The nurse is caring for a client who is receiving vancomycin. The nurse notes the client is experiencing flushing, rash, pruritus, and urticaria. The client's heart rate is 120 beats/min, and blood pressure is 92/57 mm Hg. What complication is the client experiencing?

Rhabdomyolysis

Red man syndrome

Side effects

Stevens-Johnson syndrome

Answer and Explanation

The Correct Answer is B

A) Rhabdomyolysis is a serious condition characterized by the breakdown of skeletal muscle tissue and is not associated with the symptoms described.

B) Red man syndrome is an infusion reaction associated with the rapid infusion of vancomycin. Symptoms include flushing, rash, pruritus, urticaria, tachycardia, and hypotension.

C) Side effects are general and can include a range of symptoms. Red man syndrome is a specific reaction associated with vancomycin.

D) Stevens-Johnson syndrome is a severe skin reaction that involves blistering and peeling of the skin. It is not associated with the rapid infusion of vancomycin.

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Correct Answer is B

Explanation

a) The taste of cough medicine is not the primary concern for not recommending it to infants. The key issue lies in potential adverse effects, especially on the central nervous system. b) Infants have an immature central nervous system and are more susceptible to the sedative effects of medications. This is a critical factor in avoiding medications with sedative side effects in infants.

c) Gastric emptying time and drug absorption are generally faster in infants, making them more susceptible to rapid drug effects rather than less. However, the central nervous system effects are of greater concern.

d) Infants may metabolize drugs differently, but this does not necessarily mean the drugs are less effective. The primary concern is the potential for increased susceptibility to adverse effects.

A. Instruct the client to notify the nurse if they have any tingling in their toes. B. Interpret the peak and trough levels. C. Assess the client's urine output. D. Consult the provider about the need for a less nephrotoxic medication.

Correct Answer is B

Explanation

a) Tingling in the toes may be indicative of peripheral neuropathy but is not specifically related to elevated BUN and serum creatinine levels.

b) Elevated BUN and serum creatinine levels suggest potential renal impairment, and interpreting peak and trough levels of vancomycin is essential to assess the drug's impact on renal function.

c) Assessing urine output is important in evaluating renal function, but the specific action related to the elevated BUN and creatinine levels is to interpret vancomycin levels.

d) Consulting the provider about the need for a less nephrotoxic medication may be a consideration, but understanding the impact of vancomycin on renal function through peak and trough levels is a crucial initial step.

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The nurse is caring for a client who is receiving vancomycin. The nurse notes the client is experiencing flushing, rash, pruritus, and urticaria. The client's heart rate is 120 beats/min, and blood pressure is 92/57 mm Hg. What complication is the client experiencing?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Parents ask the nurse why an over-the-counter cough suppressant with sedative side effects is not recommended for infants. Which response by the nurse is correct?

Correct Answer is B

Explanation

A client with an infection is being treated with vancomycin. The nurse providing care reviews the client's laboratory reports and notes that the client's blood urea nitrogen (BUN) and serum creatinine levels are newly elevated. What would be the appropriate nursing intervention?

Correct Answer is B

Explanation

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