ANTI TB VIRAL FUNGAL Chpt 41
The education of a patient using a topical azole for tinea corporis should include what information? 1. Use the medication over the entire body once per week for 1 month. 2. Sun exposure will delay drug effectiveness. 3. Continue the therapy for at least 1 week after the symptoms have cleared. 4. These drugs are effective after a single application
3
When providing patient education about amphotericin B, the nurse would explain that the drug works primarily by: 1. decreasing cell permeability. 2. destroying protein synthesis. 3. increasing cell membrane permeability. 4. an unknown mechanism.
3
Which patient is the most likely to receive caspofungin? 1. The patient with onychomycosis 2. The patient with a recalcitrant vaginal candidal infection 3. The patient with invasive aspergillosis unresponsive to amphotericin B 4. The patient with an allergy to voriconazole
3
Patients started on interferon should be told that the most common adverse effect is: 1. anxiety and agitation. 2. vomiting. 3. hirsutism. 4. a flulike syndrome
4
Adefovir is recommended for use in patients with hepatitis and: 1. HIV infection with a low CD4 count. 2. renal insufficiency on dialysis. 3. no clinical or laboratory evidence of HIV infection. 4. an allergy to purine nucleoside analogues.
3
. Econazole is indicated for: 1. topical application in the treatment of ringworm and superficial candidiasis. 2. systemic treatment of aspergillosis. 3. oral treatment of esophageal candidiasis. 4. oral treatment of tinea capitis.
1
A patient is diagnosed with multidrug-resistant tuberculosis. When the patient asks about the length of the treatment regimen, the nurse's best response is which of the following? 1. "After the sputum is converted to negative for TB organisms, the therapy continues for 12 to 24 months." 2. "The entire course of therapy will last 3 to 6 months or until the chest radiograph is normal." 3. "Therapy is indefinite because there is no method of determining responsiveness." 4. "No therapy is completely effective in multidrug-resistant tuberculosis, so treatment is needed for several years."
1
A patient receives valacyclovir for herpes-zoster virus. How should the nurse instruct the patient to take the medication? 1. Without regard to meals 2. At least 1 hour before a meal 3. More than 2 hours after a meal 4. Only during a meal
1
A patient telephones a nurse and reports that since the patient began ribavirin therapy 6 months ago, mild fatigue has been evident. For the last week, shortness of breath has developed and progressed. Which instruction should the nurse give? 1. "Come to the office for a complete blood count immediately. You may have developed hemolytic anemia." 2. "This is a normal response to this medication. It should resolve spontaneously in a few days." 3. "Fatigue and shortness of breath may indicate an allergic reaction to the drug. Take an antihistamine and report the effect." 4. "Discontinue this medication. Another medication will be required to treat your hepatitis."
1
After receiving inactivated influenza vaccine, an adult patient telephones a nurse and complains of lethargy and a fever of 101° F that has lasted for 6 hours. Select the nurse's best action. 1. Advise the patient to take acetaminophen and rest. 2. Instruct the patient to return to the clinic immediately. 3. Inform the patient that an allergic reaction is occurring. 4. Notify the Centers for Disease Control and Prevention.
1
An adult has active tuberculosis diagnosed by sputum examination and culture. In evaluating the patient's response to therapy, the nurse will want to see which finding? 1. An improved radiograph within 3 months 2. The absence of symptoms by 8 weeks 3. A return to a negative skin test by 4 weeks 4. A negative CT scan by 2 weeks
1
As a component of a multidrug regimen for tuberculosis, a patient is taking pyrazinamide. The nurse would question this drug in the regimen if the patient has a history of: 1. cirrhosis. 2. migraine headaches. 3. contact lens use. 4. osteoarthritis.
1
The nurse assesses a PPD on the forearm of a patient being screened for employment in an outpatient clinic. The induration is 4 mm. How should this finding be interpreted? 1. Negative, insignificant 2. Moderately significant, requiring chest radiograph 3. Moderately significant, requiring sputum culture 4. Significant, requiring treatment
1
The nurse instructs a patient about scheduling rifampin doses. The best advice for this patient is to: 1. always take the drug on an empty stomach. 2. take the drug with meals. 3. take the drug within 30 minutes after a meal. 4. take the drug without regard to meals
1
When a patient is given griseofulvin, which dietary instruction should be given? 1. Taking the drug with a fatty meal can enhance absorption. 2. The medication should be taken on an empty stomach. 3. Diet is irrelevant because the drug is used only intravenously. 4. The drug should be taken with apple juice to decrease the risk of toxicity
1
When a patient is scheduled to receive ganciclovir, which laboratory result would cause the nurse to interrupt therapy? 1. An absolute neutrophil count of 450/mm3 2. A platelet count of 47,000 3. A total white blood cell count of 900 4. An absolute lymphocyte count of 500
1
Which agent is commonly prescribed in conjunction with flucytosine to deter the development of fungal resistance in serious infections? 1. Amphotericin B 2. Voriconazole 3. Dexamethasone 4. Miconazole
1
Before the administration of amantadine to treat influenza in a patient, the nurse should ensure that the: 1. symptoms have been present for over 48 hours. 2. patient is not allergic to eggs. 3. patient is not pregnant. 4. patient does not have Parkinson's disease.
3
When assessing a patient for adverse reactions to the combination of isoniazid and rifampin, the nurse would monitor which laboratory results? You may select more than one answer. 1. Liver function tests 2. CBC 3. Creatinine clearance 4. Uric acid levels 5. Calcium levels
12
. Itraconazole has been prescribed for a patient with onychomycosis. Prior to the use of this drug, the nurse should review the patient's history and assess the patient for signs of which problem(s)? You may select more than one answer. 1. Heart failure 2. Autoimmune hemolytic anemia 3. Ulcerative colitis 4. Lupus 5. Osteoarthritis
13
Ketoconazole is used as an alternative to amphotericin B in less severe systemic mycosis. Select the primary reason(s) for choosing ketoconazole in this case. You may select more than one answer. 1. Ketoconazole can be given orally. 2. Ketoconazole can be used safely in patients with hepatic dysfunction. 3. Ketoconazole can be given once per week rather than daily. 4. It is the prescriber's choice because the drugs are comparable. 5. Ketoconazole is safer.
15
. A patient experienced a mild infusion reaction when amphotericin B was administered yesterday. What can the nurse do to decrease the next day's infusion reaction? 1. Administer meperidine 4 hours before the infusion. 2. Pretreat the patient with acetaminophen. 3. Administer dexamethasone simultaneously with the drug. 4. Administer diphenhydramine after the infusion.
2
. A patient is receiving amphotericin B for a systemic fungal infection. The nurse should constantly monitor the patient for the development of: 1. the emergence of resistant fungi. 2. nephrotoxicity. 3. neurotoxicity. 4. hyperkalemia
2
A patient is taking oral ketoconazole for a systemic fungal infection. A nurse reviews the drug list and notices that the patient is also receiving omeprazole for reflux disease. What action should the nurse take? 1. Administer the omeprazole 1 hour before the ketoconazole. 2. Administer the omeprazole at least 2 hours after the ketoconazole. 3. Confer with the physician about this hazardous interaction. 4. The nurse should not administer omeprazole to a patient receiving ketoconazole.
2
A patient is using oral antifungal therapy for onychomycosis. What information should the nurse provide? 1. It is important to completely eradicate this infection because of the risk of systemic spread. 2. This infection is difficult to eradicate and requires prolonged therapy. 3. A single dose of an oral antifungal agent is usually sufficient. 4. The drug is taken twice daily for 1 week only. Prolonged therapy provides no benefit and increases the risk of adverse effects.
2
An elderly patient lives alone in the community and is concerned about recent exposure to the flu. The patient requests an influenza vaccination. Which information should be given? 1. Because exposure has already occurred, the injection will not reduce the risk of developing flu this season. 2. Protection against the flu should begin in about 1 to 2 weeks after injection. 3. Elderly persons should not receive the vaccine unless they live in a confined space. 4. The vaccine is given only if the exposures have been verified as type A influenza.
2
Patients on streptomycin for tuberculosis should be monitored for the development of: 1. alopecia. 2. hearing loss. 3. hirsutism. 4. urinary retention.
2
Patients treated with clofazimine for leprosy must be closely monitored for the development of: 1. a blue tint to urine and feces. 2. intestinal obstruction. 3. hair loss. 4. vitamin deficiencies.
2
The induction phase of active tuberculosis therapy: 1. begins after the continuation phase is completed. 2. comprises the first 2 months of drug treatment. 3. generally consists of a single active agent. 4. lasts 4 to 6 months
2
The nurse manages care for a patient with HIV/AIDS who has taken protease inhibitors for 18 months. The patient is now diagnosed with active TB. The addition of rifampin as part of the new antituberculosis regimen is: 1. the most effective combination of agents for these two infections. 2. contraindicated because the rifampin will decrease the effects of the protease inhibitor. 3. not required because the protease inhibitor will treat both infections. 4. likely to require a decrease in the protease inhibitor dosage
2
To minimize the nephrotoxicity associated with intravenous acyclovir, the nurse will: 1. provide a low-protein diet for 1 day before and 2 days after the acyclovir infusion. 2. infuse hydration during and for 2 hours after the acyclovir infusion. 3. restrict oral fluids on the day of the acyclovir infusion. 4. withhold the infusion if there is any concern about potential elevations in BUN.
2
Voriconazole is an important drug for the treatment of life-threatening fungal infections. In comparison with amphotericin B, which statement best describes this agent? 1. Voriconazole is less likely to cause liver damage with prolonged use. 2. Voriconazole is equally as effective and less likely to cause kidney damage. 3. Voriconazole is not associated with infusion reactions, so it is considered safer. 4. No teratogenicity is associated with voriconazole, so it is safer in women who may become pregnant.
2
When monitoring a patient on cycloserine, the nurse should: 1. obtain a urine sample 12 hours after administration. 2. draw a serum level 2 hours after administration. 3. measure the drug level in a 24-hour urine sample. 4. draw a serum level immediately before the next dose is due.
2
Which statement is accurate regarding non-HIV antiviral drugs? 1. The advances made with antiviral drugs in the past decade surpass those made with antibacterial antibiotics. 2. These medications are active against a narrow spectrum of viruses. 3. As a rule, antiviral drugs are safer than antibiotic agents. 4. Clinically useful antivirals suppress the host cell's biological processes
2
While taking rifabutin a patient experiences the sudden onset of eye pain and blurred vision. The nurse suspects the development of: 1. cataracts. 2. uveitis. 3. glaucoma. 4. conjunctivitis.
2
. How is a definitive diagnosis of tuberculosis made? You may select more than one answer. 1. Tuberculin skin testing 2. Chest radiographs 3. Microscopic examination of sputum 4. Chronic cough 5. Night sweats
23
. A patient is beginning therapy for active tuberculosis. The patient asks, "Why do I have to take so many drugs?" What is the nurse's best response? 1. "When a case is severe enough, multiple drugs are required." 2. "The more agents used, the shorter the duration of the therapy." 3. "Multiple agents prevent the emergence of resistant organisms." 4. "It is assumed that patients take about 50% of the prescribed drug."
3
A patient already taking a sulfonylurea has been prescribed fluconazole. For which effect of this drug combination would the nurse monitor the patient? 1. Allergy 2. Hyperkalemia 3. Hypoglycemia 4. Bleeding
3
A patient being followed for latent tuberculosis has been on INH therapy for 2 months. When reviewing the laboratory tests, the nurse notes that the liver function test results have become grossly abnormal. The nurse will instruct the patient to: 1. continue the drug unless jaundice, nausea, or itching develops. 2. continue the drug and have liver function tests repeated weekly. 3. stop the medication immediately. Other drugs will be prescribed. 4. stop the drug and restart when liver function returns to normal.
3
A patient taking ketoconazole tells a nurse, "I'm also taking over-the-counter cimetidine." The nurse should provide what information? 1. Cimetidine may cause the level of ketoconazole to reach toxic levels in the body. 2. The patient may safely take the cimetidine with the ketoconazole. 3. Cimetidine decreases gastric acidity, which the ketoconazole needs to be absorbed. 4. The patient should take an antacid instead as long as ketoconazole therapy continues.
3
A patient taking valganciclovir for CMV retinitis reports, "I'm having difficulty taking the tablets. Can I cut them in half?" Which information should the nurse provide? 1. "Tablets can be cut and handled safely." 2. "Crush the tablets on a cutting board." 3. "The tablets must be swallowed intact." 4. "Dissolve the tablets in water."
3
Which statement by a patient indicates a correct understanding of teaching regarding ethambutol? 1. "Dizziness, drowsiness, and decreased urinary output are common with this drug, but they will subside over time." 2. "Constipation will be a problem, so I will increase the fiber in my diet." 3. "I will need to have my eyes checked periodically while I am taking this drug." 4. "This medication may cause my bodily secretions to turn bluish-green."
3
. When a patient with recurrent herpes simplex genitalis infection is cared for, an important component of patient education is that: 1. the infection is contagious only when lesions are visible. 2. antiviral agents are curative in the majority of cases. 3. the patient will need to take antiviral agents daily for life. 4. the patient will need to use condoms even when no lesions are evident.
4
A nurse cares for a patient who developed severe varicella-zoster virus in the setting of postrenal transplant immunosuppression. This patient should receive: 1. topical acyclovir therapy. 2. oral acyclovir only. 3. topical as well as oral acyclovir. 4. intravenous acyclovir.
4
A nurse manages the care of a patient on rifampin for leprosy. The patient telephones, reporting, "My urine and saliva have looked an orange-red color for the past 2 days." The nurse's best response is which of the following? 1. "This is consistent with an allergic response, and the drug should be stopped." 2. "Continue the drug for another week to see if the coloration returns to normal." 3. "Stop the drug, as it is likely that hepatitis has developed." 4. "This is a normal effect of the drug and is harmless."
4
A patient asks, "Why can't I take amphotericin B in pill form?" Select the nurse's best response. 1. "The drug takes too long to work when it is taken by mouth." 2. "The medication will alter the taste of food so that you will not want to eat." 3. "The drug is too water soluble and is absorbed too fast from the gastrointestinal tract to work well." 4. "The drug is not absorbed well from the gastrointestinal tract, so the oral route is not useful for systemic infections."
4
A patient has been receiving amphotericin B for 4 weeks. The nurse can minimize toxicity by administering _____ along with the drug. 1. diphenhydramine 2. 40 mg of dexamethasone 3. 100 mg of prednisone 4. 1 L of normal saline IV
4
A patient starting INH for latent tuberculosis should be monitored for peripheral neuropathy. Which symptom or sign would alert the nurse to its development? 1. Cramps in the back when walking up steps 2. Headaches and lightheadedness on awakening 3. Dry mouth and difficulty swallowing solids 4. Difficulty buttoning shirts
4
In the treatment of leprosy, rifampin is generally administered: 1. twice daily. 2. daily. 3. twice weekly. 4. monthly.
4
The nurse describes a typical course of therapy to a newly diagnosed patient with active tuberculosis. Which description is the most accurate? 1. "The course of therapy generally lasts 1 year. Four drugs are required during that period." 2. "Most patients require 4 full months of therapy, followed by 1 year of weekly tuberculin skin tests." 3. The four-drug regimen should last for 4 weeks; if the radiograph is normal, the medications are discontinued." 4. "The entire course should take 6 months—the first 2 months with four drugs, and the last 4 months with two drugs."
4
Topical miconazole is the drug of choice for the treatment of which problem(s)? You may select more than one answer. 1. Systemic pulmonary aspergillosis 2. Catheter-related fungal infections 3. Central nervous system fungal invasions 4. Cutaneous candidiasis 5. Vulvovaginal candidiasis
45
A patient is taking pyrazinamide as a component of a multidrug regimen for tuberculosis. Which co-morbid condition in the patient's health history would most concern the nurse? a. Cirrhosis b. Migraine headaches c. Diabetes d. Osteoarthritis
ANS: A A history of cirrhosis would most concern the nurse, because liver injury is the principal adverse effect of pyrazinamide. Migraine headaches, diabetes, and osteoarthritis are not co-morbid conditions that would affect a patient taking pyrazinamide.
Voriconazole (Vfend), an antifungal used to treat life-threatening fungal infections, has which unique adverse effect? a. Visual disturbances b. Kidney damage c. Osteopenia d. Blood dyscrasias
ANS: A An adverse effect unique to voriconazole is visual disturbances. Voriconazole does not cause kidney damage, osteopenia, or blood dyscrasias.
For which diagnosis would the nurse expect econazole (Spectazole) to be ordered? a. Ringworm and superficial candidiasis b. Aspergillosis c. Esophageal candidiasis d. Tinea capitis
ANS: A Econazole is indicted as a topical application for the treatment of ringworm and superficial candidiasis. Econazole is not indicted as a systemic treatment. Econazole is not indicated for treatment of esophageal candidiasis or tinea capitis.
A patient who has been diagnosed with multidrug-resistant tuberculosis asks how long the treatment regimen will last. Select the nurse's best response. a. "After the sputum is converted to negative for TB organisms, the therapy continues for 12 to 24 months." b. "The entire course of therapy lasts 3 to 6 months or until the chest radiograph is normal." c. "Therapy is indefinite, because there is no method of determining responsiveness." d. "No therapy is completely effective in multidrug-resistant tuberculosis, so treatment is needed for several years."
ANS: A Multidrug resistance is defined as resistance to at least isoniazid and rifampin. Treatment requires at least three drugs to which the organism is sensitive and should continue for 12 to 24 months after sputum conversion. Initial therapy may consist of five, six, or even seven drugs. Three to 6 months is too short a drug regimen. Therapy is long but not indefinite Treatment is required for 1 to 2 years, not several years.
After receiving a first-time dose of the inactivated influenza vaccine, an adult patient telephones the nurse and complains of lethargy and a fever of 101° F that has lasted for 6 hours. Select the nurse's best action. a. Advise the patient to take acetaminophen and rest. b. Instruct the patient to return to the clinic immediately. c. Inform the patient that an allergic reaction is occurring. d. Notify the Centers for Disease Control and Prevention (CDC).
ANS: A People who have not been vaccinated previously may experience fever, myalgia, and malaise lasting 1 to 2 days. The nurse should advise the patient to rest and take acetaminophen for the fever. Nothing indicates that an adverse effect is occurring, therefore the patient need not return to the clinic. These are not symptoms of an allergic response but an expected response. There is no need to notify the CDC.
The nurse assesses a PPD on the forearm of a patient being screened for employment in an outpatient clinic. The induration is 4 mm. How should this finding be interpreted? a. Negative, insignificant b. Moderately significant, requiring chest radiograph c. Moderately significant, requiring sputum culture d. Significant, requiring treatment
ANS: A The finding should be interpreted as negative; induration of less than 5 mm is negative. The finding is neither moderately significant nor significant, and it does not require intervention.
The nurse is providing education for a patient receiving griseofulvin (Fulvicin) for treatment of a fungal infection. The nurse advises the patient to take the medication a. with a fatty meal to enhance absorption. b. on an empty stomach. c. 2 hours after an antacid. d. without milk or dairy products.
ANS: A The nurse should advise the patient to take the medication with a fatty meal to enhance absorption of the drug. The medication should be taken with food to reduce gastrointestinal upset. Antacids, milk, and dairy products do not affect the absorption of griseofulvin.
Itraconazole (Sporanox) has been prescribed for a patient with onychomycosis. Prior to the use of this drug, the nurse should review the patient's history and assess the patient for which co-morbid condition? a. Heart failure b. Asthma c. Lupus d. Osteoarthritis
ANS: A The nurse should assess the patient for heart failure, because this medication causes cardiac suppression. Sporanox is not contraindicated for patients with asthma, lupus, or osteoarthritis.
When assessing a patient for adverse reactions to the combination of isoniazid and rifampin (Rifadin), the nurse would monitor which laboratory results? a. Liver function tests (LFTs) b. Complete blood cell count (CBC) c. Uric acid levels d. Calcium levels
ANS: A The nurse should monitor LFTs and creatinine clearance, because isoniazid and rifampin are hepatotoxic, and the chances of hepatotoxicity are increased when the two are given together. Nothing indicates a need to monitor a CBC, uric acid levels, or calcium levels.
The nurse is caring for a patient who has a fungal infection and has been prescribed fluconazole (Diflucan). The patient is also taking tolbutamide (Orinase). The nurse would especially monitor the patient for which effects? a. Hypoglycemia b. Hyperkalemia c. Hyperglycemia d. Bleeding
ANS: A The nurse should monitor the patient for hypoglycemia. Fluconazole can increase levels of other drugs, including warfarin, phenytoin, sulfonylureas, and others. Because it would increase the effects of tolbutamide, the blood glucose level would be lowered. The patient is not at risk for hyperglycemia, bleeding, or hyperkalemia.
An adult has active tuberculosis, as diagnosed by sputum examination and culture. In evaluating the patient's response to therapy, the nurse would want to see which finding? a. Improved x-ray report within 3 months b. Absence of symptoms by 8 weeks c. Return to a negative skin test by 4 weeks d. Negative computed tomography (CT) scan by 2 weeks
ANS: A The nurse would expect to see an improved x-ray report within 3 months. Therapy is evaluated in three ways: bacteriologic evaluation of the sputum, clinical evaluation, and chest radiographs. The nurse would not expect symptoms to be absent or a negative TB skin test. The patient will always have a positive test result, because antibodies are in the system. A CT scan is not indicated.
A patient comes to the sexually transmitted disease (STD) clinic and receives valacyclovir (Valtrex) for a herpes-zoster virus. The nurse instructs the patient to take the medication a. without regard to meals. b. without any dairy products. c. each morning. d. on a empty stomach.
ANS: A The patient may take the medication without regard to meals. The patient does not need to avoid dairy products, take the pill only in the morning, or take it on an empty stomach.
A patient telephones a nurse and reports that since beginning ribavirin (Rebetol) therapy 6 months ago, the patient has had increasing fatigue. Over the past week, shortness of breath also has developed. Which instruction should the nurse provide? a. "Come to the office for a complete blood count immediately." b. "This is a normal response to this medication. It should resolve spontaneously in a few days." c. "Fatigue and shortness of breath may indicate an allergic reaction to the drug. Take an antihistamine." d. "Break the pills in half to reduce possible side effects."
ANS: A The principal concerns with ribavirin are hemolytic anemia and birth defects. The nurse should instruct the patient to come in for a CBC, because the signs and symptoms are consistent with hemolytic anemia. The patient's symptoms are not a normal response to the medication. Fatigue and shortness of breath will not be fixed by administration of an antihistamine. The medication dosage may be reduced, but the priority is to have the patient come in immediately for a blood test.
A patient taking valganciclovir (Valcyte) for cytomegalovirus (CMV) retinitis reports, "I'm having difficulty taking the tablets. Can I cut them in half?" The nurse should inform the patient that the medication may not be cut in half because a. the potential exists for mutagenesis and carcinogenesis. b. the effectiveness of the pill could be lost. c. when the coating is destroyed, a bolus of medication is released. d. the first-pass effect in the liver is increased.
ANS: A The tablets should be ingested intact, without crushing or chewing, because they have the potential for mutagenesis and carcinogenesis and should be handled carefully. The pills effectiveness would not be lost by this action. A bolus would not be delivered, and the first-pass effect would not be affected by this action.
The nurse is caring for a patient who is scheduled to receive a dose of ganciclovir (Cytovene). Prior to administration of the medication, the nurse reviews the patient's laboratory test results. Which finding would cause the nurse to withhold the medication? a. Absolute neutrophil count of 450/mm3 b. Platelet count of 47,000/mm3 c. Total white blood cell count (WBC) of 900/mm3 d. Absolute lymphocyte count of 500/mm3
ANS: A Treatment should be interrupted if the absolute neutrophil count falls below 500/mm3 or if the platelet count falls below 25, 000/mm3. Treatment need not be interrupted for a platelet count of 47, 000/mm3, a WBC of 900/mm3, or a lymphocyte count of 500/mm3. DIF: Cognitive Level: Application REF: p. 1074 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
Ketoconazole (Sporanox) is used as an alternative to amphotericin B for less severe systemic mycosis. The primary reason (or reasons) for choosing ketoconazole is which of the following? (Select all that apply.) a. Ketoconazole can be given orally. b. Ketoconazole can be used safely in patients with hepatic dysfunction. c. Ketoconazole can be given once per week rather than daily. d. It is the prescriber's choice because the drugs are comparable. e. Ketoconazole is safer.
ANS: A, E Ketoconazole is given instead of amphotericin B because it is safer and can be administered orally. Amphotericin B is administered intravenously. Ketoconazole is hepatotoxic. It is given daily. The drugs are comparable in effect but not in safety.
The nurse is caring for a patient with TB who is being treated with capreomycin. During the assessment, the patient states that he has been a little dizzy lately, and he asks the nurse to repeat bits of the conversation multiple times. Why would this concern the nurse? a. Dizziness may indicate head congestion from the TB. b. Hearing loss is associated with capreomycin toxicity. c. The patient displays worsening symptoms of TB. d. This is an indication that the patient should be checked for urinary retention.
ANS: B Capreomycin may cause injury to the eighth cranial nerve, which results in hearing loss and disturbance of balance. Dizziness does not indicate head congestion, but it may indicate a disturbance of balance. No evidence indicates that the patient's symptoms are worsening. Nothing indicates that urinary retention has occurred.
A public health nurse is providing education on antiviral medications to a group of medical-surgical nurses. Which statement by one of the nurses about non-HIV antiviral drugs best demonstrates understanding? a. "The advances made with antiviral drugs in the past decade surpass those made with antibacterial antibiotics." b. "These medications are active against a narrow spectrum of viruses." c. "As a rule, antiviral drugs are safer than antibiotic agents." d. "Clinically useful antivirals suppress the host cell's biologic processes."
ANS: B Non-HIV antiviral drugs are active against a narrow spectrum of viruses. Advances in antibiotics have kept pace or surpassed those made with antivirals. These drugs are not safer than antibiotics, nor do they suppress the host cell's biologic processes.
The nurse is preparing to administer amphotericin B intravenously. The nurse should pretreat the patient with which of the following? a. Ibuprofen (Motrin), diphenhydramine (Benadryl), and meperidine (Demerol) b. Acetaminophen (Tylenol), diphenhydramine (Benadryl), and meperidine (Demerol) c. Aspirin, diphenhydramine (Benadryl), and meperidine (Demerol) d. Morphine sulphate (Morphine) and acetaminophen (Tylenol)
ANS: B Optimal pretreatment before administration of amphotericin B is with acetaminophen, diphenhydramine, and meperidine (for rigors). Motrin is not suggested as pretreatment. Aspirin is an option, but it may increase kidney damage. Morphine is not indicated in the pretreatment regimen.
The nurse is caring for a patient who is taking rifabutin (Mycobutin). The patient begins to complain of a sudden onset of eye pain and blurred vision. The nurse suspects the patient is experiencing a. cataracts. b. uveitis. c. glaucoma-like syndrome. d. conjunctivitis.
ANS: B Rifabutin poses a risk of uveitis and should be discontinued if ocular pain or blurred vision develops. Cataracts, a glaucoma-like syndrome, and conjunctivitis are not effects associated with rifabutin.
The nurse is caring for a patient with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) who has taken protease inhibitors for 18 months. The patient has been diagnosed with active tuberculosis. The nurse would not expect the addition of which drug to the patient's medication regimen? a. Isoniazid (INH) b. Rifampin (Rifadin) c. Pyrazinamide (PZA) d. Kanamycin (Kantrex)
ANS: B Rifampin is contraindicated as part of the new antituberculosis regimen, because it would reduce the effects of the protease inhibitors. Isoniazid, pyrazinamide, and kanamycin could be included in the treatment of a patient with HIV/AIDS.
A patient is taking oral ketoconazole (Nizoral) for a systemic fungal infection. The nurse reviews the medication administration record and notes that the patient is also taking omeprazole (Prilosec) for reflux disease. What action should the nurse take? a. Administer the omeprazole 1 hour before the ketoconazole. b. Administer the omeprazole at least 2 hours after the ketoconazole. c. Confer with the prescriber about a potential hazardous interaction. d. The nurse should not administer omeprazole to a patient receiving ketoconazole.
ANS: B The nurse should administer the omeprazole at least 2 hours after the ketoconazole to prevent a drug-drug interaction. Drugs that reduce gastric acidity should be administered no sooner than 2 hours after ingestion of ketoconazole because they reduce absorption of the drug. Drugs that reduce gastric acidity should be administered no sooner than 2 hours after ingestion of ketoconazole because they reduce absorption of the drug. There is no need to confer with prescriber or refuse to administer the drugs as this is an appropriate drug combination.
The nurse is caring for a patient receiving IV acyclovir. To prevent nephrotoxicity associated with intravenous acyclovir, the nurse would do which of the following? a. Provide a low-protein diet for 1 day before and 2 days after the acyclovir infusion. b. Infuse IV fluids during and for 2 hours after the acyclovir infusion. c. Increase the patient's intake of vitamin C rich foods. d. Monitor urinary output every 30 minutes.
ANS: B The nurse should include the infusion of IV fluids during and for 2 hours after the acyclovir infusion to prevent nephrotoxicity by perfusing the kidneys. A low-protein diet is not indicted after an acyclovir infusion. Increasing vitamin C would not help prevent nephrotoxicity. Monitoring urine output is important but would not help prevent nephrotoxicity.
A patient has been receiving amphotericin B (Fungizone) for systemic mycoses. The nurse most likely would monitor for which signs and symptoms in this patient? a. Liver function tests b. Kidney function c. Tinnitus d. Hyperkalemia
ANS: B The nurse should monitor kidney function, because amphotericin B is nephrotoxic. Nothing indicates a need to monitor liver enzymes. Tinnitus is not an expected adverse effect. Hypokalemia is a possibility, but hyperkalemia is not anticipated.
A patient admitted to the unit for treatment of leprosy has been prescribed clofazimine (Lamprene). Which clinical finding would most concern the nurse? a. Reddish tint to the urine and feces b. Sluggish, hypoactive bowel sounds c. Hair loss d. Nausea and abdominal cramps
ANS: B The nurse would be most concerned about sluggish bowel sounds, which may indicate the development of intestinal obstruction, a condition for which the nurse should monitor the patient. Intestinal obstruction results from the deposition of clofazimine in the small intestine and may also produce pain and bleeding. The medication does not give a reddish tint to the feces, urine, sweat, or tears. Hair loss is not an expected finding. GI symptoms (nausea, vomiting, cramping, and diarrhea) are common
A patient is prescribed cycloserine (Seromycin pulvules) for resistant tuberculosis. What laboratory test results would the nurse monitor this patient? a. Urine sample 12 hours after administration b. Serum drug level 2 hours after administration c. Drug level through a 24-hour urine sample d. Serum level immediately before the next dose is due
ANS: B The nurse would monitor a serum drug level 2 hours after administration. To minimize the risk of adverse effects, serum concentrations of cycloserine should be measured periodically; peak concentrations are measured 2 hours after dosing. These options do not reflect appropriate monitoring of patients taking this medication.
An elderly patient who lives alone in the community is concerned about recent exposure to the flu and asks for an influenza vaccination. What patient education should the nurse provide? a. "Because exposure has already occurred, the injection will not reduce the risk of developing flu this season." b. "Protection against the flu should begin about 1 to 2 weeks after injection." c. "A person should not receive the vaccine unless direct contact has been confirmed." d. "The vaccine is given only if the exposures have been verified as type A influenza."
ANS: B The patient should be instructed that protection against the flu should begin about 1 to 2 weeks after injection with the vaccine. The patient should receive the vaccine regardless of whether exposure (direct/indirect) has occurred. Verification of exposure to type A influenza is not necessary to receive the vaccine.
A patient has been diagnosed with onychomycosis and is prescribed terbinafine (Lamisil). The nurse provides education about the medication. Which statement by the patient best demonstrates understanding of treatment with terbinafine? a. "I should take the medication daily with food for 1 month." b. "I will be taking this medication for 3 to 6 months." c. "I should take the medication on an empty stomach to increase absorption." d. "I understand that the cure rate is 75% with this medication."
ANS: B The patient will be taking terbinafine for 3 to 6 months. The medication causes gastrointestinal upset and should be taken with food to minimize effects. The cure rate with terbinafine is 50%.
The nurse at a public health clinic is working with some students on rotation through the clinic. The nurse asks the students, "How is a definitive diagnosis of tuberculosis made?" The students would be correct to respond that a definitive diagnosis of tuberculosis is made by which of the following means? (Select all that apply.) a. Tuberculin skin testing b. Chest radiographs (x-ray films) c. Microscopic examination of sputum d. Chronic cough e. Night sweats
ANS: B, C Definitive diagnosis of TB is made by chest radiographs and microscopic examination of the sputum. TB skin testing, a chronic cough, and night sweats are not definitive and may not even be related to TB.
The nurse is caring for a patient with chronic hepatitis B who is being treated with adefovir (Hepsera). Which of the following findings would indicate that this medication is appropriate for this patient? a. Human immunodeficiency virus (HIV) infection and a low CD4 count b. Renal insufficiency on dialysis c. No clinical or laboratory evidence of HIV infection d. Allergy to purine nucleoside analogues
ANS: C Adefovir is used in patients who have no clinical or laboratory evidence of HIV infection. HIV, renal insufficiency, and allergy to purine derivatives are contraindications to treatment with adefovir.
A student nurse is caring for a patient who is to receive caspofungin (Cancidas). The medication is used most commonly in a patient with which of the following? a. Onychomycosis b. Recalcitrant vaginal candidal infection c. Invasive aspergillosis that is unresponsive to amphotericin B d. Allergy to voriconazole
ANS: C Caspofungin is ordered for a patient with invasive aspergillosis that is unresponsive to amphotericin B. Caspofungin is not indicated for patients with onychomycosis or vaginal candidal infections. Caspofungin is not indicated for patients an allergy to voriconazole.
The nurse is caring for a patient who comes to the clinic with tinea corporis, for which the prescriber orders clotrimazole. What education about this medication should the nurse provide? a. "Use the medication over the entire body once a week for 1 month." b. "Sun exposure will delay the drug's effects." c. "Continue the therapy for at least 1 week after the symptoms have cleared up." d. "This drug is effective after a single application."
ANS: C The nurse should advise the patient to continue therapy for at least 1 week after the symptoms have cleared up. The medication should be applied only to affected areas. Sun exposure will not delay the effects of clotrimazole. The drug is not effective after only a single application.
A patient being followed for latent tuberculosis has been on INH therapy for 2 months. While reviewing the laboratory test results, the nurse notes that the liver function test results have become grossly abnormal. The nurse should instruct the patient to a. continue the drug unless jaundice, nausea, or itching develops. b. continue the drug and have liver function tests repeated weekly. c. stop the medication immediately, and other drugs will be prescribed. d. stop the drug and restart it when liver function returns to normal.
ANS: C The nurse should instruct the patient to stop taking the medication immediately to prevent further damage to the liver, because INH therapy may cause hepatotoxicity. Liver function should be monitored closely. The drug should not be continued. The patient should not be instructed to restart the drug unless advised to do so by the prescriber. The patient would not know when liver function has returned to normal.
The nurse is caring for a 36-year-old female who has the flu. Prior to administration of amantadine (Symmetrel) to treat the influenza, the nurse should make sure that the a. patient's symptoms have been present for longer than 48 hours. b. patient is not allergic to eggs. c. patient is not pregnant. d. patient does not have a history of Guillain-Barré syndrome.
ANS: C The nurse should make sure that the patient is not pregnant, because amantadine is teratogenic. Symptoms need not have been present for longer than 48 hours. There is no need to screen the patient for an allergy to eggs or a history of Guillain-Barré syndrome, because amantadine is not a vaccination, but rather a treatment.
A patient is beginning therapy for active tuberculosis (TB). The patient asks, "Why do I have to take so many drugs?" What is the nurse's best response? a. "When a case is severe enough, multiple drugs are required." b. "The more agents used, the shorter the duration of the therapy." c. "Multiple agents prevent the emergence of resistant organisms." d. "It is assumed that patients take about 50% of the prescribed drug."
ANS: C The nurse's best response would be that multiple agents prevent the emergence of resistant organisms. Nothing indicates that the TB is severe. The use of multiple agents does not shorten the duration of therapy. It is not assumed that patients take about 50% of their medication.
The nurse is providing care to a patient with tuberculosis who is taking ethambutol (Myambutol). Which statement by the patient indicates a correct understanding of the effects of ethambutol? a. "Dizziness, drowsiness, and decreased urinary output are common with this drug, but they will subside over time." b. "Constipation will be a problem, so I will increase the fiber in my diet." c. "I will need to have my eyes checked periodically while I am taking this drug." d. "This medication may cause my bodily secretions to turn bluish green."
ANS: C The only significant adverse effect of ethambutol is optic neuritis. Patients should be advised to have their eyes checked periodically. Dizziness, drowsiness, and decreased urinary output are not listed as adverse effects. Gastrointestinal (GI) upset may occur, but constipation is not listed as an adverse effect. Ethambutol does not turn the urine bluish green.
The nurse is providing patient education about antifungal medications. Which of the following statements by the patient best demonstrates understanding of the administration of this medication? "To enhance absorption, I should take the medication with a. beer." b. milk." c. soda." d. lemonade."
ANS: C The patient should drink soda or eat food when taking an antifungal medication to enhance absorption of the drug. Milk, lemonade, and beer are not suggested.
A patient admitted for an acute outbreak of herpes-zoster virus is receiving valacyclovir (Valtrex). The nurse provides patient education about valacyclovir (Valtrex). What comment by the patient indicates a need for further teaching? a. "Valtrex will help reduce the duration of my pain." b. "Valtrex will help reduce the duration of postherpetic neuralgia." c. "Valtrex will prevent recurrent infection." d. "Valtrex may be taken without food."
ANS: C Valacyclovir will not prevent recurrent infection; this statement indicates that further teaching is necessary. Valacyclovir does help reduce the duration of pain and postherpetic neuralgia; no further teaching is necessary. Valacyclovir may be taken with or without food; no further teaching is necessary.
The nurse is caring for a patient starting INH for latent tuberculosis. Which clinical manifestations would most concern the nurse? a. Cramps in the back when walking up steps b. Headaches and lightheadedness on awakening c. Dry mouth and difficulty swallowing solids d. Difficulty buttoning shirts
ANS: D Difficulty buttoning shirts would most concern the nurse, because this may indicate neuropathy. Dose-related peripheral neuropathy is the most common adverse effect of INH therapy. The patient may experience numbness, burning, or tingling in the hands and feet. Cramps in the back do not indicate neuropathy. Headaches and lightheadedness on awakening are not associated with INH administration even over longer periods of time. Dry mouth and difficulty swallow are not consistent with neuropathy.
The nurse is preparing to administer micafungin (Mycamine) to a patient for the treatment of esophageal candidiasis. When the nurse reviews the medication administration record (MAR), which drug, when administered concurrently with micafungin, would cause the nurse the greatest concern? a. Mycophenolate (CellCept) b. Cyclosporine (Sandimmune) c. Tacrolimus (Prograf) d. Nifedipine (Procardia)
ANS: D Micafungin has a drug-drug interaction with Procardia (a calcium channel clocker). Patients treated with micafungin should be monitored closely for signs of toxicity. No drug-drug interactions are associated with micafungin and mycophenolate, cyclosporine, or tacrolimus.
A patient complains of mouth sores. Upon assessment, the nurse notes white, patchy spots and redness of the tongue and throat. The nurse expects the prescriber to order a. miconazole (Micatin). b. itraconazole (Sporanox). c. fluconazole (Diflucan). d. nystatin (Mycostatin).
ANS: D Nystatin is used to treat candidal infection of the skin, mouth, esophagus, and vagina. Miconazole (indicated for cutaneous and vaginal candidiasis) and itraconazole are not indicated for the treatment of candidal infections. Oral candidiasis is treated with topical agents, such as nystatin, clotrimazole, and amphotericin B. In an immunocompromised host, oral therapy with fluconazole or ketoconazole usually is required. Fluconazole is recommended for use in immunocompromised patients, and nothing indicates that the patient is immunocompromised.
The nurse is providing education to a patient with recurrent herpes simplex genitalis. The nurse should make sure to advise the patient that a. the infection is contagious only when lesions are visible. b. antiviral agents are curative in most cases. c. the patient will need to take antiviral agents daily for life. d. the patient will need to use condoms even when no lesions are evident.
ANS: D Patients should be advised to avoid all sexual contact when lesions are present, and they should use a condom even when lesions are absent. The nurse should not advise the patient that infection is contagious only when lesions are visible. Antiviral agents are not curative in most cases. There is no indication that the antiviral medication is necessary as a lifelong treatment.
The nurse is performing a physical assessment on a patient with tuberculosis who takes rifampin (Rifadin). Which of the following would be an expected finding? a. Peripheral neuropathy b. Myopathy c. Crystalluria d. Red-orange-tinged urine
ANS: D Red-orange-tinged urine is a normal finding associated with rifampin. Peripheral neuropathy, myopathy, and crystalluria are manifestations of adverse effects.
The nurse is caring for a patient who is being discharged home on rifampin (Rifadin) for the treatment of leprosy. What statement by the patient about the administration of this drug best indicates understanding? "I will take my medication a. twice daily." b. daily." c. twice weekly." d. monthly."
ANS: D The dosage currently recommended by the World Health Organization (WHO) is 600 mg once a month. Monthly dosing is just as effective as daily dosing and therefore is recommended. Twice daily, daily and twice weekly are not appropriate dosing regimens.
The nurse describes a typical course of therapy to a patient newly diagnosed with active tuberculosis. Which description is the most accurate? a. "The course of therapy generally lasts 1 year. Four drugs are required during that period." b. "Most patients require 4 full months of therapy, followed by 1 year of weekly tuberculin skin tests." c. "The four-drug regimen should last for 4 weeks. If the radiograph is normal, the medications are discontinued." d. "The entire course should take 6 months; the first 2 months with four drugs, and the last 4 months with two drugs."
ANS: D The most accurate description for the course of therapy for a newly diagnosed patient is that the entire course should take 6 months; the first 2 months with 4 drugs, and the last 4 months with 2 drugs. Therapy does not take a year or 4 full months. Therapy takes longer than 4 weeks.
The nurse is providing patient education for a patient who is to start taking interferon. The nurse should instruct the patient that the most common adverse effect is a. anxiety and agitation. b. vomiting. c. hirsutism. d. flulike syndrome.
ANS: D The most common side effect of interferon is a flulike syndrome, which occurs in 50% of those who take the drug. Anxiety and agitation, hirsutism, and vomiting are not side effects associated with interferon.
A patient has been taking itraconazole (Sporanox) for 3 months for a persistent fungal infection. The patient has nausea, vomiting, anorexia, fatigue, right upper abdominal pain, dark urine, and pale stools. The nurse would be correct to suspect a. anemia. b. renal failure. c. sepsis. d. liver injury.
ANS: D The nurse is correct to suspect liver injury, because these signs and symptoms are associated with liver dysfunction. Nothing indicates the presence of anemia or renal failure. The symptoms are not consistent with sepsis.
A nurse manages the care of a patient who is taking rifampin (Rifadin) for leprosy. The patient telephones and reports, "My urine and saliva have looked orange-red for the past 2 days." Select the nurse's best response. a. "This is consistent with an allergic response, and the drug should be stopped." b. "Continue the drug for another week to see if the color returns to normal." c. "Stop the drug, because it is likely that hepatitis has developed." d. "This is a normal effect of the drug and is harmless."
ANS: D The nurse should reassure the patient that orange-red urine is a normal effect of rifampin. The color change does not indicate an allergic reaction. The color will persist until the medication is discontinued. The color change is not an indication of hepatitis.
The nurse recognizes that miconazole (Micatin) is the drug of choice for the treatment of which problem or problems? (Select all that apply.) a. Systemic pulmonary aspergillosis b. Catheter-related fungal infections c. Central nervous system fungal invasions d. Cutaneous candidiasis e. Vulvovaginal candidiasis
ANS: D, E Miconazole is the drug of choice for cutaneous and vulvovaginal candidiasis. Miconazole is not effective for the treatment of systemic infections, such as pulmonary aspergillosis. Miconazole is not used to treat catheter-related fungal infections. Miconazole does not cross the blood-brain barrier, therefore it cannot be used for central nervous system infections.