NR 566 Midterm Exam 2025

What pathogen is highly associated with CAP in general population? - Correct Answer-streptococcus pneumoniae Other common pathogens with CAP - Correct Answer-atypical bacteria (mycoplasma pneumonia) viruses (influenza, respiratory syncytial virus) First line treatment CAP in previous healthy adults - Correct Answer-Amoxicillin, doxycycline, macrolides (DAM) Treatment of CAP in pregnancy - Correct Answer-amoxicillin, cephalosporins, erythromycin (ACE) Treatment for mycoplasma pneumonia in the pediatric patient - Correct Answer-Macrolides (erythromycin, clarithromycin, azithromycin) treatment of chlamydial pneumonia in infant - Correct Answer-Erythromycin base/ethylsuccinate Broad spectrum antibiotics - when to use? - Correct Answer-empiric therapy When you don't know which bacteria it is more likely to facilitate emergence of drug-resistant organisms and superinfections prescribe these before culture results back suspects patient has UTI Narrow spectrum antibiotics - when to use? - Correct Answer-When the pathogen is known Preferred What are empiric antibiotics? - Correct Answer-Broad Spectrum antibiotics that are given BEFORE the results are in for certain circumstances. Also can be prescribed when the NP believes it is a certain disease. A)Prescription for an antibiotic for severe infection based on knowledge B)Prescription of an antibiotic for severe infection based on clinical evaluation C)Prescription of antibiotic for severe infection based on most likely causative agent When to prescribe empiric antibiotics? - Correct Answer-E for Emergency E for enticpation Embulatory patients Pt has severe infxn, initiate treatment before test results available How to treat C Diff - Correct Answer-Stop taking the abx that caused it flagyl and vancomycin Drug class known for all drugs in class to promote development of C diff - Correct Answer-cephalosporins (especially second or third generations) Penicillin's have cross-sensitivity with which drug class? - Correct Answer-cephalosporins Can you take penicillin's if pregnant? - Correct Answer-Yes Can you prescribe cephalosporins if pregnant? - Correct Answer-yes Patient education needed for cephalosporins - Correct Answer-Can promote C diff, instruct patients to report increase in stool frequency Can you prescribe tetracyclines in pregnant patients - Correct Answer-No - can cause tooth staining Patient education for tetracyclines - Correct Answer-Photosensitivity. Advise patients to avoid prolonged exposure to sunlight, to wear protective clothing, and to apply sunscreen to exposed skin/avoid tanning beds. Instruct patients not to take this medication together with calcium supplements, milk products, iron supplements, magnesium-containing laxatives, and most antacids. Advise patients to notify the provider if diarrhea occurs, as this is an indication of potentially life-threatening superinfection of the bowel. Macrolides patient education - Correct Answer-increased risk of Torsades due to prolonged QT Which macrolide is ok for pregnancy? - Correct Answer-erythromycin Aminoglycosides patient education (ex. gentamicin, tobramycin, amikacin) - Correct Answer-use is associated with ototoxicity and nephrotoxicity Prescribing sulfonamides during pregnancy - Correct Answer-not safe (especially in first trimester)- causes birth defects if taken near term, infant can develop kernicterus (brain damage caused by too much bilirubin) Which cephalosporins may induce a disulfiram-like reaction if alcohol is ingested? - Correct Answer-Cefazolin and cefotetan sulfonamides patient education - Correct Answer-complete full course even if symptoms resolved take with 8-10 glasses of water or noncaffeinated beverages per day to decrease risk of crystalluria protect skin from sun no tanning beds monitor for hypersensitivity symptoms sulfonamides renal dosing - Correct Answer-Avoid in older adults for For patients with creatinine clearance 30mL/min: For patients concurrently prescribed warfarin, avoid trimethoprim/sulfamethoxazole, macrolides, and ciprofloxacin do not give if creatine is under 15 Gentamicin (aminoglycoside) - Correct Answer-monitor Cr cl in elderly renal adjustments If renal dx dose reduces or dosing interval increased What do we need to be aware of in our female patients of childbearing age with clindamycin - Correct Answer-decrease oral contraceptive activity Aminoglycosides are safe for what age