NUR566 Week 1 Open Book – With 100% Correct Answers

I understand the value of doing my own work and learning the skills needed to support my future independent practice as a nurse practitioner. I understand that while there may be opportunities beyond my faculty’s control for me to collaborate or share answers with peers, that it would not benefit my own personal and professional growth to do so. I agree to do my own work and take personal responsibility for my learning. I do I do not Thank you for acknowledging your personal responsibility for your learning and professional practice while acting with honesty and integrity. If a patient is taking Bactrim and their creatinine clearance falls below 15 mL/min, what should the provider do? Have patient continue the medication until it is complete. It depends on how many doses the patient has taken. Stop the drug immediately. List the drug as an allergy and instruct the patient to stop taking it immediately. Rationale: If creatinine clearance falls below 15 mL/min when taking Trimethoprim/Sulfamethoxazole (Bactrim), the drug use must be discontinued. This is covered on page 694 of your course textbook. In patients with a creatinine clearance of 15-30 mL/min taking Bactrim, how should the dosing be adjusted? Reduced by 50% Reduced by 25% Increased by 50% Increased by 25% Rationale: In patients with renal impairment (creatinine clearance of 15–30 mL/min), dosage should be decreased by 50%. This is covered on page 690 and 694 of your course textbook. What baseline data is needed to prescribe trimethoprim/sulfamethoxazole? (Select all that apply) Establish an infection appropriate for this drug class exists Complete blood count with white cell differential for prolonged therapy Hepatic function if there is concern in may be compromised Renal function if there is concern in may be compromised Rationale: This information can be found in the Summary of Key Prescribing Considerations in the chapter that covers this drug class. Using your textbook, match the antibiotic class to the patient care concern for children/adolescents. Use each option only once by selecting the option that is most true. Commonly used to treat bacterial infections, including otitis media and gonococcal and pneumococcal infections. Common drug used to treat bacterial infections. Should not be used in children younger than 8 years because they may cause permanent discoloration of the teeth. Safe for use against bacterial infections but not commonly used in outpatient settings. Rationale: This information can be found in the Summary of Key Prescribing Considerations in the chapter that covers this drug class. Which representative antibiotics are inhibitors of cell wall synthesis as listed in your course textbook? (Select all that apply) Penicillins Cephalosporins Vancomycin Clindamycin Rationale: See table 70.2 in textbook Which medication requires patient education to avoid prolonged exposure to sunlight? Cephalosporins Tetracyclines Macrolides Aminoglycosides Rationale: This information can be found in the Summary of Key Prescribing Considerations in the chapter that covers this drug class. Question 8 0 / 4 pts Which drug class is contraindicated for UTI in the third trimester of pregnancy and in older adults with decreased renal function? Trimethoprim/sulfamethoxazole Nitrofurantoin Fluoroquinolones Cephalosporins Rationale: This information can be found in the Summary of Key Prescribing Considerations in the chapter that covers this drug class. Which patients should penicillins be used with extreme caution? Patients with renal impairment, preexisting hearing impairment, and those receiving ototoxic and nephrotoxic drugs. Patients with a history of severe allergic reactions to cephalosporins, or carbapenems. Patients with QT prolongation. Patients using valproate to control seizures. Rationale: Penicillins should be used with extreme caution in patients with a history of severe allergic reactions to penicillins, cephalosporins, or carbapenems. Review Summary of Key Prescribing Considerations for Penicillins. Which antibiotic class is most likely to be given to someone with otitis media if there are no contraindications? Penicillin Aminoglycoside Tetracycline Macrolide After 3 days of observation, start 10 days of amoxicillin or amoxicillin/clavulanate. Information found in the course module. Which antimicrobial agents do the most to facilitate the emergence of antimicrobial resistance according to your textbook? All antimicrobial drugs None Narrow-spectrum antimicrobials Broad-spectrum antimicrobials Rationale: All antimicrobial drugs promote the emergence of drug-resistant organisms. However, some agents are more likely to promote resistance than others. Because broad-spectrum antibiotics kill more competing organisms than do narrow-spectrum drugs, broad-spectrum agents do the most to facilitate emergence of resistance. Pg. 654 Which antibiotic drug class is generally not expected to cause adverse effects in breastfed infants? Cephalosporins Tetracyclines Sulfonamides Penicillin Rationale: This information can be found in the Summary of Key Prescribing Considerations in the chapter that covers this drug class. Using your textbook, match the antibiotic class to the patient care concern for pregnant persons. Use each option only once by selecting the option that is most true. All appear to be safe for use in pregnancy Although there are no well-controlled studies in pregnant women, evidence we do have suggests there is no second or third trimester fetal risk. Animal studies reveal that these drugs can cause fetal harm in pregnancy. Thus this class of drugs should be avoided in during pregnancy. There is evidence that use of this drug class in pregnancy can harm the fetus so they should not be used. Systemic drugs in this class may cause birth defects, especially if taken during the first semester. If taken near term, the infant may develop kernicterus. Rationale: This information can be found in the Summary of Key Prescribing Considerations in the chapter that covers this drug class. Which patients being treated with a penicillin are at high risk for toxicity? (Select all that apply) renal impaired acutely ill very young very old active hepatitis Rationale: Renal impairment causes the half-life to increase dramatically and may necessitate a reduction in dosage. In patients at high risk for toxicity (those with renal impairment, the acutely ill, the very young, and older adults), kidney function should be monitored. p. 665 Which antibiotic requires the following monitoring? CBC in patients with symptoms of blood disorders, CD4+ counts in patients with HIV and potassium 4 days after starting treatment in patients with possible hyperkalemia Penicillins Vancomycin Aminoglycosides Trimethoprim/Sulfamethoxazole Rationale: This information can be found in the Summary of Key Prescribing Considerations in the chapter that covers this drug class. Question 16 4 / 4 pts Locate the Prescribers' Digital Reference website () to answer this question. A patient is prescribed Amoxicillin for an infection. They have a creatinine clearance of 24mL/min. What dose of amoxicillin should they be prescribed? no dosage adjustment needed 250-500mg PO every 12 hours 250-500 mg PO every 24 hours 875 mg Extended Release PO every 24 hours Rationale: The following dosing recommendations pertain to adults. No specific dosage adjustments for pediatric patients with renal impairment are available at this time; however, dosage intervals should be adjusted. CrCl > 30 mL/min: no dosage adjustment needed. CrCl 10—30 mL/min: 250—500 mg PO every 12 hours, depending on the severity of the infection. Do not use the 875 mg-tablet strength or the extended-release tablet for dosing. CrCl < 10 mL/min: 250—500 mg PO every 24 hours, depending on the severity of the infection. Do not use the 875 mg-tablet strength or the extended-release tablet for dosing. Match the recommended treatment for UTI according to the assigned textbook for this course. Use each option only once by selecting the option that is most true. Ampicillin and gentamycin Methenamine hippurate Methenamine mandelate Short-term Fluoroquinolones Rationale: This information can be found in the Drugs for Urinary Tract Infection table in chapter 76. Acute otitis externa presents with what symptoms that differentiates it from otitis media to determine diagnosis and treatment? (Select all that apply) Rapid-onset ear pain that include pruritis. Correct Answer Tenderness associated with manipulation of the external ear. Edema or erythema of the external auditory canal. No tenderness associated with manipulation of the external ear. Rationale: Patients who have AOE present with one or more of the following: rapid- onset ear pain associated with pruritus, a sensation of ear fullness, tenderness on manipulation of the external ear, or edema or erythema of the EAC. Impaired hearing and purulent discharge may occur. Pg. 853 Which antibiotic drug class listed is known for all drugs within the class promoting the development of a Clostridioidies difficile infection? Tetracycline Macrolide Aminoglycoside Cephalosporin Rationale: All cephalosporins can promote Clostridioidies difficile infection. While other drug classes may have some drugs in the class that can cause C.Diff as well, all the drugs in the cephalosporins can promote the infection. Pg. 671 What is the likely causative agent for acute otitis media? Staphylococcus Aureus Pseudomonas Streptococcus pneumoniae Streptococcus pyogenes Rationale: Streptococcus pneumoniae is the most likely causative agent for acute otitis media. Information found in the course module. Trimethoprim should be avoided in patients with which deficiency? Vitamin C Vitamin A Folate Iodine Rationale: Trimethoprim is contraindicated in patients with folate deficiency (manifested as megaloblastic anemia). Which antibiotic does the course textbook recommend for treating a UTI in breastfeeding women? Ampicillin and Gentamycin Methenamine Hippurate Methenamine Mandelate Short-term Fluoroquinolones Rationale: This information can be found in the Summary of Key Prescribing Considerations in the chapter that covers this drug class. Which representative antibiotics are bacteriostatic inhibitors of protein synthesis as listed in your course textbook? (Select all that apply) Erythromycin Linezolid Clindamycin Vancomycin Rationale: This information can be found in the Summary of Key Prescribing Considerations in the chapter that covers this drug class. Which UTI drug can cause permanent lung damage? Nitrofurantoin Trimethoprim/sulfamethoxazole Levofloxacin Cefdinir Rationale: Nitrofurantoin can induce two kinds of pulmonary reactions: acute and subacute. Acute reactions, which are most common, manifest as dyspnea, chest pain, chills, fever, cough, and alveolar infiltrates. These symptoms resolve 2 to 4 days after discontinuing the drug. Acute pulmonary responses are thought to be hypersensitivity reactions. Patients with a history of these responses should not receive nitrofurantoin again. Subacute reactions are rare and occur during prolonged treatment. Symptoms (e.g., dyspnea, cough, malaise) usually regress over weeks to months after nitrofurantoin withdrawal. However, in some patients, permanent lung damage may occur. pg. 697 Which antibiotic classes should have a culture and sensitivity prior to prescribing and which ones do not according to your textbook? Culture Not indicated Rationale: This information can be found across the Summary of key prescribing considerations in the assigned reading chapters. Using your textbook, match the antibiotic class to the patient care concern for infants. Use each option only once by selecting the option that is most true. Third-generation drugs are used to treat bacterial infections in neonates as well as infants. Used safely in infants with bacterial infections, including syphilis, meningitis, and group A streptococcus. Approved to treat bacterial infections in infants younger than 8 days. Dosing is based on weight and length of gestation. Used in infants younger than 2 months can cause kernicterus, a potentially fatal condition. Rationale: This information can be found in the Summary of Key Prescribing Considerations in the chapter that covers this drug class.