Pharmacology Chapter 87
Before administering an aminoglycoside, it is most important for the nurse to assess the patient for a history of what? A) Myasthenia gravis B) Asthma C) Hypertension D) Diabetes mellitus
A Aminoglycosides can inhibit neuromuscular transmission, causing flaccid paralysis and potentially fatal respiratory depression. These drugs should be used with extreme caution in patients with myasthenia gravis.
The nurse knows that there is an increased risk of ototoxicity in a patient receiving an aminoglycoside if which level is high? A) Concentration B) Trough C) Peak D) Dose
B When trough levels remain elevated, aminoglycosides are unable to diffuse out of inner ear cells, thus exposing the cells to the medication for an extended time. Prolonged exposure (i.e., high trough levels), rather than brief exposure to high levels, underlies cellular injury.
A patient is receiving an aminoglycoside (tobramycin) antibiotic. A nurse asks the patient to choose daily meal selections, to which the patient responds, "Oh, dear, I don't want another IV." The nurse makes which assessment about the patient's response? A) Some hearing loss may have occurred. B) The confusion is due to the hospital stay. C) A nutrition consult most likely is needed. D) The patient has a family history of dementia.
A The patient's comment suggests that the person did not hear the instructions. Aminoglycoside antibiotics can cause ototoxicity. The first sign may be tinnitus (ringing in the ears), progressing to loss of high-frequency sounds. Audiometric testing is needed to detect it. Nutrition, confusion, and a family history of dementia do not address the problem of possible hearing loss associated with aminoglycosides.
Which statements about serum drug levels does the nurse identify as true? (Select all that apply.) A) With once-daily dosing, only trough levels need to be drawn. B) Peak levels for intramuscular (IM) injections should be drawn 30 minutes after administration of the medication. C) The trough level ideally should be close to zero. D) For patients receiving once-daily doses, the sample should be drawn 2 hours before the next dose. E) For patients receiving divided doses, trough levels should be drawn 1 hour before the next dose.
A,B,C For patients receiving once-daily doses, the sample should be drawn 1 hour before the next dose. For patients receiving divided doses, trough levels should be drawn immediately before the next dose. The other three statements are true.
When administering an aminoglycoside to a patient with myasthenia gravis, it is most important for the nurse to assess what? A) Deep tendon reflexes B) Breath sounds C) Eyelid movement D) Muscle strength
B Aminoglycosides can inhibit neuromuscular transmission, causing potentially fatal respiratory depression. Patients with myasthenia gravis (MG) are at an increased risk. Deep tendon reflexes, eyelid movement, and muscle strength are important assessments for a patient who has MG, but they are not as important as airway and breathing ability.
A nurse is administering a daily dose of tobramycin (Nebcin) at 1000. At which time should the nurse obtain the patient's blood sample to determine the trough level? A) 0800 B) 0900 C) 1130 D) 1200
B Trough levels determine the lowest level between doses. Blood is drawn just before the next dose is administered when a divided dose is used or 1 hour before the next dose if a single daily dose is used.
A nurse monitors a patient who is receiving an aminoglycoside (gentamicin) for symptoms of vestibular damage. Which finding should the nurse expect the patient to have first? A) Unsteadiness B) Vertigo C) Headache D) Dizziness
C Gentamicin causes irreversible ototoxicity, which results in both impaired hearing and disruption of balance. Headache is the first sign of impending vestibular damage (balance) and may last 1 to 2 days. Unsteadiness, vertigo, and dizziness appear after headache.
A patient who is receiving an aminoglycoside (gentamicin) has a urinalysis result with all of these findings. Which finding should a nurse associate most clearly with an adverse effect of gentamicin? A) White blood cells (WBCs) B) Glucose C) Ketones D) Protein
D Aminoglycoside-induced nephrotoxicity usually presents as acute tubular necrosis. Symptoms of concern are protein in the urine, dilute urine, and elevation of the serum creatinine and blood urea nitrogen (BUN) levels. WBCs, glucose, and ketones are not specifically related to gentamicin use.
A patient who is receiving an aminoglycoside develops flaccid paralysis and impaired breathing. Which medication does the nurse anticipate administering? A) Magnesium sulfate (Epsom salt) B) Potassium chloride (K-Dur) C) Sodium bicarbonate (Citrocarbonate) D) Calcium gluconate (Kalcinate)
D Flaccid paralysis and impaired breathing are signs of impaired neuromuscular transmission, which may occur with aminoglycosides, especially if they are administered concurrently with a neuromuscular blocking agent. Impaired transmission can be reversed with intravenous infusion of a calcium salt (calcium gluconate). Magnesium sulfate, potassium chloride, and sodium bicarbonate do not reverse impaired neuromuscular transmission caused by aminoglycosides.
Which enteral aminoglycoside would the nurse expect to be ordered preoperatively for a patient having intestinal surgery? A) Gentamicin B) Tobramycin C) Amikacin D) Neomycin
D In general, aminoglycosides are poorly absorbed in the gastrointestinal (GI) tract. Neomycin is given orally to suppress bowel flora before surgery of the intestine and is not used parenterally because of its high nephrotoxicity and ototoxicity. Gentamicin, tobramycin, and amikacin are administered parenterally only.
Which statements about ototoxicity and aminoglycosides does the nurse identify as true? (Select all that apply.) A) The risk of ototoxicity is related primarily to excessive peak levels. B) The first sign of impending cochlear damage is headache. C) The first sign of impending vestibular damage is tinnitus . D) Ototoxicity is largely irreversible. E) Use of aminoglycosides for less than 10 days is recommended to avoid ototoxicity.
D,E The risk of ototoxicity with aminoglycoside use is related primarily to excessive trough levels. The first sign of impending vestibular damage is headache. The first sign of cochlear damage is tinnitus. The other two statements are true.
