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NURS 302 (Pharmacology): Exam 2 Questions with Complete Solutions, Exams of Nursing

Victor Valley CollegeNursing

A comprehensive set of questions and answers related to the second exam in a nurs 302 pharmacology course. It covers key concepts such as antimicrobial agents, selective toxicity, drug resistance, and specific antibiotic classes like penicillins and cephalosporins. Detailed explanations of drug mechanisms of action, therapeutic uses, adverse effects, and drug interactions, making it a valuable resource for students studying pharmacology.

Typology: Exams

2024/2025

Available from 01/27/2025

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NURS 302 (Pharmacology): Exam 2 Questions
With Complete Solutions
Antimicrobial correct answer: Any agent that can kill or
suppress microorganisms. Modern antimicrobials discovered
1930's-40's which significantly reduced morbidity due to
bacterial/viral/fungal infections.
Selective Toxicity correct answer: Toxic to microbes, but
harmless to host due to different cellular chemistry.
What is an antimicrobial drug group that is classified by it's
MOA of inhibiting cell well synthesis or activating enzymes to
disrupt the cell wall? correct answer: Penicillins
Bacteriocidal correct answer: Drugs that are directly lethal to
bacteria at clinically achievable concentrations
Bacteriostatic correct answer: Drugs that can slow drug growth,
but does not eliminate them. Elimination is done by the immune
system
Four basic actions of drug resistance correct answer: - Decrease
the concentration of a drug at its site of action
- Inactivate the drug
- Alter the structure of drug target molecules
- Produce a drug antagonist (binding to or blocking a receptor
that a drug would normally bind to)
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Download NURS 302 (Pharmacology): Exam 2 Questions with Complete Solutions and more Exams Nursing in PDF only on Docsity!

NURS 302 (Pharmacology): Exam 2 Questions

With Complete Solutions

Antimicrobial correct answer: Any agent that can kill or suppress microorganisms. Modern antimicrobials discovered 1930's-40's which significantly reduced morbidity due to bacterial/viral/fungal infections. Selective Toxicity correct answer: Toxic to microbes, but harmless to host due to different cellular chemistry. What is an antimicrobial drug group that is classified by it's MOA of inhibiting cell well synthesis or activating enzymes to disrupt the cell wall? correct answer: Penicillins Bacteriocidal correct answer: Drugs that are directly lethal to bacteria at clinically achievable concentrations Bacteriostatic correct answer: Drugs that can slow drug growth, but does not eliminate them. Elimination is done by the immune system Four basic actions of drug resistance correct answer: - Decrease the concentration of a drug at its site of action

  • Inactivate the drug
  • Alter the structure of drug target molecules
  • Produce a drug antagonist (binding to or blocking a receptor that a drug would normally bind to)

Acquired Resistance: Spontaneous Mutation correct answer: Random changes in a microbe's DNA that creates drug resistance. Acquired Resistance: Conjugation correct answer: Extrachromosomal DNA is transferred from one bacterium to another (sharing of drug resistant DNA). Multiple drug resistance. Nosocomial Infections correct answer: Organisms are often extremely resistant. HAI's often fall under this category and are harder to treat. Superinfection correct answer: New infection that appears during the course of treatment for a primary infection. Often difficult to treat. Empiric Therapy correct answer: Therapy before the causative organism is identified. Medical treatment based on past experience and knowledge. Therapy based off of a clinical "educated guess" in the absence of complete information. What are some factors the RN should consider about the host before choosing an antibiotic? correct answer: - Host defenses (Is their immune system impaired at all?)

  • Site of infection
  • Previous allergic reactions
  • Genetic factors

d) "I should immediately report vaginal itching and discharge" correct answer: a) "I can stop the medication as soon as the symptoms have disappeared" The microbes will not fully be destroyed if not taken for the prescribed amount of time, and more resistant microbes may develop. How often are antibiotics prescribed inappropriately in the United States? correct answer: 1 out of every 4 prescriptions Penicillins mechanism of action correct answer: Penicillins weaken the cell wall which cause the bacterial cell to take up excessive water and rupture. They do this by inhibiting transpeptidase, an enzyme in the bacterial cell wall, which in turn inhibits cell growth. Penicillins are only active against active/growing bacteria and are bactericidal. Penicillins:

  1. Are active against ____________________
  2. Is their direct toxicity low or high?
  3. What is their principle adverse affect (most common)? correct answer: 1. A wide variety of bacteria
  4. Low toxicity (meaning no direct effects on mammalian cells)
  5. Allergic reaction Penicillins:
  6. Chemically have a ___________________ structure
  7. Some examples of other drugs that contain the same chemical structure are?
  1. All drugs with this cellular structure have the same MOA which is? correct answer: 1. Beta-lactum ring structure
  2. Other drugs in beta-lactum ring family: cephalosporins, aztreonam, imipenem, meropenem, ertapenem
  3. Disruption of cell wall by targeting PBP (Penicillin-binding protein) Penicillin G (Benzylpenicillin)
  4. Bactericidal or Bacteriostatic?
  5. Narrow, broad, or extended spectrum? Is it safe?
  6. Most commonly is administered through _________ and is measured in ________.
  7. Similar to what other penicillin? correct answer: 1. Bactericidal to numerous gram-positive and some gram-negative organisms
  8. Narrow, least toxic of all antibiotics
  9. IV/IM, units
  10. Penicillin V (Pen VK) - Similar to penicillin G but administered orally Penicillin G Therapeutic Uses correct answer: - Pneumonia: Infection of the lungs can cause fluid buildup
  • Meningitis: Inflammation of brain and spinal cord membranes typically cause by infection
  • Pharyngitis
  • Gangrene: Death of tissue caused by lack of blood flow or infection
  • Tetanus
  • Anthrax Prophylaxis (used before infection):

patient has history of mild reactions to PCN's such as minor rash, consider cephalosporins. If the patient has history of anaphylaxis to PCN's do not give cephalosporins. Penicillin drug interactions correct answer: - Aminoglycosides (broad spectrum bactericidal antibiotics): May be given in conjunction with PCN's but NOT in same IV solution What may be given at the same time as a PCN to reduce excretion? correct answer: Probenecid (uric acid reducer) Would you give more than one bacteriostatic drug at a time? correct answer: No Penicillinase-resistant penicillins include which three available in the US? These are used for _________ infections. correct answer: - Nafcillin

  • Oxacillin
  • Dicloxacillin Used for staph infections (MRSA) What is the effect of combining an beta-lactamase inhibitor with a penicillinase-sensitive antibiotic? correct answer: Extends antimicrobial spectrum A patient is to receive Penicillin G intravenously. The nurse will administer:

a) Peniciilin V (Veetids) b) Procaine Penicillin G (Wycillin) c) Benzathine Penicillin G (Bacillin L-A) d) Potassium Penicillin G (Pfizerpen) correct answer: d) Potassium Penicillin G (Pfizerpen) Potassium penicillin G is only penicillin to be given IV Cephalosporins:

  1. Chemical structure is _____________
  2. Similar in function to _____________
  3. Bactericidal or bacteriostatic?
  4. Usually administered _____________
  5. Toxicity low or high? correct answer: 1. Beta-lactum ring
  6. PCN's
  7. Bactericidal
  8. Parenterally
  9. Low Cephalosporins
  10. Mechanism of action (MOA)
  11. Resistant to... correct answer: 1. Bind to penicillin-binding proteins (PCP's), disrupt cell wall synthesis, and cause cell lysis (breakdown)
  12. Betalactamases (cephalosporinases), 3rd and 4th generation more resistant Classification of cephalosporins: As you go from 1st to 5th generation, what becomes increased? correct answer: Increased activity against gram negative
  1. Fourth generation uses correct answer: 1. Rarely used for active infections. Exception would be staph infections of the skin. Prophylaxis before surgery.
  2. Preferred therapy for several infections, highly active against most gram negative organisms. Able to penetrate CSF.
  3. HAI Cephalosporins pharmacokinetics: A: D: M&E: correct answer: A: Poor GI absorption, mainly administered parenterally D: Well distributed in tissues, gets into CSF better with later generations M&E: Excreted through kidneys with exception of ceftrioxone. Cephalosporins: Adverse effects correct answer: - Hypersensitivity reaction (anaphylaxis is rare)
  • Bleeding with ceftetan and ceftriaxone
  • Thromboplebitis (blood clot in veins, typically in legs)
  • Hemolytic anemia (RBC's destroyed faster than they can be made) Cephalosporins: drug interactions correct answer: - Probenecid delays excretion
  • Alcohol mixed with cefezolin and cefotetan
  • Drugs that promote bleeding with cefotetan and centriaxone
  • Calcium and ceftriaxone (precipitates) Drugs that weaken cell wall: Carbapenems
  1. What kind of chemical structure? Broad or narrow spectrum?
  1. Not active specifically against what infection?
  2. Example?
  3. All administered by which route? correct answer: 1. Beta lactum, broad
  4. MRSA
  5. Imipenem
  6. All parenteral Why should you avoid concurrent bacteriostatic drug administration when administering penicillin? correct answer: PCN works best with actively dividing microbes and bacteriostatic slows down bacterial growth, so it may inhibit PCN from working. Drugs that weaken the bacterial cell wall: Vancomysin (Vancocin, Vancoled):
  7. Action
  8. Uses correct answer: 1. Inhibits cell wall synthesis by bonding with molecules for cell wall synthesis, not PBP's
  9. Most widely used hospital antibiotic, severe infections only. Used for MRSA or clostridium difficile. Vancomycin: Adverse effects correct answer: - Renal failure
  • Ototoxicity
  • Red man syndrome
  • Thrombophlebitis (common, change IV site and dilute)
  • Thrombocytopenia (rare)
  • Allergy (no cross-RXN to PCN)
  1. Do they inhibit mammalian cell protein synthesis? correct answer: 1. Broad spectrum antibiotics
  2. Inhibit protein synthesis and are bacteriostatic (typically a second line drug)
  3. Yes, but do not harm human cells Give some examples of first line uses for Tetracyclines: correct answer: - Rickettsial disease (RMSF, Typhus)
  • Chlamydia trachomatis
  • Brucellosis
  • Cholera
  • Mycoplasma pneumoniae
  • Lyme disease
  • Anthrax
  • Peptic ulcer disease
  • Acne If a patient was prescribed a tetracycline and had kidney failure, would this be of concern? correct answer: Kidney problems can cause toxic levels with short and intermediate tetracyclines. Tetracyclines adverse effects: correct answer: - Gastrointestinal irritation
  • Effect on bone and teeth
  • Suprainfections (c. difficile, fungal overgrowths such as black hairy tongue and yeast infections)
  • Heptatotoxicity with large IV doses
  • Renal Toxicity
  • Photosensitivity

Are tetracyclines okay to administer to children? Pregnant women? correct answer: Tetracyclines should not be administered to children under the age of 8 years old because they can permanently stain teeth. Over 8 years old the dosage is based off of weight. They are also teratogens to pregnant women because they can discolor the babies teeth. Absorption of tetracyclines decreased if given with: correct answer: - Milk products

  • Calcium
  • Iron
  • Magnesium containing laxatives
  • Most antacids Macrolides (Erythromycin)
  1. Broad or narrow spectrum?
  2. MOA
  3. Frequently used if allergic to _______
  4. Active against?
  5. Bacteriostatic or cidal? correct answer: 1. Broad spectrum
  6. Inhibition of protein synthesis
  7. PCN
  8. Most gram positive and some gram negative bacteria
  9. Mostly bacteriostatic but some bactericidal A patient taking erythromycin for an upper respiratory tract infection should hold the medication and contact the provider if the patient is also prescribed? a) Guaifenesin (Guiatuss) b) Hydrocodone (Vicodin)

Macrolides (Erythromycin) drug interactions correct answer: (hepatic inhibition)

  • Theophylline
  • Carbamazepine
  • Warfarin
  • Verapamil
  • Diltiazem
  • HIV protease inhibitors
  • Azole antifungals Clindamycin (Cleocin):
  1. MOA
  2. Active against
  3. Indicated only for certain types of infection correct answer:
  4. Type of macrolide, inhibits protein synthesis
  5. Active against most anaerobic gram positive and gram negative infection
  6. Indicated for only certain anaerobic infections outside the CNS:
  • Severe group A strep
  • Gas gangrene (C. perfingens)
  • Some abdominal infections Linezolid (Zyvox)
  1. Historical importance of this drug?
  2. Active against...
  3. Should be reserved for only.... correct answer: 1. First member of new class of antibiotics --oxazolidinones
  4. multidrug-resistant gram positive pathogens (i.e. vancomycin- resistant enterococci (VRE), MRSA)
  1. Should be saved for VRE and MRSA only Aminoglycosides
  2. Most common agent
  3. MOA
  4. Narrow or broad spectrum? Gram negative or positive?
  5. Administered by correct answer: 1. Gentamicin
  6. Disrupt bacterial protein synthesis. Bactericidal.
  7. Narrow spectrum antibiotics only for serious aerobic gram negative bacterial infections
  8. Mostly parenterally Aminoglycosides
  9. Not absorbed from...
  10. In the CSF?
  11. Can oral forms be used prophylactically?
  12. Eliminated by... correct answer: 1. GI Tract
  13. Can not enter CSF
  14. No
  15. Kidney and is unchanged Aminoglycosides adverse effects correct answer: Nephrotoxicity, ototoxicity Aminoglycosides drug interactions correct answer: PCN's do not mix, cephalosporins and vancomycin give an enhanced effect, ototoxic drugs, nephrotoxic drugs, skeletal muscle relaxants Purpose in measuring serum levels of a patient taking aminoglycosides.... correct answer: Peak serum levels must be

Sulfonamides:

  1. Used commonly?
  2. MOA
  3. Primary use now? correct answer: 1. Used to be until the sulfonamide disaster. More effective and less toxic drugs now available
  4. Inhibit the synthesis of folic acid
  5. Urinary tract infections Sulfamthoxazole (SMZ)
  • Always combined with... correct answer: Type of sulfonamide Sulfonamides adverse effects correct answer: Renal damage from crystal formations Hypersensitivity reactions: Stevens-Johnson syndrome Photosensitivity Hematologic effects Kernicterus Renal damage from crystalluria Trimethoprim (Proloprim and Trimpex)
  1. Inhibits...
  2. Uses:
  3. Adverse effects
  4. Avoid using specifically during... correct answer: 1. Inhibits dihydrofolate reductase
  5. Acute and uncomplicated urinary tract infections
  6. Minimal adverse effects: itching and rash
  7. Pregnancy and lactation

A patient has active pulmonary tuberculosis, the nurse will accurately teach the patient: a) that minimal adverse effects occur with tuberculosis drug therapy b) that sputum cultures will be clear of the mycobacterium within 2 weeks c) treatment will continue until the chest x ray is clear of tubercles d) about multi drug and long term drug therapy to treat the disease correct answer: d) about multi drug and long term drug therapy to treat the disease What promotes emergence of drug-resistant mycobacteria? correct answer: Drug toxicity and poor patient adherence to treatment regimens. Mycobacterium Tuberculosis

  1. Where does it reside?
  2. Is the bacteria active?
  3. What are the symptoms? correct answer: 1. Lungs primarily but may disseminate
  4. Bacteria quiescent (not active)
  5. No obvious symptoms The prime directive of TB treatment correct answer: ALWAYS treat tuberculosis with two or more drugs Tuberculosis Treatment:
  6. Duration of treatment