NRNP 6566 / NRNP6566 Advanced Care of Adults in Acute Settings I Week 9 Knowledge Check | Questions and Verified Answers | Latest 2020 / 2021

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NRNP 6566 / NRNP6566 Advanced Care of Adults in Acute Settings I Week 9 Knowledge Check | Questions and Verified Answers | Latest 2020 / 2021 • Question 1 What factors are considered whe... n making empiric antibiotic decisions? Apply those factors to a patient with suspected acute otitis media. Correct Answer: Once a clinical diagnosis is made based on patient symptoms and exam findings, factors that assist in making empiric antibiotic decisions include the most common bacteria that cause this type of infection, the patients immunocompetence status, knowledge of any recent antibiotic use, past medical history, and recent health history, The most common bacterial pathogen for acute otitis media is streptococcal pneumoniae followed by haemophilus influenza and moraxelia catarrhalis. If the patient has a competent immune system and no previous antibiotics in the past 30 days, then amoxicillin or amoxicillin / clavulanic acid would be considered the best first line treatment. If the patient had been on amoxicillin for a throat infection two weeks ago, then a different antibiotic such as cefdinir or cefuroxime (considered second line antibiotic) would be selected now. It would be assumed that the bacteria causing the acute otitis is not sensitive to the amoxicillin that was given previously. Also, the cephlosporins have more activity against gram negative bacteria (such as H. Influenza and M. Catarrhalis) then amoxicillin does. Recent inpatient hospitalizations or more than two episodes of acute otitis media in the past few months may also indicate the need to choose a second or third line antibiotic because of suspected resistance to the first line drug (amoxicillin). • Question 2 A 42 year old female has a severe bacterial infection. She is being treated with a broach spectrum IV drug. The drug is administered too rapidly causing hypotension, flushing and itching over the upper portion of her chest, neck, and face. What antibiotic is likely responsible for these symptoms? Correct Answer: Vancomycin is the likely culprit in causing these symptoms. This is common-ly referred to as “red man” syndrome. These are caused by histamine relief when vancomycin is infused too rapidly. • Question 3 A 72 year old male is admitted to the hospital from his long term can facility after complaints of dyspnea and cough for 1 week. He was diagnosed with a COPD exacerbate and started on azithromycin. He has had little improvement after 3 days on this antibiotic. His past medical history includes hypertension, COPD, and hyperlipidemia. Current medications include lisinopril, atrovastatin, salmeterol, and albuterol inhaler. Current symptoms include fever, chills, productive cough, and worsening dyspnea. Current vital signs T 101.6 HR 92. RR 20 BP 138/82. O2 saturation is 96% on 4L of O2 Chest x-ray shows consolidation in the left lower lobe CBC and CMP are all within normal limits. How would you manage this patient? [Show More]

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