The client is a 75-year-old female admitted to the preoperative area to prepare for pacemaker insertion. Client reports she is having this done because her heart rate has been staying very low, she is always tired, and she has passed out once from low heart rate. Client has history of worsening symptomatic bradycardia. History of atrial fibrillation controlled. The nurse is preparing the client's plan of care. Select 4 findings that would indicate to the nurse that the administration of the vancomycin antibiotic would be safe to administer.

No known allergies

Peripheral IV in large vein

Potassium 4.4 mEq/L (4.4 mmol/L)

Used for prophylaxis

Blood urea nitrogen 17 mg/dL (6.07 mmol/L)

Dosage in safe range

Answer and Explanation

Correct Answer : A,B,D,F

A. No known allergies:
Having no known allergies is a significant factor in determining the safety of administering vancomycin, as it reduces the risk of an allergic reaction. Vancomycin can cause allergic reactions or hypersensitivity, so it’s important to ensure the client is not allergic to this medication.

B. Peripheral IV in large vein:
Vancomycin should be administered through a large vein because it can be irritating to smaller veins and potentially cause thrombophlebitis or vein damage. Using a large vein helps to minimize these risks and ensure safe administration.

C. Potassium 4.4 mEq/L (4.4 mmol/L):
While potassium levels are important to monitor, they are not directly related to the safety of administering vancomycin. Vancomycin does not have a direct impact on potassium levels, so this finding does not specifically indicate the safety of vancomycin administration.

D. Used for prophylaxis:
Vancomycin is often used as prophylaxis in certain surgical procedures to prevent infection, especially in cases where there is a high risk of methicillin-resistant Staphylococcus aureus (MRSA) infection. The use of vancomycin for prophylaxis is a common practice and indicates it is being administered for an appropriate reason.

E. Blood urea nitrogen 17 mg/dL (6.07 mmol/L):
A blood urea nitrogen (BUN) level of 17 mg/dL is slightly elevated but not necessarily a contraindication for vancomycin administration. However, vancomycin can impact kidney function, so it is important to monitor renal function but not the sole factor in determining safety.

F. Dosage in safe range:
Ensuring the dosage of vancomycin is within the safe range is crucial for preventing toxicity and achieving therapeutic efficacy. This is an essential consideration when administering the medication to avoid adverse effects and ensure effective treatment.

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Correct Answer is D

Explanation

A) Avoid prolonged exposure to direct sunlight: While erythromycin can increase sensitivity to sunlight, this is not directly related to the interaction between oral contraceptives and erythromycin. The primary concern with erythromycin and oral contraceptives is their interaction rather than sun exposure.

B) Stop the oral contraceptive immediately: There is no need to stop oral contraceptives when taking erythromycin. However, erythromycin can potentially reduce the effectiveness of oral contraceptives, so additional precautions should be taken rather than discontinuing the contraceptive.

C) Take the medications at least 12 hours apart: Timing of administration is not a primary concern for this interaction. The main issue is the potential reduction in contraceptive efficacy rather than timing the doses of the medications.

D) Use an additional form of contraception: Erythromycin can potentially decrease the effectiveness of oral contraceptives due to its effect on liver enzymes and drug metabolism. It is advisable to use an additional form of contraception to prevent unintended pregnancy while taking erythromycin.

A. Food diary shows increased consumption of iron-rich foods. B. Reports of increased energy levels and decreased fatigue. C. Takes concurrent iron therapy without adverse effects. D. Hemoglobin level increased to 12 g/dL (7.45 mmol/L).

Correct Answer is D

Explanation

A. Food diary shows increased consumption of iron-rich foods:

While iron-rich foods are important for managing anemia, this finding does not directly indicate the effectiveness of epoetin alfa. The primary measure of epoetin alfa's effectiveness is an improvement in hemoglobin levels, not dietary changes.

B. Reports of increased energy levels and decreased fatigue:

Increased energy and decreased fatigue are positive effects and may suggest that the medication is helping. However, these symptoms are subjective and not as definitive as a measurable increase in hemoglobin levels.

C. Takes concurrent iron therapy without adverse effects:

Iron therapy is often used alongside epoetin alfa to enhance its effectiveness, but the absence of adverse effects from iron therapy does not alone confirm the effectiveness of epoetin alfa. The key indicator is the improvement in hemoglobin levels.

D. Hemoglobin level increased to 12 g/dL (7.45 mmol/L):

An increase in hemoglobin level to 12 g/dL is a direct measure of the effectiveness of epoetin alfa. This increase demonstrates that the medication is successfully stimulating red blood cell production, which is the intended therapeutic effect.

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Naxlex Comprehensive Predictor Exams

A client who is taking an oral contraceptive receives a new prescription for erythromycin. Which instruction should the nurse provide to the client?

Correct Answer is D

Explanation

A client with anemia secondary to chronic kidney disease (CKD) started a prescription for epoetin alfa two months ago. Which client finding best indicates that the medication is effective? Reference Range: Hemoglobin (Hgb) [14 to 18 g/dl. (8.7 to 11.2 mmol/L)]

Correct Answer is D

Explanation

A female client with a history of peptic ulcer disease receives a prescription for misoprostol. Which information provided by the client indicates to the nurse a need for further teaching?

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To control asthma, a client in a residential treatment facility uses a fluticasone propionate and salmeterol discus inhalation system, which provides an inhaled powdered form of these combined medications. Which instruction should the nurse provide to this client's caregivers?

The nurse is caring for a client who takes methotrexate for rheumatoid arthritis and receives a prescription for adalimumab. Which instructions should the nurse provide the client?

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The nurse is educating a client about acetaminophen. Which information provided by the client requires additional instruction by the nurse?

A client with benign prostatic hyperplasia receives a new prescription of tamsulosin. Which intervention should the nurse perform to monitor for an adverse reaction?

A client receives a prescription for penicillin 1.2 million units IM. The available vial is labeled, "600,000 units/2 mL." How many mL should the nurse administer? (Enter numeric value only.)