Mr. Thomas, who is receiving oral penicillin, reports that he has a sore mouth. On inspection, the nurse notes bright red oral mucous membranes with some white patches. The primary care provider is notified immediately because these symptoms may be caused by:
a Vitamin C deficiency
dehydration
poor oral hygiene
a superinfection
The Correct Answer is D
A. A Vitamin C deficiency:
While a Vitamin C deficiency can lead to oral health issues such as bleeding gums or scurvy, it is less likely to present with bright red oral mucous membranes and white patches. Vitamin C deficiency typically manifests with other symptoms such as fatigue, weakness, and joint pain.
B. Dehydration:
Dehydration can cause dry mouth and oral discomfort, but it is less likely to present with bright red oral mucous membranes and white patches. Dehydration may also result in a dry, sticky feeling in the mouth rather than soreness with white patches.
C. Poor oral hygiene:
Poor oral hygiene can lead to various oral health problems, including gingivitis and dental caries, but it is less likely to cause bright red oral mucous membranes with white patches. Poor oral hygiene typically results in plaque accumulation, gum inflammation, and dental decay rather than the specific symptoms described.
D. A superinfection:
This is the correct option. A superinfection occurs when opportunistic microorganisms, such as fungi or resistant bacteria, proliferate and cause infection following antibiotic therapy. Penicillin, like other antibiotics, can disrupt the normal balance of microorganisms in the mouth, allowing opportunistic pathogens to flourish and lead to conditions such as oral thrush (caused by Candida albicans) or oral candidiasis. The presence of bright red oral mucous membranes with white patches suggests the possibility of a superinfection, which warrants immediate attention from the primary care provider for further evaluation and management.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Ibuprofen:
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) commonly used to relieve pain and reduce inflammation. There are no significant interactions reported between erythromycin and ibuprofen.
B. Lasix (Furosemide):
Lasix is a diuretic medication used to treat fluid retention (edema) and high blood pressure. There are no significant interactions reported between erythromycin and furosemide.
C. Lovastatin:
Lovastatin is a statin medication used to lower cholesterol levels. Erythromycin can increase the levels of lovastatin in the blood by inhibiting its metabolism through the CYP3A4 enzyme. This can lead to an increased risk of statin-related side effects, including muscle pain and weakness, and in rare cases, rhabdomyolysis.
D. Lisinopril:
Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure and heart failure. There are no significant interactions reported between erythromycin and lisinopril.
Correct Answer is C
Explanation
A. By assessing the temperature every 4 hours:
Monitoring temperature every 4 hours is a common practice in hospitalized patients to detect fever, which could indicate an infection or an inflammatory response. However, this method does not directly assess the therapeutic blood levels of vancomycin. Fever alone does not provide specific information about the effectiveness or concentration of the antibiotic in the bloodstream.
B. By repeating a culture and sensitivity test on day 3:
Culture and sensitivity tests involve taking a sample from the patient (such as blood, urine, or sputum) and growing the microorganisms in a laboratory to identify the causative organism and determine its susceptibility to antibiotics. While this test is essential for identifying the appropriate antibiotic therapy initially, repeating it on day 3 does not directly monitor therapeutic blood levels of vancomycin. It also doesn't provide real-time information about the concentration of vancomycin in the bloodstream.
C. By obtaining drug peak and trough levels:
This choice involves measuring the highest (peak) and lowest (trough) concentrations of vancomycin in the bloodstream. Peak levels are typically measured about 1 hour after the completion of a vancomycin infusion, while trough levels are measured just before the next dose is administered. These measurements allow healthcare providers to ensure that the drug concentration remains within the therapeutic range to effectively treat the infection while minimizing the risk of toxicity.
D. By assessing for breathlessness:
Assessing for breathlessness is important for monitoring respiratory status, particularly in patients receiving vancomycin, as rare side effects like red-man syndrome or anaphylaxis can cause respiratory distress. However, this method does not directly monitor therapeutic blood levels of vancomycin.
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