Ch8 - Focus on Nursing Pharmacology 6e Instructor Test Bank PDF

Preview

Summary

Focus on Nursing Pharmacology 6e
Instructor Test Bank...

Description

Chapter 8- Anti-infective Agents

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. 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 toxicityrefers to the ability to affect certain proteins or enzyme systems that are used by infecting organisms, but not by human cells. 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?

1

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. 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

2

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 4.

an anti-infective. 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

3

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. 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 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

4

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 anti6.

infective drugs. What is one way the nursing students would learn that microorganisms develop resistance to anti-infective 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. 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?

5

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 8.

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. Prescriptions for antibiotics should be readily available so they can be filled as soon

C)

6

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 9.

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

7

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.

8

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 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. 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

9

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. 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

10

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 14. 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.  What you have described is the halo effect of the drug, making you feel better

C)

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:

11

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.

12

A group of nursing students are giving a report on the emergence of drug-resistant 16.

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. 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. The home care nurse is taking care of a patient on IV vancomycin for cellulitis of the left 17.

calf. How would the nurse explain how microorganisms develop resistance to anti-

13

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. 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. 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

14

C) Protozoans D) Pseudomonas Ans:

D

Feedback: Common superinfections include vaginal or gastrointestinal yeast infections, which are associated with antibiotic therapy, and infections caused by Proteus and Pseudomonasthroughout 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. The pharmacology instructor is explaining combination drugs to the nursing class. The 19.

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 Ans:

A

15

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. 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 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

16

replication , do not inhibit cell wall synthesis, and do not impact leukocytes. The nurse is caring for a child who weighs 30 kg. The physician orders gentamicin 21.

(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 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 drugresistant organisms as well. The proper dosage is needed to eradicate the bacteria. Lactic acid removal i...