340 pharm. test 3
The nurse administers ceftriaxone (Rocephin) to a patient who also is taking warfarin (Coumadin). The nurse will monitor the patient carefully for which problem? increased neutrophil counts elevated levels of ceftriaxone bruising or bleeding gums hyperkalemia
bruising or bleeding gums Rationale: The nurse should monitor the patient for bruising or bleeding gums, because ceftriaxone can promote bleeding, especially when administered concurrently with warfarin. The combination of these 2 drugs does not alter the effectiveness of the antibiotic; monitoring neutrophils will provide information only about the stage of the infection. Monitoring ceftriaxone levels provides information about whether the drug levels are sufficient to address the infection. Neither drug impacts the patient's potassium levels. See Lehne p. 1073
A patient tells the nurse during the health history that anaphylaxis was experienced the last time penicillin was taken. Based on this information, the nurse would question an order for which of the following medications? ibuprofen (Motrin) doxycycline (Vibramycin) erythromycin ceftriaxone (Rocephin)
ceftriaxone (Rocephin) Rationale: Cephalosporins can be used with minimal concern in patients with a mild penicillin allergy; however, they should not be administered to patients with a history of a life-threatening reaction such as anaphylaxis to penicillin. The patient should also be asked to describe the reaction that occurred and this information would be reported to the prescriber. See Lehne p. 1072-1073. Cross-allergies between tetracyclines (doxycycline) or macrolides (erythromycin) and penicillin have not been reported.
The nurse notifies the health care provider that a patient who is concurrently taking ciprofloxacin (Cipro) and warfarin (Coumadin). What change to the patient's medication dosages does the nurse anticipate? increase in the ciprofloxacin dose. decrease in the warfarin dose. increase in the warfarin dose. decrease in the ciprofloxacin dose.
decrease in the warfarin dose. Rationale: Ciprofloxacin can elevate levels of warfarin in the blood which will cause more warfarin to be available and will thereby further decrease the patient's ability to clot. Decreasing the warfarin dosage while the patient is on ciprofloxacin will help keep the patient's clotting time within therapeutic range. The prothrombin time and INR level should be monitored, and the dosage of warfarin should be reduced as indicated. See Lehne p. 1132
A patient has acquired hospital-associated MRSA. Which drug does the nurse anticipate will be ordered to treat this infection? imipenem (Primaxin) azithromycin (Zithromax) TMP/SMZ (Bactrim) vancomycin (Vancocin)
vancomycin (Vancocin) Rationale: MRSA is resistant to all penicillins and cephalosporins. These include beta lactam antibiotics such as imipenem. Most strains of MRSA are also resistant to many other antibiotics. The drug of choice is vancomycin although there are others that may be used. TMP/SMZ is a preferred drug for community-acquired MRSA. Azithromycin is a macrolide used for respiratory and skin infections as well as other infections such as mycobacterium avium and chlamydia. See Lehne, pg 1066-1067, 1075, 1088
A patient is prescribed azithromycin (Zithromax). The patient previously experienced nausea and vomiting when taking erythromycin and wants to know whether to expect the same effects with azithromycin. How will the nurse respond? "I need to call your health care provider and ask for a different antibiotic." "This drug is like erythromycin but has less severe gastrointestinal side effects." "Take the drug with a hearty meal to reduce gastrointestinal side effects." "I will get a prescription for an antiemetic in case this drug causes vomiting."
"This drug is like erythromycin but has less severe gastrointestinal side effects." Rationale: The nurse's best response is that azithromycin has fewer severe gastrointestinal (GI) side effects than erythromycin. Calling the health care provider is not necessary because it is not known whether the patient will have any GI side effects; they occur in only 3 - 5% of those who take the drug. Obtaining a prescription for an antiemetic is not necessary. Azithromycin may be taken with or without food. The patient may take the medication with food to reduce GI side effects, but a large meal is not necessary to achieve this effect. See Lehne p. 1088
A patient who works as a landscaper is preparing to be discharged home. Ciprofloxacin (Cipro) has been prescribed for outpatient therapy. Which of the following will the nurse include in the discharge teaching for this patient? "Take the medication until all symptoms subside." "Use sunscreen and protective clothing when outdoors." "You may take the medication with milk of magnesia." "Take the medication with crackers and cheese."
"Use sunscreen and protective clothing when outdoors." Rationale: The patient, a landscaper, should be advised to wear sunscreen and protective clothing when outdoors, because the medication may cause phototoxicity. The medication should be taken until it is gone, not just until the patient's symptoms are improved. Absorption of fluoroquinolones is reduced when taken with a number of products including aluminum or magnesium containing antacids and milk or other dairy products. See Lehne p. 1132
The nurse is reviewing laboratory test results for a patient who is starting penicillin G. Which test result, if elevated, would suggest a contraindication to penicillin G? PT/INR BUN and creatinine hematocrit and hemoglobin liver enzymes SGOT and ALT
BUN and creatinine Rationale: Treatment with penicillin drugs requires normal kidney function. The BUN and creatinine level are indicators of kidney function. PT/INR is indicted for warfarin, not pencillin. Penicillin does not affect red cell production or cause bleeding so hematocrit and hemoglobin are not needed. SGOT and ALT are indicated for drugs that are hepatotoxic, which penicillin is not. See Lehne, p. 1062
A hospitalized patient is receiving gentamicin (Garamycin) 80 mg IV twice daily for acute osteomyelitis. Which data about the patient is most important for the nurse to obtain before administering the gentamicin? oral temperature BUN and creatinine levels reports of nausea when an antacid was administered
BUN and creatinine levels Rationale: Although the patient's temperature will be monitored on a regular basis in the hospital, gentamicin is nephrotoxic and can cause renal failure. Therefore monitoring renal function is critical. Nausea is not a common side effect of IV gentamicin. Because the drug is administered IV, an antacid will not affect absorption of the gentamicin. See Lehne, pg 1097-1098, 1100, & 1102
The nurse is assessing a patient taking penicillin G (Benzylpenicillin). The patient shows confusion and hallucinations. How would the nurse interpret these symptoms? Blood levels of pencillin G are too high. The patient has a history of alcohol abuse. An intra-arterial injection has been administered. Medication was administered into a peripheral nerve.
Blood levels of pencillin G are too high. Rationale: Neurotoxicity (seizure, confusion, hallucination) may occur if blood levels of penicillin G are too high. The signs and symptoms are clearly neurological in nature, thus suggesting the possibility of neurotoxicity. Nothing indicates that the patient has a history of alcohol abuse. Manifestations of an intra-arterial injection are gangrene, necrosis, or sloughing of tissue. A peripheral nerve injection may result in reversible motor or sensory dysfunction. See Lehne pp. 1063
The nurse is providing medication instruction for a 75-year-old patient who has been prescribed ciprofloxacin (Cipro) for an acute sinus infection. The nurse instructs the patient and family to immediately report which of the following symptoms? ringing in the ears nausea confusion peripheral edema
Confusion Rationale: Older adults have an increased risk for adverse CNS effects such as confusion, sleeping problems, or visual disturbances when taking fluoroquinolones such as Cipro. These effects are more problematic than mild GI effects such as nausea. Fluoroquinolones are not associated with tinnitus or peripheral edema. See Lehne p. 1132.
An hour after an amphotericin B infusion was started, the patient experiences a sudden episode of fever, chills, rigors, and nausea. Which drug, ordered as needed for this patient, should the nurse administer at this time? acetaminophen (Tylenol) dantrolene (Dantrium) diphenhydramine (Benadryl) hydrocortisone
Dantrolene Rationale: Fever, chills, rigors, and nausea are symptoms of an infusion reaction. This type of reaction occurs 1 to 3 hours after the infusion is started and can last for an hour. Intravenous dantrolene or meperidine is given for rigors. Pre-treatment with acetaminophen and diphenhydramine may reduce the occurrence of mild reactions. Glucocorticoids are used if other measures are ineffective, but reduce the patient's ability to fight the infection. See Lehne pg 1138.
A patient is prescribed both erythromycin and warfarin. It is important for the nurse to monitor which of the following laboratory tests? BUN Hgb/Hct INR RBC
INR Rationale: Erythromycin can affect plasma levels of warfarin which will change the patient's ability to clot. Increased plasma levels would mean more warfarin in the bloodstream and a decreased ability to clot. The patient's ability to clot should be monitored with an INR. See Lehne pg 1087.
The nurse on a medical-surgical unit is caring for a patient experiencing fever of unknown origin. The prescriber has ordered a broad-spectrum antibiotic. Which intervention is the nurse's priority? Administer the antibiotic as soon as it is available. Administer an antipyretic as soon as possible. Obtain all cultures before the antibiotic is administered. Delay administration of the antibiotic until culture results are available.
Obtain all cultures before the antibiotic is administered. Rationale: It is essential that samples of exudates and body fluids (in this case, blood cultures) be obtained for culture prior to initiation of treatment. Administration of the antibiotic is important, but not more important than obtaining specimens for culture. Antipyretics may be indicated, but the priority is obtaining specimens for culture. Treatment may be initiated before the test results are available. See Lehne p. 1051
The nurse is teaching a patient who is taking a systemic sulfonamide for a complex urinary tract infection. What side effects will the nurse instruct the patient about? (Select all that apply.) Rash Ototoxicity Blurred vision Fever Photosensitivity
Rash, fever, photosensitivity Rationale: Common side effects of sulfonamides include rash, fever, and photosensitivity. Hearing and vision are not affected by sulfonamides. See Lehne p. 1104
A nurse is administering dalfopristin/quinupristin (Synercid) to a hospitalized patient. What are the most likely indications for this drug combination? (Select all that apply.) Urinary tract infection (UTI) with E. coli Vancomycin-resistant E. faecium Pneumococcal infection in a patient with hepatic failure Peptic ulcer disease (PUD) Methicillin-resistant S. aureus or S. epidermidis
Vancomycin-resistant E. faecium Methicillin-resistant S. aureus or S. epidermidis Rationale: Synercid is reserved for serious infections caused by resistant organisms that have not responded to vancomycin. Examples includ vancomycin-resistant E. faecium and methicillin-resistant S. aureus or S. epidermidis. UTI and PUD are not indications for treatment with dalfopristin/quinupristin. A patient with hepatic failure should not receive this medication, because it has hepatotoxic effects. See Lehne p. 1090 - 1091
A patient who is receiving penicillin begins to wheeze and reports a feeling of impending doom. Upon assessing the patient, the nurse finds a blood pressure of 88/47 mm Hg. and a weak pulse of 120 beats per minute. Which order will the nurse implement first? obtain an oropharyngeal airway device administer epinephrine (adrenalin) apply oxygen at 3L per nasal cannula administer 500 mL IV fluid bolus
administer epinephrine (adrenalin) Rationale: The priority is to reverse the allergic reaction. This can be done by administering epinephrine, which is used to treat anaphylaxis (which the patient is manifesting). If the reaction is not reversed, an airway may be necessary. Oxygen is applied after the epinephrine is administered or a second nurse may apply the oxygen as the epinephrine is being given. IV fluids may be a consideration if the blood pressure does not rise after administration of epinephrine, but epinephrine is the priority. See Lehne, p. 1063
A student nurse prepares to administer itraconazole (Sporanox) to a patient. Which of the following statements is most accurate about this drug? "Itraconazole is always administered intravenously (IV) rather than by mouth." an inhibitor of drug-metabolizing enzymes in the liver." effective against more fungi than amphotericin B." toxic to the kidneys, central nervous system and liver."
an inhibitor of drug-metabolizing enzymes in the liver." Rationale: Itraconazole inhibits hepatic enzymes that metabolize other drugs. This results in increased blood levels of these drugs. Therefore, concurrent use of itraconazole with drugs that affect heart rhythms is contraindicated. Itraconazole is administered by mouth rather than IV and may be used in place of amphotericin B for some types of fungal infections. Although itraconazole can cause liver damage, it is not nephrotoxic and does not cause toxicity in the central nervous system. See Lehne pg 1139.
The nurse is preparing to administer an antibiotic to a patient with community-acquired methicillin-resistant Staphylococcus aureus (MRSA). The nurse would expect the health care provider to order which of these antibiotics? daptomycin (Cubicin) metronidazole (Flagyl) doxycycline (Vibramycin) ceftriaxone (Rocephin)
doxycycline (Vibramycin) Rationale: Although daptomycin (Cubicin) is effective against MRSA, for CA-MRSA it is reserved for the most severe infections or for failure of treatment with other drugs. Doxycycline or TMP/SMZ is more likely to be ordered if an antibiotic is needed. MRSA organisms are resistant to all penicillins and cephalosporins. Metronidazole is used for protozoal and anaerobic bacterial infections and is frequently used to treat Clostridium difficile infection. See Lehne pp. 1066-1067, 1133.
A patient complains of mouth sores during antibiotic therapy. Upon assessment, the nurse notes white, patchy spots and redness of the tongue and throat. Which of the following medications could be used to treat this condition? (Select all that apply.) bacitracin fluconazole (Diflucan) nystatin (Mycostatin) clotrimazole troche
fluconazole (Diflucan) nystatin (Mycostatin) clotrimazole troche Rationale: Fluconazole, nystatin and clotrimazole are antifungal agents that may be used to treat candidiasis of the mouth and esophagus. Bacitracin is an antibiotic ointment used for topical treatment of bacterial infections of the skin. See Lehne pp. 1144 Table 92-4, and pp. 1145-1147.
A patient who is receiving intravenous (IV) vancomycin (Vancocin) calls the nurse into the room. Which of the following assessment findings would suggest that the patient is having a reaction to an unintentional rapid infusion of this drug? shortness of breath, chest pain with deep inspiration, cough urticaria, edema around lips and eyes, dyspnea flushing, rash, pruritus, urticaria, tachycardia, and hypotension extremity weakness, visual changes, cognitive impairment
flushing, rash, pruritus, urticaria, tachycardia, and hypotension Rationale: Flushing of the skin with an itching rash and hives that occurs during rapid infusion of vancomycin is known as red man syndrome and is a unique complication associated with this situation. Red man syndrome is also accompanied by tachycardia and hypotension. Shortness of breath with pain on inspiration is symptomatic of a pleural effusion. Hives with facial edema is indicative of angioedema. This may progress to shortness of breath and swelling of the oral cavity and throat. Angioedema signals a significant allergic response and is not limited to rapid infusion of vancomycin. Extremity weakness, visual changes and cognitive impairment suggest neurotoxicity. See Lehne page 1078 for a description of red man syndrome.
The nurse is caring for a patient receiving gentamicin intravenously (IV). To decrease the risk of ototoxicity, the nurse will ask the patient to report which of the following symptoms? dizziness ear pain tone deafness high-pitched ringing
high-pitched ringing Rationale: Aminoglycosides can be toxic to the inner ear which is supplied by the vestibulo-coclear nerve. The first sign of impending cochlear damage (hearing) is high-pitched tinnitus (ringing in the ears). As injury to cochlear hair cells proceeds, hearing in the high-frequency range begins to decline. Vestibular damage which causes balance problems is initially experienced as a headache which may last 1 to 2 days. Nausea, unsteadiness, dizziness, and vertigo then begin to appear. Tone deafness is difficulty identifying musical pitches and/or notes. Lehne p. 1097-1098
The nurse is caring for a patient who receives a divided dose of IV amikacin (Amikin) twice a day. When will the nurse draw blood for measurement of a trough aminoglycoside level? 30 minutes after the IV infusion is complete. 1 hour after the IV infusion is complete. just prior to administration of the next dose. 1 hour before the next dose.
just prior to administration of the next dose. Rationale: When divided daily doses are prescribed, blood samples for measurement of trough levels are drawn immediately before administration of the next dose. This is the time at which the blood levels of the drug are at the lowest. To obtain peak levels, the nurse will draw a blood sample 30 after infusion the infusion is complete when the most drug is in the patient's bloodstream. See Lehne pp. 1099-1100
Which of the following would be classified as a suprainfection? monilial vaginal infection that developed during antibiotic therapy peritonitis that developed after surgery for a ruptured appendix pneumonia in a patient with chronic obstructive pulmonary disease varicella outbreak after injection with varicella vaccine
monilial vaginal infection that developed during antibiotic therapy Rationale: "A suprainfection is defined as a new infection that appears during the course of treatment for a primary infection." Normal flora are inhibited by the antibiotic which then allows a secondary infectious agent to thrive. See Lehne p. 1048.
The nurse is providing education about tetracycline (Sumycin). Which patient statement confirms that the patient understood the teaching? "I will not take my medication with dairy products." take my antibiotic with my calcium supplements." follow my antibiotic with an antacid." expect a slight, acnelike rash with this medication."
not take my medication with dairy products." Rationale: A food-drug interaction occurs between dairy products and tetracycline. If the patient states that he or she will not take tetracycline with dairy products, the patient understands this food-drug interaction. A drug-drug interaction will occur with calcium-based supplements and magnesium or aluminum-based antacids and tetracycline. These products will produce chelation, a process by which these products bind with tetracycline and render it ineffective. The patient should take the tetracycline 1 hour before or 2 hours after ingesting any dairy foods or drugs with calcium, iron, magnesium, aluminum or zinc. An acnelike reaction would indicate an unexpected allergic response. See Lehne p. 1084 - 1085
A nurse transcribes a new prescription for potassium penicillin G given intravenously (IV) q 8 hours and gentamicin IV q 12 hours. Which plan is the best schedule for administering these drugs? penicillin at 0800, 1600, and 2400; gentamicin at 0600 and 1800 penicillin at 0800, 1600, and 2400; gentamicin at 1200 and 2400 penicillin at 0600, 1400, and 2200; gentamicin at 0600 and 1800 penicillin at 0100, 0900, and 1700; gentamicin at 0900 and 1800
penicillin at 0800, 1600, and 2400; gentamicin at 0600 and 1800 Rationale: Gentamicin should never be administered concurrently with penicillin, because they will interact, and the penicillin may inactivate the aminoglycoside. All options except A show concurrent administration. See Lehne p. 1064
The nurse is caring for an older adult patient with Crohn's disease. The patient has been taking metronidazole (Flagyl) for 6 months. The patient begins to complain of numbness and tingling in the lower extremities. The nurse should suspect myopathy. peripheral neuropathy. myalgia. extrapyramidal symptoms.
peripheral neuropathy. Rationale: The patient's symptoms correlate with peripheral neuropathy, which is a risk of long-term treatment with metronidazole. The patient's symptoms do not describe myopathy (muscle weakness), myalgia (muscle pain), or extrapyramidal symptoms (drug-induced parkinsonism). See Lehne p. 1133-1134
A patient with an infection caused Pseudomonas aeruginosa is being treated with an aminoglycoside. Which of the following findings would most concern the nurse? decreased white blood cell count proteinuria decreased serum creatinine concentrated urine
proteinuria Rationale: Aminoglycoside-induced nephrotoxicity usually manifests as acute tubular necrosis. Prominent symptoms are proteinuria, casts in the urine, production of dilute urine, and elevations in the serum creatinine and BUN. Resolution of infection results in a decrease in the white blood cell count. See Lehne p. 1098
The nurse is reviewing a patient's test results before administering the next dose of amphotericin B. The nurse's priority is to review which one of the following tests? serum creatinine levels serum sodium levels liver function tests blood cultures
serum creatinine levels Rationale: Amphotericin B is highly nephrotoxic and some degree of renal impairment occurs in almost all patients who receive this drug. Therefore, it is of vital importance to closely monitor renal function in patients who are receiving amphotericin B. The dosage of the drug may need to be reduced. Blood cultures, if ordered, would have been drawn before the initial dose. Potassium levels, not sodium levels, should be monitored secondary to renal damage. Liver failure is a rare adverse effect. See Lehne pg 1138-1139.
Metronidazole (Flagyl) is ordered for a patient being prepared for colorectal surgery. The nurse understands that the rationale for administration of metronidazole for this patient is that it inhibits the C. difficile toxin. treats fungal infections in the bowel. serves as prophylaxis for infection. is a broad-spectrum antibiotic.
serves as prophylaxis for infection. Rationale: Metronidazole is used for prophylaxis in surgical procedures associated with a high risk of infection by anaerobic bacteria (colorectal surgery, abdominal surgery, vaginal surgery). Although metronidazole is given for colitis caused by C. difficile, there are no indicators of this problem in the question. Metronidazole is not indicated for treatment of a fungal infection, and nothing indicates that the patient has such an infection. Metronidazole is not a broad-spectrum antibiotic; the action of metronidazole is limited to obligate anerobic bacteria. See Lehne p. 1133
A patient with osteomyelitis has been admitted to the nursing unit. Which of the following medications would the nurse expect to administer specifically to treat this condition? abatacept (Orencia) nystatin (Mycostatin) tobramycin TMP/SMZ (Bactrim)
tobramycin Rationale: Tobramycin, like gentamicin, is an aminoglycoside type of antibiotic that is often effective in the treatment of osteomyelitis (see Lewis page 1620-1622). Abatacept is a biologic DMARD used to reduce inflammation in chronic inflammatory diseases. Nystatin is classified as a polyene antibiotic and is used only to treat candidiasis. TMP/SMZ (Bactrim or Septra) is a fixed-dose combination of a sulfonamide and trimethoprim which is used for UTI, otitis media, and infections of the respiratory tract. See also Lehne, pg. 1095, 1100, 1106-1107, and 1147.
