ADULT-GERONTOLOGY ACUTE CARE
NURSE PRACTITIONER CERTIFICATION
REVIEW WITH DETAILED RATIONALES
1. A 56-year-old white female patient presents to the
intensive care unit with some respiratory distress following
an elective total hysterectomy. Before the procedure she was
in good overall health. The patient received cefotetan 1 g
intravenous × 1 dose before her surgery. She had issues
during surgery with her respiratory status and required
mechanical ventilation at that time. The patient has been on a
ventilator for 3 days and the staff now notices increased
sputum production, decreased pulmonary function, elevated
temperature, and elevated white blood cell count. A chest
radiograph was ordered and shows significant left lower lobe
infiltrates. She has been diagnosed with health care-
associated pneumonia to be treated in the intensive care
unit. Which of the following drug regimens would be
appropriate for empiric therapy if you determine that she is at
risk for multidrug-resistant pathogens?
1. Cefepime (Maxipi
Answer: 1. Cefepime (Maxipime) + Levofloxacin (Levaquin) +
Vancomycin.
Rationale: When empiric treatment that includes coverage for
methicillin-sensitive Staphylococcus aureus (and not methicillin-
resistant S. aureus [MRSA]) is indicated, the guidelines suggest a
,regimen, including piperacillin-tazobactam, cefepime,
levofloxacin, imipenem, or meropenem. If empiric coverage for
MRSA is indicated, either vancomycin or linezolid is
recommended.1. Cefepime (Maxipime) + levofloxacin (Levaquin)
+ vancomycin.1. Cefepime (Maxipime) + levofloxacin (Levaquin)
+ vancomycin.1. Cefepime (Maxipime) + levofloxacin (Levaquin)
+ vancomycin.
17. How could total lung capacity be described?
1. Forced expiratory volume.
2. Forced vital capacity.
3. Volume of air in the lungs at end of inspiration.
4. Volume of air in the lungs at end of exhalation.
Answer: 3. Volume of air in the lungs at end of inspiration
Rationale: Total lung capacity is the volume of air in the lungs at
the end of inspiration.
2. A patient was properly cultured and was found to be
growing methicillin-resistant Staphylococcus aureus (MRSA)
in the sputum. Which of the following medications would
best treat this organism?
1. Amikacin.
2. Gentamicin (Garamycin).
3. Linezolid (Zyvox).
4. Levofloxacin (Levaquin).
Answer: 3. Linezolic (Zyvox)
Rationale: In an effort to minimize patient harm and exposure to
unnecessary antibiotics and reduce the development of antibiotic
resistance, the Infectious Diseases Society of America (IDSA) and
the American Thoracic Society (ATS) guidelines recommend that
,the antibiogram data be used to decrease the unnecessary use of
dual gram-negative and empiric methicillin-resistant
Staphylococcus aureus (MRSA) antibiotic treatment. If empiric
coverage for MRSA is indicated, either vancomycin or linezolid is
recommended.
3. Which of the following regimens would be appropriate
empiric therapy for a patient with community-acquired
pneumonia (CAP) that requires admission to the intensive
care unit?
1. Azithromycin (Zithromax) intravenously (IV).
2. Azithromycin IV + ceftriaxone (Rocephin) IV.
3. Azithromycin oral + amoxicillin/clavulanate (Augmentin)
oral.
4. Levofloxacin (Levaquin) oral.
Answer: 2. Azithromycin IV + ceftriaxone (Rocephin) IV.
Rationale: Typical bacterial pathogens causing community-
acquired pneumonia (CAP) include streptococcal pneumonia
(penicillin-sensitive/resistant strains), Haemophilus influenza
(ampicillin-sensitive/resistant strains), and Moraxella catarrhalis
(all strains penicillin-resistant) and account for about 85% of CAP
cases. Aspiration pneumonia is the only form of CAP caused by
multiple pathogens (e.g., aerobic/anaerobic oral organisms).
Klebsiella pneumoniae CAP occurs primarily in individuals with
chronic alcoholism, and Staphylococcus aureus may cause CAP
in influenza patients. Pseudomonas aeruginosa is a cause of CAP
in patients with bronchiectasis or cystic fibrosis. Empiric therapy
for a hospitalized intensive care patient is azithromycin
intravenously (IV) + ceftriaxone (Rocephin) IV.
, 4. You are working in the walk-in clinic today and your first
patient is a 62-year-old male patient with chronic diabetes
mellitus, hypertension, and hyperlipidemia. He was recently
on some antibiotics for a tooth infection this last month. He
presents with a mild case of community-acquired
pneumonia, and you determine that he is a good candidate
for outpatient therapy. Which antibiotics choice would be the
most appropriate on which to send him home?
1. A macrolide alone.
2. Doxycycline alone.
3. Fluoroquinolone alone.
4. β-lactam plus a fluoroquinolone.
Answer: 3. Fluoroquinolone alone.
Rationale: If there are comorbidities present (e.g., alcoholism,
bronchiectasis/cystic fibrosis, chronic obstructive pulmonary
disease, intravenous (IV) drug user, post influenza, asplenia,
diabetes mellitus, lung/liver/renal diseases) then use levofloxacin
750 mg by mouth (PO) every 24 hours or moxifloxacin 400 mg
PO every 24 hours or a combination of a β-lactam (amoxicillin 1 g
PO every 8 hours or amoxicillin-clavulanate 2 g PO every 12
hours or ceftriaxone 1 g IV/intramuscularly every 24 hours or
cefuroxime 500 mg PO twice daily) plus a macrolide (azithromycin
or clarithromycin).
5. KS had a complicated intensive care unit (ICU) stay. He
developed heparin-induced thrombocytopenia, resulting in a
pulmonary embolus. He was unable to be extubated. He
remains on the ventilator. It is day 8 of his ICU stay. Today
you note that he has developed fever and decreasing oxygen
saturation. Chest x-ray reveals a right lower lobe infiltrate
NURSE PRACTITIONER CERTIFICATION
REVIEW WITH DETAILED RATIONALES
1. A 56-year-old white female patient presents to the
intensive care unit with some respiratory distress following
an elective total hysterectomy. Before the procedure she was
in good overall health. The patient received cefotetan 1 g
intravenous × 1 dose before her surgery. She had issues
during surgery with her respiratory status and required
mechanical ventilation at that time. The patient has been on a
ventilator for 3 days and the staff now notices increased
sputum production, decreased pulmonary function, elevated
temperature, and elevated white blood cell count. A chest
radiograph was ordered and shows significant left lower lobe
infiltrates. She has been diagnosed with health care-
associated pneumonia to be treated in the intensive care
unit. Which of the following drug regimens would be
appropriate for empiric therapy if you determine that she is at
risk for multidrug-resistant pathogens?
1. Cefepime (Maxipi
Answer: 1. Cefepime (Maxipime) + Levofloxacin (Levaquin) +
Vancomycin.
Rationale: When empiric treatment that includes coverage for
methicillin-sensitive Staphylococcus aureus (and not methicillin-
resistant S. aureus [MRSA]) is indicated, the guidelines suggest a
,regimen, including piperacillin-tazobactam, cefepime,
levofloxacin, imipenem, or meropenem. If empiric coverage for
MRSA is indicated, either vancomycin or linezolid is
recommended.1. Cefepime (Maxipime) + levofloxacin (Levaquin)
+ vancomycin.1. Cefepime (Maxipime) + levofloxacin (Levaquin)
+ vancomycin.1. Cefepime (Maxipime) + levofloxacin (Levaquin)
+ vancomycin.
17. How could total lung capacity be described?
1. Forced expiratory volume.
2. Forced vital capacity.
3. Volume of air in the lungs at end of inspiration.
4. Volume of air in the lungs at end of exhalation.
Answer: 3. Volume of air in the lungs at end of inspiration
Rationale: Total lung capacity is the volume of air in the lungs at
the end of inspiration.
2. A patient was properly cultured and was found to be
growing methicillin-resistant Staphylococcus aureus (MRSA)
in the sputum. Which of the following medications would
best treat this organism?
1. Amikacin.
2. Gentamicin (Garamycin).
3. Linezolid (Zyvox).
4. Levofloxacin (Levaquin).
Answer: 3. Linezolic (Zyvox)
Rationale: In an effort to minimize patient harm and exposure to
unnecessary antibiotics and reduce the development of antibiotic
resistance, the Infectious Diseases Society of America (IDSA) and
the American Thoracic Society (ATS) guidelines recommend that
,the antibiogram data be used to decrease the unnecessary use of
dual gram-negative and empiric methicillin-resistant
Staphylococcus aureus (MRSA) antibiotic treatment. If empiric
coverage for MRSA is indicated, either vancomycin or linezolid is
recommended.
3. Which of the following regimens would be appropriate
empiric therapy for a patient with community-acquired
pneumonia (CAP) that requires admission to the intensive
care unit?
1. Azithromycin (Zithromax) intravenously (IV).
2. Azithromycin IV + ceftriaxone (Rocephin) IV.
3. Azithromycin oral + amoxicillin/clavulanate (Augmentin)
oral.
4. Levofloxacin (Levaquin) oral.
Answer: 2. Azithromycin IV + ceftriaxone (Rocephin) IV.
Rationale: Typical bacterial pathogens causing community-
acquired pneumonia (CAP) include streptococcal pneumonia
(penicillin-sensitive/resistant strains), Haemophilus influenza
(ampicillin-sensitive/resistant strains), and Moraxella catarrhalis
(all strains penicillin-resistant) and account for about 85% of CAP
cases. Aspiration pneumonia is the only form of CAP caused by
multiple pathogens (e.g., aerobic/anaerobic oral organisms).
Klebsiella pneumoniae CAP occurs primarily in individuals with
chronic alcoholism, and Staphylococcus aureus may cause CAP
in influenza patients. Pseudomonas aeruginosa is a cause of CAP
in patients with bronchiectasis or cystic fibrosis. Empiric therapy
for a hospitalized intensive care patient is azithromycin
intravenously (IV) + ceftriaxone (Rocephin) IV.
, 4. You are working in the walk-in clinic today and your first
patient is a 62-year-old male patient with chronic diabetes
mellitus, hypertension, and hyperlipidemia. He was recently
on some antibiotics for a tooth infection this last month. He
presents with a mild case of community-acquired
pneumonia, and you determine that he is a good candidate
for outpatient therapy. Which antibiotics choice would be the
most appropriate on which to send him home?
1. A macrolide alone.
2. Doxycycline alone.
3. Fluoroquinolone alone.
4. β-lactam plus a fluoroquinolone.
Answer: 3. Fluoroquinolone alone.
Rationale: If there are comorbidities present (e.g., alcoholism,
bronchiectasis/cystic fibrosis, chronic obstructive pulmonary
disease, intravenous (IV) drug user, post influenza, asplenia,
diabetes mellitus, lung/liver/renal diseases) then use levofloxacin
750 mg by mouth (PO) every 24 hours or moxifloxacin 400 mg
PO every 24 hours or a combination of a β-lactam (amoxicillin 1 g
PO every 8 hours or amoxicillin-clavulanate 2 g PO every 12
hours or ceftriaxone 1 g IV/intramuscularly every 24 hours or
cefuroxime 500 mg PO twice daily) plus a macrolide (azithromycin
or clarithromycin).
5. KS had a complicated intensive care unit (ICU) stay. He
developed heparin-induced thrombocytopenia, resulting in a
pulmonary embolus. He was unable to be extubated. He
remains on the ventilator. It is day 8 of his ICU stay. Today
you note that he has developed fever and decreasing oxygen
saturation. Chest x-ray reveals a right lower lobe infiltrate
