Ch 39 Antibiotics Affecting The Bacterial Cell Wall

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Antibiotics Quizzes & Trivia

Quiz for Ch 39 Antibiotics affecting the bacterial cell wallGSU Fall 2009


Questions and Answers
  • 1. 

    Which of the following classes of antibiotics is most likely to induce an allergic reaction?

    • A.

      Aminoglycosides

    • B.

      Macrolides

    • C.

      Penicillins

    • D.

      Cephalosporins

    Correct Answer
    C. Penicillins
    Explanation
    Penicillins are the most likely class of antibiotics to induce an allergic reaction. This is because penicillins contain a beta-lactam ring structure, which can trigger an immune response in some individuals. Allergic reactions to penicillins can range from mild skin rashes to severe anaphylaxis. Other classes of antibiotics, such as aminoglycosides, macrolides, and cephalosporins, are generally less likely to cause allergic reactions compared to penicillins.

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  • 2. 

    Generally speaking, penicillin G in ineffective if the management of

    • A.

      Most gram-negative bacteria infections

    • B.

      Gram-positive anaerobic infections

    • C.

      Gram-positive spirochete infections

    • D.

      Endocarditis prophylaxis

    Correct Answer
    A. Most gram-negative bacteria infections
    Explanation
    Penicillin G is generally ineffective against most gram-negative bacteria infections. Gram-negative bacteria have an outer membrane that makes it difficult for penicillin to penetrate and reach the target site. Additionally, gram-negative bacteria produce enzymes called beta-lactamases that can break down penicillin and render it ineffective. Therefore, alternative antibiotics or combination therapies are usually required to treat gram-negative bacterial infections.

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  • 3. 

    Which of the following routes is inappropriate for administration of penicillin?

    • A.

      PO

    • B.

      SC

    • C.

      IM

    • D.

      IV

    Correct Answer
    B. SC
    Explanation
    The route of administration that is inappropriate for penicillin is subcutaneous (SC). Penicillin is typically administered orally (PO), intramuscularly (IM), or intravenously (IV). Subcutaneous administration involves injecting the medication into the fatty tissue just below the skin, which may not be suitable for penicillin due to its potential irritant effects on the skin and tissues.

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  • 4. 

    Before the administration of penicillin, it is important to

    • A.

      Check the CBC results

    • B.

      Determine if any previous reactions to antibiotics have occured

    • C.

      Ask the patient to void

    • D.

      Check the patient's pregnancy status

    Correct Answer
    B. Determine if any previous reactions to antibiotics have occured
    Explanation
    Before administering penicillin, it is important to determine if any previous reactions to antibiotics have occurred. This is because some individuals may have had allergic reactions or adverse effects to antibiotics in the past, and penicillin is known to cause allergic reactions in some people. By checking for previous reactions, healthcare providers can ensure the safety of the patient and choose an alternative treatment if necessary.

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  • 5. 

    Penicillin has a cross sensitivity to which of the following drug classes?

    • A.

      Aminoglycosides

    • B.

      Cephalosporins

    • C.

      Erythromycins

    • D.

      Tetracyclines

    Correct Answer
    B. Cephalosporins
    Explanation
    Penicillin has a cross sensitivity to cephalosporins. This means that individuals who are allergic to penicillin may also have an allergic reaction to cephalosporins. Both penicillin and cephalosporins belong to the beta-lactam class of antibiotics, which share a similar chemical structure. As a result, there is a higher risk of cross-reactivity and allergic reactions between these two drug classes. It is important for healthcare professionals to be aware of this potential cross sensitivity and to consider alternative antibiotics when treating patients with a known penicillin allergy.

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  • 6. 

    In contrast to narrow-spectrum penicillins, aminopenicillins such as amoxicillin have increased effectiveness against

    • A.

      Gram-negative bacteria infections

    • B.

      Gram-positive anaerobic infections

    • C.

      Gram-positive spirochete infections

    • D.

      Endocarditis prophylaxis

    Correct Answer
    A. Gram-negative bacteria infections
    Explanation
    Aminopenicillins such as amoxicillin are more effective against gram-negative bacteria infections compared to narrow-spectrum penicillins. This is because aminopenicillins have a broader spectrum of activity, meaning they can target a wider range of bacteria. Gram-negative bacteria are known to have an outer membrane that can make them more resistant to antibiotics, but aminopenicillins have the ability to penetrate this membrane and effectively kill these bacteria. Therefore, aminopenicillins are a preferred choice for treating gram-negative bacterial infections.

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  • 7. 

    Extended-spectrum penicillins are extremely effective against

    • A.

      Gonorrhea

    • B.

      Streptococcus

    • C.

      Pseudomonas

    • D.

      Staphylococcus

    Correct Answer
    C. Pseudomonas
    Explanation
    Extended-spectrum penicillins are a type of antibiotic that have an expanded spectrum of activity against various bacteria. They are particularly effective against Pseudomonas, a type of bacteria that can cause severe infections in various parts of the body, including the lungs, urinary tract, and bloodstream. Pseudomonas infections can be difficult to treat due to the bacteria's resistance to many antibiotics, but extended-spectrum penicillins have shown good efficacy against this pathogen. Therefore, extended-spectrum penicillins are a suitable choice for treating Pseudomonas infections.

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  • 8. 

    Beta-lactamase inhibitors are given in conjunction with penicillins to

    • A.

      Change the protein binding sites

    • B.

      Increase the spectrum of activity

    • C.

      Target the enzyme that may decrease the efficacy of penicillin

    • D.

      Decrease the potential for adverse effects

    Correct Answer
    C. Target the enzyme that may decrease the efficacy of penicillin
    Explanation
    Beta-lactamase inhibitors are given in conjunction with penicillins to target the enzyme that may decrease the efficacy of penicillin. Beta-lactamases are enzymes produced by certain bacteria that can inactivate penicillins and other beta-lactam antibiotics. By using beta-lactamase inhibitors, the activity of these enzymes is targeted and inhibited, allowing the penicillins to remain effective against the bacteria. This helps to overcome resistance mechanisms and enhance the efficacy of penicillin treatment.

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  • 9. 

    A benefit of aztreonam therapy is that it

    • A.

      Has an increased spectrum of activity

    • B.

      May be used in penicillin-allergic patients

    • C.

      Has decreased potential for adverse effects

    • D.

      Has decreased potential for drug-drug interactions

    Correct Answer
    B. May be used in penicillin-allergic patients
    Explanation
    Aztreonam therapy is beneficial because it can be used in patients who are allergic to penicillin. This is important because penicillin is a commonly used antibiotic, and patients who are allergic to it may have limited treatment options. Aztreonam provides an alternative treatment choice for these patients, allowing them to receive effective therapy without the risk of an allergic reaction.

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  • 10. 

    What is the difference between imipenem and meropenem?

    • A.

      Meropenem has a narrow spectrum of activity, imipenem does not

    • B.

      Imipenem has a narrow spectrum of activity, meropenem does not

    • C.

      Meropenem is easily inactivated and must be administered with cilastatin

    • D.

      Imipenem is easily inactivated and must be administered with cilastatin

    Correct Answer
    D. Imipenem is easily inactivated and must be administered with cilastatin
    Explanation
    Imipenem is easily inactivated and must be administered with cilastatin because cilastatin inhibits the enzyme dehydropeptidase, which breaks down imipenem in the kidneys. This allows imipenem to remain active in the body and exert its antimicrobial effects. In contrast, meropenem does not require cilastatin co-administration as it is not as easily inactivated by dehydropeptidase.

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  • 11. 

    What is the major difference between the different "generations" of cephalosporin agents?

    • A.

      Pharmacodynamics

    • B.

      Spectrum of activity

    • C.

      Emergence of drug resistance

    • D.

      Ability to induce allergic responses

    Correct Answer
    B. Spectrum of activity
    Explanation
    The major difference between the different "generations" of cephalosporin agents is their spectrum of activity. Each generation of cephalosporins has a different range of bacteria that they are effective against. The earlier generations have a narrower spectrum and are effective against Gram-positive bacteria, while the later generations have a broader spectrum and are effective against both Gram-positive and Gram-negative bacteria. This difference in spectrum of activity allows healthcare professionals to choose the appropriate generation of cephalosporin based on the type of infection and the suspected bacteria causing it.

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  • 12. 

    Generally speaking, cephalosporin antibiotics should be taken for 

    • A.

      7-10 d

    • B.

      2-3 d

    • C.

      1-5 d

    • D.

      10-21 d

    Correct Answer
    A. 7-10 d
    Explanation
    Cephalosporin antibiotics are typically prescribed for a duration of 7-10 days. This duration allows enough time for the antibiotics to effectively treat the infection and reduce the risk of antibiotic resistance. Taking the antibiotics for a shorter duration may not fully eradicate the infection, while taking them for a longer duration may increase the risk of side effects and contribute to antibiotic resistance. Therefore, a 7-10 day course is considered appropriate for most cases.

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  • 13. 

    Hypersensitivity to cephalosporins frequently presents with

    • A.

      Shortness of breath

    • B.

      Hives

    • C.

      Nausea and vomiting

    • D.

      Maculopapular rash

    Correct Answer
    D. Maculopapular rash
    Explanation
    Hypersensitivity to cephalosporins often manifests as a maculopapular rash. This type of rash is characterized by flat, red areas (macules) and raised, bumpy areas (papules) on the skin. It is a common allergic reaction to medications, including cephalosporins. Other symptoms such as shortness of breath, hives, nausea and vomiting may also occur, but the maculopapular rash is a specific manifestation of hypersensitivity to cephalosporins.

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  • 14. 

    Vancomycin is used in the management of

    • A.

      STDs

    • B.

      UTIs

    • C.

      Serious systemic bacterial infections

    • D.

      Cellulitis

    Correct Answer
    C. Serious systemic bacterial infections
    Explanation
    Vancomycin is a potent antibiotic that is commonly used to treat serious systemic bacterial infections. It is particularly effective against infections caused by gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin is often reserved for severe infections that are resistant to other antibiotics or when the patient has an allergy to alternative treatments. It is not typically used to treat STDs or UTIs, as these infections are usually caused by different types of bacteria. Cellulitis, a skin infection, can sometimes be treated with vancomycin, but it is primarily used for more severe systemic infections.

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  • 15. 

    The most serious adverse effect to vanomycin are

    • A.

      Sinus tachycardia and hypotension

    • B.

      Ototoxicity and neurotoxicity

    • C.

      Hepatoxicity and neurotoxicity

    • D.

      Histamine release and phlebitis

    Correct Answer
    B. Ototoxicity and neurotoxicity
    Explanation
    Vancomycin is a potent antibiotic that is used to treat serious bacterial infections. Ototoxicity refers to damage to the inner ear, which can result in hearing loss or balance problems. Neurotoxicity refers to damage to the nervous system, which can cause symptoms such as confusion, seizures, or hallucinations. These are considered the most serious adverse effects of vancomycin because they can have long-lasting or permanent effects on a patient's hearing and neurological function. Sinus tachycardia and hypotension, hepatoxicity, and histamine release and phlebitis are also potential adverse effects of vancomycin, but they are not considered as serious or potentially debilitating as ototoxicity and neurotoxicity.

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  • 16. 

    Your patient is prescribed penicillin V for a dental infection. Which of the following instructions would you give?

    • A.

      "Take the medication with food for best results"

    • B.

      "Although it is ordered 4 times a day, you can double the dose and take it twice a day"

    • C.

      "You can take it every other day if you experience GI distress"

    • D.

      "Take the medication 1 h before or 2 h after a meal"

    Correct Answer
    D. "Take the medication 1 h before or 2 h after a meal"
    Explanation
    Taking the medication 1 hour before or 2 hours after a meal is the correct instruction for taking penicillin V for a dental infection. This is because food can interfere with the absorption of the medication, so it is best to take it on an empty stomach. By following this instruction, the patient can ensure that they are getting the maximum benefit from the medication.

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  • 17. 

    Your 86 yo patient has pneumonia and is prescribed penicillin. She has a history of renal insufficiency. Which of the following lab tests should be done before initiating therapy?

    • A.

      Pulmonary function

    • B.

      BUN and creatinine

    • C.

      ALT and AST

    • D.

      Urinalysis

    Correct Answer
    B. BUN and creatinine
    Explanation
    Before initiating therapy with penicillin in a patient with a history of renal insufficiency, it is important to assess kidney function. BUN (blood urea nitrogen) and creatinine levels are commonly used lab tests to evaluate renal function. These tests help determine if the patient's kidneys are functioning properly and can handle the medication without causing further harm. Monitoring BUN and creatinine levels can help prevent potential drug toxicity and ensure safe administration of penicillin in this patient population.

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  • 18. 

    Your patient is hospitalized with bacteremia. He is prescribed IV penicillin G and gentamicin. How would you administer these drugs?

    • A.

      Wait at least 2 h between administration of these drugs

    • B.

      Wait 30 min between administration of these drugs

    • C.

      Administer each drug on an alternate day

    • D.

      Administer the 1st drug, flush the tubing, then administer the 2nd drug

    Correct Answer
    A. Wait at least 2 h between administration of these drugs
    Explanation
    The correct answer is to wait at least 2 hours between administration of these drugs. This is because penicillin G and gentamicin are both antibiotics that can interact with each other and decrease their effectiveness if given too close together. Waiting at least 2 hours allows for proper absorption and distribution of each drug before the next one is administered, ensuring that they can work effectively against the infection.

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  • 19. 

    Your patient comes to the clinic and receives a diagnosis of infection. When asked about allergies, the patient stated "I have an allergy to penicillin, but I can take ampicillin". With your knowledge about these drugs, you know that

    • A.

      This is a possibility because they are two different types of penicillins

    • B.

      The patient should not take any form of drug with "cillin" in its name if he has an allergy to penecillin

    • C.

      As long as they are not taken together, it is alright for your patient to take either drug

    • D.

      You should substitute another type of antibiotic

    Correct Answer
    B. The patient should not take any form of drug with "cillin" in its name if he has an allergy to penecillin
    Explanation
    The correct answer is that the patient should not take any form of drug with "cillin" in its name if he has an allergy to penicillin. This is because ampicillin is a type of penicillin and can cause an allergic reaction in individuals who are allergic to penicillin. Therefore, it is not safe for the patient to take ampicillin or any other drug with "cillin" in its name if they have a penicillin allergy.

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  • 20. 

    Your patient has just received an injection of IM procaine penicillin. Within 30 seconds, the patient becomes confused and agitated and runs from the exam room. You suspect

    • A.

      The patient has been taking some type of illicit drugs

    • B.

      An allergy to pencillin

    • C.

      A toxic response of penicillin

    • D.

      A procaine reaction

    Correct Answer
    D. A procaine reaction
    Explanation
    The patient's sudden onset of confusion and agitation immediately after receiving an injection of IM procaine penicillin suggests a procaine reaction. Procaine is a local anesthetic that can cause various side effects, including confusion, agitation, and even hallucinations in some cases. This reaction is not related to illicit drugs, an allergy to penicillin, or a toxic response to penicillin. Therefore, a procaine reaction is the most likely explanation for the patient's symptoms.

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  • 21. 

    Your patient has been receiving IV cefazolin for the past 24 h, and the next dose is now due. You note that the culture and sensitivity test results indicate the infection is resistant to cephalosporins. You should

    • A.

      Hang the cefazolin, and write a note in the progress notes

    • B.

      Hand the cefazolin

    • C.

      Hold the cefazolin, contact the HCP, and get an order for a new antibiotic

    • D.

      Hold the cefazolin and tell the next shift to discuss the test results with the physician when he or she makes rounds in the evening

    Correct Answer
    C. Hold the cefazolin, contact the HCP, and get an order for a new antibiotic
    Explanation
    The patient's culture and sensitivity test results indicate that the infection is resistant to cephalosporins, which includes cefazolin. Therefore, it is important to hold the cefazolin to prevent further administration of an ineffective antibiotic. The next step is to contact the healthcare provider (HCP) to inform them of the test results and request an order for a new antibiotic that is effective against the specific infection. This ensures that the patient receives appropriate treatment based on the updated information.

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  • 22. 

    Your patient has an order for IV cefazolin. As you take the medication out of the refrigerator, you note that the solution was reconstituted yesterday. You should

    • A.

      Allow the solution to warm for 15 min, then administer

    • B.

      Give the infusion now

    • C.

      Call the pharmacy and have a replacement sent

    • D.

      Warm the solution in the microwave, then administer

    Correct Answer
    C. Call the pharmacy and have a replacement sent
    Explanation
    It is important to note that cefazolin, like many other medications, has specific storage requirements. Once reconstituted, cefazolin should be stored in the refrigerator and used within a certain time frame, typically 24 hours. Since the solution was reconstituted yesterday, it is no longer within the recommended time frame for use. Therefore, the appropriate course of action would be to call the pharmacy and request a replacement, ensuring the patient receives a fresh and effective medication.

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  • 23. 

    Your patient is receiving IV vanomycin. To minimize adverse effects, the HCP has ordered peak-and-trough blood levels. When is the optimal time for you to obtain the peak blood level?

    • A.

      30 min before the next infusion

    • B.

      20 min after the onset of infusion

    • C.

      1 h before next infusion

    • D.

      1 h after the completion of infusion

    Correct Answer
    D. 1 h after the completion of infusion
    Explanation
    To obtain the peak blood level of vancomycin, it is best to wait for 1 hour after the completion of the infusion. This allows enough time for the medication to be fully distributed throughout the body and reach its maximum concentration in the blood. Obtaining the peak level at this time will provide an accurate measurement of the highest concentration of vancomycin in the patient's bloodstream, which is important for monitoring drug efficacy and preventing toxicity.

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  • 24. 

    Your patient is scheduled to receive IV vanomycin. To safely administer this medication, you should infuse it

    • A.

      Over 20 min

    • B.

      Over 60 min

    • C.

      Over 2-3 h

    • D.

      Within 10 min

    Correct Answer
    B. Over 60 min
    Explanation
    Vancomycin is a potent antibiotic that can cause adverse reactions, such as "red man syndrome" or hypotension, if infused too rapidly. Therefore, it is recommended to administer vancomycin over a longer period of time, typically over 60 minutes, to minimize the risk of these side effects. This slower infusion rate allows the body to tolerate the medication better and reduces the likelihood of adverse reactions.

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  • 25. 

    Your patient with a GI infection is prescribed vancomycin PO. The patient states, "My friend had this drug, but she got it in her veins. Isn't that a better way to get it?" Your response?

    • A.

      "Since your problem is in your GI system, giving the drug this way will have a localized action on the infection"

    • B.

      "Why don't you ask the doctor that question?"

    • C.

      "I'm sure your friend received a different drug"

    • D.

      "I have no idea"

    Correct Answer
    A. "Since your problem is in your GI system, giving the drug this way will have a localized action on the infection"
    Explanation
    Giving vancomycin orally (PO) for a gastrointestinal (GI) infection allows the drug to directly target the infection in the GI system. When the drug is given intravenously (IV), it enters the bloodstream and can have systemic effects throughout the body. By administering it orally, the drug can act locally on the infection in the GI system, providing targeted treatment.

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  • 26. 

    To maximize the therapeutic effect of penicillin G, you should administer

    • A.

      The drug with milk

    • B.

      The doses only during normal waking hours

    • C.

      IV forms directly from the refrigerator

    • D.

      The drug for at least 2 days after the patient feels better

    Correct Answer
    D. The drug for at least 2 days after the patient feels better
    Explanation
    To maximize the therapeutic effect of penicillin G, it is important to continue administering the drug for at least 2 days after the patient feels better. This is because even though the symptoms may have subsided, there may still be bacteria present in the body that could cause a relapse if not completely eradicated. Continuing the medication for the recommended duration ensures that all the bacteria are eliminated and reduces the risk of recurrence or antibiotic resistance.

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  • 27. 

    Your patient is to be discharged on cefazolin, a cephalosporin. The nurse should teach the patient to avoid which of the following while taking this drug?

    • A.

      Wine

    • B.

      Potassium chloride elixirs (such as Kay Ciel)

    • C.

      Cough medicine

    • D.

      All of the above

    • E.

      None of the above

    Correct Answer
    D. All of the above
    Explanation
    The correct answer is "all of the above". Cefazolin is an antibiotic that belongs to the cephalosporin class. It is important for the patient to avoid consuming wine, potassium chloride elixirs, and cough medicine while taking this drug. Wine can interact with cefazolin and cause adverse effects. Potassium chloride elixirs may also interact with cefazolin and affect its effectiveness. Cough medicine may contain ingredients that could interact with cefazolin or cause additional side effects. Therefore, the patient should avoid all of these substances to ensure the safe and effective use of cefazolin.

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  • 28. 

    Your patient is receiving vancomycin as treatment for endocarditis. To minimize adverse effects from the drug therapy, the nurse should administer the drug by

    • A.

      IV push

    • B.

      Slow IV infusion

    • C.

      SC injection

    • D.

      PO

    Correct Answer
    B. Slow IV infusion
    Explanation
    To minimize adverse effects from vancomycin therapy, the nurse should administer the drug by slow IV infusion. This method allows for a controlled and gradual delivery of the medication into the bloodstream, reducing the risk of adverse reactions such as hypotension or infusion-related reactions. IV push administration may lead to rapid drug absorption and potential toxic effects. SC injection and PO routes are not suitable for vancomycin administration as the drug is not well absorbed through these routes.

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  • 29. 

    You are to administer the first IV dose of penicillin G to treat a patient's pneumonia. To minimize adverse effects, you should 

    • A.

      Determine if a sputum culture and sensitivity has been obtained

    • B.

      Ask her if she has any drug allergies

    • C.

      Monitor her closely during drug administrations

    • D.

      All of the above

    • E.

      None of the above

    Correct Answer
    D. All of the above
    Explanation
    To minimize adverse effects when administering the first IV dose of penicillin G to treat a patient's pneumonia, it is important to consider all of the options mentioned. Determining if a sputum culture and sensitivity has been obtained helps to identify the specific bacteria causing the infection and determine the most effective treatment. Asking the patient if she has any drug allergies is crucial to avoid administering a medication that may cause an allergic reaction. Lastly, monitoring the patient closely during drug administration allows for early detection of any adverse effects and prompt intervention if needed.

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  • 30. 

    You are to administer procaine penicillin to a patient in the outpatient department who has syphilis. To maximize therapeutic effects and minimize adverse effects, you should

    • A.

      Administer the drug into the deltoid muscle

    • B.

      Keep the drug in the refrigerator until the time of administration

    • C.

      Locate anatomic landmarks to determine the injection site

    • D.

      All of the above

    • E.

      None of the above

    Correct Answer
    C. Locate anatomic landmarks to determine the injection site
    Explanation
    To maximize therapeutic effects and minimize adverse effects, it is important to locate anatomic landmarks to determine the injection site when administering procaine penicillin to a patient with syphilis. This ensures that the injection is accurately placed in the correct muscle, allowing for optimal absorption and distribution of the drug. Administering the drug into the deltoid muscle can help avoid potential complications associated with other injection sites. Keeping the drug in the refrigerator until the time of administration is not necessary for maximizing therapeutic effects or minimizing adverse effects. Therefore, the correct answer is to locate anatomic landmarks to determine the injection site.

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  • 31. 

    Your patient has a mixed infection and is receiving cefazolin, a cephalosporin, and gentamicin, and aminoglycoside antibiotic. To minimize adverse effects, the nurse should most closely monitor which lab value?

    • A.

      Hematocrit

    • B.

      APTT

    • C.

      BUN

    • D.

      Cafazolin blood levels

    Correct Answer
    C. BUN
    Explanation
    The nurse should most closely monitor the BUN (blood urea nitrogen) lab value in a patient receiving cefazolin and gentamicin. Both of these medications can potentially cause kidney damage, and an increase in BUN levels may indicate impaired kidney function. Monitoring BUN levels can help the nurse detect early signs of kidney dysfunction and take appropriate measures to prevent further complications. Hematocrit, aPTT, and cefazolin blood levels may also be monitored, but they are not as closely related to the potential adverse effects of these medications as BUN levels.

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  • 32. 

    Your are caring for an 80 yo patient who has a respiratory infection caused by VRE. The patient also has chronic renal failure. The patient has been prescribed daptomycin to treat the infection. You would expect to administer to this patient

    • A.

      The standard adult dose

    • B.

      More than the standard adult dose

    • C.

      Less than the standard adult dose

    • D.

      A different drug because daptomycin is not effective against VRE

    Correct Answer
    C. Less than the standard adult dose
    Explanation
    In patients with chronic renal failure, the dosage of daptomycin needs to be adjusted because the drug is primarily eliminated through the kidneys. Since the patient in question has chronic renal failure, their kidney function is impaired, and therefore, the drug may not be cleared from their system efficiently. Consequently, a lower dose of daptomycin would be expected to minimize the risk of drug accumulation and potential toxicity.

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  • Current Version
  • Mar 21, 2023
    Quiz Edited by
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  • Sep 06, 2009
    Quiz Created by
    Jmtruong1

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