Nokea
A 79-year-old patient is receiving a quinolone as treatment for a complicated incision infection. The nurse will monitor for which adverse effect that is associated with these drugs?
- A. Neuralgia
- B. Double vision
- C. Hypotension
- D. Tendonitis and tendon rupture
Correct Answer: D
Rationale: A black box warning is required by the U.S. Food and Drug Administration for all quinolones because of the increased risk for tendonitis and tendon rupture with use of the drugs. This effect is more common in elderly patients, patients with renal failure, and those receiving concurrent glucocorticoid therapy (e.g., prednisone). The other options are not common adverse effects.
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The nurse is reviewing the medication orders for a patient who will be receiving aminoglycoside therapy. Which other medication or medication class, if ordered, would be a potential interaction concern?
- A. Calcium channel blockers
- B. Phenytoin
- C. Proton pump inhibitors
- D. Loop diuretics
Correct Answer: D
Rationale: Concurrent use of aminoglycosides with loop diuretics increases the risk for ototoxicity. The other drugs and drug classes do not cause interactions.
A patient is receiving aminoglycoside therapy and will be receiving a beta-lactam antibiotic as well. The patient asks why two antibiotics have been ordered. What is the nurse's best response?
- A. The combined effect of both antibiotics is greater than each of them alone.
- B. One antibiotic is not strong enough to fight the infection.
- C. We have not yet isolated the bacteria, so the two antibiotics are given to cover a wide range of microorganisms.
- D. We can give a reduced amount of each one if we give them together.
Correct Answer: A
Rationale: Aminoglycosides are often used in combination with other antibiotics, such as beta-lactams or vancomycin, in the treatment of various infections because the combined effect of the two antibiotics is greater than that of either drug alone.
When a patient is on aminoglycoside therapy, the nurse will monitor the patient for which indicators of potential toxicity?
- A. Fever
- B. White blood cell count of 8000 cells/mm^3
- C. Tinnitus and dizziness
- D. Decreased blood urea nitrogen (BUN) levels
Correct Answer: C
Rationale: Dizziness, tinnitus, hearing loss, or a sense of fullness in the ears could indicate ototoxicity, a potentially serious toxicity in a patient. Nephrotoxicity is indicated by rising blood urea nitrogen and creatinine levels. Fever may be indicative of the patient's infection; a white blood cell count of 7000 cells/mm^3 is within the normal range of 5000 to 10,000 cells/mm^3.
The nurse is administering a vancomycin infusion. Which measure is appropriate for the nurse to implement in order to reduce complications that may occur with this drug's administration?
- A. Monitoring blood pressure for hypertension during the infusion
- B. Discontinuing the drug immediately if red man syndrome occurs
- C. Restricting fluids during vancomycin therapy
- D. Infusing the drug over at least 1 hour
Correct Answer: D
Rationale: Infuse the medication over at least 1 hour to reduce the occurrence of red man syndrome. Adequate hydration (at least 2 L of fluid in 24 hours) during vancomycin therapy is important for the prevention of nephrotoxicity. Hypotension may occur during the infusion, especially if it is given too rapidly.
A patient with a Pseudomonas species urinary infection will be receiving amikacin 5 mg/kg once daily via intravenous infusion. The patient weighs 143 pounds, and the medication is available in an injection solution strength of 250 mg/mL. Identify how many milliliters of medication will be drawn up for this injection. (record answer using one decimal place)
Correct Answer: 1.3 Ml
Rationale: Calculate the patient's weight in kilograms: 143 pounds ?· 2.2 = 65 kg. Calculate mg/kg/dose: 5 mg/kg ?? 65 kg = 325 mg. Calculate volume: 325 mg ?· 250 mg/mL = 1.3 mL.