NURS 317 Unit 7 Pharm Chapter 8 Flashcards
A client has been diagnosed with a bacterial infection and been prescribed a bacteriostatic antiinfective. What will occur once the drug achieves sufficient serum levels?
A) Phagocytosis will occur, resulting in bacterial death.
B) Bacterial cell walls will rupture.
C) Bacterial cells will infect one another rather than the client’s body cells.
D) Bacterial cells will be unable to replicate.
D) Bacterial cells will be unable to replicate.
Rationale:Antiinfectives that are bacteriostatic prevent the replication of bacteria, usually by interfering with proteins or enzyme systems necessary for reproduction of the bacteria. They do not turn bacterial cells on one another or cause phagocytosis. Drugs that are bactericidal are more likely to cause cell wall rupture.
The nurse would be most likely to investigate the possibility of a superinfection in a client presenting with infections caused by what? Select all that apply.
A) Streptococcus
B) Pseudomonas
C) Proteus
D) Yeast
E) Rhinovirus
B) Pseudomonas
C) Proteus
D) Yeast
Rationale:Superinfections are infections that occur when opportunistic pathogens that were kept in check by the “normal” flora bacteria have the opportunity to invade tissues. Common superinfections include vaginal or GI 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. While it is not impossible, superinfection caused by Streptococcus or a rhinovirus is highly unlikely.
A client presents to the clinic reporting mouth sores that appear consistent with an oral yeast infection. The nurse should question the client about the recent use of what?
A) Antibiotics
B) Antiprotozoals
C) Antivirals
D) Oral contraceptive agents
A) Antibiotics
Rationale: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.
One of the nurse’s clients is prescribed antiinfective therapy. What should the nurse understand about the ways organisms develop resistance to antiinfective therapy? Select all that apply.
A) The organism alters the transport system to prevent the drug from entering.
B) The organism produces an enzyme that acts as an antagonist to the drug.
C) Failure to take the drug the way it was prescribed.
D) The organism alters the binding sites on the membranes.
E) The organism produces a chemical that mimics the drug.
A) The organism alters the transport system to prevent the drug from entering.
B) The organism produces an enzyme that acts as an antagonist to the drug.
D) The organism alters the binding sites on the membranes.
Rationale:Microorganisms develop resistance by producing a chemical that acts as an antagonist to the drug, not to mimic the drug. In addition, the microorganism can produce an enzyme that deactivates the drug, change cellular permeability so that the drug can’t enter the cell, and alter binding sites to no longer accept the drug. Failure to take the drug the way it was prescribed leads to resistance, but this is not one of the ways the organism develops resistance.
The nurse has educated a client about the risk for kidney damage that accompanies the client’s antiinfective regimen. What should the nurse recommend to the client in order to reduce the risk of renal damage?
A) Avoid taking the medication right before bedtime
B) Take the medication with water
C) Temporarily adopt a low-residue diet
D) Increase intake of fluids
D) Increase intake of fluids
Rationale:Increasing fluid intake reduces the risk of renal damage. Changing diet does not have any significant effect on the risk for renal damage. Taking a medication with water does not necessarily mean that the client’s overall fluid intake is increasing. The client should take the medication when it is prescribed to be taken; taking it at bedtime poses no risk to renal function.
A client with acne has been receiving an antiinfective agent for a prolonged period. Initially, the drug was effective, but over time, its effectiveness decreased. What is the nurse’s best action?
A) Assess the client for a new onset of drug hypersensitivity.
B) Refer the client to the healthcare provider because the client may be experiencing resistance.
C) Assess the client for additional signs of superinfection.
D) Educate the client about the phenomenon of drug tolerance.
B) Refer the client to the healthcare provider because the client may be experiencing resistance.
Rationale: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 antiinfectives 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 antiinfectives, however, resistance is more likely.
A client is receiving aminoglycoside therapy. The nurse would be alert for what adverse effect commonly seen with this drug?
A) Kidney dysfunction
B) Lethargy
C) Loss of vision
D) Hallucinations
A) Kidney dysfunction
Rationale: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.
An older adult client has been brought to the emergency department by her daughter, who states that the client may have a urinary tract infection. What principle should guide the care team’s plan of treatment?
A) Signs and symptoms that are thought to be caused by infection in older adults are usually age-related changes.
B) A narrow-spectrum antibiotic should be prescribed due to the likelihood of infection.
C) The client is likely to require larger and/or more frequent doses of antibiotics than younger clients.
D) Older adults’ signs and symptoms of infection may differ from those of younger people.
D) Older adults’ signs and symptoms of infection may differ from those of younger people.
Rationale:Older adults often exhibit an atypical presentation of infection. Broad-spectrum antibiotics are a better initial approach than narrow-spectrum antibiotics. Older adults do not normally require larger or more frequent doses. Sometimes the signs of infection in older adults (e.g., confusion) are misattributed to age-related changes
The nurse is assessing a client who has recently been given the first dose of a new antiinfective. What finding should lead the nurse to suspect that the client is experiencing a hypersensitivity reaction?
A) The client recently had an episode of diarrhea.
B) The client is experiencing vertigo.
C) The client has a facial and trunk rash.
D) The client’s blood pressure is 141/88 mm Hg.
C) The client has a facial and trunk rash.
Rationale: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.
For what client would the use of prophylactic antiinfective be most appropriate?
A) A client with type 2 diabetes who lives in a crowded home
B) A client who uses street drugs intravenously
C) A client who works in a clinic where many ill children are treated
D) A presurgical client who has an artificial heart valve
D) A presurgical client who has an artificial heart valve
Rationale:A client with valve replacement is especially prone to the development of subacute bacterial endocarditis because of the vulnerability of their heart valves; prophylactic antibiotic therapy as a precaution. None of the other listed clients has particular indications for the use of prophylactic antiinfectives.
A nurse is teaching a colleague about the factors that are known to contribute to antibiotic resistance. What phenomenon should the nurse describe?
A) Use of antibiotics for viral illnesses
B) Over-the-counter availability of some antibiotics in the United States
C) Increasing incidence of adverse effects of antiinfectives in recent years
D) Use of excessive doses during antiinfective therapy
A) Use of antibiotics for viral illnesses
Rationale:The use of antibiotics for viral illnesses or infections is a contributing factor to the development of resistance. Antibiotics are not available over the counter in the United States, and there has not been a trend toward excessive dosing or increases in adverse effects.
Before the nurse administers a prescribed antiinfective agent to a client, the nurse should confirm that what action has been performed?
A) Head-to-toe assessment
B) Culture testing
C) Complete blood count
D) Renal function studies
B) Culture testing
Rationale:It is most important to ensure that a culture of the infected area has been obtained before administering the agent. The culture is necessary to determine the pathogen. Complete blood count and renal function studies are helpful to establish a baseline, but it is not important if they are drawn before administration of the antiinfective. The nurse should assess the client’s status, but a full head-to-toe examination does not need to precede the administration of an antiinfective.
A client is receiving sulfonamide therapy as treatment for an infection. The nurse understands that this drug acts by doing what?
A) Preventing the organism from dividing
B) Altering the permeability of the cell membrane
C) Dissolving the bacterial cell wall
D) Interfering with protein synthesis
A) Preventing the organism from dividing
Rationale:Sulfonamides prevent the cells of the invading organism from using substances essential to their growth and development, leading to an inability to divide and eventually to cell death. Some antibiotics, antifungals, and antiprotozoal drugs alter the permeability of the cell membrane. Aminoglycosides, macrolides, and chloramphenicol interfere with protein synthesis. Penicillins interfere with the bacterial cell wall.
The nurse is preparing to administer an intravenous antiinfective agent to a client. When monitoring for common adverse effects, what assessments should the nurse perform? Select all that apply.
A) Assessment of neurological status
B) Assessment for muscle weakness
C) Assessment of urine output
D) Cardiac monitoring
E) Assessment for signs of hypersensitivity
A) Assessment of neurological status
C) Assessment of urine output
E) Assessment for signs of hypersensitivity
Rationale:Cardiac toxicity and weakness are not typically associated with antiinfective therapy. Adverse effects commonly associated with antiinfective therapy are direct toxic effects on the kidney, gastrointestinal tract, and nervous system along with hypersensitivity and superinfections.
A client is febrile and is suspected of having a respiratory infection. A sputum culture has been collected, and the results of sensitivity testing are expected within 48 hours. The nurse should anticipate that the client may:
A) be immediately prescribed a broad-spectrum antibiotic.
B) need to provide a follow-up sputum culture before medications can be prescribed.
C) receive supportive care until an antibiotic can be prescribed in 48 hours.
D) be treated with antiviral medication on a short-term basis.
A) be immediately prescribed a broad-spectrum antibiotic.
Rationale:Broad-spectrum antibiotics are often prescribed pending sensitivity testing. There is no need to completely withhold medications until results are acquired. Antiviral medications are not used for this short-term purpose. Follow-up testing may or may not be needed.
