Chapter 86: Aminoglycosides: Bactericidal Inhibitors of Protein Synthesis

Chapter 86: Aminoglycosides: Bactericidal Inhibitors of Protein Synthesis

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1. A nurse reviews the culture report of a patient being treated with an aminoglycoside for a serious infection. Which organism identified in the report would prompt the nurse to contact the prescriber about changing the antibiotic?

a.	Staphylococcus aureus
b.	E. coli
c.	Proteus mirabilis
d.	Pseudomonas aeruginosa

 

 

ANS:   A

Staphylococcus aureus (S. aureus) is resistant to aminoglycosides, and the nurse should report this finding to the prescriber to seek a change in the prescribed antibiotic.

This medication is effective against the enterobacteriaceae, which include Escherichia coli (E. coli) and Proteus mirabilis.

The principal use for parenteral aminoglycosides is treatment of serious infection caused by aerobic gram-negative bacilli; a primary target is the organism Pseudomonas aeruginosa.

 

DIF:    Cognitive Level: Application             REF:    p. 1018

TOP:    Nursing Process: Assessment

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

 

2. The prescriber has just ordered neomycin for a patient with an infection. The nurse is aware that the most important reason neomycin is administered orally is that with parenteral administration is that it

a.	causes excessive gastric irritation.
b.	would kill beneficial intestinal flora.
c.	is inactivated by gastric enzymes after a first pass through the liver.
d.	is more ototoxic and nephrotoxic than other aminoglycosides.

 

 

ANS:   D

Neomycin is more ototoxic and nephrotoxic than any other aminoglycoside, therefore it is not given parenterally.

Neomycin does not cause excessive gastric irritation and may be used for gastrointestinal (GI) infection.

Neomycin does not kill beneficial intestinal flora.

Neomycin is not inactivated by the first-pass effect.

 

DIF:    Cognitive Level: Application             REF:    p. 1022

TOP:    Nursing Process: Planning

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

 

3. The nurse is caring for a patient receiving gentamicin (Garamycin) intravenously (IV). What statement by the patient would most concern the nurse? “I am experiencing

a.	dizziness.”
b.	ear pain.”
c.	tone deafness.”
d.	high-pitched tinnitus.”

 

 

ANS:   D

The first sign of impending cochlear damage is high-pitched tinnitus (ringing in the ears).

As injury to cochlear hair cells proceeds, hearing in the high-frequency range begins to decline.

The first sign of vestibular damage is headache, which may last 1 to 2 days. Nausea, unsteadiness, dizziness, and vertigo then begin to appear.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 1020 | p. 1022

TOP:    Nursing Process: Assessment

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

 

4. The nurse is admitting to the unit a patient who has just had a minor operation and received a general anesthetic. The nurse notices that gentamicin (Garamycin) is infusing IV. Which of the following clinical findings associated with these drug-drug interactions would most alarm the nurse?

a.	Diluted urine
b.	Decreased sensation in the lower extremities
c.	Hyperreflexia
d.	Persistent headache

 

 

ANS:   B

Neuromuscular blockade may occur after IV, intramuscular (IM), and oral administration of gentamicin. The risk of paralysis is increased by concurrent use of neuromuscular blocking agents and general anesthetics. Decreased sensation in the lower extremities may signal paralysis.

Diluted urine is not an effect of drug-drug interactions.

Hyperreflexia would not be anticipated, nor would persistent headache, which might be seen with ototoxicity related to concurrent administration of other ototoxic medications.

 

DIF:    Cognitive Level: Application             REF:    p. 1020

TOP:    Nursing Process: Assessment

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