Chapter 83: Drugs That Weaken the Bacterial Cell Wall I: Penicillins

Chapter 83: Drugs That Weaken the Bacterial Cell Wall I: Penicillins

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1. A nurse transcribes a new prescription for potassium penicillin G given intravenously (IV) q 8 h and gentamicin IV q 12 h. Which plan is the best schedule for administering these drugs?

a.	Give the penicillin at 0800, 1600, and 2400; give the gentamicin (Garamycin) at 1800 and 0600.
b.	Give the penicillin at 0800, 1600, and 2400; give the gentamicin (Garamycin) at 1200 and 2400.
c.	Give the penicillin at 0600, 1400, and 2200; give the gentamicin (Garamycin) at 0600 and 1800.
d.	Give the penicillin every 8 hours; give the gentamicin (Garamycin) simultaneously with two of the penicillin doses.

 

 

ANS:   A

Gentamicin should never be administered concurrently with penicillin, because they will interact, and the penicillin may inactivate the aminoglycoside.

All these options show concurrent administration.

 

DIF:    Cognitive Level: Application             REF:    p. 992

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

2. The nurse is reviewing laboratory test results for a patient who is about to begin taking piperacillin. An abnormal elevation in which laboratory values would cause the nurse to notify the prescriber immediately?

a.	PT and PTT
b.	BUN and creatinine
c.	Hematocrit and hemoglobin
d.	Serum glutamic-oxaloacetic transaminase (SGOT) and alanine transaminase (ALT)

 

 

ANS:   B

The medication prescribed for the patient is dependent on a normal kidney function. The BUN and creatinine level are the best indications of kidney function.

A PT and PTT are not indicated in this situation but are indicted for heparin and warfarin.

Hematocrit and hemoglobin may be needed once the patient begins treatment.

SGOT and ALT are indicated for drugs that are hepatotoxic, which piperacillin is not.

 

DIF:    Cognitive Level: Application             REF:    p. 992

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

3. The nurse is performing an assessment on a patient receiving ticarcillin (Ticar) for treatment of a Pseudomonas infection. Which of the following clinical manifestations should most concern the nurse? (Select all that apply.)

a.	High sodium level and edema
b.	Transient headache
c.	Gastrointestinal (GI) discomfort
d.	Poor skin turgor
e.	Bleeding gums

 

 

ANS:   A

E

Because the drug is administered as disodium salt, and large intravenous (IV) doses often are required, symptoms of sodium overload (CHF) may develop. Edema would be an indication of potential fluid overload, especially coupled with a high sodium level. Also, ticarcillin interferes with platelet function and can promote bleeding. Bleeding gums are a good indication that platelet function may be compromised.

A transient headache, GI discomfort, and poor skin turgor may signal other problems, but they are not consistent with administration of ticarcillin.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 992

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

4. The nurse is serving as a preceptor for a graduate nurse on a medical-surgical unit. The nurse, who is discussing the mechanisms of action of antibiotics, currently is talking about the mechanism of action of penicillins (PCNs). Which statement by the graduate nurse best demonstrates understanding? “Penicillin works by

a.	weakening the bacterial cell wall, which then ruptures and dies.”
b.	inhibiting protein synthesis and suppressing bacterial growth.”
c.	disrupting bacterial protein synthesis, destroying the bacterial wall.”
d.	disrupting biochemical reactions, which results in cellular lysis.”

 

 

ANS:   A

PCNs weaken the cell wall, causing bacteria to take up excessive amounts of water and, subsequently, rupture.

PCNs do not inhibit protein synthesis, disrupt bacterial protein synthesis, or disrupt biochemical reactions.

 

DIF:    Cognitive Level: Application             REF:    p. 984

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies