One thing that I would reassure you as you take the NCLEX is to develop a couple of test-taking strategies. I’ll talk about a few and then we will apply it in a question.
- Read the whole question. Do not read the first sentence and then answer it. NCLEX writers love to feed you too much information to distract you.
- While you are reading the question – ask yourself what is the answer before looking at the written multiple choice answers. If you can think of the answer in your head, then look down and try to find it. Chances are – you know it.
- After you have read the question, ask yourself what is the question? You will be amazed at how this will help you clarify what they are REALLY asking for.
- Eliminate all the incorrect answers. Remember a 50% change of guessing right between two answers is still better than a 25% chance between four.
- Look for the distractor. Multiple choice test writers love to throw in an answer to distract you from the real answer. It sounds right, but it’s not.
- Choose “the best” answer. A professor once told me, remember that on the NCLEX you are in “the perfect hospital with all the time in the world”. It is not testing you on how to nurse under stressful conditions when one of your staff called out sick and your IT department just declared a “downtime”.
So this is a very popular type of pharmacology question to throw on a nursing test.
You are caring for a 52 year old woman with a penicillin allergy. She reports that when exposed to the drug she suffers shortness of breath and facial swelling. She has been diagnosed with community-acquired pneumonia. If she were prescribed which drug would you want to hold administration until clarifying with the ordering provider?
- Vancocin (Vancomycin) 250mg IV Q 8 hours for 10 days.
- Teflaro (Ceftaroline) 600mg IV Q 12 hours for 5 days
- Z pack (azithromycin) 500mg day 1 then 250mg for 4 days by mouth
- Zosyn (amoxicillin clavulanate) 2000mg/125mg by mouth Q12 hours for 10 days.
Let us work through the answer together.
First – what are they asking? They could be asking are the drugs, dosages correct. But the gist of the question is – which one shouldn’t be given to someone with a penicillin allergy?
Eliminate – if you can, eliminate any incorrect answers.
Look for the distractor – so the author of this question through in several. It is common for students to think that the -cin ending of drug means it is in the –cillin family. They sound similar. You are stressed. They put Vancomycin as the first answer. You might read quickly and pick it and move on. Vancomycin is an “other antimicrobial” and is not in the pencillin family.
Similarly, azithromycin has the –cin prefix. However, it is a macrolide and is often given to those with penicillin allergies.
Teflaro (Ceftaroline) is the distractor for nursing students good at pharmacology. It is a cephalosporin. Most cephalosporins shouldn’t necessarily be given to persons that show hypersensitivity to PCN. However, since it is a fifth generation cephalosporin, it is okay to be given. First through fourth generations are not.
Finally, they leave the really penicillinase for the last answer. It is the correct one.
Also, they might have confused you by throwing in dosages. All the dosages are accurate, but it just adds to the information in the question and might confuse you or lead you off track. Think of the extra info as “red herrings”. Focus on the primary question at hand and you will do well!
Thanks for reading –