Ch 46 Quiz
A client is admitted to the emergency department with symptoms of meningitis. Reviewing the client's culture and sensitivity (C&S) report, the nurse would expect evidence of which organisms to confirm this diagnosis? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Streptococci 2. Escherichia coli 3. Haemophilus influenzae 4. Rickettsia rickettsii 5. Shigella
Correct Answer: 1,2,3 Rationale 1: Streptococci can cause meningitis in children. Rationale 2: Escherichia coli can cause meningitis in children. Rationale 3: Haemophilus influenzae can cause meningitis in children. Rationale 4: Rickettsia rickettsii is the organism responsible for Rocky Mountain spotted fever. Rationale 5: Shigella is an organism responsible for dysentery. Global Rationale: Streptococci, Escherichia coli, and Haemophilus influenzae can cause meningitis in children.
Invasiveness refers to a pathogen's ability to: 1. produce endotoxins in greater abundance. 2. multiply more rapidly. 3. increase its virulence. 4. penetrate anatomic barriers more easily.
Correct Answer: 2 Rationale 1: Invasiveness is not related to the production of endotoxins. Rationale 2: Invasiveness is the term for the ability of a pathogen to grow rapidly. Rationale 3: Virulence is the measure of an organism's pathogenicity. Rationale 4: Invasiveness is not related to the ability of certain pathogens to penetrate anatomic barriers. Global Rationale: Invasiveness is the ability of a pathogen to grow extremely rapidly and cause direct damage to surrounding tissues by their sheer numbers. Because a week or more may be needed to mount an immune response against the organism, this exponential growth can rapidly overwhelm body defenses and disrupt normal cellular function.
A pregnant client is seen in the emergency department for an infection. The nurse anticipates that antibiotics prescribed for this client would not include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. ampicillin. 2. minocycline. 3. neomycin. 4. streptomycin. 5. doxycycline.
Correct Answer: 2,3,4,5 Rationale 1: Ampicillin is not a pregnancy category D drug. Rationale 2: Minocycline is a pregnancy category D drug. Rationale 3: Neomycin is a pregnancy category D drug. Rationale 4: Streptomycin is a pregnancy category D drug. Rationale 5: Doxycycline is a pregnancy category D drug. Global Rationale: Some anti-infectives are pregnancy category D, such as minocycline, doxycycline, neomycin, and streptomycin.
The nurse sending a wound culture to the laboratory knows that the purpose of culture and sensitivity testing is to: 1. prevent an infection, a practice called chemoprophylaxis. 2. identify bacteria that have acquired resistance. 3. promote the development of drug-resistant bacterial strains by killing the bacteria sensitive to a drug. 4. determine which antibiotic is most effective against the infecting microorganism.
Correct Answer: 4 Rationale 1: Culture and sensitivity testing does not prevent infections. Rationale 2: Culture and sensitivity testing indicates resistance but not acquired resistance. Rationale 3: Culture and sensitivity testing does not assist in the killing of bacteria. Rationale 4: Culture and sensitivity testing isolates the infectious organism and determines which antibiotic would be most effective against it. Global Rationale: Specimens such as urine, sputum, blood, or pus are examined in the laboratory for the purpose of isolating and identifying specific pathogens. After isolation, the microbe is exposed in the laboratory to different antibiotics to determine the most effective ones. This process of isolating the infectious organism and identifying the most effective antibiotic is called culture and sensitivity (C&S) testing.
An advantage of using a broad-spectrum antibiotic is that: 1. it is effective against a large number of organisms. 2. it is effective against a small number of organisms. 3. it has a high potency. 4. it produces a large number of side effects.
Correct Answer: 1 Rationale 1: A broad-spectrum antibiotic is effective against a large number of organisms. Rationale 2: Narrow-spectrum antibiotics are effective against only one or a small group of organisms. Rationale 3: Potency is the strength of an antibiotic and is not related to the concept of effectiveness. Rationale 4: The presence of side effects is not related to the antibiotic spectrum. Global Rationale: Broad-spectrum antibiotics are effective against a wide variety of different microbial species. These antibiotics may be started before results of culture and sensitivity are returned, especially if the infection is severe.
The ability of an antibiotic to target pathogens without major effects on human cells is termed: 1. selective toxicity. 2. selective synthesis. 3. bacteriostatic action. 4. opportunistic action.
Correct Answer: 1 Rationale 1: Antibiotic selective toxicity allows pathogens to be killed or their growth severely hampered without major effects on human cells. Rationale 2: Selective synthesis is not an action of antibiotics. Rationale 3: Bacteriostatic action is the ability of the antibiotic to halt bacterial growth. Rationale 4: Opportunistic action is the ability of a pathogen to invade a host that is immunocompromised. Global Rationale: Antibiotics exert selective toxicity by targeting these unique differences between human and bacterial, fungal, and protozoan cells. Through this selective action, these pathogens can be killed, or their growth severely hampered, without any major effects on human cells.
The client's culture report indicates the presence of gram-negative cocci in the urine. This means that the bacteria are: 1. round with thin cell walls. 2. round with thick cell walls. 3. rod-shaped with thin cell walls. 4. spiral-shaped with thin cell walls.
Correct Answer: 1 Rationale 1: Gram-negative cocci are round with thin cell walls. Rationale 2: Gram-positive bacteria have thick walls. Rationale 3: Bacilli are rod shaped. Rationale 4: Spirilla are spiral shaped. Global Rationale: Bacteria are often described by their basic shape, which can be readily determined microscopically. Those with rod shapes are called bacilli, those that are spherical are called cocci, and those that are spiral are called spirilla. One of the simplest methods of classifying microbes is to examine them microscopically after a crystal violet Gram stain has been applied to the microbes. Bacteria that have thinner cell walls will lose the violet stain and are called gram negative.
Pathogenicity refers to an organism's ability to: 1. cause disease. 2. penetrate anatomic barriers more easily. 3. multiply more rapidly. 4. use oxygen.
Correct Answer: 1 Rationale 1: Some pathogens are extremely infectious, while others produce no symptoms at all. Pathogenicity refers to an organism's ability to cause disease. Rationale 2: Certain bacteria secrete hyaluronidase, which allows them to penetrate anatomic barriers more easily. Rationale 3: Invasiveness is the term for the ability of a pathogen to grow rapidly. Rationale 4: Pathogenicity is not related to whether bacteria are aerobic or anaerobic. Global Rationale: Some pathogens are extremely infectious and life threatening to humans, whereas others simply cause annoying symptoms or none at all. Pathogenicity, the ability of an organism to cause disease, depends on an organism's speed of reproduction and its skill in bypassing or overcoming body defenses.
The primary factor in the development of drug-resistant bacteria is the: 1. unwarranted use of antibiotics. 2. selection of the incorrect antibiotic. 3. lack of new antibiotics. 4. lack of client adherence.
Correct Answer: 1 Rationale 1: The widespread and sometimes unwarranted use of antibiotics has promoted the development of drug-resistant bacterial strains. Rationale 2: The selection of the incorrect antibiotic leads to exacerbation of an infection, not resistance. Rationale 3: New antibiotics are being released on at least an annual basis. Rationale 4: Client nonadherence can affect antibiotic effectiveness, but it is not the most important factor in the development of resistance. Global Rationale: The widespread and sometimes unwarranted use of antibiotics has promoted the development of drug-resistant bacterial strains. By killing strains of bacteria that are sensitive to the drug, the only bacteria remaining to replicate are those that acquired the mutations that made them insensitive to the effects of the antibiotic. These drug-resistant bacteria are then free to grow, unrestrained by their neighbors that are killed by the antibiotic.
A pediatric nurse is caring for a child who has an infectious organism that produces beta lactamase. The nurse knows that which drugs should not be prescribed for this infection? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Penicillins 2. Cephalosporins 3. Macrolides 4. Fluoroquinolones 5. Sulfonamides
Correct Answer: 1,2 Rationale 1: Organisms that produce beta lactamase are resistant to many of the penicillins. Rationale 2: Organisms that produce beta lactamase are resistant to many of the cephalosporins. Rationale 3: Organisms that produce beta lactamase should be susceptible to macrolides. Rationale 4: Organisms that produce beta lactamase should be susceptible to fluoroquinolones. Rationale 5: Organisms that produce beta lactamase should be susceptible to sulfonamides. Global Rationale: Organisms that produce beta lactamase are resistant to many of the penicillin and cephalosporin antibiotics.
The emergency department nurse anticipates that prophylactic antibiotics will likely be used to treat: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. a client with a suppressed immune system. 2. a client who has been bitten by a dog. 3. a client whose spouse has been diagnosed with tuberculosis (TB). 4. a client who is being treated for a venereal disease. 5. a client who has just delivered a premature baby.
Correct Answer: 1,2,3 Rationale 1: A client with a suppressed immune system would be treated with prophylactic antibiotics. Rationale 2: Deep wounds such as dog bites are treated with prophylactic antibiotics. Rationale 3: Antitubercular drugs are prescribed prophylactically for any client in close contact with a person diagnosed with TB. Rationale 4: A client who is being treated for a venereal disease would not be considered high risk and would not be treated with prophylactic antibiotics in addition to the current antibiotic regimen. Rationale 5: A client who has just delivered a premature baby would not be considered high risk and would not be treated with prophylactic antibiotics. Global Rationale: Only in rare cases are anti-infectives given prophylactically for indefinite time periods. Examples include the prevention of infections in patients with suppressed immune systems such as those with HIV infection, or those receiving immunosuppressants following an organ transplant, patients with deep puncture wounds, or close exposure to persons with active tuberculosis.
The clinic nurse is calling back clients with various symptoms. Which symptoms would suggest a superinfection? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Diarrhea 2. Painful urination 3. Abnormal vaginal discharge 4. Cough 5. Joint pain
Correct Answer: 1,2,3 Rationale 1: Antibiotics can kill normal flora in the intestinal tract, resulting in a superinfection and diarrhea. Rationale 2: Antibiotics can kill normal flora in the genitourinary tract, resulting in a superinfection and painful urination. Rationale 3: Antibiotics can kill normal flora in the vagina, resulting in a superinfection and abnormal vaginal discharge. Rationale 4: Cough is not a symptom of a superinfection. Rationale 5: Joint pain is not a symptom of a superinfection. Global Rationale: Signs and symptoms of superinfection commonly include diarrhea, bladder pain, painful urination, or abnormal vaginal discharges.
The health care provider asks the nurse to tell a client that tests confirm the client has a health care-associated infection (HAI). The nurse explains to the client that common sources of HAIs include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. the respiratory tract. 2. the urinary tract. 3. intravascular (IV) lines. 4. visitors with infectious illness. 5. drug-resistant bacteria.
Correct Answer: 1,2,3 Rationale 1: Bacteria residing in the lungs are a source of HAIs. Rationale 2: Bacteria residing in the genitourinary tract are a source of HAIs. Rationale 3: Invasive devices such as IV lines are a source of HAIs. Rationale 4: HAIs are infections that are acquired in a health care setting, not caused by visitors. Rationale 5: Drug-resistant bacteria may be the result, not the source, of HAIs. Global Rationale: HAIs are generally from one of four sources: patient flora, invasive devices, medical personnel, or the medical environment. Invasive devices are often inserted into the respiratory system and the GU system.
A client is admitted to the emergency department for an infection. The nurse recognizes that host factors that play a role in the selection of anti-infective therapy include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. status of immune system. 2. location of the infection. 3. history of allergic reactions. 4. previous infections. 5. results of culture and sensitivity (C&S).
Correct Answer: 1,2,3 Rationale 1: Clients with a weakened immune system may require more aggressive and prolonged anti-infective therapy. Rationale 2: The location of the infection must be considered in order to choose the most effective anti-infective. Rationale 3: A history of allergic reaction to an anti-infective prevents the use of that particular class. Rationale 4: Previous infections are not taken into consideration when prescribing an anti-infective for a current infection. Rationale 5: The results of the C&S are important to the selection of the anti-infective but are not a host factor. Global Rationale: Patient factors such as host defenses, local tissue conditions, history of allergic reactions, age, pregnancy status, and genetics influence the choice of anti-infective.
The nurse tells a client that the antibiotic the health care provider has prescribed is for Clostridium, the organism responsible for a number of diseases, including: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. food poisoning. 2. gas gangrene. 3. tetanus. 4. pneumonia. 5. venereal disease.
Correct Answer: 1,2,3 Rationale 1: Clostridium is an anaerobe responsible for some cases of food poisoning. Rationale 2: Clostridium is an anaerobe responsible for gas gangrene. Rationale 3: Clostridium is an anaerobe responsible for tetanus. Rationale 4: Several organisms cause pneumonia, including Staphylococcus aureus, streptococci, Haemophilus influenzae, and Klebsiella. Clostridium does not cause pneumonia. Rationale 5: Chlamydia and Neisseria are the two most common organisms that cause venereal disease. Global Rationale: Clostridium is a gram-positive anaerobic bacilli that causes food poisoning, gas gangrene, and tetanus.
The client asks the nurse why culture and sensitivity (C&S) testing has to be done prior to starting the antibiotic for a urinary tract infection (UTI). The nurse explains that several organisms can cause UTIs and a C&S is performed to identify the organism. Which organism could be isolated on this client's C&S? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Escherichia coli 2. Enterococci 3. Proteus mirabilis 4. Treponema 5. Borrelia burgdorferi
Correct Answer: 1,2,3 Rationale 1: Escherichia coli is the organism most commonly associated with UTIs. Rationale 2: Enterococci can cause UTI. Rationale 3: Proteus mirabilis can cause UTI. Rationale 4: Treponema is the organism responsible for syphilis. Rationale 5: Borrelia burgdorferi is the organism responsible for Lyme disease. Global Rationale: E. coli, P. mirabilis, and enterococci are commonly associated with UTI.
The community outreach nurse is teaching a group of older clients how bacterial organisms become resistant to antibiotics. Which statements by the clients demonstrate understanding of the instruction? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I need to get the recommended immunizations so I don't get an infection and need an antibiotic." 2. "If possible, my doctor will need to culture any infections I have to make sure I am taking the correct antibiotics." 3. "I need to take antibiotics only when my health care provider thinks I have an infection." 4. "As soon as my infection is gone, I can stop the antibiotic. This way, I'll avoid becoming resistant to the antibiotic." 5. "I should never take an antibiotic for more than 10 days. This is what causes resistance."
Correct Answer: 1,2,3 Rationale 1: It is easier to prevent an infection than it is to treat one. Rationale 2: The causative organism must be identified and the correct antibiotic prescribed. This will lower the risk of developing resistance. Rationale 3: The unwarranted use of antibiotics has promoted the development of drug-resistant bacteria. Rationale 4: Antibiotics must be taken for the entire prescribed time. This will help prevent the development of resistant bacteria. Rationale 5: Some antibiotics must be taken for longer than 10 days. It is important to take an antibiotic for the prescribed duration. Global Rationale: Methods of delaying the emergence of antibiotic resistance include preventing infections when possible, diagnosing and treating infections properly, using antimicrobials wisely, and preventing disease transmission.
The nurse is discharging a client with a prescription for penicillin. The client asks the nurse how this antibiotic works. The nurse's response is based on the knowledge that the mechanism of action of this class of anti-infectives is: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. inhibiting cell wall synthesis. 2. causing disruption of the cell wall, resulting in the cell absorbing water and lysing. 3. binding to specific proteins, resulting in the cell's inability to build a wall. 4. interfering with the transfer of ribonucleic acid (RNA). 5. changing the permeability of the cell membrane.
Correct Answer: 1,2,3 Rationale 1: Penicillin inhibits bacterial cell wall synthesis. Rationale 2: Penicillin inhibits cell wall synthesis, resulting in the cell absorbing water and lysing. Rationale 3: Binding to specific proteins disrupts the cell's ability to build a wall. Rationale 4: Interference of the transfer of RNA occurs during the inhibition of protein synthesis by the aminoglycosides, tetracyclines, macrolides, and oxazolidinones. Rationale 5: The disruption of the plasma membrane is the mechanism of action of azoles and polyenes.
A client is unable to give a urine sample for a culture and sensitivity (C&S) and asks the nurse why the health care provider does not just prescribe a "really strong" antibiotic. The nurse responds that careful selection of the correct antibiotic is important because prescribing the wrong antibiotic: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. will delay effective treatment. 2. will give the bacteria more time to grow. 3. can contribute to the development of drug-resistant bacteria. 4. could result in a lawsuit. 5. could result in an allergic response.
Correct Answer: 1,2,3 Rationale 1: Prescribing the wrong antibiotic will delay effective treatment. Rationale 2: Prescribing the wrong antibiotic will give the bacteria time to multiply. Rationale 3: Prescribing the wrong antibiotic can contribute to the development of drug-resistant strains of bacteria. Rationale 4: Prescribing the wrong antibiotic should not result in a lawsuit unless negligence is determined. Rationale 5: Prescribing the wrong antibiotic would not result in an allergic response unless the client is allergic to that particular antibiotic and this was not disclosed or known by the health care provider. Global Rationale: When the wrong antibiotic is prescribed correct treatment is delayed and bacteria have time to multiply. This action also contributes to the development of drug-resistant bacteria.
A client is admitted to the emergency department with an infection of the skin on the upper right thigh. The nurse knows this infection could be caused by which organism? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Streptococci 2. Proteus mirabilis 3. Pseudomonas aeruginosa 4. Salmonella enteritides 5. Bacillus anthracis
Correct Answer: 1,2,3 Rationale 1: Streptococci can cause skin infections. Rationale 2: Proteus mirabilis is an organism that can cause skin infections. Rationale 3: Pseudomonas aeruginosa is an organism that can cause skin infections. Rationale 4: Salmonella enteritides is one of the organisms that cause food poisoning. Rationale 5: Bacillus anthracis is the organism responsible for anthrax. Global Rationale: Streptococci, Proteus mirabilis, and Pseudomonas aeruginosa are all implicated in skin infections.
The nurse is preparing to admit a client with a serious methicillin-resistant Staphylococcus aureus (MRSA) infection. The nurse knows MRSA will not respond to treatment with: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. fluoroquinolones. 2. macrolides. 3. aminoglycosides. 4. tetracyclines. 5. linezolid.
Correct Answer: 1,2,3,4 Rationale 1: MRSA is resistant to fluoroquinolones. Rationale 2: MRSA is resistant to macrolides. Rationale 3: MRSA is resistant to aminoglycosides. Rationale 4: MRSA is resistant to tetracyclines. Rationale 5: Linezolid (Zyvox) is a newer antibiotic that is effective against MRSA. Global Rationale: MRSA is a type of bacterium that is resistant to certain antibiotics such as methicillin, amoxicillin, and penicillin. At least 60% of S. aureus infections are now resistant to penicillin. The term "methicillin resistant" is still used for these infections despite the fact that methicillin was removed from the market many years ago. In recent years, MRSA strains have developed resistance to most classes of antimicrobials, including fluoroquinolones, macrolides, aminoglycosides, tetracyclines, and clindamycin.
Guidelines for preventing antimicrobial resistance include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. using proper infection-control procedures. 2. shortening the duration of antibiotic administration. 3. using antimicrobials wisely. 4. preventing infections. 5. treating infections properly.
Correct Answer: 1,3,4,5 Rationale 1: Proper hygiene and infection control measures help prevent the transmission of infectious disease and the development of resistance. Rationale 2: Shortening administration duration leads to mutations. Antibiotics should be taken for their full duration. Rationale 3: Using antimicrobials only when there is a clear rationale for their use helps prevent the development of resistance. Rationale 4: The CDC guidelines for preventing antimicrobial resistance include preventing infections when possible. Rationale 5: Diagnosing and treating infections properly helps prevent the development of resistance. Global Rationale: Methods of delaying the emergence of antibiotic resistance include: preventing infections when possible, diagnosing and treating infections properly, using antimicrobials wisely, and preventing disease transmission.
Hyaluronidase, an enzyme secreted by certain bacteria, allows the bacteria to: 1. protect themselves from phagocytes. 2. penetrate anatomic barriers more easily. 3. multiply more rapidly. 4. produce exotoxins in greater abundance.
Correct Answer: 2 Rationale 1: Another enzyme, coagulase, is secreted by S. aureus and protects it from phagocytes. Rationale 2: Certain bacteria secrete hyaluronidase, which digests the matrix between human cells and allows the bacteria to penetrate anatomic barriers more easily. Rationale 3: Hyaluronidase does not affect cell multiplication. Rationale 4: Hyaluronidase is not involved in the production of exotoxins. Global Rationale: Some streptococci, staphylococci, and clostridia secrete hyaluronidase, an enzyme that digests the matrix between human cells, allowing the bacteria to penetrate anatomic barriers more easily. Staphylococcus aureus secretes the enzyme coagulase, causing fibrin to be deposited on its cells, thereby protecting it from phagocytes.
The nurse knows that which antibiotic, when taken by a pregnant woman, can adversely affect the newborn's hearing? 1. Mycins 2. Aminoglycosides 3. Sulfonamides 4. Tetracyclines
Correct Answer: 2 Rationale 1: Mycins do not adversely affect the newborn's hearing. Rationale 2: Aminoglycosides can adversely affect the newborn's hearing. Rationale 3: Sulfonamides can have a genetic-related adverse effect, but they do not affect the newborn's hearing. Rationale 4: Tetracyclines can affect the teeth in the newborn, but they do not affect hearing. Global Rationale: Some antibiotics are readily secreted in breast milk or cross the placenta. For example, tetracyclines taken by the mother can cause teeth discoloration in the newborn, and aminoglycosides can affect hearing. Some anti-infectives are pregnancy category D, such as minocycline, doxycycline, neomycin, and streptomycin
The nurse caring for a client with an infection knows a contributing factor to the development of drug resistance is the presence of bacterial genetic errors called: 1. plasmids. 2. mutations. 3. conjugates. 4. duplications.
Correct Answer: 2 Rationale 1: Plasmids are small pieces of DNA. Rationale 2: Genetic errors are mutations. Rationale 3: Conjugation is a part of transcription. Rationale 4: Duplication is the repeating of the genetic code, and it is a normal process. Global Rationale: During exponential division, bacteria make frequent errors, or mutations, while duplicating their genetic code. These mutations, which occur spontaneously and randomly, occasionally result in a change in physiology that gives a bacterial cell a reproductive advantage over its neighbors.
The nurse caring for a group of clients recognizes that which client has a superinfection? 1. 47-year-old client with type 2 diabetes and pneumonia 2. 50-year-old AIDS client with candida 3. 46-year-old client with vascular disease and cellulitis of the leg 4. 52-year-old client with gastroesophageal reflux disease (GERD) and gastritis
Correct Answer: 2 Rationale 1: Superinfections occur when organisms that are normally present in the body are destroyed. This client does not have the symptoms of a superinfection. Rationale 2: Those who are immunosuppressed and receiving antibiotic therapy are at greater risk of developing superinfections. Rationale 3: Cellulitis is not a symptom of superinfection. Rationale 4: Superinfections occur when organisms that are normally present in the body are destroyed. This client does not have the symptoms of a superinfection. Global Rationale: Antibiotics are unable to distinguish between host flora and pathogenic organisms. When an antibiotic kills the host's normal flora, additional nutrients and space are available for pathogenic microorganisms to grow unchecked. These new, secondary infections caused by antibiotic use are called superinfections, or suprainfections. The appearance of a new infection while receiving anti-infective therapy is highly suspicious of a superinfection. Signs and symptoms of superinfection commonly include diarrhea, bladder pain, painful urination, or abnormal vaginal discharges.
A client has been on an antibiotic for 2 weeks for treatment of an ulcer caused by Helicobacter pylori. The client asks the nurse if the antibiotic could be causing diarrhea. What is the nurse's most accurate response? 1. "The infection has become severe." 2. "This might be a secondary infection due to the antibiotic therapy." 3. "The infection has a restricted group of microorganisms." 4. "The organisms that caused the infection have developed immunity to the drug."
Correct Answer: 2 Rationale 1: There is another, more likely reason for the diarrhea. Rationale 2: A superinfection is a side effect of antibiotic therapy. Rationale 3: This is a true statement but does not answer the client's question. Rationale 4: This is not a symptom of immunity. Global Rationale: The appearance of a new infection while receiving anti-infective therapy is highly suspicious of a superinfection. Signs and symptoms of superinfection commonly include diarrhea, bladder pain, painful urination, or abnormal vaginal discharges. Broad-spectrum antibiotics are more likely to cause superinfections because they kill many microbial species, which sometimes includes host flora. Organisms that commonly cause superinfections are Clostridium albicans in the vagina, streptococci in the oral cavity, and Clostridium difficile in the colon.
The nursing student asks the instructor how concepts from microbiology directly relate to client care. The instructor's best response is: 1. "It will assist you in understanding how health care providers choose anti-infective agents." 2. "Knowledge of bacteria and their classification assists in the management of anti-infective therapy." 3. "Studying microbiology will help you understand laboratory reports." 4. "Microbiology is one of the few science electives that do not really have any direct effects on client care."
Correct Answer: 2 Rationale 1: Understanding how health care providers choose anti-infectives is not the primary focus of microbiology. Rationale 2: The knowledge of bacteria and their classification assists in the management of anti-infective therapy. Rationale 3: Being able to understand laboratory reports is a secondary goal. Rationale 4: Understanding microbiology has a direct effect on client care and on the management of the infectious process. Global Rationale: Because of the enormous number of bacterial species, several descriptive systems have been developed to simplify their study. It is important for nurses to learn these classification schemes, because drugs that are effective against one organism in a class are likely to be effective against other pathogens in the same class.
Which client would require the administration of prophylactic antibiotics? 1. A client with inflammation at the infection site 2. A client with a viral infection 3. A client with a suppressed immune system 4. A client with pus at the infection site
Correct Answer: 3 Rationale 1: A client with inflammation at the infection site might need antibiotics in increased strength, but not as prophylaxis. Rationale 2: A client with a viral infection should not receive antibiotic therapy. Rationale 3: A client with a suppressed immune system would need prophylactic antibiotics. Rationale 4: A client with pus at the infection site might need antibiotics in increased strength, but not as prophylaxis. Global Rationale: Only in rare cases are anti-infectives given prophylactically for indefinite time periods. Examples include the prevention of infections in patients with suppressed immune systems such as those with HIV infection, or those receiving immunosuppressants following an organ transplant.
A leading factor in the development of bacterial resistance is the ability of bacteria to undergo: 1. replication. 2. conjugation. 3. mutation. 4. colonization.
Correct Answer: 3 Rationale 1: Replication is bacteria reproduction, which does not necessarily play a role in the development of resistance. Rationale 2: Conjugation occurs after resistance has developed and is the ability of the bacterium to pass its resistance to other bacteria. Rationale 3: Due to their rapid growth, bacteria make errors in duplicating their genetic code, thus forming a mutation. Rationale 4: Colonization refers to the ability of the bacteria to form a colony in the host. Global Rationale: Microorganisms have the ability to replicate extremely rapidly. Under ideal conditions Escherichia coli can produce a million cells every 20 minutes, or 1 1021 cells in only 24 hours. During exponential division, bacteria make frequent errors, or mutations, while duplicating their genetic code. These mutations, which occur spontaneously and randomly, occasionally result in a change in physiology that gives a bacterial cell a reproductive advantage over its neighbors.
The nurse is preparing to administer a broad-spectrum antibiotic medication to a client. An important nursing intervention prior to administration of the anti-infective is: 1. performing a culture within 24 hours after starting the medication. 2. obtaining the culture report, as when starting any medication. 3. performing a culture prior to administering the first dose of the anti-infective. 4. administering the medicine without performing cultures.
Correct Answer: 3 Rationale 1: The culture must be obtained prior to beginning antibiotic therapy, if possible. Rationale 2: Laboratory tests should be performed prior to beginning the anti-infective therapy, but the organism does not have to be identified prior to starting medication. Rationale 3: The culture should be obtained prior to administering the first dose of the anti-infective. Rationale 4: Administering the medication without performing a culture could lead to increased symptoms of infection due to selection of the incorrect antibiotic. Global Rationale: Ideally, the pathogen should be identified before anti-infective therapy is begun.
Which location is the most difficult to reach with antibiotic therapy? 1. Gastrointestinal system 2. Integumentary system 3. Central nervous system 4. Lungs
Correct Answer: 3 Rationale 1: The gastrointestinal system is not a difficult location to reach with antibiotic therapy. Rationale 2: The integumentary system is not a difficult location to reach with antibiotic therapy. Rationale 3: The central nervous system is the most difficult location to reach with antibiotic therapy because many medications have difficulty crossing the blood-brain barrier. Rationale 4: The lungs are not a difficult location to reach with antibiotic therapy. Global Rationale: Infections of the central nervous system (CNS) are particularly difficult to treat because many medications are unable to cross the blood-brain barrier to reach the brain and associated tissues.
A female client is prescribed tetracycline for acne. When providing information regarding this drug, the nurse explains that tetracycline: 1. is contraindicated in people over 20 years old. 2. is classified as a narrow-spectrum antibiotic. 3. has been identified to be unsafe during pregnancy. 4. is used to treat a wide variety of disease processes.
Correct Answer: 3 Rationale 1: There is no indication that this drug is not safe for those over 20. Rationale 2: Tetracycline is a broad-spectrum antibiotic. Rationale 3: The drug is not safe for pregnant women as it can cross the placental barrier and cause mottling of the infant's teeth. Rationale 4: This drug is used to treat specific types of infections. Global Rationale: Some antibiotics are readily secreted in breast milk or cross the placenta. For example, tetracyclines taken by the mother can cause teeth discoloration in the newborn, and aminoglycosides can affect hearing. Some anti-infectives are pregnancy category D, such as minocycline, doxycycline, neomycin, and streptomycin.
The client on penicillin who is complaining of an abnormal vaginal discharge has a superinfection secondary to: 1. a nosocomial infection. 2. an overdose of penicillin. 3. the destruction by penicillin of normal flora in the vagina. 4. the development of an organism resistant to penicillin.
Correct Answer: 3 Rationale 1: Vaginal discharge is not a sign of nosocomial infection. Rationale 2: Vaginal discharge is not a sign of penicillin overdose. Rationale 3: Superinfections occur when organisms normally present in the body are destroyed by an antibiotic and pathogenic organisms can grow unchecked. Rationale 4: Vaginal discharge is not a sign of antibiotic resistance. Global Rationale: Antibiotics are unable to distinguish between host flora and pathogenic organisms. When an antibiotic kills the host's normal flora, additional nutrients and space are available for pathogenic microorganisms to grow unchecked. These new, secondary infections caused by antibiotic use are called superinfections, or suprainfections. The appearance of a new infection while receiving anti-infective therapy is highly suspicious of a superinfection. Signs and symptoms of superinfection commonly include diarrhea, bladder pain, painful urination, or abnormal vaginal discharges.
The ability of an organism to become unresponsive over time to an anti-infective is termed: 1. superinfection. 2. sensitivity. 3. mutation. 4. acquired resistance.
Correct Answer: 4 Rationale 1: A superinfection is a secondary infection that occurs when antibiotic therapy kills normal flora. Rationale 2: Sensitivity is the ability of an organism to be killed or of its growth to be halted by an antibiotic. Rationale 3: Mutation is the ability of an organism to adapt and change. This leads to antibiotic resistance. Rationale 4: Acquired resistance is the ability of an organism to become insensitive to the effects of an anti-infective. Global Rationale: Acquired resistance is the ability of an organism to become unresponsive over time to the effects of an anti-infective. Resistance can occur in bacteria, fungi, viruses, and protozoans. It is a major clinical problem that is growing in importance.
Anti-infectives are grouped into pharmacological classes by their: 1. staining ability. 2. size or shape. 3. sensitivity. 4. mechanism of action.
Correct Answer: 4 Rationale 1: Antibiotics are not classified according to their staining ability. Rationale 2: Antibiotics are not classified according to their size or shape. Rationale 3: Antibiotics are not classified according to their sensitivity. Rationale 4: Antibiotics are grouped into classes by their mechanism of action, susceptible organisms, and chemical structure. Global Rationale: Pharmacologic classes are used to group anti-infectives by their mechanism of action. Like chemical classes, placing an antibiotic into a pharmacologic class allows the nurse to develop a mental framework on which to organize these medications and to predict similar actions and adverse effects.
The client asks the nurse why the health care provider did not prescribe the same antibiotic that the client always receives for an infection. The best response by the nurse would be: 1. "It doesn't matter which antibiotic you take." 2. "You don't want to take the same antibiotic all the time." 3. "Try this medicine, and if you're not better in 10 days, return to the office." 4. "These bacteria have developed resistance and will respond better to this antibiotic."
Correct Answer: 4 Rationale 1: Antibiotics are prescribed specifically for the type of pathogen causing the infection, and the selection of the correct antibiotic is important. Rationale 2: This is a true statement but does not answer the client's question. Rationale 3: This response does not provide the client with accurate information, and the client might need to return sooner than 10 days. Rationale 4: Continuous use of the same type of antibiotic could lead to bacterial mutations that are insensitive to the effects of the antibiotic. Global Rationale: Acquired resistance is the ability of an organism to become unresponsive over time to the effects of an anti-infective. Resistance can occur in bacteria, fungi, viruses, and protozoans. It is a major clinical problem that is growing in importance.
Classification of bacteria by their response to Gram stain includes: 1. rods, spirals, and spheres. 2. aerobic and anaerobic. 3. fungi and viruses. 4. gram-positive and gram-negative.
Correct Answer: 4 Rationale 1: Bacteria classified according to shape include rods, spirals, and spheres. Rationale 2: Bacteria classified according to their ability to use oxygen are aerobic or anaerobic. Rationale 3: Fungi and viruses are not classifications of bacteria. Rationale 4: Bacteria are classified as gram-positive or gram-negative by their ability or inability to respond to a violet color after staining. Global Rationale: One of the simplest methods of classifying microbes is to examine them microscopically after a crystal violet Gram stain has been applied to the microbes. Some bacteria contain a thick cell wall composed of peptidoglycan and retain the violet color after staining. These bacteria are called gram positive and include Staphylococcus, Streptococcus, and Enterococcus. Bacteria that have thinner cell walls will lose the violet stain and are called gram negative. Examples of gram-negative bacteria include Bacteroides, Escherichia, Klebsiella, Pseudomonas, and Salmonella.
A new antibiotic is classified as a bacteriocidal agent. This means that the drug: 1. slows the growth of the infectious agent. 2. has a high potency. 3. is highly efficacious. 4. kills the infectious agent.
Correct Answer: 4 Rationale 1: Bacteriostatic drugs slow the growth of bacteria. Rationale 2: Potency refers to the strength of an antibiotic. Rationale 3: Efficacy refers to effectiveness. Rationale 4: Bacteriocidal drugs kill bacteria. Global Rationale: Whether it is used for treating or preventing disease, the primary goal of anti-infective therapy is to assist the body in eliminating a pathogen. Drugs that accomplish this goal by killing bacteria are called bacteriocidal. Some drugs do not kill pathogens but instead slow their growth, allowing natural body defenses to eliminate the microorganisms. These growth-slowing drugs are called bacteriostatic.
Which type of antibiotic carries the highest risk of an allergic response? 1. Tetracyclines 2. Aminoglycosides 3. Cephalosporins 4. Penicillins
Correct Answer: 4 Rationale 1: The tetracyclines do not carry the greatest risk for allergic response. Rationale 2: The aminoglycosides do not carry the greatest risk for allergic response. Rationale 3: The cephalosporins do not carry the greatest risk for allergic response. Rationale 4: The penicillins are the group of antibiotics that have the highest incidence of allergic reactions. Global Rationale: Although not common, serious hypersensitivity reactions to antibiotics may be fatal. The penicillins are the class of antibacterials that have the highest incidence of allergic reactions: Between 0.7% and 10% of all patients who receive these drugs exhibit some degree of hypersensitivity.
