Question 1

A patient with an infection caused by P. aeruginosa is being treated with piperacillin. The nurse providing care reviews the patient's laboratory reports and notes that the patient's blood urea nitrogen and serum creatinine levels are elevated. The nurse will contact the provider to discuss:

Accepted Answer

A)   adding an aminoglycoside.
B)   changing to penicillin G.
C)   reducing the dose of piperacillin.
D)   ordering nafcillin. C

Question 2

The parent of an infant with otitis media asks the nurse why the prescriber has ordered amoxicillin [Amoxil] and not ampicillin [Unasyn]. What will the nurse tell the parent?

Accepted Answer

A)   Amoxicillin is a broader spectrum antibiotic than ampicillin.
B)   Amoxicillin is not inactivated by beta-lactamases.
C)   Ampicillin is associated with more allergic reactions.
D)   Ampicillin is not as acid stable as amoxicillin. D

Question 3

A nursing student wants to know the differences between hospital-associated methicillin-resistant S. aureus (HA-MRSA) and community-associated methicillin-resistant S. aureus (CA-MRSA). Which statements about CA-MRSA are true?

Accepted Answer

A)   20% to 30% of the general population are colonized with CA-MRSA.
B)   Boils caused by CA-MRSA can be treated without antibiotics.
C)   CA-MRSA is less dangerous than HA-MRSA.
D)   CA-MRSA does not cause necrotizing fasciitis.
E)   CA-MRSA is transmitted by airborne droplets. A, B, C

Question 4

A patient with no known drug allergies is receiving amoxicillin [Amoxil] PO twice daily. Twenty minutes after being given a dose, the patient complains of shortness of breath. The patient's blood pressure is 100/58 mm Hg. What will the nurse do?

Accepted Answer

A)   Contact the provider and prepare to administer epinephrine.
B)   Notify the provider if the patient develops a rash.
C)   Request an order for a skin test to evaluate possible PCN allergy.
D)   Withhold the next dose until symptoms subside.

Question 5

A patient is about to receive penicillin G for an infection that is highly sensitive to this drug. While obtaining the patient's medication history, the nurse learns that the patient experienced a rash when given amoxicillin [Amoxil] as a child 20 years earlier. What will the nurse do?

Accepted Answer

A)   Ask the provider to order a cephalosporin.
B)   Reassure the patient that allergic responses diminish over time.
C)   Request an order for a skin test to assess the current risk.
D)   Suggest using a desensitization schedule to administer the drug.

Question 6

A nurse assisting a nursing student with medications asks the student to describe how penicillins (PCNs) work to treat bacterial infections. The student is correct in responding that penicillins:

Accepted Answer

A)   disinhibit transpeptidases.
B)   disrupt bacterial cell wall synthesis.
C)   inhibit autolysins.
D)   inhibit host cell wall function.

Question 7

A nurse is preparing to administer intramuscular penicillin to a patient who is infected with Treponema pallidum and notes that the order is for sodium penicillin G. Which action is correct?

Accepted Answer

A)   Administer the drug as prescribed.
B)   Contact the provider to discuss administering the drug intravenously.
C)   Contact the provider to discuss changing the drug to benzathine penicillin G.
D)   Request an order for piperacillin instead of penicillin G.

Question 8

A nurse is discussing methicillin-resistant S. aureus (MRSA) with a group of nursing students. Which statement by a student correctly identifies the basis for MRSA resistance?

Accepted Answer

A)   "MRSA bacteria have developed PBPs with a low affinity for penicillins."
B)   "MRSA bacteria produce penicillinases that render penicillin ineffective."
C)   "MRSA occurs because of host resistance to penicillins."
D)   "MRSA strains replicate faster than other S. aureus strains."

Question 9

A child with otitis media has had three ear infections in the past year. The child has just completed a 10-day course of amoxicillin [Amoxil] with no improvement. The parent asks the nurse why this drug is not working, because it has worked in the past. What will the nurse tell the patient?

Accepted Answer

A)   "Amoxicillin is too narrow in spectrum."
B)   "The bacteria have developed a three-layer cell envelope."
C)   "The bacteria have developed penicillin-binding proteins (PBPs)  that have a low affinity for penicillins."
D)   "The bacteria have synthesized penicillinase."

Question 10

A patient is receiving intravenous potassium penicillin G, 2 million units to be administered over 1 hour. At 1900, the nurse notes that the dose hung at 1830 has infused completely. What will the nurse do?

Accepted Answer

A)   Assess the skin at the infusion site for signs of tissue necrosis.
B)   Observe the patient closely for confusion and other neurotoxic effects.
C)   Request an order for serum electrolytes and cardiac monitoring.
D)   Watch the patient's actions and report any bizarre behaviors.

Question 11

A nurse transcribes a new prescription for potassium penicillin G given intravenously (IV) every 8 hours and gentamicin given IV every 12 hours. Which is the best schedule for administering these drugs?

Accepted Answer

A)   Give the penicillin at 0800, 1600, and 2400; give the gentamicin [Garamycin] at 1800 and 0600.
B)   Give the penicillin at 0800, 1600, and 2400; give the gentamicin [Garamycin] at 1200 and 2400.
C)   Give the penicillin at 0600, 1400, and 2200; give the gentamicin [Garamycin] at 0600 and 1800.
D)   Give the penicillin every 8 hours; give the gentamicin [Garamycin] simultaneously with two of the penicillin doses.

Question 12

A patient has an infection caused by Streptococcus pyogenes. The prescriber has ordered dicloxacillin PO. What will the nurse do?

Accepted Answer

A)   Administer the medication as ordered.
B)   Contact the provider to suggest giving the drug IV.
C)   Question the need for a penicillinase-resistant penicillin.
D)   Suggest ordering vancomycin to treat this infection.

Question 13

Which organisms can be treated with penicillin G (Benzylpenicillin)?

Accepted Answer

A)   Methicillin-resistant S. aureus
B)   Neisseria meningitidis
C)   P. aeruginosa
D)   S. pyogenes
E)   T. pallidum

Question 14

A patient has an infection caused by Pseudomonas aeruginosa. The prescriber has ordered piperacillin and amikacin, both to be given intravenously. What will the nurse do?

Accepted Answer

A)   Make sure to administer the drugs at different times using different IV tubing.
B)   Suggest giving larger doses of piperacillin and discontinuing the amikacin.
C)   Suggest that a fixed-dose combination of piperacillin and tazobactam [Zosyn] be used.
D)   Watch the patient closely for allergic reactions, because this risk is increased with this combination.

Question 15

A child with an ear infection is not responding to treatment with amoxicillin [Amoxil]. The nurse will expect the provider to order:

Accepted Answer

A)   amoxicillin-clavulanic acid [Augmentin].
B)   ampicillin.
C)   nafcillin.
D)   penicillin G [Benzylpenicillin].

Exam 84: Drugs That Weaken the Bacterial Cell Wall I: Penicillins