Chapter 05: Anti-infective Drugs: Antibacterial, Antitubercular, and Antifungal Agents Visovsky: Introduction to Clinical Pharmacology, 9th Edition

MULTIPLE CHOICE

MULTIPLE CHOICE

12. A patient receiving antibiotics for 3 days reports a skin rash over the chest, back, and arms. What is your first action? a. Ask the patient whether he or she has ever developed a rash while taking another drug. b. Reassure the patient that many people have this expected reaction to antibiotic therapy. c. Ask the patient whether the rash itches, burns, or causes other types of discomfort. d. Document the report as the only action.

ANS: A A rash is an indication that the patient is allergic to the drug; however, at this time it is not an emergency. First explore the patient's response further and hold the dose; then notify the prescriber of this problem. DIF: Cognitive Level: Applying REF: p. 72

9. Which effect or drug interaction of ampicillin would be important to teach to female patient of childbearing age? a. "Ampicillin can reduce the effect of oral contraceptives." b. "Ampicillin is given only to patients allergic to penicillin." c. "Taking ampicillin can upset your menstrual cycle for the next month." d. "NSAIDS taken for menstrual pain can decrease serum levels of ampicillin."

ANS: A Ampicillin reduces the effectiveness of oral contraceptives, which can lead to an unplanned pregnancy. Teach women of childbearing age to use two reliable methods of birth control while taking any penicillin to prevent unplanned pregnancy. DIF: Cognitive Level: Applying REF: p. 72

1. A patient receiving antibiotics for the treatment of a bacterial wound infection develops a secondary fungal infection. The patient asks you to explain why the fungal infection developed. What is your best response? a. "Antibiotics can upset the balance of normal flora and allow yeast or fungus to grow." b. "Antibiotic resistance has allowed the bacteria in your wound to become a fungus." c. "Genetic changes induced by antibiotics lead to this fungal infection." d. "There is no known cause for this secondary fungal infection."

ANS: A Antibiotic use can upset the normal flora balance in the body and cause yeast or fungal infections to occur. Candida is a common body yeast and often overgrows to cause a fungal infection. When a person is given antibiotics to kill infectious bacteria, the normal flora is killed off as well. DIF: Cognitive Level: Applying REF: p. 65

30. Which class of antifungal drugs works by altering the cell wall of the fungus? a. Azoles b. Polyenes c. Allylamines d. Antimetabolites

ANS: A Azoles work by altering the cellular membrane of the fungus by depleting a lipid-like substance (ergosterol), which damages the fungus and will not allow it to reproduce. DIF: Cognitive Level: Knowing REF: p. 85

25. A patient who is a marathon runner requires treatment with the fluoroquinolone levofloxacin (Levaquin) for the treatment of a severe infection. What statement by the patient ensures understanding of the potential adverse effects of this drug? a. "I will report the development of pain, redness, or swelling around any joint." b. "I will call my healthcare provider if I develop abnormal bruising or bleeding." c. "I will call my healthcare provider if I develop lower leg swelling." d. "I will report the development of a chronic, irritating cough."

ANS: A Fluoroquinolones can cause rupture of tendons. Teach patients to notify the healthcare provider for tendonitis symptoms that might occur (ache, pain, redness, and swelling in a joint or area where a tendon attaches to a bone). DIF: Cognitive Level: Applying REF: p. 78

11. A patient who was prescribed a cephalosporin for the treatment of an infection states he has an allergy to penicillin. What action should you take before giving this drug to the patient? a. Inform the healthcare provider immediately. b. Inform the patient that he can take the prescribed drug safely. c. Instruct the patient to call the healthcare provider only if a rash appears. d. Instruct the patient to take a dose in your presence to observe for adverse effects.

ANS: A Patients who are allergic to penicillin are often allergic to the cephalosporins because the chemical structures are similar. Inform the prescriber about a penicillin allergy. DIF: Cognitive Level: Applying REF: p. 72

35. In which situation should drugs for malaria be given? a. Prophylactically when people travel to areas in which malaria is common b. Prophylactically when people return from malaria-infested areas c. For treatment of malaria once the acute illness is over d. Prophylactically in acute cases of malaria

ANS: A People in the military or those traveling to or living in areas where malaria is endemic can use antimalarials to prevent malaria and to treat the symptoms. DIF: Cognitive Level: Understanding REF: p. 89

33. For which condition would a patient receive the drug primaquine as a treatment? a. Malaria b. Pneumonia c. Strep infection d. Tuberculosis

ANS: A Primaquine is a drug used in the treatment of malaria (antimalarial). DIF: Cognitive Level: Knowing REF: p. 88

29. You are teaching a patient prescribed rifampin for the treatment of tuberculosis. What instruction should be included in the treatment plan? a. "Avoid taking acetaminophen and alcohol while taking this drug." b. "Take this drug with milk or an antacid to avoid stomach upset." c. "Your stools may be darker than normal when taking this drug." d. "Take this drug with food."

ANS: A Rifampin can cause liver damage that is potentiated by acetaminophen and alcohol. DIF: Cognitive Level: Applying REF: p. 80

22. You are caring for a patient with type 2 diabetes who has been prescribed a course of a sulfonamide (Bactrim) for a urinary tract infection. Which statement by the patient reflects understanding of potential drug interactions? a. "I will need to watch for symptoms of low blood glucose levels." b. "I will need to restrict the amount of fluids I drink to prevent edema." c. "I will need to take the Bactrim on an empty stomach to increase drug absorption." d. "I will need to add additional salt to my food to replace sodium excreted with this drug."

ANS: A Sulphonamides can interact with some type 2 diabetic drugs, such as sulfonylureas that can cause symptoms of hypoglycemia (fatigue, shakiness, anxiety, and irritability). DIF: Cognitive Level: Applying REF: p. 77

18. The mother of a 6-year-old child with a skin infection asks why her child is not being treated with tetracycline as she was for a similar infection. What is your best response? a. "Tetracycline can impair the development of teeth and bones in young children." b. "Tetracycline is a large pill and difficult for a young child to swallow." c. "Tetracycline can cause severe headaches in young children." d. "Tetracycline can cause seizures in young children."

ANS: A Tetracycline interferes with bone development and the development of tooth enamel. Exposure to tetracycline can cause permanent tooth staining. DIF: Cognitive Level: Applying REF: p. 74

17. You are counseling a patient who is to begin a course of tetracycline for the treatment of Lyme disease. What instructions would be important to provide to this patient? a. "Tetracycline can cause sun sensitivity, so protect yourself from sun exposure." b. "Tetracycline alters blood clotting; avoid injury while taking this drug. c. "Tetracycline should be taken with food to avoid stomach upset." d. "Tetracycline may cause irritation to the vein when it is injected."

ANS: A The tetracyclines increase the sensitivity of the skin to the sun and severe sunburns are possible, even among people with dark complexions. DIF: Cognitive Level: Applying REF: p. 73

1. Under which circumstances may the body's normal flora cause infection? (Select all that apply.) a. When normal flora are present in greater amounts than normal b. When normal flora are within immunocompromised persons c. When normal flora present in an unusual place in the body d. When normal flora are exposed to probiotics e. When normal flora are exposed to antibiotics f. When normal flora undergo genetic mutations

ANS: A, B, C, E Conditions in which normal flora cause infection include: when a person has very little immunity, if the organisms are present in excessive amounts and overwhelm the body, or they are located in the wrong place. Antibiotic use can upset the normal flora balance in the body and cause yeast or fungal infections to occur. DIF: Cognitive Level: Understanding REF: p. 65

2. Which adverse reactions are associated with the use of broad-spectrum antibiotics? (Select all that apply.) a. Bacterial changes in the bowel b. Overgrowth of yeast c. Loss of appetite d. Superinfection e. Nausea f. Edema

ANS: A, B, D Several types of adverse reactions are seen with broad-spectrum antibiotics. Adverse reactions include: changes in the normal bacteria in the bowel, an overgrowth of yeast, and superinfections. DIF: Cognitive Level: Knowing REF: p. 66

4. Which of the following statements are true regarding fluoroquinolones? (Select all that apply.) a. Fluoroquinolones interact with antidiabetic drugs. b. Fluoroquinolones increase the anticoagulant action of warfarin. c. The most common side effect of fluoroquinolones is temporary incontinence. d. Fluoroquinolones should be taken 2 hours before or 4 hours after multivitamins. e. Dairy products and enteral tube feedings reduce the absorption of fluoroquinolones. f. Fluoroquinolones are the only safe antibiotics for patients taking antidysrhythmics.

ANS: A, B, D, F Nausea, vomiting, diarrhea, abdominal pain, and headache are the most common side effects. Fluoroquinolones are generally contraindicated in patients on antidysrhythmics. Fluoroquinolones should be taken 2 hours before or 4 hours after multivitamins, minerals, antacids and iron because these agents reduce the absorption of the antibiotic by as much as 90%. When taken with warfarin, fluoroquinolones increase warfarin's anticoagulant effects. Dairy products and enteral tube feedings reduce the absorption of fluoroquinolones. In patients taking antidiabetic drugs, hyper or hypoglycemia may occur. DIF: Cognitive Level: Remembering REF: p. 78

5. Which of the following instructions should be part of a teaching plan for all patients receiving treatment with antitubercular drugs? (Select all that apply.) a. Report weight loss to your healthcare provider. b. Avoid alcohol for the duration of this treatment. c. Sleep with your head elevated using two pillows. d. Take each drug at a different time throughout the day. e. Report the appearance of dark colored urine and light-colored stools. f. You will need to have weekly blood draws to assess for neutropenia.

ANS: A, B, E, F Weight loss is an indication of worsening disease and should be reported to the healthcare provider. These drugs can cause liver damage as evidenced by clay-colored stools, dark urine, and jaundice. Because these drugs affect the liver, all alcohol should be avoided. DIF: Cognitive Level: Applying REF: p. 83

24. You are providing education for a patient prescribed a fluoroquinolone. Which response made by the patient indicates that teaching has been effective? a. "There are no drug interactions associated with fluoroquinolones." b. "I should take this drug with food to decrease GI upset." c. "I can take this drug with caffeine such as a cup of coffee." d. "I can discontinue this drug once I feel better."

ANS: B Fluoroquinolones should be taken with food to decrease adverse GI effects. DIF: Cognitive Level: Applying REF: p. 78

27. A patient with a confirmed active tuberculosis (TB) exposure asks how the first-line drugs such as isoniazid (INH) work to prevent infection. What response demonstrates your understanding of the action of isoniazid? a. "INH disrupts blood flow in TB cells depriving them of oxygen." b. "INH inhibits enzymes needed for reproduction and growth of TB." c. "INH is a bacteriostatic drug that works directly in the lung when inhaled." d. "INH works by increasing the elimination of tubercular bacteria through the urine."

ANS: B Isoniazid (INH) is a bactericidal drug that inhibits the enzymes of the TB organisms needed for reproduction and growth. INH can inhibit the enzymes of the TB bacteria that are in an infectious as well as a dormant state. DIF: Cognitive Level: Understanding REF: p. 81

10. You are caring for an elderly patient in a long-term care facility who has been prescribed a cephalosporin. Which adverse effect should you monitor the patient for while taking this drug? a. Lethargy b. Nephrotoxicity c. Peripheral edema d. Sleep disturbance

ANS: B Nephrotoxicity (kidney toxic effects) has been reported with some cephalosporins, and the incidence is greater in older adult patients and in patients with poor renal function. DIF: Cognitive Level: Applying REF: p. 72

20. You are caring for a hospitalized patient receiving gentamycin IV, an aminoglycoside, for the treatment of Pseudomonas pneumonia. Which laboratory values would be important to monitor to avoid adverse effects from drugs of this classification? a. Complete blood count b. BUN and creatinine c. Troponin levels d. Liver enzymes

ANS: B Patients who are given aminoglycosides must be monitored for nephrotoxicity (kidney damage) as well as ototoxicity. The nurse should monitor BUN and creatinine during treatment, and report elevations to the healthcare provider. DIF: Cognitive Level: Applying REF: p. 76

6. You are caring for a patient with an upper respiratory infection from group A beta-hemolytic streptococci. The patient asks you what antimicrobial drug is effective for this infection. What is your best response? a. Cefazolin b. Penicillin c. Vancomycin d. Sulfamethoxazole/trimethoprim

ANS: B Penicillin is effective in the treatment of the following susceptible organisms: group A beta-hemolytic streptococci and other less common organisms. DIF: Cognitive Level: Applying REF: p. 69

13. Which of the following methods is the correct procedure for giving IM penicillin? a. Inject the penicillin into the dorsal gluteal site by deep IM injection; do not aspirate. b. Inject the penicillin using the Z-track method; aspirate before injecting the drug. c. Inject subcutaneously as a bleb; if no reaction, then proceed to inject IM. d. Penicillin is not permitted to be given by IM injection, but by IV only.

ANS: B Penicillin is given by the Z-track method and aspiration is performed before injecting the drug. If blood appears in the syringe, remove the syringe, dispose of the drug, and prepare another dose. DIF: Cognitive Level: Knowing REF: p. 70

8. Which statement is true of any antibiotic used to treat an infection caused by a penicillinase-producing organism? a. The antibiotic should be acid stable. b. The antibiotic should be penicillinase resistant. c. The antibiotic should have an extended-release formulation. d. The antibiotic should be a narrow-spectrum preparation.

ANS: B Penicillins come in different forms; one class is natural penicillinase-resistant penicillin. DIF: Cognitive Level: Knowing REF: p. 69

14. Which cell wall synthesis inhibitor drug is given in an oral form to treat Clostridium difficile? a. Gabapentin b. Vancomycin c. Doxycycline d. Clindamycin

ANS: B Vancomycin has an oral form of a cell wall synthesis inhibitor that is used to combat the pseudomembranous colitis caused by Clostridium difficile. DIF: Cognitive Level: Remembering REF: p. 71

3. A patient is being discharged home on antibacterial drug therapy. What instructions should you teach the patient about allergic reactions? (Select all that apply.) a. "Notify your prescriber immediately if you vomit." b. "Stop taking the drug if you develop hives or a rash." c. "Call 911 if you experience any difficulty breathing." d. "Avoid drinking caffeinated beverages with the drug." e. "If you notice diarrhea be sure to stop taking the drug." f. "Continue taking the drug even if you are feeling well."

ANS: B, C GI upset, vomiting, and diarrhea are common side effects of antibacterial drugs and are not signs of allergic reactions. When a patient experiences an allergic reaction, he or she should be taught to stop taking the drug if rash or hives develop and to call the prescriber immediately. A patient should also be taught to call 911 immediately for difficulty breathing or a feeling of a lump in the throat because these are signs of a serious allergic reaction. DIF: Cognitive Level: Understanding REF: p. 69

3. What is the action of an antibiotic that is classified as bacteriostatic? a. Bacteriostatic drugs kill the bacteria. b. Bacteriostatic drugs slow the growth of bacteria. c. Bacteriostatic drugs are only effective against gram-positive organisms. d. Bacteriostatic drugs are only effective against gram-negative organisms.

ANS: B. Bacteriostatic drugs limit or slow the growth of the bacteria, weakening or eventually leading to the death of the bacteria. DIF: Cognitive Level: Remembering REF: p. 66

28. Which type of treatment would you expect to be used for a patient with active tuberculosis? a. Prophylactic treatment with isoniazid (INH) only b. Rifampin for 10 days or until the cough is resolved c. Long-term treatment with several antitubercular drugs d. Ethambutol plus a course of broad-spectrum antibiotics

ANS: C Antitubercular drugs are classified as primary or secondary agents to describe the way they are used in treating tuberculosis. The combination of drugs helps to slow the development of bacterial resistance in active TB. DIF: Cognitive Level: Remembering REF: p. 79

2. A breast-feeding mother has been prescribed antimicrobial therapy for an infection. What information should be included in her teaching plan? a. Breast-feeding is permitted during antimicrobial therapy and should be continued. b. Breast-feeding can continue if the breast milk is pumped, and given by bottle. c. Breast-feeding should be avoided during antimicrobial therapy. d. Breast-feeding during antimicrobial therapy can lead to mastitis.

ANS: C Breast-feeding should be avoided during antimicrobial therapy because most of these drugs are excreted into breast milk and the infant (who may not have an infection) will be exposed to the actions, side effects, and adverse effects. DIF: Cognitive Level: Applying REF: p. 66

31. Your patient has been prescribed a course of fluconazole for the treatment of a fungal infection. Which symptoms would indicate a medical emergency due to an adverse reaction to the drug? a. Hypoglycemia and dizziness. b. White plaques coating the tongue. c. Painful red or purple rash, and blisters. d. Decreased haemoglobin and hematocrit.

ANS: C Painful red or purple rash with flu-like symptoms are signs of Steven's Johnson Syndrome, a medical emergency. DIF: Cognitive Level: Applying REF: p. 84

32. A patient with candida infection in the mouth has been prescribed nystatin suspension. Which instruction should be included in the teaching plan for this patient? a. "Take care not to shake the suspension before pouring it." b. "Take this drug after having a fatty meal to increase absorption." c. "Keep the suspension in your mouth several minutes before swallowing." d. "Check your pulse before taking this drug, report a heart rate of 100 or greater."

ANS: C Patients should be taught to retain the suspension in the mouth for several minutes before swallowing to ensure the drug comes into contact with the oral fungus. DIF: Cognitive Level: Applying REF: p. 85

23. In reviewing a patient's reported drug allergies, which drug class sensitivity would suggest the patient should not be given a sulfonamide? a. Beta blockers b. ACE-inhibitors c. Thiazide diuretics d. Calcium channel blockers

ANS: C Patients with an allergy or sensitivity to thiazide diuretics, oral sulfonylureas, or carbonic anhydrase inhibitors may exhibit the same allergy or sensitivity to sulfonamides. DIF: Cognitive Level: Remembering REF: p. 77

26. A patient newly diagnosed with tuberculosis (TB) asks how this infection is transmitted. What is your best response? a. "TB is a sexually transmitted disease." b. "TB is transmitted by living in unsanitary conditions." c. "TB is transmitted by inhaling droplets from coughing or sneezing." d. "TB is transmitted from one person to another by infected blood."

ANS: C TB is transmitted by infected humans, cows (bovine), and birds (avian). Droplets ejected during coughing or sneezing are inhaled by an uninfected host. Once the bacterium is inhaled it rapidly multiplies in the oxygen-rich lung tissue. DIF: Cognitive Level: Applying REF: p. 79

16. A patient prescribed vancomycin (Vancocin) has developed redness on the face, neck, chest, back, and arms. The family asks the nurse if the drug should be stopped because of this response. What is your best answer? a. "Yes, these problems indicate an allergic reaction." b. "Yes, these side effects eventually lead to difficulty breathing." c. "No, these uncomfortable problems are an expected drug side effect." d. "No, the problems are caused by the presence of the infection and are not related to the drug."

ANS: C Vancomycin is a powerful antibacterial drug that has many side effects, including "red man syndrome." This problem is caused by a histamine release that dilates blood vessels, giving a red appearance to the face, neck, chest, back, and arms. Sometimes this reaction can be reduced by slowing the infusion rate; however, it is not an indication to stop the drug. DIF: Cognitive Level: Applying REF: p. 71

4. Which term refers to an antibiotic with a high degree of activity against many different organisms? a. Antimycotic b. Bacteriostatic c. Antimicrobial d. Broad-spectrum

ANS: D Drugs that are effective against a variety of organisms are called broad-spectrum antibiotics. DIF: Cognitive Level: Remembering REF: p. 67

19. Which statement is true regarding macrolides? a. Macrolides are the first treatment for MRSA infection. b. Macrolides always require a longer course of treatment. c. Macrolides cannot be used for patients with a penicillin allergy. d. Macrolides are effective against the same organisms as penicillin.

ANS: D Macrolides are effective against the same infectious organisms that are sensitive to penicillin and are used for patients who have a penicillin allergy. These drugs are not effective against MRSA. DIF: Cognitive Level: Remembering REF: p. 74

34. A patient is being treated for pinworms with anthelmintics. In addition to taking the drug, what else should be included in the patient's teaching plan? a. Wash the toilet seat weekly. b. There are special diet requirements before taking this drug. c. There is no need to test other family members for this condition. d. You may have diarrhea and abdominal pain while taking this drug.

ANS: D Some people have diarrhea and abdominal discomfort while taking the drug. During the initial period of illness, patients must remember that they are contagious. Every effort must be made to protect those nearby. DIF: Cognitive Level: Understanding REF: p. 89

7. You are teaching a patient about possible side effects when taking penicillin, a broad-spectrum antibiotic. What is the most common side effect you would stress in teaching the patient about this drug? a. Edema of the lower extremities b. Metallic taste in the mouth c. Ringing in the ears d. Loose stools

ANS: D The most common side effect of penicillin (and many other antibiotics) is simple diarrhea of two to four loose stools daily DIF: Cognitive Level: Applying REF: p. 69

5. You are caring for an elderly patient who is newly admitted with a suspected urinary tract infection requiring antimicrobial therapy. Which of the following tests would you expect the healthcare provider to order before initiating treatment? a. Abdominal x-ray b. Blood chemistry c. Laparoscopic examination d. Culture and sensitivity studies

ANS: D The organisms present in the urine must be carefully cultured and tested to see which drugs are effective against them (drug sensitivity). DIF: Cognitive Level: Remembering REF: p. 67

21. A sulfonamide, Bactrim, is ordered for a patient with a urinary tract infection. What should you include in the teaching plan for the patient who is taking this drug? a. Take the drug on a full stomach. b. Drink milk when taking the drug. c. Take the drug at night before going to bed. d. Drink large amounts of water with this drug.

ANS: D To prevent crystals in the urine, the patient should be told to drink large amounts of water while taking this drug. DIF: Cognitive Level: Applying REF: p. 77

15. A patient is to receive penicillin G benzathine (Bicillin LA) 2,400,000 units intramuscularly. The drug on hand is penicillin G benzathine 600,000 units/mL. How many milliliters should you prepare for the correct dose? a. 0.25 b. 0.5 c. 2 d. 4

ANS: D Want 2,400,000 units/have 600,000 units per mL. 2,400,000/600,000 = 24/6 = 4 mL. DIF: Cognitive Level: Applying REF: p. 70