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67 Cards in this Set

  • Front
  • Back
______________ drugs are used to prevent or treat infection caused by pathogenic disease producing microorganisms
In an infection _____________ initially attach to host cell receptors (ex. proteins, carbohydrates, lipids)
__________ are intracellular parasites that survive only in living tissues.
Human pathogens include ___________ herpes viruses and retroviruses.
__________ are plant like organisms that live as parasites on living tissue or as saprophytes on decaying organic matter.
Involves growing a microorganism in the laboratory
Usually normal endogenous or environmental flora non pathogenic
Opportunistic microorganisms
Uses features of culture and serology by reduces the time required for diagnosis
Detection of antigens
Can detect whether DNA for a specific organism is present in a sample
Polymerase chain reaction (PCR)
Identifies microscopic appearance including shape and color of the organisms
Gram's stain
Ms. Green is treated with antibiotics for bacterial pneumonia. When obtaining a drug history you find that Ms. Green ceased her medication regimen when she no longer experienced symptoms during the first round of antibiotics. You are responsible for her education plan. In order to effectively treat the pneumonia, what must Ms. Green do?

a. Complete a full course of antibiotics as prescribed.

b. Continue the antibiotics for 1 week after cessation of symptoms.

c. Take the antibiotics at breakfast lunch and supper.

d. Take the antibiotics every 3 hrs during the day.

Rationale: Patient education related to antibiotic therapy should stress the importance of completing a full course of antibiotics as prescribed.
Mrs. Beach takes an antibiotic left over from her last bout with bronchitis, when she discover that her child has developed strep throat. She take the antibiotic as preventive measure. Which of the following effects might this practice have? (select all that apply)

a. Increasing adverse drug effects

b. Increasing the risk of infections with drug resistant microorganisms.

c. Becoming a cost effective method to manage infectious processes.

d. reducing health care costs
a, b

Rationale: Inappropriate use of antibiotics increases adverse drug effects, infections with drug resistant microorganisms and health care costs as well as reducing the number of available effective drugs for serious or antibiotic resistant infections.
The physician orders an antibiotic for Mrs. Beach. She states that she cannot take antibiotics on an empty stomach because they make her nauseous. Which of the following instructions should you give her?

a. Take the medicatoin with food to reduce nausea.

b. Take the medication three times a day with meals

c. Take the medication on an empty stomach.

d. Take the antibiotic on an empty stomach until symptoms abate.

rationale: Check specific recommendation with regard to the administration of the antibiotic with food and other medication to decrease binding to food and drugs and prevent inactivation.
Antibiotics should be scheduled at __________ __________ intervals around the clock, to maintain therapeutic blood levels.
Evenly spaced
Mr. Ruiz is treated for urinary tract infections several times a year, secondary to urinary retention and an enlarged prostate. He also is treated for chronic renal failure hypertension, and diabetes type 2. Which of the following might happen when Mr. Ruiz is treated with antibiotics?

a. He may be nephrotoxic

b. He may be at increased risk for congestive heart failure.

c. It may precipitate a hypertensive crisis.

d. It may cause prostate enlargement.
Rationale: Antimicrobial drug therapy requires close monitoring in patients with renal impairment because many drugs are excreted primarily by the kidneys and some are nephrotoxic and may cause further damage to the kidneys.
Mrs. Lawrence is 48 hrs post op for a hip replacement. When you assess her incision line you find redness warmth and drainage from the proximal section of the wound. Which of the following would you expect the physician to order?

a. Amoxicillin

b. Penicillin

c. Bactrim

d. Cefazolin

Rationale: For most surgeries involving an incision through the skin a first generation cephalosporin such as cefazolin (Kefzol) with activity against Staphylococcus aureus or streptococcus species is commonly used.
The physician order an antibiotic for Mr. Boone three times a day for 7 days. Mr. Boone asks you if this is correct because his son took the some antibiotic for 5 days. On which of the following factors is the amount and frequency of the antibiotic dosing based?

a. Characteristics of the causative organism

b. Age of the client

c. Sex of the client

d. Condition of the gastrointestinal system.

Rationale: The amount and frequency of anti infective and antimicrobial agents should be individualized according to characteristics of the causative organism the chosen drug and the patients size and condition (ex. type and severity of infection, ability to use the excrete the chosen drug)
Drug resistant bacterial strains can be produced in the ___________ of antimicrobial drugs.
Mr. Benjamin is diagnosed with osteomyelitis secondary to an untreated bone fracture. You Understand that IV therapy for this disease process is which of the following?

a. Short term

b. Long term

c. Modified based on the clients age

d. Modified based on the clients home environment.

Rationale: Some infections that require relatively long term IV antibiotic therapy include endocarditis, osteomyelitis, and some surgical wound infections.
You are Mr. Benjamins home care nurse. Your role will include teaching the patient and the family about which of the following? (select all that apply)

a. How to acquire the equipment and medication.

b. How to store and administer the medication

c. How to monitor the IV site

d. How to report patient responses
b, c, d

Rationale: The role of the home care nurse includes teaching the patient and caregiver how to store and administer the medication monitor the IV site, monitor the infection, manage problems and report patient responses.
Mr. Johnson is diagnosed with a drug resistant infection in his wound. As his home care nurse which of the following should you teach Mr. Johnson and his family?

a. To avoid social contact while the infection is treated.

b. To avoid using the same bathroom until the infection abates.

c. To use gloves when dandling drainage from the wound.

d. To use bleach when washing all laundry.

Rationale: General infection control practices include frequent and thorough hand hygiene, use of gloves when indicated , and appropriate handling and disposal of body substances (ex. blood, urine, feces, sputum, vomitus, wound drainage)
Mr. Treetman is admitted to your critical care unit for a trauma center. He is status post surgery after a fall from a roof in a construction site. He has multiple fractures and internal injuries. The dosage of his IV antibiotic will change based on which of the following factors?

a. Cardiovascular assessment of the critically ill patient.

b. Neurovascular assessment of the critically ill patient

c. Changing physiology of the critically ill patient.

d. Altered mentation of the critically ill patient.

Rationale: Measurement of plasma drug levels and the changing physiology of a critically ill patient. Drug levels are usually measured after four or five doses are given so that steady state concentrations have been reached.
On his second day in the unit Mr. Treetmen develops a left lower lobe infiltrate and is diagnosed with nosocomial pneumonia. Which of the following do you expect is the cause of the pneumonia?

a. Pseudomonas

b. Streptococcus

c. Clostridium difficile

d. Staphylococcus aureus

Rationale: Patients in critical care units are at high risk for acquiring nosocomial pneumonia because of the severity of their illness, duration of the hospitalization and antimicrobial drug therapy. The strongest predisposing factor is mechanical ventilation which bypasses airway defenses against movement of microorganisms from the upper to the lower respiratory tract. Organisms often associated with nosocomial pneumonia are staphylococcus aureus and gram - negative bacilli.
Mr. Treetmen's pneumonia is diagnosed as bacterial. Pending culture reslts what would you expect the physician to order?

a. Broad spectrum antibiotics

b. Short term oral antibiotic therapy

c. Short term IV antibiotic therapy

d. Long term oral antibiotic therapy

Rationale: Bacterial pneumonia is usually treated with a broad spectrum antibiotic until culture and susceptibility reports become available.
Mr. Diemen is placed on a ventilator. To reduce the rate of ventilator associated pneumonia and mortality which of the following would you expect the physician to order?

a. Antibiotic rotation

b. IV antibiotics in intervals of 4 to 6 wks

c. Oral antibiotics in intervals of 4 to 6 wks

d. An anti fungal alternated with an antibiotic

Rationale: Selection of antibacterial drugs may be difficult because of frequent changes in antibiotic resistance patterns. Antibiotic rotation (ex. switching preferred antibiotic or antibiotic classes used to treat infection on a scheduled basis) has been successful in reducing rates of ventilator associated pneumonia and mortality.
Mr. Gains is diagnosed with hepatitis and bronchitis. Which of the following medication will probably not be ordered by the physician? (select all that apply)

a. Teracycline

b. Penicillin

c. Isoniazid

d. Rifampin
a, c, d

Rationale: Antimicrobial therapy in patients with liver impairment is not well defined. Some drugs are metabolized by the liver. (ex cefoperazone, chloramphenicol, clindamycin, erythromycin) and dosage must be reduced in patients with severe liver impairment. Some are associated with elevation of liver enzymes and or hepatotxicty (ex. certain fluoraquinolones, tetracyclines, isoniazid and rifampin). Laboratory monitoring may be helpful in high risk population.
Which laboratory value of CrCl indicates severe renal impairment?

a. Greater than 15 - 30mL/min

b. Less than 45 - 60mL/min

c. Less than 15 - 30mL/ min

d. Greater than 45 -60mL/min

Rationale: A laboratory value that indicates severe renal impairment is CrCL , 15 - 30 mL/min.
Mr. King is diagnosed with severe renal failure and an infection. You know that unless the organism causing his infection is sensitive only to this class of drugs the ________ and ____________ should be avoided.
Tetracyclines (except doxycycline) and flucytosine
Mrs. Gibbs is receiving hemodialysis three times weekly. The physician order an antibiotic. Which of the following do you expect will happen with the dosage of the antibiotic related to the dialysis?

a. The dosage may be decreased on dialysis days.

b. An extra dose may be needed on dialysis days.

c. A double dose may be needed on dialysis days

d. It is not necessary to modify the dose of the antibiotic on dialysis days.

Rationale: Dosing of antibiotics is important in patients with acute or chronic renal failure who are receiving hemodialysis or peritoneal dialysis. Some drugs are removed by dialysis and an extra dose may be needed during or after dialysis.
__________ and cephalosporins are considered safe for most age groups including children
______ block synthesis of components necessary for cell metabolism and growth.
___________, ___________, and ____________ inhibit formation of cell wall.
Penicillins, cephalosporines, and vancomycin.
_________ inhibit DNA gyrase and enzyme required for reproduction.
__________,____________,____________,__________,_________ and __________ bind to ribosomes and inhibit production of essential proteins
Aminoglycosides, macrolides, ketolides, tetracyclines, linezoilid, and quinupristin dalfopristin.
__________ is resistant to many antibiotics and those strains resistant to genotamicin my be susceptible to amikacin, ceftazidime, imipenem, or aztreonam.
P. aeruginosa
True or false

Antimicrobials are effective in urinary tract infections because they are excreted in the urine. However, the choice of an effective antimicrobial drug may be limited in infections of the brain, eyes, gallbladder, or prostate gland because many drugs are unable to reach therapeutic concentrations in these tissues.
True or false

In general the least toxic drug should be used. However, for serious infection more toxic drugs may be necessary.
True or false

If an older less expensive drug meets the criteria for rational drug selection and is likely to be effective in a given infection it should be used instead of a more expensive agent. For hospitals and nursing home personnel costs relating to preparation and administration should be considered as well as purchasing costs.
True or false

Dosage should be individualized according to characteristics of the causative organism the chosen drug and the patients size and condition.
True or false

Dosage often must be reduced if the patient has renal impairment or other disorders that delay drug elimination.
True or false

Most antimicrobial drugs are given orally or IV for systemic infections. The route of administration depends on the patients condition and the available drug dosage forms. In serious infections the IV route is preferred for most drugs.
What is the average duration of antimicrobial therapy?
For most acute infections the average duration is approximately 7 to 10 days or until the recipient has afebrile and asymptomatic for 48 to 72hrs.
True or false

Penicillins and cephalosporins are considered safe for most age groups. However, they are eliminated more slowly in neonates because of immature renal function and must be used cautiously and dosed appropriately for age. Penicillins and cephalosporins do not have approval form the FDA for use in children younger than 12yrs of age.
True or false

Erythromycin, azithromycin (zithromax) and clarithromycin (Biaxin) are considered safe in use for children younger than 12yrs old
True or false

Aminoglycosides (gentamicin) may cause nephrotoxicity and ototoxicity in any patient population. Neonates are at high risk because of immature renal function.
True or false

Tetracyxclines are contraindicated in children younger than 8yrs of age because of drug effects on teeth and bones.
_____________ warrants monitoring liver and kidney function when it is given to neonates and infants.
Clindamycin (Cleocin)
__________ are contraindicated for use in children less than 18yrs of age because weight bearing joints have been impaired in young animals given the drugs. However, if these drugs are the only therapeutic option for a resistant pathogen, the prescriber may decide to use a fluoroquinolone in children.
Fluoroquinolones (ex. ciprofloxacin aka Cipro)
_______________ is used in children although children younger than 2months of age have not been evaluated.
Trimethoprim sulfamethoxazole (Bactrim)
_________ is considered safe for use in children.
Linezolid (zyvox)
Penicillins are usually safe. However, ___________ may occur with large IV dose of penicillin G potassium (1.7 mEq potassium per 1 million units).
Penicillins are usually safe. However, hypernaturemia may occur with ____________. This drug contains 5.6 mEq of sodium per gram.
Ticarcillin (Ticar)
____________ and _________ are more likely to occur with impaired renal function.
Hyperkalemia and Hypernatremia
True or false

Dosage of most cephalosporins should be reduced in the presence of renal impairment.
Tetracyclines except _________ and _________ are contraindicated in the presence of impaired renal function if less toxic drugs are effective against causative organisms.
Doxycycline and nitrofurantoin (Macrodantin)
__________ may cause diarrhea and should be used with caution in the presence of GI disease especially colitis.
_______ may be associated with an increased risk of severe adverse effects in older adults especially those with impaired liver or kidney function. Severe skin reaction and bone marrow depression are the most frequently reported severe reactions.
Timethoprim sulfamethozazole (bactrim, Septra)
Tetracyclines and flucytosine should be avoided in CrCL less than ___ mL/min.
15 to 30
Drugs that require dosage reduction in severe renal impairment are:
Penicillin G, Ampicillin, most cephalosporins, fluoroquinolones, and trimethoprimsulfamethoxazole
This is a delayed allergic reaction occurring 1 week or more after the drug is started. Signs and symptoms are caused by inflammation. Signs and symptoms include: Chills, fever, vasculitis, generalized lymphadenopathy, joint edema and inflammation, bronchospasm, urticaria.
Serum sickness
___________ is a new or secondary infection that occurs during antimicrobial therapy for primary infection.
Super infection
_________ is characterized by sore mouth, white patches on oral mucosa or a black furry tongue
Stomatitis or thrush
_______ is characterized by severe diarrhea with blood, pus, and mucus in stool.
Pseudomembranous colitis aka Clostridium difficile (C-Diff)
_________ is characterized by a rash in perineal area, itching, and vaginal discharge
Monilial vaginitis
___________ is seen when there is an increased in blood urea nitrogen and serum creatinine decreased creatinine clearance fluid and electrolyte imbalances.
Acute tubular necrosis (ATN) Aminoglycosides are the antimicrobial agents most often associated with ATN
Patient is taking large doses of penicillin or cephalosporins and has a renal impairment. A nurse would suspect that ___________ is present when their patient is confused, hallucinates, neuromuscular irritability, or has a seizure.
Bleeding (hypoprothrombinemia), platelet dysfunction is most often associated with ___________ and ________
Penicillins and cephalosporins