A nurse is preparing to administer vancomycin, a glycopeptide antibiotic, to a client with a severe infection caused by Clostridium difficile.
The nurse should select all that apply:

Monitor the client’s serum creatinine level

Monitor the client’s serum vancomycin level

Infuse the drug over at least 60 minutes

Observe the client

Answer and Explanation

Correct Answer : A,B,C

Here is why:

• Choice A: Monitor the client’s serum creatinine level.

This is correct because vancomycin can cause nephrotoxicity (damage to the kidneys) and serum creatinine is a marker of kidney function. A high serum creatinine level indicates impaired kidney function and may require dose adjustment or discontinuation of vancomycin.

• Choice B: Monitor the client’s serum vancomycin level.

This is correct because vancomycin has a narrow therapeutic range, meaning that there is a small difference between the effective dose and the toxic dose. Monitoring the serum vancomycin level can help to ensure that the drug is within the therapeutic range and avoid toxicity or suboptimal efficacy.

• Choice C: Infuse the drug over at least 60 minutes.

This is correct because vancomycin can cause a hypersensitivity reaction called “red man syndrome” or “red neck syndrome”, which is characterized by flushing, itching, rash, hypotension and tachycardia.

This reaction is not an allergy but a result of histamine release due to rapid infusion of vancomycin. Infusing the drug over at least 60 minutes can reduce the risk of this reaction.

• Choice D: Observe the client for signs of ototoxicity.

This is incorrect because vancomycin is not known to cause ototoxicity (damage to the ears) in humans. Ototoxicity has been reported in animal studies and in vitro studies, but not in clinical trials or case reports involving humans.

Therefore, there is no need to monitor for signs of ototoxicity such as hearing loss, tinnitus or vertigo.

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Correct Answer is ["A","B","C","E"]

Explanation

Cefazolin can cause serious or life-threatening allergic reactions in some patients, especially those with a history of penicillin allergy.The most common allergic reactions to cefazolin are immediate reactions, such as anaphylaxis, urticaria, bronchospasm, and angioedema.These reactions usually occur within one hour of the drug administration and may involve symptoms such as rash, itching, swelling, difficulty breathing, low blood pressure, and shock.Immediate reactions are mediated by immunoglobulin E (IgE) antibodies that bind to the drug and trigger the release of inflammatory mediators from mast cells and basophils.

Choice D is wrong because Stevens-Johnson syndrome is not a typical allergic reaction to cefazolin.

Stevens-Johnson syndrome is a rare and severe skin reaction that can be caused by various drugs, infections, or autoimmune diseases.

It involves blistering and peeling of the skin and mucous membranes, fever, malaise, and eye inflammation.

Stevens-Johnson syndrome is not mediated by IgE antibodies, but by other immune mechanisms that damage the skin cells.

Cefazolin is not known to cause Stevens-Johnson syndrome, although other cephalosporins have been reported to do so in rare cases.

A. Antibiotic guidelines in critical care reduce the hospital length of stay. B. Inappropriate antibiotic use leads to the emergence of resistance. C. Antibiotic dosing has little effect on antimicrobial resistance. D. An antibiotic stewardship programme leads to an increase in antimicrobial resistance.

Correct Answer is B

Explanation

Inappropriate antibiotic use leads to the emergence of resistance.This is a well-established fact that is supported by the CDC and other organizations.Resistance can occur when antibiotics are used unnecessarily, excessively, or incorrectly, and can lead to infections that are harder to treat and more costly.

Choice A is wrong because antibiotic guidelines in critical care do not necessarily reduce the hospital length of stay.Although some studies have suggested that adherence to pneumonia guidelines may improve outcomes in severe pneumonia, other studies have found no significant effect of antibiotic stewardship on hospital length of stay or mortality in critically ill patients.

Therefore, this statement is not universally true.

Choice C is wrong because antibiotic dosing has a significant effect on antimicrobial resistance.Optimal dosing of antibiotics can help eradicate infections, prevent relapse, and minimize the selection of resistant bacteria.Conversely, suboptimal dosing can lead to treatment failure, prolonged infection, and increased resistance.

Therefore, antibiotic dosing should be carefully adjusted according to the pharmacokinetic and pharmacodynamic properties of the drug and the patient.

Choice D is wrong because an antibiotic stewardship programme leads to a decrease in antimicrobial resistance, not an increase.An antibiotic stewardship programme is a coordinated effort to improve and measure the appropriate use of antibiotics by promoting the selection of the optimal drug regimen, dose, duration, and route of administration.Such programmes have been shown to reduce antibiotic consumption, resistance rates, adverse events, and costs in various settings.

Therefore, this statement is false.

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A nurse is preparing to administer vancomycin, a glycopeptide antibiotic, to a client with a severe infection caused by Clostridium difficile. The nurse should select all that apply:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient is receiving cefazolin, a first-generation cephalosporin, for a surgical prophylaxis. The nurse should assess the patient for which of the following possible allergic reactions? (Select all that apply.)

Correct Answer is ["A","B","C","E"]

Explanation

Which statement is true regarding antimicrobial stewardship?

Correct Answer is B

Explanation

The nurse is caring for a patient receiving vancomycin (Vancocin) for treatment of an infection caused by methicillin-resistant Staphylococcus aureus (MRSA). Which assessment finding would indicate a potentially serious adverse reaction to this drug?

A nurse is caring for a client who has trichomoniasis and is prescribed tinidazole. Which of the following instructions should the nurse give to the client?

A nurse is preparing to administer flucytosine to a client who has a systemic fungal infection. Which of the following assessments should the nurse perform before giving this medication? (Select all that apply.).

A nurse is educating a client who has a respiratory infection and a new prescription for azithromycin (Zithromax). Which of the following instructions should the nurse include? (Select all that apply).

A nurse is preparing to administer ivermectin to a client who has onchocerciasis (river blindness). Which of the following adverse effects should the nurse monitor for in this client?

The nurse is providing discharge teaching for a patient who will be taking oral linezolid (Zyvox) to treat a complicated skin infection caused by vancomycin-resistant enterococci (VRE). Which statement by the patient indicates a need for further teaching?

(Select all that apply) A microbe acquires antibiotic resistance by which means?

A nurse is caring for a client who has a severe infection and is receiving vancomycin (Vancocin). The nurse should monitor the client for which of the following manifestations of ototoxicity?

A nurse is preparing to administer vancomycin, a glycopeptide antibiotic, to a client with a severe infection caused by Clostridium difficile.
The nurse should select all that apply: