NURS 317 Unit 7 Pharm Chapter 8 Flashcards

1
Q

A client has been diagnosed with a bacterial infection and been prescribed a bacteriostatic antiinfective. What will occur once the drug achieves sufficient serum levels?

A) Phagocytosis will occur, resulting in bacterial death.

B) Bacterial cell walls will rupture.

C) Bacterial cells will infect one another rather than the client’s body cells.

D) Bacterial cells will be unable to replicate.

A

D) Bacterial cells will be unable to replicate.

Rationale:Antiinfectives that are bacteriostatic prevent the replication of bacteria, usually by interfering with proteins or enzyme systems necessary for reproduction of the bacteria. They do not turn bacterial cells on one another or cause phagocytosis. Drugs that are bactericidal are more likely to cause cell wall rupture.

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2
Q

The nurse would be most likely to investigate the possibility of a superinfection in a client presenting with infections caused by what? Select all that apply.

A) Streptococcus

B) Pseudomonas

C) Proteus

D) Yeast

E) Rhinovirus

A

B) Pseudomonas
C) Proteus
D) Yeast

Rationale:Superinfections are infections that occur when opportunistic pathogens that were kept in check by the “normal” flora bacteria have the opportunity to invade tissues. Common superinfections include vaginal or GI yeast infections, which are associated with antibiotic therapy, and infections caused by Proteus and Pseudomonas throughout the body, which are a result of broad-spectrum antibiotic use. While it is not impossible, superinfection caused by Streptococcus or a rhinovirus is highly unlikely.

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3
Q

A client presents to the clinic reporting mouth sores that appear consistent with an oral yeast infection. The nurse should question the client about the recent use of what?

A) Antibiotics

B) Antiprotozoals

C) Antivirals

D) Oral contraceptive agents

A

A) Antibiotics

Rationale:The client is exhibiting signs of a superinfection, which can occur with the use of antibiotics. Superinfections are not associated with oral contraceptives, multivitamins, or anticoagulants.

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4
Q

One of the nurse’s clients is prescribed antiinfective therapy. What should the nurse understand about the ways organisms develop resistance to antiinfective therapy? Select all that apply.

A) The organism alters the transport system to prevent the drug from entering.

B) The organism produces an enzyme that acts as an antagonist to the drug.

C) Failure to take the drug the way it was prescribed.

D) The organism alters the binding sites on the membranes.

E) The organism produces a chemical that mimics the drug.

A

A) The organism alters the transport system to prevent the drug from entering.
B) The organism produces an enzyme that acts as an antagonist to the drug.
D) The organism alters the binding sites on the membranes.

Rationale:Microorganisms develop resistance by producing a chemical that acts as an antagonist to the drug, not to mimic the drug. In addition, the microorganism can produce an enzyme that deactivates the drug, change cellular permeability so that the drug can’t enter the cell, and alter binding sites to no longer accept the drug. Failure to take the drug the way it was prescribed leads to resistance, but this is not one of the ways the organism develops resistance.

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5
Q

The nurse has educated a client about the risk for kidney damage that accompanies the client’s antiinfective regimen. What should the nurse recommend to the client in order to reduce the risk of renal damage?

A) Avoid taking the medication right before bedtime

B) Take the medication with water

C) Temporarily adopt a low-residue diet

D) Increase intake of fluids

A

D) Increase intake of fluids

Rationale:Increasing fluid intake reduces the risk of renal damage. Changing diet does not have any significant effect on the risk for renal damage. Taking a medication with water does not necessarily mean that the client’s overall fluid intake is increasing. The client should take the medication when it is prescribed to be taken; taking it at bedtime poses no risk to renal function.

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6
Q

A client with acne has been receiving an antiinfective agent for a prolonged period. Initially, the drug was effective, but over time, its effectiveness decreased. What is the nurse’s best action?

A) Assess the client for a new onset of drug hypersensitivity.

B) Refer the client to the healthcare provider because the client may be experiencing resistance.

C) Assess the client for additional signs of superinfection.

D) Educate the client about the phenomenon of drug tolerance.

A

B) Refer the client to the healthcare provider because the client may be experiencing resistance.

Rationale: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 antiinfectives 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 allergic reactions result from antibody formation. Tolerance exists when a client needs a higher dose to achieve the same therapeutic effect as in the past; with antiinfectives, however, resistance is more likely.

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7
Q

A client is receiving aminoglycoside therapy. The nurse would be alert for what adverse effect commonly seen with this drug?

A) Kidney dysfunction

B) Lethargy

C) Loss of vision

D) Hallucinations

A

A) Kidney dysfunction

Rationale: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.

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8
Q

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?

A) Signs and symptoms that are thought to be caused by infection in older adults are usually age-related changes.

B) A narrow-spectrum antibiotic should be prescribed due to the likelihood of infection.

C) The client is likely to require larger and/or more frequent doses of antibiotics than younger clients.

D) Older adults’ signs and symptoms of infection may differ from those of younger people.

A

D) Older adults’ signs and symptoms of infection may differ from those of younger people.

Rationale:Older adults often exhibit an atypical presentation of infection. Broad-spectrum antibiotics are a better initial approach than narrow-spectrum antibiotics. Older adults do not normally require larger or more frequent doses. Sometimes the signs of infection in older adults (e.g., confusion) are misattributed to age-related changes

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9
Q

The nurse is assessing a client who has recently been given the first dose of a new antiinfective. What finding should lead the nurse to suspect that the client is experiencing a hypersensitivity reaction?

A) The client recently had an episode of diarrhea.

B) The client is experiencing vertigo.

C) The client has a facial and trunk rash.

D) The client’s blood pressure is 141/88 mm Hg.

A

C) The client has a facial and trunk rash.

Rationale:Rash suggests a hypersensitivity reaction. Vertigo may suggest a neurotoxic adverse effect. Diarrhea may occur over time as a result of gastrointestinal adverse effects. A blood pressure that is slightly elevated is not suggestive of hypersensitivity.

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10
Q

For what client would the use of prophylactic antiinfective be most appropriate?

A) A client with type 2 diabetes who lives in a crowded home

B) A client who uses street drugs intravenously

C) A client who works in a clinic where many ill children are treated

D) A presurgical client who has an artificial heart valve

A

D) A presurgical client who has an artificial heart valve

Rationale:A client with valve replacement is especially prone to the development of subacute bacterial endocarditis because of the vulnerability of their heart valves; prophylactic antibiotic therapy as a precaution. None of the other listed clients has particular indications for the use of prophylactic antiinfectives.

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11
Q

A nurse is teaching a colleague about the factors that are known to contribute to antibiotic resistance. What phenomenon should the nurse describe?

A) Use of antibiotics for viral illnesses

B) Over-the-counter availability of some antibiotics in the United States

C) Increasing incidence of adverse effects of antiinfectives in recent years

D) Use of excessive doses during antiinfective therapy

A

A) Use of antibiotics for viral illnesses

Rationale:The use of antibiotics for viral illnesses or infections is a contributing factor to the development of resistance. Antibiotics are not available over the counter in the United States, and there has not been a trend toward excessive dosing or increases in adverse effects.

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12
Q

Before the nurse administers a prescribed antiinfective agent to a client, the nurse should confirm that what action has been performed?

A) Head-to-toe assessment

B) Culture testing

C) Complete blood count

D) Renal function studies

A

B) Culture testing

Rationale:It is most important to ensure that a culture of the infected area has been obtained before administering the agent. The culture is necessary to determine the pathogen. Complete blood count and renal function studies are helpful to establish a baseline, but it is not important if they are drawn before administration of the antiinfective. The nurse should assess the client’s status, but a full head-to-toe examination does not need to precede the administration of an antiinfective.

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13
Q

A client is receiving sulfonamide therapy as treatment for an infection. The nurse understands that this drug acts by doing what?

A) Preventing the organism from dividing

B) Altering the permeability of the cell membrane

C) Dissolving the bacterial cell wall

D) Interfering with protein synthesis

A

A) Preventing the organism from dividing

Rationale:Sulfonamides prevent the cells of the invading organism from using substances essential to their growth and development, leading to an inability to divide and eventually to cell death. Some antibiotics, antifungals, and antiprotozoal drugs alter the permeability of the cell membrane. Aminoglycosides, macrolides, and chloramphenicol interfere with protein synthesis. Penicillins interfere with the bacterial cell wall.

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14
Q

The nurse is preparing to administer an intravenous antiinfective agent to a client. When monitoring for common adverse effects, what assessments should the nurse perform? Select all that apply.

A) Assessment of neurological status

B) Assessment for muscle weakness

C) Assessment of urine output

D) Cardiac monitoring

E) Assessment for signs of hypersensitivity

A

A) Assessment of neurological status
C) Assessment of urine output
E) Assessment for signs of hypersensitivity

Rationale:Cardiac toxicity and weakness are not typically associated with antiinfective therapy. Adverse effects commonly associated with antiinfective therapy are direct toxic effects on the kidney, gastrointestinal tract, and nervous system along with hypersensitivity and superinfections.

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15
Q

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:

A) be immediately prescribed a broad-spectrum antibiotic.

B) need to provide a follow-up sputum culture before medications can be prescribed.

C) receive supportive care until an antibiotic can be prescribed in 48 hours.

D) be treated with antiviral medication on a short-term basis.

A

A) be immediately prescribed a broad-spectrum antibiotic.

Rationale:Broad-spectrum antibiotics are often prescribed pending sensitivity testing. There is no need to completely withhold medications until results are acquired. Antiviral medications are not used for this short-term purpose. Follow-up testing may or may not be needed.

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16
Q

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

A) Bacteriostatic

B) Narrow spectrum

C) Bactericidal

D) Broad spectrum

A

D) Broad spectrum

Rationale:One offshoot of the use of antiinfectives, especially broad-spectrum antiinfectives, is destruction of the normal flora, allowing opportunistic pathogens to invade tissue and cause a superinfection. Narrow-spectrum antiinfectives 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.

17
Q

Some recent antiinfective agents have been developed that are completely free of adverse effects.

A) FALSE

B) TRUE

A

A) FALSE

Rationale:No antiinfective agent has been developed that is completely free of adverse effects.

18
Q

After teaching a group of nursing students about the use of antiinfectives for prophylaxis, the instructor determines that the students need additional teaching when a student identifies what as an example?

A) A client who is scheduled for abdominal surgery receives antibiotic therapy.

B) A client with an oral yeast infection who receives antifungal therapy.

C) A client who receives antimalarial therapy in preparation for travel to Africa.

D) A client with a mitral valve replacement receives antibiotics before a tooth extraction.

A

B) A client with an oral yeast infection who receives antifungal therapy.

Rationale:Prophylaxis is the use of antiinfectives to prevent infections before they occur. The use of antifungal agents for an existing yeast infection is treatment, not prophylaxis. Preoperative therapy to prevent a postoperative infection would be an example of prophylaxis. Therapy before a dental procedure is an example of prophylaxis. Use of antimalarials before travel is an example of prophylaxis.

19
Q

For what client would a broad-spectrum antibiotic be most appropriate?

A) A client who has symptoms of infection but whose culture and sensitivity results are not yet available

B) A client with a respiratory infection who is 84 years old

C) A client whose urinary tract infection has been attributed to Escherichia coli

D) A client who has an oral temperature of 100.2°F (37.9°C) but no other signs or symptoms of infection

A

A) A client who has symptoms of infection but whose culture and sensitivity results are not yet available

Rationale:Broad-spectrum antibiotics are often used to treat infections while awaiting the results of culture and sensitivity testing. The presence of a fever with no other signs of infection would not be an indication for the use of broad-spectrum antibiotics. Narrow-spectrum antibiotics are generally preferred when the causative microorganism of an infection is known. Advanced age is not an indication for broad-spectrum antibiotic use.

20
Q

Cephalosporins are associated with adverse effects involving the eighth cranial nerve.

A) TRUE

B) FALSE

A

B) FALSE

Rationale:Aminoglycosides collect in the eighth cranial nerve, causing ototoxic effects.

21
Q

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

A) It is effective in interfering with cell reproduction.

B) It is effective against many different organisms.

C) It will directly cause the death of pathogenic cells.

D) It is selective in its action on organisms.

A

C) It will directly cause the death of pathogenic cells

Rationale:Bactericidal refers to a highly aggressive drug that causes cell death. An antiinfective with a narrow spectrum of activity is selective in its action so that it is effective against only a few microorganisms with a very specific metabolic pathway or enzyme. Bacteriostatic refers to a drug’s effectiveness in interfering with a cell’s ability to reproduce or divide. Broad-spectrum activity refers to effectiveness against a wide variety of pathogens.

22
Q

A drug that does not actually cause the death of a cell but does interfere with its ability to reproduce is said to be what?

A) Drug resistant

B) Bacteriostatic

C) Bactericidal

D) Broad spectrum

A

B) Bacteriostatic

Rationale:A drug that is bacteriostatic does not kill the cell but interferes with its ability to reproduce. Bactericidal drugs cause the death of the cell. Drug resistance is the ability of a pathogen to adapt and no longer be susceptible to an antiinfective. Bacteriostatic activity can be found in both broad- and narrow-spectrum antiinfectives.

23
Q

Whenever possible, culture and sensitivity testing should be performed before an antiinfective agent is prescribed.

A) FALSE

B) TRUE

A

B) TRUE

Rationale:The most effective drug can be prescribed if the exact organism is identified through a culture, and the best drug to treat the organism is identified through a sensitivity test.

24
Q

Most antiinfective agents achieve their effectiveness by acting in similar ways.

A) FALSE

B) TRUE

A

A) FALSE

Rationale:Antiinfective agents work by altering the cell membrane of the pathogen, by interfering with protein synthesis, or by interfering with the ability of the pathogen to obtain needed nutrients.

25
Q

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

A) teaching the client that significant adverse effects are expected and must be endured during treatment.

B) monitoring the client closely for signs of arrhythmias or cardiac ischemia.

C) administering antihistamines, as ordered, to prevent the development of adverse effects.

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

A

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

Rationale:In order for treatment to be effective, it is necessary for an antiinfective to be accurately matched to the offending pathogen. Antiinfectives 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.

26
Q

The nurse administering an antiinfective agent recognizes that the drug will destroy some human cells as well as pathogens because of the absence of what?

A) Virulence

B) Antigens

C) Resistance

D) Selective toxicity

A

D) Selective toxicity

Rationale:Although antiinfective 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 antiinfectives. Antigens are proteins bound to the cell that help the body identify a cell as belonging (or not) in the body and are not the cause of human cell destruction.

27
Q

The nurse is preparing to administer an antiinfective agent that is prescribed for an older adult? The nurse should prioritize what action?

A) Educate the client about the mechanism of action.

B) Monitor the client closely for signs of adverse effects.

C) Educate the client about the role of culture testing.

D) Encourage fluid intake for the duration of treatment.

A

B) Monitor the client closely for signs of adverse effects.

Rationale:The older adult is more susceptible to severe adverse effects. For this reason, close monitoring is necessary and is a priority over education that addresses culture testing and the mechanism of action. Increased fluid intake is often beneficial, but close monitoring for adverse effects is a higher priority.

28
Q

A hospital client has been prescribed IV ceftriaxone, a cephalosporin antibiotic. What assessment finding related to drug therapy would be of greatest concern to the nurse?

A) The client’s urine output is 450 mL over 8 hours.

B) The client has a fever.

C) The client develops jaundice.

D) The client’s IV site becomes infiltrated.

A

C) The client develops jaundice.

Rationale:Jaundice can signal hepatic damage, which would necessitate discontinuing a cephalosporin. Urine output of 450 mL over 8 hours is adequate. The nurse would monitor and treat the client’s fever, but jaundice is a more ominous sign. Infiltration would require resiting the client’s IV, but this is not as serious as possible liver damage

29
Q

When reviewing the medication orders, a nurse notes that combination therapy with two antiinfective agents has been ordered. What is the nurse’s best interpretation of this order?

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

B) Treatment with a single antibiotic has proven unsuccessful.

C) The client has an infection that is a result of antibiotic resistance.

D) The risk of anaphylaxis precludes the use of one antibiotic in higher doses.

A

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

Rationale:Combination therapy may be used when an infection is caused by more than one organism and each pathogen may react to a different antiinfective agent. Combined effects of different drugs sometimes delay the emergence of resistant strains. Combination therapy is not a response to a client’s risk for anaphylaxis and does not necessarily mean that single therapy has failed. Similarly, this does not mean that the client’s infection is attributable to antibiotic resistance