# A nurse is caring for a patient with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia who has been receiving vancomycin therapy for 5 days. The patient's condition has not improved, and the physician is considering adding a second antibiotic. Which nursing intervention is most appropriate when preparing to administer combination antibiotic therapy?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=541880  
> language: ko  
> subject: Infectious Diseases

## 문제

A nurse is caring for a patient with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia who has been receiving vancomycin therapy for 5 days. The patient's condition has not improved, and the physician is considering adding a second antibiotic. Which nursing intervention is most appropriate when preparing to administer combination antibiotic therapy?

## 보기

1. Verify compatibility of the antibiotics and establish separate IV access if needed to prevent drug interactions **✔ 정답**
2. Administer both antibiotics through the same IV line to minimize patient discomfort
3. Space the antibiotics 30 minutes apart using the same IV access to ensure adequate absorption
4. Mix the antibiotics in the same IV bag to reduce the number of infusions required

**정답: 1**

## 해설

Verifying antibiotic compatibility and establishing separate IV access prevents drug interactions and ensures therapeutic effectiveness. Other options risk incompatibility, reduced efficacy, or patient harm.

## 심화 해설

Clinical Judgment
This question assesses infection control priorities. The key is to identify the first action a healthcare worker must take before entering the room when Contact Precautions are applied for a patient with MRSA pneumonia. MRSA is primarily transmitted through direct contact (patient's skin or contaminated surfaces) or indirect contact (healthcare worker's hands or contaminated equipment). Therefore, the top priority measure to protect the healthcare worker and prevent transmission of the pathogen to other patients is to put on appropriate personal protective equipment (PPE) **before entering the room**. Option 1 accurately reflects this principle.

Memory Tip:
Remember Contact Precautions PPE as **C**ontact = **C**over up (gown and gloves). "Put them on before you go in!"

KR vs US:
The basic principles of Contact Precautions (gown and gloves) are the same in both Korea and the US. However, the US CDC guidelines emphasize more standardized and rigorous protocols for multidrug-resistant organisms like MRSA, with systematic education on the correct sequence for donning and doffing PPE. While Korea is also strengthening its infection control standards, compliance in practice may vary between facilities.

## 임상 시나리오

Clinical Practice Guide: Administering Combination IV Antibiotics

**Scenario:** A patient with MRSA pneumonia is failing vancomycin monotherapy, and a second IV antibiotic is ordered. The nurse must prioritize safe administration to prevent drug incompatibility.

**Key Safety Principle:** Never assume IV drugs are compatible. Vancomycin is particularly reactive and can form a precipitate with many other agents, including beta-lactams, if mixed improperly.

Nursing Actions for Safe Combination Therapy

- **Verify Compatibility First:** Consult a current, reliable drug compatibility reference (e.g., hospital pharmacy, Trissel's IV Compatibility database) before any administration. Do not rely on memory.

- **Establish Separate IV Access:** If compatibility data is unavailable or indicates incompatibility, obtain a second peripheral IV site or use a multi-lumen central line, dedicating one lumen exclusively to each incompatible drug.

- **Flush Lines Appropriately:** If administering sequentially through the same line is unavoidable and compatibility is confirmed, flush the line thoroughly with 0.9% sodium chloride before and after each drug infusion. However, separate access remains the gold standard for known incompatibilities.

- **Monitor for Adverse Reactions:** During the initial infusion, observe the patient closely for signs of a precipitate-related embolism (sudden dyspnea, chest pain, hypotension) or an infusion reaction (flushing, rash, pruritus).

Clinical Rationale

Chemical incompatibility can inactivate one or both antibiotics, leading to treatment failure and worsening of the life-threatening infection. Physical incompatibility creates a solid precipitate that can obstruct the IV catheter or travel to the pulmonary vasculature, causing a potentially fatal embolism. This practice aligns with antimicrobial stewardship by ensuring the intended drug dose reaches the patient safely and effectively.

## 핵심 개념

- **Drug Incompatibility** — An undesirable reaction between two or more drugs or between a drug and a solution, resulting in a physical precipitate or chemical inactivation, compromising safety and efficacy.
- **Vancomycin** — A glycopeptide antibiotic used to treat serious gram-positive bacterial infections, including MRSA, requiring careful IV administration and monitoring due to incompatibility risks.
- **Antimicrobial Stewardship** — A coordinated program that promotes the appropriate use of antimicrobials, improves patient outcomes, reduces microbial resistance, and decreases the spread of infections.
- **MRSA (Methicillin-resistant Staphylococcus aureus)** — A type of staph bacteria resistant to many antibiotics, including methicillin, often causing severe infections like pneumonia that require specific anti-MRSA agents.
- **Precipitate** — An insoluble solid particle formed from a chemical reaction in a liquid solution, which can obstruct IV lines or cause a pulmonary embolism if infused into a patient.

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