Nokea
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.
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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.
A patient has been diagnosed with carbapenem-resistant Enterobacteriaceae (CRE). The nurse expects to see orders for which drug?
- A. Dapsone, a miscellaneous antibiotic
- B. Ciprofloxacin, a quinolone
- C. Linezolid, an oxazolidinone
- D. Colistimethate sodium, a polypeptide antibiotic
Correct Answer: D
Rationale: Colistimethate sodium (Coly-Mycin), commonly referred to as colistin, is now being used again, often as one of the only drugs available to treat CRE. The other options are incorrect.
A patient who has been hospitalized for 2 weeks has developed a pressure ulcer that contains multidrug-resistant Staphylococcus aureus (MRSA). Which drug would the nurse expect to be chosen for therapy?
- A. Metronidazole
- B. Ciprofloxacin
- C. Vancomycin
- D. Tobramycin
Correct Answer: C
Rationale: Vancomycin is the antibiotic of choice for the treatment of MRSA. The other drugs are not used for MRSA.
The nurse is administering a vancomycin infusion. Which measure is appropriate for the nurse to implement in order to reduce complications that may occur with this drug's administration?
- A. Monitoring blood pressure for hypertension during the infusion
- B. Discontinuing the drug immediately if red man syndrome occurs
- C. Restricting fluids during vancomycin therapy
- D. Infusing the drug over at least 1 hour
Correct Answer: D
Rationale: Infuse the medication over at least 1 hour to reduce the occurrence of red man syndrome. Adequate hydration (at least 2 L of fluid in 24 hours) during vancomycin therapy is important for the prevention of nephrotoxicity. Hypotension may occur during the infusion, especially if it is given too rapidly.