Nokea
A patient is ordered to receive neomycin as part of the treatment plan for hepatic coma. Which of the following would be most important for the nurse to assess before administering this drug? Select all that apply.
- A. Ability to swallow
- B. Level of consciousness
- C. Baseline vital signs
- D. Pulmonary function
Correct Answer: A, B
Rationale: During the early stages of hepatic coma, various changes in the level of consciousness may be seen. At times, the patient may appear lethargic and respond poorly to commands. Because of these changes in the level of consciousness, the patient may have difficulty swallowing, and a danger of aspiration is present. If the patient appears to have difficulty taking an oral drug, the nurse should withhold the drug and contact the primary health care provider. Baseline vital signs are important but are not the priority when the patient has hepatic coma. The drug does not affect the patient's respiratory function. There is no infection; therefore, there is no need for culture and sensitivity testing.
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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.
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.
The nurse is completing an ongoing assessment of a client receiving erythromycin. The nurse would notify the primary health care provider immediately if assessment reveals which of the following? Select all that apply.
- A. Significant drop in blood pressure
- B. Increase in heart rate
- C. Decrease in temperature
- D. Increase in respiratory rate
Correct Answer: A, B, D, E
Rationale: During ongoing assessment of a client receiving erythromycin, the nurse should notify the primary health care provider immediately if the client has a significant drop in blood pressure, increase in heart rate, increase in respiratory rate, or sudden increase in temperature.
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.