NR 566 MIDTERM 2025 EXAM LATEST QUESTIONS AND DETAILED CORRECT ANSWERS | A+ GRADE, Exams of Nursing

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NR 566 MIDTERM 2025 EXAM LATEST

QUESTIONS AND DETAILED CORRECT

ANSWERS | A+ GRADE STUDYGUIDE

CHAMBERLAIN

What is narrow vs broad spectrum antibiotics? Correct Answer - narrow-spectrum antibiotics are active against only a few species of microorganisms

• broad-spectrum antibiotics are active against a wide variety of microbes Do we usually order narrow or broad spectrum before receive culture results? Correct Answer broad Which one is more likely to facilitate emergence of drug- resistant organisms and superinfections? Correct Answer broad Penicillin in pregnancy Correct Answer - B lactam antibiotics (contain B-lactam ring)
• bacteria resistant by enzyme, which attacks the B lactate ring
• safe in pregnancy
• good against gram + bacteria
• targets bacterial cell wall Cephalosporins in pregnancy Correct Answer - B lactam antibiotics (1-3 generations)
• safe in pregnancy (B) - >? congenital heart defects

Tetracyclines in pregnancy Correct Answer - inhibits protein synthesis

• teratogenic
• avoided entirely during pregnancy (X) - > weakening, hypoplasia, and discoloration of long bones and teeth Aminoglycosides in pregnancy Correct Answer - inhibits bacterial protein synthesis
• works against aerobic bacteria
• ineffective against anaerobic bacteria
• not safe in pregnancy (C/D)
• ototoxicity, nephrotoxicity Macrolides in pregnancy Correct Answer - bacteriostatics that inhibit a translocation step of protein synthesis by binding to bacterial ribosomes
• broad spectrum
• safe in pregnancy (B)
• arrhythmia (prolong QT interval)
• alternative for penicillins Fluoroquinolones in pregnancy Correct Answer - inhibit DNA replication - > cause DNA cleavage
• broad spectrum
• not safe in pregnancy (C)
• problems with tendons, joints, large vessels Lincomycin in pregnancy Correct Answer Ex. Clindamycin
• binds bacterial ribosome

• Rifampin Inhibitors of cell membrane function Correct Answer - Amphotericin B
• Isoniazid
• Polymyxins Which antibiotics drug classes are contraindicated in pregnancy and why? Correct Answer - Fluoroquinolones should be avoided due to potential cartilage damage risk.
• Tetracyclines should be avoided due to potential tooth damage and staining What is the difference between bactericidal and bacteriostatic drug? Correct Answer - Bactericidal drugs are directly lethal to bacteria at clinically achievable concentrations
• Bacteriostatic drugs can slow bacterial growth but do not cause cell death Bactericidal Agents Correct Answer aminoglycosides, beta-lactams, fluoroquinolones, metronidazole, most antimycobacterial agents, streptogramins, and vancomycin Bacteriostatic Agents Correct Answer clindamycin, macrolides, sulfonamides, and tetracyclines What are the four basic mechanisms microbes have for resisting drugs? Correct Answer 1. decrease the concentration of a drug at its site of action

2. alter the structure of drug target molecules
3. produce a drug antagonist
4. cause drug inactivation What is the most important patient education regarding antibiotics? Correct Answer It is imperative that antibiotics not be discontinued prematurely Bacteriostatic examples Correct Answer Erythromycin (macrolides) Clindamycin Sulfonamides Trimethoprim Tetracyclines Chloramphenicol Bactericidal examples Correct Answer Vancomycin Penicillins Fluoroquinolones Aminoglycosides Cephalosporins Carbapenems Metronidazole What classes of antibiotics are resistant to C-diff? Correct Answer aminoglycosides or cephalosporins What are generally the best antibiotics to treat C-diff? Correct Answer Flagyl and vancomycin

Are antibiotics safe when breastfeeding? Correct Answer - As a general guideline, antibiotics and all other drugs should be avoided by women who are breastfeeding

• Amoxicillin is safe for use in breastfeeding What is the MOA of Beta-Lactam antibiotics? (penicillin) Correct Answer disruption of the bacterial cell wall What other drugs are in the B-lactam family? Correct Answer cephalosporins, carbapenems, and aztreonam Are beta lactams bactericidal or bacteriostatic? Correct Answer generally bactericidal _______are enzymes that cleave the β-lactam ring and, therefore, render penicillins and other β-lactam antibiotics inactive. Correct Answer β-Lactamases What are some of the most common gram + bacterium? Correct Answer staphylococcus (Staph), Streptococcus (Strep), Enterococcus, and C.diff What are some of the most common gram - bacterium? Correct Answer Neisseria gonorrhoeae, Neisseria meningitidis, e.coli, shigella, campylobacter, salmonella, Pasteurella, rickettsia, borrelia, proteus, pseudomonas, legionella, etc What kind of reported allergic reaction to penicillin's would be ok to give a cephalosporin? Correct Answer rash or more specific—morbilliform rash

What kind of reported allergic reaction to penicillin's would NOT be ok to give a cephalosporin? Correct Answer anaphylaxis Antibiotics that cover MRSA Correct Answer Clindamycin Vancomycin Ceftaroline Doxycycline Bactrim Daptomycin What part of the body does MRSA typically infect? Correct Answer usually involves the skin and soft tissues, causing abscesses, boils, cellulitis, and impetigo How do can we eradicate MRSA in the carrier? Correct Answer intranasal application of a topical antibiotic— mupirocin or retapamulin—can be effective What other measures can we take and advise our patients to do to reduce the risk of transmission of MRSA? Correct Answer - good hand hygiene—washing with soap and water or applying an alcohol-based sanitizer

• showering after contact sports, cleaning frequently touched surfaces, keeping infected sites covered
• not sharing towels and personal items What antibiotics are used for serious infections? Correct Answer trimethoprim/sulfamethoxazole, minocycline, doxycycline, and clindamycin

What is a safe alternative for severe PCN allergy? Correct Answer vancomycin, erythromycin, and clindamycin What are the only two broad spectrum penicillin antibiotics? Correct Answer ampicillin and amoxicillin Vancomycin side effects Correct Answer Thrombophlebitis Ototoxicity Nephrotoxicity What is the MOA of Vancomycin? Correct Answer inhibits cell wall synthesis and, therefore, promotes bacterial lysis and death Is vancomycin active against gram + or - bacteria? Correct Answer gram + Is renal dosing for vancomycin necessary? Correct Answer - if patient has renal impairment, dosage must be reduced - if patient has 50% increase in serum creatinine level, dosage should be reduced Vancomycin is the drug of choice for which infections? Correct Answer infections caused by MRSA or S. epidermidis and severe C-diff What is the definition of C-diff? Correct Answer - the passage of three or more unformed stools in 24 hours or less

• plus a positive stool test for C. diff. or its toxins

What is the MOA of Telvancin? Correct Answer - inhibits bacterial cell wall synthesis

• binds to the bacterial cell membrane and disrupts membrane function Is Telvancin active against Gram (-) or (+) bacteria? Correct Answer Gram + only (S. aureus, streptococci groups, Enterococcus fecalis, IV use tx complicated skin infections What are the most common Telvancin adverse effects? Correct Answer taste disturbance, nausea, vomiting, and foamy urine What reaction can occur if Vancomycin or Telvancin is infused too fast? Correct Answer "red man syndrome," characterized by flushing, rash, pruritus, urticaria, tachycardia, and hypotension We should take caution in patients taking drugs with Telvancin such as? Correct Answer caution in patients taking other drugs that can damage the kidneys (e.g., NSAIDs, angiotensin-converting enzyme inhibitors, and aminoglycosides) and in patients taking drugs that prolong the QT interval (e.g., clarithromycin and ketoconazole) What class of antibiotics does Aztroenam belong to? Correct Answer Monobactams

9. acne Tetracycline MOA Correct Answer - bacterial growth by inhibiting protein synthesis

• bind to the 30S ribosomal subunit and thereby inhibit binding of transfer RNA to the messenger RNA-ribosome complex What is doxycycline and minocycline used for? Correct Answer periodontal disease What education for doxycycline and minocycline should we give our patients? Correct Answer Avoid calcium/iron supplements, antacids, magnesium/milk products as will chelate drug into nonabsorbable form Adverse effects:
• irritate GI tract
• discolor teeth (avoid <8yrs old)
• superinfection
• hepatic/renal toxicity
• sunburn easily
• diarrhea may indicate a potentially life-threatening - superinfection of the bowel
• high-dose intravenous therapy has been associated with - severe liver damage Should tetracycline be renal dosed? Correct Answer patients with kidney disease should not use these drugs

What medication when administered with tetracycline need close blood level monitoring Correct Answer - can increase digoxin levels through increasing absorption in the GI tract

• increase international normalized ratio (INR) levels by altering the vitamin K−producing flora in the gut
• patients on digoxin or warfarin should undergo careful drug level monitoring What are names of medications under Macrolids class? Correct Answer azithromycin and clarithromycin—are derivatives of erythromycin Erythromycin MOA Correct Answer binds to the 50S ribosomal subunit and thereby blocks the addition of new amino acids to the growing peptide chain Which CYP450 enzyme is erythromycin metabolized by? Correct Answer eliminated primarily by hepatic mechanisms, including metabolism by CYP3A What is the most serious potential adverse effect of erythromycin? Correct Answer sudden cardiac death from QT prolongation Due to the inhibition of hepatic cytochrome P450 drug metabolizing enzymes, which drugs have the potential for elevated blood levels when taken with erythromycin? Correct Answer - theophylline and warfarin
• shouldn't be combined with verapamil, diltiazem, HIV protease inhibitors, and azole antifungal drugs

• Rarely, prolonged therapy has been associated with neuropathy
• Patients taking the drug for more than 5 months have developed reversible optic neuropathy and irreversible peripheral neuropathy What monitoring should be done weekly while taking Linzeolid? Correct Answer CBCs What are the serious potential drug interactions with Linzeolid? Correct Answer MAO, SSRI, hypertensive crisis or serotonin syndrome Which non-amphetamines are FDA approved for weight loss that have lower abuse risk? Correct Answer Phentermine and Diethylpropion How does Phentermine and Diethylpropion promote weight loss? Correct Answer - Promote weight loss by decreasing appetite
• They are central nervous system (CNS) stimulants that suppress appetite by increasing the availability of norepinephrine at receptors in the brain What is the maximum recommended duration of use for non-amphetamines? Correct Answer 3 months or less What drug schedule are Phentermine and Diethylpropion under? Correct Answer Schedule IV

What labs should be monitored with Phentermine and Diethylpropion? What condition should we screen for? Correct Answer - baseline CMP (watch electrolytes and creatinine)

• screen for depression Phentermine adverse effects Correct Answer - increase HR and BP
• dry mouth and constipation What is role of topiramate in weight loss? Correct Answer Increases satiety What are some Phentermine/topiramate contraindications for use? Correct Answer not approved in children and contraindicated with severe hepatic impairment How should we educate patient to take Phentermine/topiramate to avoid insomnia? Correct Answer given before 1600 What are some high-risk patient conditions that we should use Phentermine/topiramate with caution? Correct Answer hx drug abuse, glaucoma, pregnant, HTN, hyperthyroidism Phentermine/topiramate adverse effects Correct Answer insomnia, nervousness, anxiety, depression, blurred vision Which of the following would be a contraindication to prescribing phentermine/topiramate? Select all that apply. Correct Answer A) Glaucoma

What vitamin deficiency are we concerned about when taking Orlistat...especially if the patient is on coumadin? Correct Answer Monitor Coumadin as Vitamin K deficiency may occur and intensify effect of Coumadin. A patient with a BMI of 27 would be considered: Correct Answer overweight Lorcaserin adverse effects Correct Answer headache, URI, back pain, hypoglycemia (in DM), blood dyscrasias, cognitive impairment, psychiatric disorders, priapism, pulmonary hypertension, and valvular heart disease Lorcaserin MOA Correct Answer Reduces waist circumference, fasting glucose, insulin, total cholesterol, LDL, triglycerides When is Lorcaserin contraindicated? Correct Answer CrCl <

• Not approved in children Lorcaserin drug interactions Correct Answer - MAOI inhibitors, SSRIs, SNRIs, St. Johns wart, and triptans
• Increased risk for serotonin syndrome Naltrexone and Bupropion black box warning Correct Answer increased risk for suicidal ideation and suicide attempts in children, adolescents, and young adults Do not take Naltrexone and Bupropion within ___weeks of taking a _____. Correct Answer - two

- MAOI

Due to Naltrexone and Bupropion antagonist effects, it can reduce effects of what? Correct Answer opioids Naltrexone and Bupropion contraindications Correct Answer HTN, seizure disorders, eating disorders, alcohol or drug withdrawal Liraglutide MOA Correct Answer - promotes weight loss by slowing gastric emptying

• increases satiety
• Not approved children. When taking Liraglutide, it is not unusual for baseline HR to increase ______bpm Correct Answer 10 - 20
• monitor for tachycardia When taking Liraglutide, monitor for ________ in patients with diabetes Correct Answer hypoglycemia Baseline labs for Liraglutide Correct Answer lipids, CMP, HgA1C q 6 months, triglycerides Liraglutide black box warning Correct Answer associated with a risk for thyroid C-cell tumors based on studies in rodents
• Contraindicated in people with multiple endocrine neoplasia syndrome type 2 (MEN 2) or personal/family history of medullary thyroid carcinoma