Antibiotic, Antiviral/Anti–COVID-19, and Antifungal Drugs

Every question here, with the answer

1. Fifteen minutes into an IV vancomycin infusion, a client develops flushing of the face and upper body. There is no wheezing or throat swelling. What is the nurse's best action?

   1. Increase the rate to finish the dose quickly.
   2. Give the rest of the dose orally instead.
   3. Slow the infusion so it runs over at least 60 minutes.
   4. Stop vancomycin permanently and document a vancomycin allergy.

   Answer: Slow the infusion so it runs over at least 60 minutes.

   Flushing when vancomycin is given too quickly is vancomycin flushing syndrome, which can be mistaken for an allergic reaction. All that is needed is to slow the infusion to at least 60 minutes. Speeding up worsens it, and oral vancomycin is ineffective against bloodstream pathogens.

2. A client prescribed oral doxycycline takes a daily calcium supplement. What should the nurse teach?

   1. Do not take the calcium product with the doxycycline because the drug will not be absorbed.
   2. Take both together to protect the stomach.
   3. Calcium increases doxycycline levels, so the dose will be reduced.
   4. Stop doxycycline if the stomach becomes upset.

   Answer: Do not take the calcium product with the doxycycline because the drug will not be absorbed.

   Tetracyclines bind to metal ions such as calcium and iron, so the drug is not absorbed and therapy fails. Calcium does not raise drug levels, and the client may take the drug with food for an upset stomach rather than stopping it.

3. A client is receiving IV gentamicin. Which actions by the nurse are appropriate? Select all that apply.

   1. Make sure serum drug levels are drawn at the ordered time.
   2. Ask the client about ringing in the ears or balance problems.
   3. Monitor renal function.
   4. Draw the trough level after the dose is finished.
   5. Encourage fluid restriction to protect the kidneys.

   Answer: Make sure serum drug levels are drawn at the ordered time., Ask the client about ringing in the ears or balance problems., Monitor renal function.

   Aminoglycosides are renally eliminated and need renal function and serial drug levels monitored, and they can cause ototoxicity, both vestibular and auditory. A trough is drawn immediately before a dose, not after, and the client should maintain adequate hydration.

4. A client with a history of asthma is diagnosed with influenza. Which neuraminidase inhibitor order should the nurse question?

   1. Oseltamivir started within 48 hours of symptoms
   2. Inhaled zanamivir
   3. Intravenous peramivir in a client who cannot take oral drugs
   4. Oral oseltamivir

   Answer: Inhaled zanamivir

   Zanamivir is inhaled and should not be used in clients with asthma or COPD because of bronchospasm risk. Oral oseltamivir is first line, and peramivir is appropriate for clients who cannot take oral or inhaled drugs.

5. A client taking levofloxacin reports sudden pain and swelling at the back of the heel. What should the nurse recognise?

   1. A reaction caused by taking the drug with food
   2. A sign that the infection is spreading
   3. An expected mild effect that will resolve with continued therapy
   4. A possible serious fluoroquinolone adverse effect involving the tendon

   Answer: A possible serious fluoroquinolone adverse effect involving the tendon

   Fluoroquinolones increase the risk for tendonitis and tendon rupture, and these can be disabling and potentially irreversible, so the drug is discontinued. It is not an expected effect or a sign of infection spread, and food is not the cause.

6. A client with recurrent genital herpes will use acyclovir episodically. Which teaching points are accurate? Select all that apply.

   1. Take a double dose if you miss one.
   2. The virus can be shed even when no lesion is present.
   3. Stay well hydrated while taking the medication.
   4. Begin taking the medication within 24 hours of symptom onset.
   5. The medication will cure the herpes infection.

   Answer: The virus can be shed even when no lesion is present., Stay well hydrated while taking the medication., Begin taking the medication within 24 hours of symptom onset.

   Episodic therapy must start within 24 hours of symptom onset, viral shedding can occur without a lesion, and hydration helps avoid kidney issues. No curative therapy for herpes exists, and missed doses should not be doubled.