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 an initial dose of
intravenous vancomycin to a client with a severe methicillin-
resistant Staphylococcus aureus (MRSA) infection. Which action
by the nurse is most critical to prevent a severe infusion-related
adverse reaction? A. Administer the medication via a rapid
intravenous push over 2 to 3 minutes. B. Infuse the medication
over a minimum of 60 minutes using an infusion pump. C. Apply
a warm compress to the intravenous site during the entire
infusion. D. Protect the reconstituted vancomycin solution from
all direct light sources.
Correct Answer: B Rationale: Rapid infusion of intravenous
vancomycin can cause vancomycin flushing syndrome (formerly
referred to as "red man syndrome"), which is characterized by
profound hypotension, flushing, and a maculopapular rash
across the face, neck, and upper torso. To minimize this
histamine-release reaction, vancomycin must be infused slowly
over at least 60 minutes (or at a rate of no more than 10
mg/min for higher doses). It should never be given via rapid
intravenous push. While monitoring the IV site for patency is
vital due to the risk of extravasation and thrombophlebitis,
warm compresses are not routinely applied during the infusion
to prevent systemic reactions, and vancomycin does not require
strict protection from light during administration.
,Question 2 The nurse is caring for a client who is receiving long-
term gentamycin therapy for infective endocarditis. Which
laboratory result should the nurse prioritize for monitoring to
detect early signs of a major medication toxicity? A. Serum
amylase and lipase B. Alanine aminotransferase (ALT) C. Serum
creatinine and blood urea nitrogen (BUN) D. Prothrombin time
(PT) and International Normalized Ratio (INR)
Correct Answer: C Rationale: Aminoglycosides, such as
gentamicin, are highly nephrotoxic and ototoxic. Nephrotoxicity
occurs because the drug accumulates in the proximal renal
tubules, potentially leading to acute tubular necrosis. The nurse
must closely monitor renal function indicators, including serum
creatinine and BUN, alongside daily fluid intake and output.
Aminoglycosides are not characteristically associated with
hepatic toxicity, pancreatic injury, or direct alterations to the
coagulation cascade, making the assessment of liver enzymes,
amylase, or PT/INR less relevant for tracking this specific drug's
primary toxicities.
Question 3 A client diagnosed with pulmonary tuberculosis is
prescribed a multi-drug regimen that includes rifampin. What
information should the nurse emphasize when providing
education to this client? A. Avoid eating foods high in tyramine,
such as aged cheeses and red wine. B. Expect urine, sweat, and
tears to turn a harmless red-orange color. C. Take an extra dose
, of the medication if a productive cough returns. D. Restrict daily
fluid intake to less than one liter to maximize drug
concentration.
Correct Answer: B Rationale: Rifampin commonly causes a
benign, temporary discoloration of bodily fluids—such as urine,
saliva, sweat, tears, and feces—turning them a red-orange
color. Clients must be warned about this beforehand to prevent
unnecessary anxiety, and they should be advised not to wear
soft contact lenses during treatment as they may become
permanently stained. Tyramine restrictions apply more directly
to linezolid or monoamine oxidase inhibitors (MAOIs), and
isoniazid is the antitubercular agent that interacts with certain
foods, but not rifampin. Clients should never alter their own
doses, and fluid restriction is contraindicated unless another
medical condition demands it, as adequate hydration helps
clear metabolic waste.
Question 4 A client is receiving an oral course of ciprofloxacin
for a complicated urinary tract infection. Which instruction
should the nurse include in the discharge teaching? A. Report
any sudden pain, swelling, or inflammation in the back of the
ankle immediately. B. Take the medication concurrently with an
antacid containing aluminum hydroxide to reduce gastric upset.
C. Double the next dose if a scheduled dose is missed by more
Rationales for Nursing Practice
13th Edition
• Author(s)Geralyn Frandsen;
Sandra Pennington
TEST BANK
,Question 1 A nurse is preparing to administer an initial dose of
intravenous vancomycin to a client with a severe methicillin-
resistant Staphylococcus aureus (MRSA) infection. Which action
by the nurse is most critical to prevent a severe infusion-related
adverse reaction? A. Administer the medication via a rapid
intravenous push over 2 to 3 minutes. B. Infuse the medication
over a minimum of 60 minutes using an infusion pump. C. Apply
a warm compress to the intravenous site during the entire
infusion. D. Protect the reconstituted vancomycin solution from
all direct light sources.
Correct Answer: B Rationale: Rapid infusion of intravenous
vancomycin can cause vancomycin flushing syndrome (formerly
referred to as "red man syndrome"), which is characterized by
profound hypotension, flushing, and a maculopapular rash
across the face, neck, and upper torso. To minimize this
histamine-release reaction, vancomycin must be infused slowly
over at least 60 minutes (or at a rate of no more than 10
mg/min for higher doses). It should never be given via rapid
intravenous push. While monitoring the IV site for patency is
vital due to the risk of extravasation and thrombophlebitis,
warm compresses are not routinely applied during the infusion
to prevent systemic reactions, and vancomycin does not require
strict protection from light during administration.
,Question 2 The nurse is caring for a client who is receiving long-
term gentamycin therapy for infective endocarditis. Which
laboratory result should the nurse prioritize for monitoring to
detect early signs of a major medication toxicity? A. Serum
amylase and lipase B. Alanine aminotransferase (ALT) C. Serum
creatinine and blood urea nitrogen (BUN) D. Prothrombin time
(PT) and International Normalized Ratio (INR)
Correct Answer: C Rationale: Aminoglycosides, such as
gentamicin, are highly nephrotoxic and ototoxic. Nephrotoxicity
occurs because the drug accumulates in the proximal renal
tubules, potentially leading to acute tubular necrosis. The nurse
must closely monitor renal function indicators, including serum
creatinine and BUN, alongside daily fluid intake and output.
Aminoglycosides are not characteristically associated with
hepatic toxicity, pancreatic injury, or direct alterations to the
coagulation cascade, making the assessment of liver enzymes,
amylase, or PT/INR less relevant for tracking this specific drug's
primary toxicities.
Question 3 A client diagnosed with pulmonary tuberculosis is
prescribed a multi-drug regimen that includes rifampin. What
information should the nurse emphasize when providing
education to this client? A. Avoid eating foods high in tyramine,
such as aged cheeses and red wine. B. Expect urine, sweat, and
tears to turn a harmless red-orange color. C. Take an extra dose
, of the medication if a productive cough returns. D. Restrict daily
fluid intake to less than one liter to maximize drug
concentration.
Correct Answer: B Rationale: Rifampin commonly causes a
benign, temporary discoloration of bodily fluids—such as urine,
saliva, sweat, tears, and feces—turning them a red-orange
color. Clients must be warned about this beforehand to prevent
unnecessary anxiety, and they should be advised not to wear
soft contact lenses during treatment as they may become
permanently stained. Tyramine restrictions apply more directly
to linezolid or monoamine oxidase inhibitors (MAOIs), and
isoniazid is the antitubercular agent that interacts with certain
foods, but not rifampin. Clients should never alter their own
doses, and fluid restriction is contraindicated unless another
medical condition demands it, as adequate hydration helps
clear metabolic waste.
Question 4 A client is receiving an oral course of ciprofloxacin
for a complicated urinary tract infection. Which instruction
should the nurse include in the discharge teaching? A. Report
any sudden pain, swelling, or inflammation in the back of the
ankle immediately. B. Take the medication concurrently with an
antacid containing aluminum hydroxide to reduce gastric upset.
C. Double the next dose if a scheduled dose is missed by more
