Pharm Exam 4 Practice
Vancomycin trough levels
10-20 mcg/mL
Therapeutic range of cyclosporine
100-200 ng/mL
What is the correct time to obtain a trough level of gentamicin? a. 60 minutes after IV injection. b. 30 minutes after IM injection. c. 2 hours after IV administration. d. 30 minutes before the next dose.
30 minutes before the next dose.
A patient with a history of lung transplantation is admitted for treatment for a respiratory infection. The patient has been taking cyclosporine [Sandimmune], prednisone, and azathioprine [Imuran] for 8 months. The provider has ordered azithromycin [Zithromax] to treat the infection and acetaminophen [Tylenol] as needed for fever. The nurse will contact the provider to: a. ask whether a different antibiotic can be used b. ask that the prednisone be discontinued until the infection clears c. suggest increasing the dose of cyclosporined. suggest using ibuprofen instead of acetaminophen
A. Macrolide antibiotics, such as azithromycin, can inhibit cyclosporine metabolism, leading to increased levels of the drug. This patient needs either a reduced dose of cyclosporine or a different antibiotic. There is no indication for discontinuing the prednisone during treatment. The dose of cyclosporine would need to be reduced, because azithromycin leads to increased drug levels. There is no contraindication to using acetaminophen.
A patient who is taking calcium supplements receives a prescription for ciprofloxacin [Cipro] for a urinary tract infection. The nurse will teach this patient to: a.consume extra fluids while taking the ciprofloxacin to prevent hypercalciuria. b.stop taking the calcium supplements while taking the ciprofloxacin. c.take the two medications together to increase the absorption of both. d.take the calcium either 6 hours before or 2 hours after taking the ciprofloxacin.
ANS: D Cationic compounds, including calcium supplements, can reduce the absorption of ciprofloxacin, so proper interval dosing is necessary. Consuming extra fluids is not indicated. With proper interval dosing, it is not necessary to discontinue the calcium while giving the ciprofloxacin. These two medications should not be given together.
A patient starting therapy with efavirenz [Sustiva] asks about the timing of the medication with regard to meals. What patient education about the administration of this medication should the nurse provide? a.The drug must be taken within 30 minutes after a meal. b.The drug is best taken with a high-fat meal. c.The drug can be taken anytime without regard to meals. d.The drug should be taken once daily on an empty stomach.
ANS: D The nurse should advise the patient that the medication should be taken once daily on an empty stomach. Thirty minutes after a meal is too soon to take the medication. The medication is taken on an empty stomach, because high-fat meals increase plasma levels by 39% with capsules and by 79% with tablets. The medication must not be taken with high-fat meals.
Which is the preferred drug or drugs for treating gonorrhea? a. doxycycline and azithromycin b. ceftriaxone c. metronidazole d. Acyclovir
B. ceftriaxone
The risk of ototoxicity is related primarily to
persistently elevated trough drug levels, rather than to excessive peak levels
A patient is receiving amphotericin B. The nurse identifies which medication as useful in preventing adverse effects of amphotericin B? A. Furosemide (Lasix) B. Insulin C. Vitamin K D. Potassium
D. Potassium Renal injury from amphotericin B may cause severe hypokalemia. Serum potassium levels should be monitored more frequently and potassium supplements given to correct low plasma levels. Furosemide, insulin, and vitamin K do not prevent any adverse effects of amphotericin B.
A patient is taking nitrofurantoin [Macrodantin]. Which finding should a nurse recognize as an indication that the treatment is having an undesired effect?
Dyspnea with chills Acute pulmonary reaction is considered a significant adverse reaction. Patients with a history of these responses should not receive nitrofurantoin again. p. 1079
A patient is to begin taking nitrofurantoin [Macrodantin]. The nurse should teach the patient that which manifestation should be the priority to report to the healthcare provider?
Muscle weakness and tingling Nitrofurantoin is used in acute infections of the lower urinary tract only. Muscle weakness and tingling may indicate irreversible damage to sensory and motor nerves caused by demyelinization of nerves. Patients should be informed of these symptoms and taught to report them immediately. Gastrointestinal (GI) effects may be minimized by taking the drug with milk or food. Brown urine is a harmless effect of the urinary excretion of the medication. Headache and drowsiness are less common adverse effects that are readily reversible.
Gentamicin peak and trough
Peak: 4-10 Trough: 1-2
A patient taking azithromycin reports dysgeusia. The nurse responds by:
Saying, "This is a rare, but harmless, side-effect of azithromycin."
Why must aminoglycosides be administered parenterally?
These drugs are highly polar, and thus cannot be absorbed from the GI tract.
When ceftriaxone is administered intravenously, it is most important for the nurse to avoid mixing it with what? a Ringer's lactate b Normal saline c Sterile water d D5 0.45% NS
a Mixing ceftriaxone with calcium causes precipitates to form. Ringer's lactate contains calcium; therefore, it should not be mixed with ceftriaxone. It is safe to mix normal saline, sterile water, and D5 0.45% NS with ceftriaxone.
A patient is receiving penicillin G (Bicillin C-R). Which assessment should the nurse monitor as an indicator of an undesired effect? A. Cardiac rhythm B. Serum sodium level C. Lung sounds D. Red blood cell (RBC) count
a. . Cardiac rhythm Penicillin G in high IV doses may cause hyperkalemia, which can result in dysrhythmias or cardiac arrest. Hypernatremia occurs with high IV doses of ticarcillin. Lung sounds and the RBC count are unrelated to the administration of penicillin G.
Your patient is hospitalized with bacteremia. He is prescribed IV Penicillin G and Gentamicin. How would you administer these drugs? a. Wait at least 2 hours between administration of these drug. b. Wait 30 minutes between administration of these drugs. c. Administer each drug on an alternate day. d. Administer the first drug, flushing the tubing, then administer the second drug.
a. Wait at least 2 hours between administration of these drug.
What is the drug of choice to treat ear infections?
amoxicillin
Oral tetracyclines are not used in children younger than 8 years of age because: a. Risk of bleaching of the hair b. Risk of damage to tooth enamel and developing bones c. Risk of hyperkalemia d. Risk of hyperpigmentation of the skin
b. Risk of damage to tooth enamel and developing bones
When performing shift assessment, the nurse notes a maculopapular rash over the trunk of a patient who has been taking a ceftriaxone for four days. What is the nursing priority action? a. administer standing order for epinephrine as needed b. complete the assessment c. consult the prescriber d. withhold the ceftriaxone
b. complete the assessment Because hypersensitivity is a common adverse effect and because rash is less severe the assessment needs to be completed in order to give completed information to the prescriber.
A patient who is receiving ceftriaxone has all of these medications ordered. The nurse monitors the patient for an adverse effect related to an interaction with which medication? a Regular insulin b Ampicillin [Polycillin] c Naproxen [Naprosyn] d Bisacodyl [Dulcolax]
c Three cephalosporins—cefmetazole [Zefazone], cefoperazone [Cefobid], and cefotetan [Cefotan]—cause bleeding tendencies. Caution should be used during concurrent use of anticoagulants and other nonsteroidal medications. Regular insulin, ampicillin, and bisacodyl are unrelated to adverse effects with cefotetan.
Which result would be of greatest priority to report to the prescriber of ceftriaxone? a. Albumin 3.4 g/dLb. e. GFR 88mL/min c. H/H 9.2 g/dL/27% d. INR 1
c. Hemoglobin 9.2 g/dL and hematocrit 27% These are below normal limits. All the other levels are within normal limits. Ceftriaxone can cause bleeding issues, so PT/INR needs to be monitored, but the INR of 1 is normal for a patient not on any anticoagulants. The albumin level is on the low end of the spectrum, but not cause for concern at this point.
Important for nurse to monitor which lab test when a patient is prescribed azithromycin or erythromycin and warfarin? a. BUN b. CK-MM c. INR d. RBC count
c. INR because warfarin is a blood thinner and macrolides can increase effects of warfarin
The nurse questions the order for erythromycin after seeing what in the patient's health history? a. Type II diabetes b. Calcium supplements c. Long QT syndrome d. Penicillin allergy
c. Long QT syndrome This is a major red flag and contraindicated in erythromycin. Erythromycin is often given as an alternative to penicillin for those with penicillin allergies. Calcium is contraindicated in tetracyclines; erythromycin is a macrolide.
Which of the following cannot be taken with tetracyclines:
calcium supplements milk products iron supplements magnesium-containing laxatives most antacids.
Except for ______________, all cephalosporins are eliminated by the _______________, and therefore must be given in reduced dosage to patients with renal impairment.
ceftriaxone; kidneys
Amoxicillin is often given with what to prevent breakdown from beta lactamase?
clavulanic acid or clavulanate; with Amoxicillin it's known as Augmentin or Clavamox
A compound present in grapefruit juice inhibits metabolism of ________________. As a result, consuming grapefruit juice can raise ____________________ levels by ________________, greatly increasing the risk for____________.
cyclosporine/cyclosporine/50% to 200%/toxicity.
A patient with a liver transplant has been receiving cyclosporine [Sandimmune] for 6 months. The nurse reviews this patient's laboratory results and notes a sharp increase in the blood urea nitrogen (BUN) and serum creatinine. Vital signs are normal, and the patient reports no discomfort. What does the nurse suspect? a. Hepatotoxicity b. Infection c. Organ rejection d. Nephrotoxicity
d. An elevation of BUN and serum creatinine is an indication of nephrotoxicity, which occurs in 75% of patients taking cyclosporine. Hepatotoxicity would cause elevations in liver enzymes, not the BUN and creatinine. Infection would be associated with fever. Organ rejection of a renal transplant would cause elevation in the BUN and creatinine but also would cause tenderness at the graft site and fever.
A patient taking ceftriaxone has a PT of greater than 14 seconds and an INR of 4.0. What is the nurse's first response? a. Assess for signs of bleeding. b. Ask if the patient is taking warfarin or NSAIDs. c. Withhold the ceftriaxone. d. Inform the provider and request an order for parenteral vitamin K.
d. Parenteral vitamin K can correct an abnormal prothrombin time. The nurse should continuously assess for bleeds. If bleeding develops, the medication must be withdrawn. The immediate priority is correcting the PT time.
Vancomycin is used to treat
1st hospital acquired MRSA 2nd CDIFF (PO)
Therapeutic range for tacrolimus
5-20 ng/mL
How long should the nurse administer an IV of vancomycin?
90 minutes
Nitrofurantoin should be held if creatinine clearance is
<40
The nurse notices tan lines around the arms of a female patient who is taking levofloxacin [Levaquin]. Which action should the nurse take?
Advise the patient to avoid sun exposure and wear sun screen when outside. Fluoroquinolones pose a risk of phototoxicity. Accordingly, patients should avoid sunlight and sunlamps, and should use protective clothing and a sunscreen if they must go outdoors.
A patient says they do not want to take a prescription for tetracycline because "they already have some at home." The nurse: a. Says nothing. b. Asks why they did not finish the full course of the original tetracycline? c. Informs the patient that expired tetracycline is toxic, cannot be taken, and must be safely disposed. d. Educates the patient on cost-saving prescription plans.
C. Expired tetracycline can cause a nephrotoxic reaction known as Fanconi syndrome.
An alert and oriented patient with a history of penicillin allergy is prescribed cephalexin. What is the priority action by the nurse? a. Administer the cephalexin b. Administer the cephalexin and carefully assess for allergic reaction c. Assess the type of reaction that the patient had to the penicillin d. Notify the prescriber of the allergy and ask for a different antibiotic order
C. Assess the type of reaction that the patient had to the penicillin.
This is the drug of choice for penicillin-resistant patients.
Erythromycin.
Which approach should a nurse take when administering an oral dose of levofloxacin [Levaquin]?
Give the medication with or without food. Levofloxacin should not be administered with milk products or antacids containing magnesium or aluminum, because this reduces absorption from the gastrointestinal (GI) tract. However, this does not happen with most foods. Premedicating with diphenhydramine is unnecessary.
Unlike the other tetracyclines, doxycycline:
Is safer for patients with renal impairment Absorption is not as affected by food, but oral should still be administered on an empty stomach.
The nurse is preparing to administer an IV mining of ceftriaxone in 50 mL of 5% dextrose to an infant. The infant has an IV of lactated ringers solution infusing at 35 mL/hr. What should the nurse do?
Lactated ringers contain calcium. Calcium and ceftriaxone is contraindicated in infants. If the lactated ringers must be given, they must be in separate IV lines. Don't give IV ceftriaxone and IV calcium through the same line or different lines within 48 hours of each other. If the patient must receive ceftriaxone and calcium, use oral calcium or IM ceftriaxone. p. 1041
Before administering erythromycin to a patient for an upper respiratory tract infection, it is the most important for the nurse to determine if the patient is also prescribed which drug? A. Guaifenesin (guiatuss) B. hydrocodone (vicodin) C. Nitroglycerin (tridil) D. verapamil (Calan)
d. Verapamil Drugs that inhibit CYP3A4 (e.g., verapamil, diltiazem, HIV protease inhibitors, azole antifungal drugs) can increase erythromycin levels, thereby posing a risk of QT prolongation and sudden cardiac death. People using these drugs should not use erythromycin. p. 1060
Erythromycin is an example of an a. aminoglycoside b. cephalosporin c. anti fungal d. macrolide
d. macrolide
Food decreases absorption of all three types of erythromycin EXCEPT:
erythromycin ethylsuccinate
What adverse effect is associated with tacrolimus?
torsades de pointes
A nurse should teach a patient to observe for which side effect when taking amoxicillin (Polycillin)? A. Skin rash and loose stool B. Reddened tongue and gums C. Digit numbness and tingling D. Bruising and petechiae
A. Skin rash and loose stool
The nurse is caring for a patient who is human immunodeficiency virus (HIV) positive and is taking high doses of zidovudine [Retrovir]. The nurse is providing patient education about the adverse effects of the medication. Which statement by the patient demonstrates a need for further teaching? a."I may experience fatigue from anemia." b."I may be more susceptible to infection from neutropenia." c."I may have a deficiency of vitamin B6." d."I may have a deficiency of folic acid."
ANS: C A deficiency of vitamin B12, not vitamin B6, would be expected; this statement indicates that further teaching is required. With high-dose zidovudine, the patient can expect anemia, neutropenia, and folic acid deficiency.
A 65-year-old patient who receives glucocorticoids for arthritis is admitted to the hospital for treatment of a urinary tract infection. The prescriber has ordered intravenous ciprofloxacin [Cipro]. Before administering the third dose of this drug, the nurse reviews the bacterial culture report and notes that the causative organism is Escherichia coli. The bacterial sensitivity report is pending. The patient complains of right ankle pain. What will the nurse do?a.Withhold the dose of ciprofloxacin and notify the provider of the patient's symptoms. b.Instruct the patient to exercise the right foot and ankle to minimize the pain. c.Question the patient about the consumption of milk and any other dairy products. d.Request an order to increase this patient's dose of glucocorticoids.
ANS: A A rare but serious adverse effect associated with fluoroquinolones is tendon rupture, and those at highest risk are children, patients older than 60 years, transplant patients, and any patients taking glucocorticoids. Any pain in either heel should be reported and the drug should be discontinued. Patients should be instructed not to exercise until tendonitis has been ruled out. Dairy products can reduce the absorption of ciprofloxacin, so this is not a concern with this patient. Because the pain may be caused by tendonitis associated with ciprofloxacin, it is not correct to request an increase in the glucocorticoid dosing.
A patient who is receiving intravenous ciprofloxacin for pneumonia develops diarrhea. A stool culture is positive for Clostridium difficile. The nurse will expect the provider to: a.add metronidazole [Flagyl]. b.increase the dose of ciprofloxacin. c.restrict dairy products. d.switch to gemifloxacin.
ANS: A C. difficile is resistant to fluoroquinolones; metronidazole is the drug of choice to treat this infection. Metronidazole is lethal only to anaerobic organisms, so the ciprofloxacin should be continued to treat the pneumonia. Increasing the dose of ciprofloxacin is not indicated, because C. difficile is resistant to ciprofloxacin. Gemifloxacin is approved for use in respiratory infections.
A nurse is teaching a patient who is preparing to travel for a month-long missionary trip to Africa. The provider has ordered chloroquine [Aralen Phosphate] as suppressive therapy. Which statement by the patient indicates a need for further teaching? a. "I should continue taking the drug for 2 weeks after returning home." b. "I should take 500 mg of this drug once each week." c. "I should take the first dose 1 week before leaving for Africa." d. "I should take this drug with meals."
ANS: A Patients taking chloroquine as suppressive therapy should take the medication for 4 weeks, not 2 weeks, after returning from an area where infection is likely. The patient is correct to state that 500 mg of the drug should be taken weekly, that the first dose should be taken 1 week before travel, and that the drug should be taken with meals.
The nurse is caring for a patient receiving intravenous acyclovir [Zovirax]. To prevent nephrotoxicity associated with intravenous acyclovir, the nurse will: a.hydrate the patient during the infusion and for 2 hours after the infusion. b.increase the patient's intake of foods rich in vitamin C. c.monitor urinary output every 30 minutes. d.provide a low-protein diet for 1 day before and 2 days after the acyclovir infusion.
ANS: A The nurse should ensure that the patient is hydrated during the acyclovir infusion and for 2 hours after the infusion to prevent nephrotoxicity. Increasing vitamin C would not help prevent nephrotoxicity. Monitoring urine output is important but would not help prevent nephrotoxicity. A low-protein diet is not indicated after an acyclovir infusion.
The nurse is providing patient education to a 26-year-old college student who is being treated for Trichomonas vaginalis with metronidazole [Flagyl]. Which statement by the patient indicates understanding of the teaching? a. "I should not consume alcohol while taking this medication." b. "If I have dark urine, I should stop taking the drug." c. "The drug is safe throughout pregnancy." d. "Vertigo and headaches may occur and are signs of toxicity."
ANS: A The patient should be advised to avoid drinking alcohol while taking this medication, because it may cause a disulfiram-like reaction. Darkening of the urine may occur but does not warrant discontinuing the drug. The drug is mutagenic for fetuses and should be avoided before and/or during pregnancy. Vertigo and headaches are side effects but are not signs of toxicity.
A patient will receive oral ciprofloxacin [Cipro] to treat a urinary tract infection. The nurse provides teaching for this patient. Which statement by the patient indicates a need for further teaching? a."I may have abdominal pain and nausea, but these are usually mild." b."I should take this medication with food or milk to improve absorption." c."I should stop taking the medication immediately if I experience heel pain." d."I will need to use sunscreen every time I go outdoors."
ANS: B Dairy products inhibit the absorption of ciprofloxacin, so they should be avoided. Abdominal pain and nausea and vomiting are common and usually mild. Patients should stop taking the drug if heel pain occurs until tendonitis has been ruled out. Photosensitivity can occur, so sunscreen should be used.
A patient with a history of congestive heart failure and renal impairment has esophageal candidiasis. Which antifungal agent would the nurse anticipate giving to this patient? a.Amphotericin B [Abelcet] b.Fluconazole [Diflucan] c.Itraconazole [Sporanox] d.Voriconazole [Vfend]
ANS: B Fluconazole is a drug of choice for treating systemic candidal infections. Amphotericin is nephrotoxic and should not be used in patients with existing renal disease. Itraconazole is a possible alternative agent for treating candidiasis but has serious cardiac side effects. Voriconazole is a drug of first choice for treating aspergillosis but not for candidiasis.
A family has just returned from a camping trip, and all family members have diarrhea and colicky abdominal pain after eating. The parents report that they drank water from a well while on the camping trip. While awaiting stool cultures, the nurse will expect the provider to order which agent empirically? a. Iodoquinol [Yodoxin] b. Metronidazole [Flagyl] c. Miltefosine [Impavido] d. Sodium stibogluconate [Pentostam]
ANS: B This family most likely has giardiasis, which can be acquired by drinking contaminated water. Metronidazole is the drug of choice for this infection. Iodoquinol is used for asymptomatic amebiasis. Miltefosine and sodium stibogluconate are used to treat leishmaniasis.
A patient who is pregnant has a history of recurrent genital herpesvirus (HSV). The patient asks the nurse what will be done to suppress an outbreak when she is near term. The nurse will tell the patient that: a.antiviral medications are not safe during pregnancy. b.intravenous antiviral agents will be used if an outbreak occurs. c.oral acyclovir [Zovirax] may be used during pregnancy. d.topical acyclovir [Zovirax] must be used to control outbreaks.
ANS: C Oral acyclovir is devoid of serious adverse effects and may be used safely during pregnancy. It is incorrect to tell this patient that antiviral medications are not safe during pregnancy. Oral acyclovir is used to suppress recurrent genital herpes near term; intravenous antiviral medications are not indicated. It is not necessary to rely on topical medications because oral acyclovir is safe.
A nurse is discussing intravenous amphotericin B treatment with a nursing student who is about to care for a patient with a systemic fungal infection. Which statement by the student indicates a need for further teaching? a."A test dose of amphotericin B may be given to assess the patient's reaction." b."If I see any precipitate in the IV solution, I should stop the infusion immediately." c."Infusions of amphotericin B should be administered over 1 to 2 hours." d."The IV site should be rotated frequently to reduce the risk of phlebitis."
ANS: C Infusions of amphotericin B should be given over 2 to 4 hours to minimize phlebitis and cardiovascular reactions; therefore, 1 to 2 hours is incorrect. Test doses are given to evaluate the patient's response. Any precipitate in the IV solution warrants immediate discontinuation of the IV. IV sites should be rotated frequently.
The nurse is caring for a patient who is HIV positive and is taking zidovudine [Retrovir]. Before administering the medication, the nurse should monitor which laboratory values? a.Ketones in the urine and blood b.Serum immunoglobulin levels c.Serum lactate dehydrogenase d.Complete blood count (CBC)
ANS: D The nurse should monitor the patient's CBC to determine whether the patient has anemia and neutropenia. Ketones are not an adverse effect of zidovudine. Nothing indicates a need to monitor the immunoglobulin levels or serum lactate dehydrogenase.
A patient taking metronidazole [Flagyl] for asymptomatic intestinal amebiasis complains of tingling and numbness of the hands and feet. What action by the nurse is most appropriate? a. Encourage the patient to exercise to improve circulation. b. Inform the patient that numbness is a common and reversible side effect. c. Stress the need to avoid constrictive clothing and crossing the legs. d. Withhold the drug and notify the prescriber.
ANS: D The nurse should withhold the drug and notify the prescriber, because these symptoms may indicate neurologic involvement. Numbness is not a common side effect of metronidazole. Encouraging the patient to move the hands and feet frequently to improve circulation would not address the neurologic symptoms. Advising the patient to avoid constrictive clothing and crossing the legs would not address the neurologic symptoms.
The nurse is caring for a patient who will begin receiving intravenous ciprofloxacin [Cipro] to treat pyelonephritis. The nurse learns that the patient has a history of myasthenia gravis. Which action by the nurse is correct? a.Administer the ciprofloxacin and monitor the patient for signs of muscle weakness. b.Ask the provider whether the ciprofloxacin can be given orally. c.Request an order for concurrent administration of metronidazole [Flagyl]. d.Suggest that the provider order a different antibiotic for this patient.
ANS: D Ciprofloxacin and other fluoroquinolones can exacerbate muscle weakness in patients with myasthenia gravis and should not be given to these patients. It is not correct to administer the drug and monitor for this effect. Giving the drug by a different route will not alter this effect. Metronidazole is given when C. difficile occurs.
Which instructions should a nurse provide to a patient who is to start taking amoxicillin/clavulanate (Augmentin)? A. "Take Augmentin once per day and only at bedtime." B. "Augmentin may be taken with food or meals." C. "Avoid taking Augmentin with grapefruit juice." D. "Use a minimal amount of liquid to swallow the Augmentin."
B. "Augmentin may be taken with food or meals." Amoxicillin/clavulanate is a broad-spectrum aminopenicillin that may be taken with meals (p. 1037). Most other oral penicillins must be taken with a full glass of water 1 hour before or 2 hours after meals. Taking oral penicillins only at bedtime, avoiding grapefruit juice, and taking the drug with only minimal water are not necessary.
A nurse planning care for a patient who is receiving nystatin (Mycostatin) should establish which outcome on the care plan? A. Relief of nasal congestion B. Decrease in mouth pain C. Productive cough D. Absence of urticaria
B. Decrease in mouth pain Nystatin is an antifungal medication that is used for candidiasis of the skin, mouth, esophagus, intestine, and vagina. It can be administered orally and topically and will heal mouth lesions from oral candidiasis. Nystatin has no effect on nasal congestion and cough production. It does not cause urticaria.
Your patient has been receiving IV Gentamicin for the past 2 days. The patient is scheduled for surgery today. To ensure the patient's safety, you should a. Refrain from giving benzodiazepine as a preoperative medication. b. Be sure to tape a note to the front of the chart documenting the administration of gentamicin. c. Refrain from giving any anticholinergic before surgery. d. Ask the anesthesiologist for an increased dose of premedication.
Be sure to tape a note to the front of the chart documenting the administration of gentamicin.
A patient who has acquired immunodeficiency syndrome (AIDS) is receiving trimethoprim/sulfamethoxazole (Bactrim). Which response should a nurse expect if the medication is achieving the desired effect? A) Increase in CD4 T cells B) Increased appetite and weight gain C) Resolution of pneumonia D) Decrease in joint pain
C Trimethoprim/sulfamethoxazole is the treatment of choice for Pneumocystis pneumonia (PCP), an infection caused by Pneumocystis jiroveci (formerly thought to be Pneumocystis carinii). PCP is an opportunistic pneumonia caused by a fungus that thrives in immunocompromised hosts. It does not increase the number of CD4 T cells, the targeted cells of the human immunodeficiency virus (HIV), nor does it affect joint pain. Increased appetite and weight gain are not therapeutic actions of trimethoprim/sulfamethoxazole.
A patient is scheduled to receive intravenous amphotericin B. Which medication should a nurse administer as pretreatment before the infusion? A. 10 units of regular insulin intravenously B. 20 mg famotidine (Pepcid) in 50 mL of 5% dextrose C. 50 mg of diphenhydramine (Benadryl) and 650 mg of acetaminophen D. 1 g of calcium gluconate in 100 mL of normal saline
C. 50 mg of diphenhydramine (Benadryl) and 650 mg of acetaminophen Almost all patients given intravenous amphotericin B develop fever, chills, and nausea. Pretreatment with diphenhydramine and an analgesic, such as acetaminophen, can minimize or prevent these adverse effects.
Thirty minutes after receiving an intramuscular (IM) injection of penicillin G (Pfizerpen), a patient reports itching and redness at the injection site. Which action should the nurse take first? A. Elevate the lower legs. B. Place an ice pack on the site. C. Make sure the patient stays calm. D. Administer subcutaneous epinephrine
D. Administer subcutaneous epinephrine. Itching and redness at the IM injection site indicate an allergy to penicillin. The primary treatment is epinephrine (subcutaneous, IM, or IV) plus respiratory support. Elevation, ice packs, and calming the patient are done once epinephrine has been administered.
A patient is receiving amphotericin B. It is most important for the nurse to monitor which laboratory result? A. Serum pH B. Protein level C. Glucose level D. Creatinine level
D. Creatinine level Amphotericin B is toxic to cells of the kidneys. To evaluate renal injury, the plasma creatinine level should be monitored every 3 or 4 days, as well as intake and output. It is not necessary to monitor the serum protein or glucose levels or the serum pH in patients taking amphotericin B.
Which antifungal agent is used as a one-time oral dose to treat vaginal yeast infections? A. Nystatin (Mycostatin) B. Caspofungin (Cancidas) C. Voriconazole (Vfend) D. Fluconazole (Diflucan)
D. Fluconazole (Diflucan) Fluconazole (Diflucan) has almost 100% bioavailability and therefore is often sufficient as a single dose to treat vaginal yeast infections. Caspofungin (Cancidas) cannot be administered orally. It is used in patients unresponsive to amphotericin B. Nystatin (Mycostatin) is administered as an oral or topical application for candidiasis. Voriconazole (Vfend) is used in the treatment of aspergillosis.
The nurse is performing a physical assessment on a patient who is receiving treatment with abacavir, zidovudine, and lamivudine (Trizivir). The patient complains of fatigue. Upon further assessment, the nurse finds a rash and notes that the patient has a temperature of 101.1° F. What is the nurse's best course of action? a. Tell the patient that this is an expected response to these medications and to continue the agents as prescribed. b. Have the patient hold the medications and arrange for an immediate evaluation by the prescriber. c. Have the patient continue the abacavir but discontinue the other two agents for 3 weeks. d. Instruct the patient to continue all three medications and administer an antihistamine for the symptoms.
b. Have the patient hold the medications and arrange for an immediate evaluation by the prescriber. The patient should discontinue all the medications. Immediate assessment by the provider is required, because the patient is showing early symptoms of a fatal hypersensitivity reaction. This is not an expected response; it indicates a serious reaction, which the patient should report to the prescriber immediately. The patient should not continue the medications for any additional dosages.
Aminoglycosides can cause:
irreversible injury to sensory cells of the inner ears, resulting in hearing loss and disturbed balance; nephrotoxicity
Manzotti reaction is associated with
ivermectin