Nursing Elites

1. The nurse is preparing to administer an antibiotic to a patient who has been receiving the antibiotic for 2 days after a culture was obtained. The nurse notes increased erythema and swelling, and the patient has a persistent high fever of 39°C. What is the nurse’s next action?

• A. Administer the antibiotic as ordered.
• B. Contact the provider to request another culture.
• C. Discuss the need to add a second antibiotic with the provider.
• D. Review the sensitivity results from the patient’s culture.

Correct answer: D

Rationale: In this scenario, the nurse is observing signs of a possible lack of response to the current antibiotic therapy, such as increased erythema, swelling, and persistent high fever. The next appropriate action for the nurse is to review the sensitivity results from the patient’s culture. This step is crucial to determine if the current antibiotic is effective against the causative organism. If the sensitivity results indicate resistance to the current antibiotic, the antibiotic should be discontinued, and the provider should be notified for a change in therapy. Contacting the provider to request another culture is not the immediate priority, as the existing culture results need to be reviewed first. Adding a second antibiotic should only be considered after confirming the sensitivity results, as unnecessary antibiotic use can lead to antimicrobial resistance.

2. Which of the following is the best position for a patient experiencing dyspnea?

• A. Supine position.
• B. Fowler's position.
• C. Trendelenburg position.
• D. Lateral recumbent position.

Correct answer: B

Rationale: Fowler's position is the best position for a patient experiencing dyspnea. This position involves sitting the patient upright with the head of the bed elevated between 45-60 degrees. Fowler's position helps improve breathing in patients with dyspnea by promoting lung expansion, aiding in better oxygenation, and reducing the work of breathing. The supine position (Choice A) may worsen dyspnea by limiting lung expansion. The Trendelenburg position (Choice C) with the feet elevated and the head down is not recommended for dyspnea as it can increase pressure on the chest and compromise breathing. The lateral recumbent position (Choice D) is not ideal for dyspnea as it does not provide optimal lung expansion and may not alleviate breathing difficulty.

3. The healthcare provider caring for a patient who will receive penicillin to treat an infection asks the patient about previous drug reactions. The patient reports having had a rash when taking amoxicillin (Amoxil). The healthcare provider will contact the provider to

• A. discuss giving a smaller dose of penicillin.
• B. discuss using erythromycin (E-mycin) instead of penicillin.
• C. request an order for diphenhydramine (Benadryl).
• D. suggest that the patient receive cefuroxime (Ceftin).

Correct answer: B

Rationale: When a patient reports a previous rash with amoxicillin, which is a type of penicillin, there is a concern for a penicillin allergy. In such cases, using an alternative antibiotic like erythromycin, which is not a penicillin, is the appropriate approach to avoid potential cross-reactivity and allergic reactions. Giving smaller doses of penicillin does not address the underlying allergy issue and can still lead to severe hypersensitivity reactions. Diphenhydramine (Benadryl) is used to manage allergic reactions but should not be the first choice in changing the antibiotic. While some patients allergic to penicillins may also be allergic to cephalosporins like cefuroxime, it is not the best immediate alternative in this scenario.

4. The nurse is preparing to administer the first dose of intravenous ceftriaxone (Rocephin) to a patient. When reviewing the patient’s chart, the nurse notes that the patient previously experienced a rash when taking amoxicillin. What is the nurse’s next action?

• A. Administer the drug and observe closely for hypersensitivity reactions.
• B. Ask the provider whether a cephalosporin from a different generation may be used.
• C. Contact the provider to report drug hypersensitivity.
• D. Notify the provider and suggest an oral cephalosporin.

Correct answer: A

Rationale: When a patient has a history of a rash with amoxicillin, a beta-lactam antibiotic like ceftriaxone should be administered cautiously due to a possible cross-reactivity. The nurse should still administer the drug but closely monitor the patient for any signs of hypersensitivity reactions. Asking for a different generation of cephalosporin or suggesting an oral form does not address the potential cross-reactivity issue. Contacting the provider to report drug hypersensitivity would delay care when the patient needs immediate treatment.

5. A patient is diagnosed with Mycoplasma pneumonia. Which antibiotic will the nurse expect the provider to order to treat this infection?

• A. Azithromycin (Zithromax)
• B. Clarithromycin (Biaxin)
• C. Erythromycin (E-Mycin)
• D. Fidaxomicin (Dificid)

Correct answer: C

Rationale: Erythromycin is the drug of choice for treating Mycoplasma pneumonia. Mycoplasma pneumonia is typically sensitive to macrolide antibiotics, with erythromycin being one of the first-line agents. Azithromycin and clarithromycin are also effective in treating Mycoplasma pneumonia, but erythromycin is specifically mentioned as the drug of choice in this context. Fidaxomicin, on the other hand, is not indicated for the treatment of Mycoplasma pneumonia and is primarily used to treat Clostridium difficile infections.

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