on aminoglycoside therapy have an increased risk for injury caused by nephrotoxicity. The other options are incorrect.)

A patient who has started drug therapy for tuberculosis wants to know how long he will be on the medications. Which response by the nurse is correct? a. "Drug therapy will last until the symptoms have stopped." b. "Drug therapy will continue until the tuberculosis develops resistance." c. "You should expect to take these drugs for as long as 24 months." d. "You will be on this drug therapy for the rest of your life."

c. "You should expect to take these drugs for as long as 24 months." (Drug therapy commonly lasts for 24 months if consistent drug therapy has been maintained. The other options are incorrect.)

When reviewing the allergy history of a patient, the nurse notes that the patient is allergic to penicillin. Based on this finding, the nurse would question an order for which class of antibiotics? a. Tetracyclines b. Sulfonamides c. Cephalosporins d. Quinolones

c. Cephalosporins (Allergy to penicillin may also result in hypersensitivity to cephalosporins. The other options are incorrect.)

The nurse is monitoring for therapeutic results of antibiotic therapy in a patient with an infection. Which laboratory value would indicate therapeutic effectiveness of this therapy? a. Increased red blood cell count b. Increased hemoglobin level c. Decreased white blood cell count d. Decreased platelet count

c. Decreased white blood cell count (Decreased white blood cell counts are an indication of reduction of infection and are a therapeutic effect of antibiotic therapy. The other options are incorrect.)

When monitoring patients on antitubercular drug therapy, the nurse knows that which drug may cause a decrease in visual acuity? a. Rifampin (Rifadin) b. Isoniazid (INH) c. Ethambutol (Myambutol) d. Streptomycin

c. Ethambutol (Myambutol) (Ethambutol may cause a decrease in visual acuity or even blindness resulting from retrobulbar neuritis. The other options are incorrect.)

The nurse checks the patient's laboratory work prior to administering a dose of vancomycin (Vancocin) and finds that the trough vancomycin level is 24 mcg/mL. What will the nurse do next? a. Administer the vancomycin as ordered. b. Hold the drug, and administer 4 hours later. c. Hold the drug, and notify the prescriber. d. Repeat the test to verify results.

c. Hold the drug, and notify the prescriber. (Optimal blood levels of vancomycin are a trough level of 10 to 20 mcg/mL. Measurement of peak levels is no longer routinely recommended, and only trough levels are commonly monitored. Blood samples for measurement of trough levels are drawn immediately before administration of the next dose. Because of the increase in resistant organisms, many clinicians use a trough level of 15 to 20 mcg/mL as their goal. These trough levels mean that even just before the next dose is due, when drug levels should be low, the drug levels are actually too high.)

The nurse is counseling a woman who will be starting rifampin (Rifadin) as part of antitubercular therapy. The patient is currently taking oral contraceptives. Which statement is true regarding rifampin therapy for this patient? a. Women have a high risk for thrombophlebitis while on this drug. b. A higher dose of rifampin will be necessary because of the contraceptive. c. Oral contraceptives are less effective while the patient is taking rifampin. d. The incidence of adverse effects is greater if the two drugs are taken together.

c. Oral contraceptives are less effective while the patient is taking rifampin. (Women taking oral contraceptives and rifampin need to be counseled about other forms of birth control because of the impaired effectiveness of the oral contraceptives during concurrent use of rifampin.)

A patient who has been taking isoniazid (INH) has a new prescription for pyridoxine. She is wondering why she needs this medication. The nurse explains that pyridoxine is often given concurrently with the isoniazid to prevent which condition? a. Hair loss b. Renal failure c. Peripheral neuropathy d. Heart failure

c. Peripheral neuropathy (Pyridoxine (vitamin B₆) may be beneficial for isoniazid-induced peripheral neuropathy. The other options are incorrect.)

The nurse is reviewing the medication administration record of a patient who is taking isoniazid (INH). Which drug or drug class has a significant drug interaction with isoniazid? a. Pyridoxine (vitamin B₆) b. Penicillins c. Phenytoin (Dilantin) d. Benzodiazepines

c. Phenytoin (Dilantin) (Taking INH with phenytoin will cause decreased metabolism of the phenytoin, leading to increased drug effects. Pyridoxine is often given with isoniazid to prevent peripheral neuropathy. The other options are incorrect.)

A patient is receiving his third intravenous dose of a penicillin drug. He calls the nurse to report that he is feeling "anxious" and is having trouble breathing. What will the nurse do first? a. Notify the prescriber. b. Take the patient's vital signs. c. Stop the antibiotic infusion. d. Check for allergies.

c. Stop the antibiotic infusion. (Hypersensitivity reactions are characterized by wheezing; shortness of breath; swelling of the face, tongue, or hands; itching; or rash. The nurse should immediately stop the antibiotic infusion, have someone notify the prescriber, and stay with the patient to monitor the patient's vital signs and condition. Checking for allergies should have been done before the infusion.)

A patient has a urinary tract infection. The nurse knows that which class of drugs is especially useful for such infections? a. Macrolides b. Carbapenems c. Sulfonamides d. Tetracyclines

c. Sulfonamides (Sulfonamides achieve very high concentrations in the kidneys, through which they are eliminated. Therefore, they are often used in the treatment of urinary tract infections.)

When a patient is on aminoglycoside therapy, the nurse will monitor the patient for which indicators of potential toxicity? a. Fever b. White blood cell count of 8000 cells/mm³ c. Tinnitus and dizziness d. Decreased blood urea nitrogen (BUN) levels

c. Tinnitus and dizziness (Dizziness, tinnitus, hearing loss, or a sense of fullness in the ears could indicate ototoxicity, a potentially serious toxicity in a patient. Nephrotoxicity is indicated by rising blood urea nitrogen and creatinine levels. Fever may be indicative of the patient's infection; a white blood cell count of 7000 cells/mm³ is within the normal range of 5000 to 10,000 cells/mm³.)

A patient who has been hospitalized for 2 weeks has developed a pressure ulcer that contains multidrug-resistant Staphylococcus aureus (MRSA). Which drug would the nurse expect to be chosen for therapy? a. Metronidazole (Flagyl) b. Ciprofloxacin (Cipro) c. Vancomycin (Vancocin) d. Tobramycin (Nebcin)

c. Vancomycin (Vancocin) (Vancomycin is the drug of choice for the treatment of MRSA. The other drugs are not used for MRSA.)

During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and decreased appetite. Which statement is the nurse's best advice to the patient? a. "Take it with cheese and crackers or yogurt." b. "Take each dose with a glass of milk." c. "Take an antacid with each dose as needed." d. "Drink a full glass of water with each dose."

d. "Drink a full glass of water with each dose." (Oral doses should be given with at least 8 ounces of fluids and food to minimize gastrointestinal upset; however, antacids and dairy products will bind with the tetracycline and make it inactive.)

A patient newly diagnosed with tuberculosis (TB) has been taking antitubercular drugs for 1 week calls the clinic and is very upset. He says, "My urine is dark orange! What's wrong with me?" Which response by the nurse is correct? a. "You will need to stop the medication, and it will go away." b. "It's possible that the TB is worse. Please come in to the clinic to be checked." c. "This is not what we usually see with these drugs. Please come in to the clinic to be checked." d. "This is an expected side effect of the medicine. Let's review what to expect."

d. "This is an expected side effect of the medicine. Let's review what to expect." (Rifampin, one of the first-line drugs for TB, causes a red-orange-brown discoloration of urine, tears, sweat, and sputum. Patients need to be warned about this side effect. The other options are incorrect.)

A patient is admitted with a fever of 102.8° F (39.3° C), origin unknown. Assessment reveals cloudy, foul-smelling urine that is dark amber in color. Orders have just been written to obtain stat urine and blood cultures and to administer an antibiotic intravenously. The nurse will complete these orders in which sequence? a. Blood culture, antibiotic dose, urine culture b. Urine culture, antibiotic dose, blood culture c. Antibiotic dose, blood and urine cultures d. Blood and urine cultures, antibiotic dose

d. Blood and urine cultures, antibiotic dose (Culture specimens should be obtained before initiating antibiotic drug therapy; otherwise, the presence of antibiotics in the tissues may result in misleading culture and sensitivity results. The other responses are incorrect.)

The nurse will assess the patient for which potential contraindication to antitubercular therapy? a. Glaucoma b. Anemia c. Heart failure d. Hepatic impairment

d. Hepatic impairment (Results of liver function studies (e.g., bilirubin level, liver enzyme levels) need to be assessed because isoniazid and rifampin may cause hepatic impairment; severe liver dysfunction is a contraindication to these drugs. In addition, the patient's history of alcohol use needs to be assessed.)

The nurse is administering a vancomycin (Vancocin) infusion. Which measure is appropriate for the nurse to implement in order to reduce complications that may occur with this drug's administration? a. Monitoring blood pressure for hypertension during the infusion b. Discontinuing the drug immediately if red man syndrome occurs c. Restricting fluids during vancomycin therapy d. Infusing the drug over at least 1 hour

d. Infusing the drug over at least 1 hour (Infuse the medication over at least 1 hour to reduce the occurrence of red man syndrome. Adequate hydration (at least 2 L of fluid in 24 hours) during vancomycin therapy is important for the prevention of nephrotoxicity. Hypotension may occur during the infusion, especially if it is given too rapidly.)

The nurse is reviewing the medication orders for a patient who will be receiving gentamicin therapy. Which other medication or medication class, if ordered, would be a potential interaction concern? a. Calcium channel blockers b. Phenytoin c. Proton pump inhibitors d. Loop diuretics

d. Loop diuretics (Concurrent use of aminoglycosides, such as gentamicin, with loop diuretics increases the risk for ototoxicity. The other drugs and drug classes do not cause interactions.)

The nurse is discussing adverse effects of antitubercular drugs with a patient who has active tuberculosis. Which potential adverse effect of antitubercular drug therapy should the patient report to the prescriber? a. Gastrointestinal upset b. Headache and nervousness c. Reddish-orange urine and stool d. Numbness and tingling of extremities

d. Numbness and tingling of extremities (Patients on antitubercular therapy should report experiencing numbness and tingling of extremities, which may indicate peripheral neuropathy. Some drugs may color the urine, stool, and other body secretions reddish-orange, but this is not an effect that needs to be reported. Patients need to be informed of this expected effect. The other options are incorrect.)

The nursing instructor explaining infection tells students that which factor is the best and most important barrier to infection? a. Colonization by host bacteria b. Gastrointestinal secretions c. Inflammatory processes d. Skin and mucous membranes

d. Skin and mucous membranes (The skin and mucous membranes are the most important barrier against infection. The other options are also barriers, but are considered secondary to skin and mucous membranes.)

A 79-year-old patient is receiving a quinolone as treatment for a complicated incision infection. The nurse will monitor for which adverse effect that is associated with these drugs? a. Neuralgia b. Double vision c. Hypotension d. Tendonitis and tendon rupture

d. Tendonitis and tendon rupture (A black-box warning is required by the U.S. Food and Drug Administration for all quinolones because of the increased risk for tendonitis and tendon rupture with use of the drugs. This effect is more common in elderly patients, patients with renal failure, and those receiving concurrent glucocorticoid therapy (e.g., prednisone). The other options are not common adverse effects.)

A patient has been taking antitubercular therapy for 3 months. The nurse will assess for what findings that indicate a therapeutic response to the drug therapy? a. The chronic cough is gone. b. There are two consecutive negative purified protein derivative (PPD) results over 2 months. c. There is increased tolerance to the medication therapy, and there are fewer reports of adverse effects. d. There is a decrease in symptoms of tuberculosis along with improved chest x-rays and sputum cultures.

d. There is a decrease in symptoms of tuberculosis along with improved chest x-rays and sputum cultures. (A therapeutic response to antitubercular therapy is manifested by a decrease in the symptoms of tuberculosis, such as cough and fever, and by weight gain. The results of laboratory studies (culture and sensitivity tests) and the chest radiographic findings will be used to confirm the clinical findings of resolution of the infection.)

A client is being discharged on long-term therapy for tuberculosis (TB). What referral by the nurse is most appropriate? a. Community social worker for Meals on Wheels b. Occupational therapy for job retraining c. Physical therapy for homebound therapy services d. Visiting Nurses for directly observed therapy

d. Visiting Nurses for directly observed therapy (Directly observed therapy is often utilized for managing clients with TB in the community. Meals on Wheels, job retraining, and home therapy may or may not be appropriate.)