A nurse is providing care to a client with staphylococcus epidermidis who is prescribed vancomycin. Identify the adverse effect associated with the antibiotic therapy.

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ATI Capstone Pharmacology Assessment 1 Questions

Question 1 of 5

A nurse is providing care to a client with staphylococcus epidermidis who is prescribed vancomycin. Identify the adverse effect associated with the antibiotic therapy.

Correct Answer: C

Rationale: The correct answer is C: Infusion reaction. Vancomycin can cause infusion reactions like 'Red Man Syndrome,' which involves rashes, flushing, tachycardia, and hypotension. Hepatotoxicity (choice A) is not a common adverse effect of vancomycin. Constipation (choice B) is not typically associated with vancomycin use. Immunosuppression (choice D) is not a direct adverse effect of vancomycin therapy.

Question 2 of 5

A 52-year-old client with a history of angina has been prescribed transdermal nitroglycerin. Which of the following adverse effects is not associated with this therapy?

Correct Answer: D

Rationale: The correct answer is D: Productive cough. Nitroglycerin therapy can lead to adverse effects such as tolerance, orthostatic hypotension, and headache. However, it is not known to cause a productive cough. Tolerance may develop over time, requiring dose adjustments. Orthostatic hypotension can occur due to vasodilation effects, leading to a sudden drop in blood pressure when changing positions. Headache is a common side effect due to vasodilation of cranial blood vessels. Productive cough is not a recognized adverse effect associated with transdermal nitroglycerin therapy.

Question 3 of 5

A client prescribed hydromorphone for severe pain has a decreased respiratory rate from 16 breaths per minute to 6. Which of the following medications should the nurse prepare to administer?

Correct Answer: B

Rationale: Naloxone is the correct answer as it is used to reverse opioid-induced respiratory depression. Hydromorphone is an opioid medication that can cause respiratory depression at high doses. Naloxone is an opioid antagonist that competes with opioids at receptor sites, reversing the effects of opioids like hydromorphone. Flumazenil (Choice A) is a benzodiazepine antagonist used for benzodiazepine overdose, not opioid overdose. Activated charcoal (Choice C) is used for toxin ingestion to prevent absorption in the gastrointestinal tract, but it is not indicated for opioid overdose. Aluminum hydroxide (Choice D) is an antacid and would not be the appropriate intervention for respiratory depression caused by opioid overdose.

Question 4 of 5

A nurse is preparing to administer an intramuscular injection to an adult client. At what angle should the nurse administer the medication using the ventrogluteal site?

Correct Answer: D

Rationale: Intramuscular injections in the ventrogluteal site should be administered at a 90-degree angle. This angle ensures that the medication reaches the muscle tissue effectively. Angles less than 90 degrees can cause subcutaneous injection instead of intramuscular, leading to slower absorption of the medication. Angles greater than 90 degrees risk hitting bone or nerves, causing unnecessary pain or injury. Therefore, the correct angle for administering intramuscular injections in the ventrogluteal site is 90 degrees.

Question 5 of 5

A nurse is caring for a client receiving patient-controlled analgesia (PCA). Which of the following interventions should the nurse take while caring for this client?

Correct Answer: B

Rationale: The correct answer is B because encouraging the client to use the PCA before dressing changes helps in managing pain proactively. Choice A is incorrect as PCA is a safe method of pain control when used appropriately, and the nurse should not suggest using it sparingly. Choice C is incorrect as only the client should operate the PCA to ensure they are in control of their pain management. Choice D is incorrect as changing the PCA limit without proper assessment and orders from the healthcare provider can lead to adverse effects.

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