ADVANCED P 508 Chapter 57: Principles for Prescribing Antiinfectives Test Bank QUIZ | Already Graded A+

Chapter 57: Principles for Prescribing Antiinfectives Test Bank 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: a. begin empirical antibiotic therapy. b. use a broad-spectrum antibiotic for initial treatment. c. prescribe an antibiotic when culture and sensitivity results are known. d. offer symptomatic treatment only unless the patient’s condition worsens. 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: a. begin empiric antibiotic therapy to treat sinusitis. b. reassure the patient that this is likely a viral infection. c. prescribe antiviral medications and decongestants. d. obtain a nasal culture and consider antibiotic therapy. 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: a. treat the patient empirically without a culture. b. order a microscopic evaluation of the urine and an antibiotic. c. order a urine culture and treat empirically pending culture results. d. order a urine culture and sensitivity and wait for results before treating. 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: a. the correct dose of the antibiotic. b. whether antibiotic resistance is occurring. c. whether multiple organisms are causing infection. d. the length of antibiotic therapy needed to treat the infection. 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 5. The primary care NP sees a child in the clinic who has a 5-day history of cough, poor fluid intake, and fever of 103° F. A chest radiograph shows areas of consolidation in the child’s lungs. The child’s cough is nonproductive, and the NP is unable to get a sputum specimen. The NP should: a. prescribe a broad-spectrum antibiotic to cover any possible causative organism. b. ask colleagues in the clinic about children they have treated and what they have prescribed. c. give the child’s parents a specimen cup and ask that they try to bring in a sputum specimen for culture. d. refer the child to a pulmonologist or infectious disease specialist to help determine the proper treatment. ANS: B The child shows signs of a bacterial infection, but getting a sputum culture is not likely. The NP should ask colleagues about similar cases and treat according to those patterns. Broad- spectrum antibiotics increase the incidence of resistance. If this child’s symptoms do not respond to empiric therapy, referral may be warranted. DIF: Cognitive Level: Applying (Application) REF: 654 6. A patient has a sore throat with fever. The primary care NP observes erythematous 4+ tonsils with white exudate. A rapid antigen strep test is negative, and a culture is pending. The NP orders amoxicillin as empiric treatment. The patient calls the next day to report a rash. The NP should suspect: a. penicillin drug allergy. b. a viral cause for the patient’s symptoms. c. a serum sickness reaction to the penicillin. d. scarlatiniform rash from the streptococcal infection. ANS: B Certain viral infections, such as mononucleosis, increase the frequency of rash in response to penicillin and is commonly attributed to penicillin allergy. DIF: Cognitive Level: Applying (Application) REF: 656 Show Less