Multiple Choice Questions

A nurse is caring for a client who has streptococcal pharyngitis and an allergy to penicillin. The nurse should recognize that which of the following drugs can be safely administered to this client?
  • Cefotetan + MetronidazoleRationale: Cefotetan, a second-generation cephalosporin, can cause a reaction similar to what disulfiram causes when clients consume alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension. Metronidazole, an antiparasitic drug, can cause a reaction similar to what disulfiram causes when clients consume alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension.Does not:- Nitrofurantoin (urinary tract antiseptic) can cause diarrhea, N/V.- Amoxicillin (penicillin) can cause diarrhea, N/V.- Aztreonam (a monobactum) can cause a superinfection with Candida albicans
  • Renal impairment.Rationale: Aztreonam, a monobactam, requires cautious use with clients who have renal dysfunction because it is excreted in the urine. Renal impairment could affect the excretion of aztreonam, allowing the level of the drug to accumulate. The nurse should report this finding to the provider, so the provider can prescribe a lower dose for the client or prescribe a different antimicrobial drug.- Contraindicated in those with a viral infection, used cautiously in older adults.- Metronidazole is an antimicrobial drug that req's cautious use in those with HF.
  • Azithromycin/Erythromycin.Rationale: Azithromycin, a macrolide, is an acceptable alternative to penicillin for patients who have bacterial infections and are allergic to penicillin. The medication is effective against many gram-positive and gram-negative bacteria and is used for streptococcal pharyngitis.- Nafcillin and amoxicillin/clavulanic acid are penicillins and are contraindicated for those w/a penicillin allergy. Vancomuycin and clindamycin are safer alternatives.- A small percentage of clients who are allergic to penicillin have a cross sensitivity to cephalosporins. Cephalexin is a cephalosporin and is an inappropriate choice for the client.
  • Jaundice, numbness of the hands, and dizziness.Rationale: Isoniazid, an antimycobacterial drug, can cause liver toxicity, especially in clients who abuse alcohol. The nurse should monitor liver enzymes during therapy and instruct the client to report indications of liver damage, such as jaundice, abdominal pain, and fatigue. The nurse should instruct the client to report numbness, pain, or tingling in the hands or feet. Administering pyridoxine (vitamin B6) can help minimize these effects. Isoniazid can cause dizziness, ataxia, and seizures. The nurse should instruct the client to report these CNS effects.- Also: visual disturbances and dry mouth.
A nurse is providing teaching for a client who takes an oral contraceptive and is about to begin rifampin therapy to treat TB. Which of the following instructions should the nurse include?
  • Swelling of hands or feet, or gynecomastia.Rationale: Itraconazole, an azole antifungal drug, can cause edema, which can also indicate heart dysfunction, and should be monitored closely. It can also cause a temporary decrease in sexual hormone synthesis, resulting in gynecomastia, reduced libido, low sperm counts, and menstrual irregularities.+ skin rashes, photosensitivity, dry mouth, headaches, tingling in hands and feet.
  • Isoniazid (INH).Rationale: Isoniazid is used to treat tuberculosis and reduces the possibility of resistance to rifampin when combined with the drug. Drug resistance can develop quickly if the client only takes rifampin.- Gentamicin, vancomycin, and metronidazole are not used to treat TB.
  • Use additional/non-hormonal form of contraception, as the drug can increase the metabolism of oral contraceptives.
  • DehydrationRationale: Acyclovir, an antiviral drug, can cause renal toxicity, especially in clients who are dehydrated. Hydration during and after IV infusion of the drug can help prevent crystalluria.Drugs to use cautiously for other options:- HF: metronidazole (antiparasitic)- Asthma: amoxicillin - Tinnitus: vancomycin (antimicrobial)
A nurse is caring for a client who is taking warfarin and has a new rx for trimethoprim/sulfamethoxazole to treat a UTI. The nurse should clarify the prescriptions w/the provider b/c taking these two drugs concurrently can increase the client's risk for which of the following?
  • Bleeding.Rationale: Trimethoprim/sulfamethoxazole, a sulfonamide combination, can increase the effects of warfarin and increase the client's risk for bleeding. The nurse should request another prescription to treat the infection, or, if the client decides to take the drug, ask the provider to prescribe a lower warfarin dose and monitor prothrombin time carefully. The client should report any sign of bleeding, such as easy or unexplained bruising.Other options and rationales:- Thrombosis: rifampin decreases warfarin levels and inc risk of thrombosis- ECG changes: erythromycin- Ototoxicity: erythromycin + gentamicin
  • Swelling of hands or feet, or gynecomastia.Rationale: Itraconazole, an azole antifungal drug, can cause edema, which can also indicate heart dysfunction, and should be monitored closely. It can also cause a temporary decrease in sexual hormone synthesis, resulting in gynecomastia, reduced libido, low sperm counts, and menstrual irregularities.+ skin rashes, photosensitivity, dry mouth, headaches, tingling in hands and feet.
  • Renal impairment.Rationale: Aztreonam, a monobactam, requires cautious use with clients who have renal dysfunction because it is excreted in the urine. Renal impairment could affect the excretion of aztreonam, allowing the level of the drug to accumulate. The nurse should report this finding to the provider, so the provider can prescribe a lower dose for the client or prescribe a different antimicrobial drug.- Contraindicated in those with a viral infection, used cautiously in older adults.- Metronidazole is an antimicrobial drug that req's cautious use in those with HF.
  • Cefotetan + MetronidazoleRationale: Cefotetan, a second-generation cephalosporin, can cause a reaction similar to what disulfiram causes when clients consume alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension. Metronidazole, an antiparasitic drug, can cause a reaction similar to what disulfiram causes when clients consume alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension.Does not:- Nitrofurantoin (urinary tract antiseptic) can cause diarrhea, N/V.- Amoxicillin (penicillin) can cause diarrhea, N/V.- Aztreonam (a monobactum) can cause a superinfection with Candida albicans
A nurse is caring for a client who is about to begin receiving acyclovir IV to treat a viral infection. The nurse should recognize that cautious use of the drug is essential if the client also has which of the following conditions?
  • Isoniazid (INH).Rationale: Isoniazid is used to treat tuberculosis and reduces the possibility of resistance to rifampin when combined with the drug. Drug resistance can develop quickly if the client only takes rifampin.- Gentamicin, vancomycin, and metronidazole are not used to treat TB.
  • DehydrationRationale: Acyclovir, an antiviral drug, can cause renal toxicity, especially in clients who are dehydrated. Hydration during and after IV infusion of the drug can help prevent crystalluria.Drugs to use cautiously for other options:- HF: metronidazole (antiparasitic)- Asthma: amoxicillin - Tinnitus: vancomycin (antimicrobial)
  • Ethacrynic acid or furosemide (Lasix), as they are loop diuretics and ototoxic drugs. Concurrent use increases the client's risk for hearing loss. Others:- Amphotericin B (antifungal) increases risk for nephrotoxicity.- NSAIDs (ex: ibuprofen) inc risk of nephrotoxicity.- Vancomycin (antimicrobial) increases risk of ototoxicity. Drugs that do not specifically interact w/gentamicin:- Diphenhydramine- Acetaminophen- Levothyroxine
  • Swelling of hands or feet, or gynecomastia.Rationale: Itraconazole, an azole antifungal drug, can cause edema, which can also indicate heart dysfunction, and should be monitored closely. It can also cause a temporary decrease in sexual hormone synthesis, resulting in gynecomastia, reduced libido, low sperm counts, and menstrual irregularities.+ skin rashes, photosensitivity, dry mouth, headaches, tingling in hands and feet.
A nurse is reviewing a client's prescriptions prior to administering gentamicin to the client to treat a systemic infection. The nurse should clarify the use of gentamicin with the provider if the client is taking which of the following drugs?
  • DehydrationRationale: Acyclovir, an antiviral drug, can cause renal toxicity, especially in clients who are dehydrated. Hydration during and after IV infusion of the drug can help prevent crystalluria.Drugs to use cautiously for other options:- HF: metronidazole (antiparasitic)- Asthma: amoxicillin - Tinnitus: vancomycin (antimicrobial)
  • Cefotetan + MetronidazoleRationale: Cefotetan, a second-generation cephalosporin, can cause a reaction similar to what disulfiram causes when clients consume alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension. Metronidazole, an antiparasitic drug, can cause a reaction similar to what disulfiram causes when clients consume alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension.Does not:- Nitrofurantoin (urinary tract antiseptic) can cause diarrhea, N/V.- Amoxicillin (penicillin) can cause diarrhea, N/V.- Aztreonam (a monobactum) can cause a superinfection with Candida albicans
  • Take an antacid at least 2 hr after taking the drug. Rationale: The nurse should recommend that the client take an antacid to relieve the dyspepsia at least 2 hr after taking ciprofloxacin, a fluoroquinolone. This is because antacids decrease the absorption of the drug.- Avoid caffeine b/c it can increase CNS effects.- Avoid taking supplemental iron b/c iron dec absorption of drug.- Avoid taking drug w/milk or other dairy products b/c calcium decreases absorption.
  • Ethacrynic acid or furosemide (Lasix), as they are loop diuretics and ototoxic drugs. Concurrent use increases the client's risk for hearing loss. Others:- Amphotericin B (antifungal) increases risk for nephrotoxicity.- NSAIDs (ex: ibuprofen) inc risk of nephrotoxicity.- Vancomycin (antimicrobial) increases risk of ototoxicity. Drugs that do not specifically interact w/gentamicin:- Diphenhydramine- Acetaminophen- Levothyroxine
A nurse is preparing to administer amphotericin B IV to a patient who has a systemic fungal infection. Which of the following drugs should the health care professional administer prior to the infusion to prevent or minimize adverse reactions during amphotericin B administration? (Select all that apply.)A. AspirinB. HydrocortisoneC. AcetaminophenD. DiphenhydramineE. Ibuprofen
  • Bleeding.Rationale: Trimethoprim/sulfamethoxazole, a sulfonamide combination, can increase the effects of warfarin and increase the client's risk for bleeding. The nurse should request another prescription to treat the infection, or, if the client decides to take the drug, ask the provider to prescribe a lower warfarin dose and monitor prothrombin time carefully. The client should report any sign of bleeding, such as easy or unexplained bruising.Other options and rationales:- Thrombosis: rifampin decreases warfarin levels and inc risk of thrombosis- ECG changes: erythromycin- Ototoxicity: erythromycin + gentamicin
  • Acetaminophen + diphenhydramine.Rationale: Infusion reactions to amphotericin B IV, such as fever, chills, nausea, and headache, start 1 to 2 hr after the infusion begins and subside within 4 hr. The nurse can help prevent these effects by administering acetaminophen prior to the infusion. The nurse can help prevent adverse reactions by administering diphenhydramine prior to the infusion.- Aspirin inc risk of renal injury.- Hydrocortisone decreases client's resistance to infection.- Ibuprofen inc risk of renal injury.
  • Superinfection.Rationale: Imipenem, a carbapenem, can cause the superinfection Candida albicans in the mouth, throat, or vagina. It can also cause glossitis, an inflammation or infection of the tongue. Clients taking the drug should report any mouth pain or vaginal discharge and itching because they might require treatment with an antifungal drug.- Unlikely to cause malabsorption, but can cause gastroenteritis, abdominal pain, and vomiting; unlikely to cause anorexia or dental caries.
  • Renal impairment.Rationale: Aztreonam, a monobactam, requires cautious use with clients who have renal dysfunction because it is excreted in the urine. Renal impairment could affect the excretion of aztreonam, allowing the level of the drug to accumulate. The nurse should report this finding to the provider, so the provider can prescribe a lower dose for the client or prescribe a different antimicrobial drug.- Contraindicated in those with a viral infection, used cautiously in older adults.- Metronidazole is an antimicrobial drug that req's cautious use in those with HF.
A nurse in a provider's office receives a call from a client who was recently hospitalized and treated with imipenem IV for a bacterial infection and reports an inability to eat due to mouth pain. The nurse should identify that the client might be experiencing which of the following as an adverse effect of this drug?
  • Take an antacid at least 2 hr after taking the drug. Rationale: The nurse should recommend that the client take an antacid to relieve the dyspepsia at least 2 hr after taking ciprofloxacin, a fluoroquinolone. This is because antacids decrease the absorption of the drug.- Avoid caffeine b/c it can increase CNS effects.- Avoid taking supplemental iron b/c iron dec absorption of drug.- Avoid taking drug w/milk or other dairy products b/c calcium decreases absorption.
  • Bleeding.Rationale: Trimethoprim/sulfamethoxazole, a sulfonamide combination, can increase the effects of warfarin and increase the client's risk for bleeding. The nurse should request another prescription to treat the infection, or, if the client decides to take the drug, ask the provider to prescribe a lower warfarin dose and monitor prothrombin time carefully. The client should report any sign of bleeding, such as easy or unexplained bruising.Other options and rationales:- Thrombosis: rifampin decreases warfarin levels and inc risk of thrombosis- ECG changes: erythromycin- Ototoxicity: erythromycin + gentamicin
  • Superinfection.Rationale: Imipenem, a carbapenem, can cause the superinfection Candida albicans in the mouth, throat, or vagina. It can also cause glossitis, an inflammation or infection of the tongue. Clients taking the drug should report any mouth pain or vaginal discharge and itching because they might require treatment with an antifungal drug.- Unlikely to cause malabsorption, but can cause gastroenteritis, abdominal pain, and vomiting; unlikely to cause anorexia or dental caries.
  • C. diff-associated diarrhea.Rationale: Severe diarrhea, often containing mucus and blood, can indicate Clostridium difficile-associated diarrhea. Treatment includes stopping drug therapy and replacing fluids and electrolytes. Clients should immediately report severe diarrhea and blood in the stools.
A nurse in a provider's office receives a call from a client who is taking ciprofloxacin to treat a respiratory tract infection and reports dyspepsia. Which of the following instructions should the nurse give the client?
  • Take an antacid at least 2 hr after taking the drug. Rationale: The nurse should recommend that the client take an antacid to relieve the dyspepsia at least 2 hr after taking ciprofloxacin, a fluoroquinolone. This is because antacids decrease the absorption of the drug.- Avoid caffeine b/c it can increase CNS effects.- Avoid taking supplemental iron b/c iron dec absorption of drug.- Avoid taking drug w/milk or other dairy products b/c calcium decreases absorption.
  • Ethacrynic acid or furosemide (Lasix), as they are loop diuretics and ototoxic drugs. Concurrent use increases the client's risk for hearing loss. Others:- Amphotericin B (antifungal) increases risk for nephrotoxicity.- NSAIDs (ex: ibuprofen) inc risk of nephrotoxicity.- Vancomycin (antimicrobial) increases risk of ototoxicity. Drugs that do not specifically interact w/gentamicin:- Diphenhydramine- Acetaminophen- Levothyroxine
  • Swelling of hands or feet, or gynecomastia.Rationale: Itraconazole, an azole antifungal drug, can cause edema, which can also indicate heart dysfunction, and should be monitored closely. It can also cause a temporary decrease in sexual hormone synthesis, resulting in gynecomastia, reduced libido, low sperm counts, and menstrual irregularities.+ skin rashes, photosensitivity, dry mouth, headaches, tingling in hands and feet.
  • Superinfection.Rationale: Imipenem, a carbapenem, can cause the superinfection Candida albicans in the mouth, throat, or vagina. It can also cause glossitis, an inflammation or infection of the tongue. Clients taking the drug should report any mouth pain or vaginal discharge and itching because they might require treatment with an antifungal drug.- Unlikely to cause malabsorption, but can cause gastroenteritis, abdominal pain, and vomiting; unlikely to cause anorexia or dental caries.
A nurse is caring for a client who has a new prescription for aztreonam to treat a respiratory tract infection. Which of the following findings in the client's medical record should the nurse recognize as requiring cautious use for this rx and report to the provider?
  • Renal impairment.Rationale: Aztreonam, a monobactam, requires cautious use with clients who have renal dysfunction because it is excreted in the urine. Renal impairment could affect the excretion of aztreonam, allowing the level of the drug to accumulate. The nurse should report this finding to the provider, so the provider can prescribe a lower dose for the client or prescribe a different antimicrobial drug.- Contraindicated in those with a viral infection, used cautiously in older adults.- Metronidazole is an antimicrobial drug that req's cautious use in those with HF.
  • Bleeding.Rationale: Trimethoprim/sulfamethoxazole, a sulfonamide combination, can increase the effects of warfarin and increase the client's risk for bleeding. The nurse should request another prescription to treat the infection, or, if the client decides to take the drug, ask the provider to prescribe a lower warfarin dose and monitor prothrombin time carefully. The client should report any sign of bleeding, such as easy or unexplained bruising.Other options and rationales:- Thrombosis: rifampin decreases warfarin levels and inc risk of thrombosis- ECG changes: erythromycin- Ototoxicity: erythromycin + gentamicin
  • Cefotetan + MetronidazoleRationale: Cefotetan, a second-generation cephalosporin, can cause a reaction similar to what disulfiram causes when clients consume alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension. Metronidazole, an antiparasitic drug, can cause a reaction similar to what disulfiram causes when clients consume alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension.Does not:- Nitrofurantoin (urinary tract antiseptic) can cause diarrhea, N/V.- Amoxicillin (penicillin) can cause diarrhea, N/V.- Aztreonam (a monobactum) can cause a superinfection with Candida albicans
  • Azithromycin/Erythromycin.Rationale: Azithromycin, a macrolide, is an acceptable alternative to penicillin for patients who have bacterial infections and are allergic to penicillin. The medication is effective against many gram-positive and gram-negative bacteria and is used for streptococcal pharyngitis.- Nafcillin and amoxicillin/clavulanic acid are penicillins and are contraindicated for those w/a penicillin allergy. Vancomuycin and clindamycin are safer alternatives.- A small percentage of clients who are allergic to penicillin have a cross sensitivity to cephalosporins. Cephalexin is a cephalosporin and is an inappropriate choice for the client.
A nurse is caring for a client who has a gynecologic infection and a hx of alcohol use disorder. The nurse should identify that which of the following drugs can cause a rxn similar to disulfiram if the client drinks alcohol while taking it? SATA.
  • Cefotetan + MetronidazoleRationale: Cefotetan, a second-generation cephalosporin, can cause a reaction similar to what disulfiram causes when clients consume alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension. Metronidazole, an antiparasitic drug, can cause a reaction similar to what disulfiram causes when clients consume alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension.Does not:- Nitrofurantoin (urinary tract antiseptic) can cause diarrhea, N/V.- Amoxicillin (penicillin) can cause diarrhea, N/V.- Aztreonam (a monobactum) can cause a superinfection with Candida albicans
  • Azithromycin/Erythromycin.Rationale: Azithromycin, a macrolide, is an acceptable alternative to penicillin for patients who have bacterial infections and are allergic to penicillin. The medication is effective against many gram-positive and gram-negative bacteria and is used for streptococcal pharyngitis.- Nafcillin and amoxicillin/clavulanic acid are penicillins and are contraindicated for those w/a penicillin allergy. Vancomuycin and clindamycin are safer alternatives.- A small percentage of clients who are allergic to penicillin have a cross sensitivity to cephalosporins. Cephalexin is a cephalosporin and is an inappropriate choice for the client.
  • Bleeding.Rationale: Trimethoprim/sulfamethoxazole, a sulfonamide combination, can increase the effects of warfarin and increase the client's risk for bleeding. The nurse should request another prescription to treat the infection, or, if the client decides to take the drug, ask the provider to prescribe a lower warfarin dose and monitor prothrombin time carefully. The client should report any sign of bleeding, such as easy or unexplained bruising.Other options and rationales:- Thrombosis: rifampin decreases warfarin levels and inc risk of thrombosis- ECG changes: erythromycin- Ototoxicity: erythromycin + gentamicin
  • Renal impairment.Rationale: Aztreonam, a monobactam, requires cautious use with clients who have renal dysfunction because it is excreted in the urine. Renal impairment could affect the excretion of aztreonam, allowing the level of the drug to accumulate. The nurse should report this finding to the provider, so the provider can prescribe a lower dose for the client or prescribe a different antimicrobial drug.- Contraindicated in those with a viral infection, used cautiously in older adults.- Metronidazole is an antimicrobial drug that req's cautious use in those with HF.
A patient who is taking amoxicillin to treat a respiratory infection contacts the health care professional to report a rash and wheezing. Which of the following instructions should the nurse provide?
  • Take an antacid at least 2 hr after taking the drug. Rationale: The nurse should recommend that the client take an antacid to relieve the dyspepsia at least 2 hr after taking ciprofloxacin, a fluoroquinolone. This is because antacids decrease the absorption of the drug.- Avoid caffeine b/c it can increase CNS effects.- Avoid taking supplemental iron b/c iron dec absorption of drug.- Avoid taking drug w/milk or other dairy products b/c calcium decreases absorption.
  • Call emergency services immediately. Rationale: Amoxicillin can cause a severe anaphylactic reaction. A client who has difficulty breathing should call emergency services and seek immediate care. The client will need to be treated with epinephrine and an antihistamine, such as diphenhydramine, to treat an anaphylactic reaction.
  • Swelling of hands or feet, or gynecomastia.Rationale: Itraconazole, an azole antifungal drug, can cause edema, which can also indicate heart dysfunction, and should be monitored closely. It can also cause a temporary decrease in sexual hormone synthesis, resulting in gynecomastia, reduced libido, low sperm counts, and menstrual irregularities.+ skin rashes, photosensitivity, dry mouth, headaches, tingling in hands and feet.
  • Isoniazid (INH).Rationale: Isoniazid is used to treat tuberculosis and reduces the possibility of resistance to rifampin when combined with the drug. Drug resistance can develop quickly if the client only takes rifampin.- Gentamicin, vancomycin, and metronidazole are not used to treat TB.
A nurse is administering cefotetan IV to a client to treat an intra-abdominal infection. The nurse notes that the IV insertion site is warm, edematous, and painful to the touch. Which of the following actions should the nurse take?
  • Ethacrynic acid or furosemide (Lasix), as they are loop diuretics and ototoxic drugs. Concurrent use increases the client's risk for hearing loss. Others:- Amphotericin B (antifungal) increases risk for nephrotoxicity.- NSAIDs (ex: ibuprofen) inc risk of nephrotoxicity.- Vancomycin (antimicrobial) increases risk of ototoxicity. Drugs that do not specifically interact w/gentamicin:- Diphenhydramine- Acetaminophen- Levothyroxine
  • Azithromycin/Erythromycin.Rationale: Azithromycin, a macrolide, is an acceptable alternative to penicillin for patients who have bacterial infections and are allergic to penicillin. The medication is effective against many gram-positive and gram-negative bacteria and is used for streptococcal pharyngitis.- Nafcillin and amoxicillin/clavulanic acid are penicillins and are contraindicated for those w/a penicillin allergy. Vancomuycin and clindamycin are safer alternatives.- A small percentage of clients who are allergic to penicillin have a cross sensitivity to cephalosporins. Cephalexin is a cephalosporin and is an inappropriate choice for the client.
  • Cefotetan + MetronidazoleRationale: Cefotetan, a second-generation cephalosporin, can cause a reaction similar to what disulfiram causes when clients consume alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension. Metronidazole, an antiparasitic drug, can cause a reaction similar to what disulfiram causes when clients consume alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension.Does not:- Nitrofurantoin (urinary tract antiseptic) can cause diarrhea, N/V.- Amoxicillin (penicillin) can cause diarrhea, N/V.- Aztreonam (a monobactum) can cause a superinfection with Candida albicans
  • Stop the cefotetan infusion.Rationale: The nurse should stop the infusion, remove the IV catheter, assess for tissue damage, and treat the client accordingly. The nurse should then initiate IV access via another site, continuing cefotetan therapy according to prescribed parameters.- Because the client could have thrombophlebitis, slowing the infusion will not alleviate the potential tissue damage or risk of embolus, and the IV site should be changed. To prevent thrombophlebitis, the nurse should dilute cefotetan, a second-generation cephalosporin, and infuse it slowly over 20 to 30 min.- The edematous, painful, and warm IV insertion site does not indicate an allergic reaction. The nurse should administer an antihistamine, such as diphenhydramine, if the client has hives, a rash, or other indications of an allergy to cephalosporins.- Switching the client to another antibiotic is essential when the current drug is ineffective or the client has an intolerable reaction to it.
A nurse in a provider's office receives a call from a client who has been taking penicillin V 3x daily and reports abdominal cramping w/bloody diarrhea for several days. Which of the following instructions should the nurse give the client?
  • "Bring in a stool sample for testing."- The nurse cannot make changes to client's prescription, the client should not self-treat diarrhea, and blood work is not indicated for these symptoms.
  • Isoniazid (INH).Rationale: Isoniazid is used to treat tuberculosis and reduces the possibility of resistance to rifampin when combined with the drug. Drug resistance can develop quickly if the client only takes rifampin.- Gentamicin, vancomycin, and metronidazole are not used to treat TB.
  • C. diff-associated diarrhea.Rationale: Severe diarrhea, often containing mucus and blood, can indicate Clostridium difficile-associated diarrhea. Treatment includes stopping drug therapy and replacing fluids and electrolytes. Clients should immediately report severe diarrhea and blood in the stools.
  • Take an antacid at least 2 hr after taking the drug. Rationale: The nurse should recommend that the client take an antacid to relieve the dyspepsia at least 2 hr after taking ciprofloxacin, a fluoroquinolone. This is because antacids decrease the absorption of the drug.- Avoid caffeine b/c it can increase CNS effects.- Avoid taking supplemental iron b/c iron dec absorption of drug.- Avoid taking drug w/milk or other dairy products b/c calcium decreases absorption.
When administering oral erythromycin to a client who has acute diphtheria, a nurse should monitor for which of the following adverse effects?
  • Isoniazid (INH).Rationale: Isoniazid is used to treat tuberculosis and reduces the possibility of resistance to rifampin when combined with the drug. Drug resistance can develop quickly if the client only takes rifampin.- Gentamicin, vancomycin, and metronidazole are not used to treat TB.
  • seizure disorder
  • Cardiac dysrhythmias, as the drug can cause ECG changes, such as a prolonged QT interval. Report palpitations, fainting, and dizziness.Other effects include fever, hearing loss, and diarrhea.
  • Cough
A nurse is caring for a client whose sputum culture results indicate methicillin-resistant MRSA. The nurse should recognize that which of the following medications will likely be administered to this client?
  • Tendon pain
  • Azithromycin/Erythromycin.Rationale: Azithromycin, a macrolide, is an acceptable alternative to penicillin for patients who have bacterial infections and are allergic to penicillin. The medication is effective against many gram-positive and gram-negative bacteria and is used for streptococcal pharyngitis.- Nafcillin and amoxicillin/clavulanic acid are penicillins and are contraindicated for those w/a penicillin allergy. Vancomuycin and clindamycin are safer alternatives.- A small percentage of clients who are allergic to penicillin have a cross sensitivity to cephalosporins. Cephalexin is a cephalosporin and is an inappropriate choice for the client.
  • Vancomycin
  • Urine output
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Multiple Choice Questions
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