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NR 568/ NR568 Chamberlain College Of Nursing -midterm
nr568 Exam Questions With Complete Solutions 2025 Latest
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Penicillin Monitoring - ANSWERS-Renal impairment because it can accumulate if the kidney is not working that could cause toxic levels. Penicillin high risk patients - ANSWERS-history of severe allergic reactions to penicillin, cephalosporin or carbapenems Penicillin evalutation of therapeutic effects - ANSWERS-reduction of symptoms like fever, edema, pain and inflammation Cephalosporin therapeutic goal - ANSWERS-treatment of infection that is caused by susceptible organism Cephalosporin baseline data - ANSWERS-Take samples for culture to identify the infecting organism Ceph Monitoring - ANSWERS-None. No routine lab monitroing is suggested. Ceph high risk patients - ANSWERS-history of allergic reactions to ceph, pcn and carbapenem Ceph evaluation of therapy - ANSWERS-reduction of symptoms like fever, pain, edema and inflammation Ceph miniminize adverse effects - ANSWERS-Because it can promote C-diff instruct patients to report increase in stool frequency. Carbapenems baseline - ANSWERS-take sample for culture to determine infecting organism Carbapenems monitoing - ANSWERS-None. Nothing is recommended. Carbapenems high risk patients - ANSWERS-history of allergic reaction patient using valprotate to control seizure should never be given imipenem Carbapenems evaluation - ANSWERS-decrease on symptoms like fever, pain, edema and inflammation Carbapenems minimize adverse effects - ANSWERS-dosage should be reduced for patients with renal impairment to prevent toxicity Vancomycin therapeutic goal - ANSWERS-Treatment of serious infections, including C-diff, MRSA, and infections that are caused by susceptible organisms in patients allergic to PCN. Vanco baseline - ANSWERS-culture and sensitivity
Vanco monitoring - ANSWERS-Vanco drug levels should be monitored during IV treatment Vanco high risk patients - ANSWERS-patients with renal impairment Vanco evaluating therapeutic effects - ANSWERS-monitor for indeication of antimicrobial effects, including reduction in fever, pain, edema and inflammation. What do you not administer with Tetracycline? - ANSWERS-Calcium supplements MIlk products Iron supplements Magnesium-containing laxatives most antacids (bec of content of magnesium or aluminum) What do you teach a patient taking Tetracycline? - ANSWERS-To apply sunscree, protective clothing and avoid exposure to sunlight because this medication can cause severe sunburn. Can you give Tetracycline to children? - ANSWERS-Not to be used in children younger than 8 because it could cause permanent discoloration of teeth can you give tetracyclines to a pregnant woman - ANSWERS-NOOO Can you give tetracyline to a breastfeeding woman? - ANSWERS-NOOOO because it can be passed on to the baby which could harm tooth development Tetracycline therapeutic goal - ANSWERS-treatment of tetracycline sensitive infections, acne and peridontal disease Tetracycline baseline data? - ANSWERS-none examples of narrow spectrum antibiotics - ANSWERS-Azithromycin (macrolide), Clarithromycin (macrolide), Clindamycin (lincosamine), Erythromycin (macrolide), Vancomycin (glycopeptide) Tetracycline high risk patients - ANSWERS-Highly contraindicated for pregnant women, breastfeediing and children under 8 y.o examples of broad spectrum antibiotics - ANSWERS-Penicillin, Cephalosporins, Tetracyclines, quinolones Contraindications of high risk patient when taking antibiotics - ANSWERS-Renal impairment Acutely ill Very young/old
If the patient has a renal impairment (15 to 30 ml/min) the dosage should be decreased to 50% Aminoglycosides - ANSWERS-Gentamicin (ends in -cin) Can you prescribe an aminoglycoside to infants and children? - ANSWERS-Yes. you can administer to infants younger than 8 days as long as you follow dosing weight and gestation guidelines. This is also safe for children to use. Can you prescribe aminoglycosides to a pregnant woman? - ANSWERS-No. Because can cause harm to the fetus. Can you prescribe aminoglycosides to a breastfeeding woman? - ANSWERS-Yes but keep in mind that there is a limited research behind it What do you have to watch out for when prescribing aminoglycosides to an older adult? - ANSWERS-Renal function to avoid toxicity. Aminoglycoside BB warning? - ANSWERS-Associated with irreversible ototoxicity, neurotoxic symptoms, high doses/ prolonged used in patient with preexisting renal impairment. It is also associated with nephrotoxicity. Aminoglycoside use - ANSWERS-Aerobic gram negative bacilli Monitoring for aminoglycoside? - ANSWERS-Aminoglycoside levels (peak and troughs) Renal function Aminoglycoside high risk? - ANSWERS-should be used with caustion in patients with renal impairment, pre-existing hearing impairment and those receiving ototoxic and nephrotoxic medication because it can increase risk for adverse reactions. Aminoglycoside evaluation of therapy? - ANSWERS-reduction of s/s like fever, pain or inflammation How to minimize adverse effects in patients prescribed with an aminoglycosides? - ANSWERS-Caution should be exercised and diligently checking for other medication that the patient is taking that could possibly be nephro or ototoxic. Patient teaching for Sulfonamides - ANSWERS-Should take with full glass of water should finish the prescribed course of treatment Should drink at least 8 to 10 glasses of water/ non-caffeinated fluids to decrease the risk for crystalluria
Use sunscreen and tanning beds are avoided To report to PCP if alterations to sensitivity changed (rashes) Can you prescribe sulfonamides to a pregnant woman? - ANSWERS-No! Because it can cause birth defects, especially in the 1st trimester. (Kernicterus) Can you prescribe sulfonamides to a breastfeeding? - ANSWERS-No if the patient is breastfeeding woman has <2 month old infant What adverse effect can sulfonamides give to an older adult? - ANSWERS-They are at a high risk to get an adverse effect like neutropenia, steven-johnson syndrome and toxic epidermal necrolysis. Patient education for Trimpethoprim/Sulfametoxazole? - ANSWERS-To look at early signs of blood dyscrasias (soar throat, fever, pallor) and instruct to report it to provider immediately. Trimethoprim/Sulfamethoxazole (Bactrim) goal - ANSWERS-Absence of infeciton Trimethoprim/Sulfamethoxazole (Bactrim) baseline - ANSWERS-Urinalysis if UTI is expected Culture and sensitivity as indicated CBC Renal function Trimethoprim/Sulfamethoxazole (Bactrim) monitoring - ANSWERS-CBC CD4+ for patients with HIV s/s of hypersensitivity reactions resolution of infection If HYPERkalemia is suspected because of the use of the medication, Potassium should be checked 4 days after starting treatment Trimethoprim/Sulfamethoxazole (Bactrim) high risk patients - ANSWERS-nursing, pregnant and near term women infants younger than 2 months if the patient has a G6PD deficiency is Cephalosporin safe to prescribe to pregnant women? - ANSWERS-Yes. What ABR can cause fetal harm and should be avoided during pregnancy? - ANSWERS-Tetracycline and Aminoglycoside
T.B
Treatment for Tinea Cruris (ringworm of the groin) - ANSWERS-Topical works well and should be continue 1 week after the symptoms have cleared. If Severe, give systemic antigungal like Clotrimazole or both topical and systemic glucocorticoids may be needed as well. T.B.C if severe Tinea Capitis (ringworm of the scalp) - ANSWERS-Oral griseofulvin should be take 6 to 8 weeks as a standard therapy. or Oral Terbinafine which can be take for 2 to 4 weeks (more effective) G.T Treatment for oral candidiasis (thrush) - ANSWERS-Topical agents - nystatin, clotrimaozle and miconazole If immunocompromised host, oral therapy of flucanozale or ketoconazole Treatment for asperigillosis (farmers lung) - ANSWERS-drug of choice is voriconazole alt drugs: A.B.I.I.PC.M Amphotericin B Isavuconazonium Itraconazole Posaconazole Caspofungin Micafungin What do you avoid to combine with Voriconazole? - ANSWERS-Phenobarbital. Because it is a CYP450 inducer that if given with Voriconazole will impact the levels and will not be able to reach the therapeutic level. Patient teaching of Itraconazole - ANSWERS-Avoid combing with drugs that metabolize by CYP3A Take PPIs at least 1 hour before or itraconazole 2 hours after And instruct to watch for signs of liver dysfunction. Example of a NRTI drug - ANSWERS-Abacavir
Diagnostic and Monitoring for Anthelmintics - ANSWERS-Albendazole - liver function, cbc with diff and RFT Prazuquantel - LFT Ivermectic and Moxidectic - Opthalmologic exam if baseline is abnormal CYP4A - ANSWERS-W.C.D.Q "We Can D.Q" Warfarin Cyclosporin Digozin Quinidine Adverse effect of Itraconazole - ANSWERS-Can cause cardiac supperession, liver injury and GI issues. Can also cause rash, headache, edema, abdominal pain. High risk patients with Albendazole - ANSWERS-Impaired liver and renal function, anemia, bleeding disorder and infection. High risk patients with Mebendazole - ANSWERS-Liver disease, anemia, bleeding disorder and infection High risk patients with Pyrantel Pamoate - ANSWERS-Liver impairment, neonates should not be prescribed formualation containing benzyl alcohol or its derivatives High risk patients with Ivermectic and Moxidectic - ANSWERS-Hytpotension or taking anithypertensive drugs High risk patients with Didanosine - ANSWERS-Risk for pancreatitis is increase by a history of alcoholism or pancreatitis and by use of IV pentamidine High risk patients with Zidovudine - ANSWERS-Risk for hematologic toxicity is increase by a low granulocyte count; low levels of hemoglobin, b12 or folic acid, concurrent use of drugs that are myelosuppressive, nephrotoxic or toxic to circulating blood cells. High risk patients with Lopinavir - ANSWERS-Contraindicated for full term infeants up until 14 days after birth, preterm infants. Adverse effect of Albendazole - ANSWERS-N/V/Abd pain headache temporary hair loss Adverse effect of Pyrantel Pamoate - ANSWERS-GI disturbance
ABT for less than 6 months 6 mos - 2 y.o Observation for unilateral AOM with mild symptoms without otorrhea 2 y/o > - ABT if illness is severe and observation if not AMOX- is the preferred treatment Treatment for Otitis Externa - ANSWERS-if bacterial :cleaning and using anti microbial if fungal: cleaning, application of acidifying drops to be applied 3-4 times a day for 7 days. Treatment of Acne - ANSWERS-Mild: topical benzoyl peroxide and/or topical abt (erythromycin, clindamycin) Moderate: oral systemic therapy w/ abt (tetracycline, minocycline, erythromycin, doxycycline) Severe: oral isotretinoin (accutane) - best tx Treatment of Eczema and complications that may arise - ANSWERS-Topical immunosuppressants : Tacrolimus (pose a risk for cancer) Pimecrolimus Key ingredient needed in organic sunscreen - ANSWERS-Oxybenzone Avobenzone Octinoxate Mechanism of Action of Expectorants - ANSWERS-Renders cough more productive by stimulating the flow of respiratory tract secretions Ex: Guafenesin (Mucinex, Humibid)
