A patient newly diagnosed with heart failure is admitted to the ...

[Redwolflake15]

A patient newly diagnosed with heart failure is admitted to the hospital. The nurse notes a pulse of 90 beats per minute. The nurse will observe this patient closely for:
 
  a. decreased urine output.
  b. increased blood pressure.
  c. jugular vein distension.
  d. shortness of breath.

Question 2

A child with otitis media has had three ear infections in the past year. The child has just completed a 10-day course of amoxicillin Amoxil with no improvement.
 
  The parent asks the nurse why this drug is not working, because it has worked in the past. What will the nurse tell the patient? a. Amoxicillin is too narrow in spectrum.
  b. The bacteria have developed a three-layer cell envelope.
  c. The bacteria have developed penicil-lin-binding proteins (PBPs) that have a low affinity for penicillins.
  d. The bacteria have synthesized penicilli-nase.

[mk6555]

Answer to Question 1

A
As the heart rate increases, ventricular filling decreases, and cardiac output and renal perfusion decrease. Tachycardia does not elevate blood pressure. Jugular vein distension and shortness of breath occur with fluid volume overload.

Answer to Question 2

D
Beta-lactamases are enzymes that cleave the beta-lactam ring and render the PCN inactive. This resistance is common with organisms that cause ear infections. Amoxicillin is a broad-spectrum antibiotic. A three-layer cell envelope occurs in gram-negative bacteria. Some bacterial strains, including methicillin-resistant Staphylococcus aureus (MRSA), develop PBPs with a low affinity for penicillins. MRSA is not a common cause of otitis media.

[Redwolflake15]

Excellent

[ktidd]

TYSM