Question 1

A child has received amoxicillin [Amoxil] for three previous ear infections, but a current otitis media episode is not responding to treatment. The nurse caring for this child suspects that resistance to the bacterial agent has occurred by which microbial mechanism?

A) Alteration of drug target molecules
B) Antagonist production
C) Drug inactivation
D) Reduction of drug concentration at the site of action

Drug inactivation

Accepted Answer

Drug inactivation can occur when microbes produce drug-metabolizing enzymes. Penicillin-resistant organisms, including many that cause otitis media, produce penicillinase. Alteration of drug target molecules, drug inactivation, and reduction of the drug concentration occur with other antimicrobials.

Question 2

Which are benefits of using a combination of two or more antibiotics?&#10;A) Reduced cost&#10;B) Reduced risk of superinfection&#10;C) Reduced toxicity&#10;D) Reduced resistance&#10;E) Reduced risk in severe infection

Accepted Answer

In some situations, an antibiotic combination can reduce toxicity, because the dosage of a more toxic agent can be reduced. Drug combinations can be used to suppress the emergence of resistant bacteria in the treatment of tuberculosis. With a severe infection, a combination of antibiotics is useful until culture results are known to ensure that all possible sources of infection are treated. Using multiple antibiotics is more costly and poses a greater risk of superinfection.

Question 3

A parent asks a nurse if the provider will prescribe an antibiotic for a child who attends school with several children who have strep throat. The child is complaining of a sore throat and has a fever. What will be the nurse's response?

A) "Because strep throat is likely, your child should be treated empirically."
B) "With good hand washing, your child should not get strep throat."
C) "Your child probably has strep throat, so your provider will order an antibiotic."
D) "Your child should come to the clinic to have a throat culture done today."

"Your child should come to the clinic to have a throat culture done today."

Accepted Answer

Whenever possible, the infecting organism should be identified before antibiotics are started, even if there is a strong suspicion that a particular organism is present. The nurse is correct in telling the parent to bring the child to the clinic for a throat culture. Fever and sore throat have other causes, so it is not correct to treat this child empirically, especially because these symptoms are not severe or life threatening. Although good hand washing is always indicated, this child already has symptoms and needs to be evaluated. Antibiotics should not be started until indicated by cultures.

Question 4

A recent campaign, initiated by the Centers for Disease Control (CDC), to delay the emergence of antibiotic resistance in hospitals, has what as one of its objectives?&#10;A) Allowing patients to stop antibiotics when symptoms subside&#10;B) Allowing prescribers to develop their own prescribing guidelines&#10;C) Increased adherence to prescribed antibiotics&#10;D) Increased use of antibiotics among parents of young children

Accepted Answer

The CDC initiative has identified three objectives to help delay the emergence of resistance to antibiotics in hospitals. One of the objectives is to increase adherence to prescribed antibiotics among users. Allowing patients to stop using antibiotics before the prescription ends is not one of the objectives and may increase the risk of resistance. Other objectives include ensuring that prescribers adhere to appropriate prescribing guidelines instead of developing their own and decreasing antibiotic use among parents of small children.

Question 5

Which patients should be given antibiotics prophylactically?&#10;A) Children who attend day care with other children who have strep throat&#10;B) Children undergoing chemotherapy who have mild neutropenia&#10;C) Patients with certain congenital heart defects at risk for bacterial endocarditis&#10;D) Patients with compound fractures undergoing surgical repair&#10;E) Postoperative patients who have undergone emergency cesarean sections

Accepted Answer

Antimicrobial prophylaxis is recommended for patients with congenital or other heart disease who have an increased risk for bacterial endocarditis and for patients undergoing certain surgeries in which the risk for infection is very high, including those who have compound fractures. Children who are exposed to strep throat will need to have confirmed strep infection prior to receiving antibiotics. Patients with milk neutropenia do not need antimicrobial prophylaxis. Patients undergoing emergency C-sections need antimicrobial prophylaxis prior to surgery, not after.

Question 6

A nursing student asks a nurse to clarify the differences between the mechanisms of spontaneous mutation and conjugation in acquired resistance of microbes. What will the nurse say?&#10;A) Conjugation results in a gradual increase in resistance.&#10;B) Conjugation results in random changes in the microbe's DNA.&#10;C) Spontaneous mutation leads to resistance to only one antimicrobial agent.&#10;D) Spontaneous mutation can transfer DNA from one organism to another.

Accepted Answer

Spontaneous mutation generally confers resistance to only one drug. Conjugation can occur quickly; spontaneous mutation is gradual. Spontaneous mutation is random; conjugation is not. Conjugation can occur with the transfer of DNA from one organism to another.

Question 7

An older adult patient with chronic obstructive pulmonary disease (COPD) develops bronchitis. The patient has a temperature of 39.5&#176;C. The nurse will expect the provider to:&#10;A) obtain a sputum culture and wait for the results before prescribing an antibiotic.&#10;B) order empiric antibiotics while waiting for sputum culture results.&#10;C) treat symptomatically, because antibiotics are usually ineffective against bronchitis.&#10;D) treat the patient with more than one antibiotic without obtaining cultures.

Accepted Answer

Patients with severe infections should be treated while culture results are pending. If a patient has a severe infection or is at risk of serious sequelae if treatment is not begun immediately, it is not correct to wait for culture results before beginning treatment. Until a bacterial infection is ruled out, treating symptomatically is not indicated. Treating without obtaining cultures is not recommended.

Question 8

A patient has a localized skin infection, which is most likely caused by a gram-positive cocci. Until the culture and sensitivity results are available, the nurse will expect the provider to order a ____-spectrum ____ agent.

A) broad; systemic
B) broad; topical
C) narrow; systemic
D) narrow; topical

Accepted Answer

When infections are treated before the causative agent has been identified, and after cultures have been obtained, antibiotics may be used based on the knowledge of which microbes are most likely to cause infection at that particular site. Because this is a localized infection, a topical agent is recommended. Unless the infection is very serious, a narrow-spectrum antibiotic is best.

Question 9

The nurse is teaching a pharmacology refresher course to a group of nurses. A student asks what host factors affect the choice of agents in antimicrobial therapy. The nurse will tell the students that such host factors include what?

A) Age
B) Gender
C) Immune system status
D) Infection site
E) Weight

Accepted Answer

Host factors, such as the patient's age, immune status, and the site of the infection, affect the choice of antimicrobial therapy used to treat an infection. Gender and weight do not affect the choice of antimicrobial but may affect the dose and route of administration.

Question 10

The nurse has been caring for a patient who has been taking antibiotics for 3 weeks. Upon assessing the patient, the nurse notices the individual has developed oral thrush. What describes the etiology of the thrush?

A) Antibiotic resistance
B) Community-acquired infection
C) Nosocomial infection
D) Superinfection

Accepted Answer

Oral thrush is a manifestation of a superinfection. The development of thrush is not a symptom of antibiotic resistance. Oral thrush typically is not a community-acquired infection. The development of thrush is not a nosocomial infection.

Question 11

The nurse is caring for a patient on a medical-surgical unit who has a fever of unknown origin. The prescriber has ordered a broad-spectrum antibiotic. Which intervention is the priority?&#10;A) Administering the antibiotic immediately&#10;B) Administering antipyretics as soon as possible&#10;C) Delaying administration of the antibiotic until the culture results are available&#10;D) Obtaining all cultures before the antibiotic is administered

Accepted Answer

The answer of The nurse is caring for a patient...

Question 12

A patient has a viral sinus infection, and the provider tells the patient that antibiotics will not be prescribed. The patient wants to take an antibiotic and asks the nurse what possible harm could occur by taking an antibiotic. Which response by the nurse is correct?

A) "Antibiotics are mutagenic and can produce changes that cause resistance."
B) "Even normal flora can develop resistance and transfer this to pathogens."
C) "Host cells become resistant to antibiotics with repeated use."
D) "Patients who overuse antibiotics are more likely to have nosocomial infections."

Accepted Answer

The answer of A patient has a viral sinus infection,...

Question 13

The nurse is teaching a nursing student about the mechanism by which antimicrobial agents achieve selective toxicity. Which statement by the student indicates a need for further teaching?&#10;A) &#34;Some agents disrupt the bacterial cell wall.&#34;&#10;B) &#34;Some agents act to block the conversion of para-aminobenzoic acid (PABA) to folic acid.&#34;&#10;C) &#34;Some agents cause phagocytosis of bacterial cells.&#34;&#10;D) &#34;Some agents weaken the cell wall, causing cell wall lysis.&#34;

Accepted Answer

The answer of The nurse is teaching a nursing student...

Deck 83: Basic Principles of Antimicrobial Therapy