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 C

Explanation

Choice A reason: Amoxicillin, a penicillin antibiotic, inhibits bacterial cell wall synthesis and is commonly used for infections like otitis media. It is not associated with tendon rupture, as it lacks the mechanism affecting collagen or connective tissue. Its side effects include gastrointestinal upset and allergic reactions, not musculoskeletal issues.

Choice B reason: Clarithromycin, a macrolide antibiotic, inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit. It is used for respiratory infections but is not linked to tendon rupture. Its side effects include gastrointestinal disturbances and QT prolongation, with no known impact on tendon integrity or collagen metabolism.

Choice C reason: Ciprofloxacin, a fluoroquinolone, is associated with tendon rupture, particularly in the Achilles tendon. It may disrupt collagen synthesis and extracellular matrix integrity, increasing tendon vulnerability, especially in older adults or those on corticosteroids. This rare but serious side effect requires monitoring during therapy.

Choice D reason: Doxycycline, a tetracycline antibiotic, inhibits protein synthesis and is used for infections like acne or Lyme disease. While it can cause photosensitivity or gastrointestinal issues, it is not associated with tendon rupture. Its mechanism does not involve collagen disruption, unlike fluoroquinolones such as ciprofloxacin.

A. A more potent effect B. Immediate onset C. Shorter duration D. Lack of rebound congestion

Correct Answer is D

Explanation

Choice A reason: Oral decongestants like pseudoephedrine are not inherently more potent than nasal sprays like oxymetazoline. Both stimulate alpha-adrenergic receptors to constrict nasal blood vessels, but nasal sprays often provide more rapid, localized relief. Potency depends on dose and delivery, not route, making this incorrect.

Choice B reason: Oral decongestants do not have an immediate onset. They require absorption through the gastrointestinal tract, with effects starting in 30-60 minutes. Nasal sprays act within minutes due to direct mucosal application, making them faster for acute sinus symptom relief, unlike slower-acting oral forms.

Choice C reason: Oral decongestants typically have a longer duration of action (4-6 hours for pseudoephedrine) compared to nasal sprays (often shorter unless long-acting). Shorter duration is not a benefit, as prolonged relief is preferred for sinus congestion, making this an incorrect advantage of oral administration.

Choice D reason: Oral decongestants avoid rebound congestion, a common issue with nasal sprays like oxymetazoline, which can cause rhinitis medicamentosa with prolonged use. Oral agents like pseudoephedrine act systemically, reducing nasal congestion without local dependence, making them safer for extended use without worsening symptoms upon discontinuation.

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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

Which of the following antibiotics is associated with a risk of tendon rupture?

Correct Answer is C

Explanation

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Correct Answer is D

Explanation

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