Exam Questions 3e Antimicrobial Treatment Chapter.10

Microbiology Fundamentals: A Clinical Approach, 3e (Cowan)

Chapter 10 Antimicrobial Treatment

1) Substances that are naturally produced by certain microorganisms that can inhibit or destroy other microorganisms are called ________.

A) antibiotics

B) narrow-spectrum drugs

C) semisynthetic drugs

D) synthetic drugs

E) broad-spectrum drugs

2) Antimicrobials that are effective against a wide variety of microbial types are termed ________.

A) antibiotics

B) narrow-spectrum drugs

C) semisynthetic drugs

D) synthetic drugs

E) broad-spectrum drugs

3) Antibiotics are derived from all of the following except ________.

A) Penicillium

B) Bacillus

C) Staphylococcus

D) Streptomyces

E) Cephalosporium

4) Important characteristics of antimicrobial drugs include ________.

A) low toxicity for human tissues

B) high toxicity against microbial cells

C) do not cause serious side effects in humans

D) stable and soluble in body tissues and fluids

E) All of the choices are correct.

5) The use of a drug to prevent a person at risk of an imminent infection is called ________.

A) competitive inhibition

B) synergism

C) prebiotics

D) prophylaxis

E) lantibiotics

6) The use of any chemical in the treatment, relief, or prophylaxis of a disease is called ________.

A) prophylaxis

B) chemotherapy

C) selective toxicity

D) nephrotoxicity

E) synergism

7) Penicillins and cephalosporins ________.

A) block folic acid synthesis

B) attach to the 30S ribosomal subunit and disrupt protein synthesis

C) damage cell membranes

D) block peptidases that cross-link glycan molecules

8) Selective toxicity refers to ________.

A) damage to pathogenic organisms

B) damage to prokaryotic cell membranes

C) damage to the target organisms but not host cells

D) damage to nucleic acids

E) None of the choices are correct.

9) Each of the following affect cell walls except ________.

A) penicillin

B) isoniazid

C) vancomycin

D) erythromycin

E) cephalosporin

10) Aminoglycosides ________.

A) interfere with elongation of peptidoglycan

B) block folic acid synthesis

C) attach to the 30S ribosomal subunit and disrupt protein synthesis

D) damage cell membranes

E) block peptidases that cross-link glycan molecules

11) Each of the following target bacterial ribosomes except ________.

A) streptomycin

B) gentamycin

C) polymyxins

D) tetracycline

E) erythromycin

12) Sulfonamides ________.

A) interfere with elongation of peptidoglycan

B) block folic acid synthesis

C) attach to the 30S ribosomal subunit and disrupt protein synthesis

D) damage cell membranes

E) block peptidases that cross-link glycan molecules

13) Sulfa drugs work on ________.

A) nucleic acid biosynthesis

B) ribosome biosynthesis

C) peptidoglycan biosynthesis

D) folic acid biosynthesis

E) None of the choices are correct.

14) Ampicillin, amoxicillin, mezlocillin, and penicillin G all ________.

A) target the cell wall

B) have resistance to the action of penicillinase

C) are semisynthetic

D) have an expanded spectrum of activity

E) All of the choices are correct.

15) A chemical that inhibits beta-lactamase enzymes is ________.

A) synercid

B) penicillinase

C) aztreonam

D) clavulanic acid

E) imipenem

16) What type of chemical will allow some bacteria to be resistant to many penicillins?

A) Synercid

B) Penicillinase

C) Aztreonam

D) Clavulanic acid

E) Imipenem

17) Which antimicrobial does not inhibit cell wall synthesis?

A) Gentamicin

B) Vancomycin

C) Cephalosporins

D) Penicillins

E) Bacitracin

18) Which drug is used to treat cases of tuberculosis?

A) Penicillin G

B) Vancomycin

C) Tetracycline

D) Synercid

E) Isoniazid

19) What cell wall inhibiting drug is used in cases of penicillin and methicillin resistance?

A) Penicillin G

B) Vancomycin

C) Tetracycline

D) Erythromycin

E) Isoniazid

20) Clavulanic acid ________.

A) inhibits B-lactamase activity

B) inhibits peptidoglycan synthesis

C) inhibits formation of peptidoglycan cross linkages

D) inhibits cell membrane synthesis

E) None of the choices are correct.

21) Gram-negative rods are often treated with ________.

A) penicillin G

B) vancomycin

C) aminoglycosides

D) synercid

E) isoniazid

22) Which antimicrobial does not interfere with protein synthesis?

A) Aminoglycosides

B) Tetracyclines

C) Erythromycin

D) Trimethroprim

E) Gentamicin

23) Which of these drugs has the most narrow spectrum?

A) Tetracycline

B) Isoniazid

C) Erythromycin

D) Aminoglycosides

E) Cephalosporins

24) Antimicrobials that are macrolides ________.

A) disrupt cell membrane function

B) include tetracyclines

C) include azithromycin, clarithromycin and erythromycin

D) are narrow-spectrum drugs

E) are hepatotoxic

25) The drug that can cause injury to red blood cells and white blood cells is ________.

A) chloramphenicol

B) clindamycin

C) ciprofloxacin

D) bacitracin

E) gentamicin

26) Which of the following antibacterial drug groups does not target protein synthesis?

A) Clindamycin

B) Erythromycin

C) Aminoglycosides

D) Sulfonamides

E) Tetracycline

27) Which newer synthetic drug is used to treat MRSA and VRE infections?

A) Synercid

B) Clindamycin

C) Linezolid

D) Azithromycin

E) Clarithromycin

28) Which of the following is not true of polymyxins?

A) Disrupt the cell membrane

B) Have a narrow spectrum

C) Toxic to kidneys

D) Target peptidoglycan

E) Can treat severe urinary tract infections

29) The antifungal drug that can be injected to treat serious systemic fungal infections, like histoplasmosis, is ________.

A) nystatin

B) griseofulvin

C) amphotericin B

D) sulfa drugs

E) metronidazole

30) Ketoconazole, fluconazole, clotrimazole, miconazole are broad-spectrum azoles used to treat ________ infections.

A) bacterial

B) fungal

C) protozoan

D) helminthic

E) viral

31) Which of the following is not a drug group used to treat fungal infections?

A) Quinolones

B) Macrolide polyenes

C) Echinocandins

D) Synthetic azoles

E) Allylamines

32) The drug used for several protozoan infections is ________.

A) nystatin

B) griseofulvin

C) amphotericin B

D) sulfa drugs

E) metronidazole

33) Mebendazole is a drug used to treat ________ infections.

A) bacterial

B) fungal

C) protozoan

D) helminthic

E) viral

34) There are fewer antifungal, antiprotozoan, and antihelminth drugs compared to antibacterial drugs because fungi, protozoa, and helminths ________.

A) do not cause many human infections

B) are not affected by antimicrobials

C) are so similar to human cells that drug selective toxicity is difficult

D) are parasites found inside human cells

E) have cells with fewer target sites compared to bacteria

35) Primaquine and chloroquine are drugs used in the treatment of ________.

A) gram-positive infections

B) gram-negative infections

C) fungal infections

D) protozoan infections

E) viral infections

36) Which of the following is not a mode of action of antiviral drugs?

A) Block penetration

B) Block transcription and translation

C) Inhibit DNA synthesis

D) Block maturation

E) Bond to ergosterol in the cell membrane

37) An antiviral that is a guanine analog would have an antiviral mode of action that ________.

A) blocks penetration

B) blocks transcription and translation

C) inhibits DNA synthesis

D) blocks maturation

E) bonds to ergosterol in the cell membrane

38) Antiviral drugs that target reverse transcriptase would be used to treat ________.

A) influenza A virus

B) HIV

C) herpes zoster virus

D) respiratory syncytial virus

E) hepatitis C virus

39) Acyclovir is used to treat ________.

A) influenza A virus

B) HIV

C) herpes simplex virus

D) respiratory syncytial virus

E) hepatitis C virus

40) Which of the following block HIV binding to host cell receptors?

A) AZT

B) Acyclovir

C) Nevirapine

D) Fuzeon

E) Amantidine

41) The cellular basis for bacterial resistance to antimicrobials include ________.

A) bacterial chromosomal mutations

B) synthesis of enzymes that alter drug structure

C) prevention of drug entry into the cell

D) alteration of drug receptors on cell targets

E) All of the choices are correct.

42) The multidrug-resistant pumps in many bacterial cell membranes function by ________.

A) bacterial chromosomal mutations

B) synthesis of enzymes that alter drug structure

C) removing the drug from the cell when it enters

D) alteration of drug receptors on cell targets

E) All of the choices are correct.

43) Microbial resistance resulting from mutation occurs because ________.

A) bacterial genomes undergo mutation rapidly

B) bacterial genomes undergo mutation often

C) short generation times accumulate mutations in populations

D) mutations are passed between organisms

E) All of the choices are correct.

44) Each of the following result in drug resistance except ________.

A) drug pumped out of the cell

B) drug used as a nutrient by the cell

C) drug binding site altered

D) drug inactivated

E) drug blocked from entering cell

45) Each of the following is a mechanism for drug resistance transfer between microorganisms except ________.

A) transduction

B) R-plasmids

C) conjugation

D) mutation

E) transformation

46) Each of the following contributes to emerging drug resistance except ________.

A) overuse of antibiotics

B) improper use of antibiotics

C) multiple drug therapy

D) ingestion of antibiotics with animal feed

E) addition of antibiotics to common household products

47) Nutrients that encourage the growth of beneficial microbes in the intestines are known as ________.

A) prebiotics

B) probiotics.

C) lantibiotics

D) phytobiotics

E) riboswitches

48) The use of vaginal inserts of Lactobacillus to restore healthy vaginal biota is an example of ________.

A) prebiotics

B) probiotics

C) lantibiotics

D) phytobiotics

E) riboswitches

49) Broad-spectrum drugs that disrupt the body's microbiota often cause ________.

A) nephrotoxicity

B) superinfections

C) allergic reactions

D) drug toxicity

E) mutation

50) Side effects that occur in patient's tissues while on antimicrobial drugs include all the following except ________.

A) development of resistance to the drug

B) hepatotoxicity

C) nephrotoxicity

D) diarrhea

E) deafness

51) A superinfection results from ________.

A) buildup of a drug to toxic levels in the patient

B) the wrong drug administered to the patient

C) an immune system reaction to the drug

D) decrease in the microbiota with overgrowth of an unaffected species

52) The ________ are drugs that deposit in developing teeth and cause a permanent brown discoloration.

A) streptomycins

B) cephalosporins

C) macrolides

D) tetracyclines

E) penicillins

53) Drug susceptibility testing determines ________.

A) the patient's response to various antimicrobials

B) the pathogen's response to various antimicrobials

C) if normal flora will be affected by antimicrobials

D) if the drug is increasing to toxic levels in a patient

E) None of the choices are correct.

54) A clinical microbiologist makes serial dilutions of several antimicrobials in broth, and then incubates each drug dilution series with a standard amount of a patient's isolated pathogen. What is this microbiologist setting up?

A) Kirby-Bauer

B) Antibiogram

C) E-test

D) MIC

E) Therapeutic index (TI)

55) A ratio of the dose of a drug that is toxic to humans versus the minimum effective dose for that pathogen is assessed to predict the potential for toxic drug reactions. This is called the ________.

A) Kirby-Bauer

B) antibiogram

C) E-test

D) MIC

E) therapeutic index (TI)

56) If pathogen A is more resistant to an erythromycin disc on a Kirby-Bauer plate compared to pathogen B, then pathogen A will have a(n) ________ zone of inhibition compared to pathogen B.

A) smaller

B) equal

C) larger

57) Which therapeutic index value would be the drug of choice?

A) 20

B) 10

C) 1

D) 0.1

E) Any value would be equally effective.

58) Which two antibiotics affect the DNA and RNA of bacteria?

A) Tetracycline and amphotericin B

B) Trimethoprim and sulfonamides

C) Rifampin and quinolones

D) Tetracycline and bacitracin

59) Antimicrobial drugs that inhibit folic acid synthesis work with very few side effects because mammals must get folic acid from their diet.

60) An antibiotic of the penicillin family is amoxicillin.

61) Ciprofloxacin is used to treat viral respiratory infections.

62) Resistance factor plasmids are transferred to other bacterial cells during transformation, transduction, and conjugation.

63) Bacteria can have a natural resistance to a drug that it has never been exposed to.

64) When a patient's immune system reacts adversely to a drug, this serious side effect is called a superinfection.

65) Drugs that are hepatotoxic cause damage to a patient's kidneys.

66) The MIC is the smallest concentration of an antimicrobial required to inhibit the growth of the microbe.

67) The Kirby-Bauer test uses an agar surface, seeded with the test bacterium, to which small discs containing a specific concentration of several drugs are placed on the surface.

68) An antimicrobial with a low therapeutic index is a safer choice compared to a drug with a high therapeutic index.

69) It is better to use a broad-spectrum drug instead of a more specific narrow-spectrum drug.

70) Indwelling catheter biofilm infections are more resistant to antibiotics than nonbiofilm infections.

71) Drug toxicity occurs when an antimicrobial drug acts as antigen and stimulates an allergic response.

72) Which of the following statements does not accurately reflect the origins of antimicrobial drugs?

A) All antimicrobial drugs are synthesized by medicinal chemists in a laboratory environment.

B) Bacteria and fungi are natural producers of antimicrobial drugs; the molecules are synthesized to maintain competition for nutrients and space to a minimum.

C) Scientists have learned how to modify antimicrobial molecules naturally produced by organisms to enhance their efficacy and range.

D) Some antimicrobial agents are synthesized wholly in the laboratory.

73) An example of an antibacterial drug with high selective toxicity would be one that ________.

A) targets the synthesis of the bacterial cell wall

B) targets the permeability of the cell membrane

C) targets DNA replication

D) targets RNA transcription

74) Drugs with high selective toxicity include ________.

A) ampicillin and bacitracin

B) amphotericin B and fluconazole

C) mebendazole and albendazole

D) quinine and metronidazole

75) Aminoglycosides demonstrate selective toxicity since they target the bacterial 30s subunit, leaving the host 40s subunit largely unaffected.

76) Naturally-produced penicillins are most effective against gram-positive bacteria because ________.

A) they prevent the synthesis of peptidoglycan which comprises the gram-positive cell wall

B) they target the enzymes needed by gram-positive cells for ATP production

C) they inhibit the permeability of the gram-positive cell membrane

D) they target the 30s subunit of the gram-positive ribosome

77) Semisynthetic penicillins have an advantage over their naturally occurring counterparts in that ________.

A) they have a broader target range and are less susceptible to penicillinases

B) they target both cell wall synthesis and protein synthesis by binding to the 30s ribosome

C) they can target both bacterial and eukaryotic organisms

D) they cause fewer allergic reactions than naturally occurring penicillins

78) Fluoroquinolones such as ciprofloxacin, are synthetic drugs that interfere with the action of DNA helicases.  This means that ________.

A) the bacterial cell will die since it cannot replicate or transcribe its DNA

B) binary fission cannot take place because the cell cannot make proteins

C) the bacterial cell will die since it cannot take in nutrients across the cell membrane

D) the cell will die because it cannot make folic acid, which is a precursor to DNA and RNA, as well as amino acids

79) Polymyxin B is a large molecule with a hydrophobic tail that can disrupt phospholipids, making it particularly effective against ________.

A) gram-negative cells since they have both an outer and inner membrane

B) gram-positive cells since the peptidoglycan is easily dissolved by detergent-like molecules

C) fungi since the drug can traverse the complex chitin cell wall to dissolve the cell membrane

D) both gram-positive and gram-negative cells since they both have a membrane

80) Polymyxin B and daptomycin are both narrow spectrum drugs that target the cell membrane. They differ in that polymyxin B is effective against gram-negative organisms since it disrupts both the inner and outer membranes whereas daptomycin integrates only into the gram-positive cell wall creating leakage.

81) Biofilm infections are harder to treat than the same free-living organisms because ________.

A) when part of a biofilm community, the bacterial cells express different genes thus changing their antibiotic susceptibility

B) bacteria in a biofilm exist only on synthetic surfaces such as catheters, so they cannot be treated with antibiotics

C) the organisms in the biofilm degrade the antibiotics at a much faster rate than their free-living counterparts

D) organisms in a biofilm develop antibiotic resistance more rapidly than free-living cells

82) The greatest hurdle to overcome when treating biofilm infections is finding a drug that can penetrate the extracellular material.

83) Penicillinases are enzymes produced by bacterial cells, usually after acquiring a new gene, that ________.

A) hydrolyze the β-lactam ring of penicillins and cephalosporins, rendering them ineffective

B) pump the penicillins out of the cell as soon as they enter

C) prevent the drug from crossing the cell membrane

D) block the target binding site of the drug, rendering it ineffective

84) Micafungin and caspofungin are antifungal drugs that inhibit cell wall synthesis.  They belong to the group of drugs known as ________.

A) echinocandins

B) macrolide polyenes

C) azoles

D) allylamines

85) In light of increasing antibiotic resistance, alternative antimicrobial therapies are being explored. These include the CRISPR system, which ________.

A) when delivered with an antibiotic, can splice out the genes causing resistance to the drug, which is then able to kill the bacteria

B) directly kill the bacteria instead of requiring an antibiotic

C) is comprised of immune peptides that are not susceptible to bacterial resistance

D) extracts drugs from bacteria that are not cultivable in a laboratory environment

NCLEX Prep - Test Bank Question:  Please read the clinical scenario, and then answer the questions that follow to become familiar with the traditional NCLEX question format.

A 76-year-old male visits his primary care physician with complaints of burning with urination and a frequent urge to void. The RN aids the patient in collecting a urine specimen to be sent for analysis. While awaiting the final results of drug susceptibility testing in the lab, the patient is prescribed oral sulfasoxazole.

86) In the lab, the urine specimen is spread on an agar plate with antibiotic discs placed to determine antimicrobial susceptibility. Following incubation, the clear area around each disc is measured. What term describes the observed area of antimicrobial action around each disc?  

A) Zone of inhibition

B) Zone of susceptibility

C) Zone of resistance

D) No growth zone

87) You provide education to the patient regarding sulfasoxazole, a sulfonamide that targets folic acid synthesis. The synthesis of which of the following products is affected by inhibition of folate metabolism?  

A) DNA

B) RNA

C) DNA and RNA

D) DNA, RNA, and amino acids

88) Which of the following reactions by the patient could demonstrate an allergic response to the drug?  

A) Anaphylaxis

B) Rash

C) Difficulty breathing

D) Anaphylaxis, rash development, and difficulty breathing could all indicate an allergic response.

89) The in vitro susceptibility of the pathogen is established and the patient is maintained on sulfasoxazole. If no in vivo effect of the drug is observed by the patient following the first 7 days of antibiotics, what is the most appropriate action by the medical team?

A) Increase the dose of sulfasoxazole

B) Discontinue antibiotic therapy

C) Discontinue sulfasoxazole and initiate a new antibiotic

D) Initiate antiviral therapy

NCLEX Prep - Test Bank Question:  Please read the clinical scenario, and then answer the questions that follow to become familiar with the traditional NCLEX question format.

A 12-year-old male is admitted to the pediatric unit due to persistent upper respiratory symptoms and respiratory distress. The patient has a history of developmental delay, chronic lung disease, and frequent respiratory infections. Upon assessment, the RN notes the patient to have a fever, moderate respiratory rate, productive cough, and large amount of nasal secretions. Upon report from the patient's mother, the patient has been on a 3-week course of antibiotics with no improvement in symptoms. The medical team completes a respiratory infection workup and the patient is diagnosed with bacterial pneumonia and methicillin-resistant Staphylococcus aureus (MRSA) superinfection.

90) The RN provides education to the patient and his mother regarding the diagnosis. Which of the following statements by the mother demonstrates a proper understanding of the teaching?  

A) My son has an extremely resistant form of MRSA causing his prolonged illness.

B) My son developed simultaneous bacterial infections and his antibiotics were not treating his MRSA infection.

C) My son developed a MRSA superinfection following suppression of normal resident species in his lungs by the antibiotics he was taking to treat his initial infection.

D) My son has pneumonia caused by a virus.

91) Based upon the patient's history, what is the most likely cause of the superinfection?  

A) Poor hygiene

B) Long-term antibiotic therapy

C) Fecal-oral contamination

D) Community-acquired MRSA

92) The use of which of the following drugs results in the highest risk of superinfection in a patient receiving antimicrobial chemotherapy?  

A) Broad-spectrum antibiotics

B) Narrow-spectrum antibiotics

C) Antifungals

D) Antivirals

93) Treatment of a urinary tract infection with antimicrobials is most likely to lead to a superinfection caused by which microbe?  

A) Giardia lamblia

B) Lactobacillus acidophilus

C) Escherichia coli

D) Candida albicans

NCLEX Prep - Test Bank Question:  Please read the clinical scenario, and then answer the questions that follow to become familiar with the traditional NCLEX question format.

An RN in a medical intensive care unit is leading a research study regarding administration of probiotics to critically ill patients receiving antibiotic therapy. She provides education about normal flora and probiotics as part of the consent process to patients and families.

94) Following the teaching to patients and families, the RN assesses understanding prior to obtaining consent. Which of the following demonstrates a lack of understanding by the patient?

A) Probiotics are live microorganisms.

B) Probiotics are nutrients to encourage microbe growth.

C) Probiotics augment the microbes in the intestine.

D) Probiotics can replace microbes killed during antibiotic therapy.

95) Which of the following is an example of a probiotic?  

A) Penicillin

B) Micafungin

C) Yogurt

D) Fructans

96) The RN conducting the research study most appropriately hypothesizes that probiotics may alleviate which of the following side effects of antimicrobial therapy?

A) Headache

B) Nausea

C) Diarrhea

D) Skin rash