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NUR 340 Exam 3 Questions And 100% Accurate Answers
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NUR 340 Exam 3 Questions And 100%Accurate Answers
A nurse is preparing to administer the antibiotic for a hospitalized patient who acquired
a Methicillin-resistant Staph. aureus (MRSA) infection. Based on the nurses' knowledge
of antibiotics for the treatment of MRSA, which medication may be ordered?
Vancomycin
Neomycin
Cefazolin
Ceftaroline
Metronidazole
Piperacillin - Answer Answer: Vancomycin and ceftaroline
Rationale: Methicillin-resistant Staph. aureus(MRSA), highly resistant bacteria, are
resistant to all penicillins and all cephalosporins. Because most strains of MRSA are
multidrug resistant, many other antibiotics are ineffective, including tetracyclines,
clindamycin, trimethoprim/sulfamethoxazole, and beta-lactam agents (except
ceftaroline). Preferred drugs are IV vancomycin, linezolid [Zyvox], daptomycin
[Cubicin], telavancin [Vibativ], clindamycin, and ceftaroline. See Lehne p. 1017
A nurse transcribes a new prescription for potassium penicillin G given intravenously
(IV) q 8 hours and gentamicin IV q 12 hours. Which plan is the best schedule for
administering these drugs?
a.) penicillin at 0800, 1600, and 2400; gentamicin at 1200 and 2400
b.) penicillin at 0600, 1400, and 2200; gentamicin at 0600 and 1800
c.) penicillin at 0800, 1600, and 2400; gentamicin at 0600 and 1800
d.) penicillin at 0100, 0900, and 1700; gentamicin at 0900 and 1800 - Answer Answer: C
Rationale: Gentamicin should never be administered concurrently with penicillin,
because they will interact, and the penicillin may inactivate the aminoglycoside. All
options except A show concurrent administration. See Lehne p. 1064
,A patient who works as a landscaper is preparing to be discharged home. Ciprofloxacin
(Cipro) has been prescribed for outpatient therapy. Which of the following will the nurse
include in the discharge teaching for this patient?
"You may take the medication with milk of magnesia."
"Use sunscreen and protective clothing when outdoors."
"Take the medication with crackers and cheese."
"Take the medication until all symptoms subside." - Answer "Use sunscreen and
protective clothing when outdoors."
Rationale: The patient, a landscaper, should be advised to wear sunscreen and
protective clothing when outdoors, because the medication may cause phototoxicity.
The medication should be taken until it is gone, not just until the patient's symptoms are
improved. Absorption of fluoroquinolones is reduced when taken with a number of
products including aluminum or magnesium containing antacids and milk or other dairy
products. See Lehne p. 1087
A hospitalized patient is receiving gentamicin (Garamycin) 80 mg IV twice daily for acute
osteomyelitis. Which data about the patient is most important for the nurse to obtain
before administering the gentamicin?
a.) oral temperature
b.) reports of nausea
c.) BUN and creatinine levels
d.) when an antacid was administered - Answer Answer: C
Rationale: Although the patient's temperature will be monitored on a regular basis in the
hospital, gentamicin is nephrotoxic and can cause renal failure. Therefore monitoring
renal function is critical. Nausea is not a common side effect of IV gentamicin. Because
the drug is administered IV, an antacid will not affect absorption of the gentamicin.
What is Ceftaroline (Teflaro)? - Answer New cephalosporin
*Only cephalosporin effective against MRSA*
,May be classified as 3rd generation because of antimicrobial spectrum, but sometimes
classified as 5th generation
What are the adverse reactions from cephalosporins? - Answer Rare
Allergic reactions
Most common: maculopapular rash within several days of starting treatment
Severe anaphylactic reaction rare: epinephrine & respiratory support
Rarely may see cross-reactivity with penicillin
What is a side effect of the following antibiotic, cefotetan (Cefotan)? - Answer Interferes
with vitamin K metabolism and may cause subsequent bleeding
Can cause symptoms of alcohol intolerance similar to disulfiram (Anatbuse)
What is a side effect of this antibiotic, Ceftriaxone (Rocephin) + calcium? - Answer
Potentially fatal precipitates
Give oral calcium and parenteral ceftriaxone
Do not give IV ceftriaxone with calcium-containing IVF
Ringer's solutions
What is vancomycin used for? - Answer Severe infections only
-Staphylococcus epidermidis or methicillin-resistant Staphylococcus aureus
-Pseudomembranous colitis due to antibiotics
Oral dose used for Clostridium difficile if metronidazole (Flagyl) fails
Vancomycin side effects- Answer- Ototoxicity (reversible and permanent)
Red man syndrome
, Histamine release causing flushing, pruritus, urticaria, tachycardia & hypotension
Prevent: give over at least 60 minutes
-Thrombophlebitis (very common)
-Thrombocytopenia (rare)
-Allergic reaction
Red man syndrome symptoms- Answer flushing, pruritus, urticaria, tachycardia, &
hypotension
is an infusion-related reaction peculiar to vancomycin [3]. It typically consists of
pruritus, an erythematous rash that involves the face, neck, and upper torso
Aminoglycosides - What are they? Most common: gentamicin, tobramycin, amikacin
Bactericidal
Narrow -spectrum
Used for treatment of serious infections
Adverse effects
Ototoxicity
Nephrotoxicity
Monitor trough and peak serum levels
Levels may vary among patients at same dose
Trough levels should be low enough to avoid toxicity, yet peak levels must be high
enough to exert a killing effect on the bacteria
Timing is everything-peak levels: 30 minutes postadministration, trough levels: before
next dose
What is Ciprofloxacin (Cipro)? -Answer Fluoroquinolone
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