Abrams' Clinical Drug Therapy
Rationales for Nursing Practice
13th Edition
• Author(s)Geralyn Frandsen;
Sandra Pennington
TEST BANK
,Question 1 A nurse is preparing to administer the first dose of
an intravenous cephalosporin to a patient with a severe tract
infection. Which statement by the patient would prompt the
nurse to withhold the medication and contact the healthcare
provider? A. "I developed a mild skin rash when I took
amoxicillin a few years ago." B. "I had difficulty breathing and
my face swelled up after taking penicillin." C. "I experienced
severe nausea and diarrhea the last time I took an antibiotic."
D. "I completed a course of cephalexin last month without any
problems."
Correct Answer: B Rationale: Cephalosporins are structurally
similar to penicillins, leading to a risk of cross-sensitivity. While
a mild rash (delayed hypersensitivity) does not absolutely
contraindicate cephalosporin use, a history of an immediate,
life-threatening anaphylactic reaction (angioedema, respiratory
distress) to penicillin is a strong contraindication. Nausea and
diarrhea are common adverse gastrointestinal effects rather
than true allergic hypersensitivity.
Question 2 A patient is receiving high-dose intravenous
gentamicin therapy for a systemic pseudomonal infection.
Which laboratory value requires immediate nursing
intervention? A. Serum potassium 3.6 mEq/L B. Blood urea
,nitrogen (BUN) 15 mg/dL C. Serum creatinine 2.4 mg/dL D.
White blood cell count 11,000/mm³
Correct Answer: C Rationale: Aminoglycosides like gentamicin
are highly nephrotoxic. A serum creatinine level of 2.4 mg/dL is
significantly elevated above the normal range (typically 0.6–1.2
mg/dL) and indicates acute kidney injury. The nurse must hold
the dose and notify the provider to prevent irreversible renal
damage. The BUN and potassium levels are within normal
limits, and the slightly elevated WBC count is expected with an
active infection.
Question 3 The nurse is providing discharge teaching to a
patient who has been prescribed oral tetracycline for the
treatment of severe acne. Which instruction should the nurse
include in the teaching plan? A. "Take the medication with a
glass of milk to prevent stomach upset." B. "Apply high-SPF
sunscreen and wear protective clothing when outdoors." C.
"Expect your urine to turn a bright orange-red color while on
this drug." D. "Take the pill right before lying down to sleep at
night."
Correct Answer: B Rationale: Tetracyclines cause significant
photosensitivity, increasing the risk of severe sunburns; patients
must use sun protection. Tetracyclines should not be taken with
dairy products, antacids, or iron supplements because calcium
and other divalent/trivalent cations chelate the drug, severely
, reducing its absorption. They should be taken with a full glass of
water while upright to prevent esophageal ulceration. They do
not turn urine orange.
Question 4 A nurse is caring for a patient receiving vancomycin
via an intravenous infusion. The nurse notes that the patient's
neck, face, and upper chest have become flushed and bright
red, and the patient reports feeling warm. What is the nurse's
priority action? A. Stop the infusion immediately and prepare to
administer epinephrine. B. Discontinue the IV line and restart it
at a different anatomical site. C. Slow the rate of the
vancomycin infusion and monitor the patient's blood pressure.
D. Apply cool compresses to the flushed areas and document
the reaction.
Correct Answer: C Rationale: The patient is experiencing
vancomycin flushing syndrome (formerly known as "red man
syndrome"), which is a rate-dependent, histamine-mediated
reaction rather than a true type I IgE-mediated allergic
response. The priority action is to slow the infusion rate
(typically infusing over at least 60 minutes or more). Stopping
the infusion completely or administering epinephrine is
reserved for true anaphylaxis (e.g., wheezing, stridor,
hypotension).
Question 5 A patient diagnosed with active tuberculosis is
prescribed a multi-drug regimen that includes rifampin. What
Rationales for Nursing Practice
13th Edition
• Author(s)Geralyn Frandsen;
Sandra Pennington
TEST BANK
,Question 1 A nurse is preparing to administer the first dose of
an intravenous cephalosporin to a patient with a severe tract
infection. Which statement by the patient would prompt the
nurse to withhold the medication and contact the healthcare
provider? A. "I developed a mild skin rash when I took
amoxicillin a few years ago." B. "I had difficulty breathing and
my face swelled up after taking penicillin." C. "I experienced
severe nausea and diarrhea the last time I took an antibiotic."
D. "I completed a course of cephalexin last month without any
problems."
Correct Answer: B Rationale: Cephalosporins are structurally
similar to penicillins, leading to a risk of cross-sensitivity. While
a mild rash (delayed hypersensitivity) does not absolutely
contraindicate cephalosporin use, a history of an immediate,
life-threatening anaphylactic reaction (angioedema, respiratory
distress) to penicillin is a strong contraindication. Nausea and
diarrhea are common adverse gastrointestinal effects rather
than true allergic hypersensitivity.
Question 2 A patient is receiving high-dose intravenous
gentamicin therapy for a systemic pseudomonal infection.
Which laboratory value requires immediate nursing
intervention? A. Serum potassium 3.6 mEq/L B. Blood urea
,nitrogen (BUN) 15 mg/dL C. Serum creatinine 2.4 mg/dL D.
White blood cell count 11,000/mm³
Correct Answer: C Rationale: Aminoglycosides like gentamicin
are highly nephrotoxic. A serum creatinine level of 2.4 mg/dL is
significantly elevated above the normal range (typically 0.6–1.2
mg/dL) and indicates acute kidney injury. The nurse must hold
the dose and notify the provider to prevent irreversible renal
damage. The BUN and potassium levels are within normal
limits, and the slightly elevated WBC count is expected with an
active infection.
Question 3 The nurse is providing discharge teaching to a
patient who has been prescribed oral tetracycline for the
treatment of severe acne. Which instruction should the nurse
include in the teaching plan? A. "Take the medication with a
glass of milk to prevent stomach upset." B. "Apply high-SPF
sunscreen and wear protective clothing when outdoors." C.
"Expect your urine to turn a bright orange-red color while on
this drug." D. "Take the pill right before lying down to sleep at
night."
Correct Answer: B Rationale: Tetracyclines cause significant
photosensitivity, increasing the risk of severe sunburns; patients
must use sun protection. Tetracyclines should not be taken with
dairy products, antacids, or iron supplements because calcium
and other divalent/trivalent cations chelate the drug, severely
, reducing its absorption. They should be taken with a full glass of
water while upright to prevent esophageal ulceration. They do
not turn urine orange.
Question 4 A nurse is caring for a patient receiving vancomycin
via an intravenous infusion. The nurse notes that the patient's
neck, face, and upper chest have become flushed and bright
red, and the patient reports feeling warm. What is the nurse's
priority action? A. Stop the infusion immediately and prepare to
administer epinephrine. B. Discontinue the IV line and restart it
at a different anatomical site. C. Slow the rate of the
vancomycin infusion and monitor the patient's blood pressure.
D. Apply cool compresses to the flushed areas and document
the reaction.
Correct Answer: C Rationale: The patient is experiencing
vancomycin flushing syndrome (formerly known as "red man
syndrome"), which is a rate-dependent, histamine-mediated
reaction rather than a true type I IgE-mediated allergic
response. The priority action is to slow the infusion rate
(typically infusing over at least 60 minutes or more). Stopping
the infusion completely or administering epinephrine is
reserved for true anaphylaxis (e.g., wheezing, stridor,
hypotension).
Question 5 A patient diagnosed with active tuberculosis is
prescribed a multi-drug regimen that includes rifampin. What
