Chapter 57: Principles for Prescribing Antiinfectives

Chapter 57: Principles for Prescribing Antiinfectives

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A patient comes to the clinic with a history of fever of 102° F for several days, poor appetite, and cough. A sputum culture is pending, but Gram stain indicates a bacterial infection. The primary care nurse practitioner (NP) should:

ANS:  A

Patients with signs and symptoms of a bacterial infection may be treated empirically, especially if Gram stain is positive. The antibiotic may need to be changed when culture and sensitivity results become available. It is best to use an antibiotic that is specific to the suspected organism and not a broad-spectrum antibiotic.

DIF:    Cognitive Level: Applying (Application)                           REF:   653

2. The primary care NP sees a patient who has a 1-week history of nasal congestion; red, watery eyes; cough; and a temperature ranging from 99.1° F to 100.5° F. The NP notes thin, white nasal discharge and an erythematous oropharynx without swelling or exudates. The NP should:

ANS:  B

The patient does not have severe symptoms indicating a bacterial infection. Unless symptoms worsen, reassurance is indicated. Empiric antibiotic therapy is contraindicated for viral infections. Antiviral medications are not routinely used. A nasal culture is not indicated.

DIF:    Cognitive Level: Applying (Application)                           REF:   653

3. A patient who has had two recent urinary tract infections is in the clinic with dysuria and fever. The primary care NP reviews the patient’s chart and notes that in both previous cases the causative organism and sensitivity were the same. The NP should:

ANS:  C

Because this patient has had similar infections in the past, treating empirically is acceptable. The NP must still obtain a culture and sensitivity so that appropriate antibiotic therapy can be provided, even though it is likely that this is a recurrence of the same organism. A culture should always be obtained when possible. A microscopic evaluation is used to determine whether or not a culture should be performed and is not diagnostic.

DIF:    Cognitive Level: Applying (Application)                           REF:   653

4. A new patient comes to see the primary care NP with fever, mild dehydration, and dysuria with flank pain. The patient tells the NP that a previous provider always prescribed trimethoprim-sulfamethoxazole and wonders why a urine culture is necessary because this antibiotic has worked in the past. The NP should tell this patient that a culture is necessary to help determine:

ANS:  B

Antibiotic resistance can occur when bacteria are repeatedly exposed to antibiotic agents. Even though a particular antibiotic is effective for a certain type of infection, resistance can occur, and another antibiotic may be necessary. A culture and sensitivity test is essential for choosing the right antibiotic. The culture and sensitivity test does not help determine the dose or the length of therapy.

DIF:    Cognitive Level: Applying (Application)                           REF:   654