The hospital setting presents a unique and complex environment for managing infectious diseases, starkly different from community practice. Pharmacists on the front lines are tasked with combating multidrug-resistant organisms, managing complex IV therapies, and leading antimicrobial stewardship efforts to preserve the effectiveness of our most critical medications. As a PharmD student, your curriculum, including courses like Patient Care 2 (PHA5782C) and labs like the Professional Skills Lab 3 (PHA5163L), is designed to equip you with the knowledge to handle these challenges. This quiz will test your understanding of hospital-acquired infections (HAIs) like HAP, VAP, and C. difficile, and the pharmacist’s vital role in optimizing antimicrobial therapy in the inpatient setting.
1. A patient develops pneumonia 72 hours after being admitted to the hospital. This is classified as:
- a. Community-Acquired Pneumonia (CAP)
- b. Aspiration Pneumonia
- c. Hospital-Acquired Pneumonia (HAP)
- d. Atypical Pneumonia
Answer: c. Hospital-Acquired Pneumonia (HAP)
2. Which of the following is a primary goal of an antimicrobial stewardship program in a hospital?
- a. To ensure every patient receives a carbapenem.
- b. To decrease the overall cost of medications.
- c. To improve patient outcomes while reducing microbial resistance.
- d. To replace all pharmacists with infectious disease physicians.
Answer: c. To improve patient outcomes while reducing microbial resistance.
3. For a patient undergoing elective colorectal surgery, which of the following is a common and appropriate agent for surgical prophylaxis?
- a. Oral vancomycin
- b. IV Cefazolin plus IV Metronidazole
- c. Doxycycline
- d. IV Acyclovir
Answer: b. IV Cefazolin plus IV Metronidazole
4. A patient develops watery diarrhea and has a positive stool test for Clostridioides difficile toxin after a 14-day course of clindamycin. What is the most likely cause?
- a. A foodborne illness.
- b. Antibiotic-associated C. difficile infection.
- c. A new viral gastroenteritis.
- d. An expected side effect of the clindamycin.
Answer: b. Antibiotic-associated C. difficile infection.
5. Which of the following is an example of an IV to PO therapeutic interchange that a hospital pharmacist might recommend?
- a. Switching a patient from IV vancomycin to PO vancomycin for a bloodstream infection.
- b. Switching a patient from IV levofloxacin to PO levofloxacin once they can tolerate oral intake.
- c. Switching from IV penicillin to PO amoxicillin for a Pseudomonas infection.
- d. Switching from IV acyclovir to PO ganciclovir.
Answer: b. Switching a patient from IV levofloxacin to PO levofloxacin once they can tolerate oral intake.
6. Ventilator-Associated Pneumonia (VAP) is a lung infection that develops in a patient who has been on mechanical ventilation for at least:
- a. 12 hours
- b. 24 hours
- c. 48 hours
- d. 72 hours
Answer: c. 48 hours
7. Which of the following pathogens is a common cause of hospital-acquired infections and is notoriously resistant to multiple classes of antibiotics?
- a. Streptococcus pyogenes
- b. Haemophilus influenzae
- c. Pseudomonas aeruginosa
- d. Moraxella catarrhalis
Answer: c. Pseudomonas aeruginosa
8. For optimal efficacy, when should a pre-operative prophylactic antibiotic be administered?
- a. 24 hours before surgery.
- b. Within 60 minutes prior to the surgical incision.
- c. Immediately after the surgical incision is closed.
- d. 4 hours after the surgery is complete.
Answer: b. Within 60 minutes prior to the surgical incision.
9. The recommended first-line treatment for an initial, non-severe C. difficile infection is:
- a. IV Metronidazole
- b. Oral Metronidazole
- c. Oral Fidaxomicin
- d. IV Vancomycin
Answer: c. Oral Fidaxomicin
10. “De-escalation” of antibiotic therapy is a stewardship strategy that involves:
- a. Starting with a narrow-spectrum antibiotic and escalating to a broader one if the patient does not improve.
- b. Increasing the dose of the current antibiotic.
- c. Switching from a broad-spectrum empiric regimen to a narrower-spectrum agent once culture and sensitivity results are available.
- d. Stopping all antibiotics after 24 hours.
Answer: c. Switching from a broad-spectrum empiric regimen to a narrower-spectrum agent once culture and sensitivity results are available.
11. Which of the following is a significant risk factor for developing a hospital-acquired infection?
- a. Short length of stay.
- b. Presence of invasive devices like central lines or urinary catheters.
- c. Being young and healthy.
- d. Receiving only oral medications.
Answer: b. Presence of invasive devices like central lines or urinary catheters.
12. A patient in the ICU is suspected of having an infection with Methicillin-Resistant Staphylococcus aureus (MRSA). Which antibiotic provides appropriate empiric coverage?
- a. Cefazolin
- b. Ampicillin
- c. Vancomycin
- d. Ciprofloxacin
Answer: c. Vancomycin
13. A Catheter-Associated Urinary Tract Infection (CAUTI) is an infection of the urinary tract that occurs in a patient with an indwelling urinary catheter.
- a. True
- b. False
Answer: a. True
14. A key role for a pharmacist in the management of intra-abdominal infections is ensuring the antibiotic regimen has adequate coverage for:
- a. Atypical pathogens only.
- b. Gram-positive aerobes only.
- c. Anaerobic organisms.
- d. Viruses.
Answer: c. Anaerobic organisms.
15. Piperacillin-tazobactam is a broad-spectrum antibiotic combination that covers:
- a. Only MRSA.
- b. A wide range of Gram-positive, Gram-negative, and anaerobic bacteria, including Pseudomonas aeruginosa.
- c. Only anaerobic bacteria.
- d. Only fungi and viruses.
Answer: b. A wide range of Gram-positive, Gram-negative, and anaerobic bacteria, including Pseudomonas aeruginosa.
16. Which of the following is a carbapenem antibiotic, often reserved for multidrug-resistant infections?
- a. Ceftriaxone
- b. Azithromycin
- c. Meropenem
- d. Clindamycin
Answer: c. Meropenem
17. What is the most effective way to prevent the transmission of C. difficile spores in a hospital?
- a. Using alcohol-based hand sanitizer.
- b. Wearing a surgical mask.
- c. Hand washing with soap and water.
- d. Environmental cleaning with a sporicidal agent.
Answer: d. Environmental cleaning with a sporicidal agent.
18. Surgical prophylaxis is generally discontinued within what time frame after the surgery ends?
- a. 7 days
- b. 72 hours
- c. 48 hours
- d. 24 hours
Answer: d. 24 hours
19. A patient with VAP is found to have Acinetobacter baumannii in their respiratory culture. This organism is concerning because it is:
- a. Often highly drug-resistant.
- b. Easily treated with penicillin.
- c. A common community pathogen.
- d. A gram-positive coccus.
Answer: a. Often highly drug-resistant.
20. An “IV to PO” switch program is an example of what kind of antimicrobial stewardship intervention?
- a. Formulary restriction
- b. Dose optimization
- c. Pre-authorization
- d. Prospective audit and feedback
Answer: b. Dose optimization
21. A patient with a central line develops a bloodstream infection. This would be classified as:
- a. HAP
- b. VAP
- c. SSI (Surgical Site Infection)
- d. CLABSI (Central Line-Associated Bloodstream Infection)
Answer: d. CLABSI (Central Line-Associated Bloodstream Infection)
22. Which antibiotic is only effective for C. difficile infection when given orally, as the IV formulation does not reach the colon?
- a. Metronidazole
- b. Vancomycin
- c. Ciprofloxacin
- d. Meropenem
Answer: b. Vancomycin
23. “Source control” in the management of a severe infection like an intra-abdominal abscess refers to:
- a. Starting the patient on a broad-spectrum antibiotic.
- b. Physically eliminating the source of infection, such as draining an abscess.
- c. Controlling the patient’s fever with antipyretics.
- d. Identifying the source of the drug for the pharmacy.
Answer: b. Physically eliminating the source of infection, such as draining an abscess.
24. The management of Hospital-Acquired Pneumonia is a topic within the Patient Care course series.
- a. True
- b. False
Answer: a. True
25. A patient with a history of MRSA colonization is admitted with sepsis. The empiric antibiotic regimen should include an agent that covers MRSA.
- a. True
- b. False
Answer: a. True
26. Why are carbapenems generally reserved for more severe or resistant infections?
- a. They have a very narrow spectrum of activity.
- b. To preserve their efficacy and prevent the development of carbapenem-resistant organisms (CRE).
- c. They are only available in oral formulations.
- d. They have no side effects.
Answer: b. To preserve their efficacy and prevent the development of carbapenem-resistant organisms (CRE).
27. The pharmacist’s role in managing hospital infections includes:
- a. Recommending appropriate empiric therapy.
- b. Adjusting doses based on renal function.
- c. Monitoring for therapeutic outcomes and adverse effects.
- d. All of the above.
Answer: d. All of the above.
28. Which of the following is NOT a primary goal of antimicrobial stewardship?
- a. Optimizing clinical outcomes
- b. Minimizing unintended consequences (e.g., toxicity, resistance)
- c. Ensuring all ordered antibiotics are dispensed regardless of indication
- d. Reducing healthcare costs without adversely impacting quality of care
Answer: c. Ensuring all ordered antibiotics are dispensed regardless of indication
29. The term “Enterobacterales” refers to a large order of what type of bacteria?
- a. Gram-positive cocci
- b. Gram-negative rods
- c. Anaerobic bacteria
- d. Atypical bacteria
Answer: b. Gram-negative rods
30. The “Infectious Disease in the Hospital” module is part of which course?
- a. PHA5163L Professional Skills Lab 3
- b. PHA5941 Community IPPE
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5267 Principles of Pharmacoeconomics
Answer: a. PHA5163L Professional Skills Lab 3
31. A common complication of a CAUTI is:
- a. C. difficile infection
- b. Development of a skin rash
- c. Bacteremia and sepsis
- d. Hair loss
Answer: c. Bacteremia and sepsis
32. For a patient with a documented ESBL-producing E. coli infection, which antibiotic class is often the treatment of choice?
- a. Macrolides
- b. Penicillins
- c. Carbapenems
- d. Tetracyclines
Answer: c. Carbapenems
33. What is the most important measure to prevent CAUTIs?
- a. Using broad-spectrum antibiotics prophylactically.
- b. Frequent irrigation of the catheter.
- c. Avoiding unnecessary urinary catheterization and removing catheters as soon as possible.
- d. Using the largest catheter size possible.
Answer: c. Avoiding unnecessary urinary catheterization and removing catheters as soon as possible.
34. Linezolid is an important antibiotic in the hospital because it provides coverage against:
- a. Pseudomonas aeruginosa
- b. Anaerobic bacteria
- c. Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococcus (VRE).
- d. Atypical pathogens.
Answer: c. Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococcus (VRE).
35. A patient’s respiratory culture grows Stenotrophomonas maltophilia. This finding is clinically significant because this organism is:
- a. A common cause of community-acquired pneumonia.
- b. Intrinsically resistant to carbapenems.
- c. Easily treated with amoxicillin.
- d. A gram-positive coccus.
Answer: b. Intrinsically resistant to carbapenems.
36. Pharmacists play a key role in developing hospital-wide protocols for the management of common infections.
- a. True
- b. False
Answer: a. True
37. Which of the following is a risk factor for HAP/VAP caused by multidrug-resistant pathogens?
- a. No prior hospitalizations.
- b. Prior IV antibiotic use within 90 days.
- c. Age less than 65.
- d. No comorbidities.
Answer: b. Prior IV antibiotic use within 90 days.
38. The primary rationale for combination antibiotic therapy in the hospital (e.g., using two drugs for Pseudomonas) is to:
- a. Increase the cost of treatment.
- b. Provide broad empiric coverage and potentially achieve synergy or prevent resistance.
- c. Increase the risk of side effects.
- d. Make the regimen more complicated for the nurse to administer.
Answer: b. Provide broad empiric coverage and potentially achieve synergy or prevent resistance.
39. Daptomycin is an effective antibiotic for MRSA bacteremia, but it should NOT be used for which type of infection?
- a. Skin and soft tissue infections.
- b. Pneumonia, because it is inactivated by pulmonary surfactant.
- c. Urinary tract infections.
- d. Endocarditis.
Answer: b. Pneumonia, because it is inactivated by pulmonary surfactant.
40. A patient has a documented severe allergy to penicillin. Which antibiotic has the highest risk of cross-reactivity?
- a. Vancomycin
- b. Ciprofloxacin
- c. Imipenem (a carbapenem)
- d. Azithromycin
Answer: c. Imipenem (a carbapenem)
41. The most important “source control” measure for a Central Line-Associated Bloodstream Infection (CLABSI) is:
- a. Starting a new antibiotic.
- b. Drawing new blood cultures.
- c. Removing the infected central line.
- d. Administering an antipyretic.
Answer: c. Removing the infected central line.
42. Which class of medication is the most significant risk factor for developing a C. difficile infection?
- a. Proton pump inhibitors
- b. Statins
- c. Antibiotics
- d. Antihypertensives
Answer: c. Antibiotics
43. A hospital’s formulary is a list of medications that:
- a. Are approved for use within that institution.
- b. Are currently experiencing a drug shortage.
- c. Are available over-the-counter.
- d. Have been discontinued by the manufacturer.
Answer: a. Are approved for use within that institution.
44. What does VRE stand for?
- a. Vancomycin-Resistant E. coli
- b. Very-Resistant Enterobacter
- c. Vancomycin-Resistant Enterococcus
- d. Viral Respiratory Enzyme
Answer: c. Vancomycin-Resistant Enterococcus
45. Before recommending an antibiotic, a hospital pharmacist must check the patient’s EHR for:
- a. Allergies, renal function, and recent culture data.
- b. Social security number.
- c. Room number and bed assignment.
- d. Preferred meal choice.
Answer: a. Allergies, renal function, and recent culture data.
46. Empiric treatment for HAP in a patient with no risk factors for MRSA or Pseudomonas might include:
- a. Vancomycin plus Piperacillin-tazobactam.
- b. Ceftriaxone.
- c. Oral amoxicillin.
- d. Acyclovir.
Answer: b. Ceftriaxone.
47. The primary purpose of an antibiogram in a hospital is to:
- a. Track pharmacist interventions.
- b. Guide optimal empiric antibiotic selection based on local resistance patterns.
- c. List the prices of all available antibiotics.
- d. Document medication errors.
Answer: b. Guide optimal empiric antibiotic selection based on local resistance patterns.
48. Why is oral vancomycin not effective for systemic infections like bacteremia?
- a. It tastes bad.
- b. It has poor oral bioavailability and is not absorbed into the bloodstream.
- c. It is too expensive.
- d. It is inactivated by stomach acid.
Answer: b. It has poor oral bioavailability and is not absorbed into the bloodstream.
49. An infection is considered hospital-acquired if it occurs >48 hours after hospital admission.
- a. True
- b. False
Answer: a. True
50. The ultimate goal of the pharmacist’s involvement in managing hospital infectious diseases is to:
- a. Ensure every infection is treated with at least two antibiotics.
- b. Maximize the use of restricted antibiotics.
- c. Ensure safe, effective, and evidence-based antimicrobial therapy for every patient.
- d. Eliminate the need for infectious disease physicians.
Answer: c. Ensure safe, effective, and evidence-based antimicrobial therapy for every patient. Sources
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