Week 2 part 1
When reviewing the allergy history of a patient, the nurse notes that the patient is allergic to penicillin. Based on this finding, the nurse would question an order for which class of antibiotics?
The nurse is providing teaching to a patient taking an oral tetracycline antibiotic. Which statement by the nurse is correct?
“Avoid direct sunlight and tanning beds while on this medication.”
When reviewing the medication orders for a patient who is taking penicillin, the nurse notes that the patient is also taking the oral anticoagulant warfarin (Coumadin). What possible effect may occur as the result of an interaction between these drugs?
The penicillin will cause an enhanced anticoagulant effect of the warfarin.
A patient is receiving his third intravenous dose of a penicillin drug. He calls the nurse to report that he is feeling “anxious” and is having trouble breathing. What will the nurse do first?
Stop the antibiotic infusion
During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and decreased appetite. Which statement is the nurse’s best advice to the patient?
“Drink a full glass of water with each dose.”
The nurse is monitoring a patient who has been on antibiotic therapy for 2 weeks. Today the patient tells the nurse that he has had watery diarrhea since the day before and is having abdominal cramps. His oral temperature is 101° F (38.3° C). Based on these findings, which conclusion will the nurse draw?
The patient needs to be tested for Clostridium difficile infection.
The nurse is monitoring for therapeutic results of antibiotic therapy in a patient with an infection. Which laboratory value would indicate therapeutic effectiveness of this therapy?
Decreased white blood cell count
The nurse is reviewing the sputum culture results of a patient with pneumonia and notes that the patient has a gram-positive infection. Which generation of cephalosporin is most appropriate for this type of infection?
A patient will be having oral surgery and has received an antibiotic to take for 1 week before the surgery. The nurse knows that this is an example of which type of therapy?
During drug therapy for pneumonia, a female patient develops a vaginal superinfection. The nurse explains that this infection is caused by
large doses of antibiotics that kill normal flora
The nurse is preparing to use an antiseptic. Which statement is correct regarding how antiseptics differ from disinfectants?
Disinfectants are used only on nonliving objects to destroy organisms.
A patient with a long-term intravenous catheter is going home. The nurse knows that if he is allergic to seafood, which antiseptic agent is contraindicated?
During antibiotic therapy, the nurse will monitor closely for signs and symptoms of a hypersensitivity reaction. Which of these assessment findings may be an indication of a hypersensitivity reaction? (Select all that apply.)
Shortness of breath
Swelling of the tongue
The nurse is reviewing the medication history of a patient who will be taking a sulfonamide antibiotic. During sulfonamide therapy, a significant drug interaction may occur with which of these drugs or drug classes? (Select all that apply.)
A patient will be receiving amoxicillin suspension 300 mg via a gastrostomy tube every 8 hours. The medication comes in a bottle that contains 400 mg/5 mL. How many milliliters will the nurse administer with each dose? (Record answer using one decimal place.)
400 mg : 5 mL :: 300 mg : x mL
Solve for x: (400 ´ x) = (5 ´ 300); 400x = 1500; x = 3.75, rounding to 3.8; administer 3.8 mL
A patient will be receiving penicillin G potassium, 12 million units daily in divided doses every 4 hours IVPB. How many units will the patient receive for each dose?
2 million units
If a medication is given every 4 hours, then there will be 6 doses in 24 hours
(24 ¸ 4 = 6). 12 million units ¸ 6 doses = 2 million units/dose
When a patient is on aminoglycoside therapy, the nurse will monitor the patient for which indicators of potential toxicity?
Tinnitus and dizziness
The nurse is administering a vancomycin (Vancocin) infusion. Which measure is appropriate for the nurse to implement in order to reduce complications that may occur with this drug’s administration?
Infusing the drug over at least 1 hour
Which nursing diagnosis is appropriate for a patient who has started aminoglycoside therapy?
Risk for injury (renal damage)
A patient who has been hospitalized for 2 weeks has developed a pressure ulcer that contains multidrug-resistant Staphylococcus aureus (MRSA). Which drug would the nurse expect to be chosen for therapy?
A patient is receiving aminoglycoside therapy and will be receiving a beta-lactam antibiotic as well. The patient asks why two antibiotics have been ordered. What is the nurse’s best response?
“The combined effect of both antibiotics is greater than each of them alone.”
The nurse is reviewing the medication orders for a patient who will be receiving linezolid (Zyvox) therapy. Which other medication or medication class, if ordered, would be a potential interaction concern?
Selective serotonin reuptake inhibitor antidepressants
The nurse checks the patient’s laboratory work prior to administering a dose of vancomycin (Vancocin) and finds that the trough vancomycin level is 24 mcg/mL. What will the nurse do next?
Hold the drug, and notify the prescriber.
A patient has been diagnosed with Klebsiella pneumoniae carbapenemases (KPC). The nurse expects to see orders for which drug?
colistimethate sodium (Coly-Mycin), a polypeptide antibiotic
A 79-year-old patient is receiving a quinolone as treatment for a complicated incision infection. The nurse will monitor for which adverse effect that is associated with these drugs?
Tendonitis and tendon rupture
The nurse who is administering aminoglycoside therapy must monitor the patient closely for signs of toxicity as manifested by which of these conditions? (Select all that apply.)
Rising serum creatinine level
The nurse is administering intravenous vancomycin (Vancocin) to a patient who has had gastrointestinal surgery. Which nursing measures are appropriate? (Select all that apply.)
Monitoring serum creatinine levels
Warning the patient that a flushed feeling or facial itching may occur
Instructing the patient to report dizziness or a feeling of fullness in the ears
Reporting a trough drug level of 24 mcg/mL and holding the drug
A patient will be receiving nitrofurantoin (Macrodantin) treatment for a urinary tract infection. The nurse is reviewing the patient’s history and will question the nitrofurantoin order if which disorder is present in the history? (Select all that apply.)
Chronic renal disease
A patient with a Pseudomonas species urinary infection will be receiving amikacin (Amikin) 15 mg/kg once daily via intravenous infusion. The patient weighs 198 pounds, and the medication is available in an injection solution strength of 250 mg/mL. How many milliliters of medication will be drawn up for this injection? (Record answer using one decimal place.)
Calculate the patient’s weight in kilograms: 198 pounds ¸ 2.2 = 90 kg
Calculate mg/kg dose: 15 mg ´ 90 kg = 1350 mg per dose
Calculate milliliters needed for this dose:
250 mg : 1 mL :: 1350 mg : x mL
Solve for x: (250 ´ x) = (1 ´ 1350); 250x = 1350; x = 5.4 mL
A patient who is diagnosed with shingles is taking topical acyclovir, and the nurse is providing instructions about adverse effects. The nurse will discuss which adverse effects of topical acyclovir therapy?
Transient burning when applied
A patient who has undergone a lung transplant has contracted cytomegalovirus (CMV) retinitis. The nurse expects which drug to be ordered for this patient?
An infant has been hospitalized with a severe lung infection caused by the respiratory syncytial virus (RSV) and will be receiving medication via the inhalation route. The nurse expects which drug to be used?
A patient who is HIV-positive has been receiving medication therapy that includes zidovudine (Retrovir). However, the prescriber has decided to stop the zidovudine because of its dose-limiting adverse effect. Which of these conditions is the dose-limiting adverse effect of zidovudine therapy?
Bone marrow suppression
The nurse is administering intravenous acyclovir (Zovirax) to a patient with a viral infection. Which administration technique is correct?
Infuse intravenous acyclovir slowly, over at least 1 hour.
A patient is receiving cidofovir (Vistide) as part of treatment for a viral infection, and the nurse is preparing to administer probenecid, which is also ordered. Which is the rationale for administering probenecid along with the cidofovir treatment?
Concurrent drug therapy with probenecid reduces the nephrotoxicity of the cidofovir.
A patient is taking a combination of antiviral drugs as treatment for early stages of HIV infection. While discussing the drug therapy, the patient asks the nurse if the drugs will kill the virus. When answering, the nurse keeps in mind which fact about antiviral drugs?
They may also kill healthy cells while killing viruses
A young adult calls the clinic to ask for a prescription for “that new flu drug.” He says he has had the flu for almost 4 days and just heard about a drug that can reduce the symptoms. What is the nurse’s best response to his request?
“Drug therapy should be started within 2 days of symptom onset, not 4 days.”
The nurse is providing counseling to a woman who is HIV positive and has just discovered that she is pregnant. Which anti-HIV drug is given to HIV-infected pregnant women to prevent transmission of the virus to the infant?
A patient who is diagnosed with genital herpes is taking topical acyclovir. The nurse will provide which teaching for this patient? (Select all that apply.)
“Be sure to wash your hands thoroughly before and after applying this medicine.”
“Use a clean glove when applying this ointment.”
“You will need to avoid touching the area around your eyes.”
“You will have to practice abstinence when these lesions are active.”
A patient is in the HIV clinic for a follow-up appointment. He has been on antiretroviral therapy for HIV for more than 3 years. The nurse will assess for which potential adverse effects of long-term antiretroviral therapy? (Select all that apply.)
Type 2 diabetes
A patient with a viral infection is to receive ganciclovir (Cytovene) 5 mg/kg/day IVPB every morning. The patient weighs 110 pounds. How many milligrams will this patient receive for this dose?
Convert 110 pounds to kilograms: 110 ¸ 2.2 = 50 kg
Calculate dose: 5 mg/kg/day ´ 50 kg = 250 mg/day
The nurse is discussing adverse effects of antitubercular drugs with a patient who has active tuberculosis. Which potential adverse effect of antitubercular drug therapy should the patient report to the prescriber?
Numbness and tingling of extremities
A patient who has been taking isoniazid (INH) has a new prescription for pyridoxine. She is wondering why she needs this medication. The nurse explains that pyridoxine is often given concurrently with the isoniazid to prevent which condition?
The nurse will assess the patient for which potential contraindication to antitubercular therapy?
When monitoring patients on antitubercular drug therapy, the nurse knows that which drug may cause a decrease in visual acuity?
A patient has been taking antitubercular therapy for 3 months. The nurse will assess for what findings that indicate a therapeutic response to the drug therapy?
There is a decrease in symptoms of tuberculosis along with improved chest x-rays and sputum cultures.
The nurse is counseling a woman who will be starting rifampin (Rifadin) as part of antitubercular therapy. The patient is currently taking oral contraceptives. Which statement is true regarding rifampin therapy for this patient?
Oral contraceptives are less effective while the patient is taking rifampin.
The nurse is reviewing the medication administration record of a patient who is taking isoniazid (INH). Which drug or drug class has a significant drug interaction with isoniazid?
A patient who has started drug therapy for tuberculosis wants to know how long he will be on the medications. Which response by the nurse is correct?
“You should expect to take these drugs for as long as 24 months.”
The nurse is preparing to administer morning medications to a patient who has been newly diagnosed with tuberculosis. The patient asks, “Why do I have to take so many different drugs?” Which response by the nurse is correct?
“Using multiple drugs enhances the effect of each drug.”
A patient newly diagnosed with tuberculosis (TB) has been taking antitubercular drugs for 1 week calls the clinic and is very upset. He says, “My urine is dark orange! What’s wrong with me?” Which response by the nurse is correct?
“This is an expected side effect of the medicine. Let’s review what to expect.”
The nurse is providing patient teaching for a patient who is starting antitubercular drug therapy. Which of these statements should be included? (Select all that apply.)
“Take the medications at the same time every day.”
“Avoid alcoholic beverages while on this therapy.”
“If you experience a burning or tingling in your fingers or toes, report it to your prescriber immediately.”
“Oral contraceptives may not work while you are taking these drugs, so you will have to use another form of birth control.”
During an intravenous (IV) infusion of amphotericin B, a patient develops tingling and numbness in his toes and fingers. What will the nurse do first?
Discontinue the infusion immediately.
The nurse is assessing a patient who is about to receive antifungal drug therapy. Which condition, if found in the patient, would be of most concern?
If a patient is taking fluconazole (Diflucan) with an oral anticoagulant, the nurse will monitor for which possible interaction?
Increased effects of oral anticoagulants, resulting in increased PT/INR
The nurse is preparing an infusion of amphotericin B for a patient who has a severe fungal infection. Which intervention is appropriate regarding the potential adverse effects of amphotericin B?
Before beginning the infusion, administering an antipyretic and an antiemetic drug
The nurse is administering one of the lipid formulations of amphotericin B. When giving this drug, which concept is important to remember?
The lipid formulations are associated with fewer adverse effects than the older drugs.
The nurse is reviewing instructions for vaginal antifungal drugs with a patient. Which statement by the nurse is an appropriate instruction regarding these drugs?
“Abstain from sexual intercourse until the treatment has been completed and the infection has resolved.”
A patient is infected by invasive aspergillosis, and the medical history reveals that the patient has not been able to tolerate several antifungal drugs. The nurse anticipates an order for which medication to treat this infection?
A patient with a severe fungal infection has orders for voriconazole (Vfend). The nurse is reviewing the patient’s medical record and would be concerned if which assessment finding is noted?
History of cardiac dysrhythmias
During therapy with amphotericin B, the nurse will monitor the patient for known adverse effects that would be reflected by which laboratory result?
Serum potassium level of 2.7 mEq/L
A patient has received a prescription for a 2-week course of antifungal suppositories for a vaginal yeast infection. She asks the nurse if there is an alternative to this medication, saying, “I don’t want to do this for 2 weeks!” Which is a possibility in this situation?
A single dose of a fluconazole (Diflucan) oral tablet
A patient is taking nystatin (Mycostatin) oral lozenges to treat an oral candidiasis infection resulting from inhaled corticosteroid therapy for asthma. Which instruction by the nurse is appropriate?
“Let the lozenge dissolve slowly and completely in your mouth without chewing it.”
The nurse is administering an amphotericin B infusion. Which actions by the nurse are appropriate? (Select all that apply.)
Discontinuing the drug immediately if the patient develops tingling and numbness in the extremities
Using an infusion pump for IV therapy
Monitoring the IV site for signs of phlebitis and infiltration
Administering premedication for fever and nausea
A patient will be taking fluconazole (Diflucan) 100 mg/day PO for 2 weeks. The patient is unable to swallow tablets, so an oral suspension that contains 10 mg/mL is available. How many milliliters will the nurse administer with each dose?
10 mg : 1 mL :: 100 mg : x mL
(10 ´ x) = (1 ´ 100); 10x = 100; x = 10 mL