Liver and Kidney: Lab Values and Damage
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1
Which patient does the nurse identify as being at highest risk for the development of an adverse drug reaction?
A. A 1-month-old patient whose mother has allergies to penicillin, aspirin, and codeine
B. A 16-year-old patient with multiple traumatic injuries who is taking morphine and an antibiotic
C. A 54-year-old patient with multiple sclerosis who has been enrolled in a clinical trial of a new drug
D. An 84-year-old patient with diabetes, heart failure, and hypertension who takes seven prescription medications each
day
A. A 1-month-old patient whose mother has allergies to penicillin, aspirin, and codeine
B. A 16-year-old patient with multiple traumatic injuries who is taking morphine and an antibiotic
C. A 54-year-old patient with multiple sclerosis who has been enrolled in a clinical trial of a new drug
D. An 84-year-old patient with diabetes, heart failure, and hypertension who takes seven prescription medications each
day
D kidney and liver function decrease.
2
Question 2
A patient is prescribed a medication that is potentially hepatotoxic. Before administering the medication, it is most important for the nurse to assess what?
A. Blood urea nitrogen and serum creatinine
B. Aspartate aminotransferase and alanine
aminotransferase
C. Prolonged QT interval on the electrocardiogram
D. Serum potassium, serum sodium, and serum
magnesium
A patient is prescribed a medication that is potentially hepatotoxic. Before administering the medication, it is most important for the nurse to assess what?
A. Blood urea nitrogen and serum creatinine
B. Aspartate aminotransferase and alanine
aminotransferase
C. Prolonged QT interval on the electrocardiogram
D. Serum potassium, serum sodium, and serum
magnesium
B. Hepatotoxic means that it can be damaging to the liver. The nurse should assess the liver function tests of patients who are taking hepatotoxic drugs. When liver cells are injured, two liver enzymes (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) will be elevated.
3
Which individual is at the highest risk for a drug-drug interaction?
A. A toddler who is prescribed two antibiotics for a serious infection
B. An adolescent who takes over-the-counter medications for menstrual cramping
C. An adult who takes eight prescription medications for a chronic condition
D. An older adult who takes two prescription medications and a dietary supplement for anxiety
A. A toddler who is prescribed two antibiotics for a serious infection
B. An adolescent who takes over-the-counter medications for menstrual cramping
C. An adult who takes eight prescription medications for a chronic condition
D. An older adult who takes two prescription medications and a dietary supplement for anxiety
C
4
The nurse cares for a patient who is taking a calcium channel blocker for hypertension. The nurse should be most concerned if the patient makes which statement?
A. “I take my medication with a glass of water.”
B. “I eat foods high in fiber to prevent constipation.”
C. “I drink a glass of grapefruit juice each evening.”
D. “I avoid foods such as broccoli and cabbage.”
A. “I take my medication with a glass of water.”
B. “I eat foods high in fiber to prevent constipation.”
C. “I drink a glass of grapefruit juice each evening.”
D. “I avoid foods such as broccoli and cabbage.”
C
5
A patient is prescribed a medication to be taken on an empty stomach. Which statement should the nurse include when providing patient teaching?
A. “Take the medication 1 hour before eating.”
B. “Take the medication with a small glass of water.”
C. “Take the medication before going to bed at night.”
D. “Take the medication 1 hour after a meal.”
A. “Take the medication 1 hour before eating.”
B. “Take the medication with a small glass of water.”
C. “Take the medication before going to bed at night.”
D. “Take the medication 1 hour after a meal.”
A
6
Which information should the nurse include when teaching a patient about isoniazid (INH) therapy?
A. Tubercle bacilli cannot develop resistance to isoniazid during treatment.
B. Isoniazid is administered intravenously.
C. An adverse effect of isoniazid therapy is peripheral neuropathy, which can be reversed with pyridoxine.
D. The dose of isoniazid should be lowered if the patient is also taking phenytoin.
A. Tubercle bacilli cannot develop resistance to isoniazid during treatment.
B. Isoniazid is administered intravenously.
C. An adverse effect of isoniazid therapy is peripheral neuropathy, which can be reversed with pyridoxine.
D. The dose of isoniazid should be lowered if the patient is also taking phenytoin.
C
7
Which information should the nurse include when teaching a patient about rifampin therapy?
A. Oral contraceptives are safe to use with rifampin therapy.
B. Contact your healthcare provider immediately if the color of your body fluids changes to reddish orange.
C. Rifampin is safe to use in patients who have hepatic disease.
D. Rifampin may be administered intravenously.
A. Oral contraceptives are safe to use with rifampin therapy.
B. Contact your healthcare provider immediately if the color of your body fluids changes to reddish orange.
C. Rifampin is safe to use in patients who have hepatic disease.
D. Rifampin may be administered intravenously.
D
8
A nurse is planning discharge teaching for a female client who has a new prescription for Trimethoprim-sulfamethoxazole. Which of the following information should the nurse include?
• A. Take the medication even if pregnant
• B. Maintain a fluid restriction while taking it
• C. Take in on an empty stomach
• D. Stop taking it when manifestations subside
• A. Take the medication even if pregnant
• B. Maintain a fluid restriction while taking it
• C. Take in on an empty stomach
• D. Stop taking it when manifestations subside
take it on an empty stomach
9
Question
• Which statement about erythromycin is correct?
A It inhibits cell wall formation of organisms
B It used to treat infections in clients who are allergic to penicillin
C liver function should be monitored when clients are on the drugs
D teach clients to take it with meals usually
E Monitor ECG for this drug
• Which statement about erythromycin is correct?
A It inhibits cell wall formation of organisms
B It used to treat infections in clients who are allergic to penicillin
C liver function should be monitored when clients are on the drugs
D teach clients to take it with meals usually
E Monitor ECG for this drug
B,C,D,E
10
A nurse is preparing to administer cefotaxime (claforan) IV to a client who has a severe infection and has been receiving cefotaxime for the past week. Which of the following findings indicates a potentially serious adverse reaction to this medication and should be reported to the provider?
A diaphoresis B diarrhea
C alopecia
D epistaxis
A diaphoresis B diarrhea
C alopecia
D epistaxis
D
11
Flashcard 1
Front: What is an allergic drug reaction?
Flashcard 1
Front: What is an allergic drug reaction?
Back: An immune response to a drug, often causing rash, hives, or anaphylaxis.
12
Flashcard 2
Front: What is a paradoxical drug reaction?
Flashcard 2
Front: What is a paradoxical drug reaction?
Back: A reaction where the drug causes an effect opposite to what is expected.
13
Flashcard 3
Front: How do you monitor liver toxicity in patients on medication?
Flashcard 3
Front: How do you monitor liver toxicity in patients on medication?
Back: Through liver function tests, observing for symptoms like jaundice, and checking enzyme levels like ALT and AST.
14
Flashcard 4
Front: How is kidney toxicity monitored?
Flashcard 4
Front: How is kidney toxicity monitored?
Back: By measuring serum creatinine, blood urea nitrogen (BUN), and monitoring urine output.
15
Flashcard 5
Front: What is an example of a drug-to-drug interaction that increases therapeutic effects?
Flashcard 5
Front: What is an example of a drug-to-drug interaction that increases therapeutic effects?
Back: Using aspirin with clopidogrel to enhance antiplatelet effect.
16
Flashcard 6
Front: Name a food high in Vitamin K that affects Warfarin therapy.
Flashcard 6
Front: Name a food high in Vitamin K that affects Warfarin therapy.
Back: Green leafy vegetables like spinach and kale.
17
Flashcard 7
Front: What is the purpose of a culture and sensitivity test in antibiotic therapy?
Flashcard 7
Front: What is the purpose of a culture and sensitivity test in antibiotic therapy?
Back: To identify the causative bacteria and determine which antibiotics are effective against it.
18
Flashcard 8
Front: What is a superinfection?
Flashcard 8
Front: What is a superinfection?
Back: A secondary infection that occurs during or after treatment of a primary infection, often due to antibiotic use.
19
Flashcard 9
Front: What is the function of a beta-lactamase inhibitor?
Flashcard 9
Front: What is the function of a beta-lactamase inhibitor?
Back: To prevent bacterial enzymes from breaking down beta-lactam antibiotics, thereby enhancing their effectiveness.
20
Flashcard 10
Front: What is a major adverse reaction (ADR) of penicillin?
Flashcard 10
Front: What is a major adverse reaction (ADR) of penicillin?
Back: Allergic reactions, ranging from rash to anaphylaxis.
21
Flashcard 11
Front: What is a major contraindication for Tetracycline?
Flashcard 11
Front: What is a major contraindication for Tetracycline?
Back: It should not be used in children under 8 years or during pregnancy due to risks to bone growth and teeth development.
22
Flashcard 12
Front: What is a common first-line treatment for uncomplicated UTIs?
Flashcard 12
Front: What is a common first-line treatment for uncomplicated UTIs?
Back: Trimethoprim/sulfamethoxazole (Bactrim).
23
Flashcard 13
Front: What are key signs of aminoglycoside toxicity?
Flashcard 13
Front: What are key signs of aminoglycoside toxicity?
Back: Nephrotoxicity (kidney damage) and ototoxicity (hearing damage).
24
Flashcard 14
Front: Which antibiotic is commonly associated with causing C-diff infections?
Flashcard 14
Front: Which antibiotic is commonly associated with causing C-diff infections?
Back: Clindamycin.
25
Flashcard 15
Front: What is a significant adverse reaction of macrolides like Erythromycin?
Flashcard 15
Front: What is a significant adverse reaction of macrolides like Erythromycin?
Back: Gastrointestinal disturbances, including nausea and diarrhea.
26
Flashcard 16
Front: What is a critical drug-to-food interaction to consider with Metronidazole?
Flashcard 16
Front: What is a critical drug-to-food interaction to consider with Metronidazole?
Back: Avoid alcohol due to the risk of a disulfiram-like reaction.
27
Flashcard 17
Front: What is a major side effect of Rifampin, a drug used in TB treatment?
Flashcard 17
Front: What is a major side effect of Rifampin, a drug used in TB treatment?
Back: Hepatotoxicity and orange-red discoloration of body fluids.
28
Flashcard 18
Front: What is a common adverse reaction to Amphotericin B?
Flashcard 18
Front: What is a common adverse reaction to Amphotericin B?
Back: Infusion reactions and nephrotoxicity.
29
Flashcard 19
Front: What is the primary action of antiviral drugs like acyclovir?
Flashcard 19
Front: What is the primary action of antiviral drugs like acyclovir?
Back: They inhibit viral DNA replication.
30
What are the types of adverse drug reactions and how do you monitor liver and kidney toxicity?
Allergic: Immune response causing hypersensitivity. Paradoxical: Opposite of the expected effect. Idiosyncratic: Unpredictable and rare reaction. Monitor liver toxicity: Liver function tests (AST, ALT). Monitor kidney toxicity: Creatinine clearance, serum creatinine, BUN.
31
Describe drug-to-drug and drug-to-food interactions, specifically with Warfarin/Vitamin K and MAOIs/tyramine.
Describe drug-to-drug and drug-to-food interactions, specifically with Warfarin/Vitamin K and MAOIs/tyramine.
Increased therapeutic effects: Potentiation or synergism. Increased adverse effects: Heightened side effects or toxicity. Reduced therapeutic effects: Diminished efficacy due to antagonism. Reduced adverse effects: Side effects minimized by another drug. Warfarin and Vitamin K: Vitamin K decreases Warfarin's effectiveness. MAOIs and tyramine: Tyramine increases the risk of hypertensive crises with MAOIs.
32
Antibiotics Overview Front: What general information should be known about antibiotics?
Antibiotics Overview Front: What general information should be known about antibiotics?
Types of antibiotics: Bactericidal vs. bacteriostatic. Culture and sensitivity: Guides effective antibiotic choice. Superinfection: Secondary infection from normal flora destruction. Drug resistance: When bacteria no longer respond to antibiotics. Use guideline: Base on culture, sensitivity; avoid broad-spectrum when possible. Indications: Treatment of bacterial infections.
33
What are key points regarding beta-lactam antibiotics?
What are key points regarding beta-lactam antibiotics?
Beta-lactamase inhibitor: Protects penicillin from bacterial enzymes. Cross-allergy reactions: Possible among all beta-lactam antibiotics. Cephalosporins: Varied spectrum and efficacy with each generation. MOA: Inhibit bacterial cell wall synthesis. Major ADRs for penicillin, cephalosporin, Vancomycin: Allergic reactions, GI upset, nephrotoxicity, ototoxicity. Nursing interventions: Allergy monitoring, renal function tests.
34
What should be noted about tetracycline use?
What should be noted about tetracycline use?
Indication: Chronic bronchitis, acne, chlamydia. Contraindication: Pregnancy, children under 8. Major ADR: Tooth discoloration, photosensitivity. Client education: Avoid dairy, iron, antacids; sun protection. Food-drug interaction: Calcium and iron bind tetracycline. Nursing interventions: Administer on an empty stomach, educate on sun exposure.
35
What is important about UTI treatment?
What is important about UTI treatment?
Treatment: Based on urine culture and sensitivity. Antibiotics: Often start with a broad-spectrum like trimethoprim/sulfamethoxazole. Client education: Increase fluid intake, complete antibiotic course. Nursing interventions: Monitor for effectiveness and adverse reactions.
36
How do you handle aminoglycoside toxicity?
How do you handle aminoglycoside toxicity?
Toxicity signs: Ototoxicity, nephrotoxicity. Interventions: Monitor serum drug levels, renal function tests, hearing tests.
37
What are the major ADRs and nursing considerations for sulfonamides?
What are the major ADRs and nursing considerations for sulfonamides?
Major ADRs: Stevens-Johnson syndrome, hematologic effects. Contraindications: Sulfa allergy, G6PD deficiency. Nursing considerations: Monitor for skin reactions, encourage fluids, watch for signs of anemia.
38
What should patients know about fluoroquinolones like Ciprofloxacin?
What should patients know about fluoroquinolones like Ciprofloxacin?
Major ADR: Tendonitis, tendon rupture. Food-drug interaction: Avoid calcium-rich foods which can interfere with absorption. Client education: Report tendon pain, avoid sun exposure.
39
What antibiotics commonly cause C. diff, and what are the treatment choices?
What antibiotics commonly cause C. diff, and what are the treatment choices?
Antibiotics: Clindamycin, cephalosporins, fluoroquinolones. Symptoms: Diarrhea, abdominal pain. Treatment: Metronidazole, Vancomycin.
Compare Erythromycin and Azithromycin, and their ADRs.
Compare Erythromycin and Azithromycin, and their ADRs.
40
Outline the treatment, ADRs, and prevention for TB.
Outline the treatment, ADRs, and prevention for TB.
Treatment course: 6-9 months with a combination of drugs. ADRs of major drugs: Hepatotoxicity, peripheral neuropathy. Latent vs Active TB: Latent is non-infectious and asymptomatic; active is infectious and symptomatic. Drug resistance prevention: Directly observed therapy (DOT). Drug adherence: Essential to prevent resistance and ensure cure.
41
What are the considerations for antifungal medications like Amphotericin B and Azoles?
What are the considerations for antifungal medications like Amphotericin B and Azoles?
Amphotericin B: Used for severe systemic infections. Infusion reaction: Fever, chills, hypotension. Azole drugs: Used for less severe infections. Major ADR: Liver toxicity, GI upset. Nursing interventions: Pre-medicate for infusion reactions, monitor liver enzymes.
42
Discuss the MOA and major ADRs of antiviral drugs such as Acyclovir, Zidovudine, and Ritonavir.
Discuss the MOA and major ADRs of antiviral drugs such as Acyclovir, Zidovudine, and Ritonavir.
MOA of antiviral drugs: Inhibit viral DNA replication. Acyclovir: Used for herpes simplex and varicella-zoster virus. Major ADR of Acyclovir: Nausea, headache, renal toxicity. Zidovudine and Ritonavir: Used for HIV. MOA of Zidovudine and Ritonavir: Inhibit viral reverse transcriptase and protease, respectively. Major ADR: Bone marrow suppression (Zidovudine), GI upset (Ritonavir). Nursing interventions: Monitor blood counts, liver enzymes, educate on adherence.
43
High AST and ALT in blood indicates
liver injury/failure
44
if kidney is damaged what happens to GFR and what happens to BUN and creatinine
GFR goes down, and BUN and creatinine go up
45
empty stomach means
1 hr before meal, or 2 hours after a meal
46
1.A nurse is instructing her patient about a newly prescribed drug. Which of the following should be included in the teaching to help improve patient compliance and safety?
List of pharmacies where the drug can be obtained
Measures to alleviate any discomfort associated with adverse effects The cost of the brand-name drug compared to the generic form Statistics related to phase III of testing for the prescribed drug
List of pharmacies where the drug can be obtained
Measures to alleviate any discomfort associated with adverse effects The cost of the brand-name drug compared to the generic form Statistics related to phase III of testing for the prescribed drug
Measures to alleviate any discomfort associated with adverse effects
47
3.A male patient is admitted to the emergency room in distress. The nurse suspects an anaphylactic reaction from oral penicillin. Which assessment findings are important in making this diagnosis?
A) B) C) D) Ans:
A) B) C) D)
Blood pressure: 186/100, difficulty breathing Hematocrit (Hct): 32%, decreased urine output Temperature: 102oF, swollen joints
Profuse sweating, blood pressure: 92/58
A) B) C) D) Ans:
A) B) C) D)
Blood pressure: 186/100, difficulty breathing Hematocrit (Hct): 32%, decreased urine output Temperature: 102oF, swollen joints
Profuse sweating, blood pressure: 92/58
A
48
Alterations in glucose metabolism can occur from use of oral antidiabetic drugs. A nurse will observe patients who are taking these drugs for which of the following?
Increased urination
Deep Kussmaul's respirations
Increased hunger
Tremors and lack of coordination
Increased urination
Deep Kussmaul's respirations
Increased hunger
Tremors and lack of coordination
D
49
9.A patient is being seen in the clinic for rheumatoid arthritis. Which of the following statements would indicate that she may be developing a complication from her rheumatoid medication, chloroquine (Aralen)?
A) “I have to urinate all the time.”
B) “Sometimes I have blurred vision.”
C) “I have tingling and numbness in my arms and legs.”
D) "Sometimes I feel like I am losing my balance when I walk"
A) “I have to urinate all the time.”
B) “Sometimes I have blurred vision.”
C) “I have tingling and numbness in my arms and legs.”
D) "Sometimes I feel like I am losing my balance when I walk"
B
50
A 68-year-old patient who must take antihistamines for severe allergies is planning a vacation to Mexico. The nurse will encourage the patient to:
Avoid sightseeing during the hottest part of the day
Discontinue the antihistamines if he becomes extremely restless
Decrease the dosage of the drugs if he experiences excessive thirst Continue taking the antihistamines even if he begins to hallucinate
Avoid sightseeing during the hottest part of the day
Discontinue the antihistamines if he becomes extremely restless
Decrease the dosage of the drugs if he experiences excessive thirst Continue taking the antihistamines even if he begins to hallucinate
A. Antihistamines can cause anticholinergic effects, which block the parasympathetic nervous system by blocking cholinergic receptors, and decrease sweating, placing the patient at high risk for heat stroke. Avoiding the hottest part of the day will help prevent dehydration and heat prostration. Extreme restlessness could indicate Parkinson-like syndrome not usually associated with antihistamines. Excessive thirst is characteristic of hyperglycemia, and hallucinations are associated with drugs that affect neurologic functioning. Nurses should never tell patients to decrease or discontinue a drug unless the prescriber has instructed them to do so.
51
gram positive examples
strep and staphylococci enterocci
52
gram negative example
e coli pseudomonas
53
MIC is the lowest
concentration of an antibiotic that completely surpresses the growth of microorganisms
54
empiric therapy
making an educated guess if you can't confirm the exact cause of a sickness in time
55
sulfonamides in relation to pregancy
can produce kernicterus a severe neurologic disorder in newborns
56
genatamicin causes what in babies
hearing loss
57
what can tetracylclines due to a baby and a pregnant mother
cause discoloration in developing teeth, liver toxicity to the mother
58
mechanism of action for sulfonamides
block synthesis of things necessary for growth and metabolism of the cell
59
penicillins, cephalosporins, and vancomycin MOA
inhibit formation of the cell wall
60
fluoroquinolones MOA
inhibit dna gyrase, the enzyme that are required for production
61
aminoglycosides, macrolides, ketolides, tetracyclines, linezolid, and quinipristin/dalfropristin
bind to ribosomes and inhibit production of essential proteins
62
B-lactam antibiotics
weaken the bacterial cell wall (counters beta lactamase produced by the pathogen to make the drug ineffective) like penicillins
63
is penicillin bacteriacidal or static
bacteriacidal
64
treatment for penicllin AR like rash. what other AR is most common?
epinephrine, cephalosporin. diarrhea
65
penicillins should be combined with ____ in the same iv solution. why?
aminoglycosides (gentamicin). penicillin will inactivate it
66
cephalosporin is very similar to penicillin, what is the route for admin.
IV OR IM
67
As you go up in generations for cephalosporins, do they become more effective against gram - organisms and anaerobes or less
More
68
as you go up in generations for cephalosporins, do they more or less likely to be destroyed by beta-lactamase
less likely
69
as you go up in generations for cephalosporins, are they more or less likely to reach BBB
MORE. you would rather use 5th to treat brain infections
70
First generation cephalosporins can't
penetrate bbb
71
First generation cephalosporins are really only good against gram positive or negative bacteria?
positive
72
give an example of a First generation cephalosporins, and the route of admin
cefazolin. IM OR IV
73
what would you use a 1st gen cephalosporin for
surgical prophylaxis (prevention of disease and infections) in most surgical procedures, gram positive bacteria
74
for second generation cephalosporin what kind of drugs fall under this generation, also say their routes
cefaclor for PO, cefotetan for IM or IV
75
what would u use 2nd gen cephalosporin for
surgical prophylaxis, gyn and gi surgery, poor bbb penetration but adequate for meningitis
76
For 3rd and 4th generation (r)
3rd gen, penetration to BBB is better along with activity against gram negative pathogens, 4th is even better
77
which drugs are in 3rd generation cephalosporin
cefotaxime (claforan), cetriaxone, IM or IV use
78
examples of 4th generation ceph. drugs
maxipime (cefepime) for IM or IV
79
example of 5th gen ceph, drugs. what are they effective against?
ceftaroline for IV use only. MRSA
80
carbanapems are, broad or narrow spectrum, cidal or static?
broad spectrum, bactericidal
81
monobactam are active against
gram negative bacteria
82
is vanco a narrow or broad spectrum, and is it from gram postive or negative
narrow. gram positive
83
what is vanco for
people allergic to penicillin, mrsa, inhibiting cell wall synthesis
84
what is a major adr of vanco. what do you do?
renal failure. administer over an hour, if issue occurs, slow infusion, give antihistamine
85
macrolide/ antibacterial examples
azithromycin, erythromycin (oral and iv) (static drugs). for resp or soft tissue infections
86
Which statement about erythromycin is correct?
A It inhibits cell wall formation of organisms
B It used to treat infections in clients who are allergic to penicillin C liver function should be monitored when clients are on the drugs D teach clients to take it with meals usually
E Monitor ECG for this drug
A It inhibits cell wall formation of organisms
B It used to treat infections in clients who are allergic to penicillin C liver function should be monitored when clients are on the drugs D teach clients to take it with meals usually
E Monitor ECG for this drug
b
87
aminoglycosides: static or cidal? - or +. pregnancy category? example
static, -. category D. gentamicin
88
AMINOGLYCOSIDE ADR (read)
Nephrotoxicity occurs in 5 to 25% -monitor I&O, BUN and creatine, report hematuria and cloudy urine
• Ototoxicity occurs in 3 to 14%-hearing loss for cochlear damage, loss of balance for vestibular
damage(Monitor for tinnitus, vertigo, headache, hearing loss, nausea, dizziness)
• Ototoxicity occurs in 3 to 14%-hearing loss for cochlear damage, loss of balance for vestibular
damage(Monitor for tinnitus, vertigo, headache, hearing loss, nausea, dizziness)
89
peak levels mean
amount of drug present in blood plasma after admin of drug IM or 30 min after IV infusion completion
90
Tetracyclines static or cidal , broad or narrow
static, broad
91
prototype drug for penicillin
ampicillin
92
carbapenems prototype drug, route?
imipenem-cilastin for IM or IV use
93
monobactam prototype drug
aztreonam
94
aminoglycosides prototype drug
gentamicin (garamycin)
95
prototype drug for sulfonamied and trimethoprim
trimethopram/ sulfamethoxazole, trade name bactrim, spetra, tmp/smx, co-trimoxazole- powerful
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