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A patient has been prescribed oral tetracycline for the treatment of acne. Which of the following must the nurse include in the patient teaching plan?
- A. Take the drug on an empty stomach.
- B. Take the drug along with a meal.
- C. Take the drug along with milk or fruit juice.
- D. Take the drug immediately after meals.
Correct Answer: A
Rationale: Oral preparations of tetracycline should be administered on an empty stomach with a full glass of water to maximize absorption. Tetracycline is not absorbed effectively if taken with food, with dairy products, or immediately after meals.
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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.
A patient is receiving telithromycin. Based on the nurse's understanding of potential adverse reactions, the nurse would identify which nursing diagnosis as a priority?
- A. Ineffective Renal Tissue Perfusion
- B. Risk for Injury
- C. Diarrhea
- D. Risk for Impaired Skin Integrity
Correct Answer: B
Rationale: Telithromycin can cause visual disturbances such as difficulty focusing and accommodating to light. Therefore, the priority nursing diagnosis would be Risk for Injury related to these visual disturbances. Aminoglycosides can cause nephrotoxicity, leading to a nursing diagnosis of Ineffective Renal Perfusion. Although diarrhea and skin rashes can occur, these would not be a priority at this time.
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.
After teaching a group of students about tetracyclines, the instructor determines that the teaching was successful when the students identify which of the following as a true statement? Select all that apply.
- A. Tetracyclines are broad-spectrum antibiotics.
- B. Tetracyclines may cause permanent discoloration of the teeth in children.
- C. Tetracyclines can be used when penicillins are contraindicated.
- D. Tetracyclines are contraindicated in children younger than 6 years.
- E. Tetracyclines are used to treat Rocky Mountain spotted fever.
Correct Answer: A, B, C, E
Rationale: Tetracyclines are broad-spectrum antibiotics used to treat rickettsial disease, such as Rocky Mountain spotted fever, and when the use of penicillins is contraindicated. Tetracyclines are not given to children younger than 9 years of age unless absolutely necessary because these drugs may cause permanent yellow-gray-brown discoloration of the teeth.
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.