Homework Immune System PDF

Antibiotics in General x 15 1) Which action will the nurse take after stopping the antibiotic infusion of a client who becomes restless and flushed, and begins to wheeze during the administration of an antibiotic? A. Check the client’s temperature. B. Take the client’s blood pressure. C....

Antibiotics in General x 15 1) Which action will the nurse take after stopping the antibiotic infusion of a client who becomes restless and flushed, and begins to wheeze during the administration of an antibiotic? A. Check the client’s temperature. B. Take the client’s blood pressure. C. Obtain the client’s pulse oximetry. *D. Assess the client’s respiratory status. Rationale The client is experiencing an allergic reaction that may progress to anaphylaxis. Anaphylactic shock can lead to respiratory distress as a result of laryngeal edema or severe bronchospasm. Assessing and maintaining the client’s airway is the priority. Checking the client’s temperature and taking the client’s blood pressure are not the priority; vital signs should be obtained after airway patency is ensured and maintained. Pulse oximetry is only one portion of the needed respiratory status assessment. 2) Which explanation would the nurse include when teaching a client scheduled for a bowel resection about the purpose of preoperative antibiotics? A. "They prevent incisional infection." B. "Antibiotics prevent postoperative pneumonia." C. "These medications limit the risk of a urinary tract infection." *D. "They are given to eliminate bacteria from the gastrointestinal (GI) tract." Rationale The GI tract contains numerous bacteria; antibiotics are given to decrease the number of microorganisms in the bowel before surgery. Preventing incisional infection is a potential complication prevented by the use of sterile technique when changing the dressing. Avoiding postoperative pneumonia is a potential complication prevented by coughing, deep breathing, and early ambulation postoperatively. Limiting the risk of a urinary tract infection is a potential complication prevented by hygiene, meatal care, and increased hydration postoperatively. 3) A client with advanced cancer of the bladder is scheduled for a cystectomy and ileal conduit. Which intervention would the nurse anticipate the health care provider will prescribe to prepare the client for surgery? A. Intravesical chemotherapy B. Instillation of a urinary antiseptic *C. Administration of an antibiotic D. Placement of an indwelling catheter Rationale Intestinal antibiotics and a complete cleansing of the bowel with enemas until returns are clear are necessary to reduce the possibility of fecal contamination when the bowel is resected to construct the ileal conduit. Intravesical chemotherapy is unnecessary because the urinary bladder is removed with this surgery. Instillation of a urinary antiseptic is not necessary. There is no evidence of a urinary tract infection. The urinary bladder will be removed, so there is no need for an indwelling urinary catheter. No data indicate that the client is experiencing urinary retention before surgery. 4) A client with burns develops a wound infection. The nurse plans to teach the client that local wound infections are primarily treated with which antibiotic formulation? A. Oral *B. Topical C. Intravenous D. Intramuscular Rationale Topical antibiotics are applied directly to the wound and are effective against many gram-positive and gram-negative organisms found on the skin. Although oral, intravenous, and intramuscular antibiotics may be administered, they are most effective for systemic rather than local infections; the vasculature in and around a burn is impaired, and the medication may not reach the organisms in the wound. 5) Which issue related to antibiotic use is an increased risk for the older adult? A. Allergy *B. Toxicity C. Resistance D. Superinfection Rationale The older adult is at increased risk for toxicity related to antibiotic use because of reduced metabolism and excretion of medications. Allergy, resistance, and superinfection are a risk for all antibiotic recipients but not an increased risk in the older adult population. 6) Which client would benefit most from the administration of prophylactic antibiotics? Select all that apply. One, some, or all responses may be correct. A. Chickenpox infection B. Fever of unknown origin *C. Preoperative hip replacement *D. Congenital bicuspid aortic valve *E. Current chemotherapy treatment Rationale Prophylactic antibiotics are indicated in the preoperative hip replacement client because this decreases the occurrence of infection postoperatively. Prophylactic antibiotics are indicated for the client with congenital bicuspid aortic valve disease because this decreases the risk of endocarditis with an invasive procedure. Prophylactic antibiotics are indicated for the current chemotherapy treatment client because this decreases the risk of infection due to neutropenia. A client with the chickenpox infection has a viral infection for which antibiotics are ineffective. A fever of unknown origin should not be treated with antibiotics because that may eliminate the ability to discover the causative organism, and a virus could be the cause of the fever. 7) The nurse is preparing to administer an intravenous piggyback antibiotic that has been newly prescribed. Shortly after initiation, the client becomes restless and flushed and begins to wheeze. After stopping the infusion, which priority action will the nurse take? A. Notify the primary health care provider immediately about the client’s condition. B. Take the client’s blood pressure. C. Obtain the client’s pulse oximetry. *D. Assess the client’s respiratory status. Rationale The client is experiencing an allergic reaction. Severe allergic reactions commonly cause respiratory distress as a result of laryngeal edema or severe bronchospasm. Assessing and maintaining the client’s airway is the priority. The nurse must determine the client’s status before notifying the primary health care provider. Vital signs, including blood pressure and pulse oximetry, are obtained after airway patency is ensured and maintained. 8) An infant is prescribed an antibiotic after cardiac surgery. Which instruction would the nurse emphasize to the parents regarding administration of the medication? A. Give the antibiotic between feedings. *B. Ensure that the antibiotic is administered as prescribed. C. Shake the bottle thoroughly before giving the antibiotic. D. Keep the antibiotic in the refrigerator after the bottle has been opened. Rationale Ensuring that the antibiotic is administered as prescribed is a priority because inadequate antibiotic therapy may predispose the infant to the development of bacterial endocarditis. Giving the antibiotic between feedings, shaking the bottle, and storing the medication in the refrigerator are not priority instructions because instructions often vary depending on the antibiotic. 9) A client being discharged home is prescribed an antibiotic with a dosage three times higher than it was administered when the client was in the hospital (IV route). Which route of administration should the nurse anticipate will be prescribed for the greatest first-pass effect? *A. Oral. B. Sublingual. C. Intravenous. D. Subcutaneous. The first-pass effect is a pharmacokinetic phenomenon that is related to the drug's metabolism in the liver. After oral medications are absorbed from the gastrointestinal tract, the drug is carried directly to the liver via the hepatic portal circulation, where hepatic inactivation occurs and reduces the bioavailability (strength/concentration) of the drug. 10) The nurse is assessing a client who is receiving antibiotic therapy for an infection. Which finding should indicate to the nurse that the client may be experiencing an allergic reaction to a medication? A. Xerostomia B. Hypertension *C. Pruritus D. Lymphadenopathy Rationale: If the client experiences pruritus, the nurse should be concerned about the possibility of an allergic reaction. Xerostomia, or dry mouth, and lymphadenopathy are not signs of a hypersensitivity reaction. A client experiencing an allergic reaction will experience hypotension. 11) The nurse is caring for a client with sepsis receiving broad-spectrum antibiotics. Which finding might indicate to the nurse the need for a dosage adjustment? *A. Elevated creatinine level B. Elevated heart rate C. Decreased white blood cell count D. Decreased platelet count Rationale: Septic shock is the most common type of distributive shock that threatens multi-system organ failure with a rapid onset, which is the leading cause of death in noncoronary ICU patients. Gram-negative bacteria have been the most implicated organism, and broad-spectrum antibiotics are given to help increase the likelihood of increasing tissue perfusion. The majority of broad-spectrum antibiotics are excreted through the kidneys, and an elevated creatine level will indicate the need for dosage adjustments. Elevated lactic acid levels, heart rate, and white blood cell (WBC) levels are all signs of sepsis and need to be monitored closely. Decreased platelet counts are seen when the condition is exacerbated with blood loss but does not affect the antibiotic dosage. 12) The nurse in an ambulatory clinic is speaking with the parents of a 2-year-old child diagnosed with acute otitis media. Which information is most important for the nurse to include in the instructions to the parents? A. The child may be given acetaminophen or ibuprofen drops for pain. *B. The child must complete the entire course of the prescribed antibiotic. C. The child should return to the clinic to evaluate effectiveness of the treatment. D. The child may be given a decongestant to relieve pressure on the tympanic membrane. Rationale: Acute otitis media (AOM) is an inflammation of the middle ear space with a rapid onset of the signs and symptoms of acute infection, namely, fever and otalgia (ear pain). It is one of the most prevalent early childhood illnesses. Treatment for AOM is one of the most common reasons for antibiotic use in the ambulatory setting. When antibiotics are necessary, it is most important to complete the entire course to prevent antibiotic resistance. The child should be seen after antibiotic therapy is complete to ensure that the infection has resolved. Supportive care of AOM includes treating the fever and pain. Decongestants or antihistamines are not recommended for children with ear infections. 13) The nurse in an urgent care clinic is preparing discharge instructions for the parents of a 15-month-old child with a first episode of otitis media. Which information is the priority to include? *A. Explain that the child should complete the full 10 days of antibiotics B. Describe the tympanocentesis most likely needed to clear the infection C. Offer information on recommended immunizations around the child's second birthday D. Provide a written handout describing the care of myringotomy tubes Rationale: Otitis media, an inner ear infection, commonly occurs in young children. Although not always caused by bacteria, many ear infections are treated with oral antibiotics. If a client is prescribed antibiotics, the priority is to make sure that they take the full prescription for the prescribed number of days to prevent recurrence or antibiotic resistance. 14) A nurse is assessing a 9-year-old child after several days of treatment for a documented strep throat. Which statement is incorrect and suggests that further teaching is needed? A. "Sometimes I take my medicine with fruit juice." *B. "Sometimes I take the pills in the morning and other times at night." C. "I am feeling much better than I did last week." D. "My mother makes me take my medicine right after school." Rationale: Strep throat is a bacterial infection that is treated with antibiotics. It is important to take antibiotics on a regular schedule and at approximately the same time each day. Depending on the medication, it is OK to take it with food or juice. The client should be feeling better after several days of antibiotics —however should be cautioned to complete the prescribed amount. 15) Which of the following instructions is most important for the nurse to include when discharging a client with an infection caused by staphylococcus? A. Schedule follow-up blood cultures B. Monitor for signs of recurrent infection C. Visit the provider in a few weeks *D. Complete the full course of the antibiotic Rationale: Staphylococcus is a bacteria and to rid the body of the infection, it is most important to instruct the client to complete the full course of antibiotics. Not completing the full course of antibiotics can lead to antibiotic resistant infections. At this point, there is no indication for the need for blood cultures. The client will need a follow-up appointment with the provider, and will need to monitor for signs of recurrent infections, but these are not as high a priority as completing the full course of antibiotics. “Anti-B”-prim & sulfa-“Biotic”: trimethoprim and sulfamethoxazole x 9 1) Trimethoprim/sulfamethoxazole is prescribed for a child with a urinary tract infection. Which statement by the parent indicates the nurse’s instructions about administration have been understood? A. 'Mealtime is a good time to give the medication.' *B. 'I’ll make sure to give each pill with 6 to 8 oz of fluid.' C. 'It must be taken with orange juice to ensure acidity of urine.' D. 'The medication has to be taken every 4 hours to maintain a blood level.' Rationale This is a sulfa medication; water must be encouraged to prevent urine crystallization in the kidneys. This medication does not have to be given with meals; it is administered every 12 hours. Orange juice causes an alkaline urine; water is the best fluid to be administered with this medication. This medication maintains the blood level for 8 to 12 hours; it is an intermediate-acting medication. 2) A sulfonamide preparation is prescribed for a child with a urinary tract infection. Which nursing responsibility is a priority when administering this medication? A. Weighing the child daily B. Giving the medication with milk C. Taking the child’s temperature frequently *D. Administering the medication at the prescribed times Rationale For the desired blood level to be maintained, the medication must be administered in the exact amount at the times directed. If the blood level of the medication falls, the microorganisms have an opportunity to build resistance to the medication. Weighing is important with medications that affect fluid balance, such as diuretics. Sulfa medications should be given on an empty stomach to promote absorption. Monitoring the temperature is important with antipyretic medications. 3) A child infected with human immunodeficiency virus (HIV) is admitted with Pneumocystis jiroveci pneumonia and receives trimethoprim/sulfamethoxazole. Which common side effects would the nurse anticipate? Select all that apply. One, some, or all responses may be correct. A. Jaundice *B. Vomiting C. Headache *D. Crystalluria *E. Photosensitivity Rationale Nausea and vomiting may occur as a result of gastrointestinal irritation. Crystalluria may occur with this medication, especially in the presence of restricted fluid intake secondary to nausea and vomiting. Skin reactions such as photosensitivity are also common. Hepatic side effects such as jaundice may occur but are not common. Central nervous system side effects such as headache are rare adverse reactions. 4) Trimethoprim-sulfamethoxazole is prescribed for a client with cystitis. Which instruction would the nurse include when providing medication teaching? *A. 'Drink eight to ten glasses of water daily.' B. 'Take this medication with orange juice.' C. 'Take the medication with meals.' D. 'Take the medication until symptoms subside.' Rationale A urinary output of at least 1500 mL daily should be maintained to prevent crystalluria (crystals in the urine). Taking the medication with orange juice provides no advantage. Also, orange juice produces an alkaline ash, which results in an alkaline urine that supports the growth of bacteria. Trimethoprim-sulfamethoxazole should be taken 1 hour before meals for maximum absorption. A prescribed course of antibiotics must be completed to eliminate the infection, which can exist on a subclinical level after symptoms subside. 5) The nurse is teaching a client with diabetes about newly prescribed trimethoprim and sulfamethoxazole (TMP-SMX) to treat a urinary tract infection. Which statement by the client indicates understanding? *A. I will stop taking this medication if I develop a rash." B. This antibiotic will kill mature bacteria in my urinary tract." C. I should avoid dairy products when taking this medication." D. "My blood sugar will not be affected by this medication." Rationale: TMP-SMX is a sulfonamide medication. These drugs are bacteriostatic and therefore, halt the multiplication of new bacteria, but do not kill mature bacteria. Clients using sulfonylureas for the management of diabetes should know that other sulfa drugs may increase the chances of hypoglycemia. The action of metformin is also enhanced. Dairy is avoided when clients are taking tetracyclines. TMP-SMX is the most common cause of erythema multiforme. Sulfonamides are also often implicated in cases of both toxic epidermal necrosis and Stevens-Johnson syndrome, which can be fatal. 6) The nurse is preparing to administer trimethoprim and sulfamethoxazole (TMP-SMX) to a client. When assessing client allergies, the client reports that they are allergic to glipizide. What action by the nurse is most appropriate? A. Prepare to administer the medication *B. Report the allergies to the healthcare provider C. Review the health record to see if the client is on glipizide D. Assess the client blood sugar Question Explanation Rationale: While administering a sulfonamide with a sulfonylurea may increase the risk of a hypoglycemic reaction, the real concern is the potential allergy to TMP-SMX. It may be safe to administer the medication, but the healthcare provider should be notified first. 7) A client is prescribed trimethoprim/sulfamethoxazole for recurrent urinary tract infections. Which statement by the nurse about this medication is correct? A. "You can stop the medication after five days." B. "Be sure to take the medication with food." C. "It is safe to take with oral contraceptives." *D. "Drink at least eight glasses of water a day." Rationale: Trimethoprim/sulfamethoxazole is a highly insoluble medication and should be taken with a large volume of fluid. This medication can be taken with or without food. The full prescribed amount should be taken at evenly-spaced intervals until the medication is finished. Unlike many other antibiotics, trimethoprim/sulfamethoxazole does not seem to affect hormonal birth control such as the pill, the patch or ring. 8) A client is prescribed trimethoprim/sulfamethoxazole for recurrent urinary tract infections. Which information should the nurse include during client teaching? A. "A harmless skin rash may appear." *B. "Drink at least eight large glasses of water a day." C. "Be sure to take the medication with food." D. "Stop the medication when your symptoms disappear." Rationale: Trimethoprim/sulfamethoxazole (Bactrim) is a highly insoluble drug that can cause crystalluria and clients should drink plenty of fluids while taking this medication to lower the risk of developing kidney stones. Increased fluid intake is also recommended with a UTI to promote the "flushing out" of bacteria. The drug may be taken with or without food. Clients should take the medication for the prescribed length of time. Sulfonamide-containing products should be discontinued at the first appearance of skin rash. In rare instances, a skin rash may be followed by a more severe reaction, such as Stevens-Johnson syndrome or toxic epidermal necrolysis. 9) After teaching a client about sulfonamide use for a urinary tract infection, which client statement would the nurse review for correction? A. 'I will avoid the sunlight.' B. 'I will increase my fluid intake.' C. 'I will let my doctor know if I develop a rash.' *D. 'I will stop taking the medication when my symptoms subside.' Rationale The nurse instructs the client to complete the entire course of treatment, not stop when symptoms subside. The client on sulfonamide therapy should avoid prolonged exposure to sun, increase fluid intake to support the kidneys, and report a rash to investigate possible hypersensitivity. “Anti-B”-cillins, Ceph/Cef’s-”Anti-B”: ampicillin, penicillin, cephalosporin, cefepime x 22 1) Which therapy is indicated for a client admitted to the hospital after general paresis develops as a complication of syphilis? *A. Penicillin therapy B. Major tranquilizers C. Behavior modification D. Electroconvulsive therapy Rationale Massive doses of penicillin may limit central nervous system damage if treatment is started before neural deterioration from syphilis occurs. Tranquilizers are used to modify behavior, not to treat general paresis. Behavior, not paresis, is treated with behavior modification. Electroconvulsive therapy is used to treat certain psychiatric disorders. 2) Which statement by a client prescribed ampicillin indicates that teaching by the nurse was effective? A. "I will miss eating grapefruit." *B. "I must increase my fluid intake." C. "I can stop taking this medication any time." D. "I should take this medication just after eating." Rationale The client should increase fluid intake when taking ampicillin to prevent nephrotoxicity; side effects include oliguria, hematuria, proteinuria, and glomerulonephritis. There are no restrictions on eating grapefruit when taking an antibiotic; this is contraindicated when taking some calcium channel blockers because grapefruit juice increases their serum level. An antibiotic should be continued until the entire prescription is completed; discontinuing before completion lowers its serum level, thereby decreasing its effectiveness. Ampicillin should be taken when the stomach is empty, either 1 to 2 hours before eating or 3 to 4 hours after eating. 3) Which rationale will the nurse give for the need to take penicillin G and probenecid for syphilis? A. "Each medication attacks the organism during different stages of cell multiplication." B. "The penicillin treats the syphilis, and the probenecid relieves the severe urethritis." *C. "Probenecid delays excretion of penicillin, thus maintaining blood levels for longer periods." D. "Probenecid decreases the potential for an allergic reaction to penicillin, which treats the syphilis." Rationale Probenecid results in better use of penicillin by delaying the excretion of penicillin through the kidneys. Penicillin destroys Treponema pallidum during all stages of its development; probenecid delays the excretion of penicillin. Probenecid does not treat urethritis. Probenecid does not prevent allergic reactions. 4) Which statement by a client prescribed ampicillin 250 mg by mouth every 6 hours indicates to the nurse that teaching has been effective? A. "I should drink a glass of milk with each pill." B. "I should drink at least six glasses of water every day." C. "The medicine should be taken with meals and at bedtime." *D. "The medicine should be taken 1 hour before or 2 hours after meals." Rationale Ampicillin is a form of penicillin that should be given on an empty stomach; food delays absorption. The response "I should drink a glass of milk with each pill" is incorrect; opaque liquids, such as milk, delay the absorption of this medication. It is not necessary to drink at least six glasses of water every day; however, it is appropriate to prevent crystalluria when the client is prescribed sulfonamides. The response "The medicine should be taken with meals and at bedtime" is incorrect; food delays the absorption of this medication. 5) Which information would the nurse include in the teaching plan on ampicillin? A. 'Take the ampicillin with meals.' B. 'Store the ampicillin in a light-resistant container.' *C. 'Notify the health care provider if diarrhea develops.' D. 'Continue the medication until a negative culture is obtained.' Rationale Diarrhea is a possible side effect that can be related to superinfection or to the destruction of bacterial flora in the intestine; it can lead to fluid and electrolyte imbalance. Ampicillin is absorbed best when taken with water on an empty stomach. Although storage in an airtight container is necessary, protection from light is not. A culture generally is not repeated unless the client’s condition indicates that the medication was ineffective. 6) The nurse is preparing a client for discharge from the emergency department. Which client statement provides evidence that the client understands medication teaching for high-dose ampicillin? A. 'I should take this medication with meals.' B. 'This medicine may cause constipation.' C. 'I must avoid dairy products while taking this medicine.' *D. 'I must increase my intake of fluids while taking this medication.' Rationale Because penicillin in high doses is nephrotoxic, keeping hydrated maintains adequate renal perfusion for medication excretion. It should be taken on an empty stomach for best absorption. Dietary restrictions are not imposed while this medication is taken. It may cause diarrhea, but not constipation. 7) A client has an anaphylactic reaction after receiving intravenous penicillin. Which would the nurse conclude is the cause of this reaction? A. An acquired atopic sensitization occurred. B. There was passive immunity to the penicillin allergen. *C. Antibodies to penicillin developed after a previous exposure. D. Genes encoded for allergies cause a reaction on an initial penicillin exposure. Rationale Hypersensitivity results from the production of antibodies in response to exposure to certain foreign substances (allergens). Earlier exposure is necessary for the development of these antibodies. Hay fever and asthma, not penicillin allergy, are atopic conditions. The reaction is an active, not passive, immune response. Antibodies developed when there was a previous, not first, exposure to penicillin. 8) The nurse provides teaching about ampicillin. Which client statement indicates that additional teaching is needed? A. 'I should take this on an empty stomach with a full glass of water.' B. 'This medicine will work best if I space the time out evenly.' *C. 'I can stop this medication after I am symptom-free for 48 hours.' D. 'If I get worse, I will notify my primary health care provider.' Rationale It is most important for the client to complete the full antibiotic prescription to prevent the development of antibiotic-resistant bacteria. Ampicillin should be taken on an empty stomach with a full glass of water. If the medication is spaced out evenly, the ability to maintain a steady therapeutic serum medication level is increased. Because the client has an infection, it is important to report worsening because this may indicate antibiotic failure requiring alternative treatment. 9) Which assessment findings during the administration of intravenous penicillin prompt the nurse to stop the infusion? Select all that apply. One, some, or all responses may be correct. *A. Hives *B. ItchingNausea *C. Skin rash *D. Shortness of breath Rationale Penicillin administration carries a high rate of allergic reaction, so the nurse monitors the client for signs of allergy. Hives, itching, skin rash, and shortness of breath are all indications of allergic reaction and warrant cessation of the infusion and contact with the health care provider. Nausea is not an indication of allergic reaction. 10) When a female client with a new infant is prescribed amoxicillin for a urinary tract infection, which instruction would the nurse include when teaching about the use of this medication? A. 'Take this medication on an empty stomach.' *B. 'Report signs of allergic reaction such as skin rash or itching.' C. 'Stop taking the medication as soon as you void without burning.' D. 'Breast-feeding should stop until you have finished with this medication.' Rationale Penicillin class medications have a high incidence of allergic reaction, so the client should monitor for allergy and report symptoms of an allergic reaction. Amoxicillin may be taken with food. The entire course of treatment should be completed, not stopped when symptoms are absent. It is safe to breast-feed with amoxicillin. 11) Which substance history of a severe allergic reaction results in avoidance of the cephalosporins such as cefazolin, cefditoren, cefotetan, and ceftriaxone? Select all that apply. One, some, or all responses may be correct. *A. Milk *B. Aspirin *C. Calcium *D. Penicillin E. Strawberries Rationale Use of cephalosporins like cefazolin should be avoided in the client with a history of severe allergic reaction to penicillin because of the potential of cross-sensitivity. The cephalosporin cefditoren should not be administered to the client with a milk allergy because it contains the milk protein caseinate. Bleeding can be magnified with the use of aspirin and the use of the cephalosporins cefotetan or ceftriaxone. The cephalosporin ceftriaxone and calcium should not be administered together because they cause the formation of precipitates. 12) Which medication is considered first-line therapy for an infant with congenital syphilis? A. Vidarabine B. Pyrimethamine *C. Intravenous (IV) penicillin D. Trimethoprim-sulfamethoxazole Rationale IV penicillin destroys the cell wall of Treponema pallidum, the causative organism of syphilis. Vidarabine is an antiviral medication; it does not treat congenital syphilis in an infant. Pyrimethamine and trimethoprim-sulfamethoxazole are ineffective in the treatment of syphilis. 13) A client is prescribed ampicillin sodium (Omnipen) for a sinus infection. The nurse should instruct the client to notify the healthcare provider immediately if which symptom occurs? *A. Rash. B. Nausea. C. Headache. D. Dizziness. Rash is the most common adverse effect of all penicillins, indicating an allergy to the medication that could result in anaphylactic shock, a medical emergency. 14) While taking a medical history, the client states, "I am allergic to penicillin." What related allergy to another type of antiinfective agent should the nurse ask the client about when taking the nursing history? A. Aminoglycosides. *B. Cephalosporins. C. Sulfonamides. D. Tetracyclines. According to research, there appears to be a cross sensitivity between penicillins and first generation cephalosporins; however, research shows there is no evidence of cross sensitivity between PCN and third or fourth generation cephalosporins. 15) The nurse is monitoring a client who received a first dose of intravenous ampicillin. Which finding should indicate to the nurse that the client may be experiencing an allergic reaction? A. Abdominal pain B. Increase in blood pressure C. Hypotensive bowel sounds *D. Hives on the extremities Rationale: If the client experiences an allergic reaction to medications they may display systemic signs such as hives, pruritus, dyspnea, etc. Abdominal pain, hypertension, and hyperactive bowel sounds do not indicate an allergic reaction. 16) The nurse is providing education to the parent of a pediatric client receiving amoxicillin clavulanate suspension. Which of the following statements is appropriate? *A. Use the measuring device provided by the pharmacy B. You should take this medication on an empty stomach C. Avoid shaking the medication before opening D. Take the medication with a glass of juice Question Explanation Rationale: Take augmentin (amoxicillin clavulanate) with meals to increase absorption and decrease GI upset. Acidic fluids may destroy the drug, so avoid taking the medication with citrus juice. The client should be taught to shake liquid penicillins well as the medication tends to separate out of the suspension. Measure liquid doses carefully. Use the measuring device that comes with this drug. If there is none, ask the pharmacist for a device to measure this drug. 17) A nurse is administering an intravenous piggyback infusion of penicillin. Which client statement would require the nurse's immediate attention? *A. "I am itching all over." B. "I have soreness and aching in my muscles." C. "I have cramping in my stomach." D. "I have a burning sensation when I urinate." Rationale: Allergic reactions to medications can include itching all over. This can be further supported by the presence of hives or welts. Abdominal pain or cramping could indicate a side effect of the penicillin. The other symptoms of muscle soreness and painful urination are not as urgent as the itching. 18) A 2 year-old child is being treated with amoxicillin suspension, 200 milligrams per dose, for acute otitis media. The child weighs 33 lb (15 kg) and the daily dose range is 20 to 40 mg/kg of body weight, in three divided doses every eight hours. Using principles of safe drug administration, what should a nurse do next? A. Recognize that antibiotics are over-prescribed B. Call the health care provider to clarify the dose C. Hold the medication because the dosage is too low *D. Give the medication as ordered Rationale: Amoxicillin continues to be the drug of choice in the treatment of acute otitis media. The dose range is 20 to 40 mg/kg/day divided every eight hours; 15 kg x 40 mg = 600 mg, divided by 3 = 200 mg per dose. The prescribed dose is correct and should be given as ordered. 19) The nurse is preparing to administer ceftriaxone to a client. Which of the following findings from the client’s medical record should cause the nurse to question this prescription? A. White blood cells in the urine B. History of hypertension *C. Allergy to cephalexin D. Current tobacco smoker Rationale: Ceftriaxone and cephalexin are both cephalosporins; therefore, an allergy to cephalexin should cause the nurse to question any prescription for a cephalosporin. Hypertension and tobacco use do not affect the ability to take ceftriaxone. Elevated white blood counts (WBCs) in the urine indicate a possible infection and may be why antibiotics were prescribed, but this finding should not cause the nurse to be concerned about the medication. 20) At 6 weeks’ gestation a client is found to have gonorrhea. For which medication would the nurse anticipate preparing a teaching plan? *A. Ceftriaxone B. Levofloxacin C. Sulfasalazine D. Trimethoprim/sulfamethoxazole Rationale Ceftriaxone, a broad-spectrum antibiotic, is preferred during pregnancy. Levofloxacin, although listed for unlabeled use against gonococcal infection, should not be prescribed during pregnancy. Sulfonamides, such as Sulfasalazone, may cause hemolysis in the fetus. Trimethoprim/sulfamethoxazole contains a sulfonamide and is contraindicated during pregnancy. 21) Which fact about ceftriaxone medication therapy will the nurse emphasize when teaching a client diagnosed with gonorrhea? *A. Cures the infection B. Prevents complications C. Controls its transmission D. Reverses pathologic changes Rationale Ceftriaxone, followed by doxycycline, is specific for Neisseria gonorrhoeae and eradicates the microorganism; other treatment regimens are available for resistant strains. If the disease progresses before the diagnosis is made, complications such as sterility, heart valve damage, or joint degeneration may occur. Transmission is not controlled; the organism is eliminated. If tubal structures, heart valves, or joints degenerate, the pathologic changes will not be reversed by antibiotic therapy. 21) During an assessment the client mentions taking cefotetan and drinking a few cocktails at dinner. Which symptoms might be explained by this medication–alcohol interaction? Select all that apply. One, some, or all responses may be correct. *A. Pruritus *B. Diaphoresis *C. Hypotension D. Hypertension *E. Stomach cramps F. Chest pain Rationale Individuals taking the antibiotic cefotetan need to avoid alcohol. Drinking alcohol while on this medication causes acute alcohol intolerance, resulting in pruritus, diaphoresis, hypotension, and stomach cramps. Hypertension and chest pain or pressure are not typical symptoms of acute alcohol intolerance and cannot be explained by this medication–alcohol interaction. 22) A nurse receives a prescription to administer intravenous cefepime to a client with a bacterial infection. The client has a history of lung cancer and is on a continuous cisplatin infusion. How will the nurse administer the prescribed medication? A. Piggyback the cefepime onto the cisplatin infusion B. Wait for the cisplatin infusion to finish before administering cefepime C. Infuse the cefepime via IV push at the proximal port *D. Initiate a new intravenous line for the cefepime infusion Rationale: Cefepime is an antibiotic medication used to treat bacterial infections. Cisplatin is an antineoplastic medication used in the treatment of various cancers. Cefepime and cisplatin are not compatible and should not be mixed. The nurse should initiate a new intravenous line for the administration of cefepime. Piggybacking the cefepime will cause the medication to mix with cisplatin. The medications are not compatible. A continuous cisplatin infusion is administered over 24 hours to 5 days. The nurse should not wait to administer other medications. Cefepime should be administered as an infusion, not an IV push. “Anti-B” -mycin -micin: vancomycin “Big Gun”, gentamicin, erythromycin, streptomycin, azithromycin x 29 1) The nurse is preparing to administer the next dose of prescribed vancomycin to the client being treated for sepsis. Which of the following laboratory results would be the priority for the nurse to review? A. Peak serum drug level B. Serum potassium level *C. Serum creatinine level D. White blood cell count Rationale: Vancomycin can lead to interstitial nephritis and therefore, serum creatinine should be monitored. Prior to a dose, a trough level would be drawn to help assess minimum inhibitory concentration; however, peak levels are not needed for this purpose and are drawn after administration. Do not hold the next vancomycin doses while waiting for the results of vancomycin levels unless there is a concern about renal function. Therefore, the priority is serum creatinine. While the treatment of infection is the goal, assessing white blood count (WBC) prior to administration is not necessary. 2) The nurse is caring for a client with osteomyelitis who is receiving IV infusion of prescribed vancomycin. Which statement by the client would be a priority for the nurse to report to the healthcare provider? A. I fell some burning at the catheter site B. I feel a little nauseous *C. I have a ringing in my ears D. I have a headache Rationale: The nurse who is caring for a client with osteomyelitis who is receiving IV infusion of vancomycin should assess the client for toxicity. The client who reports ringing in the ear could be experiencing ototoxicity, which is an adverse effect of vancomycin and should be reported to the healthcare provider. Headache, nausea, and burning at the IV site are side effects of the medication but not a priority for the nurse to report to the healthcare provider. 3) The nurse is caring for a client who is prescribed erythromycin 500 mg orally every six hours for the treatment of pneumonia. The nurse should monitor the client for which common side effect? A. Esophagitis B. Tendon rupture C. Orange-red discoloration of urine *D. Nausea and vomiting Rationale: Erythromycin is a macrolide anti-infective medication used that interferes with protein synthesis in susceptible bacteria. Nausea, vomiting and gastrointestinal (GI) upset are common with erythromycin. The other side effects are not commonly seen with this drug. 4) Which assessment would the nurse perform before administering a dose of vancomycin to a client? Select all that apply.One, some, or all responses may be correct. *A. Creatinine *B. Trough level *C. Hearing ability *D. Intravenous site *E. Blood urea nitrogen Rationale ALL are correct. Two major adverse effects of vancomycin are nephrotoxicity and ototoxicity. The nurse would assess the client’s creatinine and blood urea nitrogen levels to determine renal function. The nurse would also assess the vancomycin trough levels to determine if the client’s kidneys are clearing the medication. The nurse would assess for changes in hearing as a result of ototoxicity. Vancomycin can cause phlebitis, so the nurse would assess the intravenous site before initiating the infusion. 5) Which reason will the nurse explain is the purpose for neomycin being prescribed to a client with cirrhosis? A. Prevents an infection B. Limits abdominal distention C. Minimizes intestinal edema *D. Reduces the blood ammonia level Rationale Reducing the blood ammonia level decreases the effect of bacterial activity on blood and wastes in the gastrointestinal tract. Although neomycin is an aminoglycoside antimicrobial, it is not administered to prevent infection. Neomycin does not reduce abdominal distention. Neomycin has little or no effect on intestinal edema. 6) Which action would the nurse take when a client develops a maculopapular rash on the upper extremities and audible wheezing during the admistinration of intravenous vancomycin? *A. Stop the infusion. B. Decrease the flow rate. C. Reassess in 15 minutes. D. Notify the health care provider. Rationale The first action the nurse would take is to stop the infusion immediately. The client may be experiencing an allergic reaction. Decreasing the flow rate is not an appropriate action. Infusions must be stopped if an allergic reaction is suspected. This could be an emergent situation, so reassessing in 15 minutes is not the most appropriate action. The nurse would stop the medication infusion and then notify the health care provider. 7) Neomycin is prescribed preoperatively for a client with colon cancer. The client asks why this is necessary. Which response would the nurse provide? A. 'It kills cancer cells that may be missed during surgery.' B. 'This medication is helpful in decreasing the inflammatory response associated with surgical procedures.' *C. 'It kills intestinal bacteria to decrease the risk for infection.' D. 'This medication alters the body flora to prevent the occurrence of superinfections.' Rationale Neomycin is an aminoglycoside antibacterial medication that provides preoperative intestinal antisepsis. Neomycin is not a cancer chemotherapeutic medication; therefore, it does not kill cancer cells. It is not an anti-inflammatory medication; therefore it is not given for that purpose. Antibiotic alteration of body flora increases the risk for superinfections, rather than preventing them. 8) A client with pulmonary tuberculosis develops tinnitus and vertigo. Which antitubercular medication would the nurse suspect is causing these symptoms? A. Isoniazid B. Rifampin *C. Streptomycin D. Ethambutol Rationale Streptomycin is ototoxic and can cause damage to the eighth cranial nerve, resulting in deafness. Assessment for ringing or roaring in the ears, vertigo, and hearing acuity should be made before, during, and after treatment. Isoniazid does not affect the ear; however, blurred vision and optic neuritis, as well as peripheral neuropathy, may occur. Rifampin does not affect hearing; however, visual disturbances may occur. Ethambutol does not affect hearing; however, visual disturbances may occur. 9) A client with tuberculosis takes combination therapy with isoniazid, rifampin, pyrazinamide, and streptomycin. The client says, 'I’ve never had to take so much medication for an infection before.' How would the nurse respond? *A. 'The bacteria causing this infection are difficult to destroy.' B. 'Streptomycin prevents the side effects of the other medications.' C. 'You only need to take the medications for a couple of weeks.' D. 'Aggressive therapy is needed because the infection is well advanced.' Rationale Multiple medications are administered because of concerns regarding medication resistance. Streptomycin sulfate is an antibiotic; it does not prevent the side effects of other medications used in therapy. Multiple antitubercular medications are necessary for an extended period, approximately 6 to 8 months depending on the individual. Multiple dose therapy is needed regardless of whether the disease is advanced. 10) A client with an infection is receiving vancomycin. Which laboratory blood test result would the nurse report? A. Hematocrit: 45% B. Calcium: 9.0 mg/dL (2.25 mmol/L) C. White blood cells (WBC): 10,000 mm 3 (10 × 10 9/L) *D. Blood urea nitrogen (BUN): 30 mg/dL (10.2 mmol/L) Rationale Vancomycin is a nephrotoxic medication. An elevated BUN can be an early sign of toxicity. The BUN of a healthy adult is 10 to 20 mg/dL (3.6–7.1 mmol/L). This hematocrit is expected in a healthy adult; the range is from 40 to 52. The expected range of the white blood cell (WBC) count is 5000 to 10,000 mm 3 (5 to 10 × 10 9/L) for a healthy adult. This calcium level is within the expected range of 9.0 to 10.5 (2.25–2.75 mmol/L) for a healthy adult. 11) A client with a history of tuberculosis reports difficulty hearing. Which medication would the nurse consider is causing this response? *A. Streptomycin B. Pyrazinamide C. Isoniazid D. Ethambutol Rationale Ototoxicity is an adverse effect of aminoglycosides such as streptomycin. Ototoxicity is not an adverse effect of pyrazinamide, isoniazid, or ethambutol. 12) A client receiving intravenous vancomycin reports ringing in both ears. Which initial action would the nurse take? A. Notify the primary health care provider. B. Consult an audiologist. *C. Stop the infusion. D. Document the finding and continue to monitor the client. Rationale The first action the nurse would take is to stop the infusion immediately. Vancomycin can cause temporary or permanent hearing loss. The nurse would stop the medication infusion and then notify the health care provider at once if a client reports any hearing problems or ringing in the ears. An audiologist may need to be consulted at a later date, but this is not the best first action. The nurse would document the findings; however, this is not the initial action. 13) The nurse is caring for a client who is receiving intermittent intravenous piggyback (IVPG) doses of vancomycin every 12 hours. The primary health care provider prescribes trough levels of the antibiotic. The nurse schedules the blood sample to be obtained at which time? *A. Just before the medication is administered B. Between 30 and 60 minutes after the infusion is completed C. Six hours after the dose is completely infused D. In the morning before the client eats breakfast Rationale Trough levels are measured in relation to the time a medication is administered. The trough level for a medication is drawn just before a medication is given, when the medication’s level is at its lowest. Any other time would be inaccurate for a medication’s trough level. The medication’s peak level is drawn 30 to 60 minutes after the infusion is completed. Whether the client eats breakfast does not affect this medication’s trough levels, because it is an intravenous infusion. 14) After receiving streptomycin sulfate for 2 weeks as part of the medical regimen for tuberculosis, the client reports feeling dizzy and having some hearing loss. Which part of the body is the medication affecting? A. Pyramidal tracts B. Cerebellar tissue C. Peripheral motor end plates *D. Eighth cranial nerve’s vestibular branch Rationale Streptomycin sulfate is ototoxic and may cause damage to auditory and vestibular portions of the eighth cranial nerve. Pyramidal tracts, cerebellar tissue, and peripheral motor end plates are not affected by streptomycin. 15) Which action would the nurse take to avoid red man syndrome when preparing to administer a vancomycin infusion? *A. Infuse slowly. B. Change the intravenous (IV) site. C. Reduce the dosage. D. Administer vitamin K. Rationale Vancomycin should be infused slowly to avoid the occurrence of the reaction known as 'red man syndrome.' Changing the IV site reduces the incidence of thrombophlebitis. Reducing the dosage is done in the setting of renal dysfunction. Administration of vitamin K is done to correct an elevated prothrombin time. 16) The clinic nurse is planning care for a client with chlamydia. Which treatment would the nurse anticipate implementing? A. Administration of 250 mg of acyclovir orally in a single dose *B. Administration of 1 g of azithromycin orally in a single dose C. Administration of 250 mg of ceftriaxone intramuscularly in a single dose D. Administration of 2.4 million units of benzathine penicillin G intramuscularly in a single dose Rationale The treatment of choice for chlamydial infection is 1 g of azithromycin orally in a single dose. The one-dose course is preferred because of its ease of completion. Acyclovir may be prescribed in a 7-day course for a genital herpes outbreak. Administering 250 mg of ceftriaxone intramuscularly in a single dose is the medication therapy recommended for gonorrhea. Benzathine penicillin G given intramuscularly as a single 2.4 million–unit dose is the treatment for primary, secondary, and early latent syphilis. 17) Use of which medication would the nurse identify as a potential risk for hearing impairment in a child? A. Amoxicillin *B. Gentamicin C. Clindamycin D. Ciprofloxacin Rationale Gentamicin can be ototoxic because of its effects on the eighth cranial nerve. Reactions to amoxicillin are usually allergic in nature. Impaired hearing does not occur with ciprofloxacin or with clindamycin. 18) The nurse teaches an adolescent about the side effects of azithromycin. The nurse determines the teaching has been understood when the adolescent identifies which problem as the most common side effect of this medication? A. Tinnitus *B. Diarrhea C. Dizziness D. Headache Rationale Diarrhea initially is related to gastrointestinal irritation; later it is related to loss of intestinal flora, which may lead to overgrowth of drug-resistant microbes, resulting in superinfection. This also causes diarrhea. Tinnitus, dizziness (vertigo), and headache all may occur, but none is the most common side effect. 19) Which assessment would the nurse perform before administering a dose of vancomycin to a client? Select all that apply.One, some, or all responses may be correct. *A. Creatinine *B. Trough level *C. Hearing ability *D. Intravenous site *E. Blood urea nitrogen Rationale Two major adverse effects of vancomycin are nephrotoxicity and ototoxicity. The nurse would assess the client’s creatinine and blood urea nitrogen levels to determine renal function. The nurse would also assess the vancomycin trough levels to determine if the client’s kidneys are clearing the medication. The nurse would assess for changes in hearing as a result of ototoxicity. Vancomycin can cause phlebitis, so the nurse would assess the intravenous site before initiating the infusion. 20) The nurse is caring for a client who has been prescribed vancomycin intravenous infusion for the treatment of methicillin-resistant staphylococcus aureus. Which of the following laboratory values should be immediately reported to the healthcare provider? *A. Vancomycin trough of 15 mcg/dl B. Blood urea nitrogen level of 18 mg/dl C. Creatinine level of 1.1 mg d/l D. White blood cell count of 11,500 per microliter Rationale: Vancomycin has a low therapeutic index, with nephrotoxicity and ototoxicity complicating therapy if toxicity develops. In contrast, underdosing (less than the minimum inhibitory concentration) can lead to treatment failure. Nephrotoxicity is associated with a trough level above 10 mcg/dl. The BUN and creatinine in this case are still within a normal range. While the WBC count is elevated, this is an expected finding. 21) The home health nurse is teaching a female client about self-administering vancomycin. Which statement by the client demonstrates understanding of the teaching? *A. I need to call my provider if my urine changes B. Muscle tingling and weakness is an expected side effect of this medication C. Ringing in the ears is common when taking vancomycin D. I should avoid eating food with active cultures in it Rationale: Vancomycin is commonly linked to nephrotoxicity, leading to the need for monitoring trough levels. Signs of kidney injury include decreased urination, blood in the urine, and other changes in urine color and clarity. Antibiotic-associated diarrhea (colitis) results from oral or parenteral antibiotic therapy. Another pathogen is Candida albicans, which results in vaginal yeast infection and oral thrush. Probiotics can reduce these risks. Antibiotic-induced neuropathy is a rare complication of several antimicrobial agents. Hypokalemia can result from vancomycin; therefore, muscle weakness and numbness or tingling should be reported. Ototoxicity is a serious complication from vancomycin due to vestibular damage. 22) An older adult client is to receive intravenous (IV) gentamicin for urosepsis. Before administering the medication, for which finding should the nurse notify the health care provider (HCP)? A. The client has a history of acid reflux disease. B. The client has a history of retinopathy. *C. The client has a history of chronic kidney disease. D. The client has a history of urinary retention. Question Explanation Rationale: Gentamicin is an aminoglycoside antibiotic. Aminoglycosides are used to treat severe infections, such as septicemia, and are only given for a short period of time due to their toxic effects. They are not metabolized by the liver. Instead they are excreted by glomerular filtration. Aminoglycosides are nephrotoxic and requires close monitoring of renal function. A client with chronic kidney disease should not receive this medication. The other conditions do not represent a contraindication to gentamicin. 23) A hospitalized infant is receiving gentamicin. While monitoring for drug toxicity, the nurse should focus on which laboratory result? A. Platelet counts *B. Serum creatinine C. Thyroxin levels D. Growth hormone levels Rationale: Toxicity to the aminoglycoside antibiotic gentamicin is seen in increased BUN and serum creatinine levels. Kidney damage may be reversible if the drug is stopped at the first sign of toxicity. In addition to nephrotoxicity, this medication has a Black Box warning for neurotoxicity and ototoxicity. 24) The nurse receives an order to administer intravenous gentamicin to a client. For which finding should the nurse contact the health care provider to clarify the order? A. Low serum albumin B. Low serum blood urea nitrogen C. High gastric pH *D. High serum creatinine Rationale: Gentamicin is an aminoglycoside antibiotic that is excreted primarily by the kidneys. If there is reduced renal function as evidenced by the elevated serum creatinine level, the client is at greater risk for drug toxicity and further renal damage. 25) The health care provider prescribes peak and trough levels after initiation of intravenous antibiotic therapy. The client asks why these blood tests are necessary. Which reason would the nurse provide? *A. 'They determine if the dosage of the medication is adequate.' B. 'They detect if you are having an allergic reaction to the medication.' C. 'The tests permit blood culture specimens to be obtained when the medication is at its lowest level.' D. 'These allow comparison of your fever to changes in the antibiotic level.' Rationale Medication dose and frequency are adjusted according to peak and trough levels to enhance efficacy by maintaining therapeutic levels. Peak and trough levels reveal nothing about allergic reactions. Blood cultures are obtained when the client spikes a temperature; they are not related to peak and trough levels of an antibiotic. A sustained decrease in fever is the desired outcome, not a reduction just at peak serum levels of the medication. 26) When the nurse is administering a course of aminoglycoside treatment to a client with Klebsiella infection, which adverse effects prompt the nurse to hold treatment and contact the health care provider? Select all that apply. One, some, or all responses may be correct. *A. Vertigo *B. Tinnitus *C. Dizziness D. Heartburn *E. Persistent headache Rationale The nurse monitors the client administered aminoglycosides for signs of ototoxicity, which include vertigo, tinnitus, dizziness, and persistent headache. Any sign of ototoxicity should result in holding the treatment and contacting the health care provider. Heartburn is not associated with ototoxicity. 27) Which condition would the nurse monitor for in the client on aminoglycoside therapy and skeletal muscle relaxants? A. Stroke *B. Respiratory arrest C. Myocardial infarction D. Abdominal discomfort Rationale Aminoglycosides can intensify the effect of skeletal muscle relaxants, placing the client at risk for respiratory arrest. Aminoglycoside therapy with muscle relaxants does not increase the risk of stroke, myocardial infarction, or abdominal discomfort. 28) When would the nurse have the laboratory obtain a blood sample to determine the peak level of an antibiotic administered by intravenous piggyback (IVPB)? A. Halfway between two doses of the medication *B. Between 30 and 60 minutes after a dose C. Immediately before the medication is administered D. Anytime it is convenient for the client and the laboratory Rationale Because the medication was administered by IV, the blood level of the medication will be at its highest shortly after administration. A medication blood level measured halfway between two doses will not obtain the peak level. Immediately before the medication is administered is done for a trough level, when the medication level is at its lowest. Anytime it is convenient for the client and the laboratory will produce inaccurate results; peak and trough levels are measured in relation to the time a medication is administered. 29) A peak and trough level is prescribed for a client receiving antibiotic therapy. When should the nurse should obtain the trough level? A. Sixty minutes after the antibiotic dose is administered. *B. Immediately before the next antibiotic dose is given. C. Upon completion of the prescribed antibiotic regime. D. An hour before the next antibiotic dose is given. Trough levels are drawn when the blood level is at its lowest, which is typically just before the next dose is given. “Anti-B” -cycline: doxycycline, tetracycline x 11 1) Which action would the nurse take when administering tetracycline? A. Administer the medication with meals or a snack. B. Provide orange or other citrus fruit juice with the medication. *C. Administer the medication at least an hour before ingestion of milk products. D. Offer antacids 30 minutes after administration if gastrointestinal side effects occur. Rationale Any product containing aluminum, magnesium, or calcium ions should not be taken in the hour before or after an oral dose of tetracyclines (with the exception of doxycycline) because it decreases absorption by as much as 25% to 50%. Food interferes with absorption; it should be given 1 hour before or 2 hours after meals. Citrus juice does not improve absorption. Antacids will interfere with absorption. 2) Which effect has resulted in the avoidance of tetracycline use in children under 8 years old? A. Birth defects B. Allergic responses C. Severe nausea and vomiting *D. Permanent tooth discoloration Rationale Tetracycline use in children under the age of 8 years has been discontinued because it causes permanent tooth discoloration. Birth defects, allergic responses, and severe nausea and vomiting are not prevalent reasons for the discontinuation of tetracycline medications in children under 8 years old. 3) How would the nurse reply when a client prescribed a tetracycline class medication asks why milk and antacids should be avoided before and after dosing? A. 'Taking these together can lead to kidney impairment.' B. 'The pairing of these substances leads to tooth staining.' C. 'Severe diarrhea can occur when taking these substances together.' *D. 'This can lead to decreased absorption of the medication you need.' Rationale Tetracyclines chelate with calcium, iron, and magnesium, so substances containing these minerals are avoided to optimize absorption of the antimicrobial. 4) A pregnant client with an infection tells the nurse that she has taken tetracycline for infections in the past and prefers to take it now. Which response would the nurse give regarding the avoidance of tetracycline administration during pregnancy? A. 'It affects breast-feeding adversely.' B. 'Tetracycline causes fetal allergies.' *C. 'It alters the development of fetal teeth buds.' D. 'It increases fetal tolerance to the medication.' Rationale Tetracycline has an affinity for calcium; if used during tooth bud development it may cause discoloration of teeth. Tetracycline does not adversely affect breast-feeding, cause fetal allergies to the medication, or increase fetal tolerance of the medication. 5) A mother complains that her child’s teeth have become yellow in color. The nurse understands that with prolonged use, which medication may be responsible? *A. Tetracycline B. Promethazine C. Chloramphenicol D. Fluoroquinolones Rationale When administered to neonates and infants, tetracycline may cause staining of developing teeth. Promethazine can cause respiratory depression in children under 2 years of age. Chloramphenicol can cause Gray baby syndrome, and fluoroquinolones may cause tendon rupture in pediatric clients. 6) A child is prescribed tetracycline. The nurse understands which possible medication-related reaction is associated with this medication? A. Kernicterus B. Gray syndrome C. Reye syndrome *D. Staining of teeth Rationale Tetracycline causes staining or discoloration of developing teeth in children. Sulfonamides may cause kernicterus in neonates. Chloramphenicol may cause Gray syndrome in infants. Aspirin may cause Reye syndrome in pediatric clients with a history of chickenpox or influenza. 7) Which information would the nurse provide to a client diagnosed with chlamydia and prescribed doxycycline? Select all that apply. One, some, or all responses may be correct. *A. Report worsening symptoms. *B. Refrain from sexual relations. *C. Use barrier protection devices. *D. Contact partners to be tested. *E. Take the entire course of antibiotics. Rationale The nurse would instruct clients taking doxycycline for an STI to report worsening symptoms to the health care provider as it could indicate antibiotic resistance. Clients would also be instructed to refrain from sexual relations while the infection is being treated. If they do choose to have sexual relations, they would be instructed on the importance of using barrier protection. The nurse would also instruct clients to contact their sexual partners and inform them of the need to be tested and treated for the STI. Clients should take the entire prescribed course of antibiotics to prevent recurrence of the infection. 8) The nurse is preparing to administer doxycycline to a client to treat syphilis. Which lab results should the nurse review before administering this medication? *A. Pregnancy test B. Hematocrit C. Sodium level D. Arterial blood gas Rationale: Tetracyclines, such as doxycycline, may cause fetal harm and should not be administered during pregnancy. It is important to know the client’s pregnancy status prior to administration. Reviewing hematocrit, serum sodium level, and ABGs may be a part of the client’s assessment, but these do not affect the prescription for doxycycline. 9) The nurse is providing medication teaching for a client who has been prescribed tetracycline. The client regularly takes calcium supplements to prevent osteoporosis. Which statement is appropriate for the nurse to make? *A. Take your calcium two hours before you take the antibiotic B. You can take the calcium with the antibiotic to decrease an upset stomach C. Try taking the antibiotic and calcium with orange juice D. It is best to take the antibiotic and calcium on an empty stomach Rationale: All tetracycline derivatives are bacteriostatics, and their concentration in serum should not fall during the therapy below the generally accepted minimum therapeutic concentration. Tetracyclines have a high affinity to form chelates with iron, aluminum, magnesium, and calcium. These complexes are poorly absorbed in the gastrointestinal tract; therefore, an interval between the ingestion of tetracyclines and cations is necessary. Taking tetracyclines with orange juice may increase irritation because the medication itself is also acidic. Additionally, orange juice may have added calcium, which would interact with the antibiotic. It is okay to take tetracyclines with food as long as it doesn’t contain dairy. This may reduce stomach-related side effects. 10) The nurse in the urgent-care clinic is reviewing discharge instructions with a client who is prescribed doxycycline. Which statement by the client indicates understanding of the instructions? A. "I will not wear my contact lenses while taking this medication." B. "I will carry glucose tablets with me in case I experience low blood sugar." C. "I will take this medication with an antacid to prevent an upset stomach." *D. "I will apply sunscreen when outside to prevent a sunburn." Rationale: Doxycycline is a tetracycline antibiotic. All tetracyclines can increase the sensitivity of the skin to ultraviolet light. The most common result is a sunburn. Clients on these types of medications should prevent sunburn by avoiding prolonged exposure to sunlight, wearing protective clothing and applying sunscreen to exposed skin while outdoors. This drug should be taken two hours before or after antacids, not with them. Hypoglycemia is not a common side effect of doxycycline. Wearing contact lenses is not contraindicated with this medication. 11) The health care provider has prescribed tetracycline for a 28-year-old female client with severe acne. When teaching the client about this medication, which information is important for the nurse to include? A. It may cause staining of the teeth. *B. It may decrease the effectiveness of oral contraceptives. C. It should be taken with food or milk. D. It may cause hearing loss. Rationale: Tetracycline, a broad-spectrum antibiotic, can decrease the effectiveness of oral contraceptives; therefore, it is important to recommend use of an additional form of contraception such as a condom when taking this medication. Tetracycline should be taken on an empty stomach and never with milk. It is not given to children younger than 8 years old because it can stain developing teeth. Tetracycline is not known to cause hearing loss. “Anti-B” -floxacin: levofloxacin, ciprofloxacin x 5 1) The nurse is educating an older adult client about newly prescribed levofloxacin for the treatment of pneumonia. The nurse should teach the client that which side effect is a priority for the client to report to the provider? *A. Joint tenderness B. Diarrhea C. Dizziness D. Difficulty sleeping Rationale: There is a black box warning for fluoroquinolones alerting health professionals not only to the increased disabling risk of tendinitis and tendon rupture but also to the significant risk of peripheral neuropathy, central nervous system and cardiac effects, and dermatologic and hypersensitivity reactions. Signs of tendonitis and tendon rupture include pain and tenderness in the affected limb or joint. The medication must be stopped immediately. The other options are common side effects and while reportable, are not a priority. 2) The nurse is reviewing discharge instructions with a client who has been prescribed ciprofloxacin following a minor burn injury. Which statement by the client requires additional teaching? A. "I will protect my skin from the sun with sunscreen and clothing." B. "I will not take ciprofloxacin prior to sun exposure." C. "After healing, I should have no scarring from this burn." D. "I can take ibuprofen for the pain related to this burn." Rationale: Ciprofloxacin is an antibiotic that is associated with causing photosensitivity. Clients should be instructed to protect their skin from sun exposure while taking this medication. Appropriate methods to protect the skin are to limit sun exposure and to wear sunscreen and protective clothing. For a superficial-thickness burn, no scarring will occur and healing should take 3 to 6 days. The client may take a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, to alleviate the pain associated with the burn. It is inappropriate for the client to stop taking their antibiotic. However, if the client cannot avoid sun exposure, the nurse may contact the health care provider and request that the antibiotic be changed to one that does not cause photosensitivity. 3) The nurse teaches a teenage client about the administration of levofloxacin to treat a sinus infection. The nurse concludes the teaching is effective when the client makes which statement? A. 'I should take the medication at mealtime.' B. 'I should take the medication just before a meal.' *C. 'I should take the medication 1 hour before a meal.' D. 'I should take the medication 30 minutes after a meal.' Rationale Absorption of the oral solution levofloxacin is enhanced when the stomach is empty, and it should be taken 1 hour before meals or 2 hours after meals. Tablets can be taken without regard for food. Food in the stomach will interfere with absorption. If the medication is taken just before a meal, food in the stomach shortly afterward will interfere with absorption. If the medication is taken 30 minutes after a meal, food remaining in the stomach will interfere with absorption. 4) Levofloxacin is prescribed for a woman who has been experiencing urinary frequency and burning for the past 24 hours. The nurse concludes the teaching has been effective when the client states she will make which change in her routine? A. Limit her fluid intake. B. Strain her urine for calculi. C. Monitor her urine output. *D. Take mineral supplements 2 hours before or after levofloxacin. Rationale Mineral substances taken within 2 hours of a levofloxacin dose decrease the medication’s effectiveness. Fluid intake should be increased to prevent crystalluria. Although the urine should be inspected for crystals, straining is not necessary. It is unnecessary to monitor urine output. 5) A 5-year-old child is given fluoroquinolones. Which potential adverse effect unique to pediatric clients would the nurse anticipate? *A. Tendon rupture B. Cartilage erosion C. Staining of developing teeth D. Central nervous system toxicity Rationale Fluoroquinolones may cause tendon rupture in children. Nalidixic acid can cause cartilage erosion, and tetracycline can cause staining of developing teeth. Hexachlorophene may cause central nervous system toxicity in infants. “Anti-B”-nidazole: Metronidazole, mebendazole (Flagyl) x 7 1) A child with pinworms is prescribed mebendazole. Which expected response to the medication would the nurse teach the parents watch for? A. Blood B. Constipation C. Yellow stools *D. Passage of worms Rationale Passage of worms is the expected response because the medication causes the death of the worms. Neither the medication nor the worms cause intestinal bleeding. Transient diarrhea, not constipation, may occur. The medication may color the stool red, not yellow. 2) The nurse is caring for a pregnant client who has contracted a trichomonal protozoan infection. For which oral medication would the nurse anticipate preparing to provide education? A. Penicillin G B. Acyclovir C. Nystatin *D. Metronidazole Rationale Metronidazole is a potent amebicide that is safe in pregnancy. It is effective in eradicating the protozoan Trichomonas vaginalis. Penicillin is administered for its effect on bacterial, not protozoal, infections. Acyclovir is an antiviral medication; therefore, it would not be effective in treating protozoal infections such as trichomonas. Nystatin is an antifungal for infections caused by Candida albicans. 3) A client with giardiasis is taking metronidazole (Flagyl) 2 grams PO. Which information should the nurse include in the client's instruction? A. Notify the clinic of any changes in the color of urine. B. Encourage the use of over-the-counter cough/cold syrup when a cough/cold develops. C. Stop the medication after the diarrhea resolves. *D. Take the medication with food. Flagyl, an amoebicide and antibacterial agent, may cause gastric distress, so the client should be instructed to take the medication on a full stomach. Urine may be red-brown or dark from Flagyl, but this side effect is an expectant finding and not necessary to report to the healthcare provider. The client should also avoid using alcohol-containing products such as cough or cold syrups or mouthwash while taking the medication and for at least three days after stopping it. 4) Which instruction) should the nurse give to a female client who just received a prescription for oral metronidazole (Flagyl) for treatment of trichomonas vaginalis? (Select all that apply.) *A. Increase fluid intake, especially cranberry juice. B. Do not abruptly discontinue the medication; taper use. C. Check blood pressure daily to detect hypertension. *D. Avoid drinking alcohol while taking this medication. *E. Use condoms until treatment is completed. *F. Ensure that all sexual partners are treated at the same time. Increased fluid intake and cranberry juice are recommended for prevention and treatment of urinary tract infections, which frequently accompany vaginal infections. It is not necessary to taper use of this drug or to check the blood pressure daily, as this condition is not related to hypertension. Flagyl can cause a disulfiram-like reaction if taken in conjunction with ingestion of alcohol, so the client should be instructed to avoid alcohol. All sexual partners should be treated at the same time and condoms should be used until after treatment is completed to avoid reinfection. 5) The nurse is teaching the client with bacterial vaginosis who has been prescribed metronidazole tablets. What statement is appropriate? A. You may continue to experience symptoms after you stop the medication *B. You should avoid drinking alcohol while taking this medication C. Call your healthcare provider if you experience diarrhea D. Your sexual partner will need to be treated as well Rationale: Alcohol should be avoided while on metronidazole to reduce the risk of a disulfiram reaction. Routine treatment of male sexual partners is not needed and does not affect re-infection rates. If the client experiences continued symptoms, this may indicate treatment failure and the need for follow-up may be required. Diarrhea is a common side effect of metronidazole and should subside once treatment ends. 6) The nurse is educating a client prescribed metronidazole. Which of the following findings should the nurse include in the education as reportable to the healthcare provider? *A. Pinpoint red spots on the skin B. Nausea after beginning the medication C. Metallic taste D. Occasional diarrhea Rationale: The most common gastrointestinal effects of metronidazole are nausea, vomiting, diarrhea, and metallic taste. Drug-induced immune thrombocytopenia (DITP) is a rare, but serious, adverse effect where medications cause the body to produce antibodies to platelets. The medication must be stopped immediately because DITP can be life-threatening. Heparin-induced thrombocytopenia is one example. Metronidazole is associated with DITP. Petechiae are pinpoint, round spots that appear on the skin as a result of bleeding. The bleeding causes the petechiae to appear red, brown, or purple. 7) Which explanation would the nurse provide to a client with gastric ulcer disease who asks the nurse why the health care provider has prescribed metronidazole? A. To augment the immune response B. To potentiate the effect of antacids *C. To treat Helicobacter pylori infection D. To reduce hydrochloric acid secretion Rationale Approximately two-thirds of clients with peptic ulcer disease are found to have Helicobacter pylori infecting the mucosa and interfering with its protective function. Antibiotics do not augment the immune response, potentiate the effect of antacids, or reduce hydrochloric acid secretion. “nitro BIOTIC furantoin”: nitrofurantoin (Macrobid) x 2 1) A client has a prescription for nitrofurantoin 50 mg orally every evening to manage recurrent urinary tract infections. Which instruction would the nurse give to the client? *A. 'Increase your intake of fluids.' B. 'Strain your urine for crystals and stones.' C. 'Stop taking the medication if your urinary output increases.' D. 'This may turn your urine green.' Rationale To prevent crystal formation, the client should have sufficient intake to produce 1000 to 1500 mL of urine daily while taking this medication. Straining urine is not indicated when the client is taking a urinary anti-infective. If fluids are encouraged, the client’s output should increase. Nitrofurantoin turns urine dark yellow to brown, not green. 2) A client has received a prescription for nitrofurantoin to treat a urinary tract infection. Which of the following statements made by the client indicates the need for additional teaching about the medication? A. "I will be sure to finish taking the antibiotics, even if I start feeling better." *B. "I will spend extra time in the sun to get plenty of vitamin D." C. "I'll call my primary health care provider immediately if I develop a rash after taking the medication." D. "I will take the medication with food." Rationale: Clients taking nitrofurantoin should avoid exposure to sunlight while taking the medication. Exposure to sunlight while taking this medication can lead to damage to the skin. A client planning to spend extra time in the sun while taking nitrofurantoin should be informed of the dangers of sun exposure and counseled to avoid sun exposure while taking the medication. permethrin “lice” x 1 1) Permethrin 1% lotion is prescribed for a 5-year-old child with pediculosis capitis. Which instruction would the nurse include when teaching the parents about treatment? A. Personal belongings must be discarded. B. Side effects are nonexistent with the medicated shampoo. C. Other children should be kept away from the child for a week. *D. The child’s hair must be combed with a fine-toothed comb to remove nits. Rationale A fine-toothed comb removes any nits that remain after the application of permethrin 1% lotion. Personal belongings do not need to be disposed of; clothing and linens should be laundered in hot water and dried in a hot dryer, and other personal items may be soaked in a pediculicidal solution. Excessive use of permethrin 1% lotion may cause the lice to develop resistance to the shampoo. Once the hair has been shampooed, there is no reason to isolate the child. nystatin: “Use STAT for fungal mouth” x 3 1) The nurse teaches the mother of an infant prescribed nystatin for oral thrush, how to prevent aggravation of the condition. Which statements by the mother indicate the need for further teaching? Select all that apply. One, some, or all responses may be correct. A. 'I should rinse the infant’s mouth with plain water after feeding.' *B. 'I should boil the pacifier for at least 20 minutes on alternate days.' *C. 'I should apply the medication at least 20 minutes before feeding.' D. 'I should apply the medication to the infant’s oral cavity four times a day.' *E. 'I should boil the reusable nipples for at least 5 minutes after washing.' Rationale Nystatin is used to treat oral thrush in infants. Boiling the pacifier for 20 minutes on alternate days is inadequate because daily boiling of the pacifier is the best way to ensure efficient sterilization and killing of pathogens. Pacifiers should be boiled daily for at least 20 minutes. Nystatin should be administered to the child after feeding, not before feeding. Reusable nipples should be boiled at least 20 minutes after washing to remove spores, which are heat-resistant. Rinsing the infant’s mouth after feeding with plain water reduces the risk of infection in the infant. Nystatin should be applied four times a day to the infant’s oral cavity to ensure effective medication action. 2) After completing a week of antibiotic therapy, an infant develops oral thrush. Which medication is indicated for treatment of this condition? A. Acyclovir B. Vidarabine *C. Nystatin D. Fluconazole Rationale White, adherent patches on the tongue, palate, and inner aspects of the infant’s cheeks indicate oral candidiasis (thrush). Oral candidiasis is caused by a fungus called Candida albicans. Nystatin is an antifungal agent prescribed to treat oral thrush in an infant. Acyclovir and vidarabine are antiviral agents and are not used to treat oral candidiasis in the infant. Fluconazole can effectively treat oral thrush, but its use in infants is not approved by the US Food and Drug Administration. 3) A nurse is giving instructions to the parents of a newborn infant with oral candidiasis. Which statement made by a parent is incorrect and indicates a need for more teaching? *A. "The therapy can be discontinued when the spots disappear." B. "I will boil the nipples and pacifiers for 20 minutes." C. "I will use a dropper to place the medicine on each side of my baby's mouth." D. "Nystatin should be given four times a day after my baby eats." Rationale: The therapy should be continued for a week, even if lesions have disappeared within a few days. If the mother is breast-feeding, mother and baby should be treated at the same time to prevent re-infection. interferon “interferes the autoimmune disease” x 2 1) Which statement regarding treatment with interferon indicates that the client understands the nurse’s teaching? *A. 'I will drink 2 to 3 liters [2–3 quarts] of fluid a day.' B. 'Any reconstituted solution must be discarded in 1 week.' C. 'I can continue driving my car as long as I have the stamina.' D. 'While taking this medicine I should be able to continue my usual active lifestyle.' Rationale Adequate fluid intake helps prevent nephrotoxicity, especially during the early phase of treatment. Reconstituted solution may be stored in the refrigerator for 1 month. Confusion, dizziness, and hallucinations are side effects of this medication; the client should avoid hazardous tasks, such as driving or using machinery. Activity may have to be altered because fatigue and other flu-like symptoms are common with this medication. 2) An ambulatory client with relapsing-remitting multiple sclerosis is to receive every-other-day injections of interferon beta-1a. Which adverse effects would the nurse explain may occur when taking this medication? Select all that apply. One, some, or all responses may be correct. *A. Depression B. Polycythemia *C. Flu-like symptoms *D. Increased risk for infection E. Decreased perspiration Rationale Central nervous system effects include depression that may lead to suicide attempts. Interferon immune modifier causes flu-like symptoms, such as fever, muscle aches, and lethargy. Myelosuppression can cause leukopenia, thus increasing the risk for infection. It also increases the risk for anemia because of decreased production of red blood cells (RBCs); this is the opposite of polycythemia (too many RBCs). An integumentary response to this medication is sweating, not lack of perspiration (anhidrosis). pyrazinamide “my TB” x 1 1) The nurse is assessing a client with tuberculosis who has been taking prescribed pyrazinamide. Which finding reported by the client should the nurse immediately report to the healthcare provider? *A. Joint pain B. Fatigue C. Nausea D. Decreased appetite Rationale: Joint pain is a symptom of gout, which is a side effect of pyrazinamide. While fatigue, nausea, and loss of appetite are common side effects of the drug, the joint pain is the priority. TB in General x 7 1) Which essential test results will the nurse review before starting antitubercular pharmacotherapy when caring for a client with human immunodeficiency virus (HIV) infection who is diagnosed with tuberculosis? *A. Liver function studies B. Pulmonary function studies C. Electrocardiogram and echocardiogram D. White blood cell counts and sedimentation rate Rationale Antitubercular medications, such as isoniazid (INH) and rifampin (RIF), are hepatotoxic; liver function should be assessed before initiation of pharmacological therapy. Pulmonary function studies, electrocardiogram, and echocardiogram might be done; the results of these tests are not crucial for the nurse to review before administering antitubercular medications. White blood cell counts and sedimentation will not provide information relative to starting antitubercular therapy or to its side effects. 2) Which laboratory test result would the nurse review before initiating a prescribed antitubercular pharmacotherapy for a client with tuberculosis associated with human immunodeficiency virus? *A. Liver function studies B. Pulmonary function studies C. Electrocardiogram D. White blood cell (WBC) count Rationale Antitubercular medications, such as isoniazid and rifampin, are hepatotoxic. Pulmonary function studies and electrocardiograms are not related to the administration of antitubercular medications or to their side effects. The WBC count is expected to be higher in the presence of infection, but with acquired immunodeficiency syndrome, the WBC count will be less than 2500/cm 3 (2.5 × 10 9/L), and helper T cells will number less than 200 mm 3; the T4/T8 ratio will be 1:2. These tests will not provide information relative to starting antitubercular therapy or to its side effects. 3) The nurse is preparing a client for discharge following inpatient treatment for pulmonary tuberculosis. Which instruction should be given to the client? *A. Continue taking medications as prescribed. B. Continue taking medications until symptoms are relieved. C. Avoid contact with children, pregnant women or immunosuppressed persons. D. Take medication with aluminum hydroxide if epigastric distress occurs. Rationale: Early cessation of treatment may lead to development of drug-resistant tuberculosis (TB). Active TB is usually treated with a combination of four different antibiotics (Isoniazid, rifampin, ethambutol and pyrazinamide) and can now take anywhere from 6-12 months to completely kill the bacteria. As with any antibiotics, clients should continue to take medications even after they begin to feel better. There is no reason to avoid contact with children, pregnant women or immunosuppressed persons once discharged from the hospital as long as the client is adhering to medication schedules. Isoniazid should be taken on an empty stomach; ethambutol can be taken with food to avoid stomach upset. If taken with TB medications, aluminum hydroxide will interfere with absorption of these medications. 4) The client is diagnosed with tuberculosis (TB). The nurse understands that the treatment plan for this client will involve what type of drug therapy? *A. Administering two antituberculosis drugs B. Aminoglycoside antibiotics C. An anti-inflammatory agent D. High doses of B complex vitamins Rationale: In order to prevent drug-resistant strains of TB, clients are always prescribed at least two different anti-tubercular medications. Rifampin and isoniazid are the most effective drugs used to treat TB and are always used together, for at least six months. Additional medications, such as pyrazinamide and either streptomycin or ethambutol, may also be prescribed. Vitamin B6 is usually prescribed to help prevent expected side effect of isoniazid. 5) The nurse provides discharge teaching to a client with tuberculosis. Which treatment measure would the nurse reinforce as the highest priority? A. Getting sufficient rest B. Getting plenty of fresh air C. Maintaining a healthy lifestyle *D. Consistently taking prescribed medication Rationale Tubercle bacilli are particularly resistant to treatment and can remain dormant for prolonged periods; medication must be taken consistently as prescribed. Although getting sufficient rest, getting plenty of fresh air, and maintaining a healthy lifestyle are important, to heal the microorganisms must be eliminated with medication. 6) Which response by the nurse is appropriate when a client asks what to expect when beginning treatment for tuberculosis? A. 'Therapy will last a few weeks.' *B. 'Therapy will occur over two phases.' C. 'Therapy will involve one medication.' D. 'Therapy will require monitoring kidney function.' Rationale Therapy for tuberculosis occurs over two phases. The target of the induction phase is to achieve noninfectious sputum, and the target of the continuation phase is to eradicate the intracellular bacteria. Therapy for tuberculosis is prolonged, lasting 6 months to 2 years. Therapy for tuberculosis involves two to four medications. Therapy for tuberculosis requires monitoring liver, not kidney, function. 7) A client has been admitted for the second time to treat tuberculosis (TB). Which referral does the nurse initiate as a priority? A. Psychiatric nurse liaison to assess reasons for noncompliance B. Infection control nurse to arrange testing for drug resistance C. Social worker to see if the client can afford the medications *D. Visiting nurses to arrange for directly observed therapy (DOT) Rationale: Clients with TB must take multiple drugs for six months or longer, making adherence a very real problem. Non-adherence is the most common cause of treatment failure and relapse. This client has a risk of non-adherence, as evidenced because this is their second admission to treat TB. When the client is discharged, they most likely will need to be placed on DOT to ensure compliance. This is the priority referral in order to prevent transmission of TB to others in the community. The other referrals may also be appropriate depending on the client's needs. Rifampin: “PIN my TB” x 12 1) Which statement indicates that a female client who is receiving rifampin for tuberculosis understands the teaching? Select all that apply. One, some, or all responses may be correct. *A. "This medication may be hard on my liver, so I must avoid alcoholic drinks while taking it." *B. "This medication may reduce the effectiveness of the oral contraceptive I am taking." C. "I cannot take an antacid within 2 hours before taking my medicine." *D. "My health care provider must be called immediately if my eyes and skin become yellow." Rationale Alcohol may increase the risk of hepatotoxicity. Rifampin has teratogenic properties and may reduce the effectiveness of oral contraceptives. Yellowing of the eyes and skin are signs of hepatitis and should be reported immediately. An antacid may be taken 1 hour before taking the medication. 2) Which class is contraindicated in clients who take rifampin? A. Loop diuretics *B. Oral contraceptives C. Proton pump inhibitor D. Intermediate-acting insulin Rationale Rifampin increases metabolism of oral contraceptives, which may result in an unplanned pregnancy. Rifampin does not interact with a loop diuretic, a proton pump inhibitor, or intermediate-acting insulin. 3) A client who takes rifampin tells the nurse, 'My urine looks orange.' Which action would the nurse take? *A. Explain that this is expected. B. Check the liver enzymes. C. Ask the provider to order a urinalysis. D. Ask what foods were eaten. Rationale Rifampin causes a reddish-orange discoloration of secretions such as urine, sweat, and tears. Although liver enzymes should be monitored because of the risk of hepatitis, this action is not addressing the client’s statement. A urinalysis is not indicated for an anticipated finding. The medication, not food, is responsible for the urine color. 4) A client with tuberculosis is started on rifampin. The nurse evaluates that the teaching about rifampin is effective when the client makes which statement? A. 'I need to drink a lot of fluid while I take this medication.' *B. 'My sweat will turn orange from this medication.' C. 'I should have my hearing tested while I take this medication.' D. 'Most people who take this medication develop a rash.' Rationale Rifampin causes body fluids, such as sweat, tears, and urine, to turn orange. It is not necessary to drink large amounts of fluid with this medication; it is not nephrotoxic. Damage to the eighth cranial nerve is not a side effect of rifampin; it is a side effect of streptomycin sulfate, which is sometimes used to treat tuberculosis. A skin rash is not a side effect of rifampin. 5) A client is diagnosed with pulmonary tuberculosis, and the health care provider prescribes a combination of rifampin and isoniazid. The nurse evaluates that the teaching regarding the medications is effective when the client reports which action as most important? A. 'Report any changes in vision.' B. 'Take the medicine with my meals.' C. 'Call my doctor if my urine or tears turn red-orange.' *D. 'Continue taking the medicine even after I feel better.' Rationale The medication should be taken for the full course of therapy; most regimens last from 6 to 9 months, depending on the state of the disease. Visual changes are not side effects of this medication. The medication should be taken 1 hour before meals or 2 hours after meals for better absorption. Urine or tears turning red-orange is a side effect of rifampin; although this should be reported, it is not an adverse side effect. 7) Which statement by the client indicates to the nurse a need for further teaching on rifampin therapy? *A. 'I can expect my skin to turn yellow.' B. 'I can expect my sweat to change color.' C. 'I can expect my urine to turn red-orange.' D. 'I can expect my contact lenses to stain orange.' Rationale The skin turning yellow indicates jaundice, a serious unexpected adverse effect of rifampin therapy that needs to be reported to the prescriber. Sweat, urine, saliva, and tears (which may stain contact lenses) may turn to a red-orange color during rifampin therapy, which is expected. 8) Clients who take rifampin should not take medications from which class? A. Loop diuretics *B. Oral contraceptives C. Proton pump inhibitor D. Intermediate-acting insulin Rationale Rifampin increases metabolism of oral contraceptives, which may result in an unplanned pregnancy. Rifampin does not interact with a loop diuretic, a proton pump inhibitor, or intermediate-acting insulin. 9) A client is prescribed rifampin after being exposed to active tuberculosis. Which finding would the nurse immediately report to the health care provider? Select all that apply. One, some, or all responses may be correct. A. Reddish-orange color urine B. Yellow-colored teeth stains C. Orange-colored sweat and tears *D. Small, red, pinpoint areas on the arms E. Numbness, tingling, and burning of extremities Rationale Pinpoint red areas that appear on the arms, legs, or trunk of the body are known as petechiae. The petechiae are tiny hemorrhages that occur under the skin as a result of a low circulating platelet count (thrombocytopenia). Thrombocytopenia occurs with liver stress or damage. As hepatotoxicity is a possible adverse reaction to rifampin, the health care provider must be notified of the appearance of petechiae. Reddish-orange colored urine or stool is a normal effect of the rifampin. Yellow-colored stains on the teeth are side effects that are not dangerous; however, there is no way to reverse the staining, and they may be permanent. Orange-colored sweat and tears are also normal side effects of rifampin, but they are not dangerous. Numbness, tingling, and burning of the extremities could indicate peripheral neuropathy, which can be treated with vitamin B 12, so this is not an immediate emergency. 10) The nurse is assessing a client who is taking rifampin for the treatment of tuberculosis. Which finding reported by the client should the nurse immediately report to the healthcare provider? A. Blurred vision B. Orange-tinged tears *C. Dark amber urine D. Diarrhea Rationale: Rifampin causes a temporary yellow-orange discoloration of body fluids. Soft contact lenses may be permanently stained. Dark amber urine is an indication of liver dysfunction and should be reported. A major adverse effect of ethambutol, not rifampin, is optic neuritis. Diarrhea is a common side effect of antibiotics and is not the priority in this case. 11) A client diagnosed with tuberculosis is prescribed rifampin and isoniazid. Which information should the nurse include when reinforcing information about these medications? A. "You can take the medication with food." B. "You may experience an increase in appetite." *C. "You may notice an orange-red color to your urine." D. "You may have occasional problems sleeping." Rationale: Rifampin can cause reddish-orange discoloration of the urine and other body fluids, including tears and sweat. This is harmless, but the client needs to be made aware of it. The nurse should caution the client not to wear soft contacts while taking this medication because they can become discolored. The other information does not apply to those two medications. 12) A client begins treatment with rifampin for suspected pulmonary tuberculosis. Which information should the nurse include when teaching the client about this drug? A. "It is important to stay upright for 30 minutes after taking this drug." B. "Check your radial pulse before taking the drug." C. "Avoid prolonged exposure to the sun while taking this drug." *D. "You may notice an orange-red color to your urine." Rationale: Rifampin can cause a harmless reddish-orange discoloration of urin