Nokea
A middle-aged patient has been prescribed tetracycline as part of his treatment of H. pylori. The patient has a history of heart disease for which he is receiving digoxin. Given his history and current medications, the patient is at risk for which of the following conditions?
- A. Respiratory depression
- B. Decreased effectiveness of tetracycline
- C. Prolonged clotting times
- D. Risk of digoxin toxicity
Correct Answer: D
Rationale: When digoxin interacts with tetracyclines, the patient is at risk for digoxin toxicity. Respiratory depression is an effect observed when neuromuscular blocking drugs interact with lincosamides. A decrease in the effectiveness of tetracycline is seen when the drug is taken with antacids, dairy products, or iron. An increased risk for bleeding with prolonged clotting times is noted when tetracycline is given with anticoagulants.
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A patient is receiving linezolid. The patient is fond of eating chocolates and coffee, both of which contain tyramine. The nurse would instruct the patient that he is at risk for which of the following should he consume foods containing tyramine while taking linezolid?
- A. Severe hypertension
- B. Drowsiness
- C. Nervousness
- D. Nausea
Correct Answer: A
Rationale: The nurse should inform the patient that if tyramine found in chocolates and coffee interacts with linezolid, the patient will develop an increased risk for severe hypertension. Tyramine-containing foods interacting with linezolid do not cause drowsiness, nervousness, or nausea.
A client who is receiving statin therapy as treatment for elevated lipid levels is also prescribed daptomycin. The nurse would assess which of the following laboratory test results for changes?
- A. Creatine phosphokinase levels
- B. Blood glucose levels
- C. White blood cell count
- D. International normalized ratio
Correct Answer: A
Rationale: Myopathy with elevated creatine phosphokinase (CPK) levels may occur if daptomycin is administered with statin drugs (cholesterol reduction). Therefore, the nurse would assess CPK levels. The combination of statin therapy and daptomycin has no effect on blood glucose levels, white blood count, or international normalized ratio (INR).
A client is receiving gentamicin. Assessment of which of the following would lead the nurse to suspect that the client is developing nephrotoxicity? Select all that apply.
- A. Proteinuria
- B. Hematuria
- C. Decreased urine output
- D. Increased serum creatinine
Correct Answer: A, B, C, D
Rationale: Proteinuria, hematuria, decreased urine output, increased serum creatinine, and increased blood nitrogen urea (BUN) are suggestive of nephrotoxicity. Decreased fluid intake would support dehydration.
A nurse suspects that a patient receiving an aminoglycoside is developing neurotoxicity based on assessment of which of the following? Select all that apply.
- A. Paresthesias
- B. Tingling around the mouth
- C. Ringing in the ears
- D. Vertigo
Correct Answer: A, B, E
Rationale: Signs and symptoms of neurotoxicity include numbness, skin tingling, circumoral (around the mouth) paresthesia, peripheral paresthesia, tremors, muscle twitching, convulsions, muscle weakness, and neuromuscular blockade (acute muscular paralysis and apnea). Ringing in the ears and vertigo would suggest ototoxicity.
A nurse is reviewing the medical record of a client who is prescribed tetracycline. The nurse would be alert for an increased risk of toxicity if the client is taking which of the following? Select all that apply.
- A. Digoxin (Lanoxin)
- B. Phenytoin (Dilantin)
- C. Warfarin (Coumadin)
- D. None of the above
Correct Answer: A
Rationale: Tetracyclines may increase the risk of toxicity in clients who take digoxin for heart disease and increase the risk of bleeding in clients who take warfarin.