Exam 4
What advice should a nurse give to a patient who was prescribed omeprazole for peptic ulcers? "Take omeprazole only at bedtime." "Take aspirin along with omeprazole." "Eat foods that are rich in magnesium." "Take dietary supplements containing vitamin D."
"Eat foods that are rich in magnesium." Omeprazole is a proton pump inhibitor (PPI). PPIs come with the warning that they deplete magnesium. Therefore, the nurse should advise the patient to eat magnesium-rich foods to combat the adverse effect associated with omeprazole. Taking vitamin D supplements along with omeprazole does not have any therapeutic benefit unless taken along with calcium supplements. A patient with peptic ulcers should not take aspirin along with omeprazole; this combination will aggravate the situation because aspirin is a nonsteroidal antiinflammatory drug that can cause peptic ulcers. Omeprazole works better when taken before meals, not before bedtime.
A patient has been taking docusate sodium daily for 1 year. Which statement by the patient would indicate a complication associated with use of this drug? "My doctor says that I've developed colon polyps." "I've noticed that I'm having tremors now in my left hand." "I only have a bowel movement when I take the medicine." "The dental hygienist said I was losing the enamel on my teeth."
"I only have a bowel movement when I take the medicine." Docusate sodium is a surfactant laxative that softens stool by allowing water penetration. Chronic exposure to laxatives can diminish defecation reflexes, leading to further reliance on laxatives. Patient education is the key to reducing laxative abuse. Colon polyps, loss of tooth enamel, and tremors are unrelated to docusate sodium.
Which statement by a patient makes the nurse aware of a need for further education about drug resistance in antimicrobial therapy? "The bacteria in my body have become resilient." "My body has become resistant to the antibiotic." "The antibiotic I have been taking doesn't work as well as it used to." "Over time, an organism that had once been highly sensitive to an antibiotic may become less susceptible, or it may lose drug sensitivity entirely."
"My body has become resistant to the antibiotic." The patient needs further education when he or she states, "My body has become resistant to the antibiotic," because it is the microbe that becomes resistant, not the patient. A correct statement by the patient is: "The bacteria in my body have become resilient." "The antibiotic I have been taking doesn't work as well as it used to" and "Over time, an organism that had once been highly sensitive to an antibiotic may become less susceptible, or it may lose drug sensitivity entirely" are also correct explanations about drug resistance.
A patient is prescribed amoxicillin for the treatment of a bacterial infection. What instruction should the nurse give to the patient to improve drug efficacy? "Take the medicine with milk." "Take the medicine with food." "Take the medicine with juice." "Take the medicine with water."
"Take the medicine with water." The nurse should instruct the patient to take the antibiotic with water. Amoxicillin is a penicillin antibiotic and should be taken with water to improve drug efficacy. Giving the medication with milk will interfere with drug absorption. Oral penicillin should be administered 1 hour before or 2 hours after meals to maximize absorption. It should not be administered with food because this reduces its absorption. Oral penicillin should not be administered with juice, because the latter is acidic and may nullify the drug's antibacterial action.
A patient is prescribed enteric-coated omeprazole for hyperacidity. What instructions should the nurse provide to the patient regarding medication administration? "Take the medication by chewing or crushing it." "Take this medication 30 to 60 minutes after meals." "Take the medication by dissolving it in water or milk." "Take this medication 30 to 60 minutes before meals."
"Take this medication 30 to 60 minutes before meals." Omeprazole and other proton pump inhibitors act directly on the proton pump on parietal cells and decrease acid levels. For the drug to be absorbed and show its action, it should be administered at least 30 to 60 minutes before meals. Crushing and chewing the drug will damage its enteric coating and thus should be avoided. The medication can be given by dissolving in water only when the patient has difficulty swallowing and for patients with a nasogastric tube. The medication will have no effect when taken after meals because of the presence of food.
A patient has been ordered azithromycin and asks the nurse why the medication does not have to be taken as often as other antibiotics that have previously been ordered. What is the nurse's best response? "You'll need to ask your health care provider questions like that." "This drug has a longer duration of action than some of the other antibiotics." "I'll call the pharmacy and ask about the chemical makeup of the drug." "This is a much more effective drug than what you received previously."
"This drug has a longer duration of action than some of the other antibiotics." Azithromycin is one of the newer macrolide antibiotics. It has a longer duration of action as well as fewer and less severe gastrointestinal side effects than erythromycin. The nurse does not have to call the pharmacy to ask about the chemical makeup of the drug; the nurse can research the pharmacokinetics in a database if unsure of the medication. The nurse can answer questions about drug therapy. It is not necessarily a more effective drug, but it does have a longer half-life.
A patient prescribed azithromycin expresses concern regarding gastrointestinal upset experienced when taking erythromycin. What should the nurse tell this patient? "I will call the doctor and ask for a different antibiotic." "You need this medication and will have to tolerate the nausea." "I will ask the doctor for a prescription for an antiemetic for possible nausea." "This drug is like erythromycin but has less severe gastrointestinal side effects."
"This drug is like erythromycin but has less severe gastrointestinal side effects." Azithromycin is one of the newer macrolide antibiotics. It has a longer duration of action as well as fewer and less severe gastrointestinal (GI) side effects than erythromycin. The nurse should not immediately ask for a different antibiotic, because many antibiotics cause GI upset, and a medication has to be administered to treat the specific infection. The patient should try the antibiotic before the nurse calls for a medication to treat nausea or tells the patient to tolerate the nausea.
Which instruction should a nurse include in the discharge teaching for a patient who is to start taking tetracycline? "Use sunscreen and protective clothing when outdoors." "You'll need to return to the clinic for weekly blood work." "You may stop taking the pills when you begin to feel better." "Take the medication with yogurt or milk so you won't have nausea."
"Use sunscreen and protective clothing when outdoors." Tetracyclines are bacteriostatic antibiotics; photosensitivity and severe sunburn are common adverse effects. A full course of antibiotics must always be taken. Blood studies are not necessary for therapeutic levels. Absorption decreases after ingestion of chelates such as calcium and magnesium, so doses should be given 2 hours before or 2 hours after ingestion of milk products.
A nurse instructs a female patient with peptic ulcer disease who is to start a treatment regimen that includes ranitidine and bismuth subsalicylate. Which statement by the patient indicates that the teaching has been effective? "I'll include more calcium and vitamin D in my diet to prevent osteoporosis." "While I'm taking these medications, my bowel movements could look black." "I'm so glad that my allergies will be helped while I'm taking these medications." "I have a medicine at home to take when I start having some loose diarrhea stools."
"While I'm taking these medications, my bowel movements could look black." Regimens for eradicating H. pylori include using two or three antibacterials with an antisecretory agent or histamine 2 receptor antagonist. Bismuth acts topically to disrupt the cell wall of H. pylori. It can cause a harmless black stool discoloration. Loose stools are an adverse effect of systemic antibacterials such as amoxicillin. Ranitidine produces selective blockade of H 2 receptors, which inhibits gastric acid secretion only, not allergy symptoms. Osteoporosis is an adverse effect of omeprazole, a proton pump inhibitor.
A patient on antibiotic therapy needs drug trough levels drawn. Which is the most appropriate time for the nurse to draw the trough level? 90 minutes after the intravenous antibiotic is scheduled to be administered 10 minutes before administration of the intravenous antibiotic 60 minutes after completion of the intravenous antibiotic infusion 30 minutes after beginning administration of the intravenous antibiotic
10 minutes before administration of the intravenous antibiotic Trough levels are drawn just before infusion. Peak serum drug levels should be drawn 30 to 60 minutes after the medication is infused. The nurse should document the time drug administration is started and completed and the exact time a peak and/or trough level is drawn.
Which preoperative patient is at risk for an intensified effect from succinylcholine? A patient who takes aspirin daily A patient who takes isosorbide mononitrate daily A patient receiving gentamicin intravenously three times daily. A patient receiving a continuous intravenous infusion of normal saline.
A patient receiving gentamicin intravenously three times daily. The effects of succinylcholine can be intensified if the drug is administered concomitantly with certain antibiotics, such as aminoglycosides and tetracyclines, as well as other nonpenicillin antibiotics. Gentamicin is an aminoglycoside antibiotic. Aspirin, isosorbide mononitrate, and normal saline would not intensify the effect of succinylcholine.
A patient with a severe urinary tract infection is prescribed amikacin and penicillin (penicillin VK). Which administration process will the nurse be asked to implement? Administer penicillin followed by amikacin. Administer amikacin first and then penicillin. Administer amikacin oral and penicillin intravenously. Administer both amikacin and penicillin simultaneously.
Administer penicillin followed by amikacin. Penicillin is administered first because it breaks the bacterial cell wall. After this, amikacin is administered; this drug destroys the bacterial cell, thereby enhancing the effect of the antibiotic. Amikacin can be administered only via the intravenous and intramuscular routes. The nurse should not infuse the drugs simultaneously because this would not be as effective in treating the severe infection. Beta-lactam antibiotics (penicillin) are initially administered to enhance the drug's activity against microbes.
The nurse notes tan lines around the arms of a female patient who is taking levofloxacin. Which action should the nurse take? Discontinue the medication. Continue the antibiotic with an anti-inflammatory medication. No action is needed because this is a temporary but expected side effect. Advise the patient to avoid sun exposure and wear sunscreen when outside.
Advise the patient to avoid sun exposure and wear sunscreen when outside. Fluoroquinolones pose a risk for phototoxicity. Accordingly, patients should avoid sunlight and sunlamps and use protective clothing and a sunscreen outdoors. It is not necessary to discontinue the medication or add an antiinflammatory medication.
The nurse is caring for a patient who is taking antibiotics. The patient reports flushing, itching, hives, anxiety, and throat and tongue swelling. The nurse finds that the patient has a rapid, irregular pulse. Which condition may the patient have as a result of taking the antibiotic? Tolerance to the antibiotic drugs An allergic anaphylactic reaction Clostridium difficile bacterial infection Glucose-6-phosphate dehydrogenase (G6PD) deficiency
An allergic anaphylactic reaction The patient has developed an allergic anaphylactic reaction to the antibiotics. Flushing, itching, hives, anxiety, and throat and tongue swelling are symptoms associated with an allergic anaphylactic reaction. In this condition, the patient's pulse rate may become rapid and irregular. Watery diarrhea, abdominal pain, and fever are the symptoms of a Clostridium difficile infection. The administration of antibiotics to patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency leads to hemolysis. The patient has no symptoms associated with hemolysis and therefore does not have G6PD deficiency. Tolerance means a diminished effect at a usual dose, which is more common with opioids.
While instructing a patient about antibiotic therapy, the nurse explains to the patient that bacterial resistance to antibiotics can occur when what happens? Select all that apply. Antibiotics are taken with water or juice Antibiotics are prescribed to treat a viral infection Antibiotics are taken with ascorbic acid (vitamin C) Patients stop taking an antibiotic after they feel better Antibiotics are prescribed according to culture and sensitivity reports
Antibiotics are prescribed to treat a viral infection Patients stop taking an antibiotic after they feel better Not completing a full course of antibiotic therapy can allow bacteria that have been exposed to the antibiotic (but not killed) to adapt their physiology to become resistant to that antibiotic. The same thing can occur when bacteria are exposed to antibiotics in the environment or when antibiotics are erroneously used to treat a viral infection. Taking antibiotics with water or juice or vitamin C may impact the drug's absorption, but will not lead to bacterial resistance. Prescribing antibiotics according to culture and sensitivity reports helps reduce the risk of bacterial resistance.
A patient reports abdominal bloating and infrequent, small, hard stools after taking psyllium for 2 weeks. Which is the nurse's priority action? Consult the physician about another laxative choice. Check the dose because an increase may be indicated. Ask whether the patient is toileting at the same time every day. Ask whether the patient is using at least 8 ounces of fluid to prepare the psyllium
Ask whether the patient is using at least 8 ounces of fluid to prepare the psyllium Bulk-forming laxatives, such as psyllium, must be given with at least 8 ounces (240 mL) of liquid, plus additional liquid each day, to prevent intestinal impaction. Another laxative may not be necessary at this time. A dosage increase and monitoring are appropriate after proper mixing of the medication has been validated.
A patient is prescribed tetracycline for acne. What instructions should the nurse give to the patient to prevent antagonistic effects? Take an antacid along with the drug. Take the drug with vitamin supplements. Take the drug with an iron-rich food such as spinach. Avoid taking the drug with calcium-containing foods.
Avoid taking the drug with calcium-containing foods. An antagonistic effect occurs when the combination of two drugs results in a lesser drug effect compared to that when the drugs are administered individually. Tetracycline antibiotics have an antagonistic effect with calcium-containing foods; therefore, it should not be administered with milk or other dairy products. Some vitamins (A, C), many antacids, and iron supplements or iron-rich foods also have an antagonistic effect when combined with tetracycline and therefore should not be used at the same time.
A cancer patient has been taking analgesics for pain but has now developed diffuse bone pain. What treatment options are available for this patient? Select all that apply. Antibiotics Mouthwashes Bisphosphonates Hemibody therapy Cognitive behavioral modalities
Bisphosphonates Hemibody therapy Diffuse bone pain can be treated with the following: bisphosphonates, hemibody therapy, nonsteroidal antiinflammatory drugs (NSAIDs) and opioid optimized doses, radiopharmaceuticals, and hypophysectomy. Mucositis can be treated with mouthwashes and antibiotics. Cognitive behavioral modalities are for unacceptable side effects.
A nurse administers metoclopramide to a patient who is having nausea and vomiting postoperatively. The nurse should expect which therapeutic action if the medication is having the desired result? Reduced motility in the small intestine Inactivation of histaminergic (H 1) receptors Blocking of serotonin and dopamine receptors Activation of chloride channels in the intestine
Blocking of serotonin and dopamine receptors Metoclopramide works by blocking serotonin and dopamine receptors in the chemoreceptor trigger zone and by increasing motility in the small intestine. This action minimizes gastric distention and the accompanying stimulation of the vomiting center. Metoclopramide does not block H 1 receptors or activate chloride channels in the intestine.
How are cephalosporins like penicillins? Select all that apply. Both are bactericidal antibiotics. Both activate autolysin enzymes. Both bind to penicillin-binding proteins (PBPs). Both take up excess water and cause the cell wall to rupture. Both are active only against bacteria undergoing growth and division.
Both are bactericidal antibiotics. Both activate autolysin enzymes. Both bind to penicillin-binding proteins (PBPs). Both are active only against bacteria undergoing growth and division Cephalosporins have a mechanism of action like penicillins; they are both bactericidal antibiotics, activate autolysin enzymes, bind to penicillin-binding proteins (PBPs), and are active only against bacteria undergoing growth and division. Only penicillin takes up excess water and causes the cell wall to rupture.
Which administration technique(s) would be appropriate when giving a sucralfate tablet to a patient with a duodenal ulcer? Select all that apply. Break the tablet in half so it is easier to swallow. Administer the tablet with an antacid for maximum benefit. Allow the tablet to dissolve in water before administering it. Administer the tablet with sips of water 1 hour before meals. Crush the tablet into a fine powder before mixing it with water.
Break the tablet in half so it is easier to swallow. Allow the tablet to dissolve in water before administering it. Administer the tablet with sips of water 1 hour before meals. Sucralfate acts through a compound that is a sticky gel, which adheres to an ulcer crater, creating a barrier to back-diffusion. The drug is best taken on an empty stomach. The tablet form should not be crushed because crushing it could reduce the effectiveness of the drug. Sucralfate tablets are large and difficult to swallow but can be broken or dissolved in water prior to ingestion. Sucralfate acts under mildly acidic conditions; antacids raise the gastric pH above 4 and may interfere with the effects of sucralfate.
The nurse provides a patient with educational materials about antacids. Which statements about antacids are appropriate? Select all that apply. Calcium-containing antacids cause constipation. Antacids form a protective barrier in the stomach. Aluminum-containing antacids cause constipation. Antacids neutralize the acid present in the stomach. Magnesium-containing antacids cause constipation. Antacids decrease the secretion of acid in the stomach.
Calcium-containing antacids cause constipation. Aluminum-containing antacids cause constipation. Antacids neutralize the acid present in the stomach. Both calcium- and aluminum-containing antacids cause constipation as an adverse effect. Antacids neutralize the excess acid secreted in the stomach by forming salts. Agents protective against ulcers, such as sucralfate, form a mucous barrier in the stomach; the antacids do not. Antacids can only neutralize the acid secreted in the stomach; they cannot influence the secretion of acids. Magnesium-containing antacids reduce the effect of constipation resulting from aluminum- and calcium-containing antacids.
A nurse assesses a male patient who has developed gynecomastia while receiving treatment for peptic ulcers. Which medication from the patient's history should the nurse recognize as a contributing factor? Amoxicillin Cimetidine Omeprazole Metronidazole
Cimetidine Cimetidine binds to androgen receptors, producing receptor blockade, which can cause enlarged breast tissue (gynecomastia), reduced libido, and impotence. All these effects reverse when dosing stops. Amoxicillin, metronidazole, and omeprazole are not associated with gynecomastia.
An elderly, critically ill patient who was hospitalized underwent gastric surgery 1 week ago. The caregiver reports that the patient has seemed confused for the past 2 to 3 days. Which drug would most likely have caused this symptom in the patient? Sucralfate Misoprostol Cimetidine Pantoprazole
Cimetidine Cimetidine is an H 2 receptor antagonist that is associated with confusion and disorientation as adverse effects in elderly patients. Sucralfate is an agent that protects against ulcers. It is not prescribed for critically ill patients. Misoprostol is a prostaglandin analogue associated with adverse effects such as gastrointestinal distress, bleeding in the vagina, and headache. Pantoprazole is a proton pump inhibitor associated with gastric tumors.
Which medication is associated with risk for superinfection? Rifampin Gentamicin Vancomycin Ciprofloxacin
Ciprofloxacin Because broad-spectrum antibiotics kill off more normal flora than do narrow-spectrum drugs, superinfections are more likely in patients receiving broad-spectrum agents. Ciprofloxacin is a fluoroquinolone that is considered a broad-spectrum antibiotic. Rifampin, gentamicin, and vancomycin are narrow-spectrum antibiotics.
The primary health care provider prescribes a medication along with ampicillin to enhance the effectiveness of the antibiotic. Which medication would enhance the effectiveness of the ampicillin? Calcium citrate Clavulanic acid Acetaminophen Carbamazepine
Clavulanic acid Clavulanic acid is a beta-lactamase inhibitor. Administered concurrently, it augments the therapeutic effect of antibiotics such as ampicillin. When ampicillin is administered by mouth, concurrent administration of calcium citrate can diminish its absorption. Acetaminophen and carbamazepine do not affect the pharmacokinetics of ampicillin.
Which outcome assessment is essential to monitor for in the patient taking diphenoxylate with atropine? Decrease in urination Increase in bowel sounds Decrease in gastric motility Increase in number of bowel movements
Decrease in gastric motility Diphenoxylate with atropine acts on the smooth muscle of the intestinal tract to inhibit gastrointestinal motility and excessive propulsion of the gastrointestinal tract (peristalsis). A decrease in the gastric motility results in a decrease in the number of bowel movements. Bowel movements should not increase, bowel sounds should not increase, and there should be no change in urination.
The nurse is providing medication teaching for a patient with a duodenal ulcer. Which statement is accurate regarding symptoms that would require a patient on cimetidine to call the health care provider? Onset of headaches Ongoing mild acid indigestion Development of mild allergic rhinitis Development of a productive cough
Development of a productive cough Elevation of gastric pH with an antisecretory agent increases the risk of pneumonia. Reduction in gastric acidity increases bacterial colonization of the stomach, resulting in a secondary increase in colonization of the respiratory tract. Among people using H 2 receptor antagonists such as cimetidine, the relative risk of acquiring pneumonia is doubled. Development of a productive cough may indicate pneumonia, so a patient would notify the health care provider in this case. A headache is a minor, expected side effect that may occur with the use of cimetidine. Acid indigestion is treated by cimetidine, so this would be expected to improve gradually with treatment. Allergic rhinitis is not a typical side effect of cimetidine.
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)? Ileus Ascites Diarrhea Abdominal rigidity
Diarrhea Antibiotic-associated pseudomembranous colitis (AAPMC), which is manifested initially by diarrhea and abdominal cramping, may develop with the use of broad-spectrum cephalosporins. Rigidity, ileus, and ascites are unrelated to cephalosporin use.
A patient complains of having diarrhea over a 5-day period. During the assessment and history, the nurse finds the patient is a travel guide and has recently traveled abroad. Which medication does the nurse expect to be most beneficial to the patient? Ondansetron HCl Dexamethasone Difenoxin with atropine Diphenoxylate with atropine
Diphenoxylate with atropine Patients who engage in extensive traveling are at risk for traveler's diarrhea, which is caused by the consumption of contaminated food. Diphenoxylate with atropine is an opiate that decreases bowel activity and alleviates traveler's diarrhea. Although diphenoxylate is an opiate, the addition of atropine decreases the potential for abuse. Ondansetron HCl is a serotonin receptor agonist that alleviates nausea and vomiting caused by chemotherapy; it does not relieve diarrhea. Dexamethasone is a glucocorticoid that helps to prevent nausea and vomiting caused by anticancer medications. It does not decrease bowel activity or alleviate diarrhea. Difenoxin with atropine is a schedule IV drug with a higher potential for abuse.
The nurse who is working in a pediatric unit administers tetracycline to a preschool-age child. What is a potential side effect of the medication for this child? Anabolic change Cartilage damage Discoloration of teeth Suppression of growth
Discoloration of teeth Tetracycline sometimes causes premature discoloration of teeth in children, and it is not supposed to be used in growing children. Cartilage damage is caused by quinolone antibiotics. Suppression of growth is caused by systemic administration of steroids. Tetracycline does not produce anabolic effects in children.
The patient who takes ciprofloxacin and runs 6 miles daily tells a nurse about heel and calf tenderness. The nurse anticipates the health care provider to take which action? Continue the antibiotic with an antiinflammatory medication. Instruct the patient to slow the running pace and walk more. Discontinue the medication because severe damage can result. No action is needed because this is a temporary but expected side effect.
Discontinue the medication because severe damage can result. Fluoroquinolones may result in tendinitis and rupture by disrupting the extracellular matrix of cartilage. Because tendon injury is reversible if diagnosed early, fluoroquinolones should be discontinued at the first sign of tendon pain or inflammation. Adding an antiinflammatory medication or slowing the pace and walking more will not decrease the risk for tendon rupture while taking ciprofloxacin.
The nurse is aware that laxatives are contraindicated in patients with which condition(s)? Select all that apply. Pregnancy Constipation Diverticulitis Abdominal pain Bowel obstruction
Diverticulitis Abdominal pain Bowel obstruction Laxatives are contraindicated for individuals with abdominal pain, nausea, cramps, and other symptoms of appendicitis, regional enteritis, diverticulitis, and obstruction of the bowel. Laxatives should be used with caution during pregnancy and lactation. Laxatives are used to treat constipation.
The provider has prescribed intravenous administration of promethazine. The nurse would question the intravenous (IV) use instead of intramuscular (IM) administration of promethazine for which reason? IM injection has a more rapid onset of action. The risk of respiratory depression is eliminated with IM injection. Extrapyramidal reactions do not occur when the drug is administered IM. Extravasation of IV promethazine can lead to abscess formation or tissue necrosis.
Extravasation of IV promethazine can lead to abscess formation or tissue necrosis. Extravasation of IV promethazine can lead to abscess formation, tissue necrosis, and gangrene, leading to amputation; therefore, IV administration should be avoided. If it must be done, promethazine should be given through a large-bore IV line. Respiratory depression and extrapyramidal side effects can occur regardless of the route of administration. Drugs administered IM have a longer onset of action than those given IV.
A nurse administering 30 mL of magnesium hydroxide (milk of magnesia) tells the patient to expect a bowel movement in which amount of time? In 1 to 3 days In 2 to 4 hours In 6 to 12 hours In 15 minutes to 1 hour
In 6 to 12 hours Low-dose (30 mL) milk of magnesia, an osmotic laxative, acts to retain water and soften the feces. Fecal swelling promotes peristalsis in 6 to 12 hours.
The nurse prepares to administer a bisacodyl suppository to a patient who has not had a bowel movement in several days. When should the nurse administer the PRN medication? In the evening before bed In the afternoon before lunch In the morning after breakfast In the morning before breakfast
In the morning after breakfast Bisacodyl suppositories act rapidly (in 15 to 60 minutes). They can be given at any time, but for patient convenience, they should not be given at bedtime to avoid disrupting sleep. For convenience and patient ease, a fast-acting laxative should not be given before a meal, which could cause the urge to have a bowel movement during the meal.
A postoperative patient is scheduled to start taking a daily oral dose of bisacodyl. When does the nurse administer the medication? After ambulating Just before bedtime At the evening meal Before the morning bath
Just before bedtime Oral bisacodyl is a stimulant laxative that acts within 6 to 12 hours. When given at bedtime, it produces a response the next morning. Administration at another time might produce a bowel movement at an inconvenient time, such as during a meal or in the middle of the night. Oral bisacodyl does not need to be given at a specific time in relation to ambulating, but ambulation will improve gastric motility following surgery.
A patient is having high-volume output from a new ileostomy. A nurse develops a plan that includes teaching the patient to take which antidiarrheal agent? Alosetron Loperamide Bismuth subsalicylate Paregoric (camphorated opium tincture)
Loperamide Opioids are the most effective antidiarrheal agents because they activate opioid receptors in the gastrointestinal tract, thus slowing intestinal transit. This action allows more time for fluid and electrolyte absorption in the colon. Loperamide, a structural analog of meperidine, is used to reduce the volume of discharge from ileostomies. Alosetron is a dangerous medication that is approved only for diarrhea-predominant irritable bowel syndrome. Paregoric is not appropriate as an antidiarrheal for long-term use because it has a moderate potential for abuse. Bismuth subsalicylate is effective only for mild diarrhea.
A patient who takes multiple antibiotics starts to experience diarrheal stools. The nurse anticipates administration of which antibiotic if a stool sample tests positive for Clostridium difficile? Rifaximin Daptomycin Gemifloxacin Metronidazole
Metronidazole Metronidazole is the treatment of choice for antibiotic-associated colitis caused by C. difficile. Rifaximin, daptomycin, and gemifloxacin are not used in the treatment of C. difficile infection.
Which antibiotic is used in patients who have infections of the eyes, ears, or skin and for suppressing bowel flora before bowel surgery? Amikacin Neomycin Gentamicin Tobramycin
Neomycin Neomycin is an antibiotic commonly used for bacterial decontamination of the gastrointestinal tract before any surgical procedures and can be administered orally, topically, and rectally. Neomycin is used to treat eye, ear, and skin infections. Amikacin is used to treat infections resistant to neomycin and gentamicin. Tobramycin is one of the most common antibiotics for the treatment of recurring pulmonary infections in patients with cystic fibrosis. Gentamicin is an aminoglycoside antibiotic administered intravenously or intramuscularly for the treatment of susceptible gram-positive and gram-negative bacteria.
With the exception of pyelonephritis, the nurse should be aware that most urinary tract infections (UTIs) are treated by which method? Oral antibiotics in the home setting IV antibiotics in the urgent care setting Intravenous (IV) antibiotics at the hospital Intramuscular (IM) antibiotics at the primary physician's office
Oral antibiotics in the home setting Except for pyelonephritis, most UTIs can be treated with oral therapy at home. Complicated UTIs and pyelonephritis require IV antibiotics in the hospital. IM antibiotics are infrequently used in the treatment of UTIs.
The use of a sodium-based antacid is contraindicated in which group of patients? Patients with infections Patients with renal failure Patients with heart failure Patients with low bone density
Patients with heart failure Sodium-based antacids have adverse effects on patients with heart failure because the sodium content in these formulations is very high. Sodium-based antacids can be taken by patients suffering from renal disorders because they are easily excreted. Patients with infection can also consume sodium-based antacids in low doses since the acids protect the system from infection. Patients with a low bone density are advised not to consume aluminum-based antacids.
Before administering a cephalosporin to a patient, it is most important for the nurse to assess the patient for an allergy history to which substance? Opioids Peanuts Penicillins Soy products
Penicillins 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. An allergy to soy products, peanuts, and opioids is unrelated to cephalosporins.
Which statements about penicillins are true? Select all that apply. Penicillins are the safest antibiotics available. The principal adverse effect of penicillins is allergic reaction. Penicillins are normally eliminated rapidly by the kidneys but can accumulate to harmful levels if renal function is severely impaired. A patient who is allergic to penicillin always has a cross-allergy to cephalosporins. A patient who is allergic to penicillin is also allergic to vancomycin, erythromycin, and clindamycin.
Penicillins are the safest antibiotics available. The principal adverse effect of penicillins is allergic reaction. Penicillins are normally eliminated rapidly by the kidneys but can accumulate to harmful levels if renal function is severely impaired. Penicillins are the safest antibiotics available, with the principal adverse effect being allergic reaction. If renal function is severely impaired, penicillin can accumulate to harmful levels. A patient who is allergic to penicillin has a 1% chance of also being allergic to cephalosporins. Patients who are allergic to penicillin are safely able to take vancomycin, erythromycin, and clindamycin.
The nurse observes a red streak and palpates the vein as hard and cordlike at the intravenous (IV) site of a patient receiving cefepime. Which assessment should the nurse make about the IV site? The drug has infiltrated the extravascular tissues. An allergic reaction has developed to the drug solution. Phlebitis of the vein used for the antibiotic has developed. Local infection from bacterial contamination has occurred.
Phlebitis of the vein used for the antibiotic has developed. IV cephalosporins may cause thrombophlebitis. To minimize this, the injection site should be rotated, and a dilute solution should be administered slowly. An allergic response would be shown as itching, redness, and swelling. Infiltration would show as a pale, cool, and puffy IV site. Infection would show as purulent discharge, tenderness, and redness.
A patient with hepatic encephalopathy receives lactulose. The nurse expects which therapeutic outcome if the medication is having the desired effect? Less ascitic fluid Reduced ammonia level Release of glycogen stores Normal serum sodium level
Reduced ammonia level Some practitioners use lactulose to reduce blood ammonia levels by forcing ammonia from the blood into the colon. Lactulose is useful for treating patients with hepatic encephalopathy. It does not result in less ascitic fluid, a normal serum sodium level, or release of glycogen stores.
The nurse has just received a prescription from the primary health care provider to administer ampicillin to an 80-year-old patient. Which assessment is the nurse's priority before administering the antibiotic? Renal function Total body fluid Hepatic function Cross sensitivity
Renal function The most important assessment before administering ampicillin to an older adult is renal function because older adults are more sensitive to medications. Ampicillin formulations contain large amounts of sodium and/or potassium. Doses must be adjusted for patients with renal dysfunction. If the patient is hypervolemic, assessment of renal function is even more important; however, the nurse should monitor intake and output and edema with the administration of ampicillin. In addition, older adults are likely to have declining organ function, which can lead to impaired elimination of any medication. Cross sensitivity to other antibiotics is not important until ampicillin fails to eliminate the bacteria after one course of treatment. Total body fluid is a reasonable assessment before the administration of ampicillin; however, eradication of the infection may be the priority.
While reviewing the blood reports of a patient who is on amikacin therapy, the nurse finds that the serum drug concentration is elevated. Which further laboratory reports should the nurse check to ensure the patient's safety? Blood platelet count Blood glucose concentration Serum thyroxine concentration Serum creatinine concentration
Serum creatinine concentration Amikacin is an aminoglycoside antibiotic. Aminoglycosides have the potential to cause nephrotoxicity, and thus the patient's serum drug concentrations should be monitored regularly. The usual serum drug concentration of aminoglycosides is expected to be 1 mcg/mL or less (considered a safe range). Concentrations higher than this may cause adverse effects. Therefore, the nurse should check the serum creatinine concentration to evaluate proper renal function. Aminoglycosides do not affect blood glucose concentration. Therefore, the nurse need not check the patient's blood glucose concentration. Aminoglycosides do not affect platelet count. Therefore, the nurse need not check the patient's platelet count. Aminoglycosides do not affect thyroxine hormone concentration. Therefore, the nurse need not check the patient's serum thyroxine concentration.
A patient is prescribed ranitidine for the treatment of peptic ulcers. To ensure drug safety, what should the nurse assess before administering the drug? Blood glucose levels Blood pressure levels Serum antibody levels Serum creatinine levels
Serum creatinine levels Assessment of serum creatinine levels is useful for determining the kidney function that is required to prescribe H 2 receptor antagonist drugs such as ranitidine. Monitoring blood glucose and blood pressure gives a general idea about the patient's well-being. Serum antibody levels detect possible infections in the patient.
The patient is receiving tobramycin. The nurse asks the patient to choose daily meal selections, to which the patient responds, "Oh, dear, I don't want another IV." The nurse makes which assessment about the patient's response? Some hearing loss may have occurred. A nutrition consult most likely is needed. The confusion is due to the hospital stay. The patient has a family history of dementia.
Some hearing loss may have occurred. The patient's comment suggests that the person did not hear the instructions. Aminoglycoside antibiotics can cause ototoxicity. The first sign may be tinnitus (ringing in the ears) progressing to loss of high-frequency sounds. Audiometric testing is needed to detect it. Nutrition, confusion, and a family history of dementia do not address the problem of possible hearing loss associated with aminoglycosides.
A patient with a peptic ulcer is prescribed sucralfate. To promote drug efficiency, the nurse advises the patient to take the drug on an empty stomach. The nurse also asks the patient to avoid consuming any other form of antacid along with sucralfate. What is the most appropriate reason for giving these instructions? Sucralfate promotes the healing of ulcers. Sucralfate is active in acidic environments. Sucralfate reduces the absorption of other drugs. Sucralfate forms a protective barrier between the ulcer and gastric acids.
Sucralfate is active in acidic environments. An empty stomach has a high content of gastric acids. Sucralfate is an acid-controlling drug that is activated and dissociates into aluminum hydroxide and sulfate anions when it comes into contact with the acid present in the stomach. If accompanied with any other antacid, the activity of the drug decreases. It is consumed independently and rarely reduces the absorption of other drugs. It binds and accumulates the epidermal growth factor in the gastric tissue and forms a protective barrier between the ulcer and the gastric acids. Sucralfate promotes ulcer healing by this mechanism.
The patient taking antibiotics for strep throat presents to the outpatient clinic to report vaginal candidiasis. The nurse should use which term to describe this phenomenon? Superinfection Allergic reaction Resistant infection Nosocomial infection
Superinfection Antibiotic therapy can destroy the normal flora of the body, which normally would inhibit the overgrowth of fungi and yeast. When the normal flora are decreased, these organisms can overgrow and cause a new infection, or superinfection. The patient's symptoms are not indicative of an allergic reaction or resistant infection. Nosocomial infections are infections patients get in the hospital, not at home.
Which is the mechanism of action of a proton pump inhibitor? Reacts with gastric acid to form neutral salts Forms a barrier over the ulcer crater to protect it from acid and pepsin Suppresses acid secretion by inhibiting the enzyme that makes gastric acid Eradicates the H. pylori that is associated with the ulceration of the mucosa
Suppresses acid secretion by inhibiting the enzyme that makes gastric acid Proton pump inhibitors are antisecretory agents which suppress acid secretion by inhibiting the enzyme that makes gastric acid. Antacids react with gastric acid to form neutral salts. A mucosal protectant is prescribed to form a barrier over the ulcer crater to protect it from acid and pepsin. An antibacterial drug is prescribed to eradicate H. pylori.
Which statement is accurate regarding a culture and sensitivity test of purulent wound drainage? The microbe must be identified prior to sensitivity. Drugs are prescribed prior to the testing of sensitivity. Treatment is prescribed after the microbe has been identified. Prescribed treatment for the microbe is initiated after the culture is obtained.
The microbe must be identified prior to sensitivity. Before sensitivity testing can be done, the microbe must first be identified so that it can be tested appropriately for sensitivity. This testing ensures that the appropriate drugs for treatment are prescribed. A culture is always obtained prior to the administration of specific antibiotics because drugs prescribed prior to identifying the sensitivity of the infecting organism may not be effective. A broad-spectrum antibiotic may be prescribed while waiting for the results of the culture and sensitivity but places the patient at risk for a superinfection.
The nurse reviews the patient's medication record and notes the following: sucralfate 1 gram orally 4 times daily before meals (7:30 AM, 11:30 AM, and 4:30 PM) and at bedtime (10:00 PM); phenytoin 200 mg orally daily at 8:00 AM. Which modifications, if any, should be made to the medication regimen? The medications can be administered as ordered. The nurse should obtain a prescriber order to administer the phenytoin at 9:30 AM daily. The nurse should obtain a prescriber order for intravenous phenytoin to avoid a drug interaction. The nurse should administer the phenytoin with the 7:30 AM dose of sucralfate, because this is more time efficient.
The nurse should obtain a prescriber order to administer the phenytoin at 9:30 AM daily. Sucralfate can impede the absorption of phenytoin; therefore, a period of 2 hours should separate these drugs. The nurse should consult the prescriber for a time administration change. Based on this information, it is not appropriate to administer the drugs as ordered, switch the phenytoin to the IV form, or administer the phenytoin with the sucralfate.
After completing a course of ciprofloxacin for a skin infection, the patient says, "I took the whole bottle of pills, but my infection hasn't gotten any better." Which additional information should the nurse recognize as most significant? The patient takes antacids on a daily basis. The medication was stored in a cool, dry area. The patient did not use sunscreen while taking the ciprofloxacin. The patient took two doses of diphenhydramine while on ciprofloxacin therapy.
The patient takes antacids on a daily basis. Antacids interfere with the absorption of quinolone antibiotics, such as ciprofloxacin, and many other drugs; therefore, this patient has not received the full dosing regimen, which is required if ciprofloxacin is to be effective against the infection. Storing the drug in a cool, dry area and using sunscreen or diphenhydramine would not disrupt the effectiveness of ciprofloxacin.
The nursing instructor explains to the nursing students about penicillins. Which is true about penicillins? Select all that apply. They are bacteriostatic. They are known as beta-lactam antibiotics. They are considered one of the safest antibiotics. They are active only against bacteria that are growing and dividing. They cause bacteria to take up excess amounts of water and rupture.
They are known as beta-lactam antibiotics. They are considered one of the safest antibiotics. They are active only against bacteria that are growing and dividing. They cause bacteria to take up excess amounts of water and rupture Penicillins are known as beta-lactam antibiotics and are the safest antibiotics. In addition, penicillins are active only against bacteria that are growing and dividing. They cause bacteria to take up excess amounts of water and rupture, and hence are bactericidal (not bacteriostatic).
The nurse recognizes which of the following as examples of the improper use of antibiotic therapy? Select all that apply. Treating a viral infection Basing treatment on sensitivity reports Using dosing that results in a superinfection Treating fever in an immunodeficient patient Using surgical drainage as an adjunct to antibiotic therapy
Treating a viral infection Using dosing that results in a superinfection Common misuses of antibiotics include (1) treatment of a viral infection, which results in exposure of the patient to the risks of the medication without providing any benefits, and (2) improper dosing (dosing that is too high results in superinfection). Basing treatment on sensitivity reports, treating fever in an immunodeficient patient, and using surgical drainage as an adjunct to antibiotic therapy are examples of the proper use of antimicrobial therapy.
The patient recently prescribed vancomycin asks the nurse for more information about the medication. Which response(s) by the nurse are correct? Select all that apply. The major toxicity of vancomycin therapy is liver failure. Vancomycin is effective in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections. Vancomycin is the most widely used antibiotic in U.S. hospitals. Patients who are allergic to penicillin are also allergic to vancomycin. Vancomycin is effective in the treatment of Clostridium difficile infection.
Vancomycin is effective in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections. Vancomycin is the most widely used antibiotic in U.S. hospitals. Vancomycin is effective in the treatment of Clostridium difficile infection. Vancomycin is effective against C. difficile and MRSA and is the most widely used antibiotic in U.S. hospitals. Patients who are allergic to penicillin are able to take vancomycin. The major toxicity of vancomycin therapy is kidney failure.
How does superinfection occur in a patient? When the serum level of an antibiotic is too high When the patient has a gram-positive bacterial infection When the patient has a gram-negative bacterial infection When the antibiotic eliminates the normal bacterial flora
When the antibiotic eliminates the normal bacterial flora The normal bacterial flora consists of certain bacteria and fungi that are needed to maintain normal function in various organs. Superinfection can occur when antibiotics completely eliminate the normal bacterial flora. When these bacteria or fungi are killed by antibiotics, then other bacteria or fungi cause infection, which is known as superinfection. When the serum level of the antibiotic is too high, a toxic reaction can occur. Gram-positive and gram-negative bacterial infections do not cause superinfection.
