1
NURS 6015: Unit 2 Study Guide Spring 2021
When studying the drugs in this unit think about the following:
1. What do you need to teach the client?
2. What side effects does the nurse need to be looking for?
3. What should the client or nurse do to prevent side effects?
4. What should the nurse do when a client presents with a side effect?
5. What clients are most susceptible to side effects of drugs?
6. What is the nurse’s priority action?
7. What is the nurse’s priority assessment?
8. What does the nurse need to do before starting antibiotic therapy?
9. What should the nurse include in a teaching plan?
10. What are contraindication to this drug?
11. What are serious drug-drug interactions?
12. What should the nurse do if serious drug interactions occur?
13. What laboratory tests should be monitored?
14. What to do when side effects occur?
15. What side effects warrant a call to the provider?
16. What does the nurse look for to know that the anti-microbial is working?
Examples of Question Stems:
“A client is taking X drug (e.g. gentamicin). Based on the nurse’s knowledge of
the drug’s side effects, it would be important for the nurse to assess which of the
following?”
ANSWER: You are looking for what body system, lab test, or physical
assessment finding that would be impacted by the effects of the drug.
“The nurse should question the use of X drug (certain class of drug or a drug
name) for a client with a history of which of the following underlying health
problems?”
ANSWER: You are looking for a client health problem such as heart block,
asthma, glaucoma that could pose problems when taking this drug.
“X drug has been ordered for a client. The nurse knows that this drug would be
used to treat which of the following health problems? “
ANSWER: You are looking for a therapeutic usage
“Which of the following statements made by the client about the drug would
require further teaching?”
ANSWER: You are looking for an incorrect statement about a drug that would
need clarification or correction
Principles of Anti-infective Therapy
1
, 2
Antibiotics
What does selective toxicity mean?
o Selective toxicity: evaluating of pathogens obtained in a culture to
determine the anti-infectives to which the organisms are sensitive and
which agent would be appropriate for treatment of a particular infection
Bactericidal versus bacteriostatic
o Is it ok to use a bacteriostatic drug?
Bactericidal: substance that causes the death of bacteria,
usually by interfering with cell membrane stability or with
proteins or enzymes necessary to maintain cellular integrity of
the bacteria
Bacteriostatic: substance that prevents the replication of
bacteria, usually by interfering with proteins or enzyme systems
necessary for reproduction of the bacteria
Yes, it is okay to use bacteriostatic drugs, especially in
cases of endocarditis, meningitis, and osteomyelitis
Broad versus narrow spectrum
o Why is one used over the other?
o Risks of using broad spectrum
Broad spectrum: are used to treat a wide range of bacteria
Typically used when there’s not enough time for culture
sensitivity
Risks: can lead to C-diff, can create antibiotic resistant
bacteria, can cause rashes
Kill good bacteria along with the bad
Narrow spectrum: only effective against very selective bacteria
Used when the known bacteria has been identified
through cultures to treat the specific bacteria
o Little risk of developing superinfections
Legitimate reasons for prophylactic antibiotic use
o To prevent infections before they occur.
o Anti-malarial drugs are used when travelling to a place where there is
an endemic of malaria
o Patients undergoing GI or GU surgery are given prophylactic
antibiotics to prevent infection after surgery.
o Cardiac surgeries like valve replacements and prone to develop
subacute bacterial endocarditis because of their vulnerable valves
o Dental work with patients who have had invasive procedures to
prevent bacteria travelling to heart and causing valve failure
Importance of culturing first
o Process of identifying organism and selecting therapy
Cultures are performed in a lab by swabbing the infected tissue
and allowing it to grow in an agar plate
2
, 3
Staining techniques are used as well as microscopic
examination to determine the offending bacterium.
Sensitivity testing: on cultured microbes to evaluate bacteria
and determine which drugs are capable of controlling the
particular organism
o What are methods of obtaining a culture?
Swab, staining, microscopic identification
o What is the overall goal of obtaining a culture?
To identify the causal pathogen and choosing the appropriate
drug for treating the infection
What are ways to reduce antibiotic resistance, FDA and CDC (Box 9.4)
o The Food and Drug Administration (FDA) and Centers for Disease
Control and Prevention (CDC) have joined efforts to educate the public
and healthcare providers about the dangers of inappropriate use of
antibiotics. The evidence-based practice guidelines combine data from
many studies to outline the most efficacious use of antibiotics. To
review some of the studies, look at the references listed in the
“Bibliography and References” section. Nurses should include some of
the following points about the risks and dangers of antibiotic abuse in
the patient education plan:
Explain clearly that a particular antibiotic is effective against only
certain bacteria and that a culture needs to be taken to identify
the bacteria.
Explain that bacteria can develop resistant strains that will not
be affected by antibiotics in the future, so use of antibiotics now
may make them less effective in situations in which they are
really necessary.
Ensure that patients understand the importance of taking the full
course of medication as prescribed, even if they feel better.
Stopping an antibiotic midway through a regimen often leads to
the development of resistant bacteria. Using all of the
medication will also prevent patients from saving unused
medication to self-treat future infections or to share with other
family members.
Tell patients that allergies may develop with repeated exposures
to certain antibiotics. In addition, explain to patients that saving
antibiotics to take later, when they think they need them again,
may lead to earlier development of an allergy, which will negate
important tests that could identify the bacteria making them sick.
Offer other medications, such as antihistamines,
decongestants, or even chicken soup, to patients who request
antibiotics; this may satisfy their need for something to take.
Explaining that viral infections do not respond to antibiotics
usually offers little consolation to patients who are suffering from
a cold or the flu.
How does resistance develop?
3
NURS 6015: Unit 2 Study Guide Spring 2021
When studying the drugs in this unit think about the following:
1. What do you need to teach the client?
2. What side effects does the nurse need to be looking for?
3. What should the client or nurse do to prevent side effects?
4. What should the nurse do when a client presents with a side effect?
5. What clients are most susceptible to side effects of drugs?
6. What is the nurse’s priority action?
7. What is the nurse’s priority assessment?
8. What does the nurse need to do before starting antibiotic therapy?
9. What should the nurse include in a teaching plan?
10. What are contraindication to this drug?
11. What are serious drug-drug interactions?
12. What should the nurse do if serious drug interactions occur?
13. What laboratory tests should be monitored?
14. What to do when side effects occur?
15. What side effects warrant a call to the provider?
16. What does the nurse look for to know that the anti-microbial is working?
Examples of Question Stems:
“A client is taking X drug (e.g. gentamicin). Based on the nurse’s knowledge of
the drug’s side effects, it would be important for the nurse to assess which of the
following?”
ANSWER: You are looking for what body system, lab test, or physical
assessment finding that would be impacted by the effects of the drug.
“The nurse should question the use of X drug (certain class of drug or a drug
name) for a client with a history of which of the following underlying health
problems?”
ANSWER: You are looking for a client health problem such as heart block,
asthma, glaucoma that could pose problems when taking this drug.
“X drug has been ordered for a client. The nurse knows that this drug would be
used to treat which of the following health problems? “
ANSWER: You are looking for a therapeutic usage
“Which of the following statements made by the client about the drug would
require further teaching?”
ANSWER: You are looking for an incorrect statement about a drug that would
need clarification or correction
Principles of Anti-infective Therapy
1
, 2
Antibiotics
What does selective toxicity mean?
o Selective toxicity: evaluating of pathogens obtained in a culture to
determine the anti-infectives to which the organisms are sensitive and
which agent would be appropriate for treatment of a particular infection
Bactericidal versus bacteriostatic
o Is it ok to use a bacteriostatic drug?
Bactericidal: substance that causes the death of bacteria,
usually by interfering with cell membrane stability or with
proteins or enzymes necessary to maintain cellular integrity of
the bacteria
Bacteriostatic: substance that prevents the replication of
bacteria, usually by interfering with proteins or enzyme systems
necessary for reproduction of the bacteria
Yes, it is okay to use bacteriostatic drugs, especially in
cases of endocarditis, meningitis, and osteomyelitis
Broad versus narrow spectrum
o Why is one used over the other?
o Risks of using broad spectrum
Broad spectrum: are used to treat a wide range of bacteria
Typically used when there’s not enough time for culture
sensitivity
Risks: can lead to C-diff, can create antibiotic resistant
bacteria, can cause rashes
Kill good bacteria along with the bad
Narrow spectrum: only effective against very selective bacteria
Used when the known bacteria has been identified
through cultures to treat the specific bacteria
o Little risk of developing superinfections
Legitimate reasons for prophylactic antibiotic use
o To prevent infections before they occur.
o Anti-malarial drugs are used when travelling to a place where there is
an endemic of malaria
o Patients undergoing GI or GU surgery are given prophylactic
antibiotics to prevent infection after surgery.
o Cardiac surgeries like valve replacements and prone to develop
subacute bacterial endocarditis because of their vulnerable valves
o Dental work with patients who have had invasive procedures to
prevent bacteria travelling to heart and causing valve failure
Importance of culturing first
o Process of identifying organism and selecting therapy
Cultures are performed in a lab by swabbing the infected tissue
and allowing it to grow in an agar plate
2
, 3
Staining techniques are used as well as microscopic
examination to determine the offending bacterium.
Sensitivity testing: on cultured microbes to evaluate bacteria
and determine which drugs are capable of controlling the
particular organism
o What are methods of obtaining a culture?
Swab, staining, microscopic identification
o What is the overall goal of obtaining a culture?
To identify the causal pathogen and choosing the appropriate
drug for treating the infection
What are ways to reduce antibiotic resistance, FDA and CDC (Box 9.4)
o The Food and Drug Administration (FDA) and Centers for Disease
Control and Prevention (CDC) have joined efforts to educate the public
and healthcare providers about the dangers of inappropriate use of
antibiotics. The evidence-based practice guidelines combine data from
many studies to outline the most efficacious use of antibiotics. To
review some of the studies, look at the references listed in the
“Bibliography and References” section. Nurses should include some of
the following points about the risks and dangers of antibiotic abuse in
the patient education plan:
Explain clearly that a particular antibiotic is effective against only
certain bacteria and that a culture needs to be taken to identify
the bacteria.
Explain that bacteria can develop resistant strains that will not
be affected by antibiotics in the future, so use of antibiotics now
may make them less effective in situations in which they are
really necessary.
Ensure that patients understand the importance of taking the full
course of medication as prescribed, even if they feel better.
Stopping an antibiotic midway through a regimen often leads to
the development of resistant bacteria. Using all of the
medication will also prevent patients from saving unused
medication to self-treat future infections or to share with other
family members.
Tell patients that allergies may develop with repeated exposures
to certain antibiotics. In addition, explain to patients that saving
antibiotics to take later, when they think they need them again,
may lead to earlier development of an allergy, which will negate
important tests that could identify the bacteria making them sick.
Offer other medications, such as antihistamines,
decongestants, or even chicken soup, to patients who request
antibiotics; this may satisfy their need for something to take.
Explaining that viral infections do not respond to antibiotics
usually offers little consolation to patients who are suffering from
a cold or the flu.
How does resistance develop?
3
