Chapter 32 Antimycobacterial Drugs
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 dm 401
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 mcg/mL 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 dm 401
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 dm 401 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 patients
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 dm 402 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 dm 407
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 nurses 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.
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 dm 401
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 mcg/mL 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 dm 401
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 dm 401 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 patients
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 dm 402 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 dm 407
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 nurses 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.
