Pharmacology Chapter 86
The nurse should include which instructions when teaching a patient about tigecycline therapy? (Select all that apply.) A) "Use sunscreen when you are outside." B) "If you have diarrhea more than five times a day, notify your healthcare provider." C) "Avoid using this drug if you are pregnant." D) "Stop taking the drug if you experience nausea." E) "Stop taking the drug if you experience vomiting."
A,B,C Nausea and vomiting may occur. The patient should not stop taking the medication; rather, the healthcare provider should be notified so that an alternative plan can be discussed. The other three instructions should be included in the patient teaching.
Which cardiovascular finding does the nurse identify as a possible adverse effect of erythromycin (Ery-Tab) therapy? A) Heart rate of 52 beats per minute B) Prolonged QT interval C) Jugular vein distention D) Grade III diastolic murmur
B When present in high levels, erythromycin can prolong the QT interval, causing a potentially fatal ventricular dysrhythmia. It should be avoided by patients taking class IA or class III antidysrhythmic medications or others that inhibit metabolism.
A patient who has a vancomycin-resistant enterococci (VRE) infection is receiving linezolid (Zyvox). Which laboratory result indicates that the patient is having an adverse effect? A) White blood cell (WBC) count of 1200 units/L B) Hemoglobin (Hgb) level of 18 g/dL C) Potassium level of 3.0 mEq/dL D) Glucose level of 200 mg/dL
A Linezolid can cause reversible myelosuppression, manifesting as anemia, leukopenia, or even pancytopenia. The potassium and blood glucose levels are not affected by linezolid.
The nurse identifies which drug as a short-acting tetracycline? A) Sumycin B) Declomycin C) Vibramycin D) Minocin
A Sumycin is a short-acting tetracycline. Declomycin is an intermediate-acting tetracycline, and Vibramycin and Minocin are long-acting tetracyclines.
What does the nurse identify as an adverse effect of clindamycin (Cleocin) therapy? A) Cyanosis and gray discoloration of the skin B) Frequent loose, watery stools with mucus and blood C) Reduction in all blood cells produced in the bone marrow D) Elevated bilirubin, with dark urine and jaundice
B Clostridium difficile-associated diarrhea (CDAD) is the most severe toxicity associated with clindamycin and is characterized by profuse, watery stools. The cause is superinfection of the bowel with Clostridium difficile, an anaerobic gram-positive bacillus. Gray syndrome, which usually occurs in infants and those with aplastic anemia, is an adverse effect of chloramphenicol (Chloromycetin). Hepatotoxicity is associated most closely with telithromycin (Ketek).
Which instruction should a nurse include in the discharge teaching for a patient who is to start taking tetracycline (Sumycin)? A) "You may stop taking the pills when you begin to feel better." B) "Use sunscreen and protective clothing when outdoors." C) "You'll have to come back to the clinic for weekly blood work." D) "Take the medication with yogurt or milk so you won't have nausea."
B 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.
Which statements about CDAD associated with clindamycin therapy does the nurse identify as true? (Select all that apply.) A) Leukopenia commonly occurs. B) It is a potentially fatal condition. C) Patients usually experience abdominal pain. D) Anticholinergics are effective in treating the diarrhea. E) Clindamycin therapy should be discontinued and vancomycin started.
B,C,E CDAD is a potentially fatal condition in which patients experience abdominal pain. If CDAD develops, clindamycin therapy should be stopped and vancomycin or metronidazole therapy started. Leukocytosis, not leukopenia, develops. Anticholinergics can make the diarrhea worse and therefore should be avoided.
The nurse identifies tigecycline (Tygacil) as a derivative of what? A) Penicillins B) Cephalosporins C) Tetracyclines D) Macrolides
C Tigecycline is the first representative of a new class of antibiotics, the glycyclines. It is a tetracycline derivative made to overcome drug resistance and is active against many drug-resistant strains. It has adverse effects similar to those of the tetracyclines.
Which laboratory result should a nurse monitor more frequently when a patient is receiving clarithromycin (Biaxin) and warfarin (Coumadin)? A) Activated partial thromboplastin time (aPTT) B) Platelet count C) Erythrocyte sedimentation rate (ESR) D) International normalized ratio (INR)
D Clarithromycin is a macrolide similar to erythromycin and can inhibit hepatic metabolism of medications such as warfarin and theophylline. The INR is the blood test used to evaluate warfarin ranges. The aPTT is the blood test used in monitoring heparin. The platelet count and ESR are not affected by clarithromycin.
A nurse assessing a patient who is 12 years old should associate which complication with the patient's receiving tetracycline (Sumycin) as a younger child? A) Delay in long bone growth B) Early onset of puberty C) Severe face and body acne D) Discoloration of the teeth
D Tetracycline is contraindicated in children younger than 8 years of age, because it binds to calcium in developing teeth, resulting in permanent discoloration of the teeth. Delay in long bone growth, early onset of puberty, and severe face and body acne are not adverse effects associated with tetracyclines.