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NUR 340 Exam 3 Questions And Accurate Solutions
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NUR 340 Exam 3 Questions And AccurateSolutions 2024-2025
A nurse is preparing to administer the antibiotic for a hospitalized patient who acquired
a Methicillin-resistant Staph. aureus 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,
resistant to all penicillins and all cephalosporins. Because most strains of MRSA are
multidrug resistant many other antibiotics are ineffective, tetracyclines, clindamycin,
trimethoprim/sulfamethoxazole, beta-lactam agents, except ceftaroline. Preferred drugs
are IV vancomycin, linezolid [Zyvox], daptomycin [Cubicin], telavancin [Vibativ],
clindamycin, and ceftaroline. See Lehne p. 1017
A new prescription is transcribed for potassium penicillin G IV q 8 hr and gentamicin IV
q 12 hr. Which of the following plans represents the best schedule for administering
these drugs? a) Penicillin: 0800, 1600, 2400 Gentamicin: 1200, 2400 b) Penicillin: 0600,
1400, 2200 Gentamicin: 0600, 1800
c.) at 0800, 1600, and 2400; gentamicin at 0600 and 1800
d.) at 0100, 0900, and 1700; gentamicin at 0900 and 1800 Answer: Answer: C Rationale:
Gentamicin should never be given simultaneously with penicillin, as they will interact,
and the penicillin may inactivate the aminoglycoside. All options, except A, reflect
simultaneous administration. See Lehne p. 1064
A landscaper client is being discharged to home. The client has been prescribed
,Ciprofloxacin (Cipro) for outpatient therapy. Which of the following should the nurse
teach the client during discharge instructions?
"You can take the medication with milk of magnesia."
"Wear sunscreen and protective clothing when outside."
"Take the medication with crackers and cheese."
"Take the medication until all symptoms have cleared up." Solution "Wear sunscreen
and proper covering when out in the sun."
Rationale: Due to the fact that this medication can cause phototoxicity, the patient
should be counseled to wear sunscreen and protective clothing if they are outside. Like
most medications, this should be taken until it is gone, not just until symptoms are
improved. Absorption of fluoroquinolones are reduced when given with a number of
products including aluminum or magnesium containing antacids and milk or other dairy
products. See Lehne p. 1087
A client is hospitalized and receiving gentamicin (Garamycin) 80 mg IV b.i.d. for acute
osteomyelitis. Which information about the client is most valuable for the nurse to
gather prior to administration of the gentamicin?
a) oral temperature
b) reports of nausea
c) BUN and creatinine levels
d) when an antacid was administered - Answer Answer: C
Rationale: While the patient's temperature will be monitored routinely in the hospital, the
potential for the development of renal failure due to nephrotoxicity from gentamicin
requires monitoring of renal function. Nausea is not a frequent side effect of IV
gentamicin. Because the drug is given IV, an antacid will not impact absorption of the
gentamicin.
A patient has developed hospital-associated MRSA. The nurse can expect which
medication to be prescribed to treat this infection?
vancomycin (Vancocin)
,TMP/SMZ (Bactrim)
imipenem (Primaxin)
azithromycin (Zithromax) - Answer Answer: Vancomycin
Rationale: MRSA resists all of the penicillins and cephalosporins. These include beta
lactam antibiotics such as imipenem. Most strains of MRSA are also resistant to many
other antibiotics. The drug of choice is vancomycin although there are others that may
be used. TMP/SMZ is a preferred drug for communityacquired MRSA. Azithromycin is a
macrolide used for respiratory and skin infections as well as other infections such as
mycobacterium avium and chlamydia.
A patient who is receiving penicillin starts wheezing and says he has a feeling of
impending doom. The nurse finds that the blood pressure is 88/47 mm Hg. with a
thready pulse of 120 beats per minute. Which order will the nurse carry out first?
A.) 500 mL IV fluid bolus
B.) oxygen at 3L per nasal cannula
C.) epinephrine
D.) get an oropharyngeal airway device - Answer Answer: C
Rationale: The priority is to reverse the allergic reaction. This can be done by
administering epinephrine which is utilized for the treatment of anaphylaxis which the
patient is manifesting. If the reaction is not reversed, an airway may be necessary.
Oxygen is given after the epinephrine has been administered or a second nurse can
apply the oxygen as the epinephrine is being given. IV fluids could be considered but
only if the blood pressure does not improve after the administration of epinephrine.
Epinephrine is still the first line of treatment. See Lehne, p. 1020
The nurse is preparing to initiate penicillin G for a patient and is reviewing the patient's
laboratory test results. Which of the following elevated laboratory test results is a
contraindication to penicillin G? hematocrit and hemoglobin BUN and creatinine liver
enzymes SGOT and ALT PT/INR - Answer BUN and creatinine
Rationale: Treatment with the penicillin drugs requires normal renal function. The BUN
and creatinine level are indications of renal status. PT/INR is indicated for warfarin, not
, pencillin. Penicillin does not affect red cell production or cause bleeding so hematocrit
and hemoglobin are not needed. SGOT and ALT are indicated for drugs which are
hepatotoxic, which penicillin is not. See Lehne, p. 1062
Which of the following constitutes a suprainfection?
A.) peritonitis that developed after surgery for a ruptured appendix
B.) monilial vaginal infection that developed during antibiotic therapy
C.) pneumonia in a patient with chronic obstructive pulmonary disease
D.) varicella outbreak after injection with varicella vaccine - Answer Answer: B
Rationale: "A suprainfection is defined as a new infection that appears during the
course of treatment for a primary infection." Normal flora are inhibited by the antibiotic
which then allows a secondary infectious agent to thrive.
An hour after the infusion of amphotericin B was initiated, the client suddenly
experiences fever, chills, rigors, and nausea. Which of the following medications,
ordered prn for this client, should the nurse administer now?
diphenhydramine (Benadryl)
acetaminophen (Tylenol)
dantrolene (Dantrium)
hydrocortisone - Answer Dantrolene
Rationale: Symptoms of an infusion reaction include fever, chills, rigors, and nausea.
This reaction occurs within 1 to 3 hours after the infusion is initiated and can remain for
an hour. Rigors are treated with intravenous dantrolene or meperidine. Mild reactions
may be minimized with pre-treatment with acetaminophen and diphenhydramine.
Glucocorticoids are used if other measures are not successful but weaken the patient's
ability to fight the infection. See Lehne pg 1138.
The nurse is preparing to administer a dose of amphotericin B and is reviewing the
patient's test results prior to drug administration. The nurse's priority would be to
review which one of the following tests?
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