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After taking penicillin as prescribed, a patient shows signs of diarrhea and informs the nurse that there is blood in his stools. Which of the following interventions should the nurse do next?
- A. Contact primary health provider immediately.
- B. Have the patient consume yogurt with his next meal.
- C. Decrease fiber content in diet.
- D. Continue with prescribed regimen.
Correct Answer: A
Rationale: If diarrhea is suspected, the nurse should notify the primary health care provider immediately. The nurse should wait for the primary health care provider's instructions before continuing with the prescribed regimen. Yogurt or buttermilk may help prevent fungal superinfections, but they will not help alleviate the patient's condition at this stage. Changes in the diet are not recommended unless instructed by the primary health care provider.
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A group of students are reviewing information about the different penicillins. The students demonstrate understanding of the information when they identify which of the following as an example of a beta-lactamase inhibitor? Select all that apply.
- A. Piperacillin
- B. Amoxicillin
- C. Tazobactam
- D. Sulbactam
- E. Clavulanic acid
Correct Answer: C,D,E
Rationale: Examples of beta-lactamase inhibitors are clavulanic acid, sulbactam, and tazobactam. Amoxicillin is an example of an aminopenicillin. Piperacillin is an example of an extended-spectrum penicillin.
A patient receiving penicillin therapy tells the nurse that she feels like her mouth is irritated and that she has a sore throat. Inspection reveals a red, swollen tongue with ulcerations. The nurse suspects a fungal superinfection and identifies which nursing diagnosis as most appropriate for this patient?
- A. Impaired Comfort
- B. Impaired Oral Mucous Membranes
- C. Deficient Knowledge
- D. Inadequate Nutrition: Less Than Body Requirements
Correct Answer: B
Rationale: The assessment suggests a fungal superinfection, which would lead to the nursing diagnosis of Impaired Oral Mucous Membranes. Although Impaired Comfort may be appropriate, Impaired Oral Mucous Membranes is more specific. There is no evidence of lack of knowledge or problems with nutrition. However, if the superinfection is not addressed, the patient may experience difficulty eating due to the irritation and discomfort.
A patient who has been on penicillin therapy for several days has developed inflamed oral mucous membranes and swelling in the tongue and the gums. The primary health care provider has diagnosed it as a fungal superinfection of the oral cavity resulting in impaired oral mucous membranes. Which of the following interventions should the nurse perform?
- A. Inspect mouth and gums regularly.
- B. Instruct patient to avoid brushing teeth.
- C. Offer patient a liquid diet.
- D. Instruct the patient to gargle every 2 hours.
Correct Answer: A
Rationale: The nurse should regularly inspect the patient's mouth and gums to assess the patient's progress. The nurse should instruct the patient to use a soft-bristled toothbrush. The patient need not follow a liquid diet; a nonirritating soft diet can be recommended. Gargling every 2 hours may not help relieve the symptoms and may even aggravate the existing condition.
A nurse is reviewing the laboratory test results of a client receiving penicillin therapy. Which of the following would the nurse identify as indicating an adverse hematologic reaction? Select all that apply.
- A. Pancytopenia
- B. Anemia
- C. Thrombocytopenia
- D. Leukopenia
- E. Hemoglobulinemia
Correct Answer: B,C,D
Rationale: Nurses should monitor blood counts of clients taking penicillins for the following hematopoietic changes: anemia, thrombocytopenia, leucopenia, and bone marrow suppression.
A client is prescribed penicillin therapy to treat an infection. Which of the following would the nurse include in the teaching plan for the client to reduce her risk of fungal superinfections? Select all that apply.
- A. Yogurt can sometimes help.
- B. Try drinking some buttermilk.
- C. You could take Acidophilus capsules.
- D. Rinse your mouth daily with an alcohol-based mouthwash.
- E. Use a soft-bristle toothbrush when brushing.
Correct Answer: A,B,C,E
Rationale: The nurse can recommend that, if the diet permits, yogurt, buttermilk, or Acidophilus capsules may be taken to reduce the risk of fungal superinfection. Also, brushing with a soft-bristle toothbrush and frequent mouth care with a nonirritating solution can be helpful.