Anti-Infective Pharmacotherapy

A leading factor in the development of bacterial resistance is the ability of bacteria to undergo: 1. Replication. 2. Conjugation. 3. Mutation. 4. Colonization.

3. Due to their rapid growth, bacteria make errors in duplicating their genetic code, thus forming a mutation.

An advantage of using a broad-spectrum antibiotic is that: 1. It is effective against a large number of organisms. 2. It is effective against a small number of organisms. 3. It has a high potency. 4. It produces a large number of side effects.

1. A broad-spectrum antibiotic is effective against a large number of organisms.

The nurse sending a wound culture to the lab knows that the purpose of culture and sensitivity testing is to: 1. Prevent an infection, a practice called chemoprophylaxis. 2. Identify bacteria that have acquired resistance. 3. Promote the development of drug-resistant bacterial strains by killing the bacteria sensitive to a drug. 4. Determine which antibiotic is most effective against the infecting microorganism.

4. Culture and sensitivity testing isolates the infectious organism and determines which antibiotic would be most effective against it.

The nurse is preparing to admit a client with a serious methicillin-resistant Staphylococcus aureus (MRSA) infection. The nurse knows MRSA will not respond to treatment with: Select all that apply. 1. Fluoroquinolones. 2. Macrolides. 3. Aminoglycosides. 4. Tetracyclines. 5. Linezolid.

1,2,3,4. MRSA is resistant to fluoroquinolones. MRSA is resistant to macrolides. MRSA is resistant to aminoglycosides. MRSA is resistant to tetracyclines.

The emergency department nurse anticipates that prophylactic antibiotics will likely be used to treat: Select all that apply. 1. A client with a suppressed immune system. 2. A client who has been bitten by a dog. 3. A client whose spouse has been diagnosed with tuberculosis (TB). 4. A client who is being treated for a venereal disease. 5. A client who has just delivered a premature baby.

1,2,3. A client with a suppressed immune system would be treated with prophylactic antibiotics. Deep wounds such as dog bites are treated with prophylactic antibiotics. Antitubercular drugs are prescribed prophylactically for any client in close contact with a person diagnosed with TB.

The clinic nurse is calling back clients with various symptoms. Which symptoms would suggest a superinfection? Select all that apply. 1. Diarrhea 2. Painful urination 3. Abnormal vaginal discharge 4. Cough 5. Joint pain

1,2,3. Antibiotics can kill normal flora in the intestinal tract, resulting in a superinfection and diarrhea. Antibiotics can kill normal flora in the genitourinary tract, resulting in a superinfection and painful urination. Antibiotics can kill normal flora in the vagina, resulting in a superinfection and abnormal vaginal discharge.

The health care provider asks the nurse to tell a client that tests confirm the client has a health care-associated infection (HAI). The nurse explains to the client that common sources of HAIs include: Select all that apply. 1. The respiratory tract. 2. The urinary tract. 3. Intravascular (IV) lines. 4. Visitors with infectious illness. 5. Drug-resistant bacteria.

1,2,3. Bacteria residing in the lungs are a source of HAIs. Bacteria residing in the genitourinary tract are a source of HAIs. Invasive devices such as IV lines are a source of HAIs.

A client is admitted to the emergency department for an infection. The nurse recognizes that host factors that play a role in the selection of anti-infective therapy include: Select all that apply. 1. Status of immune system. 2. Location of the infection. 3. History of allergic reactions. 4. Previous infections. 5. Results of culture and sensitivity (C&S).

1,2,3. Clients with a weakened immune system may require more aggressive and prolonged anti-infective therapy. The location of the infection must be considered in order to choose the most effective anti-infective. A history of allergic reaction to an anti-infective prevents the use of that particular class.

The nurse tells a client that the antibiotic the health care provider has prescribed is for Clostridium, the organism responsible for a number of diseases, including: Select all that apply. 1. Food poisoning. 2. Gas gangrene. 3. Tetanus. 4. Pneumonia. 5. Venereal disease.

1,2,3. Clostridium is an anaerobe responsible for some cases of food poisoning. Clostridium is an anaerobe responsible for gas gangrene. Clostridium is an anaerobe responsible for tetanus.

The client asks the nurse why culture and sensitivity (C&S) testing has to be done prior to starting the antibiotic for a urinary tract infection (UTI). The nurse explains that several organisms can cause UTIs and a C&S is performed to identify the organism. Which organism could be isolated on this client's C&S? Select all that apply. 1. Escherichia coli 2. Enterococci 3. Proteus mirabilis 4. Treponema 5. Borrelia burgdorferi

1,2,3. Escherichia coli is the organism most commonly associated with UTIs. Enterococci can cause UTI. Proteus mirabilis can cause UTI.

The community outreach nurse is teaching a group of older clients how bacterial organisms become resistant to antibiotics. Which statements by the clients demonstrate understanding of the instruction? Select all that apply. 1. "I need to get the recommended immunizations so I don't get an infection and need an antibiotic." 2. "If possible, my doctor will need to culture any infections I have to make sure I am taking the correct antibiotics." 3. "I need to take antibiotics only when my health care provider thinks I have an infection." 4. "As soon as my infection is gone, I can stop the antibiotic. This way I'll avoid becoming resistant to the antibiotic." 5. "I should never take an antibiotic for more than 10 days. This is what causes resistance."

1,2,3. It is easier to prevent an infection than it is to treat one. The causative organism must be identified and the correct antibiotic prescribed. This will lower the risk of developing resistance. The unwarranted use of antibiotics has promoted the development of drug-resistant bacteria.

The nurse is discharging a client with a prescription for penicillin. The client asks the nurse how this antibiotic works. The nurse's response is based on the knowledge that the mechanism of action of this class of anti-infectives is: Select all that apply. 1. Inhibiting cell wall synthesis. 2. Causing disruption of the cell wall, resulting in the cell absorbing water and lysing. 3. Binding to specific proteins, resulting in the cell's inability to build a wall. 4. Interfering with the transfer of ribonucleic acid (RNA). 5. Changing the permeability of the cell membrane.

1,2,3. Penicillin inhibits bacterial cell wall synthesis. Penicillin inhibits cell wall synthesis, resulting in the cell absorbing water and lysing. Binding to specific proteins disrupts the cell's ability to build a wall.

A client is unable to give a urine sample for a culture and sensitivity (C&S) and asks the nurse why the health care provider does not just prescribe a "really strong" antibiotic. The nurse responds that careful selection of the correct antibiotic is important because prescribing the wrong antibiotic: Select all that apply. 1. Will delay effective treatment. 2. Will give the bacteria more time to grow. 3. Can contribute to the development of drug-resistant bacteria. 4. Could result in a lawsuit. 5. Could result in an allergic response.

1,2,3. Prescribing the wrong antibiotic will delay effective treatment. Prescribing the wrong antibiotic will give the bacteria time to multiply. Prescribing the wrong antibiotic can contribute to the development of drug-resistant strains of bacteria.

A client is admitted to the emergency department with symptoms of meningitis. Reviewing the client's culture and sensitivity (C&S) report, the nurse would expect evidence of which organisms to confirm this diagnosis? Select all that apply. 1. Streptococci 2. Escherichia coli 3. Haemophilus influenzae 4. Rickettsia rickettsii 5. Shigella

1,2,3. Streptococci can cause meningitis in children. Escherichia coli can cause meningitis in children. Haemophilus influenzae can cause meningitis in children.

A client is admitted to the emergency department with an infection of the skin on the upper right thigh. The nurse knows this infection could be caused by which organism? Select all that apply. 1. Streptococci 2. Proteus mirabilis 3. Pseudomonas aeruginosa 4. Salmonella enteritides 5. Bacillus anthracis

1,2,3. Streptococci can cause skin infections. Proteus mirabilis is an organism that can cause skin infections. Pseudomonas aeruginosa is an organism that can cause skin infections.

A pediatric nurse is caring for a child who has an infectious organism that produces beta lactamase. The nurse knows that which drugs should not be prescribed for this infection? Select all that apply. 1. Penicillin 2. Cephalosporin 3. Macrolide 4. Fluoroquinolones 5. Sulfonamide

1,2. Organisms that produce beta lactamase are resistant to many of the penicillins. Organisms that produce beta lactamase are resistant to many of the cephalosporins.

Guidelines for preventing antimicrobial resistance include: Select all that apply. 1. Using proper infection-control procedures. 2. Shortening the duration of antibiotic administration. 3. Using antimicrobials wisely. 4. Preventing infections. 5. Treating infections properly.

1,3,4,5. Proper hygiene and infection control measures help prevent the transmission of infectious disease and the development of resistance. Using antimicrobials only when there is a clear rationale for their use helps prevent the development of resistance. The CDC guidelines for preventing antimicrobial resistance include preventing infections when possible. Diagnosing and treating infections properly helps prevent the development of resistance.

The ability of an antibiotic to target pathogens without major effects on human cells is termed: 1. Selective toxicity. 2. Selective synthesis. 3. Bacteriostatic action. 4. Opportunistic action.

1. Antibiotic selective toxicity allows pathogens to be killed or their growth severely hampered without major effects on human cells.

The nurse caring for a client with an allergy to penicillin would be cautious in implementing an order for an anti-infective agent from which class? 1. Cephalosporins 2. Fluoroquinolones 3. Sulfonamides 4. Aminoglycosides

1. Cephalosporins are a widely prescribed class of antibiotics, similar in structure and mechanism of action to the penicillins.

The client's culture report indicates the presence of gram-negative cocci in the urine. This means that the bacteria are: 1. Round with thin cell walls. 2. Round with thick cell walls. 3. Rod-shaped with thin cell walls. 4. Spiral-shaped with thin cell walls.

1. Gram-negative cocci are round with thin cell walls.

Pathogenicity refers to an organism's ability to: 1. Cause disease. 2. Penetrate anatomic barriers more easily. 3. Multiply more rapidly. 4. Use oxygen.

1. Some pathogens are extremely infectious, while others produce no symptoms at all. Pathogenicity refers to an organism's ability to cause disease.

A female client is prescribed tetracycline for acne. When providing information regarding this drug, the nurse explains that tetracycline: 1. Is contraindicated in children younger than 8 years old. 2. Is classified as a narrow-spectrum antibiotic. 3. Has been identified to be safe during pregnancy. 4. Is used to treat a wide variety of disease processes.

1. The drug has the ability to cause permanent mottling and discoloration of teeth and therefore is not good for children younger than 8 years old.

A major factor in the development of drug-resistant bacteria is the: 1. Unwarranted use of antibiotics. 2. Selection of the incorrect antibiotic. 3. Lack of new antibiotics. 4. Lack of client adherence.

1. The widespread and sometimes unwarranted use of antibiotics has promoted the development of drug-resistant bacterial strains.

A pregnant client is seen in the emergency department for an infection. The nurse anticipates that antibiotics prescribed for this client would not include: Select all that apply. 1. Ampicillin. 2. Minocycline. 3. Neomycin. 4. Streptomycin. 5. Doxycycline.

2,3,4,5. Minocycline is a pregnancy category D drug. Neomycin is a pregnancy category D drug. Streptomycin is a pregnancy category D drug. Doxycycline is a pregnancy category D drug.

A client has been on an antibiotic for 2 weeks for treatment of an ulcer caused by Helicobacter pylori. The client asks the nurse if the antibiotic could be causing diarrhea. What is the nurse's most accurate response? 1. "The infection has become severe." 2. "This might be a secondary infection due to the antibiotic therapy." 3. "The infection has a restricted group of microorganisms." 4. "The organisms that caused the infection have developed immunity to the drug."

2. A superinfection is a side effect of antibiotic therapy.

The nurse knows that which antibiotic, when taken by a pregnant woman, can adversely affect the newborn's hearing? 1. Mycins 2. Aminoglycosides 3. Sulfonamides 4. Tetracyclines

2. Aminoglycosides can adversely affect the newborn's hearing.

Hyaluronidase, an enzyme secreted by certain bacteria, allows the bacteria to: 1. Protect themselves from phagocytes. 2. Penetrate anatomic barriers more easily. 3. Multiply more rapidly. 4. Produce exotoxins in greater abundance.

2. Certain bacteria secrete hyaluronidase, which digests the matrix between human cells and allows the bacteria to penetrate anatomic barriers more easily.

The nurse caring for a client with an infection knows a contributing factor to the development of drug resistance is the presence of bacterial genetic errors called: 1. Plasmids. 2. Mutations. 3. Conjugates. 4. Duplications.

2. Genetic errors are mutations.

Invasiveness refers to a pathogen's ability to: 1. Produce endotoxins in greater abundance. 2. Multiply more rapidly. 3. Increase its virulence. 4. Penetrate anatomic barriers more easily.

2. Invasiveness is the term for the ability of a pathogen to grow rapidly.

The nursing student asks the instructor how concepts from microbiology directly relate to client care. The instructor's best response is: 1. "It will assist you in understanding how health care providers choose anti-infective agents." 2. "Knowledge of bacteria and their classification assists in the management of anti-infective therapy." 3. "Studying microbiology will help you understand laboratory reports." 4. "Microbiology is one of the few science electives that do not really have any direct effects on client care."

2. The knowledge of bacteria and their classification assists in the management of anti-infective therapy.

The nurse caring for a group of clients recognizes that which client has a superinfection? 1. 47-year-old client with type 2 diabetes and pneumonia 2. 50-year-old AIDS client with candida 3. 46-year-old client with vascular disease and cellulitis of the leg 4. 52-year-old client with gastroesophageal reflux disease (GERD) and gastritis

2. Those who are immunosuppressed and receiving antibiotic therapy are at greater risk of developing superinfections.

Which client would require the administration of prophylactic antibiotics? 1. A client with inflammation at the infection site 2. A client with a viral infection 3. A client with a suppressed immune system 4. A client with pus at the infection site

3. A client with a suppressed immune system would need prophylactic antibiotics.

The client on penicillin who is complaining of an abnormal vaginal discharge has a superinfection secondary to: 1. A nosocomial infection. 2. An overdose of penicillin. 3. The destruction by penicillin of normal flora in the vagina. 4. The development of an organism resistant to penicillin.

3. Superinfections occur when organisms normally present in the body are destroyed by an antibiotic and pathogenic organisms can grow unchecked.

Which location is the most difficult to reach with antibiotic therapy? 1. Gastrointestinal system 2. Integumentary system 3. Central nervous system 4. Lungs

3. The central nervous system is the most difficult location to reach with antibiotic therapy because many medications have difficulty crossing the blood-brain barrier.

The nurse is preparing to administer a broad-spectrum antibiotic medication to a client. An important nursing intervention prior to administration of the anti-infective is: 1. Performing a culture within 24 hours after starting the medication. 2. Obtaining the culture report, as when starting any medication. 3. Performing a culture prior to administering the first dose of the anti-infective. 4. Administering the medicine without performing cultures.

3. The culture should be obtained prior to administering the first dose of the anti-infective.

The ability of an organism to become unresponsive over time to an anti-infective is termed: 1. Superinfection. 2. Sensitivity. 3. Mutation. 4. Acquired resistance.

4. Acquired resistance is the ability of an organism to become insensitive to the effects of an anti-infective.

Anti-infectives are grouped into pharmacological classes by their: 1. Staining ability. 2. Size or shape. 3. Sensitivity. 4. Mechanism of action.

4. Antibiotics are grouped into classes by their mechanism of action, susceptible organisms, and chemical structure.

Bacteria classified by their response to Gram staining include: 1. Rods, spirals, and spheres. 2. Aerobic and anaerobic. 3. Fungi and viruses. 4. Gram-positive and gram-negative.

4. Bacteria are classified as gram-positive or gram-negative by their ability or inability to respond to a violet color after staining.

A new antibiotic is classified as a bacteriocidal agent. This means that the drug: 1. Slows the growth of the infectious agent. 2. Has a high potency. 3. Is highly efficacious. 4. Kills the infectious agent.

4. Bacteriocidal drugs kill bacteria.

The client asks the nurse why the health care provider did not prescribe the same antibiotic that the client always receives for an infection. The best response by the nurse would be: 1. "It doesn't matter which antibiotic you take." 2. "You don't want to take the same antibiotic all the time." 3. "Try this medicine, and if you're not better in 10 days, return to the office." 4. "This is a different bacteria from the last one and will respond to this new antibiotic."

4. Continuous use of the same type of antibiotic could lead to bacterial mutations that are insensitive to the effects of the antibiotic.

Which type of antibiotic carries the highest risk of an allergic response? 1. Tetracyclines 2. Aminoglycosides 3. Cephalosporins 4. Penicillins

4. The penicillins are the group of antibiotics that have the highest incidence of allergic reactions