Pharmacology Chapter 8: Anti-Infective Agents – Flashcards
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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? A. Refer the client to the health care provider because the client may be experiencing resistance. B. Assess the client for additional signs of superinfection. C. Assess the client for a new onset of drug hypersensitivity. D. Educate the client about the phenomenon of drug tolerance.
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A. 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 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 anti-infectives, however, resistance is more likely.
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The nurse is assessing a client who has recently been given the first dose of a new anti-infective. What finding should lead the nurse to suspect that the client is experiencing a hypersensitivity reaction? A. The client has a facial and trunk rash. B. The client is experiencing vertigo. C. The client's blood pressure is 141/88 mm Hg. D. The client recently had an episode of diarrhea.
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A. 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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When caring for infants and the elderly who are in need of an antimicrobial agent, the nurse is aware that when compared with doses for young and middle-aged adults, these clients may require: A. higher dose. B. the same dose. C. a lower dose. D. the same dose but less frequent.
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C. Infants and the elderly are the populations most vulnerable to drug toxicity. In the infant, the liver and kidneys are still immature and may have difficulty metabolizing or excreting the drug, which results in accumulation. The same process in the elderly is related to the age of their liver and kidneys, which may no longer be functioning at an optimal level. Prescribers may request lower doses of antimicrobial agents for these two populations to minimize the risk for toxicity. The frequency is important in antimicrobial therapy and would not be decreased.
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A nurse is aware that the concept of selective toxicity is foundational to antimicrobial therapy. Which statement most accurately describes selective toxicity? A. A drug harms microbes without harming human cells. B. A drug's effect on microorganisms is proportionate to dose. C. Most microbes may be collected from a host and cultured on an alternative medium. D. A drug can be isolated and produced in a controlled manner in a laboratory setting.
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A. An important principle of antimicrobial therapy is selective toxicity, which is the ability to suppress or kill an infecting microbe without injury to the host. This concept does not denote dose-dependent effects, the ability to culture a microorganism, or the production of a drug.
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When describing an anti-infective agent with a narrow spectrum of activity, what would the nurse include? A. The drug is highly aggressive in killing the pathogen. B. The drug is selective in its action on organisms. C. The drug is effective in interfering with the cell's reproduction. D. The drug is effective against many different organisms.
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D. An anti-infective with a narrow spectrum of activity is selective in its action; thus, it is effective against only a few microorganisms with a very specific metabolic pathway or enzyme. Broad-spectrum activity refers to effectiveness against a wide variety of pathogens. Bactericidal refers to a highly aggressive drug that causes cell death. Bacteriostatic refers to a drug's effectiveness in interfering with a cell's ability to reproduce or divide.
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The hospital nurse is caring for a group of adult clients. For which client should the nurse most likely administer prophylactic anti-infectives? A. A client with diabetic nephropathy who has recently begun dialysis B. A client who has hyperkalemia and who is receiving sodium polystyrene C. A client with colorectal cancer who is pre-operative for a bowel resection D. A client who is undergoing cardiac rehabilitation following a myocardial infarction
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C. Abdominal surgery is a common indication for antibiotic prophylaxis, since these surgeries present a significant risk for infection. For this reason, a pre-operative 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.
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A client has been diagnosed with an infection. The nurse can help to ensure the success of anti-infective treatment by: A. confirming that the medication prescribed is the drug of choice for the specific microorganism. B. teaching the client that significant adverse effects are expected, and must be endured during treatment. C. administering antihistamines, as ordered, to prevent the development of adverse effects. D. monitoring the client closely for signs of arrhythmias or cardiac ischemia.
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A. 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.
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A nurse is asked to explain the difference between community-acquired infections and nosocomial infections. What response best describes the difference? A. Usually, community-acquired infections are less severe and easier to treat since nosocomial infections often occur in people whose immunity is impaired. B. Usually, nosocomial infections are less severe and easier to treat since community-acquired infections often result from drug-resistant microorganisms. C. There is no epidemiological difference between the infection types; they are simply categorized as community-acquired or nosocomial. D. Only drug-resistant strains of staphylococci, Pseudomonas, and Proteus are categorized as nosocomial infections.
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A. Infections are often categorized as community-acquired or nosocomial. Because the microbial environments differ, the two types of infections often have different causes and require different antimicrobial treatment. Generally, community-acquired infections are less severe and easier to treat, although antibiotic-resistant strains are increasing (e.g., methicillin-resistant Staphylococcus aureus [MRSA]). Nosocomial infections may be more severe and difficult to manage because they often result from drug-resistant microorganisms and occur in people whose immunity is impaired. Drug-resistant strains of staphylococci, Pseudomonas, and Proteus are common causes of nosocomial infections.
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What is a major factor that influences whether an individual will acquire an infection? A. the number of effective drugs available to an antibiotic-resistant infections B. implementation of continuous antimicrobial treatment of the infection C. the infection's tendency to recur and involve simple organisms D. the person's ability to defend against the would-be invaders
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D. 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 increase the incidence and severity of infections and impede recovery. In addition, use of antimicrobial drugs may lead to serious infections caused by drug-resistant microorganisms.
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Although the numbers and virulence of microorganisms help determine whether a person acquires an infection, another major factor is: A. the number of effective drugs available for serious or antibiotic-resistant infections. B. the host's ability to defend itself against the would-be invaders. C. infections that tend to recur and involve simple organisms. D. continuous antimicrobial treatment of infections.
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B. 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 increase the incidence and severity of infections and impede recovery. In addition, use of antimicrobial drugs may lead to serious infections caused by drug-resistant microorganisms.
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A client is receiving aminoglycoside therapy. The nurse would be alert for: A. lethargy. B. kidney dysfunction. D. loss of vision. D. hallucinations.
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B. 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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A client comes to the clinic reporting mouth sores that appear consistent with an oral yeast infection. The nurse should question the client about recent use of: A. antibiotics. B. antivirals. C. oral contraceptive agents. D. antiprotozoals.
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A. 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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The nurse is preparing to administer a drug that is bactericidal. The nurse should explain what characteristic of this drug? A. It is selective in its action on organisms. B. It is effective against many different organisms. C. It will directly cause the death of pathogenic cells. D. It is effective in interfering with cell reproduction.
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C. Bactericidal refers to a highly aggressive drug that causes cell death. An anti-infective 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.
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An elderly client is treated for pneumonia with clindamycin. One week after the completion of the medication, the client develops diarrhea. What is the most probable cause of the diarrhea? A. incontinence B. Crohn's disease C. food-borne illness D. change in normal flora
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D. Much of the normal flora can cause disease under certain conditions, especially in the elderly, debilitated, or immunosuppressed people. Normal bowel flora also synthesizes vitamin K and vitamin B complex. The development of infectious diarrhea is related to the change in the normal flora of the bowel. Food-borne illness, Crohn's disease, and incontinence do not contribute to the development of diarrhea.
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A client with burns has developed a wound infection. This client is experiencing what type of wound infection? A. food-borne infection B. fungal infection C. nosocomial infection D. opportunistic infection
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D. 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, or food-borne infection, but the risk for all infections is high due to the client's opportunistic nature of the burn.
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An immunocompromised patient in a critical care setting has developed a respiratory infection that has been attributed to methicillin-resistant Staphylococcus aureus (MRSA). The nurse should anticipate that the patient will require treatment with A. vancomycin. B. clindamycin. C. ciprofloxacin. D. an antistaphylococcic penicillin.
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A. Vancomycin is the drug of choice to manage infections caused by MRSA. MRSA is resistant to all of the antistaphylococcic penicillins, as well as to ciprofloxacin and clindamycin.
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The client is taking an antibiotic for a urinary tract infection. The client asks how the antibiotic interferes with the growth of bacteria. The nurse explains that the antibiotic has the ability to suppress or kill an infecting microbe without injury to the host. This is referred to as: A. host cell reactivity. B. cell-specific immunity. C. selective toxicity. D. homeostasis.
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C. An important principle of antimicrobial therapy is selective toxicity, which is the ability to suppress or kill an infecting microbe without injury to the host. Selective toxicity is achievable because the drug accumulates in a microbe at a higher level than in human cells; the drug has a specific action on cellular structures or biochemical processes that are unique to the microbe; or an action of a drug on biochemical processes is more harmful to the microbe than to host cells.
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A client is admitted to the hospital with elevated temperature, chills, cough, and fatigue. The health care provider orders a chest x-ray, which indicates pneumonia. The blood cultures also come back positive for a Gram-negative bacillus. The provider orders two antibiotics to be given to the client, one for Gram-negative organisms and one for Gram-positive organisms. Why does the provider not prescribe just one antibiotic for both types of bacteria? A. Broad-spectrum antibiotics can cause antibiotic resistance. B. It is better for the client to be on two medications. C. There is a cost savings when prescribing narrow-spectrum antibiotics. D. There are not any antibiotics available in the United States that treat both bacteria.
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A. All antimicrobials have the ability to promote the emergence of drug-resistant microbes. However, resistance is more likely to occur in organisms exposed to broad-spectrum drugs. Although the use of antimicrobials promotes the potential for drug resistance to occur, they do not directly cause the resistance.
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When an anti-infective's function is to destroy the infective pathogen, it is classified as: A. bacteriostatic. B. sensitive. C. resistant. D. bacteriocidal.
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D. 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.
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Aminogylcoside antibiotics tend to collect in the eighth cranial nerve. The nurse would anticipate that which clinical manifestation may occur from the cranial nerve involvement? A. Slurred speech B. Inability to swallow C. Vertigo D. Blindness
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C. The aminoglycosides antibiotics collect in the eighth cranial nerve and can cause dizziness, vertigo, and loss of hearing.
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Which would be tested to determine parasitic sources of infection? A. Sputum B. Sweat C. Blood D. Stool
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D. When investigators search for parasitic sources of infection, they may examine stool for ova and parasites.
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Some anti-infective medications are more powerful when given in combination. This means that they are: A. antagonistic. B. compatible. C. incompatible. D. synergistic.
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D. Synergistic drugs are drugs which are more powerful when given in combination.
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A female client calls the pediatrician's office because her child reports a sore throat. The nurse anticipates the pediatrician will take what action? A. Order an antibiotic. B. Request a throat culture. C. Request a list of drug allergies. D. Order an antitussive.
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B. For sore throat, a throat culture for streptococcal organisms should be performed and the results obtained before an antibiotic is prescribed.
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To ensure that the most appropriate drug is being used to treat a pathogen, which would need to be done first? A. Evaluating the bactericidal effects B. Obtaining sensitivity testing C. Using combination therapy D. Checking client allergies
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B. 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 drug. The bactericidal effects of a drug may or may not play a role in the selection of the drug.
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A drug that does not actually cause the death of a cell but does interfere with its ability to reproduce is said to be: A. bactericidal. D. drug resistant. C. bacteriostatic. D. broad spectrum.
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C. 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 anti-infective. Bacteriostatic activity can be found in both broad- and narrow-spectrum anti-infectives.
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An adult client has been treated for strep throat with ampicillin by mouth. The client visits the occupational health nurse and states she has vaginal itching. What organism is the cause of the vaginal itching? A. Proteus B. Klebsiella C. Enterobacter D. Candida
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D. The yeast Candida is a normal resident of the vagina and the intestinal tract. An antibacterial drug may destroy the normal bacterial flora without affecting the fungal organism. Klebsiella, Enterobacter, and Proteus will not contribute to the development of a yeast infection.
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A critically ill client has developed a fever of 38.9°C, and blood cultures have been drawn and sent to the laboratory for culture and sensitivity testing. Determination of the culture will give the care team what information? A. the most likely location of the infection B. whether the infection is antibiotic resistant C. the exact identity of the infectious microorganism D. the most likely origin of the infection
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C. Culture identifies the causative microorganism. It does not necessarily indicate the presence of antibiotic resistance. The origin or location of the infection may often been indirectly determined by the culture, but this is not always the case.
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A client has been taking antibiotics at home for the treatment of a respiratory infection for the past 6 days, and there is no evident improvement in the infection. Which nursing assessment is most appropriate? A. Assess the client's understanding of the illness. B. Assess the client's adherence to the medication regimen. C. Assess the client's use of herbal or alternative remedies. D. Assess the client's home hygiene.
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B. Nonadherence to antibiotic therapy can result in a continuation or exacerbation of the infection. Poor hygiene is a risk factor for the development of infection but is less likely to perpetuate an existing infection that is being treated appropriately with antibiotics. Herbs may be contraindicated but are unlikely to negate the therapeutic effects of an antibiotic. The nurse should gauge the client's understanding of the illness, but this does not have a bearing on the client's lack of improvement.
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An adult client is experiencing pain and swelling in the ankle from a fall. Which medications are appropriate for the nurse to suggest to the prescriber for symptom management? Select all that apply. A. antibiotics B. corticosteroid C. antianxiety D. non-steroidal anti-inflammatory (NSAID) E. aspirin
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B, D, E Aspirin, NSAIDs, and corticosteroids are administered to decrease inflammation such as swelling. Antibiotics are antimicrobial drugs used to treat bacterial infections, and antianxiety drugs are used to treat anxiety.
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Bactericidal
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Substance that causes the death of bacteria. Usually by interfering with CELL MEMBRANE STABILITY or with PROTEINS or ENZYMESnecessary to maintain the cellular integrity of the bacteria.
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Bacteriostatic
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Substance that prevents the replication of bacteria. Usually by interfering with PROTEINS or ENZYME SYSTEMS necessary for reproduction of the bacteria.
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Culture
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Sample of the bacteria. Sputum, cell scrapings, urine. Used to determine the species of bacteria that is causing the infection. Grown in a lab.
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Prophylaxis
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Treatment to prevent and infection BEFORE it occurs. Ex: The use of antibiotics in high risk patients to prevent bacterial endocarditis. Ex: The use of antiprotozoals to prevent malaria.
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Resistance
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The ability of pathogens to adapt to an anti-infective to produce cells that are no longer affected by a specific drug.
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Selective Toxicity
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Affects the infecting organisms but not the human cells.
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Spectrum
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Range of bacteria against which an antibiotic is effective
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Broad spectrum
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Antibiotics are effective against a wide range of bacteria.
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Narrow spectrum
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Antibiotics are effective only against very selective bacteria.
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Superinfection
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Infections that occur when opportunistic pathogens invade tissues and cause infections because the normal flora bacteria have been destroyed by antibiotic therapy.
