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A 75-year-old patient with a history of renal impairment is admitted to the primary health care center with a UTI and has been prescribed a cephalosporin. Which of the following interventions is most important for the nurse to perform when caring for this patient?
- A. Monitoring fluid intake
- B. Monitoring blood creatinine levels
- C. Testing for occult blood
- D. Testing for increased glucose levels
Correct Answer: B
Rationale: An elderly patient is more susceptible to the nephrotoxic effects of the cephalosporins. Since renal impairment is present, it is important for the nurse to closely monitor the patient's blood creatinine levels. The nurse should conduct a test for occult blood if blood and mucus occur in the stool and monitor the fluid intake if there is a decrease in urine output. The nurse does not need to monitor for increased glucose levels unless the patient has a history of diabetes.
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The nurse administers cefuroxime to a patient at least 1 hour before meals, as prescribed. However, the patient experiences GI upset. Which of the following would be most appropriate for the nurse to do?
- A. Administer an antacid.
- B. Lower the dosage.
- C. Discontinue the drug.
- D. Administer the drug with food.
Correct Answer: D
Rationale: If the patient experiences GI upset, the nurse can administer cefuroxime with food. A decrease in the dosage is suggested in a patient with renal impairment. A change in dosage, discontinuation of the drug, or use of an antacid is recommended only if prescribed by the physician.
A nursing instructor is preparing a class about cephalosporins for a group of nursing students. When describing progression from first-generation to fourth-generation cephalosporins, which of the following would the instructor include as the result? Select all that apply.
- A. An increase in the sensitivity of gram-negative microorganisms
- B. A decrease in the sensitivity of gram-negative microorganisms
- C. An increase in the sensitivity of gram-positive microorganisms
- D. A decrease in the sensitivity of gram-positive microorganisms
- E. An increase in the sensitivity of viral microorganisms
Correct Answer: A,D
Rationale: In general, progression from first-generation to fourth-generation cephalosporins shows an increase in the sensitivity of gram-negative microorganisms and a decrease in the sensitivity of gram-positive microorganisms.
Before administering the first dose to the client, which assessment should the nurse perform as part of the preadministration assessment?
- A. Review of renal and hepatic function tests
- B. Inspection of patient's stools
- C. Evaluation of patient's lifestyle and diet
- D. General history of patient's health
Correct Answer: D
Rationale: Before administering the first dose of penicillin, the nurse should obtain and review the patient's general health history, including any allergy history, a history of all medical and surgical treatments, a drug history, and the current symptoms of the infection. The patient's stool is examined only after penicillin has been administered if the patient has diarrhea. It is not required to evaluate the patient's lifestyle and diet as part of the preadministration assessment for the first dose. Renal and hepatic function tests may be performed at intervals during penicillin therapy, usually not before it.
A nurse is monitoring a client who is receiving penicillin. The nurse would assess the client for which of the following common GI tract adverse reactions? Select all that apply.
- A. Glossitis
- B. Stomatitis
- C. Esopliagitis
- D. Diarrhea
- E. Gastritis
Correct Answer: A,B,D,E
Rationale: A nurse monitoring a client taking penicillin should be aware of the common GI tract adverse reactions, including glossitis, stomatitis, gastritis, nausea, vomiting, diarrhea, and abdominal pain.
After taking penicillin as prescribed, a patient shows signs of diarrhea and informs the nurse that there is blood in his stools. Which of the following interventions should the nurse do next?
- A. Contact primary health provider immediately.
- B. Have the patient consume yogurt with his next meal.
- C. Decrease fiber content in diet.
- D. Continue with prescribed regimen.
Correct Answer: A
Rationale: If diarrhea is suspected, the nurse should notify the primary health care provider immediately. The nurse should wait for the primary health care provider's instructions before continuing with the prescribed regimen. Yogurt or buttermilk may help prevent fungal superinfections, but they will not help alleviate the patient's condition at this stage. Changes in the diet are not recommended unless instructed by the primary health care provider.