NURS 329 Midterm Exam 2025

In order for Penicillin to work, which of the following must happen? A) Must bind to Penicillin Binding Proteins (PCB'S) B) Must block the receptor sites of Penicillin Binding Proteins (PCB'S) C) Inhibit the breakdown of the cell wall D) Must activate beta lactamase to work - Correct Answer-A) Must bind to Penicillin Binding Proteins (PCB'S) If someone is allergic to PCN which other antibiotic might they also be allergic to? A) Carpapenem B) Gentamicin C) Cephalosporins D) Azithromycin - Correct Answer-C) Cephalosporins Which of the following types of penicillin can be given intravenously (IV)? A) Potassium penicillin B) Procaine penicillin C) Benzathine penicillin D) Sodium penicillin - Correct Answer-A and D A patient is prescribed cefixime. The nurse should teach the patient to immediately report any signs of what? A. Milk intolerance B. Skin rash, hives, or itching C. Constipation, nausea, or vomiting D. Headache, contusions, or seizures - Correct Answer-B. Skin rash, hives, or itching Rationale: Hypersensitivity reactions are common with cephalosporins. Patients should be instructed to report any signs of allergy, such as skin rash, itching, or hives. Cefditoren contains a milk protein and should not be prescribed for patients with a milk protein allergy. Cefoperazone and cefotetan can promote bleeding. Diarrhea associated with antibiotic-associated pseudomembranous colitis (AAPMC) is a possible side effect with cephalosporins. A patient is prescribed vancomycin orally for antibiotic-associated pseudomembranous colitis. The nurse will monitor the patient for what? A. Leukopenia NURS 329 NURS 329 B. "Red man" syndrome C. Liver impairment D. Ototoxicity - Correct Answer-D. Ototoxicity Rationale: The most serious adverse effect of vancomycin is ototoxicity. "Red man" syndrome occurs only with rapid intravenous administration. Thrombocytopenia is an adverse effect of vancomycin. Which statement about allergic reactions to penicillin does the nurse identify as true? A.Anaphylactic reactions occur more frequently with penicillins than with any other drug. B.Allergy to penicillin always increases over time. C.Benadryl is the drug of choice for anaphylaxis due to penicillin allergy. D.Patients allergic to penicillin are also allergic to vancomycin. - Correct Answer A.Anaphylactic reactions occur more frequently with penicillins than with any other drug. Rationale: Anaphylactic reactions occur more frequently with penicillins than with any other drug. Allergy to penicillin can decrease over time. Epinephrine is the drug of choice for anaphylaxis. Vancomycin, erythromycin, and clindamycin are effective and safe alternatives for patients with penicillin allergy. A prescriber states that a patient will need to receive penicillin intravenously. The nurse anticipates administering which drug? A. Penicillin V B. Procaine penicillin G C. Benzathine penicillin G D. Potassium penicillin G - Correct Answer-D. Potassium penicillin G A patient with a history of a severe anaphylactic reaction to penicillin has an order to receive cephalosporin. What should the nurse do? A. Administer the cephalosporin as ordered. B. Contact the health care provider for a different antibiotic. C. Administer a test dose of cephalosporin to determine reactivity. D. Have an epinephrine dose available when administering the cephalosporin. - Correct Answer-B. Contact the health care provider for a different antibiotic. Rationale: A few patients with penicillin allergy (about 1%) display cross-sensitivity to cephalosporins. If at all possible, patients with penicillin allergy should not be treated with any member of the penicillin family. Use of cephalosporins depends on the intensity of the allergic response to penicillin; if the penicillin allergy is mild, use of cephalosporins is probably safe. However, if the allergy is severe, cephalosporins should be avoided. NURS 329 NURS 329 A patient is prescribed cefazolin. It is most important for the nurse to teach the patient to avoid which substance while taking cefazolin? A. Warfarin B. Milk products C. Digitalis D.Alcohol - Correct Answer-D.Alcohol Rationale: Cefazolin and cefotetan can cause alcohol intolerance. A serious disulfiram like reaction may occur if alcohol is consumed. Inform patients about alcohol intolerance and warn them not to drink alcoholic beverages. If you have a patient receiving IV Clindamycin and they develop hypotension and ECG changes, what would you do? A) Continue monitoring the patient closely B) Transfer Pt to ICU C) Stop the drug D) Slow the rate of administration - Correct Answer-C) Stop the drug Your patient has intermittent colitis. Which antibiotic is contraindicated for use in this patient? A. Erythromycin B. Doxycycline C. Clindamycin D. Azithromycin - Correct Answer-C. Clindamycin Your patient has an infected pressure ulcer. The wound culture reveals a vancomycin resistant staph. Which medication would you expect to be ordered? A.Tetracycline B.Clindamycin C.Chloramphenicol D.Linezolid (Zyvox) - Correct Answer-D.Linezolid (Zyvox) The nurse is assessing for adverse effects of IV gentamycin. Which change would be a priority to report to the prescriber? A. Dilute urine B. Headache C. Limp, weak muscles D. Ringing in the ears - Correct Answer-C. Limp, weak muscles Rationale: Aminoglycosides can inhibit neuromuscular transmission, causing flaccid paralysis and potentially fatal respiratory depression. Most episode of nm blockade NURS 329 NURS 329 have occurred following intraperitoneal or intrapleural instillation (not common!!), however, nm blockade has also occurred with IV, IM ,and PO dosing. Which type of rash would most likely indicate the start of Stevens-Johnson syndrome when a patient is receiving sulfonamides? A. Amber-colored, crusty rash on the cheeks B. Papular rash on the shoulders C. Pruritic rash on the lower arms D. Vesicular rash in the mouth - Correct Answer-D. Vesicular rash in the mouth What is the priority reason why the nurse teaches a patient who is prescribed sulfamethoxazole to take this medication with a full glass of water? A. Decrease the risk of esophageal irritation B. Minimize crystal formation in the urine C. Prevent nausea D. Stimulate frequent voiding - Correct Answer-B. Minimize crystal formation in the urine Which INR result would be a reason to contact the prescriber in a patient with atrial fibrillation taking warfarin who has also been prescribed a sulfonamide? A. INR 2 B. INR 2.5 C. INR 3 D. INR 3.5 - Correct Answer-D. INR 3.5 What is a benefit of trimethoprim-sulfamethoxazole (TMP/SMZ) over using the two drugs components alone? A. Lack of interaction with drugs that have a narrow therapeutic range B. Fewer adverse effects C. Less resistance has developed D. Lower incidence of toxicity - Correct Answer-C. Less resistance has developed Which of these assessment findings, if identified in a patient who is receiving nitrofurantoin (Macrodantin), should the nurse report to the prescriber immediately? A. Brown colored urine B. Dyspnea C. Nausea D. Headache - Correct Answer-B. Dyspnea 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 NURS 329 NURS 329 a. inhibit autolysins. b. inhibit host cell wall function. c. disrupt bacterial cell wall synthesis d. disinhibit transpeptidases. - Correct Answer-c. disrupt bacterial cell wall synth