Chapter 84: Drugs That Weaken the Bacterial Cell Wall I: Penicillins

Chapter 84: Drugs That Weaken the Bacterial Cell Wall I: Penicillins

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

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

ANS:  A

Gentamicin should never be administered concurrently with penicillin, because they will interact, and the penicillin may inactivate the aminoglycoside. All the other options show concurrent administration.

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 1015 | p. 1021

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

2. A patient has an infection caused by Pseudomonas aeruginosa. The prescriber has ordered piperacillin and amikacin, both to be given intravenously. What will the nurse do?

ANS:  A

When penicillins are present in high concentrations, they interact with aminoglycosides and inactivate the aminoglycoside; therefore, these two drugs should never be mixed in the same IV solution. The drugs should be given at different times with different tubing. In the treatment of Pseudomonas infections, extended-spectrum penicillins, such as piperacillin, usually are given in conjunction with an antipseudomonal aminoglycoside, such as amikacin; therefore, suggesting a larger dose of piperacillin and discontinuation of the amikacin is incorrect. Zosyn is not recommended. The risk of allergic reactions does not increase with this combination of drugs.

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 1015 | p. 1021 | p. 1023

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

3. A nurse assisting a nursing student with medications asks the student to describe how penicillins (PCNs) work to treat bacterial infections. The student is correct in responding that penicillins:

ANS:  B

PCNs weaken the cell wall, causing bacteria to take up excessive amounts of water and subsequently rupture. PCNs inhibit transpeptidases and disinhibit autolysins. PCNs do not affect the cell walls of the host.

PTS:   1                    DIF:    Cognitive Level: Comprehension     REF:   p. 1015

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

4. A child with otitis media has had three ear infections in the past year. The child has just completed a 10-day course of amoxicillin [Amoxil] with no improvement. The parent asks the nurse why this drug is not working, because it has worked in the past. What will the nurse tell the patient?

ANS:  D

Beta-lactamases are enzymes that cleave the beta-lactam ring and render the PCN inactive. This resistance is common with organisms that cause ear infections. Amoxicillin is a broad-spectrum antibiotic. A three-layer cell envelope occurs in gram-negative bacteria. Some bacterial strains, including methicillin-resistant Staphylococcus aureus (MRSA), develop PBPs with a low affinity for penicillins. MRSA is not a common cause of otitis media.

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 1015-1017

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies