Unit5: Chapter 08 (Karch 7th Ed) - Anti-infective Agents Flashcards
- A patient asks the nurse how an anti-infective produces a therapeutic effect. What key point will the
nurse explain to this patient?
A) Drugs used to treat infections date back to the 17th century.
B) All anti-infectives work in the same way to destroy organisms.
C) Selective toxicity determines the appropriate drug dosage needed.
D) The goal of anti-infectives is to interfere with normal functioning of the organism.
Ans: D
Feedback:
The goal of anti-infectives is to interfere with the normal function of the invading organism to prevent
it from reproducing and to cause cell death without affecting host cells. Each class of anti-infectives
works in a different way, but all have the same goal. Because bacteria cells have a slightly different
composition than human cells, the bacteria are destroyed without interfering with the host. The first
drugs used to treat systemic infections were developed in the early 20th century. The term selective
toxicity refers to the ability to affect certain proteins or enzyme systems that are used by infecting
organisms, but not by human cells.
- The nursing student learns about anti-infectives in class and demonstrates the need to study more when
making what statement about how anti-infectives work?
A) Some anti-infectives interfere with biosynthesis of the pathogen’s cell wall.
B) Some anti-infectives prevent the cells of the organism from using essential substances.
C) Many anti-infectives interfere with the steps involved in protein synthesis.
D) Some anti-infectives interfere with ribonucleic acid (RNA) synthesis in the cell leading to cell
death.
Ans: D
Feedback:
Some anti-infectives interfere with deoxyribonucleic acid (DNA) synthesis, not RNA synthesis, in the
cell, leading to inability to divide and causing cell death. The fluoroquinolones work in this way. The
other three options are correct and would not indicate the need for further study time. Penicillins interfere with biosynthesis of the cell wall, sulfonamides prevent organisms from using substances
essential to their growth and development, whereas aminoglycosides, macrolides, and chloramphenicol
interfere with protein synthesis.
The nurse administers a drug to treat Neisseria gonorrhoeae that works on no other bacteria. How would the nurse describe this drug? A) Broad spectrum B) Narrow spectrum C) Bactericidal D) Bacteriostatic
Ans: B
Feedback:
Without knowing the name of the antibiotic and how it works to treat N. gonorrhoeae, the only thing
that can be said is that it is a narrow-spectrum anti-infective because it only treats one specific
organism. Broad-spectrum anti-infectives treat multiple organisms. The name of the drug and how it
works would need to be known to determine whether it is bacteriocidal or bacteriostatic.
The nurse has provided patient teaching for a patient who will be discharged to home on an antiinfective.
What statement made by the patient indicates the nurse needs to provide additional teaching
concerning the use of anti-infectives?
A) Antibiotics will not help me when I have a viral infection.
B) A bacterial culture will be done before antibiotics are prescribed for me.
C) I could develop diarrhea as a result of taking an antibiotic.
D) I will stop taking the antibiotic as soon as I feel better.
Ans: D
Feedback:
Compliance with anti-infective therapy is a concern. Patients tend to stop taking the drugs when they
begin to feel better. A nurse should instruct the patient to take the entire course of prescribed drug to
ensure a sufficient period to rid the body of pathogens and to help prevent the development of
resistance. Antibiotics are not prescribed for viral infections. It is important that cultures be performed
before antibiotics are prescribed to determine what organism is causing the infection so that the correct
drug is prescribed. Diarrhea is the most common adverse effect from anti-infectives.
- The nurse attends a class on preventing resistance to anti-infectives and learns that the critical concept
in preventing the development of resistant strains of microbes is what?
A) Exposure of pathogens to an antimicrobial agent without cellular death
B) Drug dosages that are below a therapeutic level
C) The duration of drug use
D) Frequency of drug ingestion
Ans: C
Feedback:
Exposure of pathogens to an antimicrobial agent without cellular death leads to the development of
resistance so it is important to limit the use of these agents to treat pathogens with a known sensitivity
to the drug being used. Drug dosages are also important in preventing the development of resistance.
However, the duration of drug use is critical to ensure that microbes are completely eliminated and not
given the chance to grow and develop resistant strains. It is hard to convince patients that they must
always complete the entire course of antimicrobial agents when they begin to feel better, because
stopping early favors the emergence of drug-resistant strains.
- The pathophysiology class is learning how microorganisms develop resistance to anti-infective drugs.
What is one way the nursing students would learn that microorganisms develop resistance to antiinfective
drugs?
A) By rearranging their deoxyribonucleic acid (DNA) to produce membranes that are permeable to the
drug
B) By producing an enzyme that stimulates the drug
C) By changing the cellular membrane to allow the drug entry into the cell
D) By altering binding sites on the membrane or ribosomes so that the drug cannot enter the cell
Ans: D
Feedback:
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.
- The nurse, writing a care plan for a patient on an aminoglycoside, includes what intervention to reduce the accumulation of the drug in the kidney?
A) Avoid caffeine intake.
B) Increase fluids.
C) Decrease activity.
D) Increase consumption of fruits and vegetables.
Ans: B
Feedback:
To prevent the accumulation of anti-infective drugs in the kidneys, which can damage the kidney,
patients taking anti-infective drugs should be well hydrated. Decreasing the dosage will likely reduce
the therapeutic action and increase risk of resistance. There is no evidence of association between
caffeine intake and drug accumulation in the kidney. Decreasing activity and increasing fruits and
vegetables in the diet would not be effective in decreasing drug accumulation.
- When conducting patient teaching about using antibiotic medications, what is it critical for the nurse to
include to help stop the development of resistant strains of microorganisms?
A) Antibiotics should be used quickly to treat colds and other viral infections before the invading
organism has a chance to multiply.
B) Antibiotic dosage should be reduced and used for shorter periods of time to reduce unnecessary
exposure to the drug.
C) Prescriptions for antibiotics should be readily available so they can be filled as soon as patients
suspect they have an infection.
D) It is very important to take the full course of an antibiotic as prescribed and not save remaining
drugs for future infections.
Ans: D
Feedback:
Teaching patients to take the full course of their antibiotic as prescribed can help to decrease the
number of drug-resistant strains. Antibiotics should only be used to treat bacterial infections that have
been cultured to identify the antibiotic sensitivity and then patients should be instructed to use the
antibiotic for the prescribed course, which will help to eliminate drug-resistant strains. Reducing
dosage and time intervals increases the chance for drug resistance because anti-infectives are most
effective when taken exactly as indicated.
- A patient is told that he or she will have to undergo extensive dental surgery. The dentist prescribes a course of antibiotic therapy before beginning the procedures and continuing for 5 days after the
procedure. What is this is an example of?
A) Chemotherapy
B) Curative treatment
C) Prophylaxis
D) Synergism
Ans: C
Feedback:
In a situation where an infection is likely to occur, antibiotics can be used to prevent it. This is called
prophylaxis. Synergism is using two antibiotics at the same time to improve their effectiveness.
Chemotherapy is the use of drugs to destroy abnormal cells, usually cancer cells. Curative treatment
involves treating an actual infection to promote a cure.
10. A patient is receiving meropenem (Merrem IV). What drug-related reaction will the nurse assess for? A) Gastrointestinal toxicity B) Hepatic toxicity C) Nephrotoxicity D) Neurotoxicity
Ans: A
Feedback:
This drug has been associated with potentially fatal pseudomembranous colitis, which affects the
gastrointestinal tract. This drug is not associated with liver, kidney, or nerve toxicity.
- A patient is admitted to the unit and the nurse assesses whether he or she is at increased risk for
infection when what factors are determined? (Select all that apply.)
A) Malnutrition
B) Hypertension
C) Suppression of immune system
D) Advanced age
E) Decreased amylase levels
Ans: A, C, D
Feedback:
Factors that suppress the host defense mechanisms include malnutrition, suppression of immune
system, and advanced age. Hypertension does not predispose a person to infection neither does a
decreased amylase level.
- The nurse is caring for a patient receiving penicillin. The nurse knows this type of antibiotic works by
what mechanism?
A) Inhibiting growth and development of the organism
B) Inhibiting protein synthesis
C) Inhibiting cell wall biosynthesis
D) Stimulating bacterial reproduction
Ans: C
Feedback:
Some anti-infectives interfere with biosynthesis of the bacterial cell wall. Because bacterial cells have a
slightly different composition than human cells, this is an effective way to destroy the bacteria without
interfering with the host (see Box 8.2). The penicillins work in this way. The sulfonamides inhibit
growth and development of the organism’s cells. Aminoglycosides, macrolides, and chloramphenicol
interfere with protein synthesis. Fluoroquinolones interfere with synthesis of deoxyribonucleic acid,
resulting in the inability to reproduce.
- A nurse collects a culture sample of infected tissue. What does the result of testing the culture
contribute to the patient’s care?
A) Identifies the specific organism causing the infection
B) Pinpoints the exact site of the infection
C) Identifies individualized patient factors contributing to infection
D) Describes the length of time the patient has experienced infection
Ans: A
Feedback:
A culture is collected to identify the causative organism of an infection. It can help with determining
the site of infection in some cases if the infection is limited only to the site where the culture is
collected. It does not individualize patient factors contributing to infection. These must be determined
through assessment. It cannot indicate how long the patient has had the infection, which is often
determined by the white blood cell count and differential.
- A patient calls the clinic to talk to the nurse. The patient states that he or she saw the physician last
week and was prescribed penicillin for a strep throat. The patient goes on to say that they feel so much
better they stopped taking the drug today, even though there are a few pills left. What is the nurse’s best
response?
A) Okay, thank you for letting me know. I will document in your medical record that the treatment
was effective.
B) It is important that you take all the medication so all the germs are killed. Otherwise they could
come right back and be even stronger.
C) What you have described is the halo effect of the drug, making you feel better when you are still
infected. You’ll feel sick again when the drug is out of your system.
D) You will need to come to the clinic and be evaluated by your physician to make sure the infection
is really gone.
Ans: B
Feedback:
The duration of drug use is critical to ensure that the microbes are completely, not partially, eliminated
and are not given the chance to grow and develop resistant strains. The nurse must explain the
importance of taking all of the prescribed medication and should not agree with the patient. This is not
related to a halo effect and the patient may feel well until drug levels decrease rather than being
completely eliminated from the body. The patient does not need to be seen if the infection is responding
to treatment, but they must take the rest of the antibiotic.
15. When administering anti-infectives to patients, the nurse is aware of the risk for what potentially fatal adverse effect? A) Gastrointestinal toxicity B) Eighth cranial nerve damage C) Anaphylaxis D) Toxic effects on the kidney
Ans: C
Feedback:
Anaphylaxis is an acute, systemic allergic response to a substance that can be fatal if medical
intervention does not occur almost immediately because the airway closes due to tissue edema making
it impossible to breathe. Gastrointestinal toxicity, hearing loss due to eighth cranial nerve damage and,
toxic effects to the kidney are all adverse effects that may be seen with some anti-infectives. Although
these adverse effects can be serious, they are not usually fatal.