Pharmacology Chapter 15: Key Terms, PrepU, Notes

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

The hospital nurse is caring for a group of adult clients. For which client should the nurse most likely administer prophylactic anti-infectives?

selective toxicity.

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:

The drug has a narrow spectrum

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?

"Vancomycin is a powerful drug with many adverse effects and it is generally reserved for when no other drug will work."

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?

Increase intake of fluids.

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?

"What happened the last time you took aspirin?

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?

Some healthy cells will be damaged.

The nurse is administering an anti-infective medication that is known to lack total selective toxicity. What consequence should the nurse anticipate?

It will directly cause the death of pathogenic cells.

The nurse is preparing to administer a drug that is bactericidal. The nurse should explain what characteristic of this drug?

Assessment for allergic reaction

The nurse is preparing to administer a new anti-infective to a client. The nurse should prioritize what assessment?

Ensuring that the duration of drug use is appropriate

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?

Coughing Stomach acid Swallowing

The nursing instructor is discussing normal body defense against infection. The nursing students answer correctly when they identify what as defense factors? (Select all that apply.)

Edema

The nursing instructor is discussing the signs and symptoms of infection. Which of the following is a local sign of infection?

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

What information about antibiotic therapy should the nurse should include in a client's medication education?

the person's ability to defend against the would-be invaders

What is a major factor that influences whether an individual will acquire an infection?

Maintain the optimum duration of the antimicrobial agent.

What is critical to helping prevent development of resistant strains of microbes?

Super infection

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

Antibiotic prescription for viral illness

What would contribute to drug resistance?

The drug is selective in its action on organisms.

When describing an anti-infective agent with a narrow spectrum of activity, what would the nurse include?

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

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?

True

Whenever possible, culture and sensitivity testing should be performed before an anti-infective agent is prescribed. True or False

a client with an impaired immune system a client experiencing diarrhea chronically an elderly client who has one chronic disease

Which client would be at risk of developing an infection? Select all that apply.

Good hand-washing between each patient contact

Which of the following is the most important nursing action to help prevent antimicrobial resistance in health care settings?

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.

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:

An education campaign that focuses on handwashing between patients

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?

Gram-positive bacteria

-Staphylococcus -Streptococcus -Bacillus -Clostridium -Corynebacterium -Listeria

Guidelines to promote more appropritate use of antimicrobial drugs include the following:

1) Avoid treating for viral infections 2)only provide when significant bacterial infection is diagnosed 3) use narrow spectrum drug 4)collect specimens ( urine, blood) for culture 5) Follow CDC recommendations

The five main processes of intrinsic mechanisms of resistance are outlined below:

1) Bacteria may inactivate the antibiotic 2) Bacteria may modify target sites for the antibiotic 3) Bacteria may alter metabolic pathways or substitute the usual enzymes need to carry out activites involved w/ growth and reproduction 4) Bacteria alter their cell all structure to reduce permeability 5) Some bacteria have the ability to pump drug molecules out of the cell

the three processes of acquired resistance are

1)In gene transfer bacteria are in close approximation to then transfer to genetic content. 2)In transfer mutations, the mutations often develop during bacterial replication. 3) Selective pressure, or natral selection, refers to the survival of the fittest bacteria.

"Make sure that you take all the pills that you're prescribed, even if your infection gets better."

A 70-year-old client has been prescribed an antimicrobial drug for the treatment of a urinary tract infection (UTI). What teaching point should the nurse prioritize when providing client education?

Penicillin interferes with biosynthesis of the bacteria cell wall.

A client asks the nurse how an anti-infective produces a therapeutic effect. What should be included in the nurse's teaching plan?

confirming that the medication prescribed is the drug of choice for the specific microorganism

A client has been diagnosed with an infection. The nurse can help to ensure the success of anti-infective treatment by:

the microorganism causing the infection is likely known.

A client has been diagnosed with osteomyelitis and has been prescribed clindamycin, a narrow spectrum antibiotic. When planning this client's care, the nurse should understand that

The client's infection is resistant to the medication

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?

Broad-spectrum antibiotics can cause antibiotic resistance.

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?

Impaired blood supply Suppression of immune system Advanced age

A client is admitted to the unit. The nurse knows that the client is at high risk for infection. What factors predispose the client to infection? (Mark all that apply.)

Broad-spectrum antibiotics

A client is diagnosed with bacterial pneumonia. Pending culture results, what would the nurse expect the health care provider to order?

be immediately prescribed a broad-spectrum antibiotic.

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:

hearing loss.

A client is receiving an aminoglycoside antibiotic for an infection. The nurse would monitor the client closely for:

Interfering with the pathogen cell wall

A client is to receive penicillin. The nurse understands that this drug achieves its effect by which action?

Diarrhea

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

death of the microbial cells.

A client with an infection has been prescribed metronidazole, a bactericidal antibiotic. The nurse should anticipate a therapeutic effect that is based on:

Development of drug resistance

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?

broad spectrum anti-infective for recent infection

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?

Avoid the use of broad-spectrum antibacterial drugs when treating trivial or viral infections. Use narrow-spectrum agents if they are thought to be effective. Do not use vancomycin unnecessarily.

A group of nursing students are giving a report on the emergence of drug-resistant microbial agents. What could the students cite as a good way to minimize the emergence of drug-resistant microbial agents? (Mark all that apply.)

To use gloves when handling drainage from the wound

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?

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

A nurse has questioned why a client's health care provider has prescribed a narrow-spectrum antibiotic rather than a broad-spectrum drug in the treatment of an infection. Which facts provide the best rationale for the use of narrow-spectrum antibiotics whenever possible?

Prevent overdose in the child. Give a safe dose for this size child. To eradicate the bacteria

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.)

The microbiology data is identifying another antibiotic appropriate for the client."

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?

Penicillin interferes with synthesis of the bacteria cell wall.

A nurse is instructing a colleague on how an antimicrobial produces a therapeutic effect. What should be included in the nurse's teaching?

What the allergic reaction was

A nurse is taking a history on a client new to the clinic. The client reports being allergic to penicillin. What would it be important for the nurse to find out?

Antibacterial

Ability to kill bacteria or interfere with the ability of bacteria to grow and replicate

broad spectrum

Administration of what type of antibiotic by the nurse would be most likely to cause a superinfection?

Cardiac toxicity

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?

It is essential to monitor patients receiving antibiotics closely for evidence of improvement. A failure to improve within 24 to 36 hours indicates

Antibiotic resistance

Drug therapy for inflammation include

Aspirin, NSAIDs, and corticosteriods

Gram-negative bacteria

Bacteroides Escherichia coli Klebsiella Proteus Pseudomonas Serratia marcescens Salmonella Shiglla

To identify the organism causing the infection

Culture and susceptibility tests are performed prior to the prescription of antimicrobial drugs. What is the specific purpose of the culture?

Antibiotic

Drug that has the ability to kill or inhibit bacterial growth and replication

Inflammation

Immunologic response to allergy, infection, or injury that increases the migration of leukocytes

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

Inappropriate use of antibiotics does all of the following except increase:

Obtain culture specimens prior to administration of antibiotic therapy. Use proper isolation procedures. Report culture results to the health care provider.

It is the duty of all health care providers to prevent antibiotic resistance. As a nurse, how can you play an active role in preventing antibiotic resistance? (Select all that apply.)

Toxic effects on the kidney

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?

Increased platelet cells.

Major defense mechanisms of the human body include all of the following EXCEPT:

Oppotunistic

Microorganisms in normal flora that become pathogenic under conditions that are favorable for their growth likely to occur in people with burns, cancer, human immunodeficiency virus (HIV) indwelling intrvenous or Urinary catheters, and antibiotic or corticosteriod drug therpy

Two kinda of chronic inflammation include:

Nonspecific chronic inflammation and Granulomatour chronic inflammation

Health care associated peumonia

Pneumonia that has been acquired i other health care facilities such as nursing homes

colonization

Presence and growth of microorganisms on hot tissues

It contributes to the proliferation of antibiotic-resistant organisms.

Some clients expect a prescription for antibiotics when they see a health care provider for nearly any illness. Why is excessive use of antibiotics a problem?

Inflammation occurs in what three stages

Stage 1: Vascular Stage Stage 2: Cellular Stage Stage 3: Opsonization

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

Successful treatment with bacteriostatic antibiotics depends upon:

Susceptibilty

Vulnerability of the bacteria to an antibiotics effects

Characteristics of the causative organism

The health care provider orders an oral antibiotic for a male client three times a day for 7 days. The client asks the nurse if this is correct, because his sister took the same antibiotic for 5 days. On what factor is the amount and frequency of the antibiotic dosing based?

By altering binding sites on the membrane or ribosomes so that the drug cannot enter the cell

The pathophysiology class is learning how microorganisms develop resistance to anti-infective drugs. What is one way the students would learn that microorganisms develop resistance to anti-infective drugs?

Obtaining sensitivity testing

To ensure that the most appropriate drug is being used to treat a pathogen, which would need to be done first?

first stage of inflammation: Vascular stage

Vasoconstriction results followed by vasodilation of capillaries and venules to increase capilliary blood flow, increasing temp and redness at the site.

Antibiotic resistance

ability of certain bacteria to survive and multiply in the presence of antibiotics

Anti- Infective

agent or substance with antibacterial, antiviral, and antifungal properties

bacteriostatic

agent that inhibits bacterial growth and replication

Bactericidal

agent that kills bacteria

Anti-inflammatory agents

drug indicated when the inflammatory response is inappropriate, abnormal, or persistent or destroys tissue

Antimicrobial Agent

drug used to prevent or treat infections caused by pathogenic (disease-producing) microorganisms such as bacteria, fungi, viruses, and parasites Overuse of antimicrobial agents may lead to serious infections caused by drug resisteant microorganisms.

Third Stage of inflammation : Opsoization

faciliates phagocytosis.

The anti- inflammatory agents administered to reduce the inflammatory process include:

include asprin, nonsteroidal anti - inflammatory agents administered to reduce the inflammatory drugs (NSAIDs) and coriticosteroids.

hospital acquired infection

infection acquired from microorganisms in hospitals and other health care facilities

community acquired pneumonia

infection caused by microorganisms that originated in a setting outside of a health care facility

Viruses

intracellular parasites that survive only in living tissues

Serology

method of identifying infectious agents by measuring the antibody level (titer) in the serum of an infected host

Clinical manifestations of acute inflammation include

pain, redness, swelling fever, general malaise.

Fungi

plant like microorganisms that live as parasites on living tissue or as saprophytes on dexaying organic matter

penicillin binding proteins

proteins in bacteria that serve as target sites for penicillin to bind

bacteria

single celled microorganisms that do not have nuclei and reproduce by fission or splitting

Detection of antigens

technique to identify pathogens that uses features of culture and serology but reduces the time required for diagnosis

Skin rash Any sign of a new infection Diarrhea

the nurse is discharging a client who will be taking an antimicrobial at home. What adverse effects related to antimicrobial therapy should be reported to the health care provider? (Select all that apply.)

second stage of inflammation: Cellular Stage

there is an influx of leukocytes, primarily neutrophils to the injury site.