Antiviral/Antifungal/Antitubercular
The nurse is counseling a woman who is beginning anti tubercular therapy with rifampin. The patient also takes an oral contraceptive. Which statement by the nurse is most accurate regarding potential drug interaction? a. you will need to switch to another form of birth control while you are taking the rifampin b. your birth control pills will remain effective while you are taking the rifampin c. you will need to take a stronger dose of birth control pills while you are on the rifampin d. you will need to abstain from sexual intercourse while on the rifampin to avoid pregnancy
a
When the nurse is teaching a patient who is taking acyclovir for genital herpes, which statement by the nurse is accurate? a. This drug will help the lesions to dry and crust over b. acyclovir will eradicate the herpes virus c. this drug will prevent the spread of the virus to others d. be sure to give this drug to your partner too
a
How is the effectiveness of antiviral drugs administered to treat HIV infection assessed and evaluated? a. Viral load b. Megakaryocytes c. Lymphocyte counts d. Red blood cell counts
a All antiretroviral drugs work to reduce the viral load, which is the number of viral RNA copies per milliliter of blood.
A client visits the health care provider for treatment of tinea pedis (athlete's foot). Which medication would the nurse MOST likely instruct the client to take to treat this condition? a. Terbinafine (Lamisil) b. Voriconazole (Vfend) c. Caspofungin (Cancidas) d. Amphotericin B (Amphocin)
a Terbinafine (Lamisil) is classified as an allylamine antifungal drug and is currently the only drug in its class. It is available in a topical cream, gel, and spray for treating superficial dermatologic infections, including tinea pedis (athlete's foot), tinea cruris (jock itch), and tinea corporis (ringworm).
The nurse would question a prescription for voriconazole (Vfend) if the client was taking which medication? a. Quinidine b. Prednisone (Deltasone) c. Captopril (Capoten) d. Clindamycin (Cleocin)
a The nurse would question a prescription for quinidine because both voriconazole and quinidine are metabolized by the cytochrome P-450 enzyme system. The drugs will compete for the limited number of enzymes, and one of the drugs will end up accumulating.
What instruction should the nurse include for a client prescribed rifampin (Rifadin) and isoniazid (Nydrazid) prophylactically secondary to TB exposure? a. Advise that these drugs will only need to be taken for 7 to 10 days. b. Remind that sunscreen is not needed during outdoor activities. c. Explain that isoniazid may decrease blood serum glucose in susceptible people. d. Emphasize that oral contraceptives become ineffective when given with rifampin.
d Women taking oral contraceptives who are prescribed rifampin must be switched to another form of birth control because oral contraceptives become ineffective when given with rifampin. These medications must be taken long term because mycobacterium is slow growing. They can cause photosensitivity, necessitating the use of sunscreen. Finally, isoniazid may increase, not decrease, serum glucose levels.
Bedaquiline (Sirturo) is prescribed for a patient, and the nurse is providing instructions to the patient about the medication. Which statement by the patient indicates a correct understanding of the instructions? a. i will take this with food b. i need to take this 1 hour before breakfast c. i can stop this drug if the side effects bother me d. it's okay to have a glass of wine while taking this drug
a
The most significant drug interactions with use of antivirals occur when antivirals are administered via which route? a. Rectally b. Topically c. Optically d. Intravenously
d Significant drug interactions that occur with antiviral drugs arise most often when they are administered via systemic routes such as intravenously and orally. Many of these drugs are also applied topically to the eye or body, however, and the incidence of drug interactions associated with these routes of administration is much lower.
The nurse needs to know that major adverse effects are MOST common by which drug? a. Fluconazole (Diflucan) b. Ketoconazole (Nizoral) c. Griseofulvin (Fulvicin P/G) d. Amphotericin B (Amphocin)
d The major adverse effects caused by antifungal drugs are encountered most commonly in conjunction with amphotericin B treatment. Drug interactions and hepatotoxicity are the primary concerns in clients receiving other antifungal drugs, but the IV administration of amphotericin B is associated with a multitude of adverse effects.
When assessing for adverse effects to Rifamate (combination isoniazid and rifampin), the nurse would monitor which laboratory values? (Select all that apply.) a. Cholesterol b. Uric acid levels c. Sputum cultures d. Liver function tests e. Complete blood cell count
d and e Rifamate can lead to impairment of liver function as well as hematologic disorders. Assessment of sputum cultures confirms the diagnosis but is not related to adverse effects. The drug does not affect uric acid levels or cholesterol.
After giving an injection to a patient with HIV infection, the nurse accidentally received a needlestick from a two-full needed disposal box. Recommendations for occupational HIV exposure may include the use of which drug(s)? a. didanosine b. lamivudine and enfuviritied c. emtricitabine and tenofovir e. acyclovie
a
When teaching patients about treatment of viral infection with Acyclovir (Zovirax), which of the following statements will the nurse include? a. The drug is used mainly to suppress the replication of HSV-1, HSV-2, and VZV. b. Acyclovir (Zovirax) is only effective for initial viral infections. c. Acyclovir (Zovirax) is available in topical form only. d. Acyclovir (Zovirax) is taken once daily.
Correct answer: A Rationale: Acyclovir (Zovirax) is a synthetic nucleoside analogue that is used mainly to suppress the replication of HSV-1, HSV-2, and VZV. Acyclovir is considered the drug of choice for the treatment of both initial and recurrent episodes of these viral infections. Acyclovir is available in oral, topical, and injectable formulations. Acyclovir (Zovirax) is taken five times daily.
Which statement should the nurse include when teaching the patient about Indinavir (Crixivan) therapy? a. The drug must be taken with food. b. Patients taking the drug should be encouraged to drink at least 48 ounces of liquid daily. c. This drug is best absorbed in an alkaline environment. d. Indinavir decreases CD4 cell counts.
Correct answer: B Rationale: Patients who take indinavir are encouraged to drink at least 48 oz of liquids every day to maintain hydration and help avoid nephrolithiasis. This drug is best dissolved and absorbed in an acidic gastric environment, and the presence of high-protein and high-fat foods reduces its absorption. Therefore, it is recommended that it be administered in a fasting state. Indinavir therapy produces increases in CD4 cell counts and significant reductions in viral load.
When reviewing the antiviral medications oseltamivir (Tamiflu) and zanamivir (Relenza) used for treatment of the flu, which of the following statements should the nurse include? a. These drugs are effective only for influenza A. b. These drugs decrease the effects of the flu by 12 hours. c. Zanamivir is currently indicated only for treatment of active influenza. d. The most commonly reported adverse events with oseltamivir are diarrhea, nausea, and sinusitis.
Correct answer: C Rationale: Zanamivir is currently indicated only for treatment of active influenza. These drugs are active against influenza virus types A and B. They have been shown to reduce the duration of influenza infection by several days. The most commonly reported adverse events with oseltamivir are nausea and vomiting.
An 82-year-old woman is unable to take the influenza vaccine because of allergies, but she has been exposed to the virus through a family reunion. She does not yet have symptoms of the flu. Which option would be best for her? a. She should receive the flu vaccine as soon as possible. b. She should receive zanamivir (Relenza) in the inhalation form. c. She should begin oral oseltamivir (Tamiflu) therapy when symptoms begin. d. She should begin oral oseltamivir (Tamiflu) therapy as soon as possible.
Correct answer: D Rationale: Oseltamivir (Tamiflu) is the only one indicated for prophylaxis of influenza infection. Both oseltamivir and zanamivir can be used to treat active influenza illness. Treatment with oseltamivir and zanamivir ideally should begin within 2 days of symptom onset.
Which of the following drugs does the nurse include when teaching caregivers about treatment of neonates with RSV? a. Telbivudine (Tyzeka) b. Sofosbuvir (Solvald) c. Ganciclovir (Cytovene) d. Ribavirin (Virazole)
Correct answer: D Rationale: Telbivudine (Tyzeka) is a nucleoside analogue RTI indicated for chronic hepatitis B. Sofosbuvir (Solvald) is the first-in-class RNA polymerase inhibitor for the treatment of chronic hepatitis C. Ganciclovir (Cytovene) is indicated for the treatment of infections caused by CMV. The inhalational form (Virazole) is used primarily in the treatment of hospitalized infants with severe lower respiratory tract infections caused by RSV.
When monitoring a patient who is receiving caspofungin, the nurse will look for which serious adverse effects? (SATA) a. blood dycrasias b. hypotension c. pulmonary infiltrates d. tinnitus e. hepatotoxicity
a, b, and e blood dyscrasia = abnormal cellular elements
Before administration of any antiviral medication, what nursing responsibilities would be performed? (Select all that apply.) a. Baseline vital signs b. History of medication use c. Head-to-toe physical assessment d. Documentation of known allergies e. Monitor for medication adverse effects
a, b, c, and d Before administering an antiviral drug, perform a thorough head-to-toe physical assessment and take a medical and medication history. Document any known allergies before use of these and any other medications. Also assess the client's nutritional status and baseline vital signs because of the profound effects of viral illnesses on physiologic status, especially if the client is immunocompromised. Assess and document any contraindications, cautions, and drug interactions associated with all of the antiviral drugs. Monitoring for adverse effects would occur after the medication has been administered.
The nurse is aware that viruses can enter the body through various routes. Through which routes can viruses enter the body? (Select all that apply.) a. Through an animal bite b. Transplacentally from mother to infant c. Inhalation through the respiratory tract d. Localized allergic reaction to medication e. Ingestion via the gastrointestinal (GI) tract
a, b, c, and e Viruses can enter the body through at least four routes: (1) inhalation through the respiratory tract, (2) ingestion via the GI tract, (3) transplacentally via mother to infant, and (4) inoculation via skin or mucous membranes. The inoculation route can take several forms, including sexual contact, blood transfusions, sharing of syringes or needles, organ transplantation, and animal bites (including human, animal, insect, spider, and others). Viruses cannot enter the body through an allergic reaction caused by medication.
Which types of antiviral drugs are used to treat HIV infection? (Select all that apply.) a. Fusion inhibitors b. Protease inhibitors c. Neuraminidase inhibitors d. Reverse transcriptase inhibitors e. Nonnucleoside reverse transcriptase inhibitors
a, b, d, and e Neuraminidase inhibitors are used in the treatment of the influenza virus.
What are important for the nurse to monitor in a client receiving an antifungal medication? (Select all that apply.) a. Creatinine b. Daily weights c. Mental status d. Intake and output e. Blood urea nitrogen
a, b, d, and e Nursing interventions appropriate to clients receiving antifungal drugs vary depending on the particular drug. However, it is important for the nurse to monitor all clients for indications of possible medication-induced renal damage so that prompt interventions can occur to prevent further dysfunction. Monitoring intake and output amounts, daily weights, and renal function tests will help prevent such damage.
During anti tubercular therapy with isoniazid, a patient received another prescription for pyridoxine. Which statement by the nurse best explains the relational for this second medication? a. this vitamin will help to improve your energy levels b. this vitamin helps to prevent neurologic adverse effects c. this vitamin works to protect your heart from toxic effects d. this vitamin helps to reduce GI adverse effects
b
The nurse is assessing a patient who is about to receive antifungal drug therapy. Which problem would be of most concern? a. endocrine disease b. hepatic disease c. cardiac disease d. pulmonary disease
b
When teaching a patient who is taking nystatin lozenges for oral candidiasis, which instruction by the nurse is correct? a. chew the lozenge carefully before swallowing b. dissolve the lozenge slowly and completely in your mouth c. dissolve the lozenge until it is half the original size, and then swallow it d. these lozenges need to be swallowed whole with a glass of water
b
The nurse is obtaining a medication history from a client diagnosed with genital herpes. Which drug would the nurse expect this client to be prescribed? a. Ribavirin (Virazole) b. Acyclovir (Zovirax) c. Zidovudine (Retrovir) d. Amantadine (Symmetrel)
b Acyclovir is the drug of choice to treat herpes simplex infections, which includes the virus type 2 that causes genital herpes. Ribavirin is effective against respiratory syncytial virus, zidovudine against human immunodeficiency virus (HIV), and amantadine against Haemophilus influenzae type A.
Which client statement regarding his or her diagnosis of HIV infection indicates a need that further teaching is necessary? a. "I must take these medications exactly as prescribed for the rest of my life." b. "I don't need to use condoms as long as I take my medication as prescribed." c. "I will notify my health care provider immediately if I bruise or bleed more easily than normal." d. "I should remain upright for 30 minutes after taking my zidovudine to prevent esophageal ulceration."
b Antiretroviral drugs do not stop the transmission of HIV, and clients need to continue standard precautions and safe sex practice, including condom use. Potential serious adverse effects of zidovudine are bone marrow suppression and esophageal ulceration.
The nurse has provided education to a client about fungal skin infections. Further client teaching is necessary when the client includes which condition in the discussion of fungal skin infections? a. Thrush b. Impetigo c. Athlete's foot d. Vaginal yeast infection
b Impetigo is a bacterial skin infection and would not be classified as a fungal skin infection. If the client included this in the discussion, further teaching is needed. All other skin infections listed are fungal and would be treated with antifungal medications.
What is the MOST common drug used to treat oral candidiasis? a. Oseltamivir (Tamiflu) b. Nystatin (Mycostatin) c. Amantadine (Symmetrel) d. Griseofulvin (Fulvicin P/G)
b Nystatin is an antifungal drug that is used for a variety of candidal infections. It is applied topically as a cream, ointment, or powder. It is also available as a troche and an oral liquid or tablet.
A new vaccination, Zostavax (Zoster Vaccine Live), has been approved to prevent the development of what condition in adults older than the age of 60 years? a. Influenza A b. Herpes zoster c. Avian influenza d. Herpes simplex
b Zoster vaccine (Zostavax) is a vaccine for the prevention of herpes zoster. Herpes zoster, also known as shingles, is an extremely painful condition caused by the varicella-zoster virus that also causes chickenpox. The vaccine is approved for clients 60 years of age or older to prevent reactivation of the zoster virus that causes shingles, although clients as young as 50 years may receive it. Zostavax is a one-time vaccine.
What conditions are considered contradictions for use of antifungal medications? (Select all that apply.) a. Heart failure b. Liver failure c. Kidney failure d. Pancreatic failure e. Respiratory failure
b and c Drug allergy, liver failure, kidney failure, and porphyria (for griseofulvin) are the most common contraindications for antifungal drugs.
The nurse is reviewing the use of multi drug therapy for HIV with a patient. Which statements are correct regarding the reason for using multiple drugs to treat HIV? (SATA) a. the combination of drugs has fewer associated toxicities b. the use of multiple drugs is more effective against resistant strains of HIV c. effective treatment results in reduced T-cell counts d. the goal of this treatment is to reduce the viral load e. this type of therapy reduces the incidence of opportunistic infections
b, d, and e
The nurse is monitoring for liver toxicity in a patient who has been receiving long-term isoniazid therapy. Manifestations of liver toxicity include: a. orange discoloration of sweat and tears b. darkened urine c. dizziness d. fatigue e. visual disturbances f. jaundice
b, d, and f
After surgery for organ transplantation, a patient is receiving ganciclovir, even though he does not have a viral infection. Which statement best explains the rationale for this medication therapy? a. ganciclovir is used to prevent potential exposure to the HIV virus b. this medication is given to prophylactically prevent influenza A infection c. ganciclovir is given to prevent CMV infection d. the drug works synergistically with antibiotics to prevent super infections
c
During an infusion of amphotericin B, the nurse knows that which administration technique may be used to minimize infusion-related adverse effects? a. forcing of fluids during the infusion b. infusing the medication quickly c. infusing the mediation over a longer period of time d. stopping the infusion for 2 hours after half of the bag has infused, then resuming 1 hour later
c
The nurse is teaching a patient who is starting anti tubercular therapy with rifampin. Which adverse effects would the nurse expect to see? a. headache and neck pain b. gynecomastia c. reddish brown urine d. numbness or tingling of extremities
c
The nurse notes in the patient's medication history that the patient is taking sofosbuvir (Solvald) with ribavirin. Based on this finding, the nurse interprets that the patient has which disorder? a. cytomegalovirus b. genital herpes c. chronic hepatitis C d. RSV
c
While monitoring a patient who is receiving IV amphotericin B, the nurse expects to see which adverse effect? a. hypertension b. bradycardia c. fever and chills d. diarrhea and stomach cramps
c
What is the MOST important action for the nurse to complete before administration of intravenous (IV) amphotericin B? a. Assess for nausea and vomiting. b. Monitor for cardiac dysrhythmias. c. Check for premedication prescriptions. d. Monitor IV site for signs of phlebitis.
c Almost all clients given IV amphotericin B experience fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache. Pretreatment with an antipyretic, antihistamine, and antiemetic can minimize or prevent these adverse reactions. The other choices are appropriate nursing actions after the IV infusion has begun.
To assess for the dose-limiting toxicity of ganciclovir (Cytovene), the nurse will monitor which laboratory test result? a. Blood urea nitrogen b. Liver function tests c. Complete blood count (CBC) d. Creatine phosphokinase
c Bone marrow suppression is a dose-limiting toxicity of ganciclovir; therefore, the CBC should be monitored.
Which client statement indicates to the nurse that the client understands the discharge teaching for ethambutol (Myambutol)? a. "Constipation will be a problem, so I will increase the fiber in my diet." b. "Dizziness and drowsiness are common adverse effects with this drug." c. "I will need to have my vision checked periodically while I am taking this drug." d. "This medication may cause my bodily secretions to turn red-orange-brown."
c Ethambutol can cause optic neuritis. Ophthalmologic examinations should be performed periodically to assess visual acuity.
Which antifungal drug can be given intravenously to treat severe yeast infections as well as a one-time oral dose to treat vaginal yeast infections? a. Voriconazole (Vfend) b. Nystatin (Mycostatin) c. Fluconazole (Diflucan) d. Caspofungin (Cancidas)
c Fluconazole is an antifungal drug that does not cause the major adverse effects of amphotericin when given intravenously. It is also very effective against vaginal yeast infections, and a single dose is often sufficient to treat vaginal infections.
When providing health promotion teaching at a senior citizen center, the nurse would include information about which medication used to decrease the duration of influenza A and B? a. Indinavir (Crixivan) b. Enfuvirtide (Fuzeon) c. Oseltamivir (Tamiflu) d. Ganciclovir (Cytovene)
c Oseltamivir (Tamiflu) and zanamivir (Relenza) are active against influenza virus types A and B and have been shown to reduce the duration of influenza infection by several days.
What information should the nurse provide to a client prescribed rifampin (Rifadin)? a. Oral contraception is the preferred method of birth control when using rifampin. b. The patient will only need to take this medication for the prescribed 14-day period. c. A nonharmful adverse effect of this medication is red-orange discoloration of urine, sweat, tears, skin, salvia, and feces. d. Peripheral neuropathy is an expected side effect, and the patient should report any numbness or tingling of the extremities.
c Red-orange-brown discoloration of the skin, sweat, tears, urine, feces, sputum, saliva, and tongue as an adverse effect of the drug, but it is not harmful. Rifampin does not cause peripheral neuropathies (isoniazid does), but it does interfere with the effectiveness of oral contraceptives. All antitubercular drugs need to be taken long term to eradicate the slow-growing mycobacterium lying deep within the tissues.
A patient who has been newly diagnosed with HIV has many questions about the effectiveness of drug therapy. After a teaching session, which statement by the patient reflects a need for more education? a. I will be monitored for side effects and improvements while I'm taking this medicine b. Test drugs do not eliminate the HIV, but hopefully the amount of virus in my body will be reduced c. There is no cure for HIV d. These drugs will eventually eliminate the virus from my body
d
During treatment with zidovudine, the nurse needs to monitor for which potential adverse effect? a. retinitis b. DVT c. Kaposi's sarcoma d. bone marrow suppression
d
The nurse notes in a patient's medication history that the patient is taking terbinafine (Lamisil). Based on this finding, the nurse interprets that the patient has which disorder? a. vaginal candidiasis b. cryptococcal meningitis c. invasive aspergillosis d. onychomycosis
d
When administering antifungal drug therapy, the nurse knows that an issue that contributes to many of the drug interactions with antifungals is the patient's a. history of cardiac disease b. history of gallbladder surgery c. ethnic background d. cytochrome P-450 enzyme system
d
When counseling a patient who has been newly diagnosed with TB, the nurse will make sure that the patient realizes that he or she is contagious a. during all phases of the illness b. any time up to 18 months after therapy begins c. during the postictal phase of TB d. during the initial period of the illness and its diagnosis
d
While monitoring a patient, the nurse knows that a therapeutic response to anti tubercular drugs would be a. the patient states that he or she is feeling much better b. the patient's laboratory test results show a lower WBC count c. the patient reports a decrease in cough and night sweats d. there is a decrease in symptoms, along with improved chest x-ray and sputum culture results
d
Medications used to treat HIV infections are more specifically classified as what type of drugs? a. Antiviral b. Antifungal c. Antiparasitic d. Antiretroviral
d HIV is a member of the retrovirus family; therefore, drugs used to treat this virus are classified as antiretroviral drugs. Although antiretroviral drugs also fall under the broader category of antiviral drugs in general, their mechanisms of action are unique to the acquired immune deficiency syndrome virus. So, they are more commonly referred to by their subclassification as antiretroviral drugs.
Before discharge, the nurse is reviewing a client's prescribed medication regimen for tuberculosis (TB). The client asks the nurse why pyridoxine (vitamin B6) has been prescribed while continuing to take isoniazid (Nydrazid) to treat TB. What is the nurse's best response? a. "Multidrug therapy is necessary to prevent the occurrence of resistant bacteria." b. "You really should not be on that drug. I will check with the health care provider." c. "Pyridoxine is another antitubercular drug that will work synergistically with the isoniazid." d. "Pyridoxine will help prevent numbness, and tingling that can occur secondary to the isoniazid."
d Isoniazid can cause neurotoxicity. Pyridoxine, vitamin B6, is the drug of choice to prevent this adverse reaction. It is not an antiinfective drug and thus will not work to destroy the mycobacterium or prevent drug resistance.
The nurse anticipates a prescription for vitamin supplementation for a client who is receiving isoniazid (Nydrazid) therapy. What vitamin supplement is usually prescribed with isoniazid? a. Folate b. Calcium c. Vitamin E d. Vitamin B6
d Pyridoxine (vitamin B6) is often given concurrently with isoniazid to prevent the adverse effect of isoniazid induced peripheral neuropathy associated with neurotoxicity.