Deck 87: Aminoglycosides: Bactericidal Inhibitors of Protein Synthesis

Question 1

A patient is receiving tobramycin 3 times daily. The provider has ordered a trough level with the 8:00 AM dose. The nurse will ensure that the level is drawn at what time?

A) 4:00 AM
B) 7:00 AM
C) 7:45 AM
D) 8:45 AM

Answer 1

7:45 AM

Question 2

A nurse is explaining to nursing students why a cephalosporin is used in conjunction with an aminoglycoside for a patient with an infection. Which statement by a student indicates understanding of the teaching?

A) "Cephalosporins enhance the actions of aminoglycosides by weakening bacterial cell walls."
B) "Cephalosporins prevent neuromuscular blockade associated with aminoglycosides."
C) "Cephalosporins prolong the postantibiotic effects of the aminoglycosides so doses can be decreased."
D) "Cephalosporins reduce bacterial resistance to aminoglycosides."

Answer 2

"Cephalosporins enhance the actions of aminoglycosides by weakening bacterial cell walls."

Question 3

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.

Answer 3

Administer gentamicin, flush the line, and then give the penicillin.

Question 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

Question 5

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.

Question 6

A patient is admitted to the unit for treatment for an infection. The patient receives IV amikacin [Amikin] twice a day. When planning for obtaining a peak aminoglycoside level, when should the nurse see that the blood is drawn?

A) 30 minutes after the IV infusion is complete
B) 1 hour after the IV infusion is complete
C) 1 hour before administration of the IV infusion
D) A peak level is not indicated with twice-daily dosing.

Question 7

Which patients may receive gentamicin safely?

A) A 6-day-old newborn
B) A 5-year-old child
C) A pregnant woman
D) A woman breast-feeding an infant
E) An elderly patient with renal disease

Question 8

A nurse is preparing to administer a dose of gentamicin to a patient who is receiving the drug 3 times daily. The nurse will monitor ____ levels.

A) peak
B) peak and trough
C) serum drug
D) trough

Question 9

A patient who is taking gentamicin and a cephalosporin for a postoperative infection requests medication for mild postsurgical pain. The nurse will expect to administer which of the following medications?

A) Acetaminophen
B) Aspirin
C) Ibuprofen
D) Morphine

Question 10

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."

Question 11

A patient who takes the loop diuretic ethacrynic acid is given intravenous gentamicin for an infection. After several days of treatment with gentamicin, the nurse reviews the patient's most recent laboratory results and notes a gentamicin trough of 2.1 mcg/mL and normal blood urea nitrogen (BUN) and serum creatinine levels. The nurse will question the patient about:

A) gastrointestinal (GI) symptoms.
B) headache, dizziness, or vertigo.
C) presence of rash.
D) urine output.

Question 12

A patient shows signs and symptoms of conjunctivitis. Which aminoglycoside would the nurse expect to be ordered?

A) Amikacin [Amikin]
B) Kanamycin [Kantrex]
C) Neomycin [Neomycin]
D) Paromomycin [Humatin]

Question 13

A patient is receiving tobramycin three times daily. A tobramycin peak level is 4.5 and the trough is 1.2. What will the nurse do?

A) Give the next dose as ordered.
B) Hold the next dose and notify the provider.
C) Monitor the patient for signs of nephrotoxicity.
D) Tell the patient to report tinnitus.

Question 14

A patient who has been receiving intravenous gentamicin for several days reports having had a headache for 2 days. The nurse will request an order to:

A) discontinue the gentamicin.
B) obtain a gentamicin trough before the next dose is given.
C) give an analgesic to control headache discomfort.
D) obtain renal function tests to evaluate for potential nephrotoxicity.

Question 15

A patient is receiving an intraperitoneal aminoglycoside during surgery. To reverse a serious side effect of this drug, the nurse may expect to administer which agent?

A) Amphotericin B
B) Calcium gluconate
C) Neuromuscular blocker
D) Vancomycin

Question 16

A patient is receiving gentamicin once daily. A nursing student asks the nurse how the drug can be effective if given only once a day. The nurse explains drug dosing schedules for aminoglycosides. Which statement by the student indicates a need for further teaching?

A) "Gentamicin has a longer halflife than other aminoglycosides."
B) "Large doses given once daily yield higher peak levels."
C) "The postantibiotic effect lasts for several hours."
D) "There is less risk of ototoxicity and nephrotoxicity with large daily doses."

Question 17

A nurse preparing to administer intravenous gentamicin to a patient notes that the dose is half the usual dose for an adult. The nurse suspects that this is because this patient has a history of:

A) antibiotic resistance.
B) interpatient variation.
C) liver disease.
D) renal disease.

Question 18

A patient who has been taking gentamicin for 5 days reports a headache and dizziness. What will the nurse do?

A) Request an order for a gentamicin peak level.
B) Suspect ototoxicity and notify the prescriber.
C) Tell the patient to ask for help with ambulation.
D) Tell the patient to report any tinnitus.