NURS 340 EXAM 3 NEWEST NURS 340 HEALTH

NURS 340 EXAM 3 NEWEST /NURS 340 HEALTH

ASSESSMENT EXAM AND PRACTICE QUESTIONS

NEWEST ACTUAL EXAM 150 QUESTIONS AND

CORRECT DETAILED ANSWERS AND RATIONALES

(VERIFIED ANSWERS) |ALREADY GRADED A+

A nurse is preparing to administer the antibiotic for a hospitalized patient who acquired a Methicillinresistant 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 - CORRECT 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 - CORRECT 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

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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." - CORRECT 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 - CORRECT 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 are cephalosporins? - CORRECT ANSWER--Most widely used group of antibiotics -Beta-lactam antibiotics -Similar to penicillin structure -Bactericidal -Broad spectrum 2 / 4

-Usually given parenterally -Toxicity is low

What are the cephalosporin pharmacokinetics? - CORRECT ANSWER-Administration/Absorption Limited number by po; may take with food More commonly by IM or IV Only cefuroxime available by oral (Ceftin) & parenteral (Zinacef)routes

Distribution Well-distributed to most tissue

Exceptions:

Ocular fluid CSF for 1st & 2nd generation

Elimination Renal Reduce dosage for renal insufficiency to prevent toxic accumulation

Hepatic Only one - 3rd generation ceftriaxone (Rocephin) Dosage reduction not necessary for renal insufficiency

What cephalosporin drug is eliminated through the liver? - CORRECT ANSWER-3rd generation ceftriaxone (Rocephin)

Dosage reduction not necessary for renal insufficiency

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First generation cephalosporin drugs are mostly used for? - CORRECT ANSWER-Most widely used for pre-op prophylaxis Rarely used for active infections

What are second generation cephalosporins commonly used for? - CORRECT ANSWER-May be used for respiratory, abdominal, or pelvic infections

What generation of cephalosporins are preferred? - CORRECT ANSWER-Third generation Preferred therapy More active against gram negative aerobes

What generations of cephalosporins are highly resistant to beta lactamases? - CORRECT ANSWER- Both 3rd & 4th generation highly resistant to beta lactamases reach clinically significant levels in CSF

What is Ceftaroline (Teflaro)? - CORRECT 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? - CORRECT 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

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