Chapter 26: Antibacterials
McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 9th Edition
MULTIPLE CHOICE
1. The nurse is caring for a patient who is receiving an intravenous antibiotic. The nurse notes
that the provider has ordered serum drug peak and trough levels. The nurse understands that
these tests are necessary for which type of drugs?
a. Drugs with a broad spectrum
b. Drugs with a narrow spectrum
c. Drugs with a broad therapeutic index
d. Drugs with a narrow therapeutic index
ANS: D
Medications with a narrow therapeutic index have a limited range between the therapeutic
dose and a toxic dose. It is important to monitor these medications closely by evaluating
regular serum peak and trough levels.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 343
TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. The nurse is caring for a patient who is receiving an intravenous antibiotic. The patient has a
serum drug trough of 1.5 mcg/mL. The normal trough for this drug is 1.7 to 2.2 mcg/mL.
What will the nurse expect the patient to experience?
a. Inadequate drug effects
b. Increased risk for superinfection
c. Minimal adverse effects
d. Slowed onset of action
ANS: A
Low peak levels may indicate that the medication is below the therapeutic level. They do
not indicate altered risk for superinfection, a decrease in adverse effects, or a slowed onset
of action.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 343
TOP: Nursing Process: Analysis/Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
3. The nurse is teaching a nursing student about the minimal effective concentration (MEC) of
antibiotics. Which statement by the nursing student indicates understanding of this concept?
a. “A serum drug level greater than the MEC ensures that the drug is bacteriostatic.”
b. “A serum drug level greater than the MEC broadens the spectrum of the drug.”
c. “A serum drug level greater than the MEC helps eradicate bacterial infections.”
d. “A serum drug level greater than the MEC increases the therapeutic index.”
ANS: C
, The MEC is the minimum amount of drug needed to halt the growth of a microorganism. A
level greater than the MEC helps eradicate infections. Drugs at or above the MEC are
usually bactericidal, not bacteriostatic. Raising the drug level does not usually broaden the
spectrum or increase the therapeutic index of a drug.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 344
TOP: Nursing Process: N/A
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
4. The nurse is caring for a patient who has recurrent urinary tract infections. The patient’s
current infection is not responding to an antibiotic that has been used successfully several
times in the past. The nurse understands that this is most likely due to
a. acquired bacterial resistance.
b. cross-resistance.
c. inherent bacterial resistance.
d. transferred resistance.
ANS: A
Acquired resistance occurs when an organism has been exposed to the antibacterial drug.
Cross-resistance occurs when an organism that is resistant to one drug is also resistant to
another. Inherent resistance occurs without previous exposure to the drug. Transferred
resistance occurs when the resistant genes of one organism are passed to another organism.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 344
TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. The nurse is preparing to administer amoxicillin (Amoxil) to a patient and learns that the
patient previously experienced a rash when taking penicillin. Which action will the nurse
take?
a. Administer the amoxicillin and have epinephrine available.
b. Ask the provider to order an antihistamine.
c. Contact the provider to discuss using a different antibiotic.
d. Request an order for a beta-lactamase resistant drug.
ANS: C
Patients who have previously experienced manifestations of allergy to a penicillin should
not use penicillins again unless necessary. The nurse should contact the provider to discuss
using another antibiotic from a different class. Epinephrine and antihistamines are useful
when patients are experiencing allergic reactions, depending on severity.
DIF: Cognitive Level: Applying (Application) REF: p. 349
TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
6. The nurse is preparing to administer an antibiotic to a patient who has been receiving the
antibiotic for 2 days after a culture was obtained. The nurse notes increased erythema and
swelling, and the patient has a persistent high fever of 39° C. What is the nurse’s next
action?
a. Administer the antibiotic as ordered.
, b. Contact the provider to request another culture.
c. Discuss the need to add a second antibiotic with the provider.
d. Review the sensitivity results from the patient’s culture.
ANS: D
The sensitivity results from the patient’s culture will reveal whether the organism is
sensitive or resistant to a particular antibiotic. The patient is not responding to the antibiotic
being given, so the antibiotic should be held and the provider notified. Another culture is not
indicated. Antibiotics should be added only when indicated by the sensitivity.
DIF: Cognitive Level: Applying (Application) REF: p. 349
TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
7. The nurse is preparing to administer the first dose of an antibiotic to a patient admitted for a
urinary tract infection. Which action is most important prior to administering the antibiotic?
a. Administering a small test dose to determine whether hypersensitivity exists
b. Having epinephrine available in the event of a severe hypersensitivity reaction
c. Monitoring baseline vital signs, including temperature and blood pressure
d. Obtaining a urine specimen for culture and sensitivity
ANS: D
To obtain the most accurate culture, the specimen should be obtained before antibiotic
therapy begins. It is important to obtain cultures when possible to correctly identify the
organism and help determine which antibiotic will be most effective. Administering test
doses to determine hypersensitivity is sometimes done when there is a strong suspicion of
allergy when a particular antibiotic is needed. Epinephrine is kept close at hand when there
is a strong suspicion of allergy.
DIF: Cognitive Level: Applying (Application) REF: p. 366
TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
8. A patient is admitted to the hospital for treatment of pneumonia after complaining of high
fever and shortness of breath. The patient was not able to produce sputum for a culture. The
nurse will expect the patient’s provider to order
a. a broad-spectrum antibiotic.
b. a narrow-spectrum antibiotic.
c. multiple antibiotics.
d. the pneumococcal vaccine.
ANS: A
Broad-spectrum antibiotics are frequently used to treat infections when the offending
organism has not been identified by culture and sensitivity (C&S). Narrow-spectrum
antibiotics are usually effective against one type of organism and are used when the C&S
indicates sensitivity to that antibiotic. The use of multiple antibiotics, unless indicated by
C&S, can increase resistance. The pneumococcal vaccine is used to prevent, not treat, an
infection.
DIF: Cognitive Level: Applying (Application) REF: p. 345
McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 9th Edition
MULTIPLE CHOICE
1. The nurse is caring for a patient who is receiving an intravenous antibiotic. The nurse notes
that the provider has ordered serum drug peak and trough levels. The nurse understands that
these tests are necessary for which type of drugs?
a. Drugs with a broad spectrum
b. Drugs with a narrow spectrum
c. Drugs with a broad therapeutic index
d. Drugs with a narrow therapeutic index
ANS: D
Medications with a narrow therapeutic index have a limited range between the therapeutic
dose and a toxic dose. It is important to monitor these medications closely by evaluating
regular serum peak and trough levels.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 343
TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. The nurse is caring for a patient who is receiving an intravenous antibiotic. The patient has a
serum drug trough of 1.5 mcg/mL. The normal trough for this drug is 1.7 to 2.2 mcg/mL.
What will the nurse expect the patient to experience?
a. Inadequate drug effects
b. Increased risk for superinfection
c. Minimal adverse effects
d. Slowed onset of action
ANS: A
Low peak levels may indicate that the medication is below the therapeutic level. They do
not indicate altered risk for superinfection, a decrease in adverse effects, or a slowed onset
of action.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 343
TOP: Nursing Process: Analysis/Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
3. The nurse is teaching a nursing student about the minimal effective concentration (MEC) of
antibiotics. Which statement by the nursing student indicates understanding of this concept?
a. “A serum drug level greater than the MEC ensures that the drug is bacteriostatic.”
b. “A serum drug level greater than the MEC broadens the spectrum of the drug.”
c. “A serum drug level greater than the MEC helps eradicate bacterial infections.”
d. “A serum drug level greater than the MEC increases the therapeutic index.”
ANS: C
, The MEC is the minimum amount of drug needed to halt the growth of a microorganism. A
level greater than the MEC helps eradicate infections. Drugs at or above the MEC are
usually bactericidal, not bacteriostatic. Raising the drug level does not usually broaden the
spectrum or increase the therapeutic index of a drug.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 344
TOP: Nursing Process: N/A
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
4. The nurse is caring for a patient who has recurrent urinary tract infections. The patient’s
current infection is not responding to an antibiotic that has been used successfully several
times in the past. The nurse understands that this is most likely due to
a. acquired bacterial resistance.
b. cross-resistance.
c. inherent bacterial resistance.
d. transferred resistance.
ANS: A
Acquired resistance occurs when an organism has been exposed to the antibacterial drug.
Cross-resistance occurs when an organism that is resistant to one drug is also resistant to
another. Inherent resistance occurs without previous exposure to the drug. Transferred
resistance occurs when the resistant genes of one organism are passed to another organism.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 344
TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. The nurse is preparing to administer amoxicillin (Amoxil) to a patient and learns that the
patient previously experienced a rash when taking penicillin. Which action will the nurse
take?
a. Administer the amoxicillin and have epinephrine available.
b. Ask the provider to order an antihistamine.
c. Contact the provider to discuss using a different antibiotic.
d. Request an order for a beta-lactamase resistant drug.
ANS: C
Patients who have previously experienced manifestations of allergy to a penicillin should
not use penicillins again unless necessary. The nurse should contact the provider to discuss
using another antibiotic from a different class. Epinephrine and antihistamines are useful
when patients are experiencing allergic reactions, depending on severity.
DIF: Cognitive Level: Applying (Application) REF: p. 349
TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
6. The nurse is preparing to administer an antibiotic to a patient who has been receiving the
antibiotic for 2 days after a culture was obtained. The nurse notes increased erythema and
swelling, and the patient has a persistent high fever of 39° C. What is the nurse’s next
action?
a. Administer the antibiotic as ordered.
, b. Contact the provider to request another culture.
c. Discuss the need to add a second antibiotic with the provider.
d. Review the sensitivity results from the patient’s culture.
ANS: D
The sensitivity results from the patient’s culture will reveal whether the organism is
sensitive or resistant to a particular antibiotic. The patient is not responding to the antibiotic
being given, so the antibiotic should be held and the provider notified. Another culture is not
indicated. Antibiotics should be added only when indicated by the sensitivity.
DIF: Cognitive Level: Applying (Application) REF: p. 349
TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
7. The nurse is preparing to administer the first dose of an antibiotic to a patient admitted for a
urinary tract infection. Which action is most important prior to administering the antibiotic?
a. Administering a small test dose to determine whether hypersensitivity exists
b. Having epinephrine available in the event of a severe hypersensitivity reaction
c. Monitoring baseline vital signs, including temperature and blood pressure
d. Obtaining a urine specimen for culture and sensitivity
ANS: D
To obtain the most accurate culture, the specimen should be obtained before antibiotic
therapy begins. It is important to obtain cultures when possible to correctly identify the
organism and help determine which antibiotic will be most effective. Administering test
doses to determine hypersensitivity is sometimes done when there is a strong suspicion of
allergy when a particular antibiotic is needed. Epinephrine is kept close at hand when there
is a strong suspicion of allergy.
DIF: Cognitive Level: Applying (Application) REF: p. 366
TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
8. A patient is admitted to the hospital for treatment of pneumonia after complaining of high
fever and shortness of breath. The patient was not able to produce sputum for a culture. The
nurse will expect the patient’s provider to order
a. a broad-spectrum antibiotic.
b. a narrow-spectrum antibiotic.
c. multiple antibiotics.
d. the pneumococcal vaccine.
ANS: A
Broad-spectrum antibiotics are frequently used to treat infections when the offending
organism has not been identified by culture and sensitivity (C&S). Narrow-spectrum
antibiotics are usually effective against one type of organism and are used when the C&S
indicates sensitivity to that antibiotic. The use of multiple antibiotics, unless indicated by
C&S, can increase resistance. The pneumococcal vaccine is used to prevent, not treat, an
infection.
DIF: Cognitive Level: Applying (Application) REF: p. 345
