RNC-NIC Pharmacology & Therapeutic Management 4 — Questions and Answers
Question 1: A neonate with suspected sepsis has a penicillin allergy documented in the chart. Which antibiotic is a safe first-line alternative for gram-positive coverage?
- Cefazolin
- Ampicillin
- Vancomycin (Correct answer)
- Piperacillin-tazobactam
Correct answer: Vancomycin
Vancomycin provides reliable gram-positive coverage including MRSA and is appropriate when penicillin allergy precludes ampicillin use in neonatal sepsis.
Question 2: A 30-week neonate is receiving total parenteral nutrition (TPN). Which TPN-associated drug interaction can occur with co-administration of calcium and phosphate in the same bag?
- Formation of calcium oxalate crystals
- Precipitation of calcium phosphate salt (Correct answer)
- Degradation of fat-soluble vitamins
- Oxidation of amino acids
Correct answer: Precipitation of calcium phosphate salt
Calcium and phosphate can combine to form insoluble calcium phosphate precipitate in TPN solutions, which is dangerous if infused through a central line.
Question 3: A nurse notes that a preterm neonate on prolonged amphotericin B deoxycholate therapy has a rising serum creatinine. What is the priority nursing action?
- Double the infusion rate to complete the dose faster
- Hold the dose and notify the physician (Correct answer)
- Administer a normal saline bolus without notifying the physician
- Switch the infusion to a peripheral IV site
Correct answer: Hold the dose and notify the physician
Amphotericin B deoxycholate is nephrotoxic; a rising creatinine indicates renal impairment and the dose should be held while the prescriber is notified to reassess the regimen.
Question 4: Which statement correctly describes the mechanism of action of bumetanide in neonates?
- Inhibits carbonic anhydrase in the proximal tubule
- Blocks the Na-K-2Cl cotransporter in the thick ascending limb of Henle (Correct answer)
- Antagonizes aldosterone receptors in the collecting duct
- Inhibits sodium reabsorption in the distal convoluted tubule
Correct answer: Blocks the Na-K-2Cl cotransporter in the thick ascending limb of Henle
Bumetanide, like furosemide, is a loop diuretic that inhibits the Na-K-2Cl cotransporter (NKCC2) in the thick ascending loop of Henle, producing potent diuresis.
Question 5: A neonate with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is in adrenal crisis. What is the drug of choice for acute management?
- Fludrocortisone oral
- Hydrocortisone IV bolus (Correct answer)
- Prednisone oral
- ACTH injection
Correct answer: Hydrocortisone IV bolus
IV hydrocortisone is the treatment of choice for acute adrenal crisis because it provides both glucocorticoid and mineralocorticoid activity needed to stabilize the infant.
Question 6: A 3-day-old term neonate with seizures is found to have pyridoxine-dependent epilepsy. Which intervention is diagnostic and therapeutic simultaneously?
- IV dextrose 10% bolus
- IM pyridoxine 100 mg trial dose
- IV pyridoxine 100 mg while monitoring EEG (Correct answer)
- IV phenobarbital 20 mg/kg loading dose
Correct answer: IV pyridoxine 100 mg while monitoring EEG
IV pyridoxine (vitamin B6) administered during EEG monitoring is both diagnostic and therapeutic—cessation of electrical seizure activity within minutes confirms pyridoxine-dependent epilepsy.
Question 7: A NICU nurse is preparing to administer intravenous immunoglobulin (IVIG) for Rh hemolytic disease. Which infusion-related adverse effect should she monitor for most closely?
- Hypertension and bradycardia
- Hemolysis and anemia worsening
- Hypotension, tachycardia, and chills (Correct answer)
- Hyperkalemia and peaked T waves
Correct answer: Hypotension, tachycardia, and chills
Anaphylactoid infusion reactions including hypotension, tachycardia, fever, and chills can occur with IVIG, especially with rapid infusion rates.
RNC-NIC Pharmacology & Therapeutic Management 4
A neonate with suspected sepsis has a penicillin allergy documented in the chart.
Which antibiotic is a safe first-line alternative for gram-positive coverage?