NR 293 Pharm-Exam 1 Study – Flashcards
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What is meant by "Definitive therapy" in regards to antibiotic therapy?
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Antibiotic therapy tailored to treat organism identified with cultures (PP Slide 13)
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What is meant by "Prophylactic therapy" in regards to antibiotic treatment?
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Treatment with antibiotics to prevent an infection such as those received before and after surgeries and traumatic injuries.
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What is a therapeutic response to antibiotic therapy? What are some indications of this?
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It means the antibiotic is working correctly. This is indicated by decreases in specific s/s of the noted infection (fever decreasing, elevated WBC counts returning to normal levels, resolution of redness, inflammation decrease, drainage cessation, pain reduction)
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What is a subtherapeutic response?
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S/S of the infection do not improve with antibiotic therapy
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What is a superinfection?
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This can occur as a result of an antibiotic dropping the levels of the normal flora, or killing them completely. When these are killed off, other non-normative body flora begin to grow and cause an infection. (Ex: a vaginal yeast infection)
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What is Pseudomembranous colitis?
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This is a type of superinfection that tends to have a higher level of severity. It is better known as Clostridium Difficile, or commonly C. Diff. -This is brought on by the elimination of normal gut flora which is then replaced by the C.Diff bacteria. - The most common s/s is watery foul smelling diarrhea occurring frequently, fever, abdominal pain and cramping.
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What is a secondary infection?
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A type of superinfection as well. It occurs when a second infection closely follows the initial infection, and comes from an external source.
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What is meant by "host-factors" in regards to antibiotic therapy?
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Important factors that pertain to the patient specifically. Examples can include age, history, allergies, pregnancy, kidney and liver function, site of infection, host defense mechanisms (immunocompromisation)
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Drugs that cause developmental abnormalities in the fetus of a pregnant woman taking them are known as what?
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Teratogens
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Some patients have certain genetic abnormalities that result in various enzyme deficiencies. Name two of the more common ones.
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-Glucose-6-phosphate dehydrogenase (G6PD) -Slow acetylation
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Explain slow acetylation
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These type of patients have a physiologic makeup that causes certain drugs to be metabolized more slowly than usual in a chemical step known as acetylation. This can lead to toxicity from drug accumulation.
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Explain what may occur if a person is administered antibiotics such as sulfonamides, nitrofurantoin, or dapsone to a person with G6PD?
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Hemolysis (destruction of red blood cells)
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Sulfonamides are one of the first drugs used as antibiotics. Although there are many compounds in this family, only one of them is commonly used in clinical practice. What is it?
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Sulfamethoxazole combined with trimethoprim. -Commonly known as Bactrim, Septra, or co-trimoxazole. Often abbreviated as SMZ-TMP. It is also commonly combined with erythromycin (macrolide) for pediatric patients. -Sulfasalazine is another form which is used to treat ulcerative colitis and RA, but not as an antibiotic.
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What is the mechanism of action of Sulfonamides?
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They are bacteriostatic. This means they don't actually kill the bacteria, but rather inhibit their growth. -They do this by preventing the bacteria from Folic acid synthesis, which is required for proper synthesis of purines, one of the chemical components of DNA and RNA.
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Are sulfonamides a broad or narrow spectrum antibiotic?
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They are broad spectrum and act against both gram-positive and gram-negative organisms.
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What organ is responsible for the elimination of sulfonamide antibiotics?
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The Kidneys -They also tend to have high concentrations in the kidneys, and are therefore often used in the treatment of UTIs (via Sulfamethoxazole/Trimethoprim)
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What are some sulfonamide susceptible organisms or strains of enterobacter species?
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-E. Coli (think UTI) -Klebsiella spp. -Proteus mirabilis -Proteus vulgaris -Staph aureus
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What are two infections that can be treated with Sulfonamides?
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-UTI -Upper respiratory
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SMX-TMP is commonly used to treat what?
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Outpatient Staphylococcus infections
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Pneumocystis jiroveci pneumonia is a bacteria that commonly causes HIV associated pneumonia. What antibiotic is usually used to treat this type of infection?
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A sulfonamide known as Sulfamethoxazole/Trimethoprim. It is usually abbreviated SMZ-TMP, or co-trimoxazole
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Sulfonamides is contraindicated in what demographic of people?
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Pregnant women and infants younger than 2 months of age
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What are some reported adverse effects of Sulfonamides?
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*Blood*-Agranulocytosis, aplastic anemia, hemolytic anemia, thrombocytopenia. *G.I.*- N/V/D, pancreatitis, hepatotoxicity *Integumentary*-Epidermal necrolysis, Steven-Johnson syndrome, photosensitivity Other effects may include convulsions, crystalluria, toxic nephrosis, HA, peripheral neuritis, urticaria, cough.
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What effect can sulfonamides have on the blood thinner Warfarin?
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It can increase the anticoagulative effectiveness causing an increased possibility of hemorrhage. -It can also increase the toxic effects of phenytoin
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Beta-Lactam antibiotics are a group of very commonly used drugs. They are so named because of the Beta-Lactam ring that is part of their chemical structure. What antibiotic types are included under this umbrella group term?
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-Penicillins -Cephalosporins -Carbapenems -Monobactams These all share a common structure and mechanism of action; inhibit the synthesis of bacterial peptidoglycan cell wall.
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The penicillins can be divided into four subgroups based on their structure and the spectrum of bacteria they are active against. What are the names of these subgroups? (Hint: NPAE)
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-Natural penicillins -Penicillinase-resistant penicillins -Aminopenicillins -Extended-spectrum penicillins
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What are two broad spectrum antibiotics are known to have frequent occurrences of allergic reactions in patients?
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Sulfonamides and Penicillins
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What is the difference between bactericidal and bacteriostatic antibiotics?
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One kills it (bactericidal) while the other inhibits bacterial growth and reproduction, eventually killing it as well.
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What is the generic names for the two types of natural penicillins?
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-Penicillin G: This is the injectable form for IV or IM -Penicillin V: This is the oral form for PO
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What are the three generic types of Penicillinase-Resistant Penicillins? (Hint: CD NO)
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-Cloxacillin -Dicloxacillin -Nafcillin -Oxacillin *These are stable against hydrolysis by most staphylococcal penicillinases (enzymes that normally break down the natural penicillins).*
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What are the two generic types of aminopenicillins? (Hint: AA)
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-Amoxicillin -Ampicillin *These have an amino group attached to the basic penicillin structure that enhances their activity against gram-negative bacteria compared with natural penicillins.*
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What are the generic names that fall under the extended-spectrum penicillin drug umbrella? (Hint: PTCpT)
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-Piperacillin -Ticarcillin -Carbenicillin -Piperacillin/tazobactam (Zosyn) *These have wider spectra of activity than do all other penicillins.*
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Are penicillins bactericidal or bacteriostatic?
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Bactericidal
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What is the mechanism of action for penicillins?
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-Penicillin enter the bacteria via small holes in the cell wall. Inside the cell, they bind to penicillin-binding protein. Once bound, normal cell wall synthesis is disrupted and the bacteria cells die from cell lysis (it explodes) -Penicillins do not kill other cells in the body.
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The microorganisms most commonly destroyed by penicillins are: 1). Gram-Positive 2). Gram-Negative 3). Tuberculin 4). Anaerobic
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1). Gram-Positive is correct -These include Streptococcus spp., Enterococcus spp., and staphylococcus spp. -Most Natural Penicillins have little, if any, ability to kill gram negative bacteria. However, the extended-spectrum penicillins (i.e., piperacillin/tazobactam [Zosyn]) have excellent gram-positive, gram-negative, and anaerobic coverage. Because of this, the extended-spectrum penicillins are used to treat many health care-associated infections, including pneumonia, intra- abdominal infections, and sepsis.
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What are the contraindications of penicillin containing or derived usage?
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There are relatively none aside from a known drug allergy to penicillin. It is listed as a safe and well tolerated medication.
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Why is it important NOT to use trade names (Zosyn, Augmentin, etc.) when talking to a patient about these types of antibiotics?
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Because they contain penicillin, which people are fairly often allergic to. It's important to remember that not all antibiotics that contain penicillin contain the word, or end in the typical "-cillin" suffix.
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Patients who are allergic to penicillins have an increased risk for allergy to other _________________ antibiotics
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Beta-lactam
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The intravenous (IV) formulations of some penicillins contain large amounts of _______ and/or ________. Thus doses must be adjusted for patients with renal dysfunction.
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Sodium and/or Potassium
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A patient is receiving Augmentin (amoxicillin and clavulanic acid) liquid solution through a percutaneous endoscopic gastrostomy tube. What is the purpose of the clavulanic acid? 1 It works synergistically with the antibiotic to improve potency. 2 It inhibits the action of the enzymes produced by beta-lactamase-producing bacteria. 3 It protects the antibiotic from the harmful gastric acid secretions in the stomach. 4 It enhances the absorption of the antibiotic in the small intestine.
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Correct answer: 2 Rationale: The clavulanic acid works to inhibit the action of the enzymes produced by the bacteria, which would normally inactivate the antibiotic.
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What pregnancy category are penicillins classified as?
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Penicillins are classified as pregnancy category B drugs. They are very safe antibiotics. Their use is contraindicated in patients with a known hypersensitivity to them, but because of their relatively good adverse effects profile, there are otherwise very few contraindications to their use.
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Which condition is contraindicated for St. John's wort herbal therapy? 1 Anxiety 2 Seizures 3 Dementia 4 Pregnancy
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3 Dementia is contraindicated for St. John's wort herbal therapy; this herbal therapy is used to treat anxiety. Seizures are contraindicated for bupropion therapy. Pregnancy is contraindicated for ginseng herbal therapy.
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Which statements are true regarding the pharmacokinetic changes observed in infants? Select all that apply. 1 An infant's fat content is higher 2 An infant's gastric pH is less acidic 3 An infant's gastric emptying is slow 4 An infant's first-pass metabolism is slow 5 An infant's transdermal absorption is rapid
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2,3,4 Pharmacokinetic changes are observed in infants. An infant's gastric pH is less acidic because the acid-producing cells in the stomach are immature. Gastric emptying is slow due to irregular peristalsis. First-pass metabolism in the liver is slow because the liver is immature and has low levels of microsomal enzymes. An infant's fat content is low because of the high levels of total body water. Transdermal absorption is not affected by age.
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A nurse is reviewing a newly admitted client's medication administration record (MAR). Which element, if missing, makes the record incomplete? 1 Height 2 Allergies 3 Vital signs 4 Body weight
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2 Allergies should be listed on all MARs to prevent the administration of drugs to which the client is allergic. Height is part of the initial health history/physical assessment data. Weight is part of the initial health history/physical assessment data. The vital signs are part of the initial health history/physical assessment data.
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Which pharmacokinetic condition of a drug may result in a high intensity and long duration of response? 1 When both absorption and elimination are rapid 2 When both absorption and elimination are delayed 3 When absorption is rapid but elimination is delayed 4 When absorption is delayed but elimination is rapid
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3 Pharmacokinetic factors determine the concentration of a drug at its sites of action. When the drug's absorption is rapid and elimination is delayed, the concentration of the drug at the site of action is high. This action increases the intensity and duration of the drug response. When both the absorption and elimination rates are rapid, the concentration of drug at the site of action is lesser. This in turn decreases the duration of the drug response. In contrast, when both the absorption and elimination of the drug are delayed, the intensity of the drug's effect is also decreased. When absorption is delayed but elimination is rapid, the duration and intensity of the drug are decreased because the concentration of the drug at the site of action is low.
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A 55-year-old client who has a long history of drug and alcohol abuse mentions taking ginkgo biloba. The nurse knows that ginkgo biloba is taken to treat what condition? 1 Insomnia 2 Depression 3 Memory impairment 4 Anxiety and nervousness
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3 Ginkgo biloba is an herb used to treat age-related memory impairment and dementia. It has not been shown to be effective in treating insomnia, depression, or anxiety.
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According to Quality and Safety Education (QSEN), what is patient-centered care? 1 Understanding that the client is the source of control when providing care 2 Functioning effectively within nursing and interprofessional teams to deliver quality care 3 Using data to evaluate outcomes of care processes and designing methods to improve health care 4 Minimizing the risk of harm to clients and health care workers through improved professional performance
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1 The Quality and Safety Education (QSEN) competency called patient-centered care requires the nurse to understand that the client is the source of control. The nurse should therefore respect the values, beliefs, and preferences of the client to provide quality care. The QSEN competency called teamwork and collaboration states that a nurse should function effectively within nursing and interprofessional teams in order to provide quality care. Quality improvement involves using data to evaluate the outcomes of care processes and design methods to improve the health care delivery system. Safety focuses on minimizing the risk of harm to clients and health care workers through improved professional performance.
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During an interview and assessment, a 60-year-old client reports to the nurse, "I've been using St. John's wort to try to feel more like myself again. I'm not sure whether it's going to work." The nurse will pursue an assessment related to the client's report of which symptom? 1 Depression 2 Sleep disturbances 3 Diminished cognitive ability 4 Sensory-perceptual disturbances
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1 St John's wort is an herb that is marketed as a natural way to improve mood and ease feelings of depression. Because St. John's wort is considered a dietary supplement, it is not regulated by the Food and Drug Administration as drugs are. It has not been shown to exert positive effects in people with sleep disturbances, diminished cognitive abilities, or sensory-perceptual disturbances.
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Which precautions should the nurse follow to minimize medication errors in children? Select all that apply. 1 Report all medication errors 2 Receive verbal orders over the telephone 3 Use authoritative resources such as drug handbooks 4 Communicate with the parents or caregivers 5 Confirming information about the client every time a dose is given
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1,3,4,5 Using authoritative resources such as drug handbooks and confirming information about the client every time a dose is given helps to minimize medication errors. Communicating with the parents and caregivers would also help to decrease any medication errors. Reporting any medication errors helps to identify the cause of such errors. Receiving verbal orders over the telephone is not recommended because there may be a bad connection and important information may be lost.
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A client is being admitted for a total hip replacement. When is it necessary for the nurse to ensure that a medication reconciliation is completed? Select all that apply. 1 After reporting severe pain 2 On admission to the hospital 3 Upon entering the operating room 4 Before transfer to a rehabilitation facility 5 At time of scheduling for the surgical procedure
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2,4 Medication reconciliation involves the creation of a list of all medications the client is taking and comparing it to the healthcare provider's prescriptions on admission or when there is a transfer to a different setting or service, or discharge. A change in status does not require medication reconciliation. A medication reconciliation should be completed long before entering the operating room. Total hip replacement is elective surgery, and scheduling takes place before admission; medication reconciliation takes place when the client is admitted.
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A nurse is preparing a lecture for a group of nursing students related to ethics and legal principles. Which statement would be appropriate to include? 1 Beneficence emphasizes the importance of preventing harm and ensuring the client's well-being. 2 After the nurse has delegated a task or activity, the unlicensed assistive personnel (UAP) is accountable for the task or activity. 3 Social justice is an obligation to protect a client as an advocate when a client is not capable of self-determination. 4 There is a universal list that all states use that describes tasks that can be safely delegated and assigned to nursing team members.
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1 Beneficence is the ethical principle that emphasizes the importance of preventing harm and ensuring the client's well-being. The nurse is always accountable for the task or activity that is delegated. Social justice refers to equality; that is, all clients should be treated equally and fairly. Each state designates which tasks may be safely delegated and assigned to nursing team members.
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What does the basic principle of advocacy provide to the nurse according to the American Nurses Association (ANA) code of ethics? 1 The basic principle of advocacy helps the nurse remain competent in nursing practice. 2 The basic principle of advocacy helps the nurse provide care on the basis of the client's specific needs. 3 The basic principle of advocacy helps the nurse make a unique contribution to the understanding of the client's point of view. 4 The basic principle of advocacy helps the nurse ensure that professional actions can be explained to clients and the employer.
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The nurse advocates for the health, safety, and rights of clients along with their right to privacy. This helps the nurse to make a unique contribution to understanding the client's point of view. The basic principle of responsibility ensures that the nurse is responsible for his or her own actions and the actions of people to who tasks are delegated. In addition, this principle helps the nurse to remain competent in his or her practice. The nurse ensures that care is provided to clients only on the basis of their need. Accountability refers to ensuring that professional actions can be explained to the clients and the employer.
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A pregnant woman at 6 weeks' gestation tells the nurse at her first prenatal visit that she uses an over-the-counter herbal product as a health supplement. What should the nurse recommend to the client? Select all that apply. 1 Stop taking the supplement immediately. 2 Discuss the use of the supplement with the practitioner. 3 Increase the dosage of the supplement as pregnancy progresses. 4 Ask the pharmacist whether the supplement is safe for use during pregnancy. 5 Discuss the use of any over-the-counter products with the practitioner
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1,2,5 Stopping the supplement is appropriate until more instructions are received from the practitioner. It is the practitioner's responsibility to counsel the client regarding all prescriptions, over-the-counter medications, and supplements. Continuing or increasing the dose of the supplement is unsafe; it may be detrimental to both the client and the fetus. The nurse may not prescribe medications of any kind, and to do so is functioning outside of the legal definition of nursing practice. It is the practitioner's responsibility, not the pharmacist's, to counsel the client regarding all prescriptions, over-the-counter medications, and supplements.
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Which of these cultural groups adopts a combination of dietary, herbal, and other naturalistic therapies to prevent and treat illness? 1 East Asian 2 Hispanic 3 Asian Indian 4 Native American
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3 Asian Indians rely on a combination of dietary, herbal, and other naturalistic therapies to prevent and treat illness. East Asians use yin treatment (which uses needles to restore balance and flow of qi) and yang treatment (which uses moxibustion or heat with acupuncture to restore the yin/yang balance). Hispanics use a combination of prayers, herbs, and other rituals to treat traditional illnesses. Native Americans rely on a combination of prayers, chanting, and herbs to treat illnesses caused by supernatural, psychologic, and physical factors.
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Which actions by the nurse help set the stage for a patient-centered interview during the first visit after admission to the healthcare facility? Select all that apply. 1 Close the door after entering the room. 2 Greet the client using his or her last name. 3 Open the curtains to allow plenty of light in the room. 4 Introduce oneself with a smile and explain the reason for the visit. 5 Obtain an authorization from the client after the interview.
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1,2,4 The nurse should maintain the client's privacy by closing the door after entering the room. The nurse should maintain the dignity of the client by greeting the client using his or her last name. Smiling is a positive sign of warmth and immediacy when first establishing the nurse-client relationship. The nurse should explain his or her role in the providing care for the client. The nurse should ensure the room is adequately lit, comfortable, and soothing for the client. The nurse need not open the curtains to allow plenty of light in the room. The Health Insurance Portability and Accountability Act (HIPAA) requires the nurse to obtain an authorization from the client before collecting personal health data.
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An intravenous piggyback (IVPB) of cefazolin 500 mg in 50 mL of 5% dextrose in water is to be administered over a 20-minute period. The tubing has a drop factor of 15 drops/mL. At what rate per minute should the nurse regulate the infusion to run? Record your answer using a whole number. ______ gtts/min
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38 gtt/min
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The nurse is assessing four clients with infections in the mouth. Which client can be treated by nystatin as an oral suspension? 1 Client A with Trench Mouth 2 Client B with Moniliasis 3 Client C with cold sores 4 Client D with Parotitis
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3 Moniliasis is a fungal infection caused by Candida albicans. Nystatin is an antifungal medication used to treat fungal infections. Therefore client B can be treated with nystatin. Client A, with trench mouth, can be treated by a topical application of antibacterial and mouth irrigations with chlorhexidine. Client C, with cold sores, can be treated with antiviral medications. Client D, with parotitis, can be treated with adequate fluid intake and antibacterial medication.
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An adolescent with leukemia is to be sent home on a protocol that includes several antineoplastic agents. Before discharge, what medication instructions should the nurse give the parents? 1 Limit contact with all peers and family members. 2 Withhold medications when nausea occurs to prevent vomiting. 3 Schedule laboratory blood tests to evaluate response to the medication. 4 Return weekly for a bone marrow aspiration to monitor effectiveness of therapy.
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3 Blood tests indicate response to therapy; if the white blood cell count drops precipitously, therapy may be halted temporarily. These children undergo therapy for extended periods, and prolonged separation from their peers may lead to social isolation. Contact with children who have active infections should be avoided. Although nausea commonly occurs with this therapy, antiemetic measures are instituted; the drug is not withdrawn for this reason. A bone marrow aspiration is a painful procedure and is performed selectively (e.g., to confirm the diagnosis), not routinely.
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A client with osteomyelitis is receiving antibiotic therapy via a central line. Trough blood levels were obtained immediately before a prescribed dose of antibiotics, and peak levels were obtained 30 minutes after the infusion was completed. The laboratory results reveal that the trough level is higher than the peak level. What does the nurse conclude that this finding probably indicates? 1 The dose should be increased. 2 The dose is in excess of the client's needs. 3 There was an adequate administration of the antibiotic. 4 There was a problem with the obtaining of blood specimens
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4 Peak levels will always be higher than trough levels; therefore this result indicates some mix-up in the drawn samples. Increasing the dose would be an appropriate action if the trough level were too low. Concluding that the dose in excess of the client's needs would be appropriate if the trough level were too high, but not exceeding the peak. There is not enough information to determine whether the antibiotic administered is adequate
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What's the onset of a sublingual medication? Fast or slow?
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Fast; absorption is also fast. The patient should not eat or drink anything with the pill and it should be dissolved under the tongue completely.
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How would liver failure affect medications given?
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With liver failure, there is delayed metabolism of the medication. This means there is also a delay in the body's ability to process and eliminate it, making it easier for toxic levels to build up in the system.
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Why don't sleeping pills work as well in older adult populations?
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Because the metabolism of an older adult is usually slower than that of a younger person. This means the med doesnt work as well as it would in the younger patient.
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What is polypharmacy?
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It's defined by the book as the simultaneous use of multiple medications (Text, pg 40).
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What are some medications that place the elderly for falls and confusion?
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Sedatives and hypnotics
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What are some factors that increase drug toxicity in neonates?
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-An infant's gastric pH is less acidic -An infant's gastric emptying is slow -An infant's first-pass metabolism is low -Skin is thinner and more permeable -Development of metabolizing and excreting organs is not fully complete
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What is first-pass effect?
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A drug that is absorbed from the intestine must first pass through the liver before it reaches the systemic circulation. If a large proportion of a drug is chemically changed into inactive metabolites in the liver, then a much smaller amount of drug will pass into the circulation (i.e., will be bioavailable). Such a drug is said to have a high first-pass effect. First-pass effect reduces the bioavailability of the drug to less than 100%. Many drugs administered by mouth have a bioavailability of less than 100%, whereas drugs administered by the intravenous route are 100% bioavailable.
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How many days are suggested that it takes for a patient to become accustomed to a new medication?
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7 days
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Neomycin is the only drug in this group of antibiotics to be given via oral route. What type of antibiotic is it?
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Aminoglycosides
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What are two important things to "be on the lookout" for when a patient is receiving a round of aminoglycoside antibiotics?
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Nephrotoxicity and Ototoxicity. They are monitored through the process known as therapeutic drug monitoring where serum levels are checked in blood samples. This allows the HCP to ensure that levels are optimal for therapeutic effect but not high enough to cause a toxic effect.
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Which condition does the nurse anticipate when assessing a patient with tumor lysis syndrome? A). Hyperuricemia B). Hypophosphatemia C). Hypokalemia D. Hypercalcemia
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A (No idea why, I couldn't find it in the book. This question is from the powerpoint).
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Penicillins given in oral doses should not be given with juice for what reason?
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-Acidic content of juices may nullify the drugs antibacterial action.
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Patients taking penicillin should be monitored for at least ______ minutes after administration.
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30
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Sulfonamides should be taken with how many mL of fluid in a 24 hour period?
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2000 to 3000 ml
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What hematologic lab should be assessed before administration of sulfonamide antibiotics?
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RBC count
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Should doses of Sulfonamides be taken with or without food?
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With
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Tetracyclines bind to what elements in order to form insoluble complexes?
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Ca+++, Mg++, and Al++
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What are some things that should not be taken when a patient is being given a round of tetracycline antibiotics?
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Dairy products, Antacids, and Iron salts. These all reduce the oral absorption of the drug.
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Why are tetracyclines contraindicated in children younger than 8 and pregnant/lactating women?
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Because these types of antibiotics are known to cause permanent tooth discoloration and breakdown; results from it binding to the calcium in the teeth.
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What medication is generally given for RSV?
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Ribavirin (Trade name: Virazole)
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What is the prefered antibiotic given for MRSA infections?
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Vancomycin
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How is vancomycin similar to aminoglycosides?
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Vancomycin is similar to the aminoglycosides in that there are very specific drug levels in the blood that are safe. If the levels are too low (less than 5 mcg/mL), the dosage may be subtherapeutic with reduced antibacterial efficacy. If the blood levels are too high (over 50 mcg/mL), toxicities may result, the two most severe of which are ototoxicity (hearing loss) and nephrotoxicity (kidney damage).
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What are some adverse effects of Amphotericin? What is Amphotericin used to treat?
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Amphotericin is an antifungal medication that is used to treat severe systemic mycosis. Adverse effects include -Fever -Chills -Hypotension -Tachycardia -N/V/D -Malaise -Muscle and Joint pain -Anorexia -Headache
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How is stomatitis managed by the RN?
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1). The patient should be instructed to perform oral hygiene before and after intake of food, or as needed for comfort. They should avoid lemon, glycerine, undiluted peroxide, or alcohol containing products......for obvious reasons. 2). Recommend a soft-bristle toothbrush or other soft tipped cleaning tool to be used with warm diluted saline 3). If dentures are worn, they should be removed and cleaned regularly. If the stomatitis is a bad case, they should only be worn at mealtimes. 4). Advise the use of OTC saliva substitutes, keeping the lips moist, and using sugarless gum or candy to stimulate saliva production. 6). Oral antifungal suspensions (Nystatin) may be used if white patches are noted on the oral mucosa.
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