If a patient is taking fluconazole with warfarin, the nurse will monitor for which possible interaction?

Increased risk for bleeding

Decreased effectiveness of the antifungal drug

Reduced action of oral anticoagulants

Hypokalemia

Answer and Explanation

The Correct Answer is A

Choice A reason: Fluconazole inhibits hepatic CYP2C9, which metabolizes warfarin, increasing warfarin’s plasma levels. This enhances its anticoagulant effect, inhibiting vitamin K-dependent clotting factors, leading to a higher risk of bleeding. Monitoring INR and bleeding signs is critical to prevent hemorrhage in patients on this combination.

Choice B reason: Warfarin does not decrease fluconazole’s antifungal efficacy. Fluconazole inhibits fungal ergosterol synthesis, and its action is unaffected by warfarin’s anticoagulant mechanism. The primary interaction is fluconazole’s effect on warfarin metabolism, not a reduction in fluconazole’s ability to treat fungal infections.

Choice C reason: Fluconazole increases, not reduces, warfarin’s anticoagulant effect by inhibiting CYP2C9, slowing warfarin metabolism. This leads to elevated warfarin levels, prolonging INR and increasing bleeding risk. Reduced anticoagulant action would occur with enzyme inducers, not inhibitors like fluconazole.

Choice D reason: Hypokalemia is not a known interaction between fluconazole and warfarin. Fluconazole’s side effects include hepatotoxicity, and warfarin affects clotting, but neither significantly alters potassium levels. Electrolyte imbalances are more associated with diuretics or amphotericin B, not this drug combination.

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Correct Answer is A

Explanation

Choice A reason: Gentamicin, an aminoglycoside, causes ototoxicity, manifesting as ringing in the ears (tinnitus). It damages cochlear hair cells, leading to hearing loss or balance issues. Monitoring for tinnitus is critical, as ototoxicity is often irreversible, requiring dose adjustment or discontinuation to prevent further auditory damage.

Choice B reason: Elevated WBC count is not a typical indicator of gentamicin toxicity. Gentamicin’s primary toxicities are nephrotoxicity and ototoxicity. Elevated WBCs suggest infection or inflammation, not a direct effect of gentamicin, which targets bacterial protein synthesis, making this an incorrect monitoring parameter.

Choice C reason: Decreased BUN levels are not associated with gentamicin toxicity. Gentamicin causes nephrotoxicity, increasing BUN and creatinine due to renal tubular damage. Monitoring for elevated, not decreased, BUN is essential to detect kidney injury early, making this an incorrect toxicity indicator.

Choice D reason: Increased body temperature is not a direct indicator of gentamicin toxicity. Fever may indicate infection persistence or a drug reaction, but gentamicin’s primary toxicities are ototoxicity and nephrotoxicity. Monitoring for tinnitus or renal function changes is more relevant than temperature for toxicity assessment.

A. The drug is usually started 1 to 2 weeks before traveling to endemic areas and is continued for 4 weeks after leaving the area. B. The drug is started 3 weeks before exposure but can be discontinued once she leaves the area. C. Hydroxychloroquine is better absorbed and has fewer adverse effects if taken on an empty stomach. D. The medication is taken only when she observes mosquito bites because it can have toxic effects if taken unnecessarily.

Correct Answer is A

Explanation

Choice A reason: Hydroxychloroquine prophylaxis for malaria starts 1-2 weeks before travel to build therapeutic blood levels, inhibiting Plasmodium heme polymerization. Continuing for 4 weeks post-travel ensures eradication of liver-stage parasites, preventing delayed malaria onset, aligning with standard guidelines for effective prophylaxis.

Choice B reason: Starting hydroxychloroquine 3 weeks before travel is excessive, as 1-2 weeks is sufficient for therapeutic levels. Discontinuing immediately after leaving risks malaria from liver-stage parasites, which can emerge weeks later. The standard 4-week post-travel continuation is critical for complete protection.

Choice C reason: Hydroxychloroquine absorption is not significantly improved on an empty stomach, and food reduces gastrointestinal irritation. Its adverse effects, like retinal toxicity, are unrelated to food intake. Taking it with food is recommended to minimize side effects, making this statement incorrect for patient education.

Choice D reason: Taking hydroxychloroquine only after mosquito bites is incorrect, as prophylaxis requires steady-state levels before exposure. Its antimalarial action prevents parasite development, not just symptomatic infection. Ad-hoc use risks inefficacy and toxicity, as consistent dosing is needed for malaria prevention.

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If a patient is taking fluconazole with warfarin, the nurse will monitor for which possible interaction?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

When a patient is on gentamicin therapy, the nurse will monitor for which indicator of potential toxicity?

Correct Answer is A

Explanation

A woman is traveling to a country where she will be at high risk for malarial infection. What will the nurse teach her regarding prophylactic therapy with hydroxychloroquine?

Correct Answer is A

Explanation

A patient with a known heart condition is prescribed an antibiotic before a dental procedure. What type of antibiotic therapy is this considered?

A patient is in an urgent care center with an acute asthma attack. The nurse expects that which medication will be prescribed for initial treatment?

A nurse is caring for a patient who has been prescribed aspirin for the management of their chronic pain. The patient asks the nurse about potential side effects and precautions related to taking aspirin. Which of the following statements by the nurse is correct regarding the use of aspirin?

A patient is receiving hydroxychloroquine therapy but tells the nurse that she has never traveled out of her city. The nurse knows that a possible reason for this drug therapy is which of these conditions?

Which of the following antibiotics is known to cause photosensitivity?

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