Exam 3 Practice Questions

Successful treatment with bacteriostatic antibiotics depends upon what factor? A. Adequate duration of drug therapy B. Using broad-spectrum antibacterial drugs to treat viral infections C. Stopping drug therapy when symptoms have subsided D. The nature of the virus being treated

A. Adequate duration of drug therapy Rationale: Successful treatment with bacteriostatic antibiotics depends on the ability of the host's immune system to eliminate the inhibited bacteria and an adequate duration of drug therapy. Stopping an antibiotic prematurely can result in rapid resumption of bacterial growth. Antibiotics are not used to treat viral infections.

The nurse is providing health education to a client prescribed isoniazid. What should the nurse instruct the client to avoid? A. Alcohol B. Foods containing purine C. Direct sunlight D. Dairy products

A. Alcohol Rationale: Alcohol increases the risk of hepatotoxicity with isoniazid even if alcohol use is stopped during therapy. There is no therapeutic reason for clients taking isoniazid to avoid sunlight, dairy products, or purine.

The nurse would include information on which possible adverse effects when educating a client regarding rifampin? Select all that apply. A. Discoloration of urine B. Skin rash C. Dry skin D. Optic neuritis E. Gastrointestinal (GI) upset

A. Discoloration of urine B. Skin rash E. Gastrointestinal (GI) upset Rationale: Adverse effects of rifampin include GI upset, skin rashes, hepatitis, and a harmless red-orange discoloration of urine, tears, sweat, and other body fluids. Soft contact lenses may be permanently stained. Dry skin is not an adverse effect. A major adverse effect of ethambutol is optic neuritis.

After 3 weeks of drug therapy for tuberculosis (TB), a client is not showing reduction of symptoms. Repeated laboratory work shows positive cultures. What issues should the nurse consider? Select all that apply. A. Drug resistance B. Defective medication C. Intermittent administration D. Misdiagnosis E. Client noncompliance

A. Drug resistance E. Client noncompliance Rationale: Adequate drug therapy of clients with active disease usually produces improvement within 2 to 3 weeks. Intermittent administration is not recommended for multidrug-resistant TB. Defective medication should not be a factor unless indicated by the Food and Drug Administration in a bulletin. Medication therapy would not be initiated unless the diagnosis of TB had been confirmed.

The nursing instructor is lecturing about the development and spread of multidrug-resistant tuberculosis (TB) around the world. What factors would the instructor identify as contributing to this development? Select all that apply. A. Lack adequate laboratory facilities B. Delayed determination of drug susceptibility C. Low cure rate D. Poor adherence to administration E. Poor-quality medications

A. Lack adequate laboratory facilities B. Delayed determination of drug susceptibility D. Poor adherence to administration E. Poor-quality medications Rationale: Factors contributing to the development of drug-resistant disease include delayed diagnosis and delayed determination of drug susceptibility. In addition, some countries lack adequate laboratory facilities or do not test TB bacteria for susceptibility to second-line anti-TB drugs. Important causes of drug-resistant TB include failure to properly complete a full course of TB treatment, prescription of the wrong treatment by a health care provider (wrong dose or length of time), lack of availability of drugs for proper treatment, and poor-quality drugs.

The nurse is providing education to a client who has been prescribed oral amoxicillin. The nurse will repeat teaching related to fluid intake if the client indicates that the drug can be taken with what beverage? A. Orange juice B. Green tea C. Carbonated soda D> Milk

A. Orange juice Rationale:Clients should not take penicillins with orange juice or any acidic beverages because these may destroy the drug. None of the other options have a negative effect on the medication.

A client has been diagnosed with an infected postoperative wound, and cultures reveal methicillin-susceptible Staphylococcus aureus. What medication should the nurse anticipate being prescribed for this client? Select all that apply. A. Oxacillin B. Doxycycline C. Dicloxacillin D. Nafcillin E. Ampicillin

A. Oxacillin C. Dicloxacillin D. Nafcillin Rationale:Penicillinase-resistant (antistaphylococcal) penicillins include three drugs (dicloxacillin, nafcillin, and oxacillin) that are the drugs of choice for methicillin-susceptible Staphylococcus aureus. These drugs are formulated to resist the penicillinases that inactivate other penicillins. Neither ampicillin nor doxycycline would be effective in treating this type of infection.

Aminoglycosides are prescribed in the treatment of what hospital-acquired infection? Select all that apply. A. Pseudomonas B. Proteus C. Klebsiella D. Escherichia coli E. Gram-positive cocci

A. Pseudomonas B. Proteus C. Klebsiella D. Escherichia coli Rationale:The major clinical use of parenteral aminoglycosides is to treat serious systemic infections caused by gram-negative microorganisms such as Pseudomonas and Proteus species and Escherichia coli, Klebsiella, Enterobacter, and Serratia species.

The nurse initiated administration of IV cefazolin with the dose ending at 13:00. When would the nurse expect the drug to reach peak effect? A. Shortly after 13:00 B. By 13:45 C. Between 14:00 and 15:00 D. Between 16:00 and 17:00

A. Shortly after 13:00 Rationale:Cefazolin is distributed into most body tissues and crosses the placenta. The onset of action is rapid with both IV and IM administration. The drug peaks at the end of IV infusion and within 1 to 2 hours with IM injection.

The nurse is caring for a client who is undergoing chemotherapy for the treatment of leukemia. The nurse should monitor the client for what potential adverse effects? Select all that apply. A. Tetany B. Mucositis C. Unusual fatigue D. Hypouricemia E. Increased urine output

A. Tetany B. Mucositis C. Unusual fatigue Rationale: Common adverse effects of cytotoxic drug administration include mucositis and fatigue. With treatment of leukemias and lymphomas, an adverse effect called tumor lysis syndrome may occur; effects of this disorder include paresthesias, tetany, decreased urine output, and hyperuricemia.

How will a client's diagnosis of liver cirrhosis affect the potential use of appropriate ampicillin therapy to treat an infected pressure ulcer? A. The client can safely be treated with ampicillin. B. Cephalosporin rather than ampicillin should be prescribed. C. The client should be treated with approximately half of the normal dose of penicillin. D. The frequency of the doses is needed to reduce the risk of hepatotoxicity.

A. The client can safely be treated with ampicillin. Rationale: Ampicillin can be used in clients experiencing hepatic impairment, as can almost all the penicillins. No specific dosing are needed.

What situation is an indication for combination antimicrobial drug therapy? Select all that apply. A. The infection is hospital acquired. B. The infection is caused by several different organisms. C. A fever is present in a client whose immune system is suppressed. D. There is a probable likelihood the client will be nonadherent to treatment. E. There is a likely emergence of drug-resistant organisms if a single drug is used.

A. The infection is hospital acquired. B. The infection is caused by several different organisms. C. A fever is present in a client whose immune system is suppressed. E. There is a likely emergence of drug-resistant organisms if a single drug is used. Rationale: Antimicrobial drugs are often used in combination. Indications for combination therapy may include the following: infections caused by multiple microorganisms; hospital-acquired infections, which may be caused by many different organisms; serious infections in which a drug combination is synergistic; likely emergence of drug-resistant organisms if a single drug is used (e.g., in tuberculosis); or fever or other signs of infection in clients whose immune system is suppressed. Nonadherence is not a justification for combination therapy.

A nurse demonstrates a need for further education when identifying a decrease in what factor as a desired consequence of use of antibiotics? A. Time needed to perform culture testing B. Presence of drug-resistant microorganisms C. Potential adverse drug effects D. Health care costs

A. Time needed to perform culture testing Rationale: Antimicrobials are among the most frequently used drugs worldwide. Their success in saving lives and decreasing severity and duration of infectious diseases has encouraged their extensive use. Appropriate use of antibiotics decreases adverse drug effects, infections with drug-resistant microorganisms, and health care costs. It is not noted to decrease the time needed to perform culture testing.

A nurse is asked to explain the difference between community-acquired infections and hospital-acquired infections. What response best describes the difference? A. ''Hospital-acquired infections are typically less severe and easier to treat because they occur in the presence of trained medical staff.'' B. ''Community-acquired infections are usually less severe and easier to treat since hospital-acquired infections often involve drug-resistant microorganisms.'' C. ''There is no epidemiologic difference between the infection types; they are simply categorized as community-acquired or hospital-acquired.'' D. ''Only drug-resistant strains of staphylococci and Pseudomonas are categorized as hospital-acquired infections.''

B. ''Community-acquired infections are usually less severe and easier to treat since hospital-acquired infections often involve drug-resistant microorganisms.'' Rationale: Infections are often categorized as community-acquired or hospital-acquired. Because the microbial environments differ, the two types of infections often have different causes and require different antimicrobial treatment. Generally, hospital-acquired infections are more severe and difficult to manage because they often result from drug-resistant microorganisms and occur in people whose immunity is impaired. A wide variety of organisms can lead to hospital-acquired infections.

A client being treated with an oral penicillin should be encouraged to administer the medication on which schedule to best achieve a therapeutic effect? Select all that apply. A. At bedtime B. Around the clock C. With meals D. At regular intervals E. Upon rising in the am

B. Around the clock D. At regular intervals Rationale:Clients should aim to take penicillins at even intervals, preferably around the clock. These drugs are not normally taken with food.

A client has been diagnosed with an infected postoperative wound, and cultures reveal methicillin-resistant S. aureus (MRSA). The client is currently receiving cephalosporins IV based on previous in vitro testing that indicated susceptibility. What is the A. Contact the health care provider to request that lab cultures be repeated. B. Contact the health care provider to discontinue cephalosporin. C. Contact the health care provider as medication should be changed to IV ampicillin. D. Continue administering cephalosporin.

B. Contact the health care provider to discontinue cephalosporin. Rationale:In infections caused by MRSA, cephalosporins are not clinically effective, even if in vitro testing indicates susceptibility (except for the newest cephalosporin, ceftaroline). The health care provider will determine the need for additional tests or alternative anti-infectives.

What intervention is most important for the nurse to perform prior to initiating prescribed antibiotic therapy? A. Increasing the client's fluid intake B. Obtaining a specimen for culture and sensitivity C. Educating the client about adverse effects D. Administering an antidiarrheal to prevent gastrointestinal (GI) upset

B. Obtaining a specimen for culture and sensitivity Rationale: It is good practice to collect specimens (e.g., sputum, urine) for culture and Gram's stain before giving the first dose of 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.

What route of administration is most commonly used for the administration of ciprofloxacin when prescribed to an older adult client? A. Subcutaneous (SQ) B. Oral (PO) C. Intramuscular (IM) D. Intravenous (IV)

B. Oral (PO) Rationale:While ciprofloxacin is typically administered by the PO or IV route, in most cases, oral administration is used. The medication is not administered by either the SQ or IM routes.

What is the defining characteristic of a sarcoma? A. Congenital in nature B. Originates from connective tissue C. Sequestered within bone or muscle tissue D. Attributable to endogenous carcinogens

B. Originates from connective tissue Rationale: Sarcomas are derived from connective tissue such as muscle, bone, cartilage, fibrous tissue, fat, or blood vessels. They are not sequestered within other tissues, and they are not the result of endogenous carcinogens. Sarcomas are not a congenital health problem.

The nurse is caring for a client who requires administration of an aminoglycoside. The nurse should perform focused assessments related to what adverse reactions? Select all that apply. A. Hypoglycemia B. Ototoxicity C. Glaucoma D. Nephrotoxicity E. Liver necrosis

B. Ototoxicity D. Nephrotoxicity Rationale:Aminoglycosides accumulate in high concentrations in the proximal renal tubules of the kidney leading to acute tubular necrosis. This damage to the kidney is termed nephrotoxicity. They also accumulate in high concentrations in the inner ear, damaging sensory cells in the cochlea and the vestibular apparatus. This damage to the inner ear is termed ototoxicity. None of the other options are associated with adverse reactions to aminoglycosides.

What event triggers the development of a superinfection? A. Bone marrow suppression triggered by antibiotic treatment B. Proliferation of antibiotic-resistant microorganisms C. Unforeseen interactions between the antibiotic and other prescribed medications D. Complete establishment of the infection prior to initiation of antibiotic therapy

B. Proliferation of antibiotic-resistant microorganisms Rationale:Superinfection is an infection after the occurrence of a previous infection, typically caused by microorganisms that are resistant to the antibiotics used earlier. None of the other options accurately describe this condition as it is associated with antibiotic-resistant microorganisms.

The nurse is providing education to a client diagnosed with metastatic cancer. What treatment will the nurse indicate is likely necessary? A. Combination of surgery and radiation therapy B. Systemic chemotherapy C. Localized chemotherapy and concurrent radiation therapy D. Radiation

B. Systemic chemotherapy Rationale:Localized tumors are often treatable with surgery, radiation, or chemotherapy combined with radiation (concurrent) therapy. Metastatic disease requires systemic chemotherapy.

What factors may prompt a change in tuberculosis (TB) treatment to include second-line anti-TB drugs? Select all that apply. A. The insurer doesn't cover the cost of first-line drugs. B. The client is unable to tolerate first-line drugs. C. There is resistance to the first-line drugs. D. The client progresses from latent TB to active TB. E. The client has recovered from primary TB infection.

B. The client is unable to tolerate first-line drugs. C. There is resistance to the first-line drugs. Rationale: Second-line anti-TB drugs are used in combination with other drugs when there is drug resistance to one of the first-line drugs or the client is unable to tolerate use of a first-line drug. This change in treatment is not warranted by funding, development of active TB, or recovery from the primary infection.

What potential benefit is unique to biologic agent therapies? A. Cytotoxic adverse effects are rarely experienced. B. They may affect cancer cells while leaving normal body cells unaffected. C. Administration does not require a certified chemotherapeutic nurse. D. They may be administered long term without the need for regular blood work.

B. They may affect cancer cells while leaving normal body cells unaffected. Rationale: Biologic agents target cellular differences between the malignant and normal cells. Consequently, they may kill cancer cells while leaving normal body cells unaffected. Like all drugs, they have adverse effects. They require exceedingly careful administration and necessitate close monitoring by specially trained staff.

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? A. ''It will help in determining where the microorganism came from.'' B. ''It will help us to stop the infection from spreading to others.'' C. ''It will identify what drug will best kill this microorganism.'' D. ''It will show us how long you've had the infection.''

C. ''It will identify what drug will best kill this microorganism.'' Rationale:Once a specific microorganism is identified by laboratory culture, it is important to determine susceptibility, which is the vulnerability of the bacteria to the effects of an antibiotic. None of the other options are associated with identifying the most effective antibiotic therapy.

To maximize the prevention of an incisional infection, when will the nurse administer the prophylactic antibiotic therapy prescribed for a surgical client? A. As part of the surgical prep B. The night before surgery C. 1 hour prior to the first planned skin incision D. When the client is admitted to postsurgical recovery

C. 1 hour prior to the first planned skin incision Rationale: When used perioperatively, cephalosporins should be given within 60 minutes before the first skin incision is made so the drug has time to reach therapeutic serum and tissue concentrations. It is not done as part of the surgical prep since that timing is not as specific.

What is the life expectancy of a client diagnosed with multidrug-resistant tuberculosis (MDR-TB)? A. 3 to 6 months B. 6 to 9 months C. 4 to 16 weeks D. 18 to 30 weeks

C. 4 to 16 weeks Rationale: MDR-TB is associated with rapid progression, with 4 to 16 weeks from diagnosis to death and a high death rate (50%-80%). The remaining time frames are of a longer duration than the expected time span from diagnosis to death.

Penicillins are more effective when used on infections caused by what organism? A. Gram-negative bacteria B. Fungi C. Gram-positive bacteria D. Gram-negative viruses

C. Gram-positive bacteria Rationale: Clinical indications for use of penicillins include bacterial infections caused by susceptible microorganisms. As a class, penicillins usually are more effective in infections caused by gram-positive bacteria than those caused by gram-negative bacteria. However, their clinical uses vary significantly according to the subgroup or individual drug and microbial patterns of resistance. Penicillins are not used to treat viral or fungal infections.

The nurse is assessing a client who has been prescribed treatment with isoniazid. What assessment finding would most likely necessitate contacting the health care provider to recommend discontinuing treatment? A. Persistent nausea B. Pruritus C. Jaundice D. Alopecia

C. Jaundice Rationale: Jaundice is a clear indication of hepatotoxicity and would most likely warrant discontinuing treatment with isoniazid. Nausea would not likely prompt any change in treatment. Pruritus may be associated with liver damage but may also have other potential causes. Alopecia does not typically accompany isoniazid therapy.

A major concern among public health authorities is an increase in drug-resistant tuberculosis (TB) infections. What new evidence suggests a possible cause for this resistant tendency? A. The clear majority of TB infections are now drug resistant. B. Only drug-resistant strains are actively infecting clients. C. Many drug-resistant infections are new infections, especially in those who are immunosuppressed. D. Client adherence is the primary cause of drug-resistant TB infections.

C. Many drug-resistant infections are new infections, especially in those who are immunosuppressed. Rationale: Drug-resistant strains can be spread from one person to another, and there is increasing evidence that many drug-resistant infections are new infections, especially in people whose immune systems are suppressed. While it may be a factor, client nonadherence to medication therapy is not the primary cause of this resistance. None of the other options present accurate information regarding the new evidence suggesting the cause for drug-resistant tuberculosis (TB) infections.

The nurse is justified in suspecting that a client who recently completed a course of ceftaroline may have been treated for what health problem? A. Chlamydial infection B. Encephalitis C. Methicillin-resistant Staphylococcus aureus (MRSA) infection D. Endocarditis

C. Methicillin-resistant Staphylococcus aureus (MRSA) infection Rationale:Ceftaroline is an IV cephalosporin for the treatment of community-acquired pneumonia and skin infections. It is the first cephalosporin to be considered active against resistant gram-positive organisms, such as MRSA. This drug is not indicated in the treatment of chlamydial infections, endocarditis, or encephalitis.

A client has been diagnosed with streptococcal pharyngitis. What drug would the nurse expect to be prescribed by the health care provider? A. Dicloxacillin B. Amoxicillin C. Penicillin G D. Cephalexin

C. Penicillin G Rationale:Some strains of streptococci have acquired resistance to penicillin G, although the drug is still effective in many streptococcal infections. It remains the drug of choice for the treatment of streptococcal pharyngitis; for prevention of recurrent attacks in clients who have had previous acute rheumatic fever due to group A streptococcus; and for the treatment of neurosyphilis. Aminopenicillins (e.g., amoxicillin) are the drugs of choice for prevention of bacterial endocarditis due to procedures that produce transient bacteremia. Penicillinase-resistant penicillins (e.g., dicloxacillin) are the drugs of choice for MRSA. Although first-generation cephalosporins such as cephalexin are effective against streptococci species, they are not the drugs of choice.

A client who is demonstrating pneumonia-like symptoms is being assessed for possible tuberculosis. The client's history suggests which phase of tuberculosis infection? A. Active tuberculosis B. Latent tuberculosis infection C. Primary infection D. Transmission

C. Primary infection Rationale: An estimated 30% of persons exposed to tuberculosis bacilli acquire primary infection and develop a mild, pneumonia-like illness. Transmission phase occurs upon initial exposure. Latent tuberculosis infection phase exhibits no symptoms, no illness, and no transmission. Active tuberculosis exhibits persistent cough with sputum, chest pain, chills, fever, hemoptysis, night sweats, weight loss, weakness, anorexia, etc.

An older adult client diagnosed with a drug-resistant urinary tract infection has been started on a regimen of aminoglycosides. The client is concerned about adverse reactions such as nephrotoxicity. When providing client education about the medication, w A. ''The drug is given for no longer than 30 days unless necessary for the treatment of certain infections.'' B. ''Clients are at a lower risk for complications when high doses are given for prolonged periods.'' C. ''Kidney function tests will reveal any decrease in function before damage occurs.'' D. ''If nephrotoxicity occurs, it is usually reversible if the drug is stopped.''

D. ''If nephrotoxicity occurs, it is usually reversible if the drug is stopped.'' Rationale:If nephrotoxicity occurs, it is usually reversible if the drug is stopped. Aminoglycosides should be given for no longer than 10 days unless necessary for the treatment of certain infections. Clients are most at risk when high doses are given for prolonged periods. Changes in renal function tests indicate that nephrotoxicity may not occur until the client has received an aminoglycoside for several days.

The nurse is monitoring several clients for the development of an opportunistic infection. The nurse understands that which client is at greatest risk? A. A client being treated for the exacerbation of rheumatoid arthritis B. A client being treated for ischemic heart disease C. A client who has just given birth vaginally to a premature infant D. A client who received electrical burns to the lower body

D. A client who received electrical burns to the lower body Rationale: Opportunistic infections are likely to occur in people with severe burns, cancer, human immunodeficiency virus (HIV) infection, indwelling intravenous or urinary catheters, and antibiotic or corticosteroid drug therapy. Autoimmune diseases, heart disease, and recent vaginal birth are not major risk factors for opportunistic infections.

A client receiving the first dose of IV ampicillin asks the nurse to evaluate a rash on the torso. What should be the nurse's initial response to the client's rash? A. Stop the infusion and administer a bolus of normal saline. B. Immediately apply a topical corticosteroid to the affected region. C. Report the rash to the primary health care provider. D. Attempt to differentiate a hypersensitivity reaction from a nonallergic ampicillin rash.

D. Attempt to differentiate a hypersensitivity reaction from a nonallergic ampicillin rash. Rationale:The nurse carefully assesses the characteristics of a rash, if present. It is necessary to distinguish, if possible, a hypersensitivity reaction from a nonallergic ampicillin rash. Corticosteroids are not indicated, and the infusion does not necessarily need to be stopped. The rash should be reported only after the initial assessment is completed.

A client being prepared for surgery has been prescribed antibiotics as prophylaxis. Which medication would the nurse anticipate being ordered? A. Amoxicillin B. Doxycycline C. Penicillin G D. Cephalosporin

D. Cephalosporin Rationale:Clinical indications for the use of cephalosporins include surgical prophylaxis and treatment of infections of the respiratory tract, skin and soft tissues, bones and joints, urinary tract, brain and spinal cord, and bloodstream (septicemia). In most infections with streptococci and staphylococci, penicillins are more effective and less expensive.

A client being prepared for surgery has been prescribed antibiotics as prophylaxis. Which medication would the nurse anticipate being ordered? A. Penicillin G B. Amoxicillin C. Doxycycline D. Cephalosporin

D. Cephalosporin Rationale:Clinical indications for the use of cephalosporins include surgical prophylaxis and treatment of infections of the respiratory tract, skin and soft tissues, bones and joints, urinary tract, brain and spinal cord, and bloodstream (septicemia). In most infections with streptococci and staphylococci, penicillins are more effective and less expensive.

A client being treated for cellulitis with a cephalosporin asks the nurse what the essential difference is between generations of this medication. The nurse should respond to the client's question based on what fact? A. The generations represent the order in which the drugs should be utilized clinically. B. The generations of cephalosporins represent formulations that produce fewer side effects. C. Each generation of cephalosporins has a different mechanism of action. D. Each successive generation is more effective against gram-negative microorganisms.

D. Each successive generation is more effective against gram-negative microorganisms. Rationale:Cephalosporins are grouped into generations by their antimicrobial properties. Each newer generation of cephalosporins has significantly greater gram-negative antimicrobial properties than the preceding generation, with decreased activity against gram-positive organisms. None of the remaining options accurately describe the concept of generations associated with medications

The nurse is educating a client who is recovering from pneumonia about ways to fight new infection. What education can the nurse provide to this client? A. If a new infection is suspected, use any antibiotic remaining from pneumonia treatment. B. Call the heath care provider at the first sign of a cold or flu. C. Take prophylactic antibiotics. D. Eat a balanced diet and get adequate fluid intake, rest, and exercise.

D. Eat a balanced diet and get adequate fluid intake, rest, and exercise. Rationale: Eating a balanced diet and getting adequate fluid intake, rest, and exercise helps the body fight infection, prevents further infection, and increases the effectiveness of antimicrobial drugs by optimizing body processes. Taking prophylactic antibiotics or using antibiotics that are left over from a previous infection increase the risk for developing antibiotic-resistant bacteria. Calling the health care provider at the first sign of infection does not assist with the prevention of infection.

Tuberculosis (TB) is a leading killer among people who have which concurrent medical diagnosis? A. Leukemia B. Hodgkin's disease C. Connective tissue disease D. Human immunodeficiency virus (HIV)

D. Human immunodeficiency virus (HIV) Rationale: TB is a leading killer of people living with HIV. TB is not associated with the other diseases.

Culture and susceptibility tests are performed prior to the prescription of antimicrobial drugs. What is the specific purpose of the culture? A. Identifies the drugs that might be effective in treatment B. Determines the severity of the infection C. Predicts the body's response to the infection D. Identifies the organism causing the infection

D. Identifies the organism causing the infection Rationale: Culture identifies the infection's causative organism. Susceptibility tests determine which drugs are likely to be effective against the organism.

What is isoniazid's mechanism of action? A. Mechanism of action unknown B. Inhibits synthesis of RNA C. Inhibits synthesis of DNA D. Inhibits cell wall formation

D. Inhibits cell wall formation Rationale: Isoniazid's known mechanism of action is to inhibit cell wall formation. Rifampin's mechanism of action is to kill Mycobacterium by inhibiting synthesis of RNA. Inhibiting DNA synthesis is not the mechanism of action for primary antitubercular drugs.

The nurse is caring for a client who has been prescribed treatment with isoniazid. The nurse should confirm that the plan of care includes administration of what supplement prior to beginning drug therapy? A. Folic acid B. Pancreatic enzymes C. Vitamin D and calcium D. Liver enzymes

D. Liver enzymes Rationale: Regardless of the route, it is necessary to take liver enzymes prior to beginning administration of isoniazid and then monthly thereafter. Folic acid, pancreatic enzyme, and vitamin D supplements are unnecessary.

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

D. Maintenance of normal bacterial flora is essential to health during the therapy. Rationale: Normal flora protects the human host in a variety of ways. For example, normal bowel flora synthesizes vitamin K and vitamin B complex. The intestinal flora also plays a role in digestion. Furthermore, by competing with potential pathogens for nutrients and by preventing adhesion and growth of pathogens, beneficial microorganisms interfere with the ability of potential pathogens to cause infections. None of the other options are accurate statements regarding antibiotic therapy.

The nurse is justified in suspecting that a client who recently completed a course of ceftaroline may have been treated for what health problem? A. Chlamydial infection B. Encephalitis C. Endocarditis D. Methicillin-resistant Staphylococcus aureus (MRSA) infection

D. Methicillin-resistant Staphylococcus aureus (MRSA) infection Rationale:Ceftaroline is an IV cephalosporin for the treatment of community-acquired pneumonia and skin infections. It is the first cephalosporin to be considered active against resistant gram-positive organisms, such as MRSA. This drug is not indicated in the treatment of chlamydial infections, endocarditis, or encephalitis.

Gentamicin therapy is indicated in the treatment of what medical diagnosis? A. Myasthenia gravis B. Acute renal failure C. Multiple sclerosis D. Osteomyelitis

D. Osteomyelitis Rationale:The major clinical use of gentamicin (most commonly with other antibacterial agents) is empiric therapy for serious infections caused by susceptible aerobic gram-negative organisms. Treatment of infections such as septicemia, respiratory tract infections, urinary tract infections, intra-abdominal infections, and osteomyelitis often involves gentamicin. A black box warning alerts health care professionals that these drugs are nephrotoxic and ototoxic and must be used very cautiously in the presence of renal impairment. The drugs must also be used cautiously in clients with myasthenia gravis and other neuromuscular disorders because muscle weakness may be increased

A client has been diagnosed with streptococcal pharyngitis. What drug would the nurse expect to be prescribed by the health care provider? A. Cephalexin B. Dicloxacillin C. Amoxicillin D. Penicillin G

D. Penicillin G Rationale: Some strains of streptococci have acquired resistance to penicillin G, although the drug is still effective in many streptococcal infections. It remains the drug of choice for the treatment of streptococcal pharyngitis; for prevention of recurrent attacks in clients who have had previous acute rheumatic fever due to group A streptococcus; and for the treatment of neurosyphilis. Aminopenicillins (e.g., amoxicillin) are the drugs of choice for prevention of bacterial endocarditis due to procedures that produce transient bacteremia. Penicillinase-resistant penicillins (e.g., dicloxacillin) are the drugs of choice for MRSA. Although first-generation cephalosporins such as cephalexin are effective against streptococci species, they are not the drugs of choice.

What event triggers the development of a superinfection? A. Unforeseen interactions between the antibiotic and other prescribed medications B. Complete establishment of the infection prior to initiation of antibiotic therapy C. Bone marrow suppression triggered by antibiotic treatment D. Proliferation of antibiotic-resistant microorganisms

D. Proliferation of antibiotic-resistant microorganisms Rationale: Superinfection is an infection after the occurrence of a previous infection, typically caused by microorganisms that are resistant to the antibiotics used earlier. None of the other options accurately describe this condition as it is associated with antibiotic-resistant microorganisms.

The normal growth-regulating genes that are present in all cells are referred to by what name? A. Neoplastic transformations B. Oncogenes C. Carcinogens D. Protooncogenes

D. Protooncogenes Rationale: Abnormal genes, called oncogenes, are mutations of normal growth-regulating genes called protooncogenes, which are present in all body cells. Carcinogens are cancer-causing agents. Neoplastic transformation is a process in which replication of abnormal cells occurs without normal immune destruction.

When a client fails to improve appreciably after 4 weeks of treatment with first-line drugs, what adjuvant first-line antitubercular drug will be considered for inclusion in the existing medication regimen? A. Levofloxacin B. Isoniazid C. Rifapentine D. Pyrazinamide

D. Pyrazinamide Rationale: Pyrazinamide is one of the adjuvant first-line antitubercular drugs. Rifapentine and isoniazid are first-line drugs. Levofloxacin is a second-line fluoroquinolone.

What is a major factor that influences whether an individual will acquire an infection? A. Implementation of continuous antimicrobial treatment of the infection B. The number of effective drugs available to an antibiotic-resistant infections C. The infection's tendency to recur and involve simple organisms D. The person's ability to defend against invading microorganisms

D. The person's ability to defend against invading microorganisms Rationale: 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.

A client is admitted to hospice with the diagnosis of extensively drug-resistant tuberculosis (XDR-TB). Knowing some of the contributing factors to this disease, the nurse understands this disease is a major indication of what treatment failure? A. To implement community-based and hospital-based treatment in a timely manner B. To promptly contact health authorities with diagnosis C. To adequately treat immunosuppressive diseases D. To adequately diagnose, prevent, and treat MDR-TB

D. To adequately diagnose, prevent, and treat MDR-TB Rationale: Authorities now describe some MDR-TB cases as extensively drug-resistant tuberculosis (XDR-TB), an even more worrisome threat to public health. XDR-TB is resistant to the second-line drugs used to treat MDR-TB. Some cases of TB are resistant to six or seven drugs, and there are essentially no effective drugs for their treatment. The development of XDR-TB indicates failure to adequately diagnose, prevent, and treat MDR-TB. The failure to adequately treat immunosuppressive diseases is not a direct precedent to developing TB. Additionally, while notifying health authorities is appropriate, a failure to do so does not impact diagnosis or treatment of individual cases and, thus, development of XDR-TB. As with all treatment regimens, personal (not health care system) responsibility is the significant consideration in treatment adherence.

When discussing viruses with a client, the nurse should include what information? A. Viruses and bacterial infections are generally treated similarly. B. Viral infections are seldom serious because of their self-limiting nature. C. Viruses have their origin in an inflammatory process that causes cellular mutation. D. Viruses are often described by the disorders and symptoms they produce.

D. Viruses are often described by the disorders and symptoms they produce. Rationale: Viruses are intracellular parasites that survive only in living tissues. They are officially classified according to their structure but are more commonly described according to origin and the disorders or symptoms they produce. They are treated differently from bacteria. Many viral illnesses are serious and/or chronic.