Chapter 59: Penicillins

Chapter 59: Penicillins

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A primary care nurse practitioner (NP) sees a 3-year-old child who has a history of recurrent otitis media. The child’s parent tells the NP that the child is allergic to penicillin. The NP learns that the child developed an all-over rash 2 days after starting amoxicillin at age 2 years. The NP should:

ANS:  A

Although it is true that patient report correlates poorly with actual allergy, there is a risk of life-threatening anaphylaxis with a true penicillin allergy. The NP should order a penicillin skin test to verify allergy. If the skin test is positive, the patient should avoid b-lactam antimicrobials. Penicillin desensitization can be used for penicillin-allergic patients who need penicillins.

DIF:    Cognitive Level: Applying (Application)                           REF:   672

2. A patient with group A b-hemolytic streptococcal pharyngitis is treated with penicillin V. At a follow-up visit 2 weeks later, the patient presents with edema of the hands and feet, blood pressure of 140/85 mm Hg, and cola-colored urine. A urine dipstick shows proteinuria. The primary care NP should:

ANS:  C

A minimum of 10 days of treatment is recommended for any infection caused by group A b-hemolytic streptococcus to prevent the occurrence of rheumatic fever or acute glomerulonephritis. This patient shows signs of acute glomerulonephritis, so the NP should obtain an ASO titer and creatinine clearance to help confirm the diagnosis. It is not necessary to repeat the throat culture. Treatment involves controlling blood pressure and maintaining renal function, not giving antibiotics.

DIF:    Cognitive Level: Applying (Application)                           REF:   673

3. A patient is taking dicloxacillin (Dynapen) 500 mg every 6 hours to treat a severe penicillinase-resistant infection. At a 1-week follow-up appointment, the patient reports nausea, vomiting, and epigastric discomfort. The primary care NP should:

ANS:  D

When giving penicillinase-resistant penicillins, it is important to monitor therapy with blood cultures, WBC with differential cell counts, and LFTs before treatment and weekly during treatment. This patient may have typical gastrointestinal side effects, but the symptoms may also indicate hepatic damage. Changing the medication is not indicated, unless serious side effects are present. Decreasing the dose is not indicated.

DIF:    Cognitive Level: Applying (Application)                           REF:   673

4. The primary care NP administers penicillin G (Bicillin) to a 75-year-old patient who has COPD and heart failure. The patient takes digoxin, warfarin, and spironolactone. To help prevent drug interactions, the NP should order:

ANS:  A

Penicillin G can cause hyperkalemia, which can increase digoxin toxicity, so serum electrolytes should be monitored. Penicillin G does not interact with warfarin or spironolactone. Coagulation studies, creatinine clearance, and LFTs are not indicated in this circumstance.

DIF:    Cognitive Level: Applying (Application)                           REF:   673