A 32 year old preschool teacher complains of difficulty swallowing, sore throat, and chills. She is febrile with a temperature of 101.6 along with white patches on her tonsils. Her rapid strep test is positive. Her past medical history is positive for an anaphylactic reaction to cefaclor two years ...
a 32 year old preschool teacher complains of difficulty swallowing
and chills she is febrile with a temperature of 101
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NRNP 6566 (NRNP6566)
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Question 1
A 32 year old preschool teacher complains of difficulty swallowing, sore throat, and chills.
She is febrile with a temperature of 101.6 along with white patches on her tonsils. Her
rapid strep test is positive. Her past medical history is positive for an anaphylactic
reaction to cefaclor two years ago. What antibiotic could be safely utilized in this patient?
Correct
Answer: Streptococcus is usually treated with amoxicillin. Her type 1 anaphylactic re-
action to a cephalosporin means you should not use a cephalosporin or peni-
cillin. Acceptable alternatives would be macrolide such as azithromycin or
clindamycin.
Question 2
A 20-year old woman was seen by her primary care provider last week and diagnosed
with a lower track UTI. Her complaints at that time included burning on urination,
frequent urination of a small amount, and superpubic pain. She was prescribed a 3 day
course of Bactrim which she completed. She is admitted to the step down unit today with
complaints of fever (102.6 and above) for the past 24 hours and CVA tenderness. She
appears very ill and is somewhat confused today. Her BP is 100/62. Her family indicates
that she has been vomiting for the last 24 hours and been unable to keep food or fluids
down.
What would your initial plan for this patient include?
Correct
Answer: This patient has classic symptoms of pyelonephritis as well as sepsis. Her high
temperature, low blood pressure, vomiting, dehydration, and confusion
indicate a need for admission and IV antibiotics. Initial antibiotic options
include ceftriazone or ciprofloxin PLUS gentamicin OR ampicillin/ sulbactam.
Intravenous fluid administration is also indicated. According to the Surviving
Sepsis campaign, an initial bolus of 30 ml/kg over 30-60 minutes should be
administered. Urine culture and sensitivity should be sent. Antibiotics should
be adjusted based on the results of these tests.
Question 3
A 26 year old male is scheduled for a lumbar laminectomy tomorrow. Penicil-lin causes a
rash in this patient. His preoperative orders include cefazolin 2 gm IV to be given on call
to the OR. The NP is called to change the antibiotic order due to the patients allergy.
What is the best action for the NP to take?
Correct
Answer: There is a 5-8% cross allergy between pencilling and cephalosporins in pa-
tients that are allergic to penicillin. The most current literature indicates that
patients with a Type 1 anaphylactic reaction to penicillin should not be given
cephlosporins. Since this patient has a rash reaction, proceeding with the
cefazolin order would be within the current recommendations. Some facilities
This study source was downloaded by 100000839287192 from CourseHero.com on 03-08-2022 13:03:24 GMT -06:00
, still have guidelines in place that would prevent a penicillin allergy patient
from getting a cephlosporin. In this instance, the Surgical Care Improvement
Pro-ject (SCIP) includes alternate recommendations of Vancomycin 1-2 grams
IV 1 hour prior to surgery or Clindamycin 900 mg IV 1 hour prior to surgery.
Question 4
What factors are considered when making empiric antibiotic decisions? Apply those
factors to a patient with suspected acute otitis media.
Correct
Answer: Once a clinical diagnosis is made based on patient symptoms and exam
findings, factors that assist in making empiric antibiotic decisions include the
most common bacteria that cause this type of infection, the patients
immunocompetence status, knowledge of any recent antibiotic use, past
medical history, and recent health history,
The most common bacterial pathogen for acute otitis media is streptococcal
pneumoniae followed by haemophilus influenza and moraxelia catarrhalis. If
the patient has a competent immune system and no previous antibiotics in the
past 30 days, then amoxicillin or amoxicillin / clavulanic acid would be
considered the best first line treatment.
If the patient had been on amoxicillin for a throat infection two weeks ago,
then a different antibiotic such as cefdinir or cefuroxime (considered second
line antibiotic) would be selected now. It would be assumed that the bacteria
causing the acute otitis is not sensitive to the amoxicillin that was given
previously. Also, the cephlosporins have more activity against gram negative
bacteria (such as H. Influenza and M. Catarrhalis) then amoxicillin does.
Recent inpatient hospitalizations or more than two episodes of acute otitis
media in the past few months may also indicate the need to choose a second
or third line antibiotic because of suspected resistance to the first line drug
(amoxicillin).
Question 5
A 42 year old female has a severe bacterial infection. She is being treated with a broach
spectrum IV drug. The drug is administered too rapidly causing hypotension, flushing and
itching over the upper portion of her chest, neck, and face. What antibiotic is likely
responsible for these symptoms?
Correct
Answer: Vancomycin is the likely culprit in causing these symptoms. This is common-
ly referred to as “red man” syndrome. These are caused by histamine relief
when vancomycin is infused too rapidly.
This study source was downloaded by 100000839287192 from CourseHero.com on 03-08-2022 13:03:24 GMT -06:00
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