Anti-infective Agents

1.

A patient asks the nurse how an anti-infective produces a therapeutic effect. What key point will the nurse explain to this patient?
A)
Drugs used to treat infections date back to the 17th century.
B)
All anti-infectives work in the same way to destroy organisms.
C)
Selective toxicity determines the appropriate drug dosage needed.
D)
The goal of anti-infectives is to interfere with normal functioning of the organism.
Ans:
D

Feedback:

The goal of anti-infectives is to interfere with the normal function of the invading organism to prevent it from reproducing and to cause cell death without affecting host cells. Each class of anti-infectives works in a different way, but all have the same goal. Because bacteria cells have a slightly different composition than human cells, the bacteria are destroyed without interfering with the host. The first drugs used to treat systemic infections were developed in the early 20th century. The term selective toxicityrefers to the ability to affect certain proteins or enzyme systems that are used by infecting organisms, but not by human cells.

2.

The nursing student learns about anti-infectives in class and demonstrates the need to study more when making what statement about how anti-infectives work?
A)
Some anti-infectives interfere with biosynthesis of the pathogen’s cell wall.
B)
Some anti-infectives prevent the cells of the organism from using essential substances.
C)
Many anti-infectives interfere with the steps involved in protein synthesis.
D)
Some anti-infectives interfere with ribonucleic acid (RNA) synthesis in the cell leading to cell death.
Ans:
D

Feedback:

Some anti-infectives interfere with deoxyribonucleic acid (DNA) synthesis, not RNA synthesis, in the cell, leading to inability to divide and causing cell death. The fluoroquinolones work in this way. The other three options are correct and would not indicate the need for further study time. Penicillins interfere with biosynthesis of the cell wall, sulfonamides prevent organisms from using substances essential to their growth and development, whereas aminoglycosides, macrolides, and chloramphenicol interfere with protein synthesis.

3.

The nurse administers a drug to treat Neisseria gonorrhoeae that works on no other bacteria. How would the nurse describe this drug?
A)
Broad spectrum
B)
Narrow spectrum
C)
Bactericidal
D)
Bacteriostatic
Ans:
B

Feedback:

Without knowing the name of the antibiotic and how it works to treat N. gonorrhoeae,the only thing that can be said is that it is a narrow-spectrum anti-infective because it only treats one specific organism. Broad-spectrum anti-infectives treat multiple organisms. The name of the drug and how it works would need to be known to determine whether it is bacteriocidal or bacteriostatic.

4.

The nurse has provided patient teaching for a patient who will be discharged to home on an anti-infective. What statement made by the patient indicates the nurse needs to provide additional teaching concerning the use of anti-infectives?
A)
“Antibiotics will not help me when I have a viral infection.”
B)
“A bacterial culture will be done before antibiotics are prescribed for me.”
C)
“I could develop diarrhea as a result of taking an antibiotic.”
D)
“I will stop taking the antibiotic as soon as I feel better.”
Ans:
D

Feedback:

Compliance with anti-infective therapy is a concern. Patients tend to stop taking the drugs when they begin to “feel better.” A nurse should instruct the patient to take the entire course of prescribed drug to ensure a sufficient period to rid the body of pathogens and to help prevent the development of resistance. Antibiotics are not prescribed for viral infections. It is important that cultures be performed before antibiotics are prescribed to determine what organism is causing the infection so that the correct drug is prescribed. Diarrhea is the most common adverse effect from anti-infectives.

5.

The nurse attends a class on preventing resistance to anti-infectives and learns that the critical concept in preventing the development of resistant strains of microbes is what?
A)
Exposure of pathogens to an antimicrobial agent without cellular death
B)
Drug dosages that are below a therapeutic level
C)
The duration of drug use
D)
Frequency of drug ingestion
Ans:
C

Feedback:

Exposure of pathogens to an antimicrobial agent without cellular death leads to the development of resistance so it is important to limit the use of these agents to treat pathogens with a known sensitivity to the drug being used. Drug dosages are also important in preventing the development of resistance. However, the duration of drug use is critical to ensure that microbes are completely eliminated and not given the chance to grow and develop resistant strains. It is hard to convince patients that they must always complete the entire course of antimicrobial agents when they begin to “feel better,” because stopping early favors the emergence of drug-resistant strains.

6.

The pathophysiology class is learning how microorganisms develop resistance to anti-infective drugs. What is one way the nursing students would learn that microorganisms develop resistance to anti-infective drugs?
A)
By rearranging their deoxyribonucleic acid (DNA) to produce membranes that are permeable to the drug
B)
By producing an enzyme that stimulates the drug
C)
By changing the cellular membrane to allow the drug entry into the cell
D)
By altering binding sites on the membrane or ribosomes so that the drug cannot enter the cell
Ans:
D

Feedback:

Microorganisms have developed resistance by changing cellular permeability to prevent the drug from entering the cell by altering binding sites on the membranes or on ribosomes so the drug can no longer be accepted and by producing enzymes that deactivate the drug. Microorganisms have not been found to be able to rearrange their DNA to change their membrane structure.

7.

The nurse, writing a care plan for a patient on an aminoglycoside, includes what intervention to reduce the accumulation of the drug in the kidney?
A)
Avoid caffeine intake.
B)
Increase fluids.
C)
Decrease activity.
D)
Increase consumption of fruits and vegetables.
Ans:
B

Feedback:

To prevent the accumulation of anti-infective drugs in the kidneys, which can damage the kidney, patients taking anti-infective drugs should be well hydrated. Decreasing the dosage will likely reduce the therapeutic action and increase risk of resistance. There is no evidence of association between caffeine intake and drug accumulation in the kidney. Decreasing activity and increasing fruits and vegetables in the diet would not be effective in decreasing drug accumulation.

8.

When conducting patient teaching about using antibiotic medications, what is it critical for the nurse to include to help stop the development of resistant strains of microorganisms?
A)
Antibiotics should be used quickly to treat colds and other viral infections before the invading organism has a chance to multiply.
B)
Antibiotic dosage should be reduced and used for shorter periods of time to reduce unnecessary exposure to the drug.
C)
Prescriptions for antibiotics should be readily available so they can be filled as soon as patients suspect they have an infection.
D)
It is very important to take the full course of an antibiotic as prescribed and not save remaining drugs for future infections.
Ans:
D

Feedback:

Teaching patients to take the full course of their antibiotic as prescribed can help to decrease the number of drug-resistant strains. Antibiotics should only be used to treat bacterial infections that have been cultured to identify the antibiotic sensitivity and then patients should be instructed to use the antibiotic for the prescribed course, which will help to eliminate drug-resistant strains. Reducing dosage and time intervals increases the chance for drug resistance because anti-infectives are most effective when taken exactly as indicated.

9.

A patient is told that he or she will have to undergo extensive dental surgery. The dentist prescribes a course of antibiotic therapy before beginning the procedures and continuing for 5 days after the procedure. What is this is an example of?
A)
Chemotherapy
B)
Curative treatment
C)
Prophylaxis
D)
Synergism
Ans:
C

Feedback:

In a situation where an infection is likely to occur, antibiotics can be used to prevent it. This is called prophylaxis. Synergism is using two antibiotics at the same time to improve their effectiveness. Chemotherapy is the use of drugs to destroy abnormal cells, usually cancer cells. Curative treatment involves treating an actual infection to promote a cure.

10.

A patient is receiving meropenem (Merrem IV). What drug-related reaction will the nurse assess for?
A)
Gastrointestinal toxicity
B)
Hepatic toxicity
C)
Nephrotoxicity
D)
Neurotoxicity
Ans:
A

Feedback:

This drug has been associated with potentially fatal pseudomembranous colitis, which affects the gastrointestinal tract. This drug is not associated with liver, kidney, or nerve toxicity.

11.

A patient is admitted to the unit and the nurse assesses whether he or she is at increased risk for infection when what factors are determined? (Select all that apply.)
A)
Malnutrition
B)
Hypertension
C)
Suppression of immune system
D)
Advanced age
E)
Decreased amylase levels
Ans:
A, C, D

Feedback:

Factors that suppress the host defense mechanisms include malnutrition, suppression of immune system, and advanced age. Hypertension does not predispose a person to infection neither does a decreased amylase level.

12.

The nurse is caring for a patient receiving penicillin. The nurse knows this type of antibiotic works by what mechanism?
A)
Inhibiting growth and development of the organism
B)
Inhibiting protein synthesis
C)
Inhibiting cell wall biosynthesis
D)
Stimulating bacterial reproduction
Ans:
C

Feedback:

Some anti-infectives interfere with biosynthesis of the bacterial cell wall. Because bacterial cells have a slightly different composition than human cells, this is an effective way to destroy the bacteria without interfering with the host (see Box 8.2). The penicillins work in this way. The sulfonamides inhibit growth and development of the organism’s cells. Aminoglycosides, macrolides, and chloramphenicol interfere with protein synthesis. Fluoroquinolones interfere with synthesis of deoxyribonucleic acid, resulting in the inability to reproduce.

13.

A nurse collects a culture sample of infected tissue. What does the result of testing the culture contribute to the patient’s care?
A)
Identifies the specific organism causing the infection
B)
Pinpoints the exact site of the infection
C)
Identifies individualized patient factors contributing to infection
D)
Describes the length of time the patient has experienced infection
Ans:
A

Feedback:

A culture is collected to identify the causative organism of an infection. It can help with determining the site of infection in some cases if the infection is limited only to the site where the culture is collected. It does not individualize patient factors contributing to infection. These must be determined through assessment. It cannot indicate how long the patient has had the infection, which is often determined by the white blood cell count and differential.

14.

A patient calls the clinic to talk to the nurse. The patient states that he or she saw the physician “last week” and was prescribed penicillin for a strep throat. The patient goes on to say that they feel so much better they stopped taking the drug “today,” even though there are “a few pills left.” What is the nurse’s best response?
A)
“Okay, thank you for letting me know. I will document in your medical record that the treatment was effective.”
B)
“It is important that you take all the medication so all the germs are killed. Otherwise they could come right back and be even stronger.”
C)
“What you have described is the halo effect of the drug, making you feel better when you are still infected. You’ll feel sick again when the drug is out of your system.”
D)
“You will need to come to the clinic and be evaluated by your physician to make sure the infection is really gone.”
Ans:
B

Feedback:

The duration of drug use is critical to ensure that the microbes are completely, not partially, eliminated and are not given the chance to grow and develop resistant strains. The nurse must explain the importance of taking all of the prescribed medication and should not agree with the patient. This is not related to a halo effect and the patient may feel well until drug levels decrease rather than being completely eliminated from the body. The patient does not need to be seen if the infection is responding to treatment, but they must take the rest of the antibiotic.

15.

When administering anti-infectives to patients, the nurse is aware of the risk for what potentially fatal adverse effect?
A)
Gastrointestinal toxicity
B)
Eighth cranial nerve damage
C)
Anaphylaxis
D)
Toxic effects on the kidney
Ans:
C

Feedback:

Anaphylaxis is an acute, systemic allergic response to a substance that can be fatal if medical intervention does not occur almost immediately because the airway closes due to tissue edema making it impossible to breathe. Gastrointestinal toxicity, hearing loss due to eighth cranial nerve damage and, toxic effects to the kidney are all adverse effects that may be seen with some anti-infectives. Although these adverse effects can be serious, they are not usually fatal.

16.

A group of nursing students are giving a report on the emergence of drug-resistant microbial agents. What could the students cite as a good way to minimize the emergence of drug-resistant microbial agents? (Select all that apply.)
A)
Avoid the use of broad-spectrum antibacterial drugs when treating trivial or viral infections.
B)
Use narrow-spectrum agents if they are thought to be effective.
C)
Do not use vancomycin unnecessarily.
D)
Antibiotics are best started before the culture and sensitivity report returns.
E)
Administer the smallest effective dosage available.
Ans:
A, B, C

Feedback:

Exposure to an antimicrobial agent leads to the development of resistance, so it is important to limit the use of antimicrobial agents to the treatment of specific pathogens known to be sensitive to the drug being used. Drug dosage is important in preventing the development of resistance. Doses should be high enough and the duration of drug therapy should be long enough to eradicate even slightly resistant microorganisms. It is best to wait until cultures return before initiating antibiotics when possible, but patients with severe infections may be started on broad­­­­­­­­­­ -spectrum antibiotics while waiting for culture results.

17.

The home care nurse is taking care of a patient on IV vancomycin for cellulitis of the left calf. How would the nurse explain how microorganisms develop resistance to anti-infective medications?
A)
Microorganisms can alter the blood supply to the infection.
B)
Microorganisms can stop the cell from reproducing.
C)
Microorganisms produce a chemical that acts as an antagonist to the drug.
D)
Microorganisms change their cell membrane to make it look like the drug.
Ans:
C

Feedback:

Microorganisms develop resistance in a number of ways, including the following: changing cellular permeability to prevent the drug from entering the cell or altering transport systems to exclude the drug from active transport into the cell; altering binding sites on the membranes or ribosomes, which then no longer accept the drug; and producing a chemical that acts as an antagonist to the drug. Microorganisms do not alter the blood supply to the infection, stop a cell from reproducing, or change the appearance of the cell membrane.

18.

Overuse of anti-infective agents is known to contribute to the onset of superinfections in the body. What is a causative agent of a superinfection?
A)
Escherichia coli
B)
Probenecid
C)
Protozoans
D)
Pseudomonas
Ans:
D

Feedback:

Common superinfections include vaginal or gastrointestinal yeast infections, which are associated with antibiotic therapy, and infections caused by Proteus and Pseudomonasthroughout the body, which are a result of broad-spectrum antibiotic use. Probenicid is a medication, not a causative organism. Protozoa and E. coli do not usually cause superinfections.

19.

The pharmacology instructor is explaining combination drugs to the nursing class. The instructor tells the students that a combination of anti-infective agents may be used for several reasons. What is one of them?
A)
Some drugs are synergistic.
B)
Increased likelihood of killing the microorganisms
C)
Requires larger doses of the drugs
D)
Absorption of drugs increased
Ans:
A

Feedback:

Some drugs are synergistic, which means that they are more powerful when given in combination. The health care provider may be encouraged to use a smaller dosage of each drug, leading to fewer adverse effects, but still having a therapeutic impact on the pathogen. Many microbial infections are caused by more than one organism; each pathogen may react to a different anti-infective agent. Combination drugs do not have a better chance at killing the microorganism and they do not increase the absorption of the drugs.

20.

Bactericidal agents do not prevent compounds fight infection and destroy microorganisms by inhibiting what?
A)
Protein synthesis
B)
Deoxyribonucleic acid (DNA) replication
C)
Cell wall synthesis
D)
Leukocytes
Ans:
A

Feedback:

Some anti-infectives are so active against the infective microorganisms that they actually cause the death of the cells they affect. These drugs are said to be bactericidal. Bactericidal action inhibits protein synthesis. Bacteriocidal agents do not prevent DNA replication , do not inhibit cell wall synthesis, and do not impact leukocytes.

21.

The nurse is caring for a child who weighs 30 kg. The physician orders gentamicin (Garamycin) tid. The recommended dosage range is 6 to 7.5 mg/kg/day. Why is it important to give a dosage within this recommended range? (Select all that apply.)
A)
To avoid toxic effects
B)
To protect other patients
C)
To reduce the risk of drug-resistant organisms
D)
To eradicate the bacteria
E)
To promote lactic acid removal
Ans:
A, B, C, D

Feedback:

By administering the correct dosage, you avoid overdosage and reduce the risk of toxic effects. The correct dosage reduces the risk of creating drug-resistant organisms; it also protects both the patient and the other patients who might be susceptible to the drug-resistant organisms as well. The proper dosage is needed to eradicate the bacteria. Lactic acid removal is not related to the proper dosage and is a distracter for this question.

22.

The nurse is administering an anti-infective to a pediatric patient. What will the nurse assess for related to adverse effects in this patient?
A)
Cardiovascular function and perfusion
B)
Hydration and nutritional status
C)
Liver and pancreatic function
D)
Rest and sleep status
Ans:
B

Feedback:

Because children can have increased susceptibility to the gastrointestinal and nervous system effects of anti-infectives, monitor hydration and nutritional status carefully. Patients should be encouraged to drink fluids. Cardiovascular, hepatic, and pancreatic function are not at greater risk in children. Rest and sleep status are important but are not impacted by anti-infectives.

23.

A parasitic infection is suspected. What type of culture is the nurse likely to collect?
A)
Blood
B)
Urine
C)
Stool
D)
Sputum
Ans:
C

Feedback:

When investigators search for parasitic sources of infection, the stool is examined for ova and parasites. Blood, urine, and sputum are unlikely to reflect signs of parasitic infection.

24.

The nurse is caring for a patient receiving IV aminoglycosides for an intractable infection in his or her leg. What would it be important for the nurse to monitor this patient for?
A)
Visual disturbances
B)
Liver dysfunction
C)
Serum glucose levels
D)
Renal dysfunction
Ans:
D

Feedback:

When patients are taking aminoglycosides, it is important they be monitored closely for any sign of renal dysfunction. Aminoglycosides do not generally cause visual disturbances, liver dysfunction, or altered serum glucose levels.

25.

The nurse collects the past medical history of a patient new to the clinic. The patient states he or she is allergic to penicillin. What would the nurse question next? (Select all that apply.)
A)
What signs and symptoms were displayed with the reaction?
B)
What treatment was required to control the allergic reaction?
C)
How was the medication administered?
D)
How many dosages were administered before the reaction occurred?
E)
Had the medication ever been prescribed before the time when the reaction occurred?
Ans:
A, D, E

Feedback:

It is important to determine what the allergic reaction was and when the patient experienced it (e.g., after first use of drug, after years of use). If she had been prescribed this medication before with no reaction and then had a reaction the next time it was prescribed, this would be important information to know. Some patients report having a drug allergy, but closer investigation indicates that their reaction actually constituted an anticipated effect or a known adverse effect to the drug. It would not necessarily be important to find out what was done to stop the reaction or who the caregiver was at the time of the reaction or what type of allergic reaction it was.

26.

A patient comes to the clinic to talk with the nurse about planned overseas travel. The patient tells the nurse that he or she is planning a trip to an area of the world where malaria is common. He wants to know how to prevent contracting the disease. What should the nurse respond?
A)
“We can ask the physician to give you some anti-infectives in case you get malaria.”
B)
“We can ask the physician for some anti-infectives for you to take prophylactically.”
C)
“Don’t worry, if you get malaria they have some good doctors where you are going.”
D)
“If you get malaria, you can always be treated on the way home.”
Ans:
B

Feedback:

Some anti-infectives are used as a means of prophylaxis when patients expect to be in situations that will expose them to a known pathogen, such as travel to an area where malaria is endemic, or undergoing oral or invasive gastrointestinal surgery in a person who is susceptible to subacute bacterial endocarditis. After the patient contracts malaria, it is much harder to treat so he would not start the medication or obtain treatment after being infected.

27.

The nurse is caring for a patient who is receiving a broad-spectrum anti-infective agents. The nurse would assess the patient for what common adverse effect of broad spectrum anti-infective agents?
A)
Destruction of pathogens
B)
Decrease in infection
C)
Destruction of the normal flora
D)
Decrease in inflammation
Ans:
C

Feedback:

One offshoot of the use of anti-infectives, especially broad-spectrum anti-infectives, is destruction of the normal flora resulting in superinfections. Destruction of pathogens is the therapeutic effect and not an adverse effect resulting in a decrease in infection. Inflammation is reduced by resolution of infection.

28.

Selective toxicity, or the ability to affect certain proteins or enzyme systems in the infecting organism, is a much sought-after quality in an anti-infective agent. How many anti-infective agents have this quality?
A)
75%
B)
50%
C)
25%
D)
0%
Ans:
D

Feedback:

Although anti-infective agents target foreign organisms infecting the body of a human host, they do not possess selective toxicity, which is the ability to affect certain proteins or enzyme systems used by the infecting organism but not by human cells. Because all living cells are somewhat similar, however, no anti-infective drug has yet been developed that does not affect the host. Therefore Options A, B, and C are incorrect.

29.

The nursing instructor teaches the students about selective toxicity when one of the students asks, “What happens when a drug doesn’t have selective toxicity?” What is the instructor’s best response?
A)
Healthy cells are damaged.
B)
All pathogens are destroyed in the body.
C)
Reduced enzymes are produced.
D)
Protein malnutrition
Ans:
A

Feedback:

When a drug does not display selective toxicity, healthy cells are damaged because the drug does not specifically target only the pathogen. Anti-infectives work by a variety of different means so one drug is not likely to kill every type of pathogen in the body. Selective toxicity does not impact enzyme production or cause protein malnutrition.

30.

The nursing instructor is talking with the students about anti-infective medication and explains that drugs that are very selective in their actions are said to be what?
A)
Broad spectrum
B)
Narrow spectrum
C)
Bactericidal
D)
Bacteriostatic
Ans:
B

Feedback:

Some anti-infectives are so selective in their action that they are effective against only a few, or possibly only one, microorganism with a very specific metabolic pathway or enzyme. These drugs are said to have a narrow spectrum of activity. They are not called broad spectrum, which applies to a drug with little selectivity; bactericidal, which is a substance that causes death of bacteria; or bacteriostatic, which prevents replication of a bacterium.

31.

The nurse administers polymyxin B to a patient with a gram-negative bacterial infection. What symptoms would cause the nurse to suspect drug fever, hold the medication, and call the health care provider immediately? (Select all that apply.)
A)
Fever
B)
Dizziness
C)
Ataxia
D)
Increased activity
E)
Reduced urine output
Ans:
A, B, C, E

Feedback:

The actions of polymyxin B on cell membranes means it can be toxic to the human host, leading to nephrotoxicity, neurotoxicity (e.g., facial flushing, dizziness, ataxia, paresthesias, drowsiness), and drug-related fever and rash. This drug is reserved for infections that do not respond to less toxic drugs; the nurse needs to be alert for serious reactions and hold the drug until notifying the provider.

32.

The charge nurse, working on a pediatric unit, sees an order was written to administer chloramphenicol (Chloromycetin) to one of the children assigned to a new graduate nurse. The charge nurse would make sure the new graduate was familiar with what possible adverse effects of this medication? (Select all that apply.)
A)
Gray syndrome
B)
Bone marrow depression
C)
Aplastic anemia
D)
Liver failure
E)
Hearing loss
Ans:
A, B, C

Feedback:

Chloramphenicol (Chloromycetin), an older antibiotic, prevents bacterial cell division in susceptible bacteria. Because of the potential toxic effects of this drug, its use is limited to serious infections for which no other antibiotic is effective. Chloramphenicol produces a “gray syndrome” in neonates and premature babies, which is characterized by abdominal distention, pallid cyanosis, vasomotor collapse, irregular respirations, and even death. In addition, the drug may cause bone marrow depression, including aplastic anemia that can result in death. Liver failure and hearing loss are not usually associated with this drug.

33.

The patient in the clinic receives a prescription for an anti-infective to treat a urinary tract infection. The patient asks the nurse, “Would you ask the doctor to give me refills on this prescription? I get a urinary tract infection almost once a year it seems and I’d like to have a refill I can store for the next time so I don’t have to come back to the clinic.” What is the nurse’s priority response?
A)
“Sure, I’d be glad to ask. How many refills would you like to have?”
B)
“Most medications, if not used, should be discarded after a year so it is better to get a new prescription next year when you need it.”
C)
“This antibiotic doesn’t destroy every pathogen that could cause a urinary tract infection so it is better to get the right antibiotic next time.”
D)
“Saving antibiotics for another time and self-diagnosing when antibiotics are needed lead to resistant organisms that no longer respond to drugs.”
Ans:
D

Feedback:

Option A is incorrect because the patient should not be given refills to use indiscriminately. The remaining options are all important teaching points for this patient, but the priority is teaching this patient about drug-resistant organisms and how they can be prevented, as well as what happens if an infection results from a resistant organism.

34.

The nurse admits a patient with septicemia (i.e., infection in the bloodstream). The patient denies any allergies and the doctor has ordered cefuroxime based on blood culture results that report the active pathogen is susceptible to this drug. The patient asks what antibiotic was ordered, and when the nurse says cefuroxime, the patient says, “Call my doctor and tell him I want vancomycin because I’ve been reading about drug-resistant bacteria and I don’t want to take any chances.” What is the nurse’s best response?
A)
“Vancomycin is a powerful drug with many adverse effects and it is reserved for when no other drug will work against the infection.”
B)
“There are some resistant infections that require vancomycin so you are right to prefer a stronger antibiotic.”
C)
“I appreciate your concern but your doctor ordered the right medication for you so don’t worry about it.”
D)
“You can’t believe anything you read on the Internet because most of it is just someone’s opinion and not fact.”
Ans:
A

Feedback:

The patient is right in saying that vancomycin is effective against drug-resistant bacteria but needs help to understand that he or she does not have a resistant infection as indicated by the culture and sensitivity and that use of such a powerful drug when it is not needed increases risk of developing a vancomycin-resistant infection. It is never right to tell a patient “not to worry” because they have every right to participate in his or her own care and should not be patronized. Although some information on the Internet may not be accurate, it would be incorrect to say it is all just someone’s opinion and not fact, especially given that the patient’s information is accurate.

35.

The mother brings her 18-month-old toddler to the pediatrician because the child has a fever and has been tugging on his or her left ear. Examination of the tympanic membrane confirms an ear infection and the toddler also has a cold with nasal congestion, rhinorrhea, and a cough. The provider tells the mother to apply heat and gives her a prescription for an otic anesthetic to make the ear more comfortable until the infection resolves. The mother is not happy and says she wants a prescription for an antibiotic. What important teaching points will the nurse include in the teaching plan? (Select all that apply.)
A)
Ear infections that accompany viral respiratory infections do not respond to antibiotics.
B)
Habitual use of antibiotics for viral infections contribute to development of resistant strains.
C)
Adverse effects from antibiotics in children can cause diarrhea and dehydration.
D)
Antibiotics will only be prescribed if a culture indicates the presence of bacteria in the ear.
E)
The pediatrician knows more than the mother and she should trust what she is being told.
Ans:
A, B, C

Feedback:

When the child has a viral respiratory infection, the organism involved in ear infections is usually viral as well. As a result, antibiotics will have no effect on the infection that will resolve independently and only comfort care is indicated. Habitual use of antibiotics for viral infections contributes to the development of resistant strains of bacteria and the adverse effects can make the child more uncomfortable causing diarrhea and dehydration. Cultures of ear fluid are almost never done because it would be an invasive procedure to remove fluid from the middle ear. It is never right for the nurse to patronize the mother, who has every right to advocate for her child, and it is more important she understand why the antibiotic is not being prescribed than telling her the pediatrician knows more.