Question: A healthcare professional is reviewing the medication list of a patient who has been prescribed metronidazole. The professional knows that concurrent use of metronidazole with which of the following medications requires careful monitoring due to an increased risk of side effects?
A) Acetaminophen
B) Warfarin
C) Aspirin
D) Metformin
E) Atorvastatin

Correct Answer: B) Warfarin

Rationale: Metronidazole can potentiate the anticoagulant effect of warfarin, leading to an increased risk of bleeding. This interaction occurs because metronidazole inhibits the metabolism of warfarin, thereby increasing warfarin’s plasma concentration and prolonging its therapeutic effects. It is crucial to monitor the patient’s international normalized ratio (INR) more closely when these medications are used together. Adjustments to the warfarin dosage may be necessary to maintain therapeutic INR levels and prevent bleeding complications.

Question: When educating a patient about taking metronidazole, the nurse should advise the patient to avoid which of the following during the course of treatment?
A) Dairy products
B) High-fiber foods
C) Alcohol
D) Caffeinated beverages
E) Acidic foods

Correct Answer: C) Alcohol

Rationale: Metronidazole can interact with alcohol, leading to a disulfiram-like reaction. This reaction can cause symptoms such as flushing, nausea, vomiting, tachycardia, and headache. The mechanism involves the inhibition of aldehyde dehydrogenase, which leads to an accumulation of acetaldehyde when alcohol is consumed. Educating patients to avoid alcohol during and for at least 48 hours after completing metronidazole treatment is crucial to prevent these unpleasant and potentially harmful effects.

A) Peripheral neuropathy
B) Acute renal failure
C) Myocardial infarction
D) Pulmonary embolism
E) Hemolytic anemia

Correct Answer: A) Peripheral neuropathy

Rationale: Peripheral neuropathy is a serious adverse effect of metronidazole, characterized by numbness, tingling, or pain in the hands or feet. This side effect is thought to result from prolonged use of high doses of metronidazole, leading to nerve damage. Although rare, it is important to monitor patients for signs of peripheral neuropathy, especially those on long-term or high-dose therapy. Early detection and management are crucial to prevent permanent nerve damage.

Question: During a follow-up visit, a patient reports experiencing dark-colored urine while taking metronidazole. The nurse recognizes that this symptom is:

A) An indication of acute liver failure.
B) Expected and not harmful.
C) A sign of severe dehydration.
D) An allergic reaction to the medication.
E) A symptom of renal impairment.

Correct Answer: B) Expected and not harmful

Rationale: Metronidazole can cause the urine to darken in color, which is a benign side effect and not indicative of harm to the patient. This change is due to the presence of metabolites of the drug in the urine and does not reflect liver failure, dehydration, an allergic reaction, or renal impairment. It’s important for healthcare providers to inform patients about this potential side effect to prevent undue alarm and ensure that patients continue their medication regimen as prescribed without interruption.

Question: A patient receiving metronidazole IV for a bacterial infection develops flushing, tachycardia, and hypotension shortly after the infusion starts. The nurse recognizes these symptoms as indicative of:
A) Anaphylactic reaction.
B) Red man syndrome.
C) Disulfiram-like reaction.
D) Stevens-Johnson syndrome.
E) Infusion reaction specific to metronidazole.

Correct Answer: E) Infusion reaction specific to metronidazole

Rationale: While the symptoms described could suggest several conditions, in the context of metronidazole infusion, they are likely indicative of an infusion reaction specific to this medication. Such reactions can occur with rapid administration and may include flushing, tachycardia, and hypotension. This is distinct from anaphylactic reactions, which are severe allergic responses, and disulfiram-like reactions, which are related to alcohol consumption. Red man syndrome is typically associated with vancomycin, and Stevens-Johnson syndrome is a severe skin reaction. Monitoring the rate of infusion and patient response is critical to managing and preventing severe infusion reactions.

Question: A patient on metronidazole therapy reports experiencing dizziness and confusion. The nurse is aware that these symptoms can be attributed to:
A) Normal aging process.
B) Expected side effects of metronidazole.
C) Insufficient dietary intake.
D) Early signs of dementia.
E) Dehydration.

Correct Answer: B) Expected side effects of metronidazole

Rationale: Dizziness and confusion are known central nervous system side effects of metronidazole. These symptoms can occur due to the drug’s ability to cross the blood-brain barrier and affect central nervous system function. While these effects can be concerning, they are generally reversible upon discontinuation of the drug. It’s important for healthcare providers to assess the severity of these symptoms, as they may necessitate a review of the patient’s treatment regimen, especially in those with pre-existing CNS conditions.

Question: A healthcare provider is considering the use of metronidazole for a patient with a history of alcoholism. The provider knows that caution is advised because:
A) Metronidazole increases cravings for alcohol.
B) The drug can lead to hepatotoxicity in patients with a history of alcoholism.
C) Metronidazole has a high alcohol content.
D) The disulfiram-like reaction risk is increased.
E) Alcohol decreases the effectiveness of metronidazole.

Correct Answer: D) The disulfiram-like reaction risk is increased

Rationale: In patients with a history of alcoholism, the use of metronidazole requires caution due to the increased risk of a disulfiram-like reaction if the patient consumes alcohol during treatment. This reaction is characterized by nausea, vomiting, flushing, tachycardia, and hypotension. It occurs because metronidazole inhibits aldehyde dehydrogenase, leading to an accumulation of acetaldehyde when ethanol is ingested. Educating patients about the importance of abstaining from alcohol during and for at least 48 hours after the completion of metronidazole therapy is crucial to avoid this potentially severe reaction.