TEST 4 - NURS 368

A client calls the clinic to talk to the nurse. The client states being prescribed penicillin for a strep throat last week. Though the client feels better, the client stopped taking the drug "today," even though there are "a few pills left." What would be the nurse's best response? "Okay, thank you for letting me know." "It is of critical importance that you take all the medication so all the germs are killed. Otherwise they could come right back and be even stronger." "You will need to come to the clinic and be evaluated by your physician to make sure the infection is really gone." "What you have described are just halo effects of the drug you were taking. They will go away when the drug is totally out of your system."

"It is of critical importance that you take all the medication so all the germs are killed. Otherwise they could come right back and be even stronger." Rationale: he duration of drug use is critical to ensure that the microbes are completely, not partially, eliminated and are not given the chance to grow and develop resistant strains

The ability of bacteria to produce substances that inactivate or destroy the antibiotic is known as which of the following? Bacterial resistance Bacterial evolution Bacterial shift Bacterial adaptation

Bacterial resistance

Drugs that slow or retard the multiplication of bacteria are known as which of the following? Bacteriocidal Bacteriostatic Bacteriostationary Bacteriophage

Bacteriostatic Rationale: Drugs that slow or retard the multiplication of bacteria are known as bacteriostatic

A client is admitted to the hospital with elevated temperature, chills, cough, and fatigue. The physician orders a chest x-ray, which indicates pneumonia. The blood cultures also come back positive for a Gram-negative bacillus. The physician orders two antibiotics to be given to the client, one for Gram-negative organisms and one for Gram-positive organisms. Why does the physician not prescribe just one antibiotic for both types of bacteria? Broad-spectrum antibiotics can cause antibiotic resistance. There is a cost savings when prescribing narrow-spectrum antibiotics. There are not any antibiotics available in the United States that treat both bacteria. It is better for the client to be on two medications.

Broad-spectrum antibiotics can cause antibiotic resistance Rationale: All antimicrobials have the ability to promote the emergence of drug-resistant microbes. However, resistance is more likely to occur in organisms exposed to broad-spectrum drugs. Although the use of antimicrobials promotes the potential for drug resistance to occur, they do not directly cause the resistance.

Which classes of drugs exert their effects by inhibiting bacterial cell wall synthesis? (Select all that apply) Monobactams Fluoroquinolones Oxazolidinones Cyclic lipopeptides Carbapenems

Carbapenems Monobactams Rationale: Carbapenems, Monobactams, and vancomycin all exert their effects by inhibiting cell wall synthesis

The nurse is preparing to administer linezolid (Zyvox) to a client and knows that it is being used in the treatment of which disorders? (Select all that apply.) Health care-acquired pneumonia Methicillin-resistant S. aureus (MRSA) Skin structure infections Gonorrhea in a client allergic to penicillin Vancomycin-resistant Enterococcus faecium (VREF)

Health care-acquired pneumonia Methicillin-resistant S. aureus (MRSA) Skin structure infections Vancomycin-resistant Enterococcus faecium (VREF) Rationale: Linezolid is used in the treatment of VREF, health care- and community-acquired pneumonia, and skin and skin structure infections (including those caused by MRSA). Spectinomycin is used for treating gonorrhea in clients who are allergic to penicillin, cephalosporins, or probenecid.

A home care nurse is taking care of a client on IV vancomycin for cellulitis of the left calf. How would the nurse explain to the client that microorganisms develop resistance to anti-infectives? Tell the client that microorganisms can stop the cell from reproducing. Teach the client that microorganisms can produce a chemical that acts as an agonist to the drug. Teach the client that microorganisms can alter the blood supply to the infection. Inform the client that microorganisms can produce a chemical that acts as an antagonist to the drug.

Inform the client that microorganisms can produce a chemical that acts as an antagonist to the drug Rationale: Microorganisms develop resistance in a number of ways, including changing cellular permeability to prevent the drug from entering the cell or altering transport systems to exclude the drug from active transport into the cell; altering binding sites on the membranes or ribosomes, which then no longer accept the drug; and producing a chemical that acts as an antagonist to the drug. Microorganisms do not alter the blood supply to the infection, stop a cell from reproducing, or act as an agonist to the drug.

Penicillins are utilized in the treatment of which of the following bacterial infections? (Select all that apply) Intra-abdominal infections Meningitis Upper respiratory tract infections Osteomyelitis Syphilis

Intra-abdominal infections Meningitis Upper respiratory tract infections Syphilis Rationale: Penicillins are utilized in the treatment of meningitis, syphilis, intra-abdominal infections, and upper respiratory infections caused by bacteria.

A patient with septicemia is administered cefotaxime sodium (Claforan). How is this medication excreted? It is excreted by the liver. It is excreted through the skin. It is excreted by the kidneys. It is excreted by the lungs.

It is excreted by the kidneys

An older adult client is prescribed an anti-infective agent. Which would the nurse need to keep in mind? Signs and symptoms of infection are the same as those for a younger client. Liver and kidney function may be reduced, requiring cautious use. The client has a lower risk for developing gastrointestinal toxicity and neurotoxicity. The client will most likely want to have a rapid cure for the problem.

Liver and kidney function may be reduced, requiring cautious use. Rationale: Anti-infectives that adversely affect the liver and kidneys must be used with caution in older clients, who may have decreased organ function. Older clients often do not present with the same signs and symptoms of infection that are seen in younger people. The older client is susceptible to severe adverse gastrointestinal, renal, and neurologic effects and must be monitored for nutritional status and hydration during drug therapy. Adults, not older adults, often demand anti-infectives for a "quick cure" of various signs and symptoms.

When preparing to administer a fluoroquinolone, the nurse understands that the majority of drugs belonging to this class are administered by which route? Topical Intramuscular Oral Subcutaneous

Oral Rationale: Most fluoroquinolones are administered orally; levofloxacin and moxifloxacin may also be given intravenously.

Clients receiving aminoglycosides should be monitored closely for which toxicities? Gastrointestinal Pancreatic Renal Neurological

Renal Rationale: When clients are taking aminoglycosides, they should be monitored closely for any signs of renal dysfunction. To prevent any accumulation of the drug in the kidney, clients should be well hydrated throughout the course of the drug therapy.

A nurse is caring for a patient who has a serious infection. The patient is being treated with combination therapy of a cefazolin and an aminoglycoside. The nurse will be sure to monitor which of the following? Serum BUN and creatinine levels Serum sodium and potassium levels Aspartate aminotransferase levels Prothrombin time (PT) and partial thromboplastin time (PTT)

Serum BUN and creatinine levels Rationale: Patients receiving combination therapy of a cefazolin and an aminoglycoside will need to be monitored for nephrotoxicity and therefore would need serum BUN and creatinine levels done. Serum sodium and potassium levels as well as aspartate aminotransferase should be monitored when receiving sodium penicillin G. PT and PTT should be monitored when a patient is receiving aztreonam, a monobactam antibiotic.

Which of the following is true of cephalosporins given via injection? (Select all that apply.) Tenderness can occur when cephalosporins are given IM. Phlebitis can occur when cephalosporins are given IM. Inflammation can occur when cephalosporins are given IM. Thrombophlebitis can occur when cephalosporins are given IV. Pain can occur when cephalosporins are given IM.

Tenderness can occur when cephalosporins are given IM. Inflammation can occur when cephalosporins are given IM. Thrombophlebitis can occur when cephalosporins are given IV. Pain can occur when cephalosporins are given IM Rationale: Administration route reactions include pain, tenderness, and inflammation at the injection site when cephalosporins are given IM, and phlebitis and thrombophlebitis along the vein may occur when cephalosporins are given IV.

A 6-year-old client is prescribed a narrow-spectrum antibiotic. What is meant by "narrow-spectrum antibiotic"? The antibiotic has little to no effect against pathogens. The antibiotic can treat both Gram-negative organisms and Gram-positive organisms. The antibiotic is effective against only a select few pathogens. The antibiotic dosage needs to be monitored carefully to prevent toxicity.

The antibiotic is effective against only a select few pathogens. Rationale: Antibacterial drugs are subdivided into narrow-spectrum, broad-spectrum, and antimycobacterial classifications. As the name implies, a narrow-spectrum drug is effective against a few types of bacteria, whereas a broad-spectrum drug is effective against many types of bacteria

The nurse is assessing a client who has recently been given the first dose of a new anti-infective. What finding should lead the nurse to suspect that the client is experiencing a hypersensitivity reaction? The client has a facial and trunk rash. The client recently had an episode of diarrhea. The client's blood pressure is 141/88 mm Hg. The client is experiencing vertigo.

The client has a facial and trunk rash Rationale: Rash suggests a hypersensitivity reaction. Vertigo may suggest a neurotoxic adverse effect. Diarrhea may occur over time as a result of gastrointestinal adverse effects. A blood pressure that is slightly elevated is not suggestive of hypersensitivity.

Your client was given tetracycline as a young child. You can tell this by changes in: Her eyesight. Her facial structure. The color of her teeth. Her shoe size.

The color of her teeth Rationale: Tetracyclines are contraindicated in pregnant women and in children to 8 years of age. In the fetus and young child, tetracyclines are deposited in bones and teeth along with calcium. If given during active mineralization of these tissues, tetracyclines can interfere with tooth enamel formation, cause permanent discoloration (mottling) of tooth enamel, and depress bone growth

Sulfonamides are commonly used to treat which of the following types of infections? Select all that apply. Urinary tract infection Ulcerative colitis Osteomyelitis Upper respiratory tract infection Acute otitis media

Urinary tract infection Ulcerative colitis Acute otitis media

Fluoroquinolones are primarily used to treat which of the following infections? Select all that apply. Skin infections Bone and joint infections Urinary tract infections Upper respiratory tract infections Sexually transmitted infections

Urinary tract infections Sexually transmitted infections Bone and joint infections Skin infections Rationale: Fluoroquinolones are primarily used to treat lower respiratory tract infections, bone and joint infections, urinary tract infections, skin infections, sexually transmitted infections, and some infections of the eye and ear

When caring for infants and the elderly who are in need of an antimicrobial agent, the nurse is aware that when compared with doses for young and middle-aged adults, these clients may require: the same dose. a higher dose. a lower dose. the same dose but less frequent.

a lower dose Rationale: Infants and the elderly are the populations most vulnerable to drug toxicity. In the infant, the liver and kidneys are still immature and may have difficulty metabolizing or excreting the drug, which results in accumulation. The same process in the elderly is related to the age of their liver and kidneys, which may no longer be functioning at an optimal level. Prescribers may request lower doses of antimicrobial agents for these two populations to minimize the risk for toxicity. The frequency is important in antimicrobial therapy and would not be decreased.

Which would be the most significant factor in the selection of an antibiotic drug for treatment of a client's infection? culture and susceptibility test results client's weight client's blood type client's insurance coverage

culture and susceptibility test results Rationale: Antibiotic selection can be based on a variety of factors, including culture and susceptibility tests and empiric therapy. Other factors that may play a role in selection are the client's health status, age, gender (since some drugs are inappropriate during pregnancy or nursing), and environment of care.

A client who is receiving anti-infective therapy is experiencing gastrointestinal toxicity. What would the nurse expect to assess? diarrhea vertigo dizziness rash

diarrhea Rationale: Gastrointestinal toxicity would be manifested by diarrhea, nausea, vomiting, or stomach upset. Dizziness and vertigo would reflect neurotoxicity. Rash may suggest a hypersensitivity or allergic reaction.

Most cells have the ability to reproduce themselves through: diffusion. homeostasis. osmosis. mitosis.

mitosis Rationale: Most cells have the ability to reproduce themselves through the process of mitosis. Diffusion is the movement of a substance from a region of higher concentration to a region of lower concentration. Homeostasis is the ability to keep the cytoplasm stable within the cell membrane. Osmosis is the movement of water across a semipermeable membrane from an area that is low in dissolved solutes to one that is high in dissolved solutes.

The nursing instructor is talking with students about anti-infective medications. Drugs that are very selective in their actions are said to be: narrow spectrum. bactericidal. broad spectrum. bacteriostatic.

narrow spectrum Rationale: Some anti-infectives are so selective in their action that they are effective against only a few microorganisms with a very specific metabolic pathway or enzyme. These drugs are said to have a narrow spectrum of activity. They are not called broad spectrum, bactericidal, or bacteriostatic

A client is receiving aminoglycosides for a severe infection. The client reports an increasing ringing in the ears. The nurse realizes this is indicative of: nephrotoxicity. ototoxicity. hepatotoxicity. cardiotoxicity.

ototoxicity Rationale: Aminoglycosides (e.g., gentamicin) may cause nephrotoxicity and ototoxicity in any client. Constant ringing is one of the major symptoms.

A client is informed of a need for extensive dental surgery. The dentist prescribes a course of antibiotic therapy before beginning the procedure and continuing for 5 days after the procedure. What is this is an example of? synergism chemotherapy curative treatment prophylaxis

prophylaxis Rationale: In a situation where an infection is likely to occur, antibiotics can be used as a means of preventing an infection; this is called prophylaxis. Synergism is using two antibiotics together to improve their effectiveness. Chemotherapy is the use of drugs to destroy abnormal cells, usually cancer cells. Curative treatment involves treating an actual infection to promote a cure.

A critical care nurse is caring for a client taking aminoglycosides. What should the nurse monitor closely to determine whether dosage adjustment is required? intestinal function lung function renal function cardiac function

renal function Rationale: Aminoglycosides are nephrotoxic. Renal function should be monitored to determine whether dosage should be adjusted, particularly in clients with existing renal dysfunction.