PHARM CHAPTER 39: ANTIBIOTICS PART 2 – Flashcards
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When a patient is on aminoglycoside therapy, the nurse will monitor the patient for which indicators of potential toxicity? A. Fever B. White Blood cell count of 8,000 cells/mm 3 C. Tinnitus and Dizziness D. Decreased Blood Urea Nitrogen (BUN) levels
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C. Tinnitus and Dizziness Rationale: Dizziness, tinnitus, hearing loss, or a sense of fullness in the ears could indicate ototoxicity, a potentially serious toxicity in a patient. Nephrotoxicity is indicated by rising blood urea nitrogen and creatinine levels. Fever may be indicative of the patient's infection; a white blood cell count of 7000 cells/mm3 is within the normal range of 5000 to 10,000 cells/mm3.
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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? A. Monitoring blood pressure for hypertension during the infusion B. Discontinuing the drug immediately if red man syndrome occurs C. Restricting fluids during vancomycin therapy D. Infusing the drug over at least 1 hour
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D. Infusing the drug over at least 1 hour Rationale: Infuse the medication over at least 1 hour to reduce the occurrence of red man syndrome. Adequate hydration (at least 2 L of fluid in 24 hours) during vancomycin therapy is important for the prevention of nephrotoxicity. Hypotension may occur during the infusion, especially if it is given too rapidly.
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Which nursing diagnosis is appropriate for a patient who has started aminoglycoside therapy? A. Constipation B. Risk for injury (renal damage) C. Disturbed body image related to gynecomastia D. Imbalanced nutrition, less than body requirements, related to nausea
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B. Risk for Injury (Renal Damage) Rationale: Patients on aminoglycoside therapy have an increased risk for injury caused by nephrotoxicity. The other options are incorrect.
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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. Metronidazole (Flagyl) B. Ciprofloxacin (Cipro) C. Vancomycin (Vancocin) D. Tobramycin (Nebcin)
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C. Vancomycin (Vancocin) Rationale: Vancomycin is the drug of choice for the treatment of MRSA. The other drugs are not used for MRSA.
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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? A. "The combined effect of both antibiotics is greater than each of them alone." B. "One antibiotic is not strong enough to fight the infection." C. "We have not yet isolated the bacteria, so the two antibiotics are given to cover a wide range of microorganisms." D. "We can give a reduced amount of each one if we give them together."
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A. " The combined effect of both antibiotics is greater than each of them alone" Rationale: Aminoglycosides are often used in combination with other antibiotics, such as beta-lactams or vancomycin, in the treatment of various infections because the combined effect of the two antibiotics is greater than that of either drug alone.
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The nurse is reviewing the medication orders for a patient who will be receiving gentamicin therapy. Which other medication or medication class, if ordered, would be a potential interaction concern? A. Calcium channel blockers B. Phenytoin C. Proton pump inhibitors D. Loop diuretics
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D. Loop Diuretics Rationale: Concurrent use of aminoglycosides, such as gentamicin, with loop diuretics increases the risk for ototoxicity. The other drugs and drug classes do not cause interactions.
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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? A. Administer the vancomycin as ordered. B. Hold the drug, and administer 4 hours later. C. Hold the drug, and notify the prescriber. D. Repeat the test to verify results.
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C. Hold the drug, notify the prescriber. Rationale: Optimal blood levels of vancomycin are a trough level of 10 to 20 mcg/mL. Measurement of peak levels is no longer routinely recommended, and only trough levels are commonly monitored. Blood samples for measurement of trough levels are drawn immediately before administration of the next dose. Because of the increase in resistant organisms, many clinicians use a trough level of 15 to 20 mcg/mL as their goal. These trough levels mean that even just before the next dose is due, when drug levels should be low, the drug levels are actually too high.
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A patient has been diagnosed with carbapenemase-resistant Enterobacteriaceae (CRE). The nurse expects to see orders for which drug? A. Dapsone (Cubicin), a miscellaneous antibiotic B. Ciprofloxacin (Cipro), a quinolone C. Linezolid (Zyvox), an oxazolidinone D. Colistimethate sodium (Coly-Mycin), a polypeptide antibiotic
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D. D. Colistimethate sodium (Coly-Mycin), a polypeptide antibiotic Rationale: Colistimethate (Coly-Mycin), commonly referred to as colistin, is now being used again, often as one of the only drugs available to treat CRE. The other options are incorrect.
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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? A. Neuralgia B. Double vision C. Hypotension D. Tendonitis and tendon rupture
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D. Tendonitis and Tendon Rupture Rationale: A black-box warning is required by the U.S. Food and Drug Administration for all quinolones because of the increased risk for tendonitis and tendon rupture with use of the drugs. This effect is more common in elderly patients, patients with renal failure, and those receiving concurrent glucocorticoid therapy (e.g., prednisone). The other options are not common adverse effects.
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The nurse is administering intravenous vancomycin (Vancocin) to a patient who has had gastrointestinal surgery. Which nursing measures are appropriate? (Select all that apply.) A. Monitoring serum creatinine levels B. Restricting fluids while the patient is on this medication C. Warning the patient that a flushed feeling or facial itching may occur D. Instructing the patient to report dizziness or a feeling of fullness in the ears E. Reporting a trough drug level of 11 mcg/mL and holding the drug F. Reporting a trough drug level of 24 mcg/mL and holding the drug
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A.Monitoring serum creatinine levels C. Warning the patient that a flushed feeling or facial itching may occur D. Instructing the patient to report dizziness or a feeling of fullness in the ears F. Reporting a trough drug level of 24 mcg/mL and holding the drug Rationale: Constant monitoring for drug-related neurotoxicity, nephrotoxicity, ototoxicity, and superinfection remain critical to patient safety. Monitor for nephrotoxicity by monitoring serum creatinine levels. Ototoxicity may be indicated if the patient experiences dizziness or a feeling of fullness in the ears, and these symptoms must be reported immediately. Vancomycin infusions may cause red man syndrome, which is characterized by flushing of the neck and face and a decrease in blood pressure. In addition, adequate hydration (at least 2 L of fluids every 24 hours unless contraindicated) is most important to prevent nephrotoxicity. Optimal trough blood levels of vancomycin are 10 to 20 mcg/mL; therefore, the drug should not be administered when there is a trough level of 24 mcg/mL.
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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.) A. Liver disease B. Coronary artery disease C. Hyperthyroidism D. Type 1 diabetes mellitus E. Chronic renal disease
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A. Liver Disease E. Chronic Renal Disease Rationale: Nitrofurantoin is contraindicated in cases of known drug allergy and also in cases of significant renal function impairment, because the drug concentrates in the urine. Because adverse effects include hepatotoxicity, which is rare but often fatal, the nurse should also question the order if liver disease is present. The other options are not contraindications.
