Question 1

A client is unable to give a urine sample for a culture and sensitivity (C&S) and asks the nurse why the health care provider does not just prescribe a "really strong" antibiotic. What does the nurse teach the client about outcomes associated with ordering the wrong antibiotic?

A) It will delay effective treatment.
B) It will give the bacteria more time to grow.
C) It can contribute to the development of drug-resistant bacteria.
D) It could result in superinfections.
E) It could result in an allergic response.

It will delay effective treatment.
It will give the bacteria more time to grow.
It can contribute to the development of drug-resistant bacteria.

Accepted Answer

Rationale 1: Prescribing the wrong antibiotic will delay effective treatment.
Rationale 2: Prescribing the wrong antibiotic will give the bacteria time to multiply.
Rationale 3: Prescribing the wrong antibiotic can contribute to the development of drug-resistant strains of bacteria.
Rationale 4: Prescribing the wrong antibiotic should not result in superinfections
Rationale 5: Prescribing the wrong antibiotic would not result in an allergic response unless the client is allergic to that particular antibiotic and this was not disclosed or known by the health care provider.

Question 2

Which of the following clients seen in the emergency does the nurse anticipate prophylactic antibiotic treatment?&#10;A) A client with a suppressed immune system.&#10;B) A client who has been bitten by a dog.&#10;C) A client whose spouse has been diagnosed with tuberculosis (TB).&#10;D) A client who is being treated for a venereal disease.&#10;E) A client who has just delivered a premature baby.&#10;

Accepted Answer

Rationale 1: A client with a suppressed immune system would be treated with prophylactic antibiotics.
Rationale 2: Deep wounds such as dog bites are treated with prophylactic antibiotics.
Rationale 3: Antitubercular drugs are prescribed prophylactically for any client in close contact with a person diagnosed with TB.
Rationale 4: A client who is being treated for a venereal disease would be treated with antibiotics to treat the venereal disease, this would not be considered prophylactic.
Rationale 5: A client who has just delivered a premature baby would not be considered high risk and would not be treated with prophylactic antibiotics.

Question 3

A client in the emergency department experienced a severe allergic response to penicillin. The client tells the nurse this is the first time she has ever taken this particular drug. Which questions can the nurse ask to determine the reason for the allergic response?

A) "Have you ever been exposed to mold?"
B) "Do you eat animal products that have been exposed to antibiotics?"
C) "Have you ever had another allergic reaction to a group of antibiotics called cephalosporins?"
D) "Do you have any seasonal allergies?"
E) "Do you have any diseases or are you taking any medications that suppress the immune system?"

"Have you ever been exposed to mold?"
"Do you eat animal products that have been exposed to antibiotics?"
"Have you ever had another allergic reaction to a group of antibiotics called cephalosporins?"

Accepted Answer

Rationale 1: Inadvertent exposure to mold could trigger an allergy to penicillin.
Rationale 2: Some farmers and ranchers use antibiotics such as penicillins to decrease the risk of infection in farm animals.
Rationale 3: There is a degree of cross-sensitivity between penicillin and cephalosporin drugs.
Rationale 4: Seasonal allergies do not predict a penicillin allergy.
Rationale 5: Immunosuppression or medications that challenge the immune system do not predict or cause a penicillin allergy.

Question 4

Student nurses are working at an outpatient clinic, where clients are often ordered antibiotics. Their instructor asks them to identify clients who would not be candidates for the drug tetracycline. Which of the following do the students choose?

A) A 60 year old with Lyme disease.
B) A 45 year old with a chlamydia infection.
C) A 6 year old with a pulmonary infection.
D) A 28 year old in her 2nd trimester of pregnancy.
E) A 42 year old with H-pylori.

Accepted Answer

Rationale 1:Tetracycline would be a drug of choice for someone with Lyme disease.
Rationale 2:Tetracycline would be a drug of choice for someone with chlamydial infections .
Rationale 3: Tetracycline is contraindicated in young children under 8 years of age and pregnant women due to it causing a yellow brown teeth discolouration and slowing of overall growth rate of fetuses.
Rationale 4: Tetracycline is contraindicated in young children under 8 years of age and pregnant women due to it causing a yellow brown teeth discolouration and slowing of overall growth rate of fetuses.
Rationale 5: Tetracycline would be a drug of choice for someone with H-pylori infection.

Question 5

Nursing students have completed a class on pharmacology for bacterial infections. At the end of the class, the nursing instructor asks the students to identify how antibiotic treatment for tuberculosis is different from other bacterial infections. What response by the students indicate further teaching is required?

A) Therapy may continue for up to 24 months
B) Therapy is necessary for approximately 2-6 months
C) Multiple drugs may be used in different combinations
D) Antituberculosis drugs can be used to prevent the disease
E) Isoniazid and Ciprofloxacin are first line drugs used to treat tuberculosis.

Accepted Answer

Rationale 1:This is a correct statement and does not indicate the need for further teaching. Therapy is necessary for usually 6-12 months, but can exceed this time period because of multi drug resistant infections.
Rationale 2: Therapy is necessary for usually 6-12 months, but can exceed this time period because of multi drug resistant infections.
Rationale 3: This is a correct statement and does not require further teaching. Multiple-drug
therapy is necessary because the mycobacteria grow slowly and resistance is common. Using multiple drugs in different combinations during the long treatment period lowers the potential
for resistance and increases the success of the therapy.
Rationale 4: This is a correct statement and does not require further teaching. difference is that antituberculosis drugs are extensively used for preventing the disease in addition to treating it. Chemoprophylaxis is used for close contacts or family members of recently infected TB clients.
Rationale 5: Isoniazid is a first line treatment, Ciprofloxacin is considered second line treatment for tuberculosis.

Question 6

Why is there a rising need for effective treatment for fungal infections over recent years?&#10;A) The increased incidence of HIV/AIDS.&#10;B) Advances in chemotherapeutic drugs.&#10;C) Increased use of indwelling IV catheters.&#10;D) The overuse of broad-spectrum antibiotics.&#10;E) The overuse of antiviral medications.&#10;

Accepted Answer

Rationale 1: The past few decades have seen a dramatic rise in the incidence of fungal infections due to AIDS. Fungi are much more complex than bacteria and require a different approach to pharmacotherapy.
Rationale 2: The past few decades have seen a dramatic rise in the incidence of fungal infections due to aggressive cancer chemotherapy. Fungi are much more complex than bacteria and require a different approach to pharmacotherapy.
Rationale 3: The past few decades have seen a dramatic rise in the incidence of fungal infections due to the widespread use of indwelling intravenous (IV) catheters. Fungi are much more complex than bacteria and require a different approach to pharmacotherapy.
Rationale 4: The past few decades have seen a dramatic rise in the incidence of fungal infections due to the overuse of broad-spectrum antibiotics. Fungi are much more complex than bacteria and require a different approach to pharmacotherapy.
Rationale 5: There is no evidence that the overuse of antiviral medications has increased the incidence of fungal infections.

Question 7

The nurse is providing instruction to a client with a fungal infection who will be discharged home soon. Which statement by the client indicates understanding of the teaching?&#10;A) &#34;Systemic infections require oral medications that have serious adverse effects.&#34;&#10;B) &#34;Superficial infections are considered more benign than are systemic infections.&#34;&#10;C) &#34;Newer medications can be used for superficial as well as systemic infections.&#34;&#10;D) &#34;Systemic infections are much more common than are superficial infections.&#34;&#10;E) &#34;Superficial infections are more difficult to treat than are systemic infections.&#34;&#10;

Accepted Answer

Rationale 1: Systemic fungal infections require many months of treatment with oral medications, many of which have serious side effects.
Rationale 2: Superficial fungal infections are considered more benign than are systemic infections.
Rationale 3: Newer medications can be used for both superficial and systemic infections.
Rationale 4: Superficial fungal infections are more common.
Rationale 5: Systemic infections are the most difficult to treat.

Question 8

Nursing students are preparing to go to a field school in Africa, an area high in malaria cases. Students will be asked to present a class on the prevention of malaria to community residents. What will the students include in their presentation?

A) Avoid eating bananas which may attract mosquitos
B) Stay indoors from dusk to dawn
C) Wear long sleeve shirts and pants
D) Use DDT based spray in areas where mosquitos lay eggs
E) Use malaria nets when sleeping

Accepted Answer

Rationale 1. There is no evidence to support that certain foods will attract mosquitos.
Rationale 2 Prevention of malaria is the best therapeutic option because the disease is very difficult to treat after it has been acquired. Staying indoors from dusk to dawn when mosquitoes are biting most, wearing long-sleeved shirts and long pants, sleeping under a mosquito
net, and using DEET-based insect repellents are recommended.
Rationale 3. Prevention of malaria is the best therapeutic option because the disease is very difficult to treat after it has been acquired. Staying indoors from dusk to dawn when mosquitoes are biting most, wearing long-sleeved shirts and long pants, sleeping under a mosquito
net, and using DEET-based insect repellents are recommended.
Rationale 4 DDT is no longer used as an insecticide due to its harmful effects on humans and animals. It is recommended that products with DEET are used as insect repellants
Rationale 5 Prevention of malaria is the best therapeutic option because the disease is very difficult to treat after it has been acquired. Staying indoors from dusk to dawn when mosquitoes are biting most, wearing long-sleeved shirts and long pants, sleeping under a mosquito net, and using DEET-based insect repellents are recommended.

Question 9

At the end of the module on pharmacotherapy of fungal, protozoan and helminthic infections, the nursing students are asked to identify why malaria is so difficult to treat. Which Answer by a student indicates understanding of the topic?

A) Overuse of drug therapies has caused resistance to all therapies.
B) The side effects are so severe that noncompliance is an issue.
C) The protozoan has mutated and is no longer affected by current drug therapies.
D) The protozoan has a multiple life stages that do not respond to one drug.

Accepted Answer

Rationale 1 While resistance is a problem, it is not the primary reason that the treatment is complex.
Rationale 2. There is no evidence to support this statement
Rationale 3. While the protozoan that is responsible for the disease goes through changes within a lifecycle, there is no evidence to support that a permanent mutation is responsible for the complex treatment.
Rationale 4. Drug therapy of protozoan infections is difficult due to the animals' complicated life cycles. Pharmacotherapy of malaria attempts to interrupt the complex life cycle of Plasmodium. Although successful early in the course of the disease, therapy becomes increasingly difficult as
the parasite enters different stages of its life cycle.

Deck 17: Basic Principles of Anti-Infective Pharmacotherapy