Abrams' Clinical Drug Therapy
Rationales for Nursing Practice
13th Edition
• Author(s)Geralyn Frandsen;
Sandra Pennington
TEST BANK
,Question 1
A client receiving a loop diuretic is prescribed a once-daily
aminoglycoside antibiotic for a healthcare-associated infection.
The nurse should plan to monitor for which potential synergistic
adverse effect?
A. Hepatotoxicity
B. Ototoxicity
C. Hyperkalemia
D. Photosensitivity
Correct Answer: B
Rationale: Loop diuretics and aminoglycosides both have the
potential for ototoxicity, and their concurrent use can produce a
synergistic effect, increasing the risk of irreversible hearing loss.
Hepatotoxicity is not a primary synergistic concern with this
combination. Loop diuretics typically cause hypokalemia, not
hyperkalemia. Photosensitivity is not a characteristic adverse
effect of this drug combination.
Question 2
A nurse is caring for a client who has been taking a
bisphosphonate for the treatment of osteoporosis for the past
18 months. The client reports new onset of gnawing epigastric
pain and difficulty swallowing. Which nursing action is the
priority?
A. Administer a proton pump inhibitor as prescribed.
,B. Instruct the client to take the medication with a full glass of
orange juice.
C. Advise the client to remain upright for at least 30 minutes
after taking the dose.
D. Assess the client's adherence to administration instructions
and notify the healthcare provider.
Correct Answer: D
Rationale: Esophagitis and esophageal ulcers are significant
adverse effects of bisphosphonates, often caused by improper
administration. The priority is to assess the client's
administration technique (e.g., taking with a full glass of water,
remaining upright for 30 minutes) and notify the provider about
the new symptoms for further evaluation. While a proton pump
inhibitor might be ordered, this is a provider decision after
assessment. Orange juice is not recommended due to
decreased absorption. Remaining upright is correct
administration, but the client is already symptomatic, so a more
comprehensive assessment and provider notification are
needed.
Question 3
A client on a medical-surgical unit has been receiving
intravenous vancomycin for a methicillin-resistant
Staphylococcus aureus infection. The nurse notes a generalized
flushing of the client's face, neck, and upper torso, along with
, hypotension. Which action should the nurse take first?
A. Stop the vancomycin infusion immediately.
B. Slow the rate of the vancomycin infusion.
C. Administer diphenhydramine as a stat dose.
D. Obtain a serum vancomycin trough level.
Correct Answer: B
Rationale: The client is experiencing "Red Man Syndrome," a
histamine-release reaction typically related to a rapid
vancomycin infusion rate. The first intervention is to slow the
infusion rate to the recommended duration of at least 60
minutes. Stopping the infusion is not typically indicated unless
the reaction is severe; slowing the rate often resolves the
symptoms. Diphenhydramine can be used for symptom
management but is not the first action. A trough level is used
for therapeutic monitoring, not for acute symptom
management.
Question 4
A nurse is providing education to a client with a new
prescription for warfarin. The client reports taking an over-the-
counter multivitamin. Which ingredient in the multivitamin is of
greatest concern due to its potential to directly affect warfarin
therapy?
A. Calcium carbonate
B. Vitamin C
Rationales for Nursing Practice
13th Edition
• Author(s)Geralyn Frandsen;
Sandra Pennington
TEST BANK
,Question 1
A client receiving a loop diuretic is prescribed a once-daily
aminoglycoside antibiotic for a healthcare-associated infection.
The nurse should plan to monitor for which potential synergistic
adverse effect?
A. Hepatotoxicity
B. Ototoxicity
C. Hyperkalemia
D. Photosensitivity
Correct Answer: B
Rationale: Loop diuretics and aminoglycosides both have the
potential for ototoxicity, and their concurrent use can produce a
synergistic effect, increasing the risk of irreversible hearing loss.
Hepatotoxicity is not a primary synergistic concern with this
combination. Loop diuretics typically cause hypokalemia, not
hyperkalemia. Photosensitivity is not a characteristic adverse
effect of this drug combination.
Question 2
A nurse is caring for a client who has been taking a
bisphosphonate for the treatment of osteoporosis for the past
18 months. The client reports new onset of gnawing epigastric
pain and difficulty swallowing. Which nursing action is the
priority?
A. Administer a proton pump inhibitor as prescribed.
,B. Instruct the client to take the medication with a full glass of
orange juice.
C. Advise the client to remain upright for at least 30 minutes
after taking the dose.
D. Assess the client's adherence to administration instructions
and notify the healthcare provider.
Correct Answer: D
Rationale: Esophagitis and esophageal ulcers are significant
adverse effects of bisphosphonates, often caused by improper
administration. The priority is to assess the client's
administration technique (e.g., taking with a full glass of water,
remaining upright for 30 minutes) and notify the provider about
the new symptoms for further evaluation. While a proton pump
inhibitor might be ordered, this is a provider decision after
assessment. Orange juice is not recommended due to
decreased absorption. Remaining upright is correct
administration, but the client is already symptomatic, so a more
comprehensive assessment and provider notification are
needed.
Question 3
A client on a medical-surgical unit has been receiving
intravenous vancomycin for a methicillin-resistant
Staphylococcus aureus infection. The nurse notes a generalized
flushing of the client's face, neck, and upper torso, along with
, hypotension. Which action should the nurse take first?
A. Stop the vancomycin infusion immediately.
B. Slow the rate of the vancomycin infusion.
C. Administer diphenhydramine as a stat dose.
D. Obtain a serum vancomycin trough level.
Correct Answer: B
Rationale: The client is experiencing "Red Man Syndrome," a
histamine-release reaction typically related to a rapid
vancomycin infusion rate. The first intervention is to slow the
infusion rate to the recommended duration of at least 60
minutes. Stopping the infusion is not typically indicated unless
the reaction is severe; slowing the rate often resolves the
symptoms. Diphenhydramine can be used for symptom
management but is not the first action. A trough level is used
for therapeutic monitoring, not for acute symptom
management.
Question 4
A nurse is providing education to a client with a new
prescription for warfarin. The client reports taking an over-the-
counter multivitamin. Which ingredient in the multivitamin is of
greatest concern due to its potential to directly affect warfarin
therapy?
A. Calcium carbonate
B. Vitamin C
