CHAPTER 15: INFLAMMATION, INFECTION, AND THE USE OF ANTIMICROBIAL AGENTS

Which client would be at risk of developing an infection? Select all that apply. a client experiencing diarrhea chronically a client with an impaired immune system an elderly client who has one chronic disease a client who performs daily hygiene care a client who takes nutritional supplements

a client experiencing diarrhea chronically a client with an impaired immune system an elderly client who has one chronic disease Explanation: Many factors impair the host defense mechanisms and predispose a person to infection by disease-producing microorganisms. These include breaks in the skin and mucous membranes, impaired blood supply, neutropenia and other blood disorders, malnutrition, poor personal hygiene, suppression of normal bacterial flora by antimicrobial drugs, diabetes mellitus and other chronic diseases, and advanced age. A client who has chronic diarrhea can experience malnutrition. A client who performs daily care and a client who takes nutritional supplements are not at risk for infection

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

Renal

A 12-year-old boy was bitten by a dog, and inflammation took place at the site of the injury. During the process of opsonization, what physiological event occurred? A) The boy's blood vessels dilated, allowing rapid peripheral blood flow. B) Viscosity of the boy's blood decreased, facilitating the migration of neutrophils. C) Antigens were coated, marking them for phagocytosis. D) T cells were released from the boy's thymus gland.

Ans: C Feedback: The third stage of inflammation involves opsonization, which facilitates phagocytosis. During opsonization, a substance coats the foreign antigens, producing inflammation. This inflammation makes the antigens more susceptible to the macrophages and leukocytes, thus increasing phagocytic activity. Opsonization is not characterized by Tcell activity or changes in blood flow and viscosity.

A client asks the nurse how an anti-infective produces a therapeutic effect. What should be included in the nurse's teaching plan? A) Drugs used to treat infections date back to the 17th century. B) Fluoroquinolones interfere with the growth and development of cells. C) Selective toxicity determines the appropriate drug dosage needed. D) Penicillin interferes with biosynthesis of the bacteria cell wall.

D) Penicillin interferes with biosynthesis of the bacteria cell wall.

A sputum specimen report from the laboratory states, "Contamination with typical oral flora." Which interpretation is correct? A. Bacteria in the mouth are growing in the lungs B. The normal flora has become pathogenic C. The patient has a pulmonary infection D. The sputum from the lungs has mixed with bacteria in the mouth.

D. The sputum from the lungs has mixed with bacteria in the mouth.

A client is to undergo extensive dental surgery. The dentist prescribes a course of antibiotics before beginning the procedure and continuing for 5 days after the procedure. This is an example of: synergism. prophylaxis. curative treatment. chemotherapy.

prophylaxis. Explanation: In a situation where an infection is likely to occur, antibiotics can be used as a means of prophylaxis to prevent an infection before it occurs. Synergism is using two antibiotics together to improve their effectiveness. Chemotherapy is the use of drugs to kill cells. Curative treatment involves treating an actual infection to promote a cure.

The nurse administering an anti-infective agent recognizes that the drug will destroy some human cells as well as pathogens because of the absence of: antigens. virulence. resistance. selective toxicity.

selective toxicity. Explanation: Although anti-infective agents target foreign organisms infecting the body of a human host, they do not possess selective toxicity, which is the ability to affect certain proteins or enzyme systems used only by the infecting organism but not by human cells. Virulence would apply to the destructive power of the infection, not the drug. Resistance is the pathogen's ability to no longer respond to specific anti-infectives. Antigens are proteins bound to the cell that help the body identify a cell as belonging (or not) in the body, and are not the cause of human cell destruction.

People taking antimicrobial drugs should be instructed to report any problem that could indicate adverse drug effects, lack of therapeutic response, or emergence of another infection. One such problem is: headache. constipation. skin rash. muscle soreness.

skin rash. Explanation: Clients should be instructed to report nausea, vomiting, diarrhea, skin rash, recurrence of symptoms for which the antimicrobial drug was prescribed, or signs of new infection (e.g., fever, cough, sore mouth, drainage). These problems may indicate adverse effects of the drug, lack of therapeutic response to the drug, or another infection.

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?

"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."

The client in the clinic receives a prescription for an anti-infective to treat a urinary tract infection. The client asks the nurse, "Would you ask the health care provider to give me refills on this prescription? I get a urinary tract infection every few months, it seems, and I'd like to have a refill on hand for next time." What is the nurse's priority response?

"Saving antibiotics for another time and trying to diagnose your own health problems can lead to resistant organisms that no longer respond to drugs."

A critically ill patient has developed a fever of 38.9°C, and blood cultures have been drawn and sent to the laboratory for culture and sensitivity testing. Determination of the culture will tell the care team A) whether the infection is antibiotic resistant. B) the exact identity of the infectious microorganism. C) the most likely location of the infection. D) the most likely origin of the infection.

Ans: B Feedback: Culture identifies the causative microorganism. It does not necessarily indicate the presence of antibiotic resistance. The origin or location of the infection may often been indirectly determined by the culture, but this is not always the case.

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) a higher dose. B) the same dose. C)a lower dose. D) the same dose but less frequent.

C)a lower dose.

The nurse understands that an infection caused by a secondary pathogen, which can occur during prolonged antibiotic therapy, is known as which of the following? Primary infection Cross-sensitivity Superinfection Acquired resistance

Superinfection

The client has been taking her antibiotic for five days. She tells the nurse that she is now experiencing vaginal itching and discharge. The nurse suspects what has occurred? The client is not taking her medications. The client has developed sepsis. The client is experiencing an adverse reaction. The client has developed a superinfection.

The client has developed a superinfection.

Which client is most at risk for an opportunistic infection? A 45-year-old client with contact dermatitis A 14-year-old client with HIV infection A 33-year-old client with hepatitis A A 25-year-old client with asthma

A 14-year-old client with HIV infection Explanation: The client most at risk for an opportunistic infection is the one with the HIV infection because the immune system is compromised with this disease.

Which scenario depicts someone using antibacterial medications appropriately?

A client refuses to share her medication with her husband, who believes that he has the same illness.

An elderly man who is a resident of a skilled nursing facility develops methicillin-resistant Staphylococcus aureus. What type of infection has this man developed? A) Community acquired B) Postoperative C) Sustained infection D) Nosocomial infection

Ans: D Feedback: Nosocomial infections are infections acquired from microorganisms in hospitals and other health care facilities. The patient's infection is not community acquired, postoperative, or sustained.

Which cells participate in this effort to control tissue injury associated with the second stage of the inflammation process? A) B cells B)neutrophils C)monocytes D) natural killer cells

B)neutrophils

A client is diagnosed with strep throat. Which of the factors has contributed to the development of the illness? Hypertension Leukopenia Hypokalemia Anxiety

Leukopenia

A client has been receiving an antibiotic for the past 36 hours for treatment of a bacterial infection, and the infection has shown no signs of improving. What does the nurse suspect is the most likely reason for a lack of improvement? The client's infection is resistant to the medication The client has a viral infection, not bacterial The client is allergic to this medication The client isn't taking the medication

The client's infection is resistant to the medication

The nurse administers a drug to treat Chlamydia trachomatis. The nurse is aware that this drug has no effect on any other bacteria. How should the nurse describe this characteristic of the drug? The drug is bacteriostatic The drug has a narrow spectrum The drug has prophylactic qualities The drugs is bactericidal

The drug has a narrow spectrum Explanation: Without knowing the name of the antibiotic and how it works to treat N. gonorrhoeae, the only thing that can be said is that it is a narrow-spectrum anti-infective because it only treats one specific organism. Broad-spectrum anti-infectives treat multiple organisms. The name of the drug and how it works would need to be known to determine whether it is bacteriocidal or bacteriostatic.

When describing an anti-infective agent with a narrow spectrum of activity, what would the nurse include? 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 effective in interfering with the cell's reproduction.

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.

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? Constipation Pain Toxic effects on the kidney Skin rash

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.

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: need to provide a follow-up sputum culture before medications can be prescribed. receive supportive care until an antibiotic can be prescribed in 48 hours. be immediately prescribed a broad-spectrum antibiotic. be treated with antiviral medication on a short-term basis.

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.

Administration of what type of antibiotic by the nurse would be most likely to cause a superinfection? bactericidal narrow spectrum broad spectrum bacteriostatic

broad spectrum Explanation: One offshoot of the use of anti-infectives, especially broad-spectrum anti-infectives, is destruction of the normal flora, allowing opportunistic pathogens to invade tissue and cause a superinfection. Narrow-spectrum anti-infectives are less likely to kill normal flora, although it is not impossible. A drug may be bactericidal, meaning it kills the pathogen; or bacteriostatic, meaning it prevents reproduction of the pathogen, but this is not related to superinfections.

A female client comes to the clinic reporting vaginal discharge with itching. When obtaining the client's medication history, what would the nurse consider as significant?

broad spectrum anti-infective for recent infection

A client is receiving an aminoglycoside antibiotic for an infection. The nurse would monitor the client closely for: visual changes. hallucinations. lethargy. hearing loss.

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.

What occurs when the normal flora is destroyed by the use of anti-infectives?

superinfection

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: clindamycin. an antistaphylococcic penicillin. vancomycin. ciprofloxacin.

vancomycin. Explanation: Vancomycin is the drug of choice to manage infections caused by MRSA. MRSA is resistant to all of the antistaphylococcic penicillins, as well as to ciprofloxacin and clindamycin.

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." "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."

"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 provider 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." "I appreciate your concern but you can certainly rest assured that the health care provider ordered the right medication for your needs." "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."

"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 diverse group of clients and is reviewing each client's medication regimen. Which client is most likely to benefit from combination therapy?

A client being treated for acquired immunodeficiency syndrome (AIDS)

For what client would a broad-spectrum antibiotic be most appropriate? A client who has symptoms of infection but whose culture and sensitivity results are not yet available A client with a respiratory infection who is 84 years old A client whose urinary tract infection has been attributed to Escherichia coli A client who has an oral temperature of 100.2° F (37.9° C) but no other signs or symptoms of infection

A client who has symptoms of infection but whose culture and sensitivity results are not yet available Explanation: Broad-spectrum antibiotics are often used to treat infections while awaiting the results of culture and sensitivity testing. The presence of a fever with no other signs of infection would not be an indication for the use of broad-spectrum antibiotics. Narrow-spectrum antibiotics are generally preferred when the causative microorganism of an infection is known. Advanced age is not an indication for broad-spectrum antibiotic use.

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 with colorectal cancer who is pre-operative for a bowel resection

The nurse in the emergency department is obtaining the health history of a new client. When asked about allergies, the client states, "I'm allergic to aspirin." What is the nurse's best response? A) "What happened the last time you took aspirin?" B) "Is your care provider aware of this?" C) "When was the last time you took aspirin?" D) "Are you able to take drugs like Tylenol and Advil?"

A) "What happened the last time you took aspirin?"

The nurse has educated a client about the risk for kidney damage that accompanies the client's anti-infective regimen. What should the nurse recommend to the client in order to reduce the risk of renal damage? A) Increase intake of fluids. B) Temporarily adopt a low-residue diet. C) Take the medication with water. D) Avoid taking the medication right before bedtime.

A) Increase intake of fluids.

When reviewing the medication orders, a nurse notes that combination therapy with two anti-infective agents has been ordered. What is the nurse's best interpretation of this order? A) The client has an infection that may be caused by more than one organism. B) The client has an infection that is a result of antibiotic resistance. C) The risk of anaphylaxis precludes the use of one antibiotic in higher doses. D) Treatment with a single antibiotic has proven unsuccessful.

A) The client has an infection that may be caused by more than one organism.

Which of the following is the most important nursing action to help prevent antimicrobial resistance in health care settings? A. Good hand-washing between each patient contact B. Reporting culture and sensitivity results in a timely manner C. Using aseptic technique for all nursing procedures D. Documenting improvement or worsening of symptoms of infection

A. 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.

The nurse is preparing to administer a drug that is bactericidal. The nurse should explain what characteristic of this drug? A. It will directly cause the death of pathogenic cells. B. It is effective against many different organisms. C. It is effective in interfering with cell reproduction. D. It is selective in its action on organisms.

A. It will directly cause the death of pathogenic cells. Explanation: Bactericidal refers to a highly aggressive drug that causes cell death. An anti-infective with a narrow spectrum of activity is selective in its action so that it is effective against only a few microorganisms with a very specific metabolic pathway or enzyme. Bacteriostatic refers to a drug's effectiveness in interfering with a cell's ability to reproduce or divide. Broad-spectrum activity refers to effectiveness against a wide variety of pathogens.

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: A. the microorganism causing the infection is likely known. B. the care team wished to reduce the client's risk of adverse effects. C. the client likely has compromised immune function. D. broad spectrum antibiotics were likely administered without success.

A. 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.

Which nursing interventions should be included in the plan of care for a client receiving antimicrobial medications? Select all that apply. Assess and document vital signs. Assist with instruction on pulmonary hygiene. Review laboratory values, including white blood cell counts. Maintain adequate fluid intake.

ALL Assess and document vital signs. Assist with instruction on pulmonary hygiene. Review laboratory values, including white blood cell counts. Maintain adequate fluid intake.

You are working as a nurse educator in the hospital setting. Part of your responsibility includes developing a plan to prevent antibiotic resistance. What is the most important part of your plan? Surveillance of staff performing invasive procedures Providing a flyer to all staff members about the importance of preventing antibiotic resistance An education campaign that focuses on handwashing between patients Conducting a poster presentation in the cafeteria of the types of isolation used at your facility

An education campaign that focuses on handwashing between patients Explanation: Handwashing is one of the most effective ways to prevent antibiotic resistance, by preventing diseases from being spread from one person to another.

The family members of a geriatric patient are angered that she has been colonized with methicillin-resistant Staphylococcus aureus during her stay in the hospital. The nurse should explain what characteristic of colonization to the members of the family? A) The bacteria are present but are not causing infection. B) The bacteria are causing an infection, but the infection is not spreading. C) The bacteria are causing tissue injury at the site of colonization. D) The bacteria are spreading within a clearly defined body region.

Ans: A Feedback: Colonization is the presence and growth of microorganisms. The microorganisms do not necessarily cause tissue injury or elicit an immune response in the human body.

When participating in the care of a patient who is being treated with antimicrobials, the nurse can promote the appropriate use of these medications in which of the following ways? A) Encouraging the use of narrow-spectrum, rather than broad-spectrum, antibiotics B) Promoting the use of prophylactic antibiotics for patients possessing risk factors for infection C) Initiating empiric therapy for all older adult patients admitted to a health care facility D) Promoting the use of herbal treatment for infection rather than antimicrobial drugs

Ans: A Feedback: Guidelines to promote more appropriate use of antimicrobial drugs include using a narrow-spectrum antibacterial drug instead of a broad-spectrum drug, whenever possible, in order to decrease the risk of a superinfection. Herbal alternatives are frequently not available. Antibiotics should not normally be administered in the absence of a diagnosed infection.

An elderly patient is treated for pneumonia with clindamycin (Cleocin). One week after the completion of the medication, she develops diarrhea. What is the most probable cause of the diarrhea? A) Change in normal flora B) Food-borne illness C) Crohn's disease D) Incontinence

Ans: A Feedback: Much of the normal flora can cause disease under certain conditions, especially in the elderly, debilitated, or immunosuppressed people. The development of infectious diarrhea is related to the change in the normal flora of the bowel. Food-borne illness, Crohn's disease, and incontinence do not contribute to this particular development of diarrhea.

Mr. Garcia has been taking antibiotics at home for the treatment of a respiratory infection for the past 6 days, and there is no evident improvement in his infection. Which of the following nursing assessments is most appropriate? A) Assess Mr. Garcia's adherence to his medication regimen. B) Assess Mr. Garcia's home hygiene. C) Assess Mr. Garcia's understanding of his illness. D) Assess Mr. Garcia's use of herbal or alternative remedies.

Ans: A Feedback: Nonadherence to antibiotic therapy can result in a continuation or exacerbation of the infection. Poor hygiene is a risk factor for the development of infection but is less likely to perpetuate an existing infection that is being treated appropriately with antibiotics. Herbs may be contraindicated but are unlikely to negate the therapeutic effects of an antibiotic. The nurse should gauge the patient's understanding of his illness, but this does not have a bearing on his lack of improvement.

A patient has presented to the emergency department after suffering a severe laceration to his hand in a workplace accident. During the acute inflammation process, which physiological event takes place first? A) The patient's B cells produced antibodies. B) The patient's blood vessels constrict. C) Neutrophils migrated to the injury site. D) Opsonization occurred.

Ans: B Feedback: Three stages of acute inflammation 1. Vascular stage - vasoconstriction, then vasodilation of capillaries and venules. Increasing temperature and redness. Goal is to increase blood supply. 2. Cellular stage. Opsonization, neutrophil migration, and antibody production. 3. Tissue remodeling phase.

A patient is to be started on an antibiotic. Which of the following is most important to take into consideration before beginning the antibiotic regimen? A) Duration of symptoms B) Culture and sensitivity C) The patient's hydration status D) The patient's age and weight

Ans: B Feedback: Culture identifies the causative organism, and susceptibility tests determine which drugs are likely to be effective against the organism. The duration of symptoms and the patient's hydration status, age, and weight are important, but not imperative, in determining the antibiotic of choice.

An adult female patient has been living with human immunodeficiency virus (HIV) for several years but has recently been admitted to the hospital after being diagnosed with herpes simplex. How would this patient's herpes infection most likely be characterized? A) Community-acquired infection B) Opportunistic infection C) Secondary infection D) Nosocomial infection

Ans: B Feedback: Microorganisms may become pathogens in hosts whose defense mechanisms are impaired. Opportunistic infections are likely to occur in people whose defenses are compromised due to human immunodeficiency virus (HIV) infection. This is not characterized as a nosocomial infection (hospital-acquired infection) or a secondary infection. The infection was likely to have been acquired in the community, but the patient's HIV diagnosis means that it would be considered to be an opportunistic infection.

A patient with burns has developed a wound infection. This patient is experiencing what type of wound infection? A) Fungal infection B) Opportunistic infection C) Nosocomial infection D) Food-borne infection

Ans: B Feedback: Opportunistic infections are likely to occur in people with severe burns, cancer, human immunodeficiency virus, and indwelling catheters and are often caused by drug-resistant microorganisms, are usually serious, and may be life threatening. The patient may be at risk for a fungal, nosocomial, or food-borne infection, but the risk for all infections is high due to the patient's opportunistic nature of the burn.

An 81-year-old female patient has been admitted to the hospital after a urinary tract infection developed into urosepsis. What assessments should the nurse prioritize when monitoring the course of this patient's infection? Select all that apply. A) Blood urea nitrogen and creatinine B) White blood cell count C) Heart rhythm D) Temperature E) Liver panel

Ans: B, D Feedback: For patients with an infection, the nurse should prioritize assessment of WBCs and temperature. Cardiac, renal, and liver function are important measures of health, but these are less directly affected by the presence of infection.

An adult patient with an autoimmune disorder regularly takes oral corticosteroids. The nurse knows that corticosteroids can be used in the successful treatment of inflammation but that they also create a risk for A) bleeding. B) leukocytosis. C) infection. D) electrolyte imbalances.

Ans: C Feedback: Corticosteroids impair phagocytosis by preventing phagocytic cells from leaving the bloodstream. They decrease the amount of lymphocytes, fibroblasts, and collagen needed for tissue repair. This causes a reduction in inflammation but a commensurate increase in the patient's risk for infection.

A 4-month-old baby has been brought to the emergency department by her parents, and initial assessment is highly suggestive of bacterial meningitis. Consequently, the baby has been admitted, and empiric antibiotic therapy has been ordered. The nurse should understand what characteristic of this infant's current treatment plan? A) Success or failure of treatment will not be apparent for several weeks. B) The infant will receive aggressive treatment with a narrow-spectrum antibiotic. C) Culture and sensitivity results of the infant's cerebrospinal fluid are still pending. D) The infant is suspected of having an antibiotic-resistant infection.

Ans: C Feedback: Empiric therapy is based on an informed estimate of the most likely pathogen(s) given the patient's signs and symptoms and the site of infection, as well as knowledge of communicable diseases currently infecting other people in the community. Because laboratory tests used to definitively identify causative organisms and to determine susceptibility to antibiotics usually require 48 to 72 hours, the prescriber usually initiates treatment with an antimicrobial drug that is likely to be effective. The other listed statements are not true of empiric therapy.

A hospital nurse is aware that nosocomial infections pose a significant threat to many patients' health status. In order to reduce the spread of nosocomial infections, the nurse should prioritize which of the following actions? A) Increased use of empiric antibiotic therapy B) Use of disinfectants when providing patient hygiene C) Vigilant and thorough hand hygiene D) Patient education on the causes of infection

Ans: C Feedback: Good hand hygiene is probably the most effective method of preventing infections. This supersedes the importance of education regarding the causes of infection or the use of disinfectants. Antibiotic therapy should only be used on patients who clearly need this treatment.

A nurse is instructing a patient on the antibiotic regimen for the treatment of pneumonia. Which of the following is most important to teach the patient? A) Take the medication with orange juice. B) Supplement the medication with multivitamins. C) Complete the entire prescription of medication. D) Administer the medication with dairy products.

Ans: C Feedback: Interruption or inadequate antimicrobial treatment of infections may also contribute to the emergences of antibiotic-resistant organisms. The administration of an antibiotic with orange juice is not recommended in all instances. The medication does not need to be supplemented with vitamins. Antibiotics need not be administered with dairy products.

A female patient has been treated for strep throat with ampicillin by mouth. She visits the occupational health nurse and states she has vaginal itching. What organism is the cause of the vaginal itching? A) Klebsiella B) Enterobacter C) Candida albicans D) Proteus

Ans: C Feedback: The yeast Candida albicans is a normal resident of the vagina and the intestinal tract. An antibacterial drug may destroy the normal bacterial flora without affecting the fungal organism. Klebsiella, Enterobacter, and Proteus will not contribute to the development of a yeast infection.

A group of nursing students are learning about the factors that underlie recent increases in the incidence and prevalence of antibiotic-resistant microorganisms. What factor is known to contribute to antibiotic resistance? A) Increased survival rates from acute infections B) Increased population density C) Use of antibiotics that are ineffective against the infectious microorganism D) Overuse of antibiotics

Ans: D Feedback: Antibiotic overuse can contribute to antibiotic resistance. Resistance is not typically attributable to increased age of patients, increased population density, or the use of ineffective antibiotics.

A medical nurse on a night shift is reviewing a patient's medication administration record for the following day. The nurse notes that a combination antimicrobial drug is ordered. What is implied by the fact that the patient has been ordered a combination drug? A) The patient's infection likely has a fungal or protozoal etiology. B) The patient likely has a history of recurrent, multisystemic infections. C) The patient may be unable to tolerate treatment with a single antimicrobial. D) The patient may have an infection caused by multiple microorganisms.

Ans: D Feedback: Indications for combination therapy may include infections caused by multiple microorganisms. A fungal or protozoal infection is not implied, and the patient may or may not have a history of recurrent infections. Intolerance of single antibiotics is not normally an indication for combination therapy.

A patient with an infection has not responded appreciably to antibiotic therapy, and the nurse suspects antibiotic resistance. What phenomenon is known to contribute to acquired antibiotic resistance? A) Bacteria take on genetic material from healthy body cells, reducing antigen recognition. B) Microorganisms remain in resting (G0) phase during antibiotic treatment. C) Distribution of an antibiotic is insufficient to cause resolution of the infection. D) The strongest microorganisms survive antibiotic treatment while the weakest are eradicated.

Ans: D Feedback: Selective pressure, or natural selection, refers to the survival of the fittest bacteria. When antibiotic therapy is initially begun, the weakest bacteria are killed first while the strongest bacteria, which are best able to withstand the effects of antibiotic therapy, remain. This contributes to antibiotic resistance. Resistance is not the result of an extended G0 phase, impaired distribution, or bacterial appropriation of human genetic material.

What would contribute to drug resistance? High dosage to eradicate the organism Around-the-clock scheduling Prescribed duration of therapy Antibiotic prescription for viral illness

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.

What information about antibiotic therapy should the nurse should include in a client's medication education? A) Bacteria can remain in the body for up to 48 to 72 hours after the completion of antibiotic therapy. B) Maintenance of normal bacterial flora is essential to health during the therapy. C) The healthy human body hosts dozens of minor infections at any given time. D) An aseptic internal environment only exists in young adults.

B) Maintenance of normal bacterial flora is essential to health during the therapy.

When a patient fails to respond to an antibiotic, the nurse suspects antibiotic resistance. Which mechanism of resistance does the nurse recognize as an example of acquired antibiotic resistance? A. Alterations are made in the bacterial cell wall structure to make it less permeable. B. Bacteria exchange genetic content that transfers resistance from one bacterial strain to another. C. Efflux is used to extrude bacteria from within the bacterial cell. D. Metabolic pathways are altered so bacteria targeting a specific enzyme of the metabolic pathway are ineffective.

B. Bacteria exchange genetic content that transfers resistance from one bacterial strain to another. All mechanisms of resistance are intrinsic, with the exception of genetic transfer of material that confers drug resistance.

A nurse is caring for a child weighing 30 kg. The health care provider orders gentamicin (Garamycin) tid for the client. The recommended dosage range is 6 to 7.5 mg/kg/day. Why is it important to give a dosage within this recommended range? (Select all that apply.) A. So the child gets too much medication B. Give a safe dose for this size child. C. To eradicate the bacteria D. Because this microorganism only affects this size child E. Prevent overdose in the child.

B. Give a safe dose for this size child. C. To eradicate the bacteria E. Prevent overdose in the child. Explanation: Drug dosage is important in preventing the development of resistance. Doses should be high enough and the duration of drug therapy should be long enough to eradicate even slightly resistant microorganisms. The recommended dosage for a specific anti-infective agent takes this issue into account. The recommended dose is not set because a microorganism only affects a certain size child or to make sure the child gets too much medication.

A patient who is taking an antibiotic for an infection shows no signs of improvement. When a laboratory report indicates that the causative organism is not susceptible to the prescribed antibiotic, what is the priority nursing intervention? (select all that apply) A. Notify the pharmacist to provide a different antibiotic B. Notify the prescriber of the culture report C. Stop the current antibiotic and use the susceptible antibiotic D. Inform the patient that the antibiotic is ineffective E. Notify the prescriber of the sensitivity report

B. Notify the prescriber of the culture report E. Notify the prescriber of the sensitivity report Once the susceptibility report is available, it is essential to let the prescriber know so that an appropriate antibiotic can be ordered. Te nurse would not stop the current drug or ask the pharmacist for a diferent drug without an order. Te nurse would not tell the client that the prescriber ordered the wrong antibiotic because the prescriber did not make an error; rather, the prescriber provided empiric therapy based on the most likely cause of infection until information regarding susceptibility was known.

The nurse is administering an anti-infective medication that is known to lack total selective toxicity. What consequence should the nurse anticipate? A. The microbe's enzyme production will be slowed B. Some healthy cells will be damaged. C. All pathogens in the body will be destroyed. D. Bacterial DNA will mutate

B. Some healthy cells will be damaged. Explanation: When a drug does not display selective toxicity, healthy cells are damaged because the drug does not specifically target only the pathogen. Anti-infectives work by a variety of different means so one drug is not likely to kill every type of pathogen in the body. Selective toxicity does not impact enzyme production or cause mutation.

When a woman who is taking an antibiotic develops a thick, white, curdlike vaginal discharge with pruritus, the nurse suspects that the patient has a vaginal yeast infection. What would explain this development? A. A drug for a fungal infection should have been prescribed instead of a drug for bacterial infection. B. The antibiotic has altered the normal vaginal environment. C. The antibiotic that was prescribed was not effective. D. Yeast infections are side effects of antibiotics.

B. The antibiotic has altered the normal vaginal environment. Antibiotics can affect beneficial bacteria as well as harmful bacteria. When some of the normal flora in the vagina are killed, this can alter the vaginal environment by ridding the vagina of bacteria that normally keeps the yeast-like fungus from proliferating. As a result, an overgrowth of fungi can occur.

A health care worker has nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA). Which interpretation of this finding by the nurse is correct? A. The health care worker has a nasal infection caused by MRSA B. The health care worker poses a danger to patients C. The health care worker is immune to MRSA D. The healthcare worker produces beta-lactamase

B. The health care worker poses a danger to patients Colonization indicates growth without infection. In other words, bacteria are growing and reproducing but do not cause tissue injury, probably because intact skin and mucous membranes form a barrier against invasion. Even though the health care worker does not have an infection, the worker still poses a danger to clients because methicillin-resistant Staphylococcus aureus can spread to clients, so the health care worker can act as a carrier.

You are speaking to a group of clients in a public meeting. They ask you to explain the difference between community-acquired infections and nosocomial infections. Your best response is: A. Only drug-resistant strains of staphylococci, Pseudomonas, and Proteus are categorized as nosocomial infections. B. Usually, community-acquired infections are less severe and easier to treat. Nosocomial infections may be more severe and difficult to manage because they often result from drug-resistant microorganisms and occur in people whose immunity is impaired. C. There is no difference between the infection types, they are simply categorized as community-acquired or nosocomial. Usually, nosocomial infections are less severe and easier to treat.

B. Usually, community-acquired infections are less severe and easier to treat. Nosocomial infections may be more severe and difficult to manage because they often result from drug-resistant microorganisms and occur in people whose immunity is impaired. Explanation:Infections are often categorized as community-acquired or nosocomial. Because the microbial environments differ, the two types of infections often have different causes and require different antimicrobial treatment. As a general rule, community-acquired infections are less severe and easier to treat, although antibiotic-resistant strains are increasing (eg, methicillin-resistant Staphylococcus aureus [MRSA]). Nosocomial infections may be more severe and difficult to manage because they often result from drug-resistant microorganisms and occur in people whose immunity is impaired. Drug-resistant strains of staphylococci, Pseudomonas, and Proteus are common causes of nosocomial infections.

Successful treatment with bacteriostatic antibiotics depends upon: A. using broad-spectrum antibacterial drugs to treat viral infections. B. the ability of the host's immune system to eliminate the inhibited bacteria and an adequate duration of drug therapy. C. stopping drug therapy when symptoms have subsided. D. the type of drug-resistant bacterial strains that can reproduce in the presence of antimicrobial drugs.

B. the ability of the host's immune system to eliminate the inhibited bacteria and an adequate duration of drug therapy.

What intervention is necessary for the nurse to perform prior to initiating prescribed antibiotic therapy? A. Increase fluid intake. B. Monitor for adverse effects. C. Obtain a specimen for culture and sensitivity. D. Administer an antidiarrheal to prevent GI upset.

C. Obtain a specimen for culture and sensitivity. Explanation: Collect specimens (e.g., sputum, urine) for culture and Gram stain before giving the first dose of an antibiotic. For best results, specimens must be collected accurately and taken directly to the laboratory. It is good practice to collect specimens (e.g., sputum, urine) for culture and Gram's stain before giving the first dose 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.

Although the numbers and virulence of microorganisms help determine whether a person acquires an infection, another major factor is: A. infections that tend to recur and involve simple organisms. B. the host's ability to defend itself against the would-be invaders. C. continuous antimicrobial treatment of infections. D. the number of effective drugs available for serious or antibiotic-resistant infections.

B. the host's ability to defend itself against the would-be invaders. 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.

Inappropriate use of antibiotics does all of the following except increase: A. infections with drug-resistant microorganisms. B. the number of available effective drugs for serious or antibiotic-resistant infections. C. health care costs. D. adverse drug effects.

B. the number of available effective drugs for serious or antibiotic-resistant infections.

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?

Broad-spectrum antibiotics can cause antibiotic resistance.

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? A. The client recently had an episode of diarrhea. B. The client is experiencing vertigo. C. The client has a facial and trunk rash. D. The client's blood pressure is 141/88 mm Hg. Alternative: A. Cranial nerve function B. Assessment for toxic epidermal necrolysis (TEN) C. Bowel pattern D. Assessment for allergic reaction

C. The client has a facial and trunk rash. Explanation: 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. Alternative: D. Assessment for allergic reaction Explanation: Anaphylaxis is an acute, systemic allergic response to a substance that can be fatal if medical intervention does not occur almost immediately because the airway closes due to tissue edema making it impossible to breathe. TEN is a serious, but rare, drug reaction. The potential seriousness of anaphylaxis means that it should be prioritized over bowel function and cranial nerve assessment.

A college student is seen in the campus health center with a sore throat. Examination of the throat reveals redness and swelling but no sign of infection. Which of the following is an accurate description of the inflammatory process? A. A granuloma will develop if the inflammation is unresolved B. The student is not at risk for the development of an infection C. There is an influx of leukocytes to the throat D. Scarring will result from phagocytic action

C. There is an influx of leukocytes to the throat

After teaching a group of students about adverse reactions to anti-infective agents, the instructor determines that the students need additional teaching when they identify what as a common adverse effect? Hypersensitivity Neurotoxicity Kidney damage Cardiac toxicity

Cardiac toxicity Explanation: Cardiac toxicity is not typically associated with anti-infective therapy. Adverse effects commonly associated with anti-infective therapy are direct toxic effects on the kidney, gastrointestinal tract, and nervous system along with hypersensitivity and superinfections.

The nurse is caring for a client who is immunocompromised following a kidney transplant and who has developed an infection. When planning this client's care, the nurse should prioritize what action?

Carefully maintaining the client's isolation precautions

A female client is treated with antibiotics for bacterial pneumonia. When obtaining a drug history, the nurse finds that the client ceased her medication regimen when she no longer experienced symptoms during the first round of antibiotics. The nurse is responsible for the client's education plan. In order to effectively treat the pneumonia, what must the client do? Continue the antibiotics for 1 week after cessation of symptoms. Complete a full course of antibiotics as prescribed. Take the antibiotics at breakfast, lunch, and supper. Take the antibiotics every 3 hours during the day.

Complete a full course of antibiotics as prescribed. Explanation: Client education related to antibiotic therapy should stress the importance of completing a full course of antibiotics as prescribed.

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? A. Maintaining reverse isolation protocols B. Maintaining access to an infectious disease specialist C. Giving antimicrobials as prescribed D. Rigorously and consistently applying recommended precautions

D. 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.

What is the best action a nurse can take to prevent infection? A. Instruct patients with respiratory illnesses on proper pulmonary hygiene B. Recommend influenza and pneumococcal vaccines to pattens older than 65 years of age C. Teach a patient the importance of adequate nutrition and rest D. Wash hands before and after each patient contact

D. Wash hands before and after each patient contact. The most important action a nurse can take to prevent the spread of infection is good hand hygiene. The nurse and all health care providers should wash their hands before and after client contact.

A client with an upper respiratory tract infection was prescribed roxithromycin, an antibiotic. To what should the nurse tell the client that irregular administration of this medication could lead? Increased rate of elimination of the drug Development of drug resistance Increased chances of serious adverse events Decreased absorption of the drug

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? Educating the client about sodium limitation Monitoring closely for hematuria Encouraging the client to increase fluid intake Administering the medication with meals whenever possible

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

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? Proactively addressing the possibility of adverse effects Ensuring that the duration of drug use is appropriate 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.

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?

Keep clients well hydrated.

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

Liver and kidney function may be reduced, requiring cautious use.

You are a critical care nurse caring for a 66-year-old male patient who requires mechanical ventilation. What type of infection is this patient particularly susceptible to acquiring?

Nosocomial pneumonia

The female client has been taking a fluoroquinolone and calls the health care provider's office to report that she is experiencing redness and is excoriated in her groin area. What is the nurse's best response?

Notify the health care provider.

To ensure that the most appropriate drug is being used to treat a pathogen, which would need to be done first? Evaluating the bactericidal effects Obtaining sensitivity testing Using combination therapy Checking client allergies

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.

An older adult client has been brought to the emergency department by her daughter, who states that the client may have a urinary tract infection. What principle should guide the care team's plan of treatment?

Older adults' signs and symptoms of infection may differ from those of younger people

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?

Penicillin

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 best action? Assess the client for a new onset of drug hypersensitivity. Refer the client to the health care provider because the client may be experiencing resistance. Assess the client for additional signs of superinfection. Educate the client about the phenomenon of drug tolerance.

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 nurse is caring for an older adult client who is being treated for community-acquired pneumonia. Over the past 12 hours, the client has had three episodes of diarrhea despite having no known history of gastrointestinal disease. What is the nurse's best action? Obtain a stool sample for ova and parasite testing. Advocate for a change in the client's medication regimen. Report this sign of a possible superinfection to the provider. Obtain a stool sample for culture and sensitivity testing.

Report this sign of a possible superinfection to the provider. Explanation: This client has most likely been receiving antibiotics and the rapid onset of diarrhea is suggestive of a superinfection. The care provider should be informed and then any necessary laboratory testing will be ordered. Interventions will likely be necessary but this may or may not include a change in the client's medication regimen.

A female client calls the pediatrician's office because her child reports a sore throat. The nurse anticipates the pediatrician will take what action? Order an antibiotic. Request a throat culture. Request a list of drug allergies. Order an antitussive.

Request a throat culture. Explanation: For sore throat, a throat culture for streptococcal organisms should be performed and the results obtained before an antibiotic is prescribed.

Bacitracin (Baciguent) interferes with the cell wall synthesis of which type of bacteria? Streptococcal Pseudomonas Staphylococcal Proteus

Staphylococcal

Which would be tested to determine parasitic sources of infection? Sweat Sputum Stool Blood

Stool

The nurse is providing care for an older adult who has a urinary tract infection. What aspect of this client's current health status should the nurse focus on when ensuring safe and effective antibiotic therapy?

The client has a history of cirrhosis.

A nurse has questioned why a client's physician 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? Broad-spectrum antibiotics confound the results of subsequent culture and sensitivity testing. The use of broad-spectrum antibiotics can create a risk for a superinfection. Narrow-spectrum antibiotics normally require a shorter duration of treatment. The efficacy of most narrow-spectrum antibiotics has not been proven.

The use of broad-spectrum antibiotics can create a risk for a superinfection.

A male client is diagnosed with a drug-resistant infection in his wound. What should the home care nurse teach the client and his family? To use gloves when handling drainage from the wound To avoid social contact while the infection is treated To use bleach when washing all laundry To avoid using the same bathroom until the infection abates

To use gloves when handling drainage from the wound Explanation: General infection-control practices include frequent and thorough hand hygiene, use of gloves when indicated, and appropriate handling and disposal of body substances (e.g., blood, urine, feces, sputum, vomitus, wound drainage).

Which are examples of bactericidal control used in the health care environment? Select all that apply.

Use of cleaning agents by the nurse or other care providers Maintaining a sterile environment when inserting a urinary catheter

Aminogylcoside antibiotics tend to collect in the eighth cranial nerve. The nurse would anticipate that which clinical manifestation may occur from the cranial nerve involvement? Slurred speech Inability to swallow Blindness Vertigo

Vertigo