A patient has been admitted with a fever of 102.8 F (39.3 C), with an unknown origin.

The patient’s urine is cloudy, foul-smelling, and dark amber.

Orders have been given to obtain urine and blood cultures immediately and to administer an antibiotic intravenously.

In what order should the nurse complete these orders?

Administer the antibiotic dose, then obtain blood and urine cultures.

Obtain urine culture, administer the antibiotic dose, then obtain blood culture.

Obtain blood culture, administer the antibiotic dose, then obtain urine culture.

Obtain blood and urine cultures, then administer the antibiotic dose.

Answer and Explanation

The Correct Answer is D

Choice A rationale:

Administering the antibiotic dose before obtaining the cultures could potentially affect the results of the cultures. Antibiotics are designed to kill or inhibit the growth of bacteria, so administering them before obtaining the cultures could lead to false negatives. This could lead to incorrect or delayed diagnosis and treatment.

Choice B rationale:

While obtaining the urine culture before administering the antibiotic dose is a good step, it should not be done before obtaining the blood culture. Blood cultures are usually obtained before urine cultures because they can help identify bacteria or fungi in the blood. This can be crucial in diagnosing conditions like sepsis. Furthermore, administering the antibiotic dose before obtaining the blood culture could affect the results of the culture.

Choice C rationale:

Obtaining the blood culture before administering the antibiotic dose is a good step, but the urine culture should also be obtained before the antibiotic dose is administered. Administering the antibiotic dose before obtaining all necessary cultures could affect the results of the cultures and lead to incorrect or delayed diagnosis and treatment.

Choice D rationale:

This is the correct sequence of actions. The nurse should first obtain both blood and urine cultures before administering the antibiotic dose. This is because the antibiotic could potentially kill or inhibit the growth of bacteria, which could affect the results of the cultures. By obtaining the cultures first, the healthcare team can ensure they are getting accurate results that have not been influenced by the antibiotics. This can lead to a more accurate diagnosis and more effective treatment plan.

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Correct Answer is D

Explanation

Choice A rationale:

Liothyronine (Cytomel) is a type of thyroid hormone used to treat an underactive thyroid (hypothyroidism). It replaces or provides more thyroid hormone, which is normally produced by the thyroid gland. However, it is not typically used to treat hyperthyroidism.

Choice B rationale:

Liotrix (Thyrolar) is a combination of two thyroid hormones, levothyroxine (T4) and liothyronine (T3), used to treat hypothyroidism, and to prevent and treat goiter. Similar to Liothyronine, it is not typically used to treat hyperthyroidism. Choice C rationale:

Levothyroxine (Synthroid) is used to treat an underactive thyroid (hypothyroidism). It replaces or provides more thyroid hormone, which is normally produced by the thyroid gland. Low thyroid hormone levels can occur naturally or when the thyroid gland is injured by radiation/medications or removed by surgery. Having enough thyroid hormone helps maintain normal mental and physical activity. In children, having enough thyroid hormone helps them grow and learn normally.

Choice D rationale:

Propylthiouracil (Propacil) is an antithyroid agent used in the treatment of hyperthyroidism. It works by decreasing the amount of thyroid hormone produced by the thyroid gland. This helps to prevent the excessive heat, rapid heart rate, and nervousness caused by too much thyroid hormone in the body.

A. Proton pump inhibitors B. Calcium channel blockers C. Loop diuretics D. Phenytoin

Correct Answer is C

Explanation

Choice A rationale:

Proton pump inhibitors (PPIs) are used extensively for the treatment of gastric acid-related disorders, often over the long term, which raises the potential for clinically significant drug interactions in patients receiving concomitant medications.

However, there is no specific mention of a significant interaction between PPIs and aminoglycosides.

Choice B rationale:

Aminoglycoside antibiotics and calcium channel blockers can interact at the neuromuscular junctions. This interaction is of clinical significance because when these agents are given concurrently during the perioperative period they may lead to respiratory depression or prolonged apnea. However, this is not directly related to the therapeutic effect of aminoglycosides, but rather a side effect of their combined use.

Choice C rationale:

The loop-diuretics (ethacrynic acid, furosemide, bumetamide) and aminoglycoside antibiotics (kanamycin, gentamicin, tobramycin, amikacin, etc.) are important drugs frequently used to treat seriously ill patients. Not uncommonly both types of drugs are given to the same patient exposing that patient to the risk of a hearing loss (ototoxicity)5. In addition, the risk of ototoxicity could be enhanced by the concomitant use of loop diuretics and aminoglycoside antibiotics.

Choice D rationale:

Phenytoin is a medication used to treat seizures. It has a complex pharmacokinetic profile and can interact with many other drugs. However, there is no specific mention of a significant interaction between phenytoin and aminoglycosides.

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Naxlex Comprehensive Predictor Exams

Which of the following medications is typically prescribed for the treatment of hyperthyroidism?

Correct Answer is D

Explanation

The nurse is reviewing the medication orders for a patient who will be receiving aminoglycoside therapy. Which other medication or medication class, if ordered, would be a potential interaction concern?

Correct Answer is C

Explanation

A nurse is reinforcing teaching about insulin injections with a client who is newly diagnosed with type I diabetes mellitus. Which of the following information should the nurse include about site selection?

A nurse is caring for a client who has recurrent kidney stones and a history of diabetes mellitus. The client is scheduled for an intravenous Pyelogram (IVP). The nurse should collect additional data about which of the following statements made by the client?

The physician orders an injection of dexamethasone (Decadron) 6mg IM for a patient. The available stock is dexamethasone 4mg/1ml in a 5ml multidose vial. How many mLs of this medication will the nurse prepare?

A 6-year-old child who has chickenpox also has a fever of 102.9 F (39.4 C). The child’s mother asks the nurse if she should use aspirin to reduce the fever. What is the best response by the nurse?

A nurse is reinforcing teaching with a client who has type 2 diabetes mellitus. The nurse determines that teaching has been effective when the client identifies which of the following manifestations of hypoglycemia? (Select all that apply.)

When a patient is undergoing aminoglycoside therapy, which indicators should the nurse monitor for potential toxicity?

When teaching a patient a skill such as self-injection of insulin, what is the best way to set up the teaching/learning session?

The nurse checks the patient’s laboratory work prior to administering a dose of vancomycin and finds that the trough vancomycin level is 24 mcg/mL. What will the nurse do next?