Anti-Infectives Quiz 1: Pharmacology Practice Questions

Anti-infectives 1 Quiz Herzing University

Anti-infectives 1 Quiz – Patient 1

Patient Data

History and Physical

A 23-year-old female patient presents to the public health clinic, stating that one of her sexual partners was recently treated for gonorrhea. The patient reports having increased vaginal discharge for the last 4 days but no other symptoms. In the last 3 months, she has had four male partners. She takes birth control pills and rarely uses condoms during sexual encounters. The patient has no relevant health history.

Nurses’ Notes

1630: Patient claims to have had sexual contact with a partner who tested positive for gonorrhea. The patient also reports having increased vaginal discharge for the last 4 days.

1645: Urine specimen obtained for testing for nucleic acid amplification (NAA) test.

1705: Order received by the RN and ceftriaxone administered to patient. Patient contacts obtained and patient education on sexually transmitted infections (STIs) provided. Patient contact information taken to call with NAA test results when received.

Orders

Urine NNA test

Ceftriaxone 500 mg IM (Z-track) twice a day

The LPN reviews the patient’s medical record and plans to administer medication to the patient.

Drag from Word Choices to complete the sentence(s).

So close!

Rationale:

Ceftriaxone is a third-generation cephalosporin. Patients who have had allergic reactions to other cephalosporins or severe allergic reactions to penicillin should not receive cephalosporins. Before administering the medication, a test should be done to determine whether an infection is present, what the infecting organism is, and what drug the organism is susceptible to. If this is done after the medication is given, it may affect the results of the test. Cephalosporins are not affected by diet. It is not necessary to obtain renal function tests before administering a cephalosporin. Aminoglycosides affect hearing; cephalosporins do not. Anti-infectives 1 Quiz

9m 38s

Clinical Judgment Skill(s):

Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Actions

1 / 2 points

Anti-infectives 1 Quiz – Patient 2

Patient Data

History and Physical

The patient is an 86-year-old female who resides in a long-term care facility and has a baseline of being alert and oriented, continent, and independent with activities of daily living (ADLs). She has a history of heart failure, type 2 diabetes, and hyperthyroidism. The unlicensed assistive personnel (UAP) reports that the patient had a few episodes of confusion during the shift, not knowing where she was or who her family members were. The patient had four incidents of incontinence in the last 2 days, and the nursing assistant noticed foul-smelling urine while assisting the patient in changing clothes. Due to confusion and fatigue, the patient needed cues for ADLs. The patient reports that she has been tired and has not had an appetite for a few days. The current temperature is 100.0°F (37.78°C).

Laboratory Results

Urine Culture

Time: 1150

Site: Clean catch

Source: Urine

Colony count
>100,000 colonies/mL

Reference range
Negative: <10,000 bacteria per milliliter of urine Final report Escherichia coli ABNORMAL Orders Amoxicillin/clavulanic acid PO 250 mg every 8 hours for 10 days So close! Rationale: Potential Conditions Urinary tract infections (UTIs) in older adults often present with confusion, fatigue, incontinence, increased temperature, and urine with a foul-smelling odor. UTIs are diagnosed with urine cultures and treated with antibiotics. This patient’s baseline is being alert and oriented, continent, and independent with activities of daily living (ADLs). The confusion is a new onset and has associated symptoms of a UTI so the LPN would not be concerned with dementia until other influences have been ruled out for cause of confusion. There are not specified symptoms that indicate dehydration or hypoglycemia. Actions to Take Amoxicillin/clavulanic is a penicillin. Penicillin should be taken with a full glass of water 1 hour before meals or 2 hours after meals. Patients should complete medication for the entire amount of time ordered even when symptoms are resolved. An IV infusion may be ordered if the patient was experiencing dehydration. Administering orange juice would be an appropriate nursing measure to treat hypoglycemia. If a patient is experiencing symptoms of dementia, a social worker is often called, but this is not needed when the confusion is related to a UTI. Anti-infectives 1 Quiz Herzing University Parameters to Monitor Although penicillin is a common drug, penicillin allergies are common, and patients should be monitored for allergic reactions such as skin rashes, itching, or hives. Monitoring temperature is a method of determining whether the medication is resolving the symptoms. Amoxicillin/clavulanic does not cause muscle cramps, pedal edema, or change blood sugar levels. 13m 17s Clinical Judgment Skill(s): Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Actions, Evaluate Outcomes 4 / 5 points Anti-infectives 1 Quiz – Patient 3 Patient Data History and Physical Day 1 : 44-year-old male client presented with shortness of breath, chest pain, pedal edema, fever, and chills that were worsening over a period of 2 days. Upon admission, cultures were obtained, and he was initiated on empiric antibiotic therapy consisting of vancomycin, gentamicin, cefepime, and rifampin. Nurses’ Notes Day 2: 1245: Physician reviews cultures and writes new orders for antibiotic therapy. 1340: Antibiotic therapy is tailored based on culture findings. Gentamicin and ceftriaxone are initiated. Laboratory Results Laboratory Value Results Reference Range Serum creatinine 1.5 mg/dL 0.6-1.2 mg/dL Alanine aspartate (AST) 22 U/L 0-35 U/L Alanine transaminase (ALT) 20 U/L 4-36 U/L Red blood cells (RBCs) 5.2 M/uL 4.7 to 6.1 M/uL Hemoglobin (Hgb) 15.6 g/dL 14-18 g/dL Hematocrit (Hct) 43.5% 40 to 52% White blood cells (WBCs) 16,000 g/uL 5 to 10 g/uL Valve culture Viridans streptococcus Negative Blood culture Viridans streptococcus Negative Flow Sheet Day 1 : Vital Signs: Temperature 100.2°F (37.9°C) Heart rate 96 bpm Respiratory rate 20 breaths per minute Blood Pressure 142/84 Orders Day 2: 1245 Gentamicin 120 mg IV infusion (over 60 minutes) every 8 hours. Duration of therapy is 2 weeks. Gentamicin trough level immediately prior to second dose Ceftriaxone 2 g IV q24h. Duration of therapy is 6 weeks. Continue warfarin 2 mg po daily, losartan 100 mg po daily, ibuprofen 400 mg po q8h; metoprolol tartrate 50 mg po bid The LPN is assigned to a 44-year-old male who was admitted 2 days ago. Blood cultures were taken, lab results are now available, and the healthcare provider has diagnosed endocarditis of a prosthetic valve (replaced 9 months ago). A new antibiotic therapy following the results of the cultures has been initiated. Drag from Word Choices to complete the sentence. That’s right! Rationale: Gentamicin is an aminoglycoside medication that can lead to toxicity of the kidneys (nephrotoxicity) and the ears (ototoxicity). Nephrotoxicity occurs in 5% to 25% of patients and is usually reversible. The risk for nephrotoxicity is increased in clients with existing renal impairment and those who are receiving other nephrotoxic drugs. In this case, the client is receiving ibuprofen and an angiotensin receptor blocker, which can increase the risk of nephrotoxicity with gentamicin. In addition, he already has an elevated serum creatinine level of 1.5 mg/dL, suggesting a level of pre-existing renal impairment, which increases his risk for nephrotoxicity. Ototoxicity may occur with gentamicin, although it is less common than nephrotoxicity. If ototoxicity occurs, it is typically irreversible and it is usually dependent on the dose and duration of therapy. Hepatotoxicity, hypertensive urgency, hyperkalemia, and seizures are not expected to occur with gentamicin therapy Anti-infectives 1 Quiz. 9m 12s Clinical Judgment Skill(s): Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Actions, Evaluate Outcomes 2 / 2 points Anti-infectives 1 Quiz Herzing University