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Pharm. Questions from book
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1. A nurse is preparing to give an oral dose of drug X to treat a patient's high blood pressure. After giving the drug, the nurse finds that it reduces the blood pressure without serious harmful effects, but it also causes the patient to have nausea and a headache. Based on this information, which property of an ideal drug is this drug lacking?
The drug is effective in lowering the blood pressure and safe in that it does not cause harmful effects. However, as do most drugs, it causes other effects besides the one response desired; therefore, it lacks selectivity. The oral form provides ease of administration.
The nurse is preparing to give a drug with certain properties. Which property of the drug is the most compelling indication that it should not be given?
The drug is not effective for its intended purpose.
If a drug is not effective, there is no justification for giving it. Some drugs may be given even though they produce unwanted side effects or are difficult to administer. Reversible action is a desired property for most drugs.
Why is it important for drugs to have ease of administration?
Fewer medication errors
Ease of administration increases convenience and adherence and can reduce administration errors. Ease of administration is not related to side effects, chemical stability, or reversibility.
The nurse teaches a patient not to consume alcohol with nitroglycerine, because the blood pressure often drops significantly when nitroglycerine is taken with alcohol. Which drug property does this illustrate?
When two or more drugs are taken together, they can interact, causing either increased or decreased drug responses. In this case, alcohol would increase the nitroglycerine response. Chemical instability, reversible action, and drug selectivity are not related to this situation.
When studying the impact a drug has on the body, the nurse is reviewing what?
The drug's pharmacodynamics
Pharmacodynamics can be thought of as the impact of drugs on the body. Pharmacokinetics describes the movement of drugs through the body. Selectivity is the ability of a drug to elicit only the response for which it is given. Predictability is the degree of certainty about how a patient will respond to a certain drug.
When studying the effects of drugs in humans, the nurse is learning about what?
Clinical pharmacology is the study of the effects of drugs in humans. Pharmacology can be defined as the study of drugs and their interactions with living systems, Therapeutics, also known as pharmacotherapeutics, is the use of drugs to diagnose, prevent, or treat disease or to prevent pregnancy. The term effectiveness indicates that the drug elicits the intended response or responses.
Which statement by a new nurse indicates that further study is indicated?
Drugs are defined as illegal substances.
A drug is any chemical that can affect living processes. All the other statements are correct.
What is the ultimate concern for the nurse when administering a drug?
Intensity of the response
The ultimate concern for the nurse when administering a drug is the intensity of the response, which is determined by the dosage size, route of administration, and timing of administration.
A new graduate nurse, who is preparing to administer medications, knows that what is required for a drug to move through the body?
The ability to cross membranes
To move through the body, drugs must cross membranes. They cross membranes to enter the bloodstream, to exit the bloodstream and reach the site of action, and to undergo metabolism and excretion. Selectivity and effectiveness are not related to drug movement. Development of an electric charge (ionization) reduces a drug's ability to be absorbed. Transporter proteins are not required for drugs to move through the body.
The nurse is preparing to give a medication for pain. The label states that the drug is "lipid soluble." Based on the nurse's knowledge of lipid-soluble drugs, how quickly would the nurse expect to observe the effects of the drug?
Cell membranes are composed of lipids; therefore, a lipid-soluble drug passes through rapidly. A water-soluble drug passes through more slowly. The nurse would expect to observe the effects of a lipid-soluble drug more quickly, because the drug is absorbed more rapidly.
The nurse is administering warfarin, an anticoagulant, to a patient with a low albumin level. As a result, the nurse can expect to observe which effect of this medication?
Increased PT/INR levels
Warfarin is an anticoagulant with a high affinity for binding with albumin. If the albumin level is low, more free drug is available for action, resulting in an increased prothrombin time/international normalized ratio (PT/INR). Deep vein thromboses can be prevented with warfarin. An increased risk of bruising and bleeding would occur with more free drug available. Warfarin acts on vitamin K, not on platelets. Aspirin is an example of an antiplatelet aggregator.
A nurse prepares to administer acetaminophen (Tylenol) to a patient with an oral temperature of 101.7°F. Which preparation would the nurse expect to have the most rapid onset of action?
A liquid does not have to dissolve first to allow absorption; therefore, the onset of action occurs more quickly than with capsules, tablets, or gel caps.
The nurse should provide which teaching point when administering an enteric-coated oral tablet to a patient?
C. "Swallow the tablet whole after double-checking the dose."
Enteric-coated tablets are covered with a material designed to dissolve in the intestine instead of the stomach. They should not be chewed or broken before administration. Sublingual tablets are placed under the tongue for absorption and are not enteric coated.
When administering a central nervous system depressant, the nurse should closely observe for drug toxicity in which patient?
A 3-week-old neonate
The blood-brain barrier is not fully developed at birth. As a result, newborns are much more sensitive than older children or adults to medicines that act on the brain.
The nurse should strictly follow safety precautions when administering intravenous (IV) medications for which reason?
IV administration is irreversible.
The IV route allows precise control over levels of drug in the blood and a rapid onset of action. Absorption of IV medication is instantaneous and complete. Once a drug has been injected, there is no turning back; the drug is in the body and cannot be retrieved.
When administering an IV medication, the nurse injects the medicine in what minimum amount of time to reduce the risk of injury to the patient?
IV drugs should be injected over at least 1 minute or longer, because all the blood in the body is circulated about once every minute. This allows the drug to be diluted in the largest volume of blood possible.
The nurse administers 100 mg of drug X by mouth. After the drug moves through the hepatic system, very little active drug is left in the general circulation as a result of what?
The term first-pass effect refers to the rapid hepatic inactivation of certain oral drugs. Drugs that undergo the first-pass effect often are administered parenterally. The therapeutic range is the range of drug level between the minimum effective concentration (MEC) and the toxic concentration. The biologic half-life is the time required for the amount of drug in the body to decrease by 50%. Plasma protein binding is involved with the transport of drugs through the bloodstream.
The nurse should instruct a patient complaining of pain to do what to reduce fluctuations in drug levels?
"Take pain medication around the clock at specified intervals and doses."
One technique to reduce drug level fluctuations is to take a specified dose at reduced dosing intervals. A patient who waits for the pain to peak will have to wait longer for the pain medicine to reach a plateau level of pain control. Avoiding daytime dosing because of drowsiness and avoiding stomach upset does not address the question of how to reduce fluctuations in drug levels
The nurse understands that the dose-response relationship is graded and therefore would expect to observe what?
As the dosage increases, the response becomes progressively greater.
If drug responses were all-or-nothing instead of graded, drugs could produce only one intensity level of response. The response may be maintained at a specific level when the therapeutic objective is achieved, but that option does not pertain to a dose-response relationship that is graded.
The nurse demonstrates the concept of maximal efficacy by administering which drug for a headache that the patient describes as a "mild dullness" and a 2 and on a 1-10 scale?
Maximal efficacy is the greatest effect a drug can produce. Potency is the amount of drug that must be given to elicit an effect. Maximal efficacy illustrates the fact that all drugs have a maximal effect, and dosages beyond this do not increase the effect. The goal is to match the intensity of the response to the patient's needs; therefore, a drug with high maximal efficacy is not always most desirable. Demerol, Talwin, and morphine all have a higher maximal efficacy than Tylenol; therefore, Tylenol is the most desirable drug for a headache rated as "mild."
A nursing instructor knows that further instruction about drug selectivity is needed when a nursing student makes which statement?
"Botulinum toxin is very selective and therefore very safe for administration." Selectivity does not guarantee safety. Botulinum toxin can cause paralysis of respiratory muscles, resulting in respiratory arrest. All of the remaining statements about receptors and selectivity of drug action are correct.
Which drug property is most enhanced by the presence of many different types of receptors throughout the body?
Selectivity Because each receptor regulates just a few processes, selective drug action is possible. Multiple types of receptors do not have as much effect on potency, safety, or convenience.
The drug dobutamine acts as an agonist of norepinephrine (NE) receptors. Which effect is the nurse likely to observe in a patient receiving this medication?
Increased heart rate
Dobutamine mimics the action of NE at receptors on the heart, thereby causing and increase in the heart's rate and force of contraction.
The nurse prepares to give a drug that will prevent receptor activation. Which term would describe this drug?
An antagonist is a drug that prevents receptor activation. An agonist is a molecule that activates receptors. A selective drug has only the desired response but may not activate receptors. A potent drug requires a lower dose to achieve its effect.
The nurse administers naloxone to a patient receiving morphine sulfate who has a respiratory rate of 8 breaths per minute. Why?
Naloxone prevents the activation of opioid receptors.
Naloxone is an antagonist, which prevents the activation of opioid receptors, reversing the respiratory depression effects of morphine. Continuous exposure of cells to antagonists can result in hypersensitivity. Continuous exposure of cells to agonists can lead to desensitization, refractoriness, or down-regulation.
The nurse is administering a drug with a low therapeutic index and monitors the patient closely. Why?
The highest dose needed to produce a therapeutic effect is close to the lethal dose.
A low therapeutic index indicates that the high doses needed to produce therapeutic effects in some people may be large enough to cause death. A high therapeutic index is more desirable, because the average lethal dose is higher than the therapeutic dose. Low variability of responses to a drug is not the definition of a low therapeutic index.
Which response would the nurse anticipate when giving two drugs that have a potentiative effect, such as meperidine and Phenergan?
Increased pain relief
A potentiative effect occurs when one drug intensifies the effects of another. An inhibitory effect would cause reduced therapeutic effects or reduced adverse effects. Potentiative effects are not unique responses. Meperidine is a morphine derivative for pain relief. Phenergan is an antiemetic that potentiates the effect of meperidine. The patient should experience decreased pain and also may be drowsy.
The nurse is preparing to begin giving phenobarbital, which is known to induce CYP isozymes, to a patient on oral contraceptives. What patient teaching will the nurse expect to provide for this patient?
"Plan to use another form of birth control while taking phenobarbital."
Phenobarbital induces CYP isozymes; therefore, it will increase the metabolism of other drugs. Because phenobarbital is an inducer, it will increase the metabolism of oral contraceptives. The nurse would anticipate that this would likely reduce the blood levels of birth control pills. The patient should use another form of birth control while taking phenobarbital.
The drug the nurse is about to give induces P-glycoprotein (PGP). What outcome might the nurse expect when this drug is given with other drugs?
Reduced absorption of other drugs
Drugs that induce PGP can cause reduced absorption of other drugs, which would reduce their levels. A PGP inducer would not increase the side effects of other drugs and could increase elimination of other drugs.
The nurse is concerned with minimizing adverse drug-drug interactions for the patient. Which drug characteristic could result in the most serious consequences from a drug-drug interaction?
Low therapeutic index
Interactions are especially important with drugs that have a low therapeutic index, because an interaction that produces a modest increase in drug levels can cause toxicity.
The nurse is teaching a patient taking felodipine (Plendil), a drug for hypertension, about taking the medication at home. Which statement by the nurse is the most appropriate to include in the teaching session?
"Avoid grapefruit juice while you are taking this medication."
Grapefruit juice can raise levels of felodipine by as much as 400% because of the effect grapefruit juice has on the CYP3A4 isozyme.
A patient with multiple sclerosis (MS) is participating in a rehabilitation program. The patient has just been started on baclofen (Lioresal) 5 mg three times/day to help manage spasticity. How will the baclofen interfere with rehabilitation activities?
By producing drowsiness, lethargy, and blurred vision
Drowsiness, lethargy, and blurred vision are adverse effects of baclofen that initially make it difficult for the patient to participate actively in rehabilitation activities. These adverse effects are most common during the early phase of therapy but subside with continued use. These effects can be reduced by starting with a small dose and gradually increasing it.
Which skeletal muscle relaxant is also the drug of choice for treating malignant hyperthermia?
Dantrolene, a direct-acting skeletal muscle relaxant, is the treatment of choice for malignant hyperthermia. Malignant hyperthermia is a life-threatening syndrome that usually occurs when a general anesthetic is used with a neuromuscular blocking agent. It presents with muscle rigidity and profound temperature elevation.
The nurse is caring for a patient receiving dantrolene (Dantrium) for spasticity associated with MS. Which laboratory test will be important in monitoring for a potential adverse effect of this drug?
In large doses dantrolene has been associated with fatal liver failure. Liver function tests, such as gamma-glutamyltransferase (GGTP), should be performed at baseline and periodically thereafter.
The nurse is caring for a patient after total hip replacement on postoperative day 1. The patient is restricted to nothing by mouth. Which skeletal muscle relaxant may be given by the intramuscular route?
All of the centrally acting skeletal muscle relaxants listed can be taken orally. Methocarbamol is the only one that also may be given by the intramuscular route.
Which statement made by a patient indicates a need for further discharge instruction about baclofen (Lioresal)?
B. "I'm glad I can still have a glass or two of wine at dinner."
Alcohol can intensify the CNS depressant effects of baclofen; therefore, further instruction is needed. The first statement indicates that the patient understands that urinary retention is a potential side effect. Baclofen should not be discontinued abruptly, because this can lead to hallucinations, paranoid ideation, and seizures. Patients should discuss withdrawal of baclofen with their healthcare provider, because it should be done over a 1 to 2 weeks. Allergy medications should be evaluated by the healthcare provider to determine whether they contain antihistamines, which intensify the depressant effects.
Administration of dantrolene (Dantrium) for the treatment of muscle spasticity is contraindicated in which patient?
A patient with multiple sclerosis and underlying cirrhosis
Although dantrolene is effective for treating spasticity in multiple sclerosis, it is contraindicated in this patient because of the underlying liver disease. Dantrolene is useful for relieving muscle spasticity associated with cerebral palsy and spinal cord injury and, in intravenous form, for managing life-threatening malignant hyperthermia.
The nurse on an orthopedic unit routinely cares for patients receiving carisoprodol (Soma). For which adverse effects should the nurse monitor these patients? (Select all that apply.)
Risk of dependence & Drowsiness and sedation
Carisoprodol is a centrally acting skeletal muscle relaxant and as such can produce generalized central nervous system (CNS) depression. These agents may also cause physical dependence when taken long term or in high doses.
1. A nurse is teaching a patient with chronic tophaceous gout who is scheduled to start taking allopurinol (Zyloprim). Which of these statements should the nurse include in the teaching?
o "You may notice an increase in your pain attacks in the first month."
Allopurinol inhibits xanthine oxidase to reduce uric acid levels in chronic tophaceous gout. During the first months of treatment, it may increase the incidence of acute gouty arthritis. Allopurinol lacks anti-inflammatory and analgesic actions and is not useful in an acute gout attack. Plasma levels of uric acid are evaluated. To prevent renal injury, fluid intake should be increased.
When evaluating the effects of probenecid, the nurse should monitor which laboratory result?
Uric acid level
Probenecid acts on the renal tubules to increase uric acid excretion, and plasma urate levels are reduced as a result. The sodium level, hemoglobin, and blood pH are not affected by probenecid.
When planning interventions for pain control in a patient with gouty arthritis, the nurse should assess for pain in which joints?
Gout is characterized by hyperuricemia and episodic pain attacks from urate crystals, which are deposited most commonly in the great toe. The kidneys also can be damaged. When gout is chronic, tophi, or large, gritty deposits, may form in the affected joint. Joints in the hands, shoulders, and neck are not commonly affected by gout.
The nurse teaches a patient with gout that naproxen (Naprosyn) is an agent of first choice for treatment over colchicine. The nurse should use which rationale for the teaching?
Naproxen achieves more predicable pain relief with fewer side effects.
Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) that is used to suppress inflammation in gout. Compared with colchicine, NSAIDs are better tolerated and have more predictable effects. Because safe, effective alternatives are available, the use of colchicine has declined. The treatment time with NSAIDs is brief, because pain relief occurs within 24 hours and swelling subsides over a few days. Hyperglycemia is more of a concern when glucocorticoids are used. NSAIDs do not affect uric acid levels.
The nurse should be concerned about which finding in a patient on long-term, low-dose colchicine therapy to prevent gout?
Platelet count of 200,000/mcL
Long-term, low-dose therapy with colchicine can cause rhabdomyolysis, which is manifested by complaints of muscle tenderness, pain, and weakness. Because the drug causes myelosuppression, patients should be monitored for leukopenia and thrombocytopenia. Both the WBC count and platelet count are within normal limits. Headache is not an adverse effect of colchicine.
A nurse obtains a health history from a patient who has gout and is taking a glucocorticoid. The nurse should follow up on which finding?
Blood glucose level of 140 mg/dL
Glucocorticoids are very effective in the treatment of acute gout attacks and are preferred for patients who are not candidates for or are unresponsive to NSAIDs. Because of their effects on carbohydrate metabolism, glucocorticoids should be avoided in patients prone to hyperglycemia. Flushing and urticaria are not associated with glucocorticoid use. The heart rate is not affected by glucocorticoids. Glucocorticoids cause weight gain, not weight loss.
To normalize a low serum calcium level, the body releases parathyroid hormone (PTH); this results in which therapeutic effect?
Increase in bone resorption of calcium
PTH restores normal calcium levels by promoting calcium resorption from bone and transferring it to the blood. PTH also activates vitamin D, which increases, not decreases, calcium absorption from the intestine. Renal losses of calcium are reduced by PTH. PTH reduces plasma levels of phosphate.
A nurse monitors the calcium level of a patient who has had a thyroidectomy. The nurse should notice which finding if the patient's calcium level is 7.5 mg/dL?
Muscle twitching and tetany
Low calcium levels may be the result of inadvertent removal of the parathyroid gland during a thyroidectomy, leading to a lack of PTH. This produces hypocalcemia and symptoms of tetany, muscle twitching, and neuromuscular excitability. Nausea and vomiting, lethargy, and confusion are symptoms of hypercalcemia. Dull, aching bone pain may be associated with osteomalacia and vitamin D insufficiency.
A nurse teaches a patient who is postmenopausal and is scheduled to start taking calcium carbonate as a dietary supplement. The nurse instructs the patient to avoid taking it with which food?
Oxalic acid, which is found in some foods, such as spinach, rhubarb, Swiss chard, and beets, can suppress the absorption of calcium. Patients should avoid eating a diet rich in these foods when taking calcium carbonate. It is not necessary to avoid milk, carrots, or potatoes when taking calcium carbonate.
A patient who has Paget's disease is receiving calcitonin-salmon (Miacalcin) nasal spray. A nurse should expect the patient to have which therapeutic response if the medication is having the desired effect?
Decrease in bone pain
Calcitonin is used to treat both osteoporosis and Paget's disease, which is characterized by increased bone resorption, skeletal abnormalities, and pain. Calcitonin acts to inhibit the activity of osteoclasts, thereby reducing bone resorption of calcium and thus bone pain. As a result of the reduced bone turnover, the alkaline phosphatase and calcium levels in the blood are lowered. Treatment should include an adequate intake of vitamin D.
A patient who is postmenopausal is scheduled to begin taking alendronate (Fosamax) to prevent osteoporosis. Which instruction should the nurse give the patient?
A. "After taking the medication, sit or stand for 30 minutes."
Oral alendronate may result in esophageal ulceration if it fails to pass completely through the esophagus and thus is not administered properly. Sitting or standing for 30 minutes after dosing is recommended to prevent prolonged contact with the esophageal mucosa. Symptoms of esophageal injury are heartburn and pain and should be reported. Because of its poor bioavailability, alendronate must be given before eating or drinking, even orange juice or coffee.
A nurse teaches a patient to avoid undergoing which procedure before receiving an intravenous dose of zoledronate (Reclast)?
Zoledronate has been associated with bisphosphonate-related osteonecrosis of the jaw (BRONJ) caused by impaired blood perfusion to bone. Most cases developed after tooth extractions or dental procedures. Patients should have preventive dentistry before being given zoledronate and should avoid elective dental procedures. It is not necessary to avoid heart catheterization, skin testing for tuberculosis, or mammography with zoledronate.
A nurse teaches a patient who takes raloxifene (Evista) for prevention of postmenopausal osteoporosis to report which finding as an adverse effect of the medication?
Calf pain and leg swelling
Raloxifene preserves bone mineral density and is used to prevent and treat osteoporosis. It increases the risk of deep vein thrombosis (DVT) because of its estrogenic effects in some tissues. Calf pain and leg swelling are symptoms of DVT. Fever and fatigue, bleeding and bruising, and hematuria and dysuria are not adverse effects of raloxifene.
Raloxifene (Evista) has been shown to have protective effects against which disorder in women?
Raloxifene is a selective estrogen receptor modulator, and one of its actions is antiestrogenic effects in some tissues. This offers protection against some types of breast cancer. It has not been shown to reduce the risk of developing ovarian cysts, PCOS, or endometriosis.
A female patient is to start treatment with teriparatide (Forteo) for osteoporosis. The nurse assesses the patient's history for which disorder, which would be a contraindication to treatment?
Teriparatide is a form of parathyroid hormone that acts to increase bone formation when it is given by daily subcutaneous injections. It has few serious side effects but has been shown in animal studies to cause bone cancer. It should be avoided by patients with bone cancer or metastases. Multiple sclerosis, myocardial infarction, and glaucoma are not contraindications to treatment with teriparatide.
A patient is ordered calcium gluconate for treatment of hypocalcemia. Which statement by the patient indicates a need for further teaching?
"I will take calcium 1 hour before eating."
Dosing of calcium with or after meals, not before, promotes absorption of the medication; therefore, further patient teaching is necessary. Calcium salts should be taken with a large glass of water. Foods to be avoided include spinach, Swiss chard, beets, bran, and whole-grain cereals. Patients should be taught the symptoms of hypercalcemia, such as nausea, vomiting, constipation, urinary frequency, lethargy, and depression, and should promptly notify the healthcare provider if these occur.
A patient has been taking raloxifene (Evista) for treatment of postmenopausal osteoporosis. Which patient complaint requires immediate investigation by the healthcare provider?
Edema and tenderness in the left calf
Raloxifene (Evista) increases the risk for development of deep vein thrombosis (DVT). Unilateral edema and tenderness may indicate DVT, and a life-threatening event may occur should the thrombus embolize. Pain on swallowing and urinary frequency are not side effects of raloxifene. Although they are a problem for the patient and require further investigation, they are not life-threatening. Hot flashes may occur but are not life-threatening.
Which statement by a patient does not indicate a need for further teaching by the nurse about the administration of alendronate (Fosamax)?
A. "I'll need to make sure I stand or sit for at least 30 minutes after taking my Fosamax." Because the medication poses a risk for esophagitis, patients must be able to maintain an upright position (sitting or standing) for a minimum of 30 minutes after taking the medication.
Alendronate (Fosamax) should be taken on an empty stomach with a full glass of water. Food and liquids, including orange juice and coffee, must be avoided for at least 30 minutes after taking the pill. The pill should be swallowed whole. New or worsening heartburn may be an indicator of esophageal injury from the medication and should be reported promptly to the health care provider.
A patient is ordered intravenous ibandronate (Boniva) for treatment of postmenopausal osteoporosis. What is a contraindication to administration of the drug?
Concurrent administration of cyclosporine because of a history of liver transplantation
Ibandronate should not be administered to patients who take other nephrotoxic drugs. Cyclosporine is nephrotoxic. Other contraindications to administration include a serum creatinine level above 2.3 mg/dL and a creatinine clearance below 30 mL/min. A BUN of 20 mg/dL is within normal limits.
Which statement by a patient indicates to the nurse that further teaching about tiludronate (Skelid) is required?
"Taking Maalox 3 times a day will help reduce heartburn from taking the Skelid."
Maalox contains magnesium, which greatly reduces the absorption of tiludronate; further teaching is necessary if the patient intends to take Maalox 3 times a day. If an isolated dose of Maalox must be taken, it should not be administered within 2 hours of taking tiludronate. Tiludronate should be taken with a full glass of water. Aspirin should be avoided for 2 hours after taking tiludronate, because it reduces the drug's absorption. Food should not be consumed for 2 hours before or after taking tiludronate.
nurse should establish which outcomes when planning care for optimal bone health in a child? (Select all that apply.)
Takes a multivitamin containing vitamin D
Has daily exposure to sunlight
Has a daily intake of cereal, cheese, and milk
Has absence of skeletal deformities Vitamin D is needed to ensure calcium absorption. It is obtained through the diet, especially vitamin D-fortified cereals, milk, and cheese, as well as exposure to sunlight. The American Academy of Pediatrics recommends that children take vitamin D, 400 international units/day in a multivitamin, to prevent abnormal skeletal conditions, such as rickets. A DEXA scan is used to measure bone mineral density when diagnosing osteoporosis, a bone condition common in adults.
A nurse instructs a patient at risk of developing osteoporosis to implement which measures to maximize bone strength? (Select all that apply.)
Engage in regular weight-bearing exercise.
Ensure a daily intake of calcium and vitamin D.
Have routine bone mineral density (BMD) tests.
Avoid smoking and excessive alcohol.
The risk of osteoporosis can be minimized through a sufficient intake of calcium and vitamin D. Bone health also is promoted by regular weight-bearing exercise, such as walking, jogging, and dancing. Avoiding smoking and excessive alcohol intake are also healthy activities conducive to bone strength. Bone resorption can be reduced with estrogen replacement therapy through inhibition of osteoclast activity. However, because of new information about the benefits and risks of estrogen, prolonged replacement is no longer considered appropriate for most women. As a predictor of fracture risk, BMD testing is recommended for all women after a certain age.
An antimicrobial medication that has selective toxicity has which characteristic?
Ability to avoid injuring host cells
Selective toxicity refers to an antibiotic that has the ability to injure only invading microbes, not the host. Conjugation is the process through which DNA coding for drug resistance is transferred from one bacterium to another. Antibiotics do not suppress bacterial resistance, but rather promote the emergence of drug-resistant microbes. Antibiotics that are narrow spectrum are active against only a few microbes.
The development of a new infection as a result of the elimination of normal flora by an antibiotic is referred to as what?
Antibiotic therapy can destroy the normal flora of the body, which normally would inhibit the overgrowth of fungi and yeast. When the normal flora is decreased, these organisms can overgrow and cause a new infection, or superinfection.
A microbe acquires antibiotic resistance by which means?
Transfer of DNA coding to other bacteria
All alterations in structure and function result from changes in the microbial genome. The microbe, not the host, becomes medication resistant. Genetic changes in a microbe result either from spontaneous mutation or from acquisition of DNA from conjugation with other bacteria. The minimum bacterial concentration (MBC) is used in testing for drug sensitivity. Incorrect dosing does not lead to microbe mutations.
The nurse identifies which host factor as the most important when choosing an antimicrobial drug?
Competent immune function
Two factors—host defenses and the site of infection—are unique to the selection of antibiotics. It is critical for success that antibiotics act synergistically with the immune system to subdue infection. Other host factors, such as age, genetic heritage, and previous drug reactions, are the same factors that must be considered when choosing any other medication.
What is the minimum bactericidal concentration (MBC)?
The lowest concentration of an antibiotic needed to reduce the number of bacterial colonies by 99.9% The MBC is the lowest concentration of drug that produces a 99.9% decline in the number of bacterial colonies (indicating bacterial kill). The lowest antibiotic concentration needed to suppress bacterial growth or to produce effects and the lowest antibiotic dose needed to eradicate bacteria are incorrect descriptions of MBC.
Which test is the most widely used method for assessing drug sensitivity?
The most widely used method for assessing drug sensitivity is the disk diffusion test, also known as the Kirby-Bauer test. Through diffusion, an antibiotic-containing zone becomes established around each disk. As the bacteria proliferate, growth is inhibited around the disks that contain an antibiotic to which the bacteria are sensitive.
A nurse removes a central line access device once the patient no longer requires intravenous (IV) antibiotics. This action is an example of which strategy to prevent antimicrobial resistance established by the Centers for Disease Control and Prevention (CDC)?
The CDC's campaign to prevent the development of antimicrobial resistance in hospitals focuses on four approaches: (1) prevent infection, (2) diagnose and treat infection effectively, (3) use antimicrobials wisely, and (4) prevent transmission. Expeditious removal of invasive devices, such as IV catheters, and restricting these devices to essential use are examples of the CDC's strategy to prevent infection.
The nurse identifies what as the first step in the Campaign to Prevent Antimicrobial Resistance, established in 2002 by the CDC?
Although all responses are components of the Campaign to Prevent Antimicrobial Resistance, step one is vaccination.
A patient has acquired an infection while in the hospital. The nurse identifies this type of infection as what?
Nosocomial infections are acquired by patients while in the hospital. Superinfection and suprainfection are terms used to describe the emergence of drug resistance.
nurse is assessing the effects of antimicrobial therapy in a patient with pneumonia. The nurse should establish which outcomes when planning care? (Select all that apply.)
Reduction of fever, Sterile sputum cultures, Oxygen saturation of 98%
Antimicrobial therapy is assessed by monitoring clinical and laboratory responses. Clinical indicators of success in a patient with pneumonia may include afebrile status and resolution of an infectious infiltrate, resulting in an oxygen saturation above 95%. The disappearance of infectious organisms from post-treatment cultures also indicates resolution of infection. Potassium levels and elastic skin turgor are not assessment parameters for clinical infections, including pneumonia.
Which are examples of the improper use of antibiotic therapy? (Select all that apply.)
Treating a viral infection, Using dosing that results in a superinfection.
Common misuses of antibiotics include (1) treatment of a viral infection, which results in exposure of the patient to the risks of the medication without providing any benefits; and (2) improper dosing (dosing that is too high results in superinfection). The other answers are examples of the proper use of antimicrobial therapy.
A nurse should recognize that antibiotic prophylaxis is appropriate in patients with which medical conditions? (Select all that apply.)
Aortic valve replacement &Neutropenia
Antibiotic prophylaxis is appropriate and effective in certain situations. These include patients who have prosthetic valves and are at risk for bacterial endocarditis. The use of antibiotics in "dirty" surgeries, such as those for ruptured organs, is considered treatment, not prophylaxis. Severe neutropenia can put patients at risk for severe infection, and antibiotics can reduce infections but may encourage fungal invasion. Antibiotics are not prescribed preventively for bronchitis or chickenpox.
The nurse identifies appropriate use of antimicrobials to prevent infection in which situations? (Select all that apply.)
Cardiac surgery, Recurrent urinary tract infections in women, & Hysterectomy
Prophylactic use of antibiotics can reduce the incidence of infection in certain kinds of surgery. Procedures in which prophylactic efficacy has been documented include cardiac surgery, peripheral vascular surgery, orthopedic surgery, and surgery on the gastrointestinal (GI) tract (stomach, duodenum, colon, rectum, and appendix). Prophylaxis is also beneficial for women undergoing a hysterectomy or an emergency cesarean section. Severe neutropenia, not anemia puts individuals at high risk of infection. In young women with recurrent urinary tract infection, prophylaxis with trimethoprim/sulfamethoxazole may be helpful. Unless the cause of a fever is a proven infection, antibiotics should not be used. Fever by itself constitutes a legitimate indication for antibiotic use only when the fever occurs in a severely immunocompromised person. Because fever may indicate infection and because infection can be lethal to immunocompromised individuals, these patients should be given antibiotics when fever occurs, even if fever is the only indication that an infection may be present.
Which medications does the nurse identify as having antibacterial properties? (Select all that apply.)
Zidovudine and amantadine are antiviral drugs. Amphotericin B is an antifungal drug. Rifampin and imipenem are antibacterial drugs
Before administering intravenous (IV) penicillin, the nurse should do what?
Assess the patient for allergies.
The principal adverse effect of penicillins is allergic reaction. Penicillins are contraindicated in patients with a history of severe allergic reactions to penicillins, cephalosporins, or carbapenems. IV patency is important, as is monitoring renal function, because impairment can cause penicillins to reach toxic levels; however, these are not as important as determining allergy status.
Thirty minutes after receiving an intramuscular (IM) injection of penicillin G (Pfizerpen), a patient reports itching and redness at the injection site. Which action should the nurse take first?
Administer subcutaneous epinephrine
Itching and redness at the IM injection site indicate an allergy to penicillin. The primary treatment is epinephrine (subcutaneous, IM, or IV) plus respiratory support. Elevation, ice packs, and calming the patient are done once epinephrine has been administered.
A patient is receiving penicillin G
(Bicillin C-R). Which assessment should the nurse monitor as an indicator of an undesired effect?
Penicillin G in high IV doses may cause hyperkalemia, which can result in dysrhythmias or cardiac arrest. Hypernatremia occurs with high IV doses of ticarcillin. Lung sounds and the RBC count are unrelated to the administration of penicillin G.
A nurse should teach a patient to observe for which side effect when taking ampicillin (Polycillin)?
Skin rash and loose stool
Ampicillin's most common side effects are rash and diarrhea; both reactions occur more frequently with ampicillin than with any other penicillin. Reddened tongue and gums, digit numbness and tingling, and bruising and petechiae are not associated side effects of ampicillin
Both IV ampicillin/sulbactam (Unasyn) and gentamicin (Garamycin) are ordered for a patient. When administering these medications, the nurse will do what?
Ensure that separate IV solutions are used
When penicillins are present in high concentrations, they interact chemically with aminoglycosides, causing inactivation of the aminoglycoside. Therefore, penicillins and aminoglycosides should not be mixed in the same IV solution. Rather, these drugs should be administered separately. Two different peripheral IV sites are not necessary. Administering the gentamicin first does not ensure separation of the two medications.
Which instructions should a nurse provide to a patient who is to start taking amoxicillin/clavulanate (Augmentin)?
"Augmentin may be taken with food or meals." \Amoxicillin/clavulanate is a broad-spectrum aminopenicillin that may be taken with meals. Most other oral penicillins must be taken with a full glass of water 1 hour before or 2 hours after meals. Taking oral penicillins only at bedtime, avoiding grapefruit juice, and taking the drug with only minimal water are not necessary.
An immunocompromised patient who is receiving piperacillin/tazobactam (Zosyn) develops oozing and bleeding from the gums. Which additional data should the nurse determine?
The most recent platelet count
Piperacillin/tazobactam (Zosyn) is an extended-spectrum penicillin used primarily for infections caused by Pseudomonas aeruginosa in immunocompromised hosts. It can cause bleeding secondary to disrupting platelet function; therefore, the platelet count may be altered. High fever, painful teeth, and mouth care do not address the patient's bleeding gums.
A patient is admitted to the hospital with a medical diagnosis of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). When taking the patient's history, a nurse recognizes which information as the most important?
Plays a contact sport and is an athlete
CA-MRSA is transmitted by skin-to-skin contact and by contact with contaminated objects, such as sports equipment and personal items. It is seen in young, healthy people without recent exposure to healthcare facilities, which is one of the biggest risk factors for CA-MRSA. Not completing an antibiotic course is unrelated.
When performing a skin test for penicillin allergy, the nurse will do what? (Select all that apply.)
Observe for a local allergic response. Have epinephrine readily available. Have respiratory support readily available.
For a penicillin allergy skin test, a small amount of allergen is injected intradermally.
The nurse observes for a local allergic reaction and has epinephrine and respiratory support readily available. Epinephrine is administered as the first-line agent should anaphylaxis occur.
The nurse identifies which statements about penicillins as true? (Select all that apply.)
Penicillins are the safest antibiotics available,The principal adverse effect of penicillins is allergic reaction,Penicillins are normally eliminated rapidly by the kidneys but can accumulate to harmful levels if renal function is severely impaired.
A patient who is allergic to penicillin has a 1% chance of also being allergic to cephalosporins. Patients who are allergic to penicillin are safely able to take vancomycin, erythromycin, and clindamycin. The other three statements are true.
A nurse observes a red streak and palpates the vein as hard and cordlike at the intravenous (IV) site of a patient receiving cefepime (Maxipime). Which assessment should the nurse make about the IV site?
Phlebitis of the vein used for the antibiotic has developed
IV cephalosporins may cause thrombophlebitis. To minimize this, the injection site should be rotated and a dilute solution should be administered slowly. An allergic response would be shown as itching, redness, and swelling. Infiltration would show as a pale, cool, and puffy IV site. Infection would show as pus, tenderness, and redness.
A patient develops flushing, rash, and pruritus during an IV infusion of vancomycin (Vancocin). Which action should a nurse take?
Reduce the infusion rate
When vancomycin is infused too rapidly, histamine release may cause the patient to develop hypotension accompanied by flushing and warmth of the neck and face; this phenomenon is called red man syndrome. Diphenhydramine is not necessary if the infusion is administered slowly over at least 60 minutes. Changing the IV tubing would not help the symptoms. The patency of the IV needs to be checked before the administration is started.
A patient who is receiving vancomycin (Vancocin) IV for a methicillin-resistant Staphylococcus aureus (MRSA) infection asks a nurse, "Why can't I take this medicine in a pill?" Which response should the nurse make?
"It is more effective by IV, because the pill form will stay in the digestive tract."
Because of its chemical size and weight, vancomycin is absorbed poorly in the gastrointestinal (GI) tract and is given parenterally for most infections. It is used for serious infections caused by organisms such as MRSA and in patients with susceptible organisms allergic to penicillins. Oral administration is used only for infections of the intestine. It is not associated with loss of appetite or nausea.
A patient who is receiving cefotetan (Cefotan) has all of these medications ordered. The nurse monitors the patient for an adverse effect related to an interaction with which medication?
Three cephalosporins—cefmetazole (Zefazone), cefoperazone (Cefobid), and cefotetan (Cefotan)—cause bleeding tendencies. Caution should be used during concurrent use of anticoagulants and other nonsteroidal medications. Regular insulin, ampicillin, and bisacodyl are unrelated to adverse effects with cefotetan.
A patient is receiving vancomycin (Vancocin). The nurse identifies what as the most common toxic effect of vancomycin therapy?
The most common toxic effect of vancomycin (Vancocin) therapy is renal toxicity. Although ototoxicity may occur, it is rare. The liver and heart are not affected when vancomycin is used.
Before administering a cephalosporin to a patient, it is most important for the nurse to assess the patient for an allergy history to what?
The cephalosporins are beta-lactam antibiotics similar in structure and actions to the penicillins. They are contraindicated in patients with a history of severe allergic reactions to penicillins. The use of soy products, peanuts, and opioids is unrelated to cephalosporins.
The cephalosporins are beta-lactam antibiotics similar in structure and actions to the penicillins. They are contraindicated in patients with a history of severe allergic reactions to penicillins. The use of soy products, peanuts, and opioids is unrelated to cephalosporins.
Imipenem can reduce blood levels of valproate, a drug used to control seizures, and breakthrough seizures have occurred. If possible, combined use of imipenem and valproate should be avoided. If no other antibiotic will suffice, supplemental antiseizure therapy should be considered. The other responses are not associated with use of imipenem and valproate.
It is most important for the nurse to assess a patient receiving a cephalosporin for the development of which manifestation of antibiotic-associated pseudomembranous colitis (AAPMC)?
AAPMC, which is manifested initially by diarrhea and abdominal cramping, especially may develop with the use of broad-spectrum cephalosporins. Rigidity, ileus, and ascites are unrelated to cephalosporin use.
When ceftriaxone is administered intravenously, it is most important for the nurse to avoid mixing it with what?
Mixing ceftriaxone with calcium causes precipitates to form. Ringer's lactate contains calcium; therefore it should not be mixed with ceftriaxone. It is safe to mix normal saline, sterile water, and D5 0.45% NS with ceftriaxone.
Which statements about vancomycin (Vancocin) does the nurse identify as true? (Select all that apply.)
Vancomycin is the most widely used antibiotic in U.S. hospitals,Vancomycin is effective in the treatment of Clostridium difficile infection,Vancomycin is effective in the treatment of MRSA infections.
Patients who are allergic to penicillin are able to take vancomycin. The major toxicity of vancomycin therapy is kidney failure. The other three statements are true.
Which instructions will the nurse include when teaching a patient about cephalosporin therapy? (Select all that apply.)
"Notify your healthcare provider if you develop diarrhea."
"Notify your healthcare provider if you develop a rash."
Cephalosporins may enhance bleeding tendencies, so drugs such as aspirin that may promote bleeding should be avoided. Cephalosporins may be taken with food, and they are safe to take if a patient has lactose intolerance. Severe diarrhea should be reported, because it may indicate the development of C. difficile infection. Any indication of an allergic reaction, including a rash, should be reported to the healthcare provider.
Which instruction should a nurse include in the discharge teaching for a patient who is to start taking tetracycline (Sumycin)?
B. "Use sunscreen and protective clothing when outdoors."
Tetracyclines are bacteriostatic antibiotics; photosensitivity and severe sunburn are common adverse effects. A full course of antibiotics must always be taken. Blood studies are not necessary for therapeutic levels. Absorption decreases after ingestion of chelates, such as calcium and magnesium, so doses should be given 2 hours before or 2 hours after ingestion of milk products.
A nurse assessing a patient who is 12 years old should associate which complication with the patient's receiving tetracycline (Sumycin) as a younger child?
Discoloration of the teeth
Tetracycline is contraindicated in children younger than 8 years of age, because it binds to calcium in developing teeth, resulting in permanent discoloration of the teeth. Delay in long bone growth, early onset of puberty, and severe face and body acne are not adverse effects associated with tetracyclines.
Which laboratory result should a nurse monitor more frequently when a patient is receiving clarithromycin (Biaxin) and warfarin (Coumadin)?
International normalized ratio (INR)
Clarithromycin is a macrolide similar to erythromycin and can inhibit hepatic metabolism of medications such as warfarin and theophylline. The INR is the blood test used to evaluate warfarin ranges. The aPTT is the blood test used in monitoring heparin. The platelet count and ESR are not affected by clarithromycin.
A patient who has a vancomycin-resistant enterococci (VRE) infection is receiving linezolid (Zyvox). Which laboratory result indicates that the patient is having an adverse effect?
White blood cell (WBC) count of 1200 units/L
Linezolid can cause reversible myelosuppression, manifesting as anemia, leukopenia, or even pancytopenia. The potassium and blood glucose levels are not affected by linezolid.
Which cardiovascular finding does the nurse identify as a possible adverse effect of erythromycin (Ery-Tab) therapy?
Prolonged QT interval
When present in high levels, erythromycin can prolong the QT interval, causing a potentially fatal ventricular dysrhythmia. It should be avoided by patients taking class IA or class III antidysrhythmic medications or others that inhibit metabolism.
What does the nurse identify as an adverse effect of clindamycin (Cleocin) therapy?
Frequent loose, watery stools with mucus and blood
Clostridium difficile-associated diarrhea (CDAD) is the most severe toxicity associated with clindamycin and is characterized by profuse, watery stools. The cause is superinfection of the bowel with Clostridium difficile, an anaerobic gram-positive bacillus. Gray syndrome, which usually occurs in infants and those with aplastic anemia, is an adverse effect of chloramphenicol (Chloromycetin). Hepatotoxicity is associated most closely with telithromycin (Ketek).
The nurse identifies tigecycline (Tygacil) as a derivative of what?
Tigecycline is the first representative of a new class of antibiotics, the glycyclines. It is a tetracycline derivative made to overcome drug resistance and is active against many drug-resistant strains. It has adverse effects similar to those of the tetracyclines.
The nurse identifies which drug as a short-acting tetracycline?
Sumycin is a short-acting tetracycline. Declomycin is an intermediate-acting tetracycline, and Vibramycin and Minocin are long-acting tetracyclines.
Which statements about CDAD associated with clindamycin therapy does the nurse identify as true? (Select all that apply.)
It is a potentially fatal condition, Patients usually experience abdominal pain, & Clindamycin therapy should be discontinued and vancomycin started.
CDAD is a potentially fatal condition in which patients experience abdominal pain. If CDAD develops, clindamycin therapy should be stopped and vancomycin or metronidazole therapy started. Leukocytosis, not leukopenia, develops. Anticholinergics can make the diarrhea worse and therefore should be avoided.
The nurse should include which instructions when teaching a patient about tigecycline therapy? (Select all that apply.)
"Use sunscreen when you are outside." "If you have diarrhea more than five times a day, notify your healthcare provider." "Avoid using this drug if you are pregnant."
Nausea and vomiting may occur. The patient should not stop taking the medication; rather, the healthcare provider should be notified so that an alternative plan can be discussed. The other three instructions should be included in the patient teaching.
A nurse is administering a daily dose of tobramycin (Nebcin) at 1000. At which time should the nurse obtain the patient's blood sample to determine the trough level?
Trough levels determine the lowest level between doses. Blood is drawn just before the next dose is administered when a divided dose is used or 1 hour before the next dose if a single daily dose is used.
A patient who is receiving an aminoglycoside (gentamicin) has a urinalysis result with all of these findings. Which finding should a nurse associate most clearly with an adverse effect of gentamicin?
Aminoglycoside-induced nephrotoxicity usually presents as acute tubular necrosis. Symptoms of concern are protein in the urine, dilute urine, and elevation of the serum creatinine and blood urea nitrogen (BUN) levels. WBCs, glucose, and ketones are not specifically related to gentamicin use.
A patient is receiving an aminoglycoside (tobramycin) antibiotic. A nurse asks the patient to choose daily meal selections, to which the patient responds, "Oh, dear, I don't want another IV." The nurse makes which assessment about the patient's response?
Some hearing loss may have occurred.
The patient's comment suggests that the person did not hear the instructions. Aminoglycoside antibiotics can cause ototoxicity. The first sign may be tinnitus (ringing in the ears), progressing to loss of high-frequency sounds. Audiometric testing is needed to detect it. Nutrition, confusion, and a family history of dementia do not address the problem of possible hearing loss associated with aminoglycosides.
A nurse monitors a patient who is receiving an aminoglycoside (gentamicin) for symptoms of vestibular damage. Which finding should the nurse expect the patient to have first?
Gentamicin causes irreversible ototoxicity, which results in both impaired hearing and disruption of balance. Headache is the first sign of impending vestibular damage (balance) and may last 1 to 2 days. Unsteadiness, vertigo, and dizziness appear after headache.
The nurse knows that there is an increased risk of ototoxicity in a patient receiving an aminoglycoside if which level is high?
When trough levels remain elevated, aminoglycosides are unable to diffuse out of inner ear cells, thus exposing the cells to the medication for an extended time. Prolonged exposure (i.e., high trough levels), rather than brief exposure to high levels, underlies cellular injury.
When administering an aminoglycoside to a patient with myasthenia gravis, it is most important for the nurse to assess what?
Aminoglycosides can inhibit neuromuscular transmission, causing potentially fatal respiratory depression. Patients with myasthenia gravis (MG) are at an increased risk. Deep tendon reflexes, eyelid movement, and muscle strength are important assessments for a patient who has MG, but they are not as important as airway and breathing ability.
A patient who is receiving an aminoglycoside develops flaccid paralysis and impaired breathing. Which medication does the nurse anticipate administering?
Calcium gluconate (Kalcinate)
Flaccid paralysis and impaired breathing are signs of impaired neuromuscular transmission, which may occur with aminoglycosides, especially if they are administered concurrently with a neuromuscular blocking agent. Impaired transmission can be reversed with intravenous infusion of a calcium salt (calcium gluconate). Magnesium sulfate, potassium chloride, and sodium bicarbonate do not reverse impaired neuromuscular transmission caused by aminoglycosides.
Which enteral aminoglycoside would the nurse expect to be ordered preoperatively for a patient having intestinal surgery?
In general, aminoglycosides are poorly absorbed in the gastrointestinal (GI) tract. Neomycin is given orally to suppress bowel flora before surgery of the intestine and is not used parenterally because of its high nephrotoxicity and ototoxicity. Gentamicin, tobramycin, and amikacin are administered parenterally only.
Before administering an aminoglycoside, it is most important for the nurse to assess the patient for a history of what?
Aminoglycosides can inhibit neuromuscular transmission, causing flaccid paralysis and potentially fatal respiratory depression. These drugs should be used with extreme caution in patients with myasthenia gravis.
Which statements about ototoxicity and aminoglycosides does the nurse identify as true? (Select all that apply.)
Ototoxicity is largely irreversible & Use of aminoglycosides for less than 10 days is recommended to avoid ototoxicity.
The risk of ototoxicity with aminoglycoside use is related primarily to excessive trough levels. The first sign of impending vestibular damage is headache. The first sign of cochlear damage is tinnitus. The other two statements are true.
Which statements about serum drug levels does the nurse identify as true? (Select all that apply.)
A. With once-daily dosing, only trough levels need to be drawn.
B. Peak levels for intramuscular (IM) injections should be drawn 30 minutes after administration of the medication.
C. The trough level ideally should be close to zero.
For patients receiving once-daily doses, the sample should be drawn 1 hour before the next dose. For patients receiving divided doses, trough levels should be drawn immediately before the next dose. The other three statements are true.
After completing a course of ciprofloxacin (Cipro) for a skin infection, the patient says, "I took the whole bottle of pills, but my infection hasn't gotten any better." Which additional information should the nurse recognize as most significant?
The patient takes antacids on a daily basis. Antacids interfere with the absorption of quinolone antibiotics, such as ciprofloxacin (Cipro), and many other drugs; therefore, this patient has not received the full dosing regimen, which is required if ciprofloxacin is to be effective against the infection. Storing the drug in a cool, dry area and using sunscreen or diphenhydramine would not disrupt the effectiveness of ciprofloxacin.
The nurse identifies which medication as posing a significant risk of causing confusion, somnolence, psychosis, and visual disturbances in elderly patients?
In elderly patients, ciprofloxacin (Cipro) poses a significant risk of confusion, somnolence, psychosis, and visual disturbances. Metronidazole, rifampin, and daptomycin are not associated with confusion in elderly patients.
Which approach should a nurse take when administering an oral dose of levofloxacin (Levaquin)?
Give the medication with or without food.
Levofloxacin should not be administered with milk products or antacids containing magnesium or aluminum, because this reduces absorption from the gastrointestinal (GI) tract. However, this does not happen with most foods. Premedicating with diphenhydramine is unnecessary.
A patient who takes ciprofloxacin (Cipro) and runs 6 miles daily tells a nurse about heel and calf tenderness. The nurse instructs the patient to take which action?
Discontinue the medication, because severe damage can result.
Fluoroquinolones may result in tendinitis and rupture by disrupting the extracellular matrix of cartilage. Because tendon injury is reversible if diagnosed early, fluoroquinolones should be discontinued at the first sign of tendon pain or inflammation.
A patient is taking daptomycin (Cubicin). The nurse should obtain a creatine phosphokinase (CPK) level when the patient shows what?
Muscle pain and weakness
Daptomycin is one of the cyclic lipopeptides, a class of antibiotics that can kill gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). It may pose a small risk of myopathy (muscle injury). Patients should be warned about muscle injury and told to report any pain or weakness. In addition, CPK levels should be measured weekly. Increased urination and urinary urgency, abdominal bloating and diarrhea, and headache and visual disturbances are not associated with daptomycin
A patient who takes multiple antibiotics starts to experience diarrheal stools. The nurse anticipates administration of which antibiotic if a stool sample tests positive for Clostridium difficile?
Metronidazole is the treatment of choice for antibiotic-associated colitis caused by C. difficile. Rifaximin, daptomycin, and gemifloxacin are not used in the treatment of C. difficile infection.
The nurse identifies rifampin as useful in the treatment of which disorders? (Select all that apply.)
Tuberculosis, Leprosy, Active meningococcal infection,& Prophylaxis of meningitis caused by Haemophilus influenzae
Rifampin is useful in the treatment of tuberculosis and can be used for prophylaxis of meningitis caused by H. influenzae. The treatment of leprosy is an unlabeled use. Rifampin is indicated for treatment of carriers of meningococcal infection, but not for active meningococcal infection. Rifampin is not indicated for the treatment of C. difficile infection.
A patient who has type 2 diabetes has a glycated hemoglobin A1c (HbA1c) of 10%. The nurse should make which change to the nursing care plan?
Refer the patient to a diabetes educator because the result reflects poor glycemic control.
Glycated hemoglobin (HbA1c) is a measure of plasma glucose levels on average over the previous 2- to 3-month period. The target value is 7% or lower. If it is greater than 7%, a diabetes educator is an additional resource who can facilitate lifestyle, exercise, and medication changes. Hypoglycemia is not a concern, because elevated HbA1c levels indicate poor glycemic control. Exercise should be part of an overall management program, because it counteracts insulin resistance
A patient who has type 2 diabetes is taking nateglinide (Starlix). Which response should a nurse expect the patient to have if the medication is achieving the desired therapeutic effect?
Promotion of insulin secretion
Nateglinide is a meglitinide medication that acts to increase pancreatic insulin release. It is used as an adjunct to calorie restriction and exercise to maintain glycemic control in patients with type 2 diabetes. It does not act to reduce insulin resistance or inhibit carbohydrate digestion. It should not be used to manage diabetic ketone formation, because its glucose-lowering effects are too slow to be of benefit.
Which instruction should the nurse provide when teaching a patient to mix regular insulin and NPH insulin in the same syringe?
"Draw up the clear regular insulin first, followed by the cloudy NPH insulin."
To ensure a consistent response, only NPH insulin is appropriate for mixing with a short-acting insulin. Unopened vials of insulin should be refrigerated; current vials can be kept at room temperature for up to 1 month. Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could alter the pharmacokinetics of subsequent doses taken out of the regular insulin vial. NPH insulin is a cloudy solution, and it should always be rotated gently to disperse the particles evenly before loading the syringe. Subcutaneous injections should be made using one region of the body (e.g., the abdomen or thigh) and rotated within that region for 1 month.
A patient is scheduled to start taking insulin glargine (Lantus). On the care plan, a nurse should include which of these outcomes related to the therapeutic effects of the medication?
Blood glucose control for 24 hours
Insulin glargine is administered as a once-daily subcutaneous injection for patients with type 1 diabetes. It is used for basal insulin coverage, not mealtime coverage. It has a prolonged duration, up to 24 hours, with no peaks. Blood glucose monitoring is still an essential component to achieve tight glycemic control.
A patient who took NPH insulin at 0800 reports feeling weak and tremulous at 1700. Which action should the nurse take?
Check the patient's capillary blood sugar.
The patient is showing symptoms of hypoglycemia at 5 PM. NPH has a peak action of 8 to 10 hours after administration. Based on the duration of action of NPH insulin, the patient's hypoglycemic symptoms are from the 8 AM injection of NPH insulin. An injection of NPH insulin at 2 AM, 1 PM, or 3 PM would not cause hypoglycemic symptoms based on the average duration of action of NPH insulin.
A teaching plan for a patient who is taking lispro (Humalog) should include which instruction by the nurse?
"Inject this insulin with your first bite of food, because it is very fast acting."
Lispro is a rapid-acting insulin and has an onset of action of 15 to 30 minutes with a peak action of about 2 hours, not 8 to 10 hours. Because of its rapid onset, it is administered immediately before a meal or with meals to control the blood glucose rise after meals. Lispro insulin must be combined with an intermediate- or a long-acting insulin, not regular insulin (which also is a short-duration insulin), for glucose control between meals and at night. To achieve tight glycemic control, patients must combine different types of insulin based on their duration of action.
A patient newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse explains that normal insulin has which action in the body?
It promotes the passage of glucose into cells for energy.
The hormone insulin promotes the passage of glucose into cells, where it is metabolized for energy. Insulin does not stimulate the pancreas to reabsorb glucose or synthesize amino acids into glucose. It does not stimulate the liver to convert glycogen into glucose.
A patient is taking glipizide (Glucotrol) and a beta-adrenergic medication. A nurse is teaching hypoglycemia awareness and should warn the patient about the absence of which symptom?
Glipizide is a sulfonylurea oral hypoglycemic medication that acts to promote insulin release from the pancreas. Beta-adrenergic blockers can mask early signs of sympathetic system responses to hypoglycemia; the most important of these is tachycardia, which is the most common adverse effect of glipizide. Vomiting, muscle cramps, and chills are not symptoms of activation of the sympathetic nervous system that arise when glucose levels fall.
A nurse assesses a patient who is taking pramlintide (Symlin) with mealtime insulin. Which finding requires immediate follow-up by the nurse?
Pramlintide is a new type of antidiabetic medication used as a supplement to mealtime insulin in patients with type 1 and 2 diabetes. Hypoglycemia, which is manifested by sweating, tremors, and tachycardia, is the adverse reaction of most concern. Skin rash, itching, and edema are not adverse effects of pramlintide.
Before administering metformin (Glucophage), the nurse should notify the prescriber about which laboratory value?
Creatinine (Cr) level of 2.1 mg/dL
Metformin can reach toxic levels in individuals with renal impairment, which is indicated by a rise in the serum creatinine level. The prescriber may need to be notified of the hemoglobin, sodium, and platelet values, but they would not affect the administration of metformin.
A nurse caring for a patient who has diabetic ketoacidosis recognizes which characteristics in the patient? (Select all that apply.)
Altered fat metabolism leading to ketones, Sudden onset, triggered by acute illness, &Plasma osmolality of 300 to 320 mOsm/L
toacidosis is the most severe manifestation of insulin deficiency in patients with type 1 diabetes. It develops and worsens acutely over several hours to days. Alterations in fat metabolism lead to the production of ketones and ketoacids. Increased ketoacid levels lead to a fall in arterial blood pH below 7.35. Altered glucose metabolism leads to hyperglycemia, water loss, and an elevated plasma osmolality (285 to 295 mOsm/L).
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