Chapter 46: Antimicrobial Agents My Nursing Test Banks

Chapter 46: Antimicrobial Agents

Test Bank

MULTIPLE CHOICE

1. A patient allergic to penicillin is being evaluated for a gram-negative infection. Which antimicrobial drug class would the health care provider be cautious in prescribing because of a possible cross sensitivity and/or allergic reaction?

a.

Cephalosporins

b.

Aminoglycosides

c.

Sulfonamides

d.

Quinolones

ANS: A

Cephalosporins may be used with caution as alternatives when patients are allergic to the penicillins, but cephalosporins are chemically similar in structure to penicillins and may produce a cross sensitivity and/or allergic reaction. Aminoglycosides, sulfonamides, and quinolones do not tend to produce cross sensitivities.

DIF: Cognitive Level: Comprehension REF: p. 736 OBJ: 7 | 8

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

2. The health care provider has prescribed penicillin and probenecid for a patient with a sexually transmitted disease. What is the purpose of combining these medications?

a.

To accelerate the excretion of the penicillin

b.

To inhibit the absorption of penicillin to allow the drug to remain in the transport phase

c.

To inhibit the excretion of the penicillin

d.

To reduce toxic effects associated with penicillin

ANS: C

The combination therapy of penicillin and probenecid allows the penicillin to remain in the body longer, which enhances drug availability and action. The combination may be used advantageously in treating serious or resistant infections. Probenecid inhibits the excretion of penicillin, slows down the excretion of penicillin, and does not affect absorption or toxic effects.

DIF: Cognitive Level: Comprehension REF: p. 730 OBJ: 6

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

3. An older adult who has septicemia is receiving IV aminoglycoside therapy. Which symptom is most important for the nurse to monitor?

a.

Bone marrow suppression

b.

Ototoxicity

c.

Gastrointestinal (GI) distress

d.

Photosensitivity

ANS: B

Eighth cranial nerve damage can result from aminoglycoside therapy. Patients should be monitored during therapy and after therapy has been discontinued for signs and symptoms of ototoxicity, including dizziness, tinnitus, and progressive hearing loss. Aminoglycosides do not produce bone marrow depression; this is characteristic of treatment with chloramphenicol. Aminoglycosides do not typically produce GI distress. Aminogylcosides do not produce photosensitivity; this is characteristic of treatment with glycylcyclines.

DIF: Cognitive Level: Application REF: p. 729 OBJ: 7 | 8

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

4. On what is the selection of an antimicrobial agent based?

a.

Sensitivity of the microorganism to the drug

b.

Half life of the medication

c.

Therapeutic levels of the drug

d.

Bioavailability of the drug

ANS: A

The selection of the antimicrobial agent must be based on the sensitivity of the pathogen and the possible toxicity to the patient. The half life of the drug is not a concern with selection in comparison to sensitivity. Therapeutic levels of the drug are not criteria for selection. Bioavailability is a lesser concern than sensitivity.

DIF: Cognitive Level: Comprehension REF: p. 727 OBJ: 6

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

5. A patient is scheduled to take tetracycline and aluminum hydroxide (Amphojel) at the same time. When will the nurse administer the medications to achieve the optimal effects?

a.

Both medications together

b.

Amphojel 30 minutes before tetracycline

c.

Tetracycline with orange juice

d.

Tetracycline 1 hour before Amphojel

ANS: D

For optimal effectiveness, tetracyclines should be administered 1 hour before or 2 hours after ingesting antacids, milk, or other dairy products, or products containing calcium, aluminum, magnesium, or iron. Taking the drugs this closely together will most likely inhibit absorption of the antibiotic. Tetracycline does not tend to interact with orange juice, but the beverage may be contraindicated in a patient who needs to take antacids.

DIF: Cognitive Level: Application REF: pp. 750-751 OBJ: 7 | 8

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

6. Which conditions may occur with the administration of broad spectrum antibiotics over an extended period of time?

a.

Cross sensitivity

b.

Immunosuppression

c.

Secondary infection

d.

Immunity

ANS: C

Secondary infections, such as oral thrush, genital and anal pruritus, and vaginitis, can occur with prolonged use of broad spectrum antibiotics. Secondary infections result when normal flora are eliminated, which causes disease producing microorganisms to multiply. Cross sensitivities develop during repeat exposures, not over a prolonged period. Immunosuppression does not develop over a prolonged interval of administration. Immunity is not produced by exposure to antibiotics.

DIF: Cognitive Level: Knowledge REF: pp. 729-730 OBJ: 7

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

7. A patient is admitted with glomerulonephritis. IV gentamicin therapy is started after cultures indicate gram negative bacilli in the blood. The patient also receives IV furosemide (Lasix). The nurse will monitor for signs and symptoms of toxicity related to which organ?

a.

Kidneys

b.

Pancreas

c.

Liver

d.

Brain

ANS: A

The results of urinalysis and kidney function tests should be closely monitored when a patient is on aminoglycoside therapy. Patients also receiving cephalosporins, enflurane, methoxyflurane, vancomycin, and diuretics, when combined with aminoglycosides, have a greater potential for nephrotoxicity. The pancreas is not vulnerable to damage from aminogylcosides. Bone marrow suppression is a result of toxicity from treatment with chloramphenicol. Central nervous system toxicities may result from toxic effects of treatment with aminoglycosides, but are not related to interactions between the antibiotic and diuretics.

DIF: Cognitive Level: Comprehension REF: p. 731 OBJ: 7

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

8. Which drug is the cornerstone of treatment for prophylaxis and treatment of tuberculosis (TB)?

a.

Amphotericin B (Abelcet)

b.

Streptomycin (Streptomycin)

c.

Isoniazid (Nydrazid)

d.

Acyclovir (Zovirax)

ANS: C

Isoniazid has been the mainstay for years in the treatment and prevention of TB. The mechanism of action of isoniazid is not fully known. Isoniazid appears to disrupt the Mycobacterium tuberculosis cell wall and inhibit replication. Amphotericin B is used in the treatment of fungal infections. Streptomycin is an aminoglycoside used to treat bacterial infections. Acyclovir is used in the treatment of viral infections associated with herpes simplex virus.

DIF: Cognitive Level: Comprehension REF: p. 752 OBJ: 6

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

9. A patient indicates during the nursing assessment that he is currently taking zidovudine (Retrovir). For which condition is the patient being treated?

a.

Influenza A

b.

HIV infection

c.

TB

d.

Herpes simplex

ANS: B

Zidovudine (Retrovir) is an antiviral agent that is effective in certain patients with HIV 1 infection. Zidovudine inhibits viral replication, reduces the risk and severity of opportunistic infections, and improves immune status. Zidovudine is not used to treat influenza, TB, or herpes infections.

DIF: Cognitive Level: Knowledge REF: p. 787 OBJ: 6

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

10. Which drug is incompatible with heparin?

a.

Gentamicin

b.

Ampicillin (Unasyn)

c.

Ticarcillin (Timentin)

d.

Ciprofloxacin (Cipro)

ANS: A

Gentamicin is incompatible with heparin. Ampicillin, ticarcillin, and ciprofloxacin are compatible with heparin.

DIF: Cognitive Level: Knowledge REF: pp. 733-734 OBJ: 7 | 8

TOP: Nursing Process Step: Planning

MSC: NCLEX Client Needs Category: Physiological Integrity

11. What adverse effect may manifest as dizziness, tinnitus, and progressive hearing loss?

a.

Ear infection

b.

Drug allergy

c.

Ototoxicity

d.

Idiosyncratic reaction

ANS: C

Damage to the eighth cranial nerve (ototoxicity) can occur from drug therapy, particularly from aminoglycosides. This may initially be manifested by dizziness, tinnitus, and progressive hearing loss. Ear infection is not an adverse effect of drug therapy. Drug allergy is not manifested by hearing loss. Idiosyncratic reaction to a medication is an unusual, unpredictable response specific to a particular person. Unlike allergy, it can occur on first exposure to the medication; unlike an adverse effect, it only affects very few individuals, possibly with a genetic or metabolic abnormality.

DIF: Cognitive Level: Comprehension REF: p. 729 | p. 733

OBJ: 7 TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity

12. The nurse will monitor patients on cephalosporins and loop diuretics for which adverse effect?

a.

Hepatic toxicity

b.

Ototoxicity

c.

Nephrotoxicity

d.

Splenotoxicity

ANS: C

Patients receiving cephalosporins, aminoglycosides, polymyxin B, vancomycin, and loop diuretics concurrently should be assessed for signs of nephrotoxicity. Urinalysis and kidney function tests should be monitored for abnormal results. Cephalosporins are unlikely to cause liver toxicity, ototoxicity, or spleen toxicity.

DIF: Cognitive Level: Comprehension REF: p. 731 | p. 733

OBJ: 7 TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity

13. The nurse is caring for a patient being treated with an antimicrobial agent for the diagnosis of a sexually transmitted infection. Which statement made by the patient shows a need for further education?

a.

I will use a barrier method when having sexual intercourse during therapy.

b.

I will increase fluid intake to 2000 to 3000 mL/day.

c.

I will increase protein in my diet.

d.

I will rest frequently.

ANS: A

Patients should be instructed to refrain from sexual intercourse during therapy for sexually transmitted infections. Fluids should be increased to 2000 to 3000 mL/day, protein should be increased, and adequate rest should be encouraged.

DIF: Cognitive Level: Analysis REF: p. 731 OBJ: 4

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

14. Which patient can safely be treated with a fluoroquinolone medication?

a.

A 40 year old on steroid therapy

b.

A 15 year old with a sore throat

c.

A 70 year old with a gait abnormality

d.

A 30 year old with a fractured tibia

ANS: D

Fluoroquinolones are safe to prescribe for a 30 year old with a fractured tibia. Fluoroquinolones should not be prescribed for patients taking corticosteroids, patients younger than 18 years, or patients older than 60 years.

DIF: Cognitive Level: Analysis REF: p. 746 OBJ: 6

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment; Physiological Integrity

MULTIPLE RESPONSE

15. An older adult with a history of asthma, rhinitis, and no known drug allergies has been admitted to receive IV antimicrobial therapy for bronchitis. The patient has received the oral form of the antimicrobial agent in the past. Which factors increase the risk for an allergic reaction? (Select all that apply.)

a.

Medical history of asthma

b.

The patients age

c.

IV antimicrobial therapy

d.

Medical history of rhinitis

e.

Subsequent use of the same antimicrobial therapy

ANS: A, D, E

Patients with a history of asthma, allergies, or rhinitis should be closely monitored for possible allergic reaction. Subsequent use of the same antimicrobial therapy may only pose a risk if a reaction occurred with the first administration of the drug; in this case, repeat exposures to a previously sensitized substance can be fatal. Older adults, because of physiologic changes of aging, require close observation for therapeutic response and drug toxicity, but not necessarily for allergic reaction. The route of administration does not increase the risk of an allergic reaction.

DIF: Cognitive Level: Application REF: p. 730 OBJ: 7

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

16. A patient has been receiving home health care and IV antimicrobial therapy for osteomyelitis (infection of the bone) of the lower right leg for the past 4 weeks. What will the nurse assess to evaluate the effectiveness of the antimicrobial agent? (Select all that apply.)

a.

Pain of the right leg

b.

Patient temperature

c.

Presence of edema, redness, or swelling in the right lower leg

d.

Culture and sensitivity parameters at the drug completion

e.

Complete blood count (CBC) and sedimentation rate laboratory values

ANS: A, B, C, E

Ongoing evaluation of treatment effectiveness includes assessing for pain of the affected leg, monitoring the patients temperature, observing the affected extremity for decreased signs of infection (including reduced swelling, wound discharge, and redness), and monitoring the CBC and sedimentation rate through regular laboratory data. Culture and sensitivity testing should be completed before therapy to determine the most effective drug for therapy.

DIF: Cognitive Level: Application REF: p. 730 OBJ: 1

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity

17. Which drugs may reach toxic blood levels if administered with macrolide antibiotics? (Select all that apply.)

a.

Benzodiazepines

b.

Digoxin

c.

NSAIDs

d.

HMG CoA reductase inhibitors

e.

Diuretics

f.

Theophylline

ANS: A, B, D, F

Macrolide antibiotics may inhibit the metabolism of benzodiazepines, digoxin, HMG CoA reductase inhibitors, and theophylline, causing accumulation and potential toxicity. NSAIDs and diuretics are not inhibited by macrolide antibiotics.

DIF: Cognitive Level: Comprehension REF: p. 741 OBJ: 7 | 8

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

18. The nurse is planning to administer ertapenem IV to a patient in the intensive care unit. When preparing this medication, the nurse will consider reconstituting it with: (Select all that apply.)

a.

water.

b.

bacteriostatic water.

c.

0.9% sodium chloride.

d.

0.45% dextrose.

e.

1% lidocaine.

ANS: A, B, C

Ertapenem for IV use should be reconstituted with water for injection, bacteriostatic water for injection, or 0.9% sodium chloride (normal saline) for injection. Ertapenem should not be reconstituted with dextrose solutions or 1% lidocaine injection.

DIF: Cognitive Level: Application REF: p. 735 OBJ: 7 | 8

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

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