An older adult patient with chronic obstructive pulmonary disease ...

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An older adult patient with chronic obstructive pulmonary disease (COPD) develops bronchitis. The patient has a temperature of 39.5 C. The nurse will expect the provider to:
 
  a. obtain a sputum culture and wait for the results before prescribing an antibiotic.
  b. order empiric antibiotics while waiting for sputum culture results.
  c. treat symptomatically, because antibiotics are usually ineffective against bronchitis.
  d. treat the patient with more than one antibiotic without obtaining cultures.

Question 2

A patient with recurrent bacterial pneumonia is treated with an antibiotic that has worked previously but is not working to reduce symptoms in a current infection. The nurse caring for this patient understands that this is likely for which reason?
 
  a. The antibiotic altered the genetic makeup of the bacterial strain causing this infection.
  b. The antibiotic caused host cells to change and become more susceptible to bacterial effects.
  c. The antibiotic caused a mutation of the organism leading to reduced drug sensitivity.
  d. The antibiotic destroyed competing organisms that secrete substances toxic to the pathogen.

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Answer to Question 1

ANS: B
Patients with severe infections should be treated while culture results are pending. If a patient has a severe infection or is at risk of serious sequelae if treatment is not begun immediately, it is not correct to wait for culture results before beginning treatment. Until a bacterial infection is ruled out, treating symptomatically is not indicated. Treating without obtaining cultures is not recommended.

Answer to Question 2

ANS: D
Antibiotics promote resistance by destroying sensitive organisms and eliminating the toxins they produce, which facilitates survival of resistant organisms. Antibiotics do not alter the genetic makeup of bacteria. The host cells are not affected. Antibiotics are not mutagenic.

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