Chapters 26-31: Antimicrobial/antifungal/antiviral drugs

Which statement indicates to the nurse that the patient understands the medication instructions regarding ketoconazole for treatment of candidiasis? "I can take this medication with antacids if it causes gastrointestinal discomfort. " "I can expect my skin to turn yellow from taking this drug." "I need to take this drug with food to minimize gastrointestinal distress." "I will take this medication with orange juice for better absorption."

"I need to take this drug with food to minimize gastrointestinal distress." Taking this medication with food will help minimize gastrointestinal upset. Ketoconazole should not be taken with coffee, tea, or acidic fruit juices. Additionally, it needs to be taken at least 2 hours before or after the ingestion of alkaline products or antacids.

A patient is prescribed long term azithromycin therapy for a skin infection. Which statement by the patient indicates understanding of the instructions? "I should complete the entire course of therapy as prescribed." "There is no need for further laboratory testing while on this medication." "The most likely side effect is constipation." "I can take the medication with juice to minimize gastric upset."

"I should complete the entire course of therapy as prescribed." Long term azithromycin therapy requires that the patient not only be compliant and finish the entire course of therapy but continue to have follow up lab work to assess liver enzymes to evaluate liver function. The medication can be taken either one hour before or two hours after meals with a glass of water. The medication should not be taken with fruit juice. Typical side effects include a range of gastrointestinal symptoms including but not limited to nausea, vomiting, diarrhea, abdominal cramps and/or itching.

A patient with Mycobacterium tuberculosis is prescribed ethambutol for long-term use. Which statement by the patient indicates understanding of the instructions? "I will need to have my eyes checked regularly while I am taking this drug." "Constipation will be a problem, so I will increase the fiber and fluids in my diet." "Dizziness, drowsiness, and decreased urinary output are common with this drug, but they will subside over time." "This medication may cause my bodily secretions to turn red-orange."

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

The patient states that she has been prescribed prophylactic medication for tuberculosis for a period of 4 weeks. What is the nurse's best response? "You should be on the medications for only 2 weeks." "Let me teach you about the medications." "We do not use medications prophylactically for tuberculosis." "You should be on the drugs for a longer period of time."

"You should be on the drugs for a longer period of time." Between 6 months and 1 year is sufficient time for prevention of active tuberculosis. Because the tuberculosis mycobacterium is slow-growing, shorter lengths of time may not sufficiently eradicate the organism.

A mother of 2 children was just diagnosed with Hep C. Which of the following statements is incorrect about hepatitis C? - A vaccine has been available for 5 years - Hep C can be transmitted by blood and bodily fluids - Hep C can cause hepatic carcinoma - Persons with Hep C can become chronic carriers

- A vaccine has been available for 5 years

Which of the following is a priority to evaluate in a patient being treated for pork tapeworm? - Increased appetite - Abdominal distension - Fatigue - Constipation

- Abdominal distension

A patient with a hx of malaria who is being treated with chloroquine is in the clinic for a follow-up. What should the nurse advise the patient to do? - Get frequent hearing checks - Take antimalarials before meals - Get frequent testing of stool specimen - Avoid sun exposure

- Avoid sun exposure

The nurse is teaching a patient about sulfadiazine. Which instructions should be included in the teaching? - Avoid caffeine - Administer 50mL of fluid over 30 mins - Avoid these drugs during the 3rd trimester of pregnancy - Use a UV light to enhance drug effectiveness

- Avoid these drugs during the 3rd trimester of pregnancy

A patient is ordered to take trimethoprim-sulfamethoxazole. The nurse knows to be aware of which adverse effect? - Bronchospasm - Tendon rupture - Red man syndrome - C diff associated diarrhea

- C diff associated diarrhea

Penicillin G has been prescribed for a patient. Which nursing interventions should be performed? Select all that apply - Collect culture and sensitivity before the first dose - Monitor for mouth ulcers - Instruct the patient to limit fluid intake to 1000 mL/day - Have epinephrine on hand for a potential allergic reaction - No particular interventions are required

- Collect culture and sensitivity before the first dose - Monitor for mouth ulcers - Have epinephrine on hand for a potential allergic reaction

The nurse teaches a patient taking amphotericin B to report which signs and symptoms to the provider? - Change in sight - Decrease in hearing - Decrease in urine - Painful red rash and blisters

- Decrease in urine

A patient is beginning isoniazid and rifampin treatment for TB. The nurse gives the patient which instruction? - Do not skip doses - Take both drugs 3 times daily - Take an antacid with the drugs - Take rifampin initially

- Do not skip doses

A patient is taking sulfasalazine. What should the nurse teach the patient to do? - Drink at least 10 glasses of fluid per day - Monitor blood glucose carefully to avoid hyperglycemia - Avoid operating a motor vehicle, it can cause drowsiness - Take with an antacid to reduce risk of GI upset

- Drink at least 10 glasses of fluid per day

A patient has been diagnosed with TB and is to begin antitubercular therapy with isoniazid, rifampin, and ethambutol. Which actions are appropriate for the nurse to do? Select all that apply - Encourage periodic eye exams - Instruct the patient to take medications with meals - Suggest that the patient take antacids with the meds to prevent GI distress - Advise the patient to report numbness and tingling of the hands and/or feet - Alert the patient that bodily fluids may develop a red-orange color - Teach the patient to avoid direct sunlight and use sunblock

- Encourage periodic eye exams - Advise the patient to report numbness and tingling of the hands and/or feet - Alert the patient that bodily fluids may develop a red-orange color - Teach the patient to avoid direct sunlight and use sunblock

Zanamivir is ordered for a patient with which disorder? - Herpes simplex type 2 - Herpes simplex type 1 - Varicella-zoster virus - Hep B

- Hep B

A patient taking isoniazid is worried about the negative effects of the drug. The nurse provides information knowing that which is an adverse effect of the drug? - Ototoxicity - Hepatotoxicity - Nephrotoxicity - Optic nerve toxicity

- Hepatotoxicity

The patient has been prescribed amoxicillin. What does the nurse know is true about this medication? - It has a normal adult dose of 2 g q6h - It has a common side effect of hypotension - It has an IM administration route - It is used to treat respiratory infections

- It is used to treat respiratory infections

A patient is admitted with multidrug resistant UTI. Lab tests show Pseudomonas aeruginosa. Colistimethate sodium is ordered in powder form and must be diluted for IM injection. The nurse understands that which of the following is the purpose for this drug? - It prevents toxic adverse reactions - It treats gram-negative bacteria - Is safe for patients with renal impairments - Prevents antibiotic resistance

- It treats gram-negative bacteria

An international traveler diagnosed with malaria is admitted to the ED and is prescribed mefloquine hydrochloride. The nurse anticipates that which lab test will be ordered? - Liver function test - Blood glucose - Sputum culture and sensitivity - WBC count

- Liver function test

Acyclovir has been ordered for a patient with genital herpes. Which nursing interventions are appropriate for this patient? Select all that apply - Monitor blood urea nitrogen and creatinine - Monitor BP for htn - Administer IV over 30 mins - Advise maintenance of fluid intake - Monitor CBC for blood dyscrasias

- Monitor blood urea nitrogen and creatinine - Advise maintenance of fluid intake - Monitor CBC for blood dyscrasias

A patient is prescribed daptomycin. Which actions should the nurse implement? Select all that apply - Monitor blood values for toxicity - Dilute in 50-100mL of normal saline, administer via IV for 30 mins - Monitor for allergic reactions like rhabdomyolysis - Advise the patient to take medication on an empty stomach, even if GI distress occurs - Culture the infected area before administering the first dose

- Monitor blood values for toxicity - Dilute in 50-100mL of normal saline, administer via IV for 30 mins - Monitor for allergic reactions like rhabdomyolysis - Culture the infected area before administering the first dose

A patient is taking azithromycin. Which nursing interventions would the nurse plan to implement? Select all that apply - Monitor periodic liver function tests - Dilute with 50 mL of 5% dextrose in water for IV admin - Instruct the patient to report and loose stools or diarrhea - Instruct the patient to report evidence of superinfection - Teach the patient to take oral drug 1 hour before or 2 hours after meals - Advise the patient to avoid antacids 2 hours before to 2 hours after administration

- Monitor periodic liver function tests - Instruct the patient to report and loose stools or diarrhea - Instruct the patient to report evidence of superinfection - Teach the patient to take oral drug 1 hour before or 2 hours after meals - Advise the patient to avoid antacids 2 hours before to 2 hours after administration

A patient is taking a cephalosporin. The nurse anticipates which nursing interventions? Select all that apply - Monitoring renal function studies - Monitoring liver function studies - Infusing IV medication over 30 minutes - Monitoring for mouth ulcers - Advising the patient to stop taking the medication when he or she feels better

- Monitoring renal function studies - Monitoring liver function studies - Infusing IV medication over 30 minutes - Monitoring for mouth ulcers

Which nursing interventions should the nurse consider for the patient taking ciprofloxacin? Select all that apply - Obtain culture before drug administration - Tell the patient to avoid taking antacids with this drug - Monitor for tinnitus - Encourage fluids to prevent crystalluria - Infuse IV over 60 mins - Monitor blood glucose because ciprofloxacin can decrease effects of oral hypoglycemics

- Obtain culture before drug administration - Tell the patient to avoid taking antacids with this drug - Monitor for tinnitus - Encourage fluids to prevent crystalluria - Infuse IV over 60 mins

Which instructions will the nurse include when teaching patients about gentamicin? Select all that apply - Patients should report any hearing loss - Patients should use sunscreen - IV gentamicin will be given over 20 mins - Patients are monitored for mouth ulcers and vaginitis - Peak levels will be drawn 30 mins before the IV dose - Patients should increase fluid intake

- Patients should report any hearing loss - Patients should use sunscreen - Patients are monitored for mouth ulcers and vaginitis - Patients should increase fluid intake

The nurse is teaching a patient about trimethoprim-sulfamethoxazole. What should the nurse include? Select all that apply - Report any bleeding or bruising - Report any diarrhea or bloody stools - Report any fever, rash, or sore throat - Avoid unprotected exposure to sunlight - Report thirst and polyuria

- Report any bleeding or bruising - Report any diarrhea or bloody stools - Report any fever, rash, or sore throat - Avoid unprotected exposure to sunlight

A 30 year old woman presents with a recurrence of Trichomonas vaginalis infection, and metronidazole is ordered. The patient's hx reveals which of the following contraindications? - A recent pregnancy test is negative - She previously took this drug and had no side effects - She drinks a glass of wine before bedtime - She takes an oral contraceptive

- She drinks a glass of wine before bedtime

A 50 year old woman is being discharged from the hospital after treatment for malaria. Which of the following would best inform the patient about adverse reactions? - The occurrence of headaches - Experiencing dizziness - Developing mild pruritus - Skin and eyes that appear yellowish

- Skin and eyes that appear yellowish

The nurse enters a patient's room to find that his heart rate is 120, BP is 70/50, and he has red blotching of his face and neck. Vancomycin is running IV piggyback. The nurse believes that the patient is experiencing a severe adverse effect called red man syndrome. Which action will the nurse take? - Stop infusion, call the health care provider - Reduce the infusion to 10mg/min - Encourage the pt to drink more fluids, up to 2 L/day - Report onset of Stevens-Johnson syndrome to the provider

- Stop infusion, call the health care provider

A patient is taking a sulfonamide for an acute UTI. Which medication does the nurse recognize as a short acting sulfonamide? - Sulfadiazine - Sulfasalazine - Seconidazole - trimethoprim-sulfamethoxazole

- Sulfasalazine

A patient is receiving tetracycline. What advice should the nurse include when teaching about this medication? - Take sunscreen precautions - Take an antacid with the drug to prevent GI distress - Obtain frequent hearing tests - Obtain frequent eye check ups

- Take sunscreen precautions

Amoxicillin is prescribed for a patient with a respiratory infection. The nurse realizes more teaching is required for this medication when the patient says what? - This mediation should not be taken with food - I will take my entire prescription of medication - I should report to the physician any genital itching - If I experience any excess bleeding, I will contact the provider

- This mediation should not be taken with food

A patient is prescribed dicloxacillin. For which adverse effect should the nurse monitor the patient? - Constipation - Tongue discoloration - Htn - Hemolytic anemia

- Tongue discoloration

The nurse is caring for a patient who has been diagnosed with genital herpes. Which medication is the drug of choice for this patient? Amantadine Ribavirin Zidovudine Acyclovir

Acyclovir Acyclovir is the drug of choice to treat herpes simplex infections. Ribavirin is effective against respiratory syncytial virus (RSV); zidovudine is effective against HIV; amantadine is effective against H. influenzae type A.

The nurse is preparing to administer the morning medications, which includes amoxicillin. While preparing to administer the medication, the dietary staff delivers the patient's breakfast tray. Which action should the nurse implement? Reschedule the dose until the following morning before breakfast Administer the medication 2 hours after the meal Administer the medication Administer the dose prior to the evening meal

Administer the medication Amoxicillin is a penicillin which is not affected by food and therefore the nurse can administer the medication. The patient does not have to NPO, nor wait until 2 hours after the meal, or have the dose given prior to the evening meal.

The health care provider has ordered ribavirin for the patient with respiratory syncytial virus (RSV). The nurse recognizes that which route is the most effective way to administer this medication to the patient? By subcutaneous injection Orally at regular intervals Aerosol inhalation Intravenously over 1 hour

Aerosol inhalation Ribavirin should be administered by aerosol inhalation.

The patient has previously taken sulfonamide therapy and had a reaction. What information should be reviewed with the patient relative to this type of medication? (Select all that apply.) Reassure the patient that reactions are self-limiting. Educate the patient about the potential for cross-sensitivity reactions. Tell the patient to increase fluids with this type of medication. Ask the patient for specific information about the type of reaction and document. Monitor the patient's lab work for three months to assess for potential damage.

Ask the patient for specific information about the type of reaction and document. Educate the patient about the potential for cross-sensitivity reactions. Patients who experience a reaction with one sulfonamide are more likely to have a reaction to others due to cross-sensitivity. There is no need to monitor lab work at the present time as there is no provided information about the nature of the reaction. Asking the patient for specific information about the type of reaction and documenting it in the medical record is appropriate. Telling the patient that reactions are self-limiting is not correct. While it is important to increase fluids with this type of medication, as the patient has had a reaction, this medication should no longer be prescribed.

The patient is being treated with intravenous amphotericin B. What is the nurse's initial intervention? Assess the IV site for infiltration. Administer with dextrose. Assess blood urea nitrogen and creatinine. Encourage the patient to drink at least a liter of fluid per shift.

Assess blood urea nitrogen and creatinine. Amphotericin B is considered highly toxic and can cause nephrotoxicity and electrolyte imbalance, especially hypokalemia and hypomagnesemia (low serum potassium and magnesium levels). Urinary output, blood urea nitrogen, and serum creatinine levels need to be closely monitored.

A 22-year-old female patient is put on amoxicillin. Which is the most important intervention for this patient? Assess if the patient is on oral contraceptives. Assess the patient for cross sensitivity. Instruct the patient to not take the medication before meals. Inform the patient about possible superinfections.

Assess if the patient is on oral contraceptives. This medication may decrease the effectiveness of oral contraceptives. The nurse needs to assess whether or not the patient is on oral contraceptives and whether or not the patient is sexually active.

The nurse is working with a patient who will be traveling to a country where the incidence of malaria is high. The nurse anticipates that the health care provider is most likely to place the patient on which medication? Artemether/lumefantrine Atovaquone/proguanil Amantadine HCl Praziquantel

Atovaquone/proguanil Of the drugs listed, atovaquone/proguanil is the drug of choice for prevention of malaria.

Which instruction should the nurse include in the education of a patient beginning therapy with metronidazole for diarrhea due to a clostridium infection? Monitor pulse daily. Use sunscreen or wear long sleeves. Avoid alcohol and products containing alcohol. Take with food.

Avoid alcohol and products containing alcohol. Patients taking metronidazole should avoid alcohol and products containing alcohol.

The nurse is caring for a patient taking a polymyxin. What should the nurse monitor to identify potential side effects of this medication? Platelets Blood urea nitrogen and creatinine Hemoglobin and hematocrit Stool guaiac

Blood urea nitrogen and creatinine Polymyxins can cause kidney damage. Blood urea nitrogen and creatinine should be closely monitored.

For which serious adverse effect should the nurse closely monitor a patient who is taking lincosamides?

C diff associated diarrhea

What is the priority treatment for patients who have otitis media? Lincomycin Fidaxomicin Clindamycin Clarithromycin

Clarithromycin Clarithromycin is the drug of choice to treat otitis media. Lincomycin is used to treat severe infections. Clindamycin is used to treat more extensive infections and fidaxomicin is used to treat CDAD.

The nurse is caring for a patient who is taking azithromycin. The patient has a heart rate of 60 beats/min, and a blood pressure of 100/89 mm Hg. What is the nurse's best action? Discontinue the medication. Assess for chest pain. Call the health care provider. Compare assessment data with prior vital sign readings.

Compare assessment data with prior vital sign readings. Azithromycin is contraindicated in patients who have bradycardia. The determination of a 60-heart rate at this time should be compared with prior vital sign assessment data. There is no need to call the healthcare provider at this time. There is no need at present to discontinue the medication based on reported findings. There is no provided evidence that the patient is experiencing chest pain and although the nurse should always assess for possible pain, this is not the current priority.

What is the priority assessment the nurse should make for a patient who is taking ganciclovir sodium? Bowel elimination Complete blood count Blood urea nitrogen Input and output

Complete blood count Bone marrow suppression is a dose-limiting toxicity of ganciclovir, and a complete blood count should be monitored.

The nurse is assessing a patient who has finished a course of therapy with metronidazole and reports a recent onset rash that is painful along with generalized aches and pains. What is the priority nursing action? Contact the healthcare provider Obtain bloodwork Isolate the patient Obtain vital signs

Contact the healthcare provider The priority action for the nurse for this patient is to contact the healthcare provider as the clinical symptoms may be related to the appearance of Stevens-Johnson syndrome. There is no need to isolate the patient as this is not an infectious process. Obtaining vital signs and bloodwork may be required but the priority at this time is to have the patient eval

The patient has been diagnosed with infective endocarditis due to a MRSA infection. The nurse recognizes that the patient is most likely to be ordered which drug? Vancomycin Daptomycin Azithromycin Lincomycin

Daptomycin Daptomycin is used to treat infective endocarditis due to a MRSA infection. Vancomycin is used to treat staphylococcal endocarditis. The other antibiotic therapies are not used to treat this type of condition.

The patient has been ordered lincomycin. The patient reports to the nurse that the patient has experienced reduced renal function in the past. The nurse anticipates that the health care provider will take which action? Place the medication on hold until renal function improves. Continue with the medication as originally ordered. Decrease the original dosage of the medication.. Increase the original dosage of the medication.

Decrease the original dosage of the medication. Rather than place the medication on hold because of the patient's decreased renal function, the health care provider will likely opt to decrease the originally ordered dosage to accommodate the change in function.

The nurse is caring for a patient who is taking rifampin. The patient has a heart rate of 90 beats/min, blood pressure of 100/89 mm Hg, and red-orange urine. What is the nurse's best action? Call the health care provider. Collect a urine culture. Discard the first void and start a 24-hour urine collection. Document the findings and teach the patient.

Document the findings and teach the patient. Red-orange discoloration of body fluids is a common side effect of rifampin, but it is not harmful and does not indicate infection. There is no need to call the health care provider, collect a urine culture, or start 24-hour urine collection.

What is the drug of choice for treatment of mycoplasmal pneumonia? Erythromycin Clindamycin Lincomycin Vancomycin

Erythromycin Erythromycin is the drug of choice for the treatment of mycoplasmal pneumonia and legionnaires disease.

The patient has been diagnosed with tinea pedis. The nurse recognizes that the patient is most likely to be ordered which drug? Miconazole nitrate Butoconazole nitrate Terconazole Griseofulvin

Griseofulvin Of the drugs listed, the patient is most likely to be treated with griseofulvin. The other drugs treat candidiasis.

A nurse is assessing a patient who has been prescribed trimethoprim-sulfamethoxazole (TMP-SMX) for a urinary tract infection. Which finding in the patient's medical history would be most significant? History of asthma History of diabetes History of HTN Social drinker

History of diabetes As the patient is a diabetic, it would be important for the nurse to assess whether or not the patient was taking oral diabetic agents as in combination with TMP-SMX could lead to increased hypoglycemic effects. Although alcohol use should be discontinued during therapy, the finding of a social drinker is not as significant. History of HTN and asthma do not present significant concerns.

Which assessment finding in the patient needing antibiotic therapy would alert the nurse to contact the healthcare provider? History of food allergies History of frequent infections with prior antibiotic usage Hemoglobin A1c 7% GFR rate above 60

History of frequent infections with prior antibiotic usage As the patient has a history of frequent infections with prior antibiotic usage, the patient is at risk to develop acquired resistance. Therefore, the nurse should contact the healthcare provider so that antibiotic resistance can be evaluated. A GFR rate above 60 indicates normal renal function. Hemoglobin A1c 7% is within normal range. History of food allergies while important does not require contacting the healthcare provider currently.

A patient has been prescribed a sulfonamide for short term usage to treat a urinary tract infection. Which priority information does the nurse include as part of the teaching plan? Make sure that the patient has an EpiPen Increase fluid intake during therapy There are no restrictions in activities Monitor blood work for dyscrasias

Increase fluid intake during therapy Anaphylactic reactions are not common with sulfonamide therapy. Photosensitivity can occur; therefore, the patient should avoid direct sunlight and/or exposure to UV light during therapy. Crystalluria can occur with this type of therapy so adequate hydration should be included in the teaching plan. With long term usage, blood work should be monitored for potential dyscrasias including but not limited to hemolytic anemia, aplastic anemia, decreased white blood cell count and platelets.

The nurse is caring for a patient taking gentamicin. What lab finding should the nurse identify as a potential side effect of this medication? Increased magnesium Increased potassium Decreased glucose Increased creatinine

Increased creatinine Gentamicin can affect renal function leading to nephrotoxicity. Increases in creatinine and BUN levels would be seen. Decreased potassium and magnesium occur. There is no direct effect on serum glucose levels.

A patient is receiving amoxicillin. The nurse understands that the action of this drug is by which process?

Inhibition of bacterial wall cell synthesis

A nurse is reviewing sulfonamides classification. Which statement best identifies the mechanism of action? Alters membrane permeability Bacteriostatic effect Inhibits folic acid Inhibits RNA synthesis

Inhibits folic acid Sulfonamides inhibit bacterial synthesis of folic acid and are not technically classified as antibiotics for they were not obtained from biologic substances. They do not specifically inhibit RNA synthesis or alter membrane permeability. Sulfonamides have a bactericidal effect.

The health care provider has ordered amphotericin B for the patient. The nurse recognizes that which is the most effective way to administer this medication to the patient? Intravenously over 2 to 6 hours Orally at regular intervals Intravenously over 1 hour By subcutaneous injection

Intravenously over 2 to 6 hours Amphotericin B should be administered by slow intravenous infusion.

A patient enters the emergency department with suspected influenza. Prior to starting the patient on the prescribed oseltamivir phosphate, what priority information should the nurse determine? Over-the-counter medications taken in the last 48 hours Allergies to antibiotics Length of time since onset of symptoms Immunization history

Length of time since onset of symptoms Oseltamivir phosphate inhibits the replication and spread of influenza if given within 48 hours of symptoms. Even though determination of allergies is important, this medication is an antiviral and not an antibiotic. While it is important to know what OTC medications were taken recently as well as immunization history, these do not represent priority information.

The patient has been sulfonamide therapy to treat an eye infection . What information should the nurse include in the discharge instructions for this patient? The medication should be in a gel format. This medication should be administered three times a day. Clarify the order with the healthcare provider as this medication is used to treat burns. Make sure that the medication obtained indicates it is for ophthalmic use.

Make sure that the medication obtained indicates it is for ophthalmic use. Ophthalmic should be printed on the drug label to indicate appropriate usage for ocular disorders. Topical sulfonamide therapy can be used to treat burns and topical therapy can come in cream, gel, lotion, or cleanser format. There is no provided information as to the frequency of administration provided. There is no need to contact the healthcare provider.

A patient has been prescribed antibiotic therapy to treat a non-complicated wound and wants to know if the medication therapy is all that is needed to resolve the infection. What is the best nursing response? Long term antibiotic therapy is needed Medication therapy, care of the wound and your body's immune system are needed Dressing changes and compliance with therapy are needed The medication will resolve the infection

Medication therapy, care of the wound and your body's immune system are needed Antibiotic therapy in combination with dressing changes and one's natural immunity may be needed along with antibacterial drugs to eliminate infection. As the wound is non-complicated, there should be no need for surgical excision. The medication alone is not sufficient to resolve the infection. Based on the provided information, there is no indication that long term therapy is needed.

The health care provider has ordered telithromycin for a cardiac patient to treat community acquired pneumonia. Which nursing action takes priority? Administer on an empty stomach Auscultate lungs Obtain daily weights Monitor digoxin levels

Monitor digoxin levels Telithromycin is administered orally and is not affected by food intake. While it is important to obtain daily weights and auscultate lungs for a cardiac patient with community acquired pneumonia, if a patient is taking digoxin concurrently with this drug, digoxin levels may be increased. Therefore, the nurse should monitor digoxin levels to be alert to potential drug toxicity.

A patient is receiving telithromycin for treatment of community acquired pneumonia and is also on statin therapy. What should the nurse be alerted to in support of this concurrent therapy? Additional dosage is needed to increase efficacy Statin dose needs to be decreased Statin dose needs to be increased Monitor telithromycin levels

Monitor telithromycin levels Telithromycin in combination with antilipidemic medication (simvastatin, lovastatin, and atorvastatin) may lead to increased levels. Therefore, the nurse should be aware of this fact and therapeutic monitoring of telithromycin should be established. There is no need to increase the dosage of telithromycin or adjust the dosage of statin therapy.

The patient has a community acquired pneumonia which requires antibiotic treatment. The health care provider has ordered telithromycin. Which finding in the patient's medical history requires immediate nursing action? Appendectomy Occasional headaches Myasthenia gravis History of asthma

Myasthenia gravis Telithromycin administration can lead to an exacerbation of myasthenia gravis. The nurse should take immediate action and consult with the healthcare provider. The other findings do not require any additional action at this time.

Which method should the nurse use to determine a therapeutic level for administration of gentamicin therapy? Assess liver function Assess renal function Obtain trough level Obtain peak level

Obtain trough level A trough level provides the best indicator of serum therapeutic level for gentamicin whereas the peak level provides the best indicator of toxicity. Renal and liver function should be assessed regarding the potential for nephrotoxicity.

The nurse is caring for a patient who has been prescribed cefazolin sodium. Which is the priority nursing assessment? Neurological assessment Cardiac assessment Obtaining a medical/surgical history History of immunizations

Obtaining a medical/surgical history The patient's medical/surgical history should include a listing of allergies. Antibiotic allergy is one of the most common drug allergies. These allergies also have the potential to cause severe anaphylaxis and death and, therefore, have more importance than the other assessments listed.

A patient had been prescribed long term erythromycin for treatment of a skin infection and liver enzymes are mildly elevated on laboratory findings. Which is the best nursing action based on this finding? Once the medication is stopped, liver function should return to normal. Perform an abdominal assessment to determine if the liver is enlarged. Refer the patient to a health care specialist. Discuss with the patient that imaging studies may be needed.

Once the medication is stopped, liver function should return to normal. Hepatotoxicity can occur with high doses of erythromycin and azithromycin and/or be accelerated if taken with other hepatotoxic drugs. Typically, once the medication is stopped the liver enzymes return to normal. There is no need to refer the patient to a health care specialist and/or require imaging studies. While the nurse can perform an abdominal assessment to determine if the liver is enlarged, it is not the priority action on this time.

The nurse is working with a patient who has been receiving aminoglycoside therapy intravenously. Which finding should alert the nurse to stop the infusion? Slightly decreased breath sounds in lower lobes Patient complaints of a mild headache Patient complaints of changes in hearing Intravenous site recently changed due to infiltration

Patient complaints of changes in hearing Hearing loss is an adverse reaction to aminoglycoside therapy and this finding should alert the nurse to stop the infusion. Complaints of a mild headache and slightly decreased breath sounds in lower lobes does not require stopping the infusion but does require continuing monitoring. The fact that the IV site was changed due to infiltration does not affect the current infusion.

The health care provider has prescribed tinidazole therapy. What finding if observed by the nurse should alert the nurse to contact the health care provider? Nausea without vomiting Increased weight gain of 1 pound Intermittent diarrhea Patient complaints of taste change of foods

Patient complaints of taste change of foods Common side effects of tinidazole therapy include but are not limited to headache, dizziness, weakness, dry mouth, dysgeusia, anorexia, nausea, vomiting, diarrhea, tongue/urine discoloration. The patient complaining of taste change which may present as a metallic taste in the mouth is a serious concern and the healthcare provider should be contacted.

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.) Patients stop taking an antibiotic after they feel better. Environmental dispersion of antibiotic liquid occurs. Antibiotics are taken with water or juice. Antibiotics are taken with ascorbic acid (vitamin C). Antibiotics are prescribed to treat a viral infection. Antibiotics are prescribed according to culture and sensitivity reports.

Patients stop taking an antibiotic after they feel better. Environmental dispersion of antibiotic liquid occurs. Antibiotics are prescribed to treat a viral infection.

The nurse is providing discharge instruction for a patient who has been prescribed tetracycline therapy for the treatment of an upper respiratory infection. Which priority information should the nurse include in the teaching plan? Avoid crowds until therapy has been finished Keep the medication in the refrigerator Perform daily mouth hygiene Complete the course of therapy

Perform daily mouth hygiene Tetracycline therapy can cause stomatitis; therefore, the nurse should provide information relative to maintaining adequate mouth hygiene. While it is important to complete any course of therapy, and/or avoid crowds until the infection is resolved, the priority is to inform the patient of potential adverse effects. Tetracyclines do not have to be refrigerated and should be kept away from light and extreme heat.

The nurse is working with a patient who has been diagnosed with tapeworms. The nurse anticipates that the health care provider is most likely to place the patient on which medication? Artemether/lumefantrine Praziquantel Atovaquone/proguanil Amantadine HCl

Praziquantel Praziquantel is the drug of choice for the treatment of tapeworms.

What will the nurse teach a patient who is taking isoniazid (INH)? Multidrug therapy is necessary to prevent the occurrence of resistant bacteria. You should not be on that drug. Pyridoxine (vitamin B6) will prevent numbness and tingling that can occur when taking isoniazid. You will need to take vitamin C to potentiate the action of INH.

Pyridoxine (vitamin B6) will prevent numbness and tingling that can occur when taking isoniazid. Isoniazid can cause neurotoxicity. Pyridoxine (vitamin B6) is the drug of choice to prevent this adverse reaction. It is not an anti-infective agent and thus will work to destroy the mycobacterium or prevent drug resistance. Vitamin C is not taken with this drug; the drug is appropriate for most patients, and INH with pyridoxine is not multidrug therapy. If the nurse has any concerns about the medication, this should be discussed directly with the health care provider and not with the patient.

A patient is receiving sulfonamide therapy. Which dietary modification should the nurse include in the teaching plan? Take medication with milk Decrease fluid intake Limit intake of caffeine Refrain from alcohol use

Refrain from alcohol use Patients taking sulfonamide should refrain alcohol use. Fluid intake should be increased. The medication should be taken with a full glass of water, not milk. There is no correlation between caffeine intake and sulfonamide therapy.

The patient states that she has been prescribed clarithromycin for a skin infection. Which finding should alert the nurse to a potential complication? Weight loss of 2 pounds since last visit Brisk capillary refill noted Reports that certain food doesn't taste good Temperature 99.2 degrees Fahrenheit

Reports that certain food doesn't taste good Dysgeusia (altered taste perception) is a side effect of clarithromycin and as the patient is reporting that certain foods don't taste good is a concern. The other findings do not indicate a potential complication related to this therapy.

A patient who will be traveling to a malaria-infested country is receiving instructions on the prophylactic use of chloroquine. What priority instruction will the nurse give the patient? Do not take the medication until you are certain you do not have the disease. Take the medication for 4 weeks. Start the medication 2 weeks before the trip. After leaving the affected area, take the medication for a year.

Start the medication 2 weeks before the trip. Treatment for malaria prophylaxis is usually started 2 weeks before travel and continued for 8 weeks after travel is completed.

When instructing a patient about antibiotic therapy, the nurse explains that which condition occurs when the normal flora is disturbed during antibiotic therapy? Superinfection Organ toxicity Hypersensitivity Rebound toxicity

Superinfection Antibiotic therapy can destroy the normal flora of the body, which typically inhibit the overgrowth of fungi and yeast. When the normal flora is decreased, these organisms can overgrow and cause infections.

Which instruction should the nurse include in the education of a patient beginning therapy with ivermectin for a helminth infection? Use sunscreen or wear long sleeves. Take with food. Monitor pulse daily. Take on an empty stomach.

Take on an empty stomach. Ivermectin should be taken on an empty stomach with water. The pulse does not need to be monitored, and the drug does not produce photosensitivity.

A patient taking amantadine complains of depression and dizziness. What intervention will the nurse perform first? Call the health care provider. Take the patient's blood pressure sitting and standing. Evaluate the patient for other central nervous system effects from the medication. Order a consult for counseling.

Take the patient's blood pressure sitting and standing. The side effects and adverse reactions to amantadine include central nervous system effects, such as insomnia, depression, anxiety, confusion, and ataxia; orthostatic hypotension; neurologic problems, such as weakness, dizziness, and slurred speech; and gastrointestinal disturbances, such as anorexia, nausea, vomiting, and diarrhea. The nurse should evaluate the patient for orthostatic hypotension first to address safety issues.

A patient is diagnosed with an oral candida infection. Which is the best intervention for the nurse to perform? Administer valacyclovir hydrochloride and monitor lips and gums. Teach the patient how to take nystatin. Start an IV so the patient does not have to eat by mouth. Instruct the patient to brush her teeth and gargle hourly.

Teach the patient how to take nystatin. Nystatin is an antifungal ointment that is used for a variety of candida infections. The patient needs to be taught how to "swish and swallow" to treat this infection. There is no need to brush the teeth hourly or administer Valtrex and starting an IV is an extreme measure.

A patient has been prescribed macrolide antibiotic therapy. Which information should the nurse include in planning for administration? The medication cannot be given intravenously. The medication can be given orally. The medication can be given intravenously as a bolus. The medication can be given intramuscularly.

The medication can be given orally. Macrolides can be administered either orally or intravenously. If given via IV, they should be administered slowly to avoid pain and/or possible phlebitis. The medication is not administered intramuscularly because it would be too painful.

A patient has been prescribed doxycycline for treatment of an infection. What priority instruction will the nurse give the patient? The medication should be taken two hours after meals. The medication can be taken with food. Serum therapeutic levels will need to be obtained. The medication is taken every 6 hours.

The medication can be taken with food. Food can improve the absorption of doxycycline as compared with older generation tetracyclines. There is no need to obtain serum therapeutic levels with this medication. The medication is dosed every 12 hours.

A patient is receiving vancomycin intravenously for treatment of MRSA. Which action if observed by a nurse warrants immediate action? The medication is diluted in normal saline solution. The medication is diluted in lactated ringers' solution. The medication is being infused over 30 minutes. The medication is given once a day.

The medication is being infused over 30 minutes. Vancomycin when administered intravenously can be diluted in normal saline, lactated ringer's D5W and/or normal saline solutions. The amount of solution is based on the prescribed dosage. Typically, vancomycin is administered once a day. The medication should be administered over 60 to 90 minutes. Too rapid administration of the medication can lead to red man syndrome or red neck syndrome which is a serious medical condition.

The nurse is caring for a patient who has been diagnosed with pneumonia and receiving treatment with linezolid. Which finding if noted would indicate a potential side effect? Phlebitis Back pain Tooth discoloration Constipation

Tooth discoloration Linezolid can lead to tooth/tongue discoloration. Other common side effects include diarrhea, nausea, vomiting, diarrhea, abdominal pain, dizziness, anemia, thrombocytopenia, CDAD and superinfection. Tedizolid can cause phlebitis and clindamycin can cause back pain.

A nurse is monitoring a patient who is receiving gentamicin intravenously. Which statement is correct as it relates to therapeutic monitoring? Trough level range should be less than 2 mcg/mL. For a trough level, a blood specimen should be obtained within 60 minutes of therapy. For a peak level, a blood specimen should be obtained prior to the start of therapy. Peak level range should be below 5 mcg/mL.

Trough level range should be less than 2 mcg/mL. A trough level should be drawn prior to administration of the next scheduled dose. A peak level should be drawn 45 to 60 minutes after the drug has been administered. The peak level range should be between 5 and 8 mcg/mL and the trough level range should be less than 1 to 2 mcg/mL.

A patient is taking azithromycin for a skin infection. The nurse is performing a medication reconciliation during an office visit. Which finding requires further action? Tums prn as needed for occasional upset Lasix 20 mg daily Metoprolol 100 mg twice a day Tylenol 1 to 2 tabs occasionally q 6 hours for general aches

Tums prn as needed for occasional upset Antacids (Tums) when taken in conjunction with azithromycin (macrolide) at the same time can decrease the effectiveness of therapy. Antacids should be taken either two hours before or two hours following the drug administration for azithromycin to be effective. None of the other medications require further action.

A patient has been prescribed clindamycin which leads to C diff. What treatment should the nurse anticipate that the health care provider will order ? Penicillin Lactulose Tylenol Vancomycin.

Vancomycin. C diff is a serious complication of multiple types of antibiotic therapy. The treatment of choice is Vancomycin. The other medications are not effective against this type of super infection.

The patient has been receiving vancomycin for several days for treatment of C diff. What is the nurse's initial responsibility in terms of intravenous administration for this therapy? Change intravenous dressing per protocol. Verify trough level prior to administration. Administer the medication as IVP. Assess the IV site for infiltration.

Verify trough level prior to administration. Vancomycin when administered intravenously is based on therapeutic range, noting trough levels prior to administration. As the patient has been receiving the therapy for several days, the priority is to monitor trough levels. Changing the intravenous dressing per protocol and assessing the IV site for infiltration are part of nursing assessment. The medication should not be administered as IVP.

What will the nurse monitor to evaluate the effectiveness of antiviral agents administered to treat human immunodeficiency virus infection? Megakaryocyte counts Lymphocyte counts Viral load Red blood cell counts

Viral load All antiretroviral agents work to reduce the viral load, which is the number of viral RNA copies per milliliter of blood.

A patient is being evaluated for CDAD (Clostridium difficile -associated diarrhea). Which finding is representative of this condition ? Steatorrhea Intermittent colicky pain Watery stools Nausea without vomiting

Watery stools CDAD is a serious condition leading to inflammation, cramping, and bleeding in the colon lining. There is an increase in watery and/or bloody stools. The pain is not categorized as being colicky. Nausea without vomiting and steatorrhea are not associated with this infection.

A patine is taking levofloxacin. What does the nurse know to be true regarding this drug? It is administered via IV only May cause htn It is classified as an aminoglycoside An adverse effect is tendon rupture

An adverse effect is tendon rupture

Which of the following would the use of amoxicillin be contraindicated? (Select all that apply.) Older adults Newborns GFR rate below 40 Allergy to penicillin Adolescents

GFR rate below 40 Older adults Allergy to penicillin

The patient has been diagnosed with candidiasis. The nurse recognizes that the patient is most likely to be ordered which drug? Tolnaftate Miconazole nitrate Haloprogin Sulconazole

Miconazole nitrate Miconazole nitrate can be ordered to treat candidiasis. The other drugs listed can be used to treat tinea pedis, corporis, and cruris.