Chapter 3 Clinical Reasoning and Decision-Making Activities

You can review additional information regarding these answers in the corresponding section in which the Critical Thinking activities appear.

Activity Section 3.2a

Client education regarding the importance of adhering to the prescribed medication regimen is vital to help prevent drug resistance.  During client education, the nurse should emphasize the need to complete the full course of medication, in the dosages and frequencies prescribed, to treat the infection and prevent the dangers of drug resistance.  In addition to client education, another solution used to prevent drug resistance in high-risk medications is called directly observed therapy (DOT).  DOT is the supervised administration of medications to clients. Clients are required to visit a health-care facility to receive their medications or a health-care professional administers medications in the clients’ homes or other designated location. DOT has been implemented worldwide for the treatment of tuberculosis (TB), and research has been shown it to be effective in treating infections successfully and preventing additional drug resistance.

Activity Section 3.5a

The administration of penicillin should be postponed for four hours because citrus juice can impede absorption of drugs like penicillin.  The remaining doses of penicillin for the day should be rescheduled based on the time the breakfast dose was actually administered. Additionally, the client should be educated about avoiding citrus juice while taking penicillin, and the dietary department should be notified to remove citrus juice from the meal choices.

Activity Section 3.6a

The changes in the client’s renal labs demonstrate decreased renal function.  The prescribing provider should be notified prior to administering additional doses of cefazolin because the medication or the dosage will likely need to be revised based on the client’s response.

Activity Section 3.7a

The nurse should check the progress notes in the electronic medical record to determine if anything is documented about John’s allergies and the decision to use imipenem. If nothing is documented, then the nurse should notify the prescribing provider of the client’s allergies to penicillin to confirm the appropriateness of this medication for John, document the provider’s response in the medical record, and provide this information in the end-of-shift handoff report.

Activity Section 3.8a

Monobactams are narrow-spectrum antibacterial medications used primarily to treat gram-negative bacteria like Pseudomonas aeruginosa.  However, MRSA is a gram-positive bacteria, so aztreonam will not be effective in fighting this infection.  The nurse should notify the prescribing provider of the results of the new culture report before administering the azotreonam.

Activity Section 3.9a

The nurse should review the other medications the client is taking.  Trimethoprim-Sulfamethoxazole has many significant drug interactions, including oral diabetics.   This medication may increase hypoglycemic effects requiring closer monitoring of blood sugars.  Additionally, the client’s renal status should be verified before administration of trimethoprim-sulfamethoxazole because dose adjustment may be required.

Activity Section 3.10a

The nurse should immediately stop the medication and notify the provider regarding the new onset of tendon pain because this symptom indicates an adverse reaction of levofloxacin may be occurring.

Activity Section 3.11a

The nurse should notify the provider of the client’s change condition because it may indicate an adverse effect of liver damage is occurring.

Activity Section 3.12a

The nurse should not administer the medication until the trough levels have been drawn.   The nurse should phone the lab and check on the status of the laboratory trough level.

Activity Section 3.13a

The client is under the age of six and is at risk for the adverse effect of teeth discoloration.  The nurse should advocate for this client by notifying the prescribing provider of this concern and requesting an alternate medication.

Activity Section 3.14a

Oseltamivir should be administered within the first 24-48 hours of the onset of influenza symptoms.  The client may have already passed the window for maximum therapeutic effectiveness of oseltamivir.  The provider should be notified regarding the onset of symptoms to clarify the prescription.

Activity Section 3.15a

If there are no signs of improvement from the prescribed medication therapy, the nurse should notify the provider.

Activity Section 3.16a

In order to prevent malaria, the CDC recommends clients should take antimalarial medications for four weeks after leaving the infected area.  The nurse should provide additional client education to the client regarding this recommendation and evaluate for client understanding.

Activity Section 3.17a

Metronidazole is commonly used to treat C-diff.  The medication must be given by mouth for the indication of a gastrointestinal infection like C-diff.

Activity Section 3.18a

The nurse should provide education regarding the use of the medication, as well as ways to prevent re-infection. Methods to prevent reinfection include using proper handwashing, washing all fruits and vegetables, and wearing shoes in the barn or where animals and their feces are present.

Activity Section 3.19a

The nurse should explain that directly observed therapy (DOT) means the administration of this medication will be supervised to ensure all doses are taken as prescribed to be sure the infection is treated properly and drug resistance does not develop. The client will be required to visit a health-care facility to receive their medications or a health-care professional will administer the medication in the client’s home or other designated location.

Activity Section 3.20a

The nurse should not administer the vancomycin until after the trough level is drawn.  The nurse should call the lab to request prioritization of completing the trough level.