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Pharmacology
Chapter 8 question
| Question | Answer |
|---|---|
| The client has been taking her antibiotic for five days. She tells the nurse that she is now experiencing vaginal itching and discharge. The nurse suspects what has occurred? | The client has developed a superinfection. Explanation: The client is experiencing a vaginal yeast superinfection related to the use of antibiotics. Adverse reactions include nausea, diarrhea, abdominal pain, headache and photosensitivity. This is not indicative of an STI in this scenario. |
| A client is to be started on an antibiotic. Which is most important to take into consideration before beginning the antibiotic regimen? | Culture and susceptibility Explanation: Culture identifies the causative organism, and susceptibility tests determine which drugs are likely to be effective against the organism. The duration of symptoms and the client's hydration status, age, and weight are important, but not imperative, in determining the antibiotic of choice. |
| A medical nurse on a night shift is reviewing a client's medication administration record for the following day. The nurse notes that a combination antimicrobial drug is prescribed. What is implied by the fact that the client has been prescribed a combination drug? | The client may have an infection caused by multiple microorganisms. Explanation: Indications for combination therapy may include infections caused by multiple microorganisms. A fungal or protozoal infection is not implied, and the client may or may not have a history of recurrent infections. Intolerance of single antibiotics is not normally an indication for combination therapy. |
| Which would be tested to determine parasitic sources of infection? | Stool When investigators search for parasitic sources of infection, they may examine stool for ova and parasites. |
| The nurse is providing care for an older adult who has a urinary tract infection. What aspect of this client's current health status should the nurse focus on when ensuring safe and effective antibiotic therapy? | The client has a history of cirrhosis Explanation: Cirrhosis causes decreased liver function, which would have a major bearing on medication therapy. Each of the other aspects of the client's history are significant, but none will have as direct an effect as liver disease. |
| Aminoglycoside antibiotics tend to collect in the eighth cranial nerve. The nurse would anticipate that which clinical manifestation may occur from the cranial nerve involvement? | Vertigo Explanation: The aminoglycosides antibiotics collect in the eighth cranial nerve and can cause dizziness, vertigo, and loss of hearing. |
| A client with burns has developed a wound infection. This client is experiencing what type of wound infection? | Opportunistic infection Explanation: Opportunistic infections are likely to occur in people with severe burns, cancer, human immunodeficiency virus, and indwelling catheters and are often caused by drug-resistant microorganisms, are usually serious, and may be life threatening. The client may be at risk for a fungal, nosocomial (hospital-acquired), or foodborne infection, but the risk for all infections is high due to the client's opportunistic nature of the burn. |
| A client is receiving aminoglycoside therapy. The nurse would be alert for: | kidney dysfunction Explanation: Kidney dysfunction (i.e., nephrotoxicity) is associated with aminoglycosides. Hallucinations are not associated with the use of aminoglycosides. Lethargy is not associated with aminoglycoside therapy. Loss of vision is more commonly associated with neurotoxic agents such as chloroquine. Hearing loss is a possibility with aminoglycosides. |
| 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.” Explanation: Laboratory tests used to definitively identify causative organisms and to determine susceptibility to antibiotics usually require 48 to 72 hours, so the prescriber usually initiates treatment with an antimicrobial drug that is likely to be effective. The nurse should communicate with the prescriber about the change so that a correction can be made as soon as possible. Telling the prescriber to review the m |
| What would be categorized as an anti-infective agent? | Anthelmintics Explanation: Anthelmintics are a type of anti-infective agent used for infections caused by worms. Anticoagulants are agents that affect blood clotting. Anticonvulsants are agents that help to control seizures. Anticholinergics are agents that block the action of acetylcholine. |
| When an anti-infective’s function is to destroy the infective pathogen, it is classified as: | bactericidal Explanation: Anti-infectives can act to destroy an infective pathogen (bactericidal) or to prevent the pathogen from reproducing (bacteriostatic). Resistance is the ability over time to adapt to an anti-infective drug and produce cells that are no longer affected by a particular drug. Culture and sensitivity testing identify the causal pathogen and the most appropriate drug for treating the infection. |
| 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 Explanation: Narrow spectrum antibiotics are appropriate when the identity of the microorganism is known or strongly suspected. This is unrelated to the client's immune function. Broad spectrum drugs are not necessarily trialed before using narrow spectrum drugs. The risk of adverse effects is not the determining factor. |
| The nurse understands that an infection caused by a secondary pathogen, which can occur during prolonged antibiotic therapy, is known as which of the following? | Superinfection A superinfection is an infection caused by a secondary pathogen that can occur during prolonged antibiotic therapy. |
| Clients receiving aminoglycosides should be monitored closely for which toxicity? | Renal Explanation: When clients are taking aminoglycosides, they should be monitored closely for any signs of renal dysfunction. To prevent any accumulation of the drug in the kidney, clients should be well hydrated throughout the course of the drug therapy. |
| In teaching about using antibiotic medications, what is it critical to include to help stop the development of resistant strains of microorganisms? | It is very important to take the full course of an antibiotic as prescribed and not save remaining drugs for future infections. Explanation: Teaching clients to take the full course of their antibiotic as prescribed can help to decrease the number of resistant strains. Antibiotics should only be used to treat bacterial infections that have been cultured to identify the antibiotic sensitivity, and then clients should be instructed to use the antibiotic for the prescribed course, which will help to elimi |
| A client with acne has been receiving an anti-infective agent for a prolonged period. Initially, the drug was effective, but over time its effectiveness as decreased. What is the nurse’s best action? | Refer the client to the health care provider because the client may be experiencing resistance Explanation: Resistance refers to the organism’s ability to adapt over time to an antibiotic and produce cells that are no longer affected by a particular drug. Destruction of the normal flora by anti-infectives commonly leads to superinfection, an infection that occurs when opportunistic pathogens that were kept in check by the normal bacteria have the opportunity to invade the tissues. Hypersensitivity or |
| 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. Explanation: In order for treatment to be effective, it is necessary for an anti-infective to be accurately matched to the offending pathogen. Anti-infectives do not normally cause cardiac adverse effects. The client should be taught that adverse effects can be managed and are not necessarily an inevitability that must be endured. Antihistamines do not prevent most adverse effects. |
| Administration of what type of antibiotic by the nurse would be most likely to cause a superinfection? | broad spectrum Explanation: One offshoot of the use of anti-infectives, especially broad-spectrum anti-infectives, is destruction of the normal flora, allowing opportunistic pathogens to invade tissue and cause a superinfection. Narrow-spectrum anti-infectives are less likely to kill normal flora, although it is not impossible. A drug may be bactericidal, meaning it kills the pathogen; or bacteriostatic, meaning it prevents reproduction of the pathogen, but this is not related to superinfections. |
| The hospital nurse is caring for a group of adult clients. For which client should the nurse most likely administer prophylactic anti-infectives? | A client with colorectal cancer who is preoperative for a bowel resection Explanation: Abdominal surgery is a common indication for antibiotic prophylaxis, since these surgeries present a significant risk for infection. For this reason, a preoperative client would be more likely to need prophylaxis than a client who has had an MI, a client with renal failure or a client with an electrolyte imbalance. |
| Vancomycin can cause a condition caused “red man syndrome.” When administering this particular drug, the nurse should be on the alert to which of the following clinical manifestations of this syndrome? (Select all that apply.) | Fever Erythema Hypotension Explanation: Vancomycin can cause renal failure, ototoxicity, superinfections, and a condition known as “red man syndrome,” which is characterized by sudden and severe hypotension, fever, chills, paresthesia, and erythema or redness of the neck and back. |
| An 82-year-old woman with influenza and pneumonia has been admitted to the hospital for IV antibiotic therapy. Which type of antibiotic would rely the least on the client's defense mechanisms? | Penicillin Explanation: Because the client's immune system is compromised, it would be better to treat the client with a penicillin-type antibiotic. Penicillin antibiotics are bactericidal and do not rely on the client's immune system to fight the infection. |
| 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. Explanation: Although anti-infective agents target foreign organisms infecting the body of a human host, they do not possess selective toxicity, which is the ability to affect certain proteins or enzyme systems used only by the infecting organism but not by human cells. Virulence would apply to the destructive power of the infection, not the drug. Resistance is the pathogen’s ability to no longer respond to specific anti-infectives. Antigens are proteins bound to the cell that help |
| 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. Explanation: The human body and the environment contain many microorganisms, most of which do not cause disease and live in a state of balance with the human host. When the balance is upset and infection occurs, characteristics of the infecting microorganism and the adequacy of host defense mechanisms are major factors in the severity of the infection and the person's ability to recover. Conditions that impair defense mechanisms increas |
| 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 Explanation: Microorganisms have developed resistance by changing cellular permeability to prevent the drug from entering the cell by altering binding sites on the membranes or on ribosomes so the drug can no longer be accepted and by producing enzymes that deactivate the drug. Microorganisms have not been found to be able to rearrange their DNA to change their membrane structure. |
| 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 Explanation: When there is irregular or indiscriminate use of antibiotics, certain pathogens may mutate or build a tolerance to the drug. The antibiotic then becomes ineffective against that organism. Irregular use does not affect the absorption or elimination of the drug or increase chances of serious adverse events of the antibiotic. |
| 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 Explanation: Broad spectrum antibiotics are effective against a wide variety of microorganisms. None of the other listed clients have obvious indications for using a broad spectrum antibiotic. |
| What occurs when the normal flora is destroyed by the use of anti-infectives? | superinfection Destruction of the normal flora by anti-infectives commonly leads to superinfection, an infection that occurs when opportunistic pathogens that were kept in check by the normal bacteria have the opportunity to invade the tissues. Neurotoxicity involves damage or interference with the function of nerve tissue, usually in areas where drugs tend to accumulate in high concentrations. Hypersensitivity or allergic reactions result from antibody formation. Resistance refers to the ability over t |
| A nurse is taking a history on a client new to the clinic. The client reports being allergic to penicillin. What additional information about this reported allergy would be important for the nurse to find out? | What reaction symptoms occurred Explanation: It is important to determine what the allergic reaction was and when the client experienced it (e.g., after first use of drug, after years of use). Some clients report having a drug allergy, but closer investigation indicates that their reaction actually constituted an anticipated effect or a known adverse effect to the drug. It would not necessarily be important to find out what was done to stop the reaction, who the caregiver was at the time of the reaction |
| 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. Explanation: 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-r |
| To ensure that the most appropriate drug is being used to treat a pathogen, which would need to be done first? | Obtaining sensitivity testing Explanation: Performing sensitivity testing on cultured microbes is important to evaluate the bacteria and determine which drugs are capable of controlling the particular organism. Once the sensitivity testing is completed, then the decision for the drug can be made. Combination therapy is used when appropriate after culture and when sensitivity testing has been completed. Checking client allergies also would be done after sensitivity testing but before administering the d |
| Administration of what type of antibiotic by the nurse would be most likely to cause a superinfection? | broad spectrum Explanation: One offshoot of the use of anti-infectives, especially broad-spectrum anti-infectives, is destruction of the normal flora, allowing opportunistic pathogens to invade tissue and cause a superinfection. Narrow-spectrum anti-infectives are less likely to kill normal flora, although it is not impossible. A drug may be bactericidal, meaning it kills the pathogen; or bacteriostatic, meaning it prevents reproduction of the pathogen, but this is not related to superinfections. |
| Bacitracin (Baciguent) interferes with the cell wall synthesis of which type of bacteria? | Staphylococcal Bacitracin is an antibiotic that interferes with the cell wall synthesis of susceptible staphylococcal bacteria. |
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