Dosage Calc
The physician orders Vancocin 375 mg po for a staph infection. After reconstitution, the medication is available as 250 mg/5 mL. How many milliliters will the nurse administer?
7.5 mL
The nurse is monitoring for therapeutic results of antibiotic therapy in a patient with an infection. Which laboratory value would indicate therapeutic effectiveness of this therapy?
Decreased white blood cell count
While assessing a woman who is receiving quinolone therapy for pneumonia, the nurse notices that the patient has a history of heart problems. The nurse will monitor for what potential cardiac effect of quinolone therapy?
Prolonged QT interval
A newly admitted patient reports a penicillin allergy. The prescriber has ordered a second-generation cephalosporin as part of the therapy. What nursing action is appropriate?
Call the prescriber to clarify the order because of the patient’s allergy.
The nurse is reviewing the orders for a patient who has been admitted for treatment of pneumonia. The antibiotic orders include an order for doxycycline. However, when the patient is asked about his allergies, he lists “doxycycline” as one of his allergies. What is the nurse’s first action at this time?
Ask the patient to explain what happened when he had the allergic reaction.
The physician orders Keflex 250 mg po for strep throat. After reconstitution, the medication is available as 125 mg/5 mL. How many milliliters will the nurse administer?
10 mL
A patient is receiving aminoglycoside therapy and will be receiving a beta-lactam antibiotic as well. The patient asks why two antibiotics have been ordered. What is the nurse’s best response?
“The combined effect of both antibiotics is greater than each of them alone.”
When administering vancomycin, the nurse knows that what is most important to assess before giving the medication?
Renal function
A teenage patient is taking a tetracycline drug as part of treatment for severe acne. When the nurse teaches this patient about drug-related precautions, which is the most important information to convey?
The patient needs to use sunscreen or avoid exposure to sunlight, because this drug may cause photosensitivity
A woman who has been taking an antibiotic for a UTI calls the nurse practitioner to complain of severe vaginal itching. She has also noticed a thick, whitish vaginal discharge. The nurse practitioner suspects what?
A superinfection has developed.
The physician orders Ampicillin 150 mg IM for a systemic infection. After reconstitution, the medication is available as 125 mg/mL. How many milliliters will the nurse administer?
1.2 mL
Drug interaction in which the bacterial killing effect of two antibiotics given together is greater is?
Synergistic effect
A patient is receiving intravenous linezolid as part of treatment for an infected leg ulcer. The nurse will watch for which possible drug interactions with linezolid?
Selective serotonin reuptake inhibitor antidepressant and vasopressor.
The nurse is administering an intravenous aminoglycoside to a patient who has had gastrointestinal surgery. What nursing measures are appropriate?
Monitor serum creatinine levels.
Instruct the patient to report dizziness or a feeling of fullness in the ears.
During patient education regarding an oral macrolide, such as erythromycin, the nurse will include which information?
Use another form of birth control if the patient is taking oral contraceptives.
The patient may take the drug with a small snack to reduce GI irritation.
The physician orders penicillin G 500,000 units IM for infection. After reconstitution, the medication is available as 1,000,000/mL. How many milliliters will the nurse administer?
0.5 mL
A patient who has been receiving intravenous doses of metro-nidazole has been discharged and will continue therapy with oral doses of this medication. The patient remarks, “I’m so glad to be going home. Our annual office party is tomorrow night, and I’ve been looking forward to it all year long.” What is the nurse’s priority when teaching the patient regarding this drug?
Drug interactions involving metronidazole include acute alcohol intolerance when taken with alcoholic beverages as the result of the accumulation of acetaldehyde, the principal alcohol metabolite. The priority education is for the nurse to tell the patient that he must avoid alcohol while on this medication for at least 36 hours after the last dose of metronidazole.
During therapy with an intravenous aminoglycoside, the patient calls the nurse and says, “I’m hearing some odd sounds, like ringing, in my ears.” What is the nurse’s priority action at this time?
Stop the infusion immediately.
The order reads: “Give vancomycin, 1250 mg in 250 mL NS, IVPB, every 12 hours. Infuse over 90 minutes.” The nurse will set the infusion pump to what setting for mL/hour? Round to a whole number.
167 mL/hr
A patient is scheduled for colorectal surgery tomorrow. His WBC count is normal, he has no fever, and he is otherwise in good health. However, there is an order to administer an antibiotic on call just before he goes to surgery. The nurse knows that the rationale for this antibiotic order is what?
To provide prophylactic therapy
The physician orders penicillin G 350,000 units IM for an infection. After reconstitution, the medication is available as 200,000 units/mL. How many milliliters will the nurse administer?
1.8 mL
A patient has a urinary tract infection caused by Pseudomo-nas spp. Two antibiotics have been ordered, and both are due at 0900:
gentamicin, 300 mg, intravenously, daily (due at 0900), infuse over 60 minutes
ceftazidime/avibactam, 2.5 grams intravenously, every 12 hours (due at 0900 and 2100), infuse over 30 minutes
Which antibiotic should the nurse infuse first?
The nurse will give the ceftazidime (a third-generation cephalosporin) first, and then the aminoglycoside gentamicin. When aminoglycosides are used in combination with beta-lactam antibiotics (i.e., penicillins, cephalosporins, monobactams), the beta-lactam antibiotic needs to be given first. This is because beta-lactams break down the cell walls of the bacteria and allow the aminoglycoside to get into the ribosomes, where they work.
When giving intravenous quinolones, the nurse needs to keep in mind that these drugs may have serious interactions with which drugs?
Oral anticoagulants
A patient has been receiving therapy with the aminoglycoside tobramycin, and the nurse notes that the patient’s latest trough drug level is 3 mcg/mL. This drug is given daily, and the next dose is to be administered now. Based on this trough drug level, what is the nurse’s priority action?
Hold the drug, and notify the prescriber.
The nurse is reviewing the medications that are due this morning for a patient and notes the following orders: doxycycline, 200 mg, PO every morning multivitamin with iron, 1 tablet, PO every morning Mylanta, 30 mL, PO, twice a day What is the nurse’s priority action when considering whether these medications can be given together?
The priority is to avoid drug interactions. The doxycycline, a tetracycline, must not be given with the multivitamin with iron or with the antacid because the iron and antacid will chelate, or bind up, the antibiotic, thus preventing its absorption. As a result, the blood level of the antibiotic will be decreased and the drug will not be effective. The nurse will give the doxycycline either 1 hour before or 2 hours after the other medications.