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 to receive tetracycline therapy at home. After teaching the patient about foods to avoid when taking the drug, the nurse determines that the teaching was successful when the patient states he will avoid which of the following? Select all that apply.
- A. Yogurt
- B. Cheese
- C. Calcium-fortified cereals
- D. Citrus fruits
Correct Answer: A, B, C
Rationale: The patient should avoid dairy products including yogurt, cheese, milk, cream, ice cream, ice milk, or frozen custard before or after taking tetracycline. Citrus fruits and green leafy vegetables should not be avoided.
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.
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).
After reviewing information about lincosamide therapy, a group of nursing students demonstrate understanding of the information when they identify which of the following as a contraindication?
- A. Children younger than 9 years
- B. Patients with pre-existing liver disease
- C. Patients taking cisapride
- D. Patients with myasthenia gravis
Correct Answer: C
Rationale: Lincosamide is contraindicated in patients taking cisapride. Tetracyclines are contraindicated in children younger than 9 years of age and pregnant women. Macrolides are contraindicated in patients with pre-existing liver disease and patients with myasthenia gravis.