A patient with a history of vancomycin-resistant Enterococcus (VRE) infection is prescribed vancomycin. Which of the following actions should the nurse take first?

Administer the vancomycin as ordered

Notify the HCP about the patient's VRE history

Monitor the patient for signs of an allergic reaction

Obtain a baseline renal function test.

Answer and Explanation

The Correct Answer is B

A. Administer the vancomycin as ordered.: Administering vancomycin without clarifying the prescription could be unsafe because the patient’s history of VRE indicates resistance to this antibiotic. Giving the drug despite known resistance would be ineffective and delay appropriate treatment.

B. Notify the HCP about the patient's VRE history.: The nurse should first notify the healthcare provider, as vancomycin is ineffective against vancomycin-resistant Enterococcus. The provider may need to prescribe an alternative antibiotic, such as linezolid or daptomycin, based on culture and sensitivity results.

C. Monitor the patient for signs of an allergic reaction.: Although monitoring for allergic reactions is always important, this action is secondary in this case. The priority is to ensure the medication chosen will be effective for the patient’s specific infection.

D. Obtain a baseline renal function test.: Vancomycin can cause nephrotoxicity, so assessing renal function is standard before therapy. However, since the infection is resistant to vancomycin, evaluating kidney function is not the first or most urgent action.

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Correct Answer is A

Explanation

A. "I can have a glass of wine or two while taking this medication.": Metronidazole causes a severe disulfiram-like reaction when combined with alcohol. Clients should avoid all alcohol-containing products during treatment and for at least 48 hours after the last dose.

B. "I might get a funny metal taste in my mouth while taking this drug.": A metallic taste is a common and harmless side effect of metronidazole. The nurse should reassure the client that this reaction is temporary and does not indicate an allergy or toxicity.

C. "This medication is an antibiotic used to treat the bacterial infection I have.": This is an accurate understanding of metronidazole’s purpose. It is an effective antimicrobial used for bacterial and protozoal infections, including some sexually transmitted infections.

D. "I should take the full prescription to get rid of this infection.": Completing the full course of metronidazole is essential to ensure eradication of the infection and prevent antibiotic resistance.

A. "If the medicine causes an upset stomach, take an antacid at the same time." B. "Limit your daily fluid intake while taking this medication." C. "This medication will affect your eyesight, wear sunglasses while outside" D. "You should report any discomfort in your tendons while taking this medication."

Correct Answer is D

Explanation

A. "If the medicine causes an upset stomach, take an antacid at the same time.": Ciprofloxacin should not be taken with antacids containing magnesium or aluminum because these reduce the medication’s absorption and effectiveness.

B. "Limit your daily fluid intake while taking this medication.": Clients should be encouraged to increase, not limit, fluid intake when taking ciprofloxacin. Adequate hydration helps prevent crystalluria and protects renal function.

C. "This medication will affect your eyesight, wear sunglasses while outside.": Ciprofloxacin does not typically cause vision changes or photosensitivity requiring sunglasses. It is not a significant or common side effect of quinolones.

D. "You should report any discomfort in your tendons while taking this medication.": Ciprofloxacin carries a risk for tendinitis and tendon rupture, especially in older adults and those taking corticosteroids. Reporting tendon pain early allows the healthcare provider to discontinue the drug and prevent permanent tendon damage.

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