Abrams' Clinical Drug Therapy
Rationales for Nursing Practice
13th Edition
• Author(s)Geralyn Frandsen;
Sandra Pennington
TEST BANK
,Question 1
A patient receiving intravenous vancomycin reports feeling a
sudden onset of itching and flushing on the face and neck. The
nurse observes a diffuse erythematous rash on the patient's
upper torso. The patient's vital signs remain stable with no
respiratory distress. What is the nurse's priority action?
A. Stop the infusion immediately and prepare to administer
diphenhydramine.
B. Slow the infusion rate and continue to monitor the patient's
vital signs.
C. Administer a bolus of normal saline to dilute the medication.
D. Notify the healthcare provider and obtain an order for a
serum vancomycin trough level.
Correct Answer: B
Rationale: The patient is describing signs of "red man
syndrome," a histamine-release reaction commonly associated
with rapid infusion of vancomycin. This reaction is not a true
allergic response and is typically managed by slowing the
infusion rate. Stopping the infusion is not indicated unless the
patient exhibits severe hypotension or respiratory compromise.
Administering a fluid bolus does not directly address the
mechanism of the reaction. While monitoring and notifying the
provider may be necessary later, the immediate priority is to
,slow the infusion as this is the standard intervention for this
non-life-threatening reaction.
Question 2
A nurse is preparing to administer a loading dose of phenytoin
to a patient with status epilepticus. Which of the following
assessment findings would most warrant a change in the
medication route or administration strategy?
A. A serum albumin level of 3.2 g/dL
B. A heart rate of 54 beats per minute
C. An intravenous site that is patent in the antecubital fossa
D. A history of type 2 diabetes mellitus controlled with
metformin
Correct Answer: C
Rationale: Phenytoin is highly alkaline and can cause severe
local tissue injury, including purple glove syndrome, if
extravasation occurs. An antecubital vein is a large vessel but is
located near a major artery and joint, increasing the risk of
severe complications if extravasation happens. The preferred
site for IV phenytoin is a large peripheral vein in the forearm or
hand, using a free-flowing saline lock. A low albumin (A) would
increase free drug levels but does not contraindicate the IV
route. Bradycardia is a side effect but not a route-changing
contraindication. Diabetes is not directly relevant to the
administration route.
, Question 3
A patient prescribed warfarin for atrial fibrillation has an
international normalized ratio (INR) of 1.8. The patient is
scheduled to start a new medication for osteoarthritis. Which of
the following over-the-counter medications should the nurse
advise the patient to avoid due to a significant drug interaction?
A. Acetaminophen
B. Ibuprofen
C. Glucosamine
D. Magnesium hydroxide
Correct Answer: B
Rationale: Ibuprofen is a nonsteroidal anti-inflammatory drug
(NSAID) that can inhibit platelet aggregation and increase the
risk of gastrointestinal bleeding when taken concurrently with
warfarin. It can also displace warfarin from protein-binding
sites, further elevating the risk of bleeding. Acetaminophen is
the preferred analgesic for patients on warfarin, though high
doses should be monitored. Glucosamine has a potential mild
interaction but is not as significant as NSAIDs. Magnesium
hydroxide can alter warfarin absorption but is not as acutely
dangerous in terms of bleeding risk.
Question 4
A patient with heart failure is receiving digoxin and furosemide.
The patient reports seeing a yellowish-green halo around lights
and has a heart rate of 48 beats per minute. Which laboratory
Rationales for Nursing Practice
13th Edition
• Author(s)Geralyn Frandsen;
Sandra Pennington
TEST BANK
,Question 1
A patient receiving intravenous vancomycin reports feeling a
sudden onset of itching and flushing on the face and neck. The
nurse observes a diffuse erythematous rash on the patient's
upper torso. The patient's vital signs remain stable with no
respiratory distress. What is the nurse's priority action?
A. Stop the infusion immediately and prepare to administer
diphenhydramine.
B. Slow the infusion rate and continue to monitor the patient's
vital signs.
C. Administer a bolus of normal saline to dilute the medication.
D. Notify the healthcare provider and obtain an order for a
serum vancomycin trough level.
Correct Answer: B
Rationale: The patient is describing signs of "red man
syndrome," a histamine-release reaction commonly associated
with rapid infusion of vancomycin. This reaction is not a true
allergic response and is typically managed by slowing the
infusion rate. Stopping the infusion is not indicated unless the
patient exhibits severe hypotension or respiratory compromise.
Administering a fluid bolus does not directly address the
mechanism of the reaction. While monitoring and notifying the
provider may be necessary later, the immediate priority is to
,slow the infusion as this is the standard intervention for this
non-life-threatening reaction.
Question 2
A nurse is preparing to administer a loading dose of phenytoin
to a patient with status epilepticus. Which of the following
assessment findings would most warrant a change in the
medication route or administration strategy?
A. A serum albumin level of 3.2 g/dL
B. A heart rate of 54 beats per minute
C. An intravenous site that is patent in the antecubital fossa
D. A history of type 2 diabetes mellitus controlled with
metformin
Correct Answer: C
Rationale: Phenytoin is highly alkaline and can cause severe
local tissue injury, including purple glove syndrome, if
extravasation occurs. An antecubital vein is a large vessel but is
located near a major artery and joint, increasing the risk of
severe complications if extravasation happens. The preferred
site for IV phenytoin is a large peripheral vein in the forearm or
hand, using a free-flowing saline lock. A low albumin (A) would
increase free drug levels but does not contraindicate the IV
route. Bradycardia is a side effect but not a route-changing
contraindication. Diabetes is not directly relevant to the
administration route.
, Question 3
A patient prescribed warfarin for atrial fibrillation has an
international normalized ratio (INR) of 1.8. The patient is
scheduled to start a new medication for osteoarthritis. Which of
the following over-the-counter medications should the nurse
advise the patient to avoid due to a significant drug interaction?
A. Acetaminophen
B. Ibuprofen
C. Glucosamine
D. Magnesium hydroxide
Correct Answer: B
Rationale: Ibuprofen is a nonsteroidal anti-inflammatory drug
(NSAID) that can inhibit platelet aggregation and increase the
risk of gastrointestinal bleeding when taken concurrently with
warfarin. It can also displace warfarin from protein-binding
sites, further elevating the risk of bleeding. Acetaminophen is
the preferred analgesic for patients on warfarin, though high
doses should be monitored. Glucosamine has a potential mild
interaction but is not as significant as NSAIDs. Magnesium
hydroxide can alter warfarin absorption but is not as acutely
dangerous in terms of bleeding risk.
Question 4
A patient with heart failure is receiving digoxin and furosemide.
The patient reports seeing a yellowish-green halo around lights
and has a heart rate of 48 beats per minute. Which laboratory
