A 51-year-old man with systemic candidemia is hospitalized in the intensive care unit. He has failed treatment with outpatient oral medications. He has begun on intravenous amphotericin. Approximately 1 h after administration of amphotericin, the patient develops fever and chills. What is the most appropriate course of action to take?

Correct Answer: A

Rationale: In this scenario, the most appropriate course of action is to choose option A) Continue infusion; premedicate with antipyretic for next doses. The patient's presentation of fever and chills following amphotericin administration suggests an infusion-related reaction known as "shake and bake" syndrome. This reaction is common with amphotericin and is characterized by flu-like symptoms. Continuing the infusion while premedicating with an antipyretic can help manage these symptoms and allow the patient to receive the necessary treatment. Option B) Discontinuing the infusion is not the best choice as the patient still requires treatment for systemic candidemia, and discontinuing the medication without proper management of symptoms may compromise the effectiveness of the therapy. Options C) Intravenous prednisone and discontinue amphotericin and D) Intravenous tetracycline and discontinue amphotericin are incorrect because prednisone and tetracycline are not indicated for managing infusion-related reactions to amphotericin. Prednisone is a corticosteroid that may not address the immediate symptoms, and tetracycline is an antibiotic with no direct relevance to managing amphotericin-induced fever and chills. From an educational perspective, understanding the common side effects and management strategies for medications like amphotericin is crucial for nursing pharmacology practice. It highlights the importance of recognizing and appropriately managing medication-related adverse events to ensure patient safety and treatment efficacy. Nurses must be equipped with this knowledge to provide prompt and effective care in similar clinical situations.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Xerostomia. Xerostomia, or dry mouth, is a common side effect of antimuscarinic medications like solifenacin, which is used to treat urinary urge incontinence. These medications block muscarinic receptors, leading to decreased saliva production and dry mouth. Option A) Diarrhea is less likely because antimuscarinic medications usually cause constipation rather than diarrhea due to their anticholinergic effects. Option B) Hypertension is an unlikely side effect as losartan, the patient's current medication for hypertension, is not known to interact in a way that would cause hypertension when combined with solifenacin. Option C) Photosensitivity is not a common side effect of solifenacin or antimuscarinic medications in general. Photosensitivity is more commonly associated with other classes of drugs like certain antibiotics or NSAIDs. Educationally, understanding common side effects of medications is crucial for nurses to provide safe and effective care to patients. By knowing the side effect profile of medications, nurses can anticipate, monitor, and manage potential adverse reactions, thereby improving patient outcomes and quality of care.

Correct Answer: A

Rationale: The correct answer is A) Aluminum hydroxide. In the context of treating GERD, aluminum hydroxide acts as an antacid that chemically elevates the pH of the stomach by neutralizing excess acid. This helps to alleviate symptoms of heartburn and indigestion by reducing the acidity in the stomach. Option B) Fexofenadine is an antihistamine used to treat allergies and does not have any effect on stomach acid levels, making it an incorrect choice for GERD. Option C) Misoprostol is a prostaglandin analog that helps protect the stomach lining from damage caused by nonsteroidal anti-inflammatory drugs (NSAIDs) but does not directly lower stomach acid levels, so it is not the appropriate choice for GERD. Option D) Omeprazole belongs to a class of medications known as proton pump inhibitors (PPIs), which work by reducing the production of stomach acid. While effective in treating GERD, omeprazole does not chemically elevate pH like aluminum hydroxide does. In an educational context, understanding the mechanisms of action of different medications used to treat GERD is crucial for nursing pharmacology. Knowing how each drug works can help nurses make informed decisions in selecting the most appropriate treatment for patients based on their symptoms and medical history. Understanding the rationale behind choosing aluminum hydroxide over other options reinforces the importance of tailoring medication therapy to individual patient needs.

Correct Answer: A

Rationale: The correct answer is A) Albuterol. Albuterol is a beta2-adrenergic agonist that acts as a bronchodilator, specifically targeting the smooth muscles in the bronchioles. In an acute asthma attack, bronchodilation is crucial to improve airflow and alleviate breathing difficulties. Albuterol works rapidly and effectively in opening up the airways, making it a first-line treatment for asthma exacerbations. Option B) Methacholine is a bronchoconstrictor used in bronchial challenge tests to diagnose asthma, so it would worsen the condition in this scenario. Option C) Neostigmine is a cholinesterase inhibitor and would not be appropriate for bronchodilation. Option D) Nicotine is a stimulant that can worsen respiratory conditions and is not used to dilate bronchioles in asthma. In an educational context, understanding the pharmacological management of asthma in different age groups is essential for nursing practice. Knowing which medications are appropriate for bronchodilation in acute asthma attacks, like albuterol, ensures safe and effective care for pediatric patients with respiratory distress. Nurses must be able to quickly recognize symptoms, choose the right medication, and administer it correctly to provide prompt relief and prevent complications in children with asthma.

Correct Answer: D

Rationale: In this scenario, the most likely medication to cause hyperglycemia in a renal transplant patient is Tacrolimus (Option D). Tacrolimus is known to be associated with new-onset diabetes after transplantation (NODAT) due to its adverse effect on glucose metabolism. This drug can lead to insulin resistance and impaired insulin secretion, resulting in elevated blood glucose levels. Azathioprine (Option A) is not typically associated with causing hyperglycemia. While Cyclosporine (Option B) can cause nephrotoxicity and hypertension, it is not a primary culprit for hyperglycemia in this case. Muromonab (Option C) is an immunosuppressive monoclonal antibody that is not commonly linked to hyperglycemia. In an educational context, understanding the potential side effects of medications used in transplant patients is crucial for nurses to provide comprehensive care. It is essential to recognize the adverse effects of immunosuppressants like Tacrolimus, including their impact on glucose metabolism, to monitor patients effectively and prevent complications such as NODAT. Nurses must be knowledgeable about medication side effects to ensure patient safety and well-being in the post-transplant period.