Pharm CH15 Prep U
For what client would the use of prophylactic anti-infective be most appropriate? A client who uses street drugs intravenously A pre-surgical client who has an artificial heart valve A client with type 2 diabetes who lives in a crowded home A client who works in a clinic where many ill children are treated
A pre-surgical client who has an artificial heart valve Explanation: A client with valve replacement is especially prone to the development of subacute bacterial endocarditis because of the vulnerability of their heart valves; prophylactic antibiotic therapy as a precaution. None of the other listed clients has particular indications for the use of prophylactic anti-infectives.
The health care provider orders an oral antibiotic for a male client three times a day for 7 days. The client asks the nurse if this is correct, because his sister took the same antibiotic for 5 days. On what factor is the amount and frequency of the antibiotic dosing based? Sex of the client Age of the client Route of administration Characteristics of the causative organism
Characteristics of the causative organism Explanation: The amount and frequency of anti-infective and antimicrobial agents should be individualized according to characteristics of the causative organism, the chosen drug, and the client's size and condition (e.g., type and severity of infection, ability to use and excrete the chosen drug).
To ensure that the most appropriate drug is being used to treat a pathogen, which would need to be done first? Checking client allergies Obtaining sensitivity testing Evaluating the bactericidal effects Using combination therapy
Obtaining sensitivity testing Explanation: Performing sensitivity testing on cultured microbes is important to evaluate the bacteria and determine which drugs are capable of controlling the particular organism. Once the sensitivity testing is completed, then the decision for the drug can be made. Combination therapy is used when appropriate after culture and when sensitivity testing has been completed. Checking client allergies also would be done after sensitivity testing but before administering the drug. The bactericidal effects of a drug may or may not play a role in the selection of the drug.
Which client would be at risk of developing an infection? Select all that apply. a client who takes nutritional supplements an elderly client who has one chronic disease a client who performs daily hygiene care a client experiencing diarrhea chronically a client with an impaired immune system
confirming that the medication prescribed is the drug of choice for the specific microorganism. Explanation: In order for treatment to be effective, it is necessary for an anti-infective to be accurately matched to the offending pathogen. Anti-infectives do not normally cause cardiac adverse effects. The client should be taught that adverse effects can be managed and are not necessarily an inevitability that must be endured. Antihistamines do not prevent most adverse effects.
A client has been diagnosed with osteomyelitis and has been prescribed clindamycin, a narrow spectrum antibiotic. When planning this client's care, the nurse should understand that: the client likely has compromised immune function. the care team wished to reduce the client's risk of adverse effects. the microorganism causing the infection is likely known. broad spectrum antibiotics were likely administered without success.
the microorganism causing the infection is likely known. Explanation: Narrow spectrum antibiotics are appropriate when the identity of the microorganism is known or strongly suspected. This is unrelated to the client's immune function. Broad spectrum drugs are not necessarily trialed before using narrow spectrum drugs. The risk of adverse effects is not the determining factor.
A sputum sample of a postsurgical client with coarse crackles audible in the lungs has been sent for culture and sensitivity testing. What response should the nurse provide when the client asks why the sample needed to be analyzed? "It will identify what drug will best kill this microorganism." "It will show us how long you've had the infection." "It will help in determining where the microorganism came from." "It will help us to stop the infection from spreading to others."
"It will identify what drug will best kill this microorganism." Explanation: Once a specific microorganism is identified by laboratory culture, it is important to determine susceptibility, which is the vulnerability of the bacteria to the effects of an antibiotic. None of the other options are associated with identifying the most effective antibiotic therapy.
A 70-year-old client has been prescribed an antimicrobial drug for the treatment of a urinary tract infection (UTI). What teaching point should the nurse prioritize when providing client education? "Make sure that you take all the pills that you're prescribed, even if your infection gets better." "Make sure that you don't miss a dose of your medication, because you'll then have to begin the cycle from the beginning." "Try to avoid over-the-counter medications until you've finished your antibiotics." "Increase the dose of your antibiotics if you aren't feeling better within 48 hours."
"Make sure that you take all the pills that you're prescribed, even if your infection gets better." Explanation: A priority teaching point around the use of antimicrobial drugs is to completely finish the prescribed course of treatment. It would be inappropriate to teach the client to increase the drug dose, and it is unnecessary to avoid all OTC drugs. A missed dose does not necessitate beginning the drug cycle from the beginning.
A nurse is caring for a client who is hospitalized for pneumonia. The nurse reviews the electronic health record and evaluates that the microbiology data does not support the use of the broad spectrum antibiotic. Which statement is the nurse's best response to the provider about the results? "The charge nurse prefers that you call her about the antibiotic coverage for the client." "The microbiology data is identifying another antibiotic appropriate for the client." "I think you need to review the microbiology report for the client." "I have reviewed the client's record and the client does not want the antibiotic."
"The microbiology data is identifying another antibiotic appropriate for the client." Explanation: Laboratory tests used to definitively identify causative organisms and to determine susceptibility to antibiotics usually require 48 to 72 hours, so the prescriber usually initiates treatment with an antimicrobial drug that is likely to be effective. The nurse should communicate with the prescriber about the change so that a correction can be made as soon as possible. Telling the prescriber to review the microbiology report is incorrect. The basis of prescribing the antibiotic should be on the identifying bacteria's culture and sensitivity. Referring the prescriber to the charge nurse is inappropriate as it is the nurse's responsibility to discuss with the prescriber the client's care.
The nurse admits a client with septicemia (infection in the bloodstream). The client denies any allergies, and the doctor has ordered cefuroxime based on blood culture and sensitivity testing. The client states, "I'd prefer vancomycin because I've been reading about drug-resistant bacteria and I don't want to take any chances." What is the nurse's best response? "You can't believe anything you read on the internet because most of it is just someone's opinion and not fact." "There are some resistant infections that require vancomycin so you are right to prefer a stronger antibiotic." "Vancomycin is a powerful drug with many adverse effects and it is generally reserved for when no other drug will work." "I appreciate your concern but you can certainly rest assured that the health care provider ordered the right medication for your needs."
"Vancomycin is a powerful drug with many adverse effects and it is generally reserved for when no other drug will work." Explanation: The client is right in saying that vancomycin is effective against drug-resistant bacteria but needs help to understand that he or she does not have a resistant infection as indicated by the culture and sensitivity and that use of such a powerful drug when it is not needed increases risk of developing a vancomycin-resistant infection. It is never right to tell a client "not to worry" because they have every right to participate in his or her own care and should not be patronized. Although some information on the internet may not be accurate, it would be incorrect to say it is all just someone's opinion and not fact, especially given that the client's information is accurate.
The hospital nurse is caring for a group of adult clients. For which client should the nurse most likely administer prophylactic anti-infectives? A client who has hyperkalemia and who is receiving sodium polystyrene A client who is undergoing cardiac rehabilitation following a myocardial infarction A client with diabetic nephropathy who has recently begun dialysis A client with colorectal cancer who is preoperative for a bowel resection
A client with colorectal cancer who is preoperative for a bowel resection Explanation: Abdominal surgery is a common indication for antibiotic prophylaxis, since these surgeries present a significant risk for infection. For this reason, a preoperative client would be more likely to need prophylaxis than a client who has had an MI, a client with renal failure or a client with an electrolyte imbalance.
The nurse is caring for several medical clients who have infections. For which client would the administration of a broad spectrum antibiotic be most appropriate? A client who is being treated for a urinary tract infection for the third time this year A client with signs of infection who is awaiting the results of laboratory testing A client with pneumonia who has a confirmed allergy to penicillins A client with an infected surgical wound
A client with signs of infection who is awaiting the results of laboratory testing Explanation: Broad spectrum antibiotics are effective against a wide variety of microorganisms. None of the other listed clients have obvious indications for using a broad spectrum antibiotic.
The nurse is caring for several medical clients who have infections. For which client would the administration of a broad spectrum antibiotic be most appropriate? A client with pneumonia who has a confirmed allergy to penicillins A client with an infected surgical wound A client who is being treated for a urinary tract infection for the third time this year A client with signs of infection who is awaiting the results of laboratory testing
A client with signs of infection who is awaiting the results of laboratory testing Explanation: Broad spectrum antibiotics are effective against a wide variety of microorganisms. None of the other listed clients have obvious indications for using a broad spectrum antibiotic.
Of the clients with a bacterial infection requiring antibacterial drug therapy, which client will most likely require long-term follow-up care by the nurse? An adolescent with weakened immunity An elderly woman with a recent pacemaker insertion A toddler with a history of allergies such as rashes and hives An anemic pregnant woman
An elderly woman with a recent pacemaker insertion Explanation: The elderly woman with a pacemaker will be the most difficult to treat; therefore, she will require the most follow-up care. It is difficult to treat infections that occur because a foreign object is introduced into the body. The immune system attempts to destroy the object by phagocytosis and is unable to, which creates chronic inflammation and increases the risk of bacteria multiplying at the site. Clients with a history of true allergic reactions require close monitoring when on antibacterial drug therapy, but would not be the most difficult to treat nor require the most long-term follow-up care by the nurse. Weakened immunity, anemia, or pregnancy may affect treatment, but are not necessarily associated with an increased difficulty in treatment and nursing care.
What would contribute to drug resistance? Around-the-clock scheduling High dosage to eradicate the organism Antibiotic prescription for viral illness Prescribed duration of therapy
Antibiotic prescription for viral illness Explanation: The use of antibiotic prescription for viral illnesses or infections is a contributing factor to the development of resistance. A high enough drug dosage and long enough duration of therapy helps to ensure complete eradication of even slightly resistant organisms. Around-the-clock dosage scheduling eliminates peaks and valleys in drug concentration and helps to maintain a constant therapeutic level to prevent the emergence of resistant microbes.
A client is diagnosed with bacterial pneumonia. Pending culture results, what would the nurse expect the health care provider to order? Long-term oral antibiotic therapy Short-term IV antibiotic therapy Short-term oral antibiotic therapy Broad-spectrum antibiotics
Broad-spectrum antibiotics Explanation: Bacterial pneumonia is usually treated with a broad-spectrum antibiotic until culture and susceptibility reports become available.
A client is admitted to the hospital with elevated temperature, chills, cough, and fatigue. The health care provider orders a chest x-ray, which indicates pneumonia. The blood cultures also come back positive for a Gram-negative bacillus. The provider orders two antibiotics to be given to the client, one for Gram-negative organisms and one for Gram-positive organisms. Why does the provider not prescribe just one antibiotic for both types of bacteria? It is better for the client to be on two medications. 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.
Broad-spectrum antibiotics can cause antibiotic resistance. Explanation: 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.
The pathophysiology class is learning how microorganisms develop resistance to anti-infective drugs. What is one way the students would learn that microorganisms develop resistance to anti-infective drugs? By producing an enzyme that stimulates the drug By altering binding sites on the membrane or ribosomes so that the drug cannot enter the cell By changing the cellular membrane to allow the drug entry into the cell By rearranging their DNA to produce membranes that are permeable to the drug
By altering binding sites on the membrane or ribosomes so that the drug cannot enter the cell Explanation: Microorganisms have developed resistance by changing cellular permeability to prevent the drug from entering the cell by altering binding sites on the membranes or on ribosomes so the drug can no longer be accepted and by producing enzymes that deactivate the drug. Microorganisms have not been found to be able to rearrange their DNA to change their membrane structure.
A nurse is asked to explain the difference between community-acquired infections and hospital-acquired infections. What response best describes the difference? There is no epidemiological difference between the infection types; they are simply categorized as community-acquired or hospital-acquired. Hospital-acquired infections are typically less severe and easier to treat because they occur in the presence of trained medical staff. Community-acquired infections are usually less severe and easier to treat since hospital-acquired infections often involve drug-resistant microorganisms. Only drug-resistant strains of staphylococci, Pseudomonas, and Proteus are categorized as hospital-acquired infections.
Community-acquired infections are usually less severe and easier to treat since hospital-acquired infections often involve drug-resistant microorganisms. Explanation: Infections are often categorized as community-acquired or hospital-acquired. Because the microbial environments differ, the two types of infections often have different causes and require different antimicrobial treatment. Generally, hospital-acquired infections are more severe and difficult to manage because they often result from drug-resistant microorganisms and occur in people whose immunity is impaired. A wide variety of organisms can lead to hospital-acquired infections.
A client with an upper respiratory tract infection was prescribed roxithromycin, an antibiotic. The nurse tells the client that irregular administration of this medication could lead to what outcome? Increased chances of serious adverse events Increased rate of elimination of the drug Decreased absorption of the drug Development of drug resistance
Development of drug resistance Explanation: When there is irregular or indiscriminate use of antibiotics, certain pathogens may mutate or build a tolerance to the drug. The antibiotic then becomes ineffective against that organism. Irregular use does not affect the absorption or elimination of the drug or increase chances of serious adverse events of the antibiotic.
A client with an inflammatory disease has been prescribed indomethacin. The nurse is aware of the risk for drug-induced nephrotoxicity and should prioritize what intervention? Administering the medication with meals whenever possible Encouraging the client to increase fluid intake Monitoring closely for hematuria Educating the client about sodium limitation
Encouraging the client to increase fluid intake Explanation: Adequate hydration is important whenever a client is receiving a potentially nephrotoxic drug. Limiting sodium intake and administering drugs with food do not mitigate this risk. Kidney damage most often results in oliguria and changes to urine and blood chemistry, not hematuria.
Which of the following is the most important nursing action to help prevent antimicrobial resistance in health care settings? Using aseptic technique for all nursing procedures Documenting improvement or worsening of symptoms of infection Reporting culture and sensitivity results in a timely manner Good hand-washing between each patient contact
Good hand-washing between each patient contact Explanation: Antimicrobial resistance is a major concern worldwide because hospitals are most likely to harbor resistant bacteria, it is important that nurses use aseptic technique for all procedures; obtain culture specimens appropriately; communicate culture and sensitivity results in a timely manner; adhere to isolation procedures; document improvement or worsening of symptoms of infection; and most importantly, practice good hand-washing between each patient contact. Washing hands between patients will help prevent the spread of resistant bacteria.
Culture and susceptibility tests are performed prior to the prescription of antimicrobial drugs. What is the specific purpose of the culture? determines the severity of the infection identifies the drugs that might be effective in treatment Identifies the organism causing the infection predicts the body's response to the infection
Identifies the organism causing the infection Explanation: Culture identifies the infection's causative organism. Susceptibility tests determine which drugs are likely to be effective against the organism.
A client has been prescribed an aminoglycoside. In order to prevent accumulation of the drug, what should the nurse encourage the client to do? Take diuretics as prescribed. Take the drug on an empty stomach. Perform moderate exercise daily, if possible. Increase fluid intake.
Increase fluid intake. Explanation: To prevent the accumulation of antiinfective drugs in the kidneys, which can damage the kidney, clients taking antiinfective drugs should be well hydrated. Diuretics do not have this effect. Exercising does not prevent accumulation and taking a drug on an empty stomach does not affect accumulation.
The pharmacology instructor is discussing ways to decrease the incidence and severity of adverse effects among children taking anti-infective agents. What would the instructor mention is one way to do this in children? Decrease dietary potassium. Keep clients well hydrated. Increase sodium in diet. Assess liver function weekly.
Keep clients well hydrated. Explanation: Because children can have increased susceptibility to the gastrointestinal and nervous system effects of anti-infectives, monitor hydration and nutritional status carefully. Clients should be encouraged to drink fluids. Decreasing dietary potassium, weekly assessment of liver function, or increasing sodium in the diet will not decrease the severity of adverse effects in children.
What information about antibiotic therapy should the nurse should include in a client's medication education? Maintenance of normal bacterial flora is essential to health during the therapy. The healthy human body hosts dozens of minor infections at any given time. Bacteria can remain in the body for up to 48 to 72 hours after the completion of antibiotic therapy. An aseptic internal environment only exists in young adults.
Maintenance of normal bacterial flora is essential to health during the therapy. Explanation: Normal flora protects the human host in a variety of ways. For example, normal bowel flora synthesizes vitamin K and vitamin B complex. The intestinal flora also plays a role in digestion. Furthermore, by competing with potential pathogens for nutrients and by preventing adhesion and growth of pathogens, beneficial microorganisms interfere with the ability of potential pathogens to cause infections. None of the other options are accurate statements regarding antibiotic therapy.
An 82-year-old woman with influenza and pneumonia has been admitted to the hospital for IV antibiotic therapy. Which type of antibiotic would rely the least on the client's defense mechanisms? Sulfonamides Erythromycin Tetracycline Penicillin
Penicillin Explanation: Because the client's immune system is compromised, it would be better to treat the client with a penicillin-type antibiotic. Penicillin antibiotics are bactericidal and do not rely on the client's immune system to fight the infection.
A client asks the nurse how an anti-infective produces a therapeutic effect. What should be included in the nurse's teaching plan? Fluoroquinolones interfere with the growth and development of cells. Drugs used to treat infections date back to the 17th century. Selective toxicity determines the appropriate drug dosage needed. Penicillin interferes with biosynthesis of the bacteria cell wall.
Penicillin interferes with biosynthesis of the bacteria cell wall. Explanation: The goal of anti-infectives is to interfere with the normal function of the invading organism to prevent it from reproducing and to cause cell death without affecting host cells. Penicillin interferes with biosynthesis of the bacterial cell wall. Because bacteria cells have a slightly different composition than human cells, the bacteria are destroyed without interfering with the host. The first drugs used to treat systemic infections were developed in the early 20th century. Fluoroquinolones interfere with DNA synthesis. The term selective toxicity refers to the ability to affect certain proteins or enzyme systems that are used by infecting organisms, but not by human cells.
A client taking trimethoprim-sulfamethoxazole for a urinary tract infection asks how the medicine works to destroy the pathogen. What would be the nurse's best answer? Binds receptor sites Prevents the pathogen from dividing Destroys proteins in the cell wall Prevents protein synthesis
Prevents the pathogen from dividing Explanation: Some anti-infectives prevent the cells of the invading organism from using substances essential to their growth and development, leading to an inability to divide and eventually to cell death. The sulfonamides, the antimycobacterial drugs, and trimethoprim-sulfamethoxazole (a combination drug frequently used to treat urinary tract infections) work in this way.
Bactericidal compounds fight infection and destroy microorganisms by inhibiting what? Protein synthesis DNA replication Cell wall synthesis Leukocytes
Protein synthesis Explanation: Some anti-infectives are so active against the infective microorganisms that they actually cause the death of the cells they affect. These drugs are said to be bactericidal. Bactericidal action inhibits protein synthesis. Therefore Options B, C, and D are incorrect.
A client with acne has been receiving an anti-infective agent for a prolonged period. Initially, the drug was effective, but over time its effectiveness as decreased. What is the nurse's bestaction? Assess the client for additional signs of superinfection. Assess the client for a new onset of drug hypersensitivity. Educate the client about the phenomenon of drug tolerance. Refer the client to the health care provider because the client may be experiencing resistance.
Refer the client to the health care provider because the client may be experiencing resistance. Explanation: Resistance refers to the organism's ability to adapt over time to an antibiotic and produce cells that are no longer affected by a particular drug. Destruction of the normal flora by anti-infectives commonly leads to superinfection, an infection that occurs when opportunistic pathogens that were kept in check by the normal bacteria have the opportunity to invade the tissues. Hypersensitivity or allergic reactions result from antibody formation. Tolerance exists when a client needs a higher dose to achieve the same therapeutic effect as in the past; with anti-infectives, however, resistance is more likely.
The nursing instructor and her students are discussing ways to prevent the spread of infection. Which of the following measures should the instructor identify as the most important? Giving antimicrobials as prescribed Maintaining reverse isolation protocols Maintaining access to an infectious disease specialist Rigorously and consistently applying recommended precautions
Rigorously and consistently applying recommended precautions Explanation: Rigorous and consistent use of recommended precautions helps to protect health care providers and patients regardless of the type of infection. These basic precautions include using appropriate personal protective gear and treating all patient fluids as infectious. The other options describe measures that may be important for specific patients or infections.
When describing an anti-infective agent with a narrow spectrum of activity, what would the nurse include? The drug is effective in interfering with the cell's reproduction. The drug is highly aggressive in killing the pathogen. The drug is selective in its action on organisms. The drug is effective against many different organisms.
The drug is selective in its action on organisms. Explanation: An anti-infective with a narrow spectrum of activity is selective in its action; thus, it is effective against only a few microorganisms with a very specific metabolic pathway or enzyme. Broad-spectrum activity refers to effectiveness against a wide variety of pathogens. Bactericidal refers to a highly aggressive drug that causes cell death. Bacteriostatic refers to a drug's effectiveness in interfering with a cell's ability to reproduce or divide.
When describing an anti-infective agent with a narrow spectrum of activity, what would the nurse include? The drug is selective in its action on organisms. The drug is highly aggressive in killing the pathogen. The drug is effective in interfering with the cell's reproduction. The drug is effective against many different organisms.
The drug is selective in its action on organisms. Explanation: An anti-infective with a narrow spectrum of activity is selective in its action; thus, it is effective against only a few microorganisms with a very specific metabolic pathway or enzyme. Broad-spectrum activity refers to effectiveness against a wide variety of pathogens. Bactericidal refers to a highly aggressive drug that causes cell death. Bacteriostatic refers to a drug's effectiveness in interfering with a cell's ability to reproduce or divide.
When preparing a teaching plan for a group of students about the ways organisms develop resistance to anti-infective therapy, what would the instructor be least likely to include in the discussion? The organism produces an enzyme that inactivates the drug. The organism alters the transport system to prevent the drug from entering. The organism alters the binding sites on the membranes. The organism produces some chemical to mimic the drug.
The organism produces some chemical to mimic the drug. Explanation: Microorganisms develop resistance by producing a chemical that acts as an antagonist to the drug, not one that would mimic the drug. In addition, the microorganism can produce an enzyme that deactivates the drug, change cellular permeability so that the drug can't enter the cell, and alter binding sites to no longer accept the drug.
What is a major factor that influences whether an individual will acquire an infection? the number of effective drugs available to an antibiotic-resistant infections implementation of continuous antimicrobial treatment of the infection The person's ability to defend against invading microorganisms the infection's tendency to recur and involve simple organisms
The person's ability to defend against invading microorganisms Explanation: The human body and the environment contain many microorganisms, most of which do not cause disease and live in a state of balance with the human host. When the balance is upset and infection occurs, characteristics of the infecting microorganism and the adequacy of host defense mechanisms are major factors in the severity of the infection and the person's ability to recover. Conditions that impair defense mechanisms increase the incidence and severity of infections and impede recovery. In addition, use of antimicrobial drugs may lead to serious infections caused by drug-resistant microorganisms.
A nurse has questioned why a client's health care provider has prescribed a narrow-spectrum antibiotic rather than a broad-spectrum drug in the treatment of an infection. Which facts provide the best rationale for the use of narrow-spectrum antibiotics whenever possible? The efficacy of most narrow-spectrum antibiotics has not been proven. Broad-spectrum antibiotics confound the results of subsequent culture and sensitivity testing. Narrow-spectrum antibiotics normally require a shorter duration of treatment. The use of broad-spectrum antibiotics can create a risk for a superinfection.
The use of broad-spectrum antibiotics can create a risk for a superinfection. Explanation: The benefit of a narrow-spectrum antimicrobial agent is that it limits the potential for adverse effects, such as superinfection. In a superinfection, an antibiotic suppresses all susceptible microbes, including the body's natural flora, which may keep other microbes in check. In the absence of these bacteria, nonsusceptible microbes can proliferate. Narrow-spectrum antibiotics do not lack demonstrated efficacy and they do not necessarily require a shorter duration of treatment. All antimicrobial drugs have the potential to impact subsequent C&S testing.
Like many other classes of drugs, anti-infective drugs can have a variety of adverse effects. What is the most common, potentially serious, adverse effect of antimicrobial drugs? Pain Skin rash Toxic effects on the kidney Constipation
Toxic effects on the kidney Explanation: The most commonly encountered adverse effects associated with the use of anti-infective agents are direct toxic effects on the kidney, gastrointestinal (GI) tract, and nervous system. Pain, constipation, and hypopnea are not common adverse effects of antimicrobial drugs.
Which client is receiving prophylactic anti-infectives? a client with metastatic lung cancer who will soon begin chemotherapy a client with human immunodeficiency syndrome who begins antiretroviral therapy a client who is prescribed a 3-day course of antibiotics prior to dental surgery a client who has been admitted for the treatment of an infected surgical incision
a client who is prescribed a 3-day course of antibiotics prior to dental surgery Explanation: In a situation where an infection is likely to occur, antibiotics can be used to prevent it. Giving antibiotics before surgery is an example of prophylaxis. Chemotherapy is the use of drugs to destroy abnormal cells, usually cancer cells; this is not prophylactic. Antiretroviral therapy and treatment of an active infection are not prophylactic.
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: a higher dose. the same dose. the same dose but less frequent. a lower dose.
a lower dose. Explanation: 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.
Successful treatment with bacteriostatic antibiotics depends upon what factor? adequate duration of drug therapy. using broad-spectrum antibacterial drugs to treat viral infections. the type of drug-resistant bacterial strains that can reproduce in the presence of antimicrobial drugs. stopping drug therapy when symptoms have subsided.
adequate duration of drug therapy. Explanation: Successful treatment with bacteriostatic antibiotics depends on the ability of the host's immune system to eliminate the inhibited bacteria and an adequate duration of drug therapy. Stopping an antibiotic prematurely can result in rapid resumption of bacterial growth. Antibiotics are not used to treat viral infections.
A drug that does not actually cause the death of a cell but does interfere with its ability to reproduce is said to be: drug resistant. bacteriostatic. bactericidal. broad spectrum.
bacteriostatic. Explanation: A drug that is bacteriostatic does not kill the cell but interferes with its ability to reproduce. Bactericidal drugs cause the death of the cell. Drug resistance is the ability of a pathogen to adapt and no longer be susceptible to an anti-infective. Bacteriostatic activity can be found in both broad- and narrow-spectrum anti-infectives.
A client is febrile and is suspected of having a respiratory infection. A sputum culture has been collected and the results of sensitivity testing are expected within 48 hours. The nurse should anticipate that the client may: receive supportive care until an antibiotic can be prescribed in 48 hours. be treated with antiviral medication on a short-term basis. be immediately prescribed a broad-spectrum antibiotic. need to provide a follow-up sputum culture before medications can be prescribed.
be immediately prescribed a broad-spectrum antibiotic. Explanation: Broad-spectrum antibiotics are often prescribed pending sensitivity testing. There is no need to completely withhold medications until results are acquired. Antiviral medications are not used for this short-term purpose. Follow-up testing may or may not be needed.
A client has been diagnosed with an infection. The nurse can help to ensure the success of anti-infective treatment by: teaching the client that significant adverse effects are expected, and must be endured during treatment. administering antihistamines, as ordered, to prevent the development of adverse effects. monitoring the client closely for signs of arrhythmias or cardiac ischemia. confirming that the medication prescribed is the drug of choice for the specific microorganism.
confirming that the medication prescribed is the drug of choice for the specific microorganism. Explanation: In order for treatment to be effective, it is necessary for an anti-infective to be accurately matched to the offending pathogen. Anti-infectives do not normally cause cardiac adverse effects. The client should be taught that adverse effects can be managed and are not necessarily an inevitability that must be endured. Antihistamines do not prevent most adverse effects.
The nurse is providing health education to a client with an infection who lives in the community. What characteristic of the client's anti-infective regimen will best prevent the development of resistant strains of microbes? ensuring that the duration of drug use is appropriate proactively addressing the possibility of adverse effects performing culture and sensitivity testing after the completion of treatment maximizing the frequency of drug ingestion
ensuring that the duration of drug use is appropriate Explanation: Exposure of pathogens to an antimicrobial agent without cellular death leads to the development of resistance so it is important to limit the use of these agents to treat pathogens with a known sensitivity to the drug being used. The duration of drug use is critical to ensure that microbes are completely eliminated and not given the chance to grow and develop resistant strains. Adverse effects must be addressed, but this is not directly related to the development of resistance. Dosing frequency must be determined with the goal of enhancing the therapeutic action, but excessive frequency can cause problems with the client's adherence. Follow-up testing is not a major component of preventing resistance.
A client is receiving an aminoglycoside antibiotic for an infection. The nurse would monitor the client closely for: lethargy. hallucinations. hearing loss. visual changes.
hearing loss. Explanation: Aminoglycosides collect in the eighth cranial nerve and can cause hearing loss, dizziness, and vertigo. Lethargy and hallucinations may be associated with other anti-infective agents. Visual changes such as blindness are associated with chloroquine use.
A nurse collects a culture sample from a client's infected wound bed. Laboratory testing of this sample will allow the care team to: approximate the client's risk for antibiotic resistance. identify the specific organism causing the infection. assess the components of the client's normal flora. identify individualized client factors contributing to infection.
identify the specific organism causing the infection. Explanation: A culture is collected to identify the causative organism of an infection. It can help with determining the site of infection in some cases if the infection is limited only to the site where the culture is collected. It does not individualize client factors contributing to infection or focus on the client's normal flora. Results of culture testing do not directly indicate the client's risk for experiencing antibiotic resistance.
What intervention is most important for the nurse to perform prior to initiating prescribed antibiotic therapy? obtaining a specimen for culture and sensitivity educating the client about adverse effects administer an antidiarrheal to prevent gastrointestinal (GI) upset increasing the client's fluid intake
obtaining a specimen for culture and sensitivity Explanation: It is good practice to collect specimens (e.g., sputum, urine) for culture and Gram's stain before giving the first dose of an antibiotic. Fluid intake and medication education may take place after the therapy is initiated, while antidiarrheal medication is administered if the client demonstrates signs/symptoms of GI distress.
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 prophylaxis chemotherapy curative treatment
prophylaxis Explanation: 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.
The critical concept in preventing the development of resistant strains of microbes is: drug dosages below a therapeutic level. exposure of pathogens to an antimicrobial agent without cellular death. frequency of drug ingestion. the duration of drug use.
the duration of drug use. Explanation: Exposure of pathogens to an antimicrobial agent without cellular death leads to the development of resistance, so it is important to limit the use of these agents to treat pathogens with a known sensitivity to the drug being used. Drug dosages are also important in preventing the development of resistance. However, the duration of drug use is critical to ensure that microbes are completely eliminated and not given the chance to grow and develop resistant strains. It is hard to convince clients that they must always complete the entire course of antimicrobial agents when they begin to "feel better," but stopping early favors the emergence of resistant strains.
Inappropriate use of antibiotics does all of the following except increase: adverse drug effects. infections with drug-resistant microorganisms. the number of available effective drugs for serious or antibiotic-resistant infections. health care costs.
the number of available effective drugs for serious or antibiotic-resistant infections. Explanation: Antimicrobials are among the most frequently used drugs worldwide. Their success in saving lives and decreasing severity and duration of infectious diseases has encouraged their extensive use. Authorities believe that much antibiotic use involves overuse, misuse, or abuse of the drugs. That is, an antibiotic is not indicated at all or the wrong drug, dose, route, or duration is prescribed. Inappropriate use of antibiotics increases adverse drug effects, infections with drug-resistant microorganisms, and health care costs. In addition, it decreases the number of effective drugs for serious or antibiotic-resistant infections.
An immunocompromised patient in a critical care setting has developed a respiratory infection that has been attributed to methicillin-resistant Staphylococcus aureus (MRSA). The nurse should anticipate that the patient will require treatment with vancomycin. clindamycin. ciprofloxacin. an antistaphylococcal penicillin.
vancomycin. Explanation: Vancomycin is the drug of choice to manage infections caused by MRSA. MRSA is resistant to all of the antistaphylococcal penicillins, as well as to ciprofloxacin and clindamycin.
