Nokea
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.
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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.
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 client is receiving iron therapy for anemia. The prescriber has ordered tetracycline as treatment for the client's infection. Which of the following would be most appropriate for the nurse to do?
- A. Give the drugs at the same time.
- B. Give the iron first, then follow with the tetracycline in 30 minutes.
- C. Separate administration times by 2 hours.
- D. Withhold the iron until the tetracycline therapy is completed.
Correct Answer: C
Rationale: Iron therapy can interfere with the absorption of tetracycline. Therefore, the nurse should give the iron 2 hours before or after administering tetracycline. The two drugs should not be given at the same time. Withholding the iron would be inappropriate.
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 group of nursing students are reviewing information about aminoglycosides. The students demonstrate understanding when they identify which of the following as an example? Select all that apply.
- A. Amikacin (Amikin)
- B. Amoxicillin (Amoxil)
- C. Kanamycin (Kantrex)
- D. None of the above
Correct Answer: A
Rationale: The aminoglycosides include amikacin, gentamicin, kanamycin, neomycin, streptomycin, and tobramycin. Amoxicillin is an aminopenicillin. Vancomycin is a miscellaneous agent that disrupts the bacterial cell wall. Azithromycin is classified as a macrolide.