Nokea
A client is receiving quinupristin/dalfopristin via a peripheral intravenous infusion. After the drug is administered, the nurse would flush the intravenous line with which of the following?
- A. Normal saline
- B. 0.45% sodium chloride
- C. Dextrose 5% and water
- D. Heparin
Correct Answer: C
Rationale: Quinupristin/dalfopristin is irritating to the vein. After peripheral infusion, the vein should be flushed with 5% dextrose in water (D5W), because the drug is incompatible with saline or heparin flush solutions.
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A patient is receiving telithromycin. Based on the nurse's understanding of potential adverse reactions, the nurse would identify which nursing diagnosis as a priority?
- A. Ineffective Renal Tissue Perfusion
- B. Risk for Injury
- C. Diarrhea
- D. Risk for Impaired Skin Integrity
Correct Answer: B
Rationale: Telithromycin can cause visual disturbances such as difficulty focusing and accommodating to light. Therefore, the priority nursing diagnosis would be Risk for Injury related to these visual disturbances. Aminoglycosides can cause nephrotoxicity, leading to a nursing diagnosis of Ineffective Renal Perfusion. Although diarrhea and skin rashes can occur, these would not be a priority at this time.
A patient is ordered to receive neomycin as part of the treatment plan for hepatic coma. Which of the following would be most important for the nurse to assess before administering this drug? Select all that apply.
- A. Ability to swallow
- B. Level of consciousness
- C. Baseline vital signs
- D. Pulmonary function
Correct Answer: A, B
Rationale: During the early stages of hepatic coma, various changes in the level of consciousness may be seen. At times, the patient may appear lethargic and respond poorly to commands. Because of these changes in the level of consciousness, the patient may have difficulty swallowing, and a danger of aspiration is present. If the patient appears to have difficulty taking an oral drug, the nurse should withhold the drug and contact the primary health care provider. Baseline vital signs are important but are not the priority when the patient has hepatic coma. The drug does not affect the patient's respiratory function. There is no infection; therefore, there is no need for culture and sensitivity testing.
A nursing instructor is preparing a class on various antibacterial drugs interfering with protein synthesis, with the discussion focusing on quinupristin/dalfopristin. Which of the following medications would the instructor include as interacting with quinupristin/dalfopristin, thus increasing the risk for toxicity? Select all that apply.
- A. Lorazepam (Ativan)
- B. Quinapril (Accupril)
- C. Ritonavir (Norvir)
- D. Atorvastatin (Lipitor)
Correct Answer: A, C, D
Rationale: When quinupristin/dalfopristin is prescribed, it may interact with the following drugs, increasing serum levels and thus the risk for toxicity: antiretrovirals, antineoplastic and immunosuppressant agents, calcium channel blockers, benzodiazepines, and cisapride.
A patient is scheduled for abdominal surgery and is ordered to receive kanamycin as part of the bowel preparation. The patient asks the nurse why he is getting this drug. Which response by the nurse would be most appropriate?
- A. You have an infection now and will probably have one after surgery, so this will help control it.
- B. We need to lower the levels of ammonia in your bloodstream to prevent problems.
- C. The drug helps eliminate bacteria so that your GI tract is as clean as possible for surgery.
- D. This is to help prevent you from developing any blood clots during and after the surgery.
Correct Answer: C
Rationale: Kanamycin and neomycin are used before surgery to reduce intestinal bacteria. It is thought that this reduces the possibility of abdominal infection that may occur after surgery on the bowel. By destroying bacteria in the gut and washing it out with laxatives or enemas, the surgical area becomes as clean as possible before the operation. The drug is not used to control an infection preoperatively. It does help to reduce blood ammonia levels with hepatic coma, but this is not the reason for its use with this patient. The drug has no effect on preventing blood clots postoperatively.
A nurse is preparing to administer lincomycin via IM injection. Which of the following would be most appropriate for the nurse to do? Select all that apply.
- A. Inspect previous injection sites.
- B. Rotate the injection site.
- C. Use the abdomen for intramuscular injections.
- D. Note the site used for injection in the client's chart.
Correct Answer: A, B, D, E
Rationale: When giving lincomycin intramuscularly, the nurse inspects previous injection sites for signs of pain or tenderness, redness, and swelling; reports the persistence of a localized reaction to the physician; rotates the injection sites; and records the site used for injection in the client's chart.