Antibiotics 2
You are giving one of your patients vancomycin to treat their C. dif infection. What adverse reactions should you monitor for? (select all)
A. Headaches
B. Urinary output of <30 ml/hr
C. Hearing loss
D. rashes, flushing, tahcycardia
E. Jaundice
B, C, D
Vancomycin is a broad spectrum antibiotic that can cause renal damage, is ototoxic, and can cause red man syndrome. Peaks and troughs of this drug will also be checked to avoid these.
What two drugs are the treatment of choice for TB infection and how long are patients typically on these two drugs?
Isoniazid and Rifampin
Patients are on these typically for 6-12 months because TB is a very resistant bacteria that requires a very long course of treatment to get rid of.
One of your patients is being given an antimitotic to help treat their lymphoma. How does this class of medication work?
A. Stops or inhibits the production of DNA and RNA
B. Stops cell division during mitosis
C. Interrupts the S phase of the cell cycle
D. Causes alkylation of cellular DNA, RNA, and protein
B
Some adverse effects of antimitotics can be things like peripheral neuropathy, alopecia, and severe tissue damage with extravasation
This supplement is given to treat megaloblastic anemia but should not be given indiscriminately for it can cover the effects of B12 deficiency.
Folic acid
It is also recommended that pregnant women or those of child-bearing age to get extra amounts of it to reduce the risk of neural tube defects.
This drug is the prototype glucocorticoid and is used to treat a lot of autoimmune/inflammatory disorders.
Prednisone
You have a patient that was just prescribed phenazopyridine to help treat her UTI. What's something you should tell her before she starts taking it?
This medication turns your urine orange-red
This medication can cause headaches
This medication will help kill the bacteria in your urinary tract
This medication should be taken on an empty stomach
1.
Phenazopyridine has the adverse effect of turning urine an orange-red color. It is also a urinary tract analgesic and has no antibiotic effects.
You just started one of your patients on Isoniazid and Rifampin to treat an active TB infection. What kind of education points should be gone over with them? (select all)
A. Take these 1 hr before meals or 2 hours after. If they upset your stomach, you can take them with meals.
B. Report any swelling or urinary retention
C. Report RUQ pain as well as any nausea or vomiting.
D. Report any abdominal pain, diarrhea, or bloody stools
E. Make sure to avoid alcohol while taking these medications
A, C, D, E
Isoniazid can cause things like liver injury and peripheral neuropathy and Rifampin can cause liver injury, pseudomembranous colitis and mild GI upset. Rifampin can also cause discoloration of bodily fluids (sweat, urine) and the patient should be warned of this.
A nurse is teaching a patient who has breast cancer about tamoxifen. Which of the following adverse effects of tamoxifen should the nurse discuss with the patient?
A. Irregular heart beat
B. Abnormal uterine bleeding
C. Yellow sclera or dark-colored urine.
D. Difficulty swallowing
B
Vaginal discharge and bleeding are adverse effects of tamoxifen. Those who take tamoxifen are also at increased risk for endometrial cancer, so any abnormal uterine bleeding should be carefully monitored and evaluated.
This type of anemia has a tell-tale beefy, red tongue as a sign of it.
Pernicious anemia (b12 deficinecy)
other symptoms include SOB, weakness, fatigue, dizziness, etc.
One of your patients is on prednisone to help reduce the risk of their new kidney being rejected. What's something to be monitored for as an adverse effect of this medication? (select all)
A. Shakiness and dizziness
B. Swelling/edema
C. Increased thirst
D. Sore throat and slight fever
E. Muscle weakness and palpitations
B, D, E
Prednisone is a corticosteroid and has adverse effects of increased risk for infection, hypokalemia, fluid retention, hyperglycemia, adrenal suppression, and GI ulcers/upset
One of your patients has strep throat and is going to be prescribed an antibiotic to treat it. In their history, you find out they have a prolonged QT interval. Which medication should be avoided in this patient?
Erythromycin
Penicillin G
Cefepime
Ciprofloxacin
1.
Macrolides (like Erythromycin) have an adverse effect of increasing someone's QT interval and should be avoided in those who already have a prolonged QT interval because it raises the risk of sudden cardiac arrest.
A nurse is teaching a patient who is beginning a course of metronidazole to treat an infection. For which of the following adverse effects should the nurse instruct the patient as a priority to stop taking metronidazole and notify the provider?
A. Metallic taste
B. Nausea
C. Ataxia
D. Dark-colored urine
C
Other adverse effects that are not so urgent are dark-colored urine and GI discomfort
One of your patients just started chemo to treat their new diagnosis of cancer. What are some education points to make while teaching them about the adverse effects of treatment? (select all)
A. Increase your intake of high calorie foods and snacks
B. Make sure to have good oral hygiene and use a soft-bristled tooth brush
C. Skip meals if you start to feel sick
D. Increase your fluid intake
E. Report a sore mouth, throat, or fevers
A, B, D, E
Chemo can cause decreased appetite, N/V, bone marrow suppression, and many are kidney toxic. This is why good oral hygiene with a soft tooth brush, reporting signs of infection, increasing fluid intake, and intaking high calorie foods is important.
What are some education points to make when a patient is taking ferrous sulfate to treat their iron deficiency anemia? (select all)
A. Rinse your mouth out after ingesting the liquid
B. Stools may become dark/green
C. Take it with antacids to increase absorption
D. Take it with citrus fruit or foods containing vitamin C
E. Increase your fiber and fluid intake because this can cause constipation
A, B, D, E
All of these are important teaching points to tell the patient.
One of your patients is receiving prednisone to treat a rheumatoid arthritis flair up. What lab value should be monitored more closely while giving this medication?
RBC
Cre
BUN
Blood glucose
4.
Prednisone is a corticosteroid and has the added adverse effect of raising BG and causing hyperglycemia.
One of your patients was prescribed Doxycycline to treat a MRSA infection. What education should be provided for them? (select all)
This has the chance to stain your teeth
Take this medication with food
Wear sunscreen if you plan to go outside for any length of time
You can drink alcohol if you want while taking this medication
Don’t take this medication with antacids or supplements containing magnesium
1, 3, 5
Tetracyclines have the chance to cause photosensitivity and to stain teeth. They should also be taken on an empty stomach to maximize absorption. Antacids should be avoided because they interfere with absorption.
This drug is an antifungal used to treat systemic fungal infections and has adverse effects of nephrotoxicity, bone marrow suppression, infusion reactions, electrolyte imbalances, and thrombophlebitis.
Amphotericin B
Monitor I/Os and kidney function, for signs of bleeding/bruising, electrolyte labs, pain/inflammation at the injection site, and for fever, chills, rashes, etc. during infusion.
This drug is used to help treat estrogen-dependent cancers like certain forms of breast cancer.
Tomoxifen
This drug blocks receptors for estrogen and so can help slow or stop the growth of estrogen-dependent cancers.
One of your patients has iron deficiency anemia. Along with their ferrous sulfate to treat it, what foods should you educate them to increase their intake of? (select all)
A. Red meat/meat sources
B. Dairy products
C. Fortified breakfast cereal
D. Fresh fruit
A, C
Other sources of iron include things like spinach, beans, tofu, and seafood
One of your patients is taking methylprednisolone to treat their asthma long-term. What education points should you make about taking this medication? (select all that apply)
A. You will need to taper the dose over a few days to come off this medication
B. You may experience some weight loss while taking this medication
C. Take this medication with food to avoid stomach upset
D. Avoid those who are sick and any live vaccines while taking this medication
A, C, D
Methylprednisolone is a corticosteroid and can cause GI upset/bleeding, immunosuppression, and patients must taper their doses when they come off of it to avoid adrenal insufficiency.
This drug is strictly used to treat UTIs and is a UT antiseptic. Some adverse effects of it are GI upset, blood dyscrasias, peripheral neuropathy, headache, drowsiness, and dizziness.
Nitrofurantoin
Some things to consider when giving this are to monitor CBCs, any tingling/numbness in the extremities, and to administer it with food.
A nurse is administering IV amphotericin B to a patient who has a systemic fungal infection. The nurse should monitor which of the following laboratory values? (Select all that apply.)
A. Serum albumin
B. Serum amylase
C. Serum potassium
D. Hematocrit
E. Serum creatinine
C, D, E
Hypokalemia is a serious adverse effect of amphotericin B. The nurse should monitor serum potassium values for hypokalemia.
Amphotericin B can cause bone marrow suppression. The nurse should monitor CBC and platelet count periodically.
Amphotericin B can cause nephrotoxicity. The nurse should monitor kidney function (with serum creatinine, BUN, and creatinine clearance).
You are giving one of your patients an alkylating agent (a nitrogen mustard) to treat their lung cancer. What things should you monitor for while giving this?
A. N/V
B. Hair loss
C. Bruising/bleeding
D. A fever
E. Increased urinary output
A, B, C, D
Adverse effects of alkylating agents include: Bone marrow suppression, GI discomfort, alopecia, acute hemorrhagic cystitis, pulmonary fibrosis, liver and kidney toxicity, hearing loss.
One of your patients has a lack of intrinsic factor in her gut. She has ended up with pernicious anemia because of this. What supplement should she receive and in what route?
Vitamin B12 in an IM injection or a nasal spray.
Intrinsic factor facilitates the absorption of B12 and so she will need IM injections every few months or daily nasal sprays for the rest of her life.
Why is it important that patients on corticosteroids, like hydrocortisone, are slowly weaned off of it by tapering doses over a few days to weeks?
Abrupt discontinuation of steroid therapy can cause adrenal insufficiency and Addison's disease.