Nokea
A nurse is reviewing the laboratory test results of a client receiving penicillin therapy. Which of the following would the nurse identify as indicating an adverse hematologic reaction? Select all that apply.
- A. Pancytopenia
- B. Anemia
- C. Thrombocytopenia
- D. Leukopenia
- E. Hemoglobulinemia
Correct Answer: B,C,D
Rationale: Nurses should monitor blood counts of clients taking penicillins for the following hematopoietic changes: anemia, thrombocytopenia, leucopenia, and bone marrow suppression.
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A client is prescribed penicillin therapy to treat an infection. Which of the following would the nurse include in the teaching plan for the client to reduce her risk of fungal superinfections? Select all that apply.
- A. Yogurt can sometimes help.
- B. Try drinking some buttermilk.
- C. You could take Acidophilus capsules.
- D. Rinse your mouth daily with an alcohol-based mouthwash.
- E. Use a soft-bristle toothbrush when brushing.
Correct Answer: A,B,C,E
Rationale: The nurse can recommend that, if the diet permits, yogurt, buttermilk, or Acidophilus capsules may be taken to reduce the risk of fungal superinfection. Also, brushing with a soft-bristle toothbrush and frequent mouth care with a nonirritating solution can be helpful.
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.
A nurse needs to administer a cephalosporin to a patient. The patient informs the nurse that he is allergic to penicillin. Which action by the nurse would be most appropriate?
- A. Inform the primary health care provider.
- B. Obtain the patient's occupational history.
- C. Administer an antipyretic drug.
- D. Obtain specimens for kidney function tests
Correct Answer: A
Rationale: Patients with a history of an allergy to penicillin may also be allergic to cephalosporin, so the nurse needs to inform the primary health care provider before the first dose of the drug is given. An antipyretic drug is administered when there is an increase in the body temperature of a patient receiving cephalosporin. Liver and kidney function tests may be ordered by the primary health care provider, not the nurse. Occupational history should be obtained before administration of any drug, irrespective of the patient's allergies.
A nurse is preparing to administer a prescribed cephalosporin by injection. Which of the following would be most important for the nurse to keep in mind? Select all that apply.
- A. Thrombophlebitis can occur when cephalosporins are given IV.
- B. Phlebitis can occur when cephalosporins are given IM.
- C. Pain can occur when cephalosporins are given IM.
- D. Tenderness can occur when cephalosporins are given IM.
- E. Swelling can occur when cephalosporins are given IM.
Correct Answer: A,C,D,E
Rationale: Administration route reactions include pain, tenderness, and inflammation at the injection site when cephalosporins are given IM, and phlebitis and thrombophlebitis along the vein may occur when cephalosporins are given IV.
While the nurse is obtaining a drug history from a patient, the patient tells the nurse that he is allergic to penicillins and has also experienced a rash when he took a cephalosporin. The nurse interprets this information as indicating which of the following?
- A. Hypersensitivity
- B. Cross-sensitivity
- C. Anaphylactoid reaction
- D. Anaphylaxis
Correct Answer: B
Rationale: Once an individual is allergic to one penicillin, he or she is usually allergic to all of the penicillins. Those allergic to penicillin also have a higher incidence of allergy to the cephalosporins. Allergy to drugs in the same or related groups is called cross-sensitivity. Hypersensitivity is an allergic reaction to one substance. Anaphylactoid reaction is an unusual or exaggerated allergic reaction. Anaphylaxis or anaphylactic shock is a severe form of hypersensitivity that occurs immediately and can be fatal.