Chapter 87: Aminoglycosides: Bactericidal Inhibitors of Protein Synthesis

Chapter 87: Aminoglycosides: Bactericidal Inhibitors of Protein Synthesis

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. A patient has a Pseudomonas aeruginosa infection that is sensitive to aminoglycosides, and the prescriber orders gentamicin. The patient tells the nurse that a friend received amikacin [Amikin] for a similar infection and wonders why amikacin was not ordered. What will the nurse tell the patient?

a.	“Amikacin is given when infectious agents are resistant to other aminoglycosides.”
b.	“Amikacin is more vulnerable to inactivation by bacterial enzymes.”
c.	“Amikacin is a narrow-spectrum drug and will probably not work for this infection.”
d.	“Gentamicin is less toxic to the ears and the kidneys.”

 

 

ANS:  A

Resistance to amikacin is uncommon at this point; to minimize the emergence of amikacin-resistant bacteria, this drug is reserved for infections in which resistance to other aminoglycosides has developed. Amikacin is the least susceptible to inactivation by bacterial enzymes. Amikacin is a broad-spectrum antibiotic. All aminoglycosides are ototoxic and nephrotoxic.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 1050 | p. 1055

TOP:   Nursing Process: Implementation

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

 

2. A patient is diagnosed with an infection caused by Staphylococcus aureus, and the prescriber orders intravenous gentamicin and penicillin (PCN). Both drugs will be given twice daily. What will the nurse do?

a.	Administer gentamicin, flush the line, and then give the penicillin.
b.	Give the gentamicin intravenously and the penicillin intramuscularly.
c.	Infuse the gentamicin and the penicillin together to prevent fluid overload.
d.	Request an order to change the penicillin to vancomycin.

 

 

ANS:  A

Gentamicin should not be infused with penicillins in the same solution, because PCN inactivates gentamicin; therefore, the nurse should give one first, flush the line, and then give the other. The nurse cannot give a drug IM when it is ordered IV without an order from the prescriber. These two drugs should not be infused in the same solution. There is no indication for changing the PCN to vancomycin; that should be done for serious infections.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 1054-1055

TOP:   Nursing Process: Planning

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

 

3. A nurse is reviewing the culture results of a patient receiving an aminoglycoside. The report reveals an anaerobic organism as the cause of infection. What will the nurse do?

a.	Contact the provider to discuss an increased risk of aminoglycoside toxicity.
b.	Continue giving the aminoglycoside as ordered.
c.	Request an order for a different class of antibiotic.
d.	Suggest adding a penicillin to the patient’s drug regimen.

 

 

ANS:  C

Aminoglycosides are not effective against anaerobic microbes, so another class of antibiotics is indicated. There is no associated increase in aminoglycoside toxicity with anaerobic infection. The aminoglycoside will not be effective, so continuing to administer this drug is not indicated. Adding another antibiotic is not useful, because the aminoglycoside is not necessary.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 1050

TOP:   Nursing Process: Assessment

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

 

4. A patient is diagnosed with a lung infection caused by P. aeruginosa. The culture and sensitivity report shows sensitivity to all aminoglycosides. The nurse knows that the rate of resistance to gentamicin is common in this hospital. The nurse will expect the provider to order which medication?

a.	Amikacin [Amikin]
b.	Gentamicin
c.	Paromomycin
d.	Tobramycin

 

 

ANS:  A

When resistance to gentamicin and tobramycin is common, amikacin is the drug of choice for initial treatment of aminoglycoside-sensitive infections. Gentamicin would not be indicated, because resistance is more likely to develop. Paromomycin is used only for local effects within the intestine and is given orally. Tobramycin is not indicated, because organisms can more readily develop resistance.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 1050 | p. 1055

TOP:   Nursing Process: Assessment

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