Exam 6
The patient has been ordered treatment with rimantadine (Flumadine). The patient has renal impairment. The nurse anticipates what change to the dose of medication?
Decreased Rationale: The dosage of the medication will be decreased when the patient has renal impairmen
Which topical antifungal medication is used to treat vaginal candidiasis?
Miconazole (Monistat) Rationale:Topical miconazole is used to treat vaginal candidiasis.
A patient reports experiencing flatulence and abdominal distension to the nurse. Which over-the-counter medication will the nurse recommend?
Mylicon Rationale: Mylicon is a brand-name simethicone, which is an antigas agent. Maalox Gas contains simethicone, while regular Maalox does not. The other products do not contain simethicone.
A patient will begin taking a urinary antimuscarinic medication. Which symptom should the patient report immediately?
Urinary Retention Rationale: Urinary retention should be reported to the provider. Dry mouth, fatigue, and increased heart rate are side effects, but they do not necessarily warrant reporting immediately. Urinary retention is more serious.
A patient asks the nurse the best way to prevent traveler's diarrhea. The nurse will provide which recommendation to the patient?
"Drink bottled water and eat only well-cooked meats." Rationale: Patients traveling to areas with potential traveler's diarrhea should be taught to drink bottled water and eat meats that are well cooked. Prophylactic antibiotics are not recommended. Patients should eat cooked, washed fruits and vegetables. Loperamide can increase exposure to pathogens by slowing motility.
The nurse is teaching a parent about administering nitrofurantoin suspension to a 5-year-old child. Which instruction will the nurse include in the patient teaching?
"Have the child rinse the mouth after taking the drug." Rationale: Nitrofurantoin suspension can stain the teeth, so patients should rinse the mouth after taking it. Nitrofurantoin should be taken with food, and patients should increase fluids. A reddish-brown color is a harmless side effect.
The nurse provides teaching for a patient who will begin taking nitrofurantoin (Macrodantin) to treat a urinary tract infection. Which statement by the patient indicates understanding of the teaching?
"I should take the drug with food and increase my fluid intake." Rationale: Patients taking nitrofurantoin should take the drug with foods and increase fluid intake. The drug should not be taken with antacids. Brown urine is a harmless side effect. Tingling of extremities can indicate neuropathy.
A patient who has pain with urination associated with cystitis will be discharged home with a prescription for phenazopyridine (Pyridium). What instruction will the nurse include when teaching the patient about this drug?
"The drug provides symptomatic relief of pain." Rationale: Phenazopyridine is used to provide symptomatic pain relief. It may be taken with antibiotics. Reddish-brown urine is a harmless side effect. It does not have antiseptic properties.
The nurse is caring for a hospitalized patient who has symptoms characteristic of pyelonephritis. Before administering the first dose of the intravenous antibiotic, the nurse will ensure that which action is performed
A urine culture is obtained. Rationale: A urinalysis, as well as a culture and sensitivity, is usually performed before initiating drug therapy. An antipyretic is indicated for fever but does not need to be timed before the antibiotic. An oral antibiotic is not indicated. A urinary analgesic is given as needed.
The child who is a candidate for treatment with an emetic after ingestion of a toxic substance or overdose is the child who has ingested which substance?
Acetaminophen elixir Rationale: An emetic, such as Ipecac, should not be given to patients who have ingested caustic substances or petroleum distillates since regurgitation carries a risk of aspiration. Acetaminophen is not a caustic substance or a petroleum distillate. Chlorine bleach and toilet cleanser are caustic substances. Kerosene is a petroleum distillate.
The nurse is preparing to administer the first dose of intravenous ceftriaxone (Rocephin) to a patient. When reviewing the patient's chart, the nurse notes that the patient previously experienced a rash when taking amoxicillin. What is the nurse's next action?
Administer the drug and observe closely for hypersensitivity reactions. Rationale:A small percentage of patients who are allergic to penicillin could also be allergic to a cephalosporin product. Patients should be monitored closely after receiving a cephalosporin if they are allergic to penicillin. There is no difference in hypersensitivity potential between different generations or method of delivery of cephalosporins.
The patient will begin taking penicillin G procaine (Wycillin). The nurse notes that the solution is milky in color. What action will the nurse take?
Administer the medication as ordered by the physician Rationale: Penicillin G procaine (Wycillin) has a milky appearance; therefore, the appearance should not concern the nurse
A patient who experiences motion sickness when flying asks the nurse the best time to take the medication prescribed to prevent motion sickness for a 0900 flight. The nurse will instruct the patient to take the medication at which time?
At 0830, just prior to boarding the plane Rationale: Motion sickness medication has its onset in 30 minutes. The patient should be instructed to take the medication a half hour prior to takeoff. It is not used as needed.
A patient who recently began having mild symptoms of gastroesophageal reflux disease (GERD) is reluctant to take medication. What measures will the nurse recommend to minimize this patient's symptoms? (Select all that apply.)
Avoiding hot, spicy foods Avoiding tobacco products Taking ibuprofen with food
A patient who is receiving chemotherapy will be given dronabinol (Marinol) to prevent nausea and vomiting. The nurse will tell the patient that this drug will be given at which time?
Before and after the chemotherapy Rationale :Cannabinoids are given prior to chemotherapy and for 24 hours after chemotherapy.
A patient will begin taking streptomycin as part of the medication regimen to treat tuberculosis. Before administering this medication, the nurse will review which laboratory values in the patient's medical record?
Blood urea nitrogen (BUN) and creatinine Rationale: Streptomycin can cause significant renal toxicity.
Which antacid is likely to cause acid rebound?
Calcium carbonate
The nurse caring for a patient who has tuberculosis and who is taking isoniazid, rifampin, and streptomycin reviews the medical record and notes the patient's sputum cultures reveal resistance to streptomycin. The nurse will anticipate that the provider will take which action?
Change the streptomycin to kanamycin. Rationale: The patient's current regimen is first-phase treatment. If resistance to streptomycin develops, the provider can change to kanamycin or to ciprofloxacin. Ethambutol is added if there is resistance to isoniazid. Clarithromycin is used during phase II. Renal function tests are not indicated.
Which diseases are caused by herpes viruses? (Select all that apply.)
Chicken pox Mononucleosis Shingles Rationale: Herpes viruses cause chicken pox, mononucleosis, and shingles.
The nurse is caring for a patient who has Zollinger-Ellison syndrome. Which medication order would the nurse question for this patient?
Cimetidine (Tagamet) Rationale: Cimetidine is not effective for treating Zollinger-Ellison syndrome. The other medications are used to treat Zollinger-Ellison syndrome.
Which actions can contribute to bacterial resistance to antibiotics?
Frequent use of antibiotics Skipping doses Treating viral infections with antibiotics
The nurse caring for a patient who will receive penicillin to treat an infection asks the patient about previous drug reactions. The patient reports having had a rash when taking amoxicillin (Amoxil). The nurse will contact the provider to
Discuss using erythromycin (E-Mycin) instead of penicillin. Rationale: Erythromycin is the drug of choice when penicillin is not an option. Giving smaller doses of penicillin does not prevent hypersensitivity reactions. Benadryl is useful when a hypersensitivity reaction has occurred. A small percentage of patients allergic to penicillins may be hypersensitive to cephalosporins.
The nurse receives the following order for a patient who is diagnosed with herpes zoster virus: PO acyclovir (Zovirax) 400 mg TID for 7 to 10 days. The nurse will contact the provider to clarify which part of the order?
Dose and frequency Rationale: Acyclovir is used for herpes zoster, but the dose should be 800 mg 5 times daily for 7 to 10 days. The nurse should clarify the dose and frequency. For herpes simplex, 400 mg 3 times daily is correct.
The nurse is caring for a patient who is receiving an intravenous antibiotic. The nurse notes that the provider has ordered serum drug peak and trough levels. The nurse understands that these tests are necessary for which type of drugs?
Drugs with a narrow therapeutic index. rationale:Medications with a narrow therapeutic index have a limited range between the therapeutic dose and a toxic dose. It is important to monitor these medications closely by evaluating regular serum peak and trough level
The nurse is caring for a patient who is taking trimethoprim-sulfamethoxazole (TMP-SMX). The nurse learns that the patient takes an angiotensin-converting enzyme (ACE) inhibitor. To monitor for drug interactions, the nurse will request an order for which laboratory test(s)?
Electrolytes Rationale: TMP-SMX can result in hyperkalemia when taken with an ACE inhibitor.
A female patient who is allergic to penicillin will begin taking an antibiotic to treat a lower respiratory tract infection. The patient tells the nurse that she almost always develops a vaginal yeast infection when she takes antibiotics and that she will take fluconazole (Diflucan) with the antibiotic being prescribed. Which macrolide order would the nurse question for this patient?
Erythromycin (E-Mycin) Rationale: When erythromycin is given concurrently with fluconazole, erythromycin blood concentration and the risk of sudden cardiac death increase.
The nurse is caring for several patients who are receiving antibiotics. Which order will the nurse question?
Erythromycin 300 mg IM QID Rationale: Erythromycin and other macrolides should not be given intramuscularly because they cause painful tissue irritation.
The parent of a child who is receiving chemotherapy asks the nurse why metoclopramide (Reglan) is not being used to suppress vomiting. The nurse will explain that, in children, this drug is more likely to cause which effect?
Extrapyramidal symptoms Rationale: Metoclopramide can cause extrapyramidal symptoms, and these effects are more likely in children. Children are not more prone to sedative effects, paralytic ileus, or vertigo while taking this drug.
The nurse is caring for a patient who is diagnosed with a urinary tract infection. The patient reports always having difficulty remembering to take medications. Which drug will the nurse expect the provider to select when treating this patient?
Fosfomycin tromethamine (Monurol) Rationale: Fosfomycin is given as a one-time, single dose. Ciprofloxacin is given daily or twice a day. Nitrofurantoin is given four times daily. Trimethoprim-sulfamethoxazole is given twice daily.
The parent of an 18-month-old toddler calls the clinic to report that the child has vomited 5 times that day. The nurse determines that the child has had three wet diapers in the past 6 hours. What will the nurse recommend for this child?
Giving frequent, small amounts of Pedialyte Rationale: The child is not dehydrated as evidenced by adequate wet diapers, so nonpharmacologic measures, such as oral fluids, are recommended. Antiemetics are not recommended unless dehydration occurs. Intravenous fluids are given when dehydration is present.
The nurse is caring for a patient who has postoperative nausea and vomiting. The surgeon has ordered promethazine HCl (Phenergan). Which aspect of this patient's health history would be of concern?
Glaucoma Rationale: Promethazine is contraindicated in patients with glaucoma since it is an anticholinergic medication. It should be used with caution in patients with asthma. The other two conditions are not concerning with this medication.
The nurse assumes care for a patient who is experiencing urinary tract spasms and is ordered to receive flavoxate HCl (Urispas). When reviewing this patient's history, which condition would cause the nurse to notify the provider?
Glaucoma Rationale: Urispas should not be used for patient who has gastrointestinal or urinary tract obstruction or if the patient has glaucoma.
The nurse is preparing to administer methenamine (Hiprex) to a patient who has pyelonephritis. Which action will the nurse perform?
Increase fluid intake to 2000 mL/day. Rationale: Patients who take methenamine can develop crystalluria and should increase fluid intake to prevent this effect. A reddish-brown color is a harmless side effect. Patients should have acidic urine, not alkaline urine. Methenamine taken with sulfonamides increases the risk of crystalluria.
The nurse is caring for an infant who has respiratory syncytial virus (RSV) and who will receive ribavirin. The nurse expects to administer this drug by which route?
Inhalation Rationale: Ribavirin is given by inhalation to treat RSV. Oral ribavirin is used to treat hepatitis C, and intravenous ribavirin is used to treat hepatitis C and Lassa fever
A patient who has been taking ranitidine (Zantac) continues to have pain associated with peptic ulcer. A noninvasive breath test is negative. Which treatment does the nurse expect the provider to order for this patient?
Lansoprazole (Prevacid) instead of ranitidine Rationale: This patient does not have H. pylori ulcer disease, so dual and triple drug therapy with antibiotics is not indicated. Patients who fail treatment with a histamine2 blocker should be changed to a proton pump inhibitor (PPI) such as lansoprazole. PPIs tend to inhibit gastric acid secretion up to 90% greater than the histamine antagonists.
The nurse is caring for a patient who is receiving a high dose of intravenous azithromycin to treat an infection. The patient is also taking acetaminophen for pain. The nurse should expect to review which lab values when monitoring for this drug's side effects?
Liver enzymes Rationale: High doses of macrolides, when taken with other, potentially hepatotoxic drugs such as acetaminophen may cause hepatotoxicity, so liver enzymes should be carefully monitored.
A patient reports having three to four stools, which are sometimes hard, per week. The nurse will perform which action?
Recommend increased fluids and dietary fiber. Rationale: This patient is having stools that are within the normal range for frequency. Nonpharmacologic measures should be used first to help soften stoo
Which side effects are common to most urinary antiseptics?
Nausea and vomiting Rationale: Nausea and vomiting are common side effects with most urinary antiseptics.
The nurse is preparing to administer methenamine (Hiprex) to a patient who is diagnosed with a urinary tract infection. The nurse reviews the patient's chart and notes a urinary pH of 6.0. Which action will the nurse take?
Obtain an order for 8 ounces of cranberry juice three times daily. Rationale: Methenamine produces a bactericidal effect when the urine pH is less than 5.5. Cranberry juice will help to acidify the urine.
The nurse is preparing to administer the first dose of an antibiotic to a patient admitted for a urinary tract infection. Which action is most important prior to administering the antibiotic?
Obtaining a urine specimen for culture and sensitivity Rationale:To obtain the most accurate culture, the specimen should be obtained before antibiotic therapy begins. It is important to obtain cultures when possible to correctly identify the organism and help determine which antibiotic will be most effective. Administering test doses to determine hypersensitivity is sometimes done when there is a strong suspicion of allergy when a particular antibiotic is needed. Epinephrine is kept close at hand when there is a strong suspicion of allergy.
A male patient reports urinary urgency and pain with burning on urination. The nurse understands that this patient will be treated for which condition?
Prostatitis Rationale: In a male patient, a lower urinary tract infection is most likely prostatitis with symptoms similar to cystitis.
A 25-year-old female patient reports urinary frequency with pain on urination, flank pain, fever, and chills. The nurse recognizes these symptoms as characteristic of which condition?
Pyelonephritis Rationale: These are symptoms of pyelonephritis, characterized by fever, dysuria, flank pain, and urinary frequency.
A child is diagnosed with pinworms. Which anthelmintic drug will the provider order for this child?
Pyrantel pamoate (Pin Rid) Rationale: Pyrantel pamoate is used to treat pinworms. The other drugs treat other types of parasites.
A patient who is diagnosed with peptic ulcer disease has been started on a regimen that includes ranitidine (Zantac) 300 mg daily at bedtime. The patient calls the clinic 1 week later to report no relief from discomfort. What action will the nurse take?
Reassure the patient that the drug may take 1 to 2 weeks to be effective. Rationale: Patients taking histamine2 blockers can expect abdominal pain to decrease after 1 to 2 weeks of drug therapy. Cimetidine is not as potent as ranitidine and interacts with many medications through the cytochrome P450 system. Three hundred milligrams is the maximum dose
A male patient who has been taking a histamine2 blocker for several months reports decreased libido and breast swelling. What will the nurse do?
Reassure the patient that these symptoms will stop when the drug is discontinued. Rationale: Drug-induced impotence and gynecomastia are reversible drug side effects. These signs do not indicate drug toxicity. Serum hormone levels and endocrinology evaluation are not indicated
An elderly patient reports using Maalox frequently to treat acid reflux. The nurse should notify the patient's provider to request an order for which laboratory tests?
Renal function tests and serum magnesium Rationale: Maalox contains magnesium and carries a risk of hypermagnesemia, especially with decreased renal function. Older patients have an increased risk of poor renal function, so this patient should especially be evaluated for hypermagnesemia.
The nurse is preparing to administer a phenazopyridine HCl (Pyridium) dose to a patient who has diabetes. The nurse notes that the patient has a positive Clinitest. What will the nurse do next?
Request an order for serum blood glucose. Rationale: Phenazopyridine can alter the glucose urine test (Clinitest), so a blood test should be done to monitor glucose levels.
The nurse is caring for an older adult who is receiving diphenoxylate with atropine (Lomotil) to treat severe diarrhea. The nurse will monitor this patient closely for which effect?
Respiratory depression Rationale: Diphenoxylate is an opium agonist and can cause respiratory depression. Children and older adults are more susceptible to this effect. It contains atropine, so it will increase heart rate. It does not contribute to fluid retention. Lomotil causes central nervous system depression and will not cause nervousness and tremors.
The nurse is preparing to administer an antibiotic to a patient who has been receiving the antibiotic for 2 days after a culture was obtained. The nurse notes increased erythema and swelling, and the patient has a persistent high fever of 39° C. What is the nurse's next action?
Review the sensitivity results from the patient's culture. Rationale: The sensitivity results from the patient's culture will reveal whether the organism is sensitive or resistant to a particular antibiotic. The patient is not responding to the antibiotic being given, so the antibiotic should be held and the provider notified. Another culture is not indicated. Antibiotics should be added only when indicated by the sensitivity.
The nurse is preparing to begin a medication regimen for a patient who will receive intravenous ampicillin and gentamicin. Which is an important nursing action?
Set up separate tubing sets for each drug labeled with the drug name and date. Rationale: Intravenous aminoglycosides can be given with penicillins and cephalosporins but should not be mixed in the same container. The IV line should be flushed between antibiotics, or separate tubing sets may be set up. Gentamicin must be infused over 30 to 60 minutes. It is not necessary to measure ampicillin peak and trough levels. Giving the drugs at the same time increases the risk of mixing them together.
A patient who is taking trimethoprim-sulfamethoxazole (TMP-SMX) calls to report developing an all-over rash. The nurse will instruct the patient to perform which action?
Stop taking TMP-SMX immediately. Rationale: A rash can indicate a serious drug reaction. Patients should stop taking the drug immediately and notify the provider.
A client is being treated for tuberculosis. Which medications are used to treat this condition? (Select all that apply.)
Streptomycin sulfate Ethambutol (Myambutol) Rifabutin (Mycobutin) Ethionamide (Trecator-SC) Pyrazinamide Rationale: Streptomycin sulfate, ethambutol (Myambutol), rifabutin (Mycobutin), ethionamide (Trecator-SC), and pyrazinamide are used to treat tuberculosis. The other medications are not used.
Which is a characteristic that distinguishes sulfonamides from other drugs used to treat bacterial infection?
Sulfonamides are not derived from biologic substances. Rationale: Sulfonamides are not derived from biologic substances. They are bacteriostatic, not bactericidal. They are not antifungals or antivirals. They act by decreasing bacterial synthesis of folic acid.
1. A patient who has been instructed to use a liquid antacid medication to treat gastrointestinal upset asks the nurse about how to take this medication. What information will the nurse include when teaching this patient?
Take 60 minutes after meals and at bedtime. Rationale: Since maximum acid secretion occurs after eating and at bedtime, antacids should be taken 1 to 3 hours after eating and at bedtime. Taking antacids before meals slows gastric emptying time and causes increased gastrointestinal (GI) secretions. Patients should not self-treat constipation or diarrhea. Patients should use 2 to 4 ounces of water when taking to ensure that the drug enters the stomach; more than that will increase GI secretions. Antacids should not be taken with milk or foods high in vitamin D.
A patient who takes propantheline bromine (Pro-Banthine) and omeprazole (Prilosec) for an ulcer will begin taking an antacid. The nurse will give which instruction to the patient regarding how to take the antacid?
Take the antacid 2 hours after taking the propantheline. Rationale: Antacids can slow the absorption of anticholinergics and should be taken 2 hours after anticholinergic administration. Antacids should be given 1 to 3 hours after a meal and should not be given with dairy products.
A patient who is taking isoniazid (INH) as part of a two-drug tuberculosis treatment regimen reports tingling of the fingers and toes. The nurse will recommend discussing which treatment with the provider?
Taking pyridoxine (B6) Rationale: Peripheral neuropathy is an adverse reaction to INH, so pyridoxine is usually given to prevent this. It is not necessary to change medications. Increasing fluids will not help with this.
The nurse is caring for a 7-year-old patient who will receive oral antibiotics. Which antibiotic order will the nurse question for this patient?
Tetracycline (Sumycin) Rationale: Tetracyclines should not be given to children younger than 8 years of age because they irreversibly discolor the permanent teeth.
The nurse is instructing a patient who will take psyllium (Metamucil) to treat constipation. What information will the nurse include when teaching this patient?
The importance of consuming adequate amounts of water Rationale:Insufficient fluid intake can cause the drug to solidify in the gastrointestinal tract. Psyllium is not digestible, so it does not have systemic side effects. Onset of action for psyllium is between 10 and 24 hours. The dry form can cause cramping.
An older woman has urgent urinary incontinence related to an overactive bladder. Which medication does the nurse expect the provider to order?
Tolterodine tartrate (Detrol) Rationale: Detrol is used to treat an overactive bladder. Dimethylsulfoxide (DMSO) and flavoxate (Urispas) are used to relax uterine smooth muscle. Phenazopyridine HCl (Pyridium) is used to alleviate the pain and burning sensation during urination that is experienced with chronic cystitis.
A female patient will receive doxycycline to treat a sexually transmitted illness (STI). What information will the nurse include when teaching this patient about this medication?
Use a back-up method of contraception if taking oral contraceptives. Rationale: so patients taking oral contraceptives should be advised to use a back-up contraception method while taking tetracyclines. Nausea and vomiting are common adverse effects. Doxycycline should not be taken with dairy products. Tetracycline may cause teratogenic effects.
A woman who is 2 months pregnant reports having morning sickness every day and asks if she can take any medications to treat this problem. The nurse will recommend that the patient take which action first?
Use nonpharmacologic measures such as saltines. Rationale: Pregnant women should avoid antiemetics during the first trimester of pregnancy because of possible teratogenic effects. The nurse should recommend nonpharmacologic measures such as saltines. If this is not effective, intravenous fluids may become necessary. Pregnant women should consult with their provider before taking prescription or over-the-counter antiemetics.
A patient with a peptic ulcer has been diagnosed with H. pylori. The provider has ordered lansoprazole (Prevacid), clarithromycin (Biaxin), and metronidazole (Flagyl). The patient asks the nurse why two antibiotics are needed. The nurse will explain that two antibiotics
combat bacterial resistance. Rationale: The use of two antibiotics when treating H. pylori peptic ulcer disease helps to combat bacterial resistance because H. pylori develops resistance rapidly. Giving two antibiotics, in this case, is not to reduce the dose or to cause synergistic effects. Antibiotics do not affect acid production.
A patient is taking esomeprazole (Nexium) 15 mg per day to treat a duodenal ulcer. After 10 days of treatment, the patient reports that the pain has subsided. The nurse will counsel the patient to
continue the medication for 4 more weeks. Rationale: With treatment, ulcer pain may subside in 10 days, but the healing process may take 1 to 2 months. Patients should be counseled to take the drug for the length of time prescribed. Reducing the dose or taking less frequently is not indicated.
The nurse is preparing to administer bethanechol chloride (Urecholine) to a patient. The nurse understands that this drug acts to
increase the tone of the urinary detrusor muscle. Rationale: Bethanechol is used to increase the tone of the detrusor muscle and increase the bladder tone to stimulate urination. It stimulates the parasympathetic nerves. It tones the smooth muscles of the urinary tract. It does not alleviate dysuria
A patient has been taking famotidine (Pepcid) 20 mg bid to treat an ulcer but continues to have pain. The provider has ordered lansoprazole (Prevacid) 15 mg per day. The patient asks why the new drug is necessary, since it is more expensive. The nurse will explain that lansoprazole
is more potent than famotidine. Rationale: Famotidine is a histamine2 (H2) blocker. When patients fail therapy with these agents, proton pump inhibitors, which can inhibit gastric acid secretion up to 90% greater than the H2 blockers, are used. Lansoprazole is not for long-term treatment and has drug interactions and drug side effects, as do all other medications.
A patient who has completed the first phase of a three-drug regimen for tuberculosis has a positive sputum acid-bacilli test. The nurse will tell the patient that
it may be another month before this test is negative. Rationale: The goal is for the patient's sputum test to be negative 2 to 3 months after the therapy. The positive test does not indicate drug resistance. The provider will not change the drugs or keep the patient in the first phase longer than planned.
The nurse is caring for a patient who will begin taking omeprazole (Prevacid) 20 mg per day for 4 to 8 weeks to treat gastroesophageal reflux disease esophagitis. The nurse learns that the patient takes digoxin. The nurse will contact the provider for orders to
monitor for digoxin toxicity Rationale: Proton pump inhibitors can enhance the effects of digoxin, so patients should be monitored for digoxin toxicity. Changing the dose of either medication is not indicated prior to obtaining lab results that are positive for digoxin toxicity.
A patient who has symptoms of peptic ulcer disease will undergo a test that requires drinking a liquid containing 13C urea and breathing into a container. The nurse will explain to the patient that this test is performed to
test for the presence of 13CO2. Rationale: When H. pylori is suspected, a noninvasive test is performed by administering 13C urea, which, in the presence of H. pylori, will release 13CO2. The test does not measure the amount of HCl acid or the pH and does not detect H. pylori antibodies.
An appropriate goal when teaching a patient who has diarrhea is that the patient
will have less frequent, more formed stools. Rationale: An appropriate goal is that patients will have formed less frequent stools, not an absence of stools. Receiving adequate intravenous fluids or antibiotic therapy are interventions, not goals.
A patient is diagnosed with mycoplasma pneumonia. Which antibiotic will the nurse expect the provider to order to treat this infection?
Erythromycin (E-Mycin) Rationale: Erythromycin is the drug of choice for treating mycoplasma pneumonia.
A patient is being treated with isoniazid (INH), rifampin, and pyrazinamide in phase I of treatment for tuberculosis. The organism develops resistance to isoniazid. Which drug will the nurse anticipate the provider will order to replace the isoniazid?
Ethambutol (Myambutol) Rationale: If there is bacterial resistance to isoniazid, the first phase may be changed to ethambutol, rifampin, and pyrazinamide. Ciprofloxacin, kanamycin, and streptomycin are not generally first-line antitubercular drugs.
A patient who takes an oral sulfonylurea medication will begin taking fluconazole (Diflucan). The nurse will expect to monitor which lab values in this patient?
Glucose Rationale: Patients taking sulfonylurea drugs may have altered serum glucose when taking antifungal medications.
A patient is diagnosed with tinea capitis. The provider will order which systemic antifungal medication for this patient?
Griseofulvin (Fulvicin) Rationale: Griseofulvin is used to treat tinea capitis. Anidulafungin is used to treat esophageal candidiasis, candidemia, and other Candida infections. Fluconazole is used to treat Candida infections and cryptococcal meningitis. Ketoconazole is used to treat Candida infections, histoplasmosis, blastomycosis, and other infections.
A patient calls the clinic in November to report a temperature of 103° F, headache, a nonproductive cough, and muscle aches. The patient reports feeling well earlier that day. The nurse will schedule the patient to see the provider and will expect the provider to order which medication?
Oseltamivir phosphate (Tamiflu) Rationale: Current recommendations for the treatment of influenza types A and B are oseltamivir or zanamivir. Amantadine and rimantadine were formally used for prophylaxis and treatment against influenza A virus; but because of resistance in circulating influenza A, amantadines are not recommended. Influenza A is sensitive to oseltamivir and zanamivir. The influenza vaccine may be given later to protect against other strains. Over-the-counter medications may be used as adjunct treatment.
A patient who has AIDS is at risk to contract aspergillosis. The nurse will anticipate that which antifungal medication will be ordered prophylactically for this patient?
Posaconazole (Noxafil) Rationale: Posaconazole is given for prophylactic treatment of Aspergillus and Candida infections.
A patient who is taking metronidazole (Flagyl) reports metallic taste in the mouth. Which action will the nurse take?
Reassure the patient that this is a harmless effect. Rationale: A metallic taste is an unpleasant, but harmless side effect of metronidazole and is not cause for concern.
The nurse is preparing to give a dose of a cephalosporin medication to a patient who has been receiving the antibiotic for 2 weeks. The nurse notes ulcers on the patient's tongue and buccal mucosa. Which action will the nurse take?
Report a possible superinfection side effect of the cephalosporin. Rationale: The patient's symptoms may indicate a superinfection and should be reported to the physician so it can be treated; however, the drug does not need to be held. It is not necessary to culture the lesions. The symptoms do not indicate impending anaphylaxis.
A female patient who is taking trimethoprim-sulfamethoxazole (TMP-SMZ) (Bactrim, Septra) to treat a urinary tract infection reports vaginal itching and discharge. The nurse will perform which action?
Report a possible superinfection to the provider. Rationale: Superinfection can occur with a secondary infection. Vaginal itching and discharge is a sign of superinfection. This is not symptomatic of pregnancy. These are not common side effects and do not indicate a hematologic reaction.
The nurse is reviewing a patient's chart prior to administering gentamicin (Garamycin) and notes that the last serum peak drug level was 9 mcg/mL and the last trough level was 2 mcg/mL. What action will the nurse take?
Report possible drug toxicity to the patient's provider. Rationale: Gentamicin peak values should be 5 to 8 mcg/mL, and trough levels should be 0.5 to 2 mcg/mL. Peak levels give information about whether or not a drug is at toxic levels, while trough levels indicate whether a therapeutic level is maintained. This drug is at a toxic level, and the next dose should not be given.
The nurse is preparing to administer clarithromycin to a patient. When performing a medication history, the nurse learns that the patient takes warfarin to treat atrial fibrillation. The nurse will perform which action?
Request an order for periodic serum warfarin levels. Rationale: Macrolides can increase serum levels of other drugs such as warfarin. If these drugs are used with macrolides, serum drug levels should be monitored. All macrolides have this drug interaction. Cardiovascular monitoring is not indicated. The drug may be given as long as serum drug levels are monitored.
A patient who has traveled to an area with prevalent malaria has chills, fever, and diaphoresis. The nurse recognizes this as which phase of malarial infection?
An erythrocytic phase Rationale: The erythrocytic phase of malarial infection occurs when the parasite invades the red blood cells and is characterized by chills, fever, and sweating.
The nurse is teaching a nursing student about the minimal effective concentration (MEC) of antibiotics. Which statement by the nursing student indicates understanding of this concept?
"A serum drug level greater than the MEC helps eradicate bacterial infections." Rationale:The MEC is the minimum amount of drug needed to halt the growth of a microorganism. A level greater than the MEC helps eradicate infections. Drugs at or above the MEC are usually bactericidal, not bacteriostatic. Raising the drug level does not usually broaden the spectrum or increase the therapeutic index of a drug.
The nurse is teaching a nursing student about the antifungal drug amphotericin B. Which statement by the student indicates a need for further teaching?
"Amphotericin B may be given intravenously or by mouth." Rationale: Amphotericin B is not absorbed from the gastrointestinal tract, so is not given by mouth. It can cause nephrotoxicity and electrolyte imbalance. It is highly toxic and is reserved for severe, systemic infection
The nurse is teaching a group of parents about the use of syrup of ipecac. Which instruction will the nurse provide?
"Do not administer ipecac without consulting a poison control center." Rationale: Ipecac should not be used for caustic substances or petroleum distillates. Ipecac should be given only after determining whether it is safe. The onset of emesis is within 15 to 30 minutes. Ipecac should not be given with milk or carbonated beverages. Ipecac syrup should be used.
The nurse is teaching a patient who is about to take a long car trip about using dimenhydrinate (Dramamine) to prevent motion sickness. What information is important to include when teaching this patient?
"Do not drive while taking this medication." Rationale: Drowsiness is a common side effect of dimenhydrinate, so patients should be cautioned against driving while taking this drug. Dry mouth is a common side effect and not a sign of toxicity. The drug should be taken 30 minutes prior to travel. The maximum recommended dose is 400 mg per day.
The nurse is counseling a patient who will begin taking a sulfonamide drug to treat a urinary tract infection. What information will the nurse include in teaching?
"Drink several quarts of water daily." Rationale: Patients should drink several quarts of water daily while taking sulfonamides to prevent crystalluria. Patients should not take antacids with sulfonamides. Sulfonamides should be avoided during pregnancy to avoid congenital malformations, neural tube defects, and kernicterus. Sore throat should be reported.
The nurse is providing teaching to a patient who will begin taking a cephalosporin to treat an infection. Which statement by the patient indicates a need for further teaching?
"I may stop taking the medication if my symptoms clear up." Rationale: Patients should take all of an antibiotic regimen even after symptoms clear to ensure complete treatment of the infection. Patients are often advised to eat yogurt or drink buttermilk to prevent superinfection. A rash is a sign of hypersensitivity, and patients should be counseled to stop taking the drug and notify the provider if this occurs. Alcohol consumption may cause adverse effects and should be avoided by patients while they are taking cephalosporins.
The nurse provides home-care instructions for a patient who will take a high dose of azithromycin after discharge from the hospital. Which statement by the patient indicates understanding of the teaching?
"I may take antacids 2 hours before taking this drug." Rationale:Azithromycin peak levels may be reduced by antacids when taken at the same time, so patients should be cautioned to take antacids 2 hours before or 2 hours after taking the drug. High-dose azithromycin carries a risk for hepatotoxicity when taken with other potentially hepatotoxic drugs such as acetaminophen. Diarrhea may indicate pseudomembranous colitis and should be reported. There is no restriction for dairy products when taking azithromycin.
The nurse is teaching a patient about rifampin. Which statement by the patient indicates understanding of the teaching?
"I should not wear soft contact lenses while taking rifampin." Rationale: Patients taking rifampin should be warned that urine, feces, saliva, sputum, sweat, and tears may turn a harmless red-orange color. Patients should not wear soft contact lenses to avoid permanent staining. Regular eye exams are necessary for patients who receive isoniazid and ethambutol. Orange urine is a harmless side effect and does not need to be reported. Renal toxicity is not common with rifampin.
A patient is taking chloroquine (Aralen) to treat acute malaria. Which statement by the patient indicates understanding of this medication?
"I should report visual changes immediately." Rationale: Patients taking chloroquine (Aralen) have a risk of visual injury related to side effects of blurred vision and should report visual changes to the provider. One does not need to abstain from alcohol, but if the patient drinks large amounts of alcohol or has a liver disorder, the liver enzymes will require closer monitoring. Patient should report urine output of less than 600 mL/day, and patients should take the drug with food.
The nurse is teaching a patient who is receiving chloroquine (Aralen) for malaria prophylaxis. Which statement by the patient indicates a need for further teaching?
"If I have gastrointestinal upset, I should take an antacid." Rationale: Patients should not take these drugs with antacids.
A patient asks the nurse about using loperamide (Imodium) to treat infectious diarrhea. Which response will the nurse give?
"Loperamide may prolong the symptoms." Rationale: Patients with infectious diarrhea should be cautioned about using loperamide since slowing transit through the intestines may prolong the exposure to the infectious agent. Loperamide causes less CNS depression than other antidiarrheals. It is taken after each loose stool.
The nurse is teaching a patient who will be discharged home from the hospital to take amoxicillin (Amoxil) twice daily for 10 days. Which statement by the nurse is correct?
"Stop taking the drug and notify your provider if you develop a rash while taking this drug." Rationale:Patients who develop signs of allergy, such as rash, should notify their provider before continuing medication therapy. Patients should be counseled to continue taking their antibiotics until completion of the prescribed regimen even when they feel well. Diarrhea is an adverse effect but does not warrant cessation of the drug. Before deciding to stop taking a medication due to a side effect, encourage the patient to contact the provider first. Patients should discard any unused antibiotic.
A patient who has oral candidiasis will begin using nystatin suspension to treat the infection. What information will the nurse include when teaching this patient?
"Swish the liquid in your mouth and then swallow after a few minutes." Rationale: Patients should be taught to swish the suspension in the mouth to coat the tongue and buccal mucosa and then spit out or swallow the medication. It should not be diluted with water or swallowed with water. Oral suspension is the preferred route for treating oral thrush.
A patient is diagnosed with histoplasmosis and will begin taking ketoconazole. What information will the nurse include when teaching this patient about this medication?
"Take the medication with food." Rationale: Ketoconazole should be taken with food. It is administered once daily. Patients taking antifungals should not consume alcohol. Antifungals can cause liver and renal toxicity, so patients will need lab monitoring.
The nurse is providing discharge teaching for a patient who will receive oral levofloxacin (Levaquin) to treat pneumonia. The patient takes an oral hypoglycemic medication and uses over-the-counter (OTC) antacids to treat occasional heartburn. The patient reports frequent arthritis pain and takes acetaminophen when needed. Which statement by the nurse is correct when teaching this patient?
"You should monitor your serum glucose more closely while taking levofloxacin." Rationale: Levofloxacin may increase the effects of oral hypoglycemic medications, so patients taking these should be advised to monitor their serum glucose levels closely. Antacids decrease the absorption of levofloxacin and should be given 2 hours before or after the antibiotic. NSAIDs taken with levofloxacin can cause central nervous system reactions, including seizures. The drug can be taken with food.
A child is being treated for pinworms, and the parent asks the nurse how to prevent spreading this to other family members. What will the nurse tell the parent?
"Your child should wash hands well after using the toilet." Rationale: To prevent the spread of pinworms, good hand washing after toileting is recommended. Patients should take showers, not baths. It is not necessary to get regular stool specimens or to wash clothing in hot water.
The nurse is caring for a patient who is receiving sulfadiazine. The nurse knows that this patient's daily fluid intake should be at least which amount?
2000 mL/day Rationale: To prevent crystalluria, patients should consume at least 2000 mL/day
A patient is diagnosed with influenza and will begin taking a neuraminidase inhibitor. The nurse knows that this drug is effective when taken within how many hours of onset of flu symptoms?
48 hours Rationale: Neuraminidase inhibitors, such as zanamivir and oseltamivir, should be taken within 48 hours of onset of symptoms for best effect.
A child who weighs 10 kg will begin taking oral trimethoprim-sulfamethoxazole (TMP-SMX). The liquid preparation contains 40 mg of TMP and 200 mg of SMX per 5 mL. The nurse determines that the child's dose should be 8 mg of TMP and 40 mg of SMX/kg/day divided into two doses. Which order for this child is correct?
5 mL PO BID Rationale: This child should receive (10 kg × 8 mg) 80 mg of TMP and (10 kg × 40 mg) 400 mL of SMX per day. When divided into two doses, the correct dose is 40 mg TMP and 200 mg SMX, or 5 mL per dose.
A patient is preparing to travel to a country with prevalent malaria. To prevent contracting the disease, the provider has ordered chloroquine HCl (Aralen). The nurse will instruct the patient to take this drug according to which schedule?
500 mg weekly beginning 2 weeks prior to travel and continuing for 4 to 8 weeks after travel Rationale: For malaria prophylaxis, chloroquine is given 500 mg/dose weekly for 2 weeks prior to travel and then weekly until 6 to 8 weeks after exposure. The dosing schedule of 1000 mg once, followed by 500 mg in 6, 24, and 48 hours is used to treat acute malaria.
Which person should be treated with prophylactic antitubercular medication?
A patient who has close contact with someone who has tuberculosis Rationale: Personal contact with a person having a diagnosis of tuberculosis is required to indicate prophylactic treatment with antitubercular therapy. Attending the same school does not necessarily mean close contact occurs. Health care professionals do not need prophylactic treatment. HIV-positive individuals with negative TB skin tests do not need prophylaxis.
A patient will begin taking amoxicillin. The nurse should instruct the patient to avoid which foods?
Acidic fruits and juices Rationale:Acidic fruits and juices should be avoided while the client is being treated with amoxicillin because amoxicillin can be irritating to the stomach. Stomach irritation will be increased with the ingestion of citrus and acidic foods. Amoxicillin may also be less effective when taken with acidic fruit or juice.
A patient whose last flu vaccine was 1 year prior is exposed to the influenza A virus. The occupational health nurse will administer which medication?
Amantadine HCl (Symmetrel) Rationale: The primary use for amantadine is prophylaxis against influenza A. Acyclovir is used to treat herpes virus. Oseltamivir phosphate (Tamiflu) is to be taken once flu symptoms appear.
A young adult female who is taking metronidazole (Flagyl) to treat trichomoniasis calls the nurse to report severe headache, flushing, palpitations, cramping, and nausea. What will the nurse do next?
Ask about alcohol consumption. Rationale: Patients who are taking metronidazole can experience a disulfiram-like reaction when they drink alcohol. These are not harmless adverse effects or a sign of worsening of her infection.
The nurse is caring for a patient who is receiving a high dose of tetracycline (Sumycin). Which laboratory values will the nurse expect to monitor while caring for this patient?
Blood urea nitrogen (BUN) and creatinine levels Rationale: High doses of tetracyclines can lead to nephrotoxicity, especially when given along with other nephrotoxic drugs. Renal function tests should be performed to monitor for nephrotoxicity.
A patient is receiving high doses of a cephalosporin. Which laboratory values will this patient's nurse monitor closely?
Blood urea nitrogen (BUN), serum creatinine, and liver function tests Rationale:Cefazolin will produce an increase in the patient's BUN, creatinine, AST, ALT, ALP, LDH, and bilirubin.
A patient taking trimethoprim-sulfamethoxazole (TMP-SMX) to treat a urinary tract infection complains of a sore throat. The nurse will contact the provider to request an order for which laboratory test(s)?
Complete blood count with differential Rationale: A sore throat can indicate a life-threatening anemia, so a complete blood count with differential should be ordered.
The nurse is preparing to administer amoxicillin (Amoxil) to a patient and learns that the patient previously experienced a rash when taking penicillin. Which action will the nurse take?
Contact the provider to discuss using a different antibiotic. Rationale:Patients who have previously experienced manifestations of allergy to a penicillin should not use penicillins again unless necessary. The nurse should contact the provider to discuss using another antibiotic from a different class. Epinephrine and antihistamines are useful when patients are experiencing allergic reactions, depending on severity.
The nurse is caring for a patient who takes low-dose erythromycin as a prophylactic medication. The patient will begin taking cefaclor for treatment of an acute infection. The nurse should discuss this with the provider because taking both of these medications simultaneously can cause which effect?
Decreased effectiveness of cefaclor Rationale: The interaction of cefaclor and erythromycin will produce a decrease in the action of the cefaclor.
The nurse receives an order to administer a purine nucleoside antiviral medication. The nurse understands that this medication treats which type of virus?
Herpes virus Rationale: Purine nucleosides, such as acyclovir, are used to treat herpes simplex viruses 1 and 2, herpes zoster virus, varicella-zoster virus, and cytomegalovirus.
The nurse is preparing to administer intravenous gentamicin to an infant through an intermittent needle. The nurse notes that the infant has not had a wet diaper for several hours. The nurse will perform which action?
Hold the dose and contact the provider to request a serum trough drug level. Rationale:Gentamicin can cause nephrotoxicity. When changes in urine output occur, the provider should be notified, and serum trough levels should be obtained to make sure the drug is not at a toxic level. If the drug level is determined to be safe, giving extra fluids either orally or intravenously may be indicated. Serum peak levels give information about therapeutic levels but are not a substitution for avoiding nephrotoxicity in the face of possible oliguria.
The nurse is preparing to give trimethoprim-sulfamethoxazole (TMP-SMX) to a patient and notes a petechial rash on the patient's extremities. The nurse will perform which action?
Hold the dose and notify the provider. Rationale: A petechial rash can indicate a severe adverse reaction and should be reported.
The nurse is preparing to administer an intravenous polymyxin antibiotic. The patient reports dizziness along with numbness and tingling of the hands and feet. The nurse will perform which action?
Hold the drug and notify the provider of these adverse reactions Rationale: Polymyxins can cause nephrotoxicity and neurotoxicity. This patient has signs of neurotoxicity, so the nurse should notify the provider. These effects are generally reversible when the drug is discontinued. It is not correct to administer the drug when these symptoms are present. Polymyxins are not absorbed orally. Serum electrolytes are not indicated.
The nurse is preparing to administer trimethoprim-sulfamethoxazole (TMP-SMX) to a patient who is being treated for a urinary tract infection. The nurse learns that the patient has type 2 diabetes mellitus and takes a sulfonylurea oral antidiabetic drug. The nurse will monitor this patient closely for which effect?
Hypoglycemia Rationale: Taking oral antidiabetic agents (sulfonylurea) with sulfonamides increases the hypoglycemic effect. Sulfonylureas do not increase the incidence of headaches, hypertension, or superinfection when taken with sulfonamides. Examples of antidiabetic sulfonylurea medications are glipizide, glimepiride, glyburide, tolazamide, and tolbutamide.
The nurse is caring for a patient who is receiving an intravenous antibiotic. The patient has a serum drug trough of 1.5 mcg/mL. The normal trough for this drug is 1.7 to 2.2 mcg/mL. What will the nurse expect the patient to experience?
Inadequate drug effects rationale:Low peak levels may indicate that the medication is below the therapeutic level. They do not indicate altered risk for superinfection, a decrease in adverse effects, or a slowed onset of action.
The nurse is teaching a patient who will receive acyclovir for a herpes virus infection. What information will the nurse include when teaching this patient?
Increase fluid intake while taking this medication. Rationale: Patients taking acyclovir should increase fluid intake to maintain hydration. A complete blood count is not required, but WBC, platelets, hemoglobin, and hematocrit should be monitored. Dizziness and confusion should be reported to the provider. Antiviral medications have many side effects.
The nurse is preparing to give a dose of oral clindamycin (Cleocin) to a patient who is being treated for a skin infection caused by Staphylococcus aureus. The patient has had several doses of the medication and reports having nausea. Which action will the nurse take next?
Instruct the patient to take the next dose with a full glass of water. Rationale: Clindamycin should be taken with a full glass of water to minimize gastrointestinal (GI) irritation such as nausea, vomiting, and stomatitis. Giving the medication on an empty stomach will increase the likelihood of GI upset. It is not necessary to hold the next dose or to give an antacid.
The nurse is caring for a patient who has unexplained, recurrent vomiting and who is unable to keep anything down. Until the cause of the vomiting is determined, the nurse will anticipate administering which medications?
Intravenous fluids and electrolytes Rationale:Antiemetics can mask the underlying cause of vomiting and should not be used until the cause is determined unless vomiting is so severe that dehydration and electrolyte imbalance occur. Nonpharmacologic measures, such as fluid and electrolyte replacement, should be used. Antibiotics are only used if an infectious cause is determined.
The nurse is caring for a patient who is diagnosed with tuberculosis. The patient tells the nurse that the provider plans to order a prophylactic antitubercular drug for family members and asks which drug will be ordered. The nurse will expect the provider to order which drug?
Isoniazid (INH) Rationale:INH is the drug of choice for prophylactic treatment of patients who have had close contact with a patient who has tuberculosis.
The nurse assumes care for a patient who is currently receiving a dose of intravenous vancomycin (Vancocin) infusing at 20 mg/min. The nurse notes red blotches on the patient's face, neck, and chest and assesses a blood pressure of 80/55 mm Hg. Which action will the nurse take?
Slow the infusion to 10 mg/min and observe the patient closely. Rationale:When vancomycin is infused too rapidly, "red man" syndrome may occur; the rate should be 10 mg/min to prevent this. This is a toxic reaction, not an allergic one, so epinephrine is not indicated. Stevens-Johnson syndrome is characterized by a rash and fever. Red man syndrome is not related to renal function.
A patient who has chronic liver disease reports contact with a person who has tuberculosis (TB). The nurse will counsel this patient to contact the provider to discuss
a TB skin test Rationale: Patients who have exposure to TB should have a TB skin test. A chest x-ray is performed if the skin test is positive. LFTs do not need to be done simply because of TB exposure. This patient is not a candidate for antitubercular drug prophylaxis.
A patient is admitted to the hospital for treatment of pneumonia after complaining of high fever and shortness of breath. The patient was not able to produce sputum for a culture. The nurse will expect the patient's provider to order
a broad-spectrum antibiotic. Rationale:Broad-spectrum antibiotics are frequently used to treat infections when the offending organism has not been identified by culture and sensitivity (C&S). Narrow-spectrum antibiotics are usually effective against one type of organism and are used when the C&S indicates sensitivity to that antibiotic. The use of multiple antibiotics, unless indicated by C&S, can increase resistance. The pneumococcal vaccine is used to prevent, not treat, an infection.
The nurse is caring for a patient who has recurrent urinary tract infections. The patient's current infection is not responding to an antibiotic that has been used successfully several times in the past. The nurse understands that this is most likely due to
acquired bacterial resistance. rationale: Acquired resistance occurs when an organism has been exposed to the antibacterial drug. Cross-resistance occurs when an organism that is resistant to one drug is also resistant to another. Inherent resistance occurs without previous exposure to the drug. Transferred resistance occurs when the resistant genes of one organism are passed to another organism
A child is brought to the emergency department after ingestion of a toxic substance. The child is alert and conscious and is reported to have ingested kerosene 20 minutes prior. The nurse will anticipate administering
activated charcoal. Rationale: Activated charcoal is used when patients have ingested a caustic substance or a petroleum distillate in a patient who is alert and awake. Gastric lavage is no longer used as therapy. Syrup of ipecac is not recommended.
The nurse is preparing to give a dose of trimethoprim-sulfamethoxazole (TMP-SMX) and learns that the patient takes warfarin (Coumadin). The nurse will request an order for
coagulation studies Rationale: Sulfonamides can increase the anticoagulant effects of warfarin. The nurse should request INR levels. An increased dose of warfarin would likely lead to toxicity and to undesirable anticoagulation.
A patient will take an anthelmintic medication and asks the nurse about side effects. The nurse will tell the patient that anthelmintic drugs
commonly have gastrointestinal (GI) side effects. Rationale: Anthelmintic drugs have many GI side effects, including anorexia, nausea, vomiting, diarrhea, and cramps. Adverse reactions do not occur frequently.
A patient who is taking diphenoxylate with atropine (Lomotil) to treat diarrhea asks the nurse why it contains atropine. The nurse will explain that atropine is added to
decrease abdominal cramping. Rationale: Atropine is added to decrease abdominal cramping and intestinal motility. It does not affect nausea and vomiting or pain.
A patient who will begin taking trimethoprim-sulfamethoxazole (TMP--SMX) asks the nurse why the combination drug is necessary. The nurse will explain that the combination is used to
decrease bacterial resistance. Rationale: The combination drug is used to decrease bacterial resistance to sulfonamides. It does not broaden the spectrum, improve the taste, or decrease toxicity.
A patient who has tuberculosis asks the nurse why three drugs are used to treat this disease. The nurse will explain that multidrug therapy is used to reduce the likelihood of
drug resistance Rationale: Without multidrug therapy, patients easily develop resistance to antitubercular drugs. Using more than one antitubercular drug does not prevent relapse, hypersensitivity reactions, or adverse effects.
The nurse is caring for a patient who is ordered to receive PO trimethoprim-sulfamethoxazole (TMP-SMX) 160/800 QID to treat a urinary tract infection caused by E. coli. The nurse will contact the provider to clarify the correct
frequency. Rationale: TMP-SMX is taken twice daily. This is the correct dose, drug, and route to treat this condition.
The nurse is teaching a group of nursing students about the use of antipsychotic drugs for antiemetic purposes. The nurse will explain that, when given as antiemetics, these drugs are given
in smaller doses. Rationale: Antipsychotic medications have antiemetic properties in smaller doses.
The nurse is caring for a 70-kg patient who is receiving gentamicin (Garamycin) 85 mg 4 times daily. The patient reports experiencing ringing in the ears. The nurse will contact the provider to discuss
obtaining a serum drug level. Rationale: Aminoglycosides can cause ototoxicity. Any changes in hearing should be reported to the provider so that serum drug levels can be monitored. The dose is correct for this patient's weight (5 mg/kg/day in 4 divided doses). A hearing test is not indicated unless changes in hearing persist.
A patient who is taking acyclovir (Zovirax) to treat an oral HSV-1 infection asks the nurse why oral care is so important. The nurse will tell the patient that meticulous oral care helps to
prevent gingival hyperplasia. Rationale: Good oral care can prevent gingival hyperplasia in patients with HSV-1.
The nurse is caring for a patient who will begin taking doxycycline to treat an infection. The nurse should plan to give this medication a.
with food to improve absorption. Rationale:Doxycycline is a lipid-soluble tetracycline and is better absorbed when taken with milk products and food. It should not be taken on an empty stomach. Antacids impair absorption of tetracyclines. Small sips of water are not necessarily indicated.
