Nokea
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.
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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 patient is being discharged with a prescription for linezolid. After teaching the patient about this drug, the nurse determines that additional teaching is needed when the patient identifies that he can consume which of the following without any risks? Select all that apply.
- A. Alcohol
- B. Prunes
- C. Aged cheese
- D. Pepperoni
Correct Answer: A, C, D
Rationale: When linezolid is taken with foods containing tyramine, such as aged cheese and meats, yogurt, chocolate, caffeinated beverages, and alcohol, the risk for severe hypertension increases. Prunes and broccoli pose no risk to the patient.
The nurse is teaching a client about possible adverse reactions that can occur with tetracyclines. The nurse determines that the teaching was successful when the client identifies which of the following? Select all that apply.
- A. Photosensitivity
- B. Hypoglycemia
- C. Diarrhea
- D. Stomatitis
Correct Answer: A, D, E
Rationale: The nurse should advise the client that nausea, vomiting, diarrhea, epigastric distress, stomatitis, sore throat, skin rashes, and photosensitivity are adverse reactions that may occur with the administration of tetracyclines.
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.
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.