Chapter 15 pharmacology course point
Which statement by a client indicates to the nurse that additional teaching concerning the use of antimicrobials is needed?
"I will stop taking the antibiotic once my symptoms have resolved."
A client with a wound infection is prescribed an antibiotic. Which client statement indicates to the nurse that teaching provided to the client to prevent the development of resistance was effective?
"I will take this medication as identified on the container.
A sputum sample of a postsurgical client with coarse crackles audible in the lungs has been sent for culture and sensitivity testing. What response should the nurse provide when the client asks why the sample needed to be analyzed?
"It will identify what drug will best kill this microorganism."
A 70-year-old client has been prescribed an antimicrobial drug for the treatment of a urinary tract infection (UTI). What teaching point should the nurse prioritize when providing client education?
"Make sure that you take all the pills that you're prescribed, even if your infection gets better."
The nurse is providing health education to a client who has been diagnosed with sinusitis. The health care provider has prescribed antibiotics. What should the nurse teach the client in order to prevent antibiotic resistance?
"Make sure to take every pill, even if you're feeling better."
A client asks why an antibiotic used to treat an infection in the past is not prescribed to treat an infection caused by the same organism now. Which response should the nurse provide to the client?
"The antibiotic that was used before no longer works to combat the same organism."
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 microbiology data is identifying another antibiotic appropriate for the client."
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?
"What happened the last time you took aspirin?"
A client asks a nurse why the health care provider has prescribed two anti-infective agents. Which response by the nurse would be most appropriate?
"Your infection, like many infections, is caused by more than one organism."
Which client is most at risk for an opportunistic infection?
A 14-year-old client with HIV infection
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
The nurse is monitoring several clients for the development of an opportunistic infection. The nurse understands that which client is at greatest risk?
A client who received electrical burns to the lower body
The nurse is caring for several medical clients who have infections. For which client would the administration of a broad spectrum antibiotic be most appropriate?
A client with signs of infection who is awaiting the results of laboratory testing
Indications for combination therapy may include all of the following EXCEPT:
A postmenopausal female with a urinary tract infection.
To ensure that the most appropriate drug is being used to treat a pathogen, which would need to be done first?
Obtaining sensitivity testing
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?
An education campaign that focuses on handwashing between patients
What would contribute to drug resistance?
Antibiotic prescription for viral illness
The nurse caring for a 24-year-old woman admitted with pneumonia explains how antibiotics work to help cure her pneumonia. Which statement would be correct about how antibiotic therapy works?
Antibiotics work by inhibiting cell wall synthesis.
A client is diagnosed with bacterial pneumonia. Pending culture results, what would the nurse expect the health care provider to order?
Broad-spectrum antibiotics
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 pathophysiology class is learning how microorganisms develop resistance to anti-infective drugs. What is one way the students would learn that microorganisms develop resistance to anti-infective drugs?
By altering binding sites on the membrane or ribosomes so that the drug cannot enter the cell
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?
Characteristics of the causative organism
A nurse is asked to explain the difference between community-acquired infections and hospital-acquired infections. What response best describes the difference?
Community-acquired infections are usually less severe and easier to treat since hospital-acquired infections often involve drug-resistant microorganisms.
A client with an upper respiratory tract infection was prescribed roxithromycin, an antibiotic. The nurse tells the client that irregular administration of this medication could lead to what outcome?
Development of drug resistance
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?
Educating the client about the need for frequent hand hygiene
Assessment of a newly admitted patient reveals the characteristic signs and symptoms of cellulitis on the back of the hand. A swab of the patient's wound was ordered upon admission, but the results of culture and sensitivity (C&S) testing are not yet available. What strategy will most likely be adopted to treat this patient's infection?
Empiric antimicrobial therapy will be implemented until laboratory results are available.
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?
Encouraging the client to increase fluid intake
The nurse is providing health education to a client with an infection who lives in the community. What characteristic of the client's anti-infective regimen will best prevent the development of resistant strains of microbes?
Ensuring that the duration of drug use is appropriate
Which of the following is the most important nursing action to help prevent antimicrobial resistance in health care settings?
Good hand-washing between each patient contact
A nurse is required to administer an antibiotic to a client. What preadministration assessment steps should the nurse perform before the first dose of antibiotic is given? Select all that apply.
Identify and record symptoms of infection• Take and record vital signs of the patient• Obtain thorough allergy history of the patient
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.)
Impaired blood supply Suppression of immune system Advanced age
A client has been prescribed an aminoglycoside. In order to prevent accumulation of the drug, what should the nurse encourage the client to do?
Increase fluid intake
Major defense mechanisms of the human body include all of the following EXCEPT:
Increased platelet cells.
The nurse is caring for a client receiving penicillin for the treatment of syphilis. When teaching the client about the therapeutic effect of this medication, the nurse should describe what mechanism?
Inhibition of cell wall biosynthesis
A client is to receive penicillin. The nurse understands that this drug achieves its effect by which action?
Interfering with the pathogen cell wall
A client experiencing a urinary tract infection has been prescribed a medication that is a combination of sulfamethoxazole and trimethoprim. What is the most likely rationale for the use of a combination antibiotic?
It is not possible to culture the microorganisms most likely responsible for the infection.
The nurse is preparing to administer a drug that is bactericidal. The nurse should explain what characteristic of this drug?
It will directly cause the death of pathogenic cells.
What is critical to helping prevent development of resistant strains of microbes?
Maintain the optimum duration of the antimicrobial agent.
What information about antibiotic therapy should the nurse include in a client's medication education?
Maintenance of normal bacterial flora is essential to health during the therapy.
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.
What intervention is most important for the nurse to perform before antibiotic therapy is initiated?
Obtain a specimen for culture and sensitivity
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
A client asks the nurse how an anti-infective produces a therapeutic effect. What should be included in the nurse's teaching plan?
Penicillin interferes with biosynthesis 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?
Penicillin interferes with synthesis of the bacteria cell wall.
After teaching a group of students about resistance, the instructor determines that the students need additional teaching when they identify what as a way that microorganisms develop resistance?
Production of a chemical to act as an agonist
A client with acne has been receiving an anti-infective agent for a prolonged period. Initially, the drug was effective, but over time its effectiveness as decreased. What is the nurse's bestaction?
Refer the client to the health care provider because the client may be experiencing resistance.
Before the nurse administers a prescribed anti-infective agent to a client, the nurse should confirm that what action has been performed?
Renal function studies
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?
Rigorously and consistently applying recommended precautions
The nurse is reviewing anti-infective medications prior to caring for a client who is diagnosed with sepsis. What statements are accurate descriptions of anti-infective therapy? Select all that apply.
Some anti-infectives interfere with biosynthesis of the pathogen's cell wall. Some anti-infectives prevent the cells of the organism from using essential substances. Many anti-infectives interfere with the steps involved in protein synthesis.
The nurse is administering an anti-infective medication that is known to lack total selective toxicity. What consequence should the nurse anticipate?
Some healthy cells will be damaged.
On his second day in the critical care unit, a client develops a left lower lobe infiltrate and is diagnosed with nosocomial pneumonia. What does the nurse expect is the cause of the pneumonia?
Staphylococcus aureus
A client is admitted to the unit and the nurse is performing a comprehensive assessment. What findings should the nurse interpret as indicating increased risk for infection? Select all that apply.
The client appears to be malnourished The client is under intense psychosocial stress The client is 81 years old
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?
The client has a facial and trunk rash.
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
When describing an anti-infective agent with a narrow spectrum of activity, what would the nurse include?
The drug is selective in its action on organisms.
When preparing a teaching plan for a group of students about the ways organisms develop resistance to anti-infective therapy, what would the instructor be least likely to include in the discussion?
The organism produces some chemical to mimic the drug.
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?
The patient has an infection that is caused by more than one organism.
A nurse has questioned why a client's health care provider has prescribed a narrow-spectrum antibiotic rather than a broad-spectrum drug in the treatment of an infection. Which facts provide the best rationale for the use of narrow-spectrum antibiotics whenever possible?
The use of broad-spectrum antibiotics can create a risk for a superinfection.
Culture and susceptibility tests are performed prior to the prescription of antimicrobial drugs. What is the specific purpose of the culture test?
To identify the organism causing the infection
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
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?
Toxic effects on the kidney
When discussing viruses with a client, the nurse should include what information?
Viruses are often described by the disorders and symptoms they produce.
Which client would be at risk of developing an infection? Select all that apply.
an elderly client who has one chronic disease a client experiencing diarrhea chronically a client with an impaired immune system
The nurse is caring for a diverse group of clients on a hospital medical unit. What client is mostlikely to experience a superinfection?
an older adult client with Clostridium difficile-associated diarrhea
The nurse is caring for a child who weighs 30 kg. The health care provider orders gentamicin t.i.d. The recommended dosage range is 6 to 7.5 mg/kg/d. What should the nurse explain is the importance of giving a dosage within this recommended range? Select all that apply.
avoiding toxic effects protecting other clients reducing the risk of drug-resistant organisms eradicating the bacteria promptly
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:
be immediately prescribed a broad-spectrum antibiotic.
Administration of what type of antibiotic by the nurse would be most likely to cause a superinfection?
broad spectrum
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
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?
cardiac toxicity
A client has been diagnosed with an infection. The nurse can help to ensure the success of anti-infective treatment by:
confirming that the medication prescribed is the drug of choice for the specific microorganism.
A client with an infection has been prescribed metronidazole, a bactericidal antibiotic. What should the nurse determine is the therapeutic effect of the medication?
death of the microbial cells
The nursing instructor is discussing the signs and symptoms of infection. Which of the following is a local sign of infection?
edema
A client is receiving an aminoglycoside antibiotic for an infection. The nurse would monitor the client closely for:
hearing loss
What is a mechanism of action found in some antimicrobial drugs?
inhibition of bacterial cell wall synthesis
An adult client is experiencing pain and swelling in the ankle from a fall. Which medications are appropriate for the nurse to suggest to the prescriber for symptom management? Select all that apply.
nonsteroidal anti-inflammatory (NSAID) aspirin corticosteroid
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:
selective toxicity.
The critical concept in preventing the development of resistant strains of microbes is:
the duration of drug use.
Although the numbers and virulence of microorganisms help determine whether a person acquires an infection, another major factor is:
the host's ability to defend itself against the would-be invaders.
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 microorganism causing the infection is likely known.
Inappropriate use of antibiotics does all of the following except increase:
the number of available effective drugs for serious or antibiotic-resistant infections.
An immunocompromised patient in a critical care setting has developed a respiratory infection that has been attributed to methicillin-resistant Staphylococcus aureus (MRSA). The nurse should anticipate that the patient will require treatment with
vancomycin.
