Mrs. Oza, age 69, has hypertension and has one functioning kidney. She loves chocolates and enjoys an alcoholic beverage twice a week. Her hobby is gardening and she goes for long walks despite having arthritis. Which one of the following pieces of information is likely to have the greatest significance if she is prescribed vancomycin?

She only has one functioning kidney

She remains outdoors for long periods of time

She has hypertension

She enjoys an alcoholic beverage twice a week

Answer and Explanation

The Correct Answer is A

A. She only has one functioning kidney:

This choice is the most significant consideration when prescribing vancomycin to Mrs. Oza. Vancomycin is primarily eliminated from the body through the kidneys. Individuals with reduced kidney function, such as Mrs. Oza with only one functioning kidney, have a higher risk of vancomycin-associated nephrotoxicity (kidney damage). Therefore, her renal status is crucial information for determining the appropriate dosage of vancomycin and monitoring for any signs of kidney impairment during treatment.

B. She remains outdoors for long periods of time:

While spending time outdoors for long periods may have implications for Mrs. Oza's overall health, it is not directly relevant to the prescription of vancomycin. This information may be important for considering sun exposure, hydration, and other factors related to her arthritis and general well-being, but it does not specifically impact the pharmacokinetics or pharmacodynamics of vancomycin.

C. She has hypertension:

Mrs. Oza's hypertension is a relevant medical condition to consider in her overall health management. However, hypertension alone does not directly affect the prescription of vancomycin. Hypertension may influence the choice of antihypertensive medications or other aspects of her medical care, but it does not have a direct impact on the renal clearance or potential nephrotoxicity of vancomycin.

D. She enjoys an alcoholic beverage twice a week:

While alcohol consumption can interact with certain medications and impact overall health, it is not the most significant consideration when prescribing vancomycin to Mrs. Oza. Moderate alcohol consumption is unlikely to directly affect the pharmacokinetics or pharmacodynamics of vancomycin. However, excessive alcohol intake may contribute to liver dysfunction, which could indirectly influence drug metabolism. Nonetheless, in Mrs. Oza's case, her reduced renal function is a more critical factor to consider when prescribing vancomycin.

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Correct Answer is C

Explanation

A. Take small amounts of food:

This advice suggests eating small, frequent meals when experiencing diarrhea. It aims to reduce the workload on the digestive system and may help alleviate symptoms such as nausea and discomfort. However, while eating small amounts of food can be beneficial, increasing fluid intake is the priority to prevent dehydration associated with diarrhea.

B. Consume large quantities of milk and smoked meat:

Consuming large quantities of milk and smoked meat is not recommended when experiencing diarrhea. Dairy products, including milk, can worsen diarrhea in some individuals, especially those who are lactose intolerant. Similarly, smoked meat may be high in fat and difficult to digest, potentially aggravating gastrointestinal symptoms. Therefore, this advice is not appropriate for managing diarrhea.

C. Increase fluid intake:

Increasing fluid intake is essential when experiencing diarrhea to prevent dehydration. Diarrhea leads to the loss of fluids and electrolytes from the body, which can quickly lead to dehydration if not replenished. Encouraging the patient to drink water, clear broths, oral rehydration solutions, and other electrolyte-rich fluids helps replace lost fluids and maintain hydration levels, making this the correct choice.

D. Take a mild medication to treat the diarrhea along with the ciprofloxacin:

While it may be tempting to take a medication to alleviate diarrhea symptoms, it's crucial to consult a healthcare provider before taking any additional medications, especially when already taking antibiotics like ciprofloxacin. Some anti-diarrheal medications can interfere with the effectiveness of antibiotics or worsen gastrointestinal symptoms. Therefore, it's important to seek medical advice before taking any additional medications.

A. Ototoxicity B. Nausea C. Constipation D. Increased urinary output

Correct Answer is A

Explanation

A. Ototoxicity:

Ototoxicity refers to damage to the auditory and vestibular nerves, leading to hearing loss and balance disturbances. Gentamicin, being an aminoglycoside antibiotic, is known for its potential to cause ototoxicity. Signs and symptoms of ototoxicity include changes in hearing, ringing in the ears (tinnitus), and imbalance. Ototoxicity is irreversible and can occur suddenly or gradually during gentamicin therapy. Therefore, any signs or symptoms of ototoxicity should be reported immediately to the physician for further evaluation and management.

B. Nausea:

Nausea is a common gastrointestinal side effect associated with gentamicin therapy. While it can be bothersome to the patient, nausea alone is not typically considered a severe adverse effect that requires immediate reporting to the physician. However, if nausea is severe or persistent and leads to dehydration or electrolyte imbalances, it should be addressed promptly.

C. Constipation:

Constipation is another potential gastrointestinal side effect of gentamicin therapy. Like nausea, constipation alone is not typically considered a severe adverse effect that requires immediate reporting to the physician. However, if constipation is severe or persistent and leads to discomfort or bowel obstruction, it should be addressed promptly.

D. Increased urinary output:

Increased urinary output may indicate improved renal function, which can be a desired effect during gentamicin therapy. Gentamicin is primarily excreted by the kidneys, and increased urinary output may help in the elimination of the drug from the body. Therefore, increased urinary output alone is not typically considered an adverse effect that requires immediate reporting to the physician. However, if there are signs of dehydration or electrolyte imbalances associated with increased urinary output, they should be addressed promptly.

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What advice should the nurse offer a patient who takes ciprofloxacin and has diarrhea?

Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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