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Harry Hadley VSIM
Medical-Surgical Nursing II (NSG 223)
Herzing University
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Pre-SIM Quiz
1: A patient is diagnosed with a MRSA infection in a wound. Which of the following interventions must be implemented when caring for this patient? (Select all that apply.)
Answer: Perform hand hygiene before leaving room., Wear gown and gloves when in patient's room., Post sign on door indicating contact precautions.
Rationale: Use standard precautions for all patients, which includes hand hygiene before leaving the room. Use contact precautions for patients with MRSA wound infections, which includes wearing a gown and gloves when in the patient's room. Masks are required for droplet or airborne precautions. Negative air pressure rooms are required for airborne precautions.
2: A patient has a creatinine clearance result of 60 mL/min. What does this result indicate?
Answer: 60 mL of the patient's blood was cleared of creatinine in 1 minute.
Rationale: The purpose of the creatinine clearance (CrCl) test is to assess renal function, primarily glomerular filtration, as well as monitor progression of renal insufficiency. CrCl determines how efficiently kidneys are clearing creatinine from the blood. Results vary with age, gender, body size, and race. Rate of clearance is expressed as volume of blood (in mL) that can be cleared of creatinine in 1 minute.
3: Many of the signs and symptoms associated with a wound infection are related to the presence of inflammation. Which of the following statements is true regarding the inflammatory process? Time Spent - 00:00:
Answer: The inflammatory process provides a path for natural defenses to quickly respond to an area of cellular injury.
Rationale: The inflammatory process includes three phases. During these phases, vasodilation allows helpful cells and chemicals to quickly arrive at the site of cellular injury to destroy invading organisms or repair injured cells. White blood cells, also known as leukocytes, travel to the site of injury and fight invading organisms. Signs of inflammation include pain, swelling, redness, and warmth. Infection is one of several processes that initiate the inflammatory process; however, inflammation and infection are not the same thing. Inflammation may also be caused by tissue injury, allergic responses, or other insults to the body.
4: A patient diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) has been prescribed oral antibiotic therapy. Which of the following medications would be most appropriate for this patient?
Answer: Sulfamethoxazole-trimethoprim
Rationale: Sulfamethoxazole-trimethoprim is one of several preferred oral antibiotics for the treatment of methicillin-resistant Staphylococcus aureus (MRSA). Ninety percent of S. aureus strains are resistant to penicillin. These strains may also resist cephalosporins such as cefazolin. Nasal mupirocin is used for prevention in cases of recurrent MRSA infection
5: Some microorganisms have begun to develop resistance to specific anti-infective agents. Which of the following interventions can help reduce emergence of new resistant microorganisms? (Select all that apply.)
Answer: Ensure antibiotic therapy is appropriate to eradicate specific antibiotic resistance., Maintain the prescribed dosing frequency to provide appropriate therapeutic levels., Educate patients to continue antibiotics even when they begin feeling better.
Rationale: Antibiotic doses and drug duration should be adequate to eradicate even slightly resistant microorganisms. This includes ensuring that the selected antibiotic therapy has been proven effective against a known resistant organism. Prescribed dosing schedules are specific to the known metabolism of specific medications. Maintaining the dosing regimen as prescribed will help to maintain appropriate therapeutic levels. Taking all the prescribed doses helps ensure that the most resilient bacteria are eliminated, reducing the likelihood of their persistence or ability to develop resistance in the future. Broad-spectrum antibiotics may not treat all pathogens, and frequent use could lead to the development of resistant bacterial strains. Antibiotics do not affect viruses. Taking antibiotics in an effort to treat a virus such as a common cold can lead to increased prevalence of antibiotic-resistant organisms.
6: A patient receiving vancomycin by rapid infusion complains of itching. Assessment findings include the presence of a red rash covered by elevated bumps on the face, neck, trunk, and arms. Vitals are temperature 100°F (38°C), heart rate of 88/min, respiratory rate of 20/min, and blood pressure of 80/50 mm Hg. Based on these findings, which of the following interventions should the nurse implement first?
Answer: Stop the vancomycin infusion
Rationale: The patient is experiencing vancomycin flushing syndrome, a reaction to the infusion caused by the release of histamine. Stop the infusion first and then notify the healthcare provider. Administration of an antihistamine and application of cool compresses would be completed as prescribed by the healthcare provider.
7: Which of the following statements best describes the goals of antibiotic therapy when treating an infectious wound? (Select all that apply.)
Answer: Identify the infectious organism., Decrease the number of invading bacteria.
Rationale: The goal of antibiotic therapy is to decrease the population of invading bacteria to a point at which the human immune system can effectively deal with the invading organism. The most effective way to do so is to first identify the type of infectious organism in order to determine the most appropriate antimicrobial agent to administer. This can be accomplished by obtaining a wound culture. Antibiotics do not increase the size of white blood cells or number of antigens in the body.
8: A patient reports pain and swelling of a lower extremity. Assessment findings include warmth erythema with indistinct margins, purulent drainage from the area, and oral temperature of 101°F (38°C). Which of the following laboratory tests should the nurse anticipate being ordered for the patient based on these signs and symptoms? (Select all that apply.)
Answer: White cell count, Wound culture, C-reactive protein
2: The nurse has noted that the creatinine clearance (CrCl) level is below normal. The nurse should include which of the following information when updating Harry Hadley regarding this finding? (Select all that apply.)
Answser: 'I will need to contact the pharmacist to adjust your vancomycin dose prior to administration.', 'With no history of kidney disease, your creatinine clearance level is likely related to normal changes that occur with aging.'
Rationale: The abnormal CrCl level indicates mild renal impairment, which will affect the dosing of vancomycin. The nurse must contact the pharmacist to request evaluation of these findings and adjust the vancomycin dose. Based on Harry's known medical history and normal blood urea nitrogen, glomerular filtration rate, and creatinine levels, his reduced renal function is likely a result of normal changes that occur with aging. Older adults undergo many physical changes that are a part of the aging process. Their bodies may respond very differently in all aspects of pharmacokinetics—less effective absorption, less efficient distribution because of fewer plasma proteins and less efficient perfusion, altered biotransformation or metabolism of drugs because of age-related liver changes, and less effective excretion owing to less efficient kidneys. Amoxicillin is not the appropriate treatment based on the presence of known MRSA. The nurse would not make changes to the vancomycin dose without first consulting with the pharmacist.
3: When planning to administer IV vancomycin, the nurse understands to include which of the following priority actions? (Select all that apply.)
Answer: Infuse slowly over 1 to 2 hours, Monitor blood pressure and temperature, Provide client education regarding medication, Monitor serum drug levels
Rationale: Vancomycin is linked to risk of adverse reactions when given too quickly. The nurse should infuse slowly and monitor the client for hypotension, flushing, or skin rash. These findings may indicate a condition sometimes called vancomycin infusion reaction or vancomycin flushing syndrome (formerly called 'red man syndrome'), which is attributed to histamine release. The patient should be aware of the purpose of the antibiotic, as well as the warning signs of adverse reactions and the dosing requirements related to renal function. Close monitoring of serum drug levels of IV vancomycin is important because levels that are too high may cause kidney damage, gastrointestinal toxicity, or ototoxicity. The white blood cell count levels would not be relevant to administration of this medication. There is not a need to eliminate food or liquid intake during therapy.
4: The pharmacist has adjusted the vancomycin dose, which is now 1700 mg in 250 mL of normal saline, to be infused over 2 hours. The nurse sets the IV pump using which of the following information? (Select all that apply.)
Your Response: Total fluid volume (250 mL), Infusion time (120 minutes), Calculated flow rate 125 mL/hr
Rationale: To accurately calculate a flow rate for IV medications, the nurse must consider the total fluid volume to be infused as well as the time within which the medication should be completed. To calculate flow rate in mL/hr, the nurse would use the following formula: total fluid volume (250 mL) ÷ infusion time (2 hours) = flow rate (125 mL/hr). A flow rate is not set using mg/hr. The size of the IV catheter would not be relevant to setting the flow rate of this medication.
5: The nurse confirms that she has appropriately educated the Hadley's regarding the current treatment plan when Mrs. Hadley states, 'Because Choose Answer.., treatment must include an antibiotic that Choose Answer..
Answer: the culture identified the presence MRSA, treats penicillin-resistant organisms
Rationale: Harry Hadley has MRSA in his wound. Ninety percent of S. aureus strains are resistant to penicillin. Selection of antibiotics is based on the causative organism. Oral forms of drugs can be as effective as intravenous forms and are often given in an outpatient setting.
6: The nurse reviews Harry Hadley's laboratory values and notes a white blood cell (WBC) count of 22 × 109/L, alanine aminotransferase (ALT) of 34, hemoglobin (Hgb) of 15 g/dL, creatinine clearance (CrCl) of 45 mL/min, and C-reactive protein (CRP) of 8 mg/L. Which of the following statements describe(s) the significance of these lab values? (Select all that apply.)
Answer: They indicate the presence of infection., They indicate reduced renal function., They indicate the need to notify the pharmacist.
Rationale: Elevated WBC and CRP levels confirm the presence of infection (cellulitis). The low CrCl level indicates impaired renal function. The values also indicate that the pharmacist should be contacted to review and update the vancomycin dose for patient safety. A wound culture, not the lab values listed, would confirm the presence of a specific bacteria (MRSA). The provided ALT level of 34 is normal and does not indicate any reduction in hepatic function. The provided Hgb level is within normal range and does not indicate that the client is anemic.
Harry Hadley VSIM
Course: Medical-Surgical Nursing II (NSG 223)
University: Herzing University
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