Walkthrough: Pharmacological and Parenteral Therapies Q13 – NCLEX-RN®

00:00 A client is started empirically on ampicillin but is then switched to clindamycin 48 hours later. When the client asked why the antibiotic was changed, which is the best answer by the nurse? Okay, so first sentence, a client is started, ahh there's our word, empirically. Do you remember what that means? So they started empirically on ampicillin but is then switched to clindamycin. So, what's going to be the best answer for why we switched from ampicillin to clindamycin 48 hours later when it was empirically prescribed? Okay, there's your topic. You got 4 answer choices, we're going to go ahead and bring those answer choices in now so you can see them. There they are. So, use your scratch paper; numbers 1, 2, 3, and 4; eliminate your answer choices and make sure you say why and we'll see you back here. Hey, how'd you do? Were you able to get it down to 1 answer choice? Alright, make sure you own that answer choice because that's where the benefit comes for use when you think about how you got to that particular answer. So, I'm really not as much interested if you got it right or if you got it wrong as I want you to learn more about how you got to the answer you chose and things that you can learn about your thinking to help you pick better next time. Alright. So let's take a look.

01:33 So, I know empirically means hey you came in with some type of infection, we don't have a culture and sensitivity on it because that takes time to come back so what we're going to do is just give you based on what we know in the community what is most likely causing this, we're going to give a broad-spectrum antibiotic.

01:52 Alright, so that's one that whoah it's the big guns, now we want to give you the most narrow spectrum that we can that will be effective because we're trying to limit the new bugs that come out that are resistant like you know VRE is vancomycin resistant or MRSA which is methicillin-resistant staphylococcus aureus. So, we don't want any more of those nasty bugs. So that's why empirically we know we have to treat it, we start with something broad. And then when we get an idea of what's a better choice, we'll switch to another medication that hopefully is more narrow spectrum and effective. So, what can we get rid of? Well, based on what we just talked about, number 3 you're gone. Right? The first medication which was ampicillin was a narrow-spectrum antibiotic while the second one is a broad spectrum, no that's not true and that is the opposite of what we want. We want to start with a broad spectrum because we don't know what's really going to be effective. When we get the culture and sensitivity back, it'll show us exactly what antibiotics will be effective and we'll switch to one of those that has a more narrow spectrum. Why? we're trying to prevent antibiotic resistance. Okay, so number 3 you're out. Now, number 2. Antibiotic choice is effective by many factors including cost, availability, and potential for side effects. That's true. So, but what is the topic of the question why the antibiotic was changed? We're saying it's affected by a lot of factors; cost, availability, and potential side effects. Well, that may come in to play but the antibiotic has to be effective, that doesn't explain why we changed it because cost would not be why we changed it. Availability, this both should be available. Potential side effects, no. So, number 2 you're out.

03:50 Number 1, we received your blood culture and sensitivity report and it showed the new antibiotic will be more effective. Okay, there you go. That sounds like a good answer, I'm going to keep it in but I'm not ready yet to say that's the correct answer because I have one that I haven't evaluated. So, 2 was out, 3 was out. Number 4, the first medication was stronger to start the eradication, I love that word, to start the eradication of the infection followed by a not quite as strong. Well, besides not being the best kind of response, right, it's kind of a vague response, number 1 is clearly better. We got your blood culture and sensitivity report back and it showed the new antibiotic will be more effective and hopefully more of a narrow spectrum.

04:42 So number 1 is the best answer by the nurse. How do we find that? We eliminated answer choices that were clearly wrong and then we kept comparing relative to the other answers to figure out which one was the priority answer or the best answer.

04:58 So, take a second and write in your notebook any notes you need for yourself, think about your thinking, what can you learn from this question that you can take to another question. But while we're here, remember what is the order for starting an antibiotic and getting a blood culture? Which should come first? If at all possible, get the blood culture first and then start the antibiotic. Now, you want that done really quickly because the quicker we get the antibiotic in, the more effective it's going to be at slowing down that infection but get a blood culture first or a sputum culture or whatever you're culturing, if at all possible.