Unit5: Chapter 08 (Karch 7th Ed) - Anti-infective Agents

Question 1

1. 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.

Answer 1

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.

Question 2

2. 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.

Answer 2

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.

Question 3

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

Answer 3

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.

Question 4

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.

Answer 4

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.

Question 5

5. 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

Answer 5

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.

Question 6

6. 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

Answer 6

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.

Question 7

7. 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.

Answer 7

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.

Question 8

8. 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.

Answer 8

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.

Question 9

9. 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

Answer 9

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.

Question 10

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

Answer 10

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.

Question 11

11. 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

Answer 11

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.

Question 12

12. 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

Answer 12

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.

Question 13

13. 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

Answer 13

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.

Question 14

14. 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.

Answer 14

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.

Question 15

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

Answer 15

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.

Question 16

16. A group of nursing students are giving a report on the emergence of drug-resistant microbial agents.
    What could the students cite as a good way to minimize the emergence of drug-resistant microbial
    agents? (Select all that apply.)
    A) Avoid the use of broad-spectrum antibacterial drugs when treating trivial or viral infections.
    B) Use narrow-spectrum agents if they are thought to be effective.
    C) Do not use vancomycin unnecessarily.
    D) Antibiotics are best started before the culture and sensitivity report returns.
    E) Administer the smallest effective dosage available.

Answer 16

Ans: A, B, C
Feedback:
Exposure to an antimicrobial agent leads to the development of resistance, so it is important to limit the
use of antimicrobial agents to the treatment of specific pathogens known to be sensitive to the drug
being used. Drug dosage is important in preventing the development of resistance. Doses should be
high enough and the duration of drug therapy should be long enough to eradicate even slightly resistant
microorganisms. It is best to wait until cultures return before initiating antibiotics when possible, but
patients with severe infections may be started on broad -spectrum antibiotics while waiting for culture
results.

Question 17

17. The home care nurse is taking care of a patient on IV vancomycin for cellulitis of the left calf. How
    would the nurse explain how microorganisms develop resistance to anti-infective medications?
    A) Microorganisms can alter the blood supply to the infection.
    B) Microorganisms can stop the cell from reproducing.
    C) Microorganisms produce a chemical that acts as an antagonist to the drug.
    D) Microorganisms change their cell membrane to make it look like the drug.

Answer 17

Ans: C
Feedback:
Microorganisms develop resistance in a number of ways, including the following: changing cellular
permeability to prevent the drug from entering the cell or altering transport systems to exclude the drug
from active transport into the cell; altering binding sites on the membranes or ribosomes, which then no
longer accept the drug; and producing a chemical that acts as an antagonist to the drug. Microorganisms
do not alter the blood supply to the infection, stop a cell from reproducing, or change the appearance of
the cell membrane.

Question 18

18. Overuse of anti-infective agents is known to contribute to the onset of superinfections in the body.
    What is a causative agent of a superinfection?
    A) Escherichia coli
    B) Probenecid
    C) Protozoans
    D) Pseudomonas

Answer 18

Ans: D
Feedback:
Common superinfections include vaginal or gastrointestinal 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. Probenicid is a medication, not a causative organism.
Protozoa and E. coli do not usually cause superinfections.

Question 19

19. The pharmacology instructor is explaining combination drugs to the nursing class. The instructor tells
    the students that a combination of anti-infective agents may be used for several reasons. What is one of
    them?
    A) Some drugs are synergistic.
    B) Increased likelihood of killing the microorganisms
    C) Requires larger doses of the drugs
    D) Absorption of drugs increased

Answer 19

Ans: A
Feedback:
Some drugs are synergistic, which means that they are more powerful when given in combination. The
health care provider may be encouraged to use a smaller dosage of each drug, leading to fewer adverse
effects, but still having a therapeutic impact on the pathogen. Many microbial infections are caused by
more than one organism; each pathogen may react to a different anti-infective agent. Combination
drugs do not have a better chance at killing the microorganism and they do not increase the absorption
of the drugs.

Question 20

20. Bactericidal agents do not prevent compounds fight infection and destroy microorganisms by inhibiting
    what?
    A) Protein synthesis
    B) Deoxyribonucleic acid (DNA) replication
    C) Cell wall synthesis
    D) Leukocytes

Answer 20

Ans: A
Feedback:
Some anti-infectives are so active against the infective microorganisms that they actually cause the
death of the cells they affect. These drugs are said to be bactericidal. Bactericidal action inhibits protein
synthesis. Bacteriocidal agents do not prevent DNA replication , do not inhibit cell wall synthesis, and
do not impact leukocytes.

Question 21

21. The nurse is caring for a child who weighs 30 kg. The physician orders gentamicin (Garamycin) tid.
    The recommended dosage range is 6 to 7.5 mg/kg/day. Why is it important to give a dosage within this
    recommended range? (Select all that apply.)
    A) To avoid toxic effects
    B) To protect other patients
    C) To reduce the risk of drug-resistant organisms
    D) To eradicate the bacteria
    E) To promote lactic acid removal

Answer 21

Ans: A, B, C, D
Feedback:
By administering the correct dosage, you avoid overdosage and reduce the risk of toxic effects. The
correct dosage reduces the risk of creating drug-resistant organisms; it also protects both the patient and
the other patients who might be susceptible to the drug-resistant organisms as well. The proper dosage
is needed to eradicate the bacteria. Lactic acid removal is not related to the proper dosage and is a
distracter for this question.

Question 22

22. The nurse is administering an anti-infective to a pediatric patient. What will the nurse assess for related
to adverse effects in this patient?
A) Cardiovascular function and perfusion
B) Hydration and nutritional status
C) Liver and pancreatic function
D) Rest and sleep status

Answer 22

Ans: B
Feedback:
Because children can have increased susceptibility to the gastrointestinal and nervous system effects of
anti-infectives, monitor hydration and nutritional status carefully. Patients should be encouraged to
drink fluids. Cardiovascular, hepatic, and pancreatic function are not at greater risk in children. Rest
and sleep status are important but are not impacted by anti-infectives.

Question 23

23. A parasitic infection is suspected. What type of culture is the nurse likely to collect?
A) Blood
B) Urine
C) Stool
D) Sputum

Answer 23

Ans: C
Feedback: When investigators search for parasitic sources of infection, the stool is examined for ova and parasites.
Blood, urine, and sputum are unlikely to reflect signs of parasitic infection.

Question 24

24. The nurse is caring for a patient receiving IV aminoglycosides for an intractable infection in his or her
    leg. What would it be important for the nurse to monitor this patient for?
    A) Visual disturbances
    B) Liver dysfunction
    C) Serum glucose levels
    D) Renal dysfunction

Answer 24

Ans: D
Feedback:
When patients are taking aminoglycosides, it is important they be monitored closely for any sign of
renal dysfunction. Aminoglycosides do not generally cause visual disturbances, liver dysfunction, or
altered serum glucose levels.

Question 25

25. The nurse collects the past medical history of a patient new to the clinic. The patient states he or she is
    allergic to penicillin. What would the nurse question next? (Select all that apply.)
    A) What signs and symptoms were displayed with the reaction?
    B) What treatment was required to control the allergic reaction?
    C) How was the medication administered?
    D) How many dosages were administered before the reaction occurred?
    E) Had the medication ever been prescribed before the time when the reaction occurred?

Answer 25

Ans: A, D, E
Feedback:
It is important to determine what the allergic reaction was and when the patient experienced it (e.g.,
after first use of drug, after years of use). If she had been prescribed this medication before with no
reaction and then had a reaction the next time it was prescribed, this would be important information to
know. Some patients 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 or who the caregiver was at the time of the
reaction or what type of allergic reaction it was.

Question 26

26. A patient comes to the clinic to talk with the nurse about planned overseas travel. The patient tells the
    nurse that he or she is planning a trip to an area of the world where malaria is common. He wants to
    know how to prevent contracting the disease. What should the nurse respond?
    A) We can ask the physician to give you some anti-infectives in case you get malaria.
    B) We can ask the physician for some anti-infectives for you to take prophylactically.
    C) Don’t worry, if you get malaria they have some good doctors where you are going.
    D) If you get malaria, you can always be treated on the way home.

Answer 26

Ans: B
Feedback:
Some anti-infectives are used as a means of prophylaxis when patients expect to be in situations that
will expose them to a known pathogen, such as travel to an area where malaria is endemic, or
undergoing oral or invasive gastrointestinal surgery in a person who is susceptible to subacute bacterial
endocarditis. After the patient contracts malaria, it is much harder to treat so he would not start the
medication or obtain treatment after being infected

Question 27

27. The nurse is caring for a patient who is receiving a broad-spectrum anti-infective agents. The nurse
    would assess the patient for what common adverse effect of broad spectrum anti-infective agents?
    A) Destruction of pathogens
    B) Decrease in infection
    C) Destruction of the normal flora
    D) Decrease in inflammation

Answer 27

Ans: C
Feedback:
One offshoot of the use of anti-infectives, especially broad-spectrum anti-infectives, is destruction of
the normal flora resulting in superinfections. Destruction of pathogens is the therapeutic effect and not
an adverse effect resulting in a decrease in infection. Inflammation is reduced by resolution of
infection.

Question 28

28. Selective toxicity, or the ability to affect certain proteins or enzyme systems in the infecting organism,
    is a much sought-after quality in an anti-infective agent. How many anti-infective agents have this
    quality?
    A) 75%
    B) 50%
    C) 25%
    D) 0%

Answer 28

Ans: D
Feedback:
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 by the
infecting organism but not by human cells. Because all living cells are somewhat similar, however, no
anti-infective drug has yet been developed that does not affect the host. Therefore Options A, B, and C
are incorrect

Question 29

29. The nursing instructor teaches the students about selective toxicity when one of the students asks, What
    happens when a drug doesn’t have selective toxicity? What is the instructor’s best response?
    A) Healthy cells are damaged.
    B) All pathogens are destroyed in the body.
    C) Reduced enzymes are produced.
    D) Protein malnutrition

Answer 29

Ans: A
Feedback:
When a drug does not display selective toxicity, healthy cells are damaged because the drug does not
specifically target only the pathogen. Anti-infectives work by a variety of different means so one drug
is not likely to kill every type of pathogen in the body. Selective toxicity does not impact enzyme
production or cause protein malnutrition.

Question 30

30. The nursing instructor is talking with the students about anti-infective medication and explains that
    drugs that are very selective in their actions are said to be what?
    A) Broad spectrum
    B) Narrow spectrum
    C) Bactericidal
    D) Bacteriostatic

Answer 30

Ans: B
Feedback:
Some anti-infectives are so selective in their action that they are effective against only a few, or
possibly only one, microorganism with a very specific metabolic pathway or enzyme. These drugs are
said to have a narrow spectrum of activity. They are not called broad spectrum, which applies to a drug
with little selectivity; bactericidal, which is a substance that causes death of bacteria; or bacteriostatic,
which prevents replication of a bacterium.

Question 31

31. The nurse administers polymyxin B to a patient with a gram-negative bacterial infection. What
    symptoms would cause the nurse to suspect drug fever, hold the medication, and call the health care
    provider immediately? (Select all that apply.)
    A) Fever
    B) Dizziness
    C) Ataxia
    D) Increased activity
    E) Reduced urine output

Answer 31

Ans: A, B, C, E
Feedback:
The actions of polymyxin B on cell membranes means it can be toxic to the human host, leading to
nephrotoxicity, neurotoxicity (e.g., facial flushing, dizziness, ataxia, paresthesias, drowsiness), and
drug-related fever and rash. This drug is reserved for infections that do not respond to less toxic drugs;
the nurse needs to be alert for serious reactions and hold the drug until notifying the provider.

Question 32

32. The charge nurse, working on a pediatric unit, sees an order was written to administer chloramphenicol
    (Chloromycetin) to one of the children assigned to a new graduate nurse. The charge nurse would make
    sure the new graduate was familiar with what possible adverse effects of this medication? (Select all
    that apply.)
    A) Gray syndrome
    B) Bone marrow depression
    C) Aplastic anemia
    D) Liver failure
    E) Hearing loss

Answer 32

Ans: A, B, C
Feedback:
Chloramphenicol (Chloromycetin), an older antibiotic, prevents bacterial cell division in susceptible
bacteria. Because of the potential toxic effects of this drug, its use is limited to serious infections for
which no other antibiotic is effective. Chloramphenicol produces a gray syndrome in neonates and
premature babies, which is characterized by abdominal distention, pallid cyanosis, vasomotor collapse,
irregular respirations, and even death. In addition, the drug may cause bone marrow depression,
including aplastic anemia that can result in death. Liver failure and hearing loss are not usually
associated with this drug.

Question 33

33. The patient in the clinic receives a prescription for an anti-infective to treat a urinary tract infection.
    The patient asks the nurse, Would you ask the doctor to give me refills on this prescription? I get a
    urinary tract infection almost once a year it seems and I’d like to have a refill I can store for the next
    time so I don’t have to come back to the clinic. What is the nurse’s priority response?
    A) Sure, I’d be glad to ask. How many refills would you like to have?
    B) Most medications, if not used, should be discarded after a year so it is better to get a new
    prescription next year when you need it.
    C) This antibiotic doesn’t destroy every pathogen that could cause a urinary tract infection so it is
    better to get the right antibiotic next time.
    D) Saving antibiotics for another time and self-diagnosing when antibiotics are needed lead to
    resistant organisms that no longer respond to drugs.

Answer 33

Ans: D
Feedback:
Option A is incorrect because the patient should not be given refills to use indiscriminately. The
remaining options are all important teaching points for this patient, but the priority is teaching this
patient about drug-resistant organisms and how they can be prevented, as well as what happens if an
infection results from a resistant organism.

Question 34

34. The nurse admits a patient with septicemia (i.e., infection in the bloodstream). The patient denies any
    allergies and the doctor has ordered cefuroxime based on blood culture results that report the active
    pathogen is susceptible to this drug. The patient asks what antibiotic was ordered, and when the nurse
    says cefuroxime, the patient says, Call my doctor and tell him I want vancomycin because I’ve been
    reading about drug-resistant bacteria and I don’t want to take any chances. What is the nurse’s best response?
    A) Vancomycin is a powerful drug with many adverse effects and it is reserved for when no other
    drug will work against the infection.
    B) There are some resistant infections that require vancomycin so you are right to prefer a stronger
    antibiotic.
    C) I appreciate your concern but your doctor ordered the right medication for you so don’t worry
    about it.
    D) You can’t believe anything you read on the Internet because most of it is just someone’s opinion
    and not fact.

Answer 34

Ans: A
Feedback:
The patient is right in saying that vancomycin is effective against drug-resistant bacteria but needs help
to understand that he or she does not have a resistant infection as indicated by the culture and
sensitivity and that use of such a powerful drug when it is not needed increases risk of developing a
vancomycin-resistant infection. It is never right to tell a patient not to worry because they have every
right to participate in his or her own care and should not be patronized. Although some information on
the Internet may not be accurate, it would be incorrect to say it is all just someone’s opinion and not
fact, especially given that the patient’s information is accurate.

Question 35

35. The mother brings her 18-month-old toddler to the pediatrician because the child has a fever and has
    been tugging on his or her left ear. Examination of the tympanic membrane confirms an ear infection
    and the toddler also has a cold with nasal congestion, rhinorrhea, and a cough. The provider tells the
    mother to apply heat and gives her a prescription for an otic anesthetic to make the ear more
    comfortable until the infection resolves. The mother is not happy and says she wants a prescription for
    an antibiotic. What important teaching points will the nurse include in the teaching plan? (Select all that
    apply.)
    A) Ear infections that accompany viral respiratory infections do not respond to antibiotics.
    B) Habitual use of antibiotics for viral infections contribute to development of resistant strains.
    C) Adverse effects from antibiotics in children can cause diarrhea and dehydration.
    D) Antibiotics will only be prescribed if a culture indicates the presence of bacteria in the ear.
    E) The pediatrician knows more than the mother and she should trust what she is being told.

Answer 35

Ans: A, B, C
Feedback: When the child has a viral respiratory infection, the organism involved in ear infections is usually viral
as well. As a result, antibiotics will have no effect on the infection that will resolve independently and
only comfort care is indicated. Habitual use of antibiotics for viral infections contributes to the
development of resistant strains of bacteria and the adverse effects can make the child more
uncomfortable causing diarrhea and dehydration. Cultures of ear fluid are almost never done because it
would be an invasive procedure to remove fluid from the middle ear. It is never right for the nurse to
patronize the mother, who has every right to advocate for her child, and it is more important she
understand why the antibiotic is not being prescribed than telling her the pediatrician knows more.