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When a patient is on aminoglycoside therapy, the nurse will monitor the patient for which indicators of potential toxicity?
- A. Fever
- B. White blood cell count of 8000 cells/mm^3
- C. Tinnitus and dizziness
- D. Decreased blood urea nitrogen (BUN) levels
Correct Answer: C
Rationale: Dizziness, tinnitus, hearing loss, or a sense of fullness in the ears could indicate ototoxicity, a potentially serious toxicity in a patient. Nephrotoxicity is indicated by rising blood urea nitrogen and creatinine levels. Fever may be indicative of the patient's infection; a white blood cell count of 7000 cells/mm^3 is within the normal range of 5000 to 10,000 cells/mm^3.
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A patient with a Pseudomonas species urinary infection will be receiving amikacin 5 mg/kg once daily via intravenous infusion. The patient weighs 143 pounds, and the medication is available in an injection solution strength of 250 mg/mL. Identify how many milliliters of medication will be drawn up for this injection. (record answer using one decimal place)
Correct Answer: 1.3 Ml
Rationale: Calculate the patient's weight in kilograms: 143 pounds ?· 2.2 = 65 kg. Calculate mg/kg/dose: 5 mg/kg ?? 65 kg = 325 mg. Calculate volume: 325 mg ?· 250 mg/mL = 1.3 mL.
Which problem may occur in a patient who has started aminoglycoside therapy?
- A. Constipation
- B. Renal damage
- C. Gynecomastia
- D. Leukocytosis
Correct Answer: B
Rationale: Patients on aminoglycoside therapy have an increased risk for nephrotoxicity. The other options are incorrect.
The nurse checks the patient's laboratory work prior to administering a dose of vancomycin and finds that the trough vancomycin level is 15 mcg/mL. What will the nurse do next?
- A. Administer the vancomycin as ordered.
- B. Hold the drug, and administer 4 hours later.
- C. Hold the drug, and notify the prescriber.
- D. Repeat the test to verify results.
Correct Answer: A
Rationale: Optimal blood levels of vancomycin are a trough level of 10 to 20 mcg/mL. Measurement of peak levels is no longer routinely recommended, and only trough levels are commonly monitored. Because of the increase in resistant organisms, many clinicians use a trough level of 15 to 20 mcg/mL as their goal.
A patient will be receiving nitrofurantoin treatment for a urinary tract infection. The nurse is reviewing the patient's history and will question the nitrofurantoin order if which disorder is present in the history? (Select all that apply.)
- A. Liver disease
- B. Coronary artery disease
- C. Hyperthyroidism
- D. Type 1 diabetes mellitus
- E. Chronic renal disease
Correct Answer: A,E
Rationale: Nitrofurantoin is contraindicated in cases of known drug allergy and also in cases of significant renal function impairment, because the drug concentrates in the urine. Because adverse effects include hepatotoxicity, which is rare but often fatal, the nurse should also question the order if liver disease is present. The other options are not contraindications.
A patient is receiving aminoglycoside therapy and will be receiving a beta-lactam antibiotic as well. The patient asks why two antibiotics have been ordered. What is the nurse's best response?
- A. The combined effect of both antibiotics is greater than each of them alone.
- B. One antibiotic is not strong enough to fight the infection.
- C. We have not yet isolated the bacteria, so the two antibiotics are given to cover a wide range of microorganisms.
- D. We can give a reduced amount of each one if we give them together.
Correct Answer: A
Rationale: Aminoglycosides are often used in combination with other antibiotics, such as beta-lactams or vancomycin, in the treatment of various infections because the combined effect of the two antibiotics is greater than that of either drug alone.