Chapter 12: Antifungal and Antiparasitic Drugs

Which medication will be administered to treat the diarrhea and abdominal distention associated with giardiasis?

Metronidazole

A client, taking metronidazole for the past 4 days, reports to the nurse that the most recent dose caused the client to feel "flushed, sweaty, and sick in the stomach." What assessment is most likely to address the cause of this phenomenon?

"Did you drink any alcoholic beverages around the time of taking the drug?"

A client is prescribed metronidazole for the treatment of trichomoniasis. What is the most important information for the nurse to teach the client about proper administration of this medication?

"Do not drink alcohol while taking this medication."

A client has been diagnosed with a fungal infection and been prescribed a topical antifungal medication. What assessment question should the nurse ask when addressing the possible etiology of the fungal infection?

"Have you been prescribed any antibiotics in the recent past?"

A client who is receiving drug therapy for treatment of giardiasis asks the nurse about how she may have gotten this infection. The nurse would incorporate knowledge of transmission into what assessment question?

"Have you drunk any water that might have been contaminated?"

The nurse at a travel clinic is working with a client who has been prescribed atovaquone (Malarone) before leaving for overseas. The client states, "I'd prefer not to take this unless I absolutely have to, because some of my colleagues say that the side effects are nasty." What health education should the nurse provide to the client?

"I can teach you some strategies for managing some of the adverse effects of the drug."

A client has been prescribed tinidazole for the treatment of a protozoal infection. What statement by the client indicates to the nurse that further teaching is warranted?

"I like to have a small glass of white wine each evening to unwind."

A college student presented to the medical center believing that she may have a sexually transmitted infection. The nurse is referring the client to the provider and suspects that the client may be diagnosed with a helminthic infection instead. What assessment question should the nurse prioritize?

"Is there any chance that you might be pregnant?"

A student has presented to the campus medical clinic reporting signs and symptoms that suggest vaginal candidiasis. What assessment question should the nurse prioritize when assessing the safety and effectiveness of drug therapy?

"Is there any possibility that you could be pregnant?"

A university student has been diagnosed with a helminth infection and tells the nurse, "I've never felt so disgusting in my life. One thing is for sure: I'm not telling a soul about this." What is the nurse's most therapeutic response?

"It's important for you to know that isn't a reflection of your character or your lifestyle."

A client has just begun treatment for trichomoniasis. What should the nurse teach the client related to treatment?

"It's important that your sexual partners be treated as well."

A nature photographer will be embarking on a trip overseas and is beginning a protocol for malaria prophylaxis involving 500 mg of chloroquine phosphate. What instruction should the nurse include in this client's health education?

"Make sure you take your pill on the same day each week."

The client is preparing to travel abroad and wants to know why he needs to begin antimalarial therapy. What is the best response by the nurse?

"Malaria makes many people ill every year. Symptoms are slow to appear, which could delay treatment."

A client with giardiasis is to receive tinidazole. The nurse should instruct the client to do what?

"Take the drug as a single dose with food."

A nurse is teaching an 82-year-old client about amphotericin B, an antifungal ordered by the health care provider. Which client statement would suggest that teaching has been effective?

"Taking this drug could damage my kidney functioning."

A client is being treated with amphotericin B. Which statement indicates that the client has understood the client teaching?

"The medication may cause kidney damage."

A 5 year-old child has been diagnosed with a pinworm infection and the child's parents described themselves as "absolutely mortified" to receive the diagnosis. The child's parent states, "We're health-conscious people who don't live in filth. How could this happen?" What is the nurse's best response?

"These infections are very common, and this doesn't mean that you're unhygienic people."

The nurse is providing health education to the parents of a child who has been diagnosed with pinworms and who is being treated with mebendazole. What should the nurse teach the parents in order to promote safe and effective treatment?

"You can give the drug with food to reduce the chance of an upset stomach."

A sexually active teen tells the nurse, "My sexual partner is being treated for trichomoniasis." What is the nurse's best response when the teen asks about receiving treatment as well?

"You need to be treated simultaneously."

The nurse is providing health education for a client who has been prescribed atovaquone (Malarone) prior to leaving on a tropical vacation. The nurse should state:

"You'll have to take this drug each day, starting before you leave on your trip."

A client has been prescribed mefloquine before embarking on a scientific survey in a malaria endemic area. What should the nurse teach the client about this prophylactic drug regimen?

"You'll need to keep taking this for about one month after you return."

A client has been prescribed 300 mg of pentamidine isethionate per week for 4 weeks for prevention of pneumonia. How many mg should the client take to complete the drug regimen?

1200 mg

The pediatric nurse is caring for a 9-year-old client who has been diagnosed with amebiasis. The client weighs 82.5 lbs. and has been prescribed metronidazole 40 mg/kg/day in three divided doses for 10 days. How many 250-mg tablets should the nurse administer for each dose?

2

A school-aged child has been prescribed albendazole 15 mg/kg/day PO in divided doses, b.i.d. The child weighs 66 lbs and is 3'11" tall. How many mg of albendazole should the nurse administer for each dose of treatment?

225

An adult client with a helminthic infection has been prescribed praziquantel 20 mg/kg PO t.i.d. The client weighs 198 lbs. How many 600 mg tablets should the nurse administer for each dose?

3

The nurse is providing emergency health care at a refugee camp and there are several clients who are being treated for helminthic infections. What client should the nurse prioritize for referral to one of the camp care providers?

A client who is taking albendazole and whose urine output has decreased sharply over the past 24 hours.

The nurse is providing health education to a client with vaginal candidiasis. The client's health provider has prescribed tioconazole. What should the nurse teach the client?

A one-time dose will likely cure the infection

A pediatric nurse is caring for a 4 year-old child who has been diagnosed with the most common childhood helminthic disease in the United States. The nurse should anticipate what intervention?

A three-day course of mebendazole

The nurse is caring for a client diagnosed with a life-threatening systemic fungal infection that is not responding to treatment with an azole. What medication should the nurse anticipate the provider may order next?

Amphotericin B

A client has been prescribed primaquine to prevent a relapse of malaria and is nearing the end of the prescribed course of treatment. During the nurse's most recent assessment, the client reports "I'm feeling dizzy and nauseous a lot, with ringing in my ears." What is the nurse's best action?

Communicate these assessment findings to the provider promptly.

The nurse is caring for a client who has been prescribed caspofungin intravenously (IV). What interventions should the nurse implement prior to administration? Select all that apply.

Add reconstituted medication to 250 mL of normal saline. Allow the medication to warm to room temperature.

A client has been diagnosed with malaria and will begin treatment promptly. What is the best way to attack the Plasmodium protozoa's life cycle?

Administer combination therapy as prescribed.

A client with systemic candidiasis has just been prescribed fluconazole 400 mg PO. What is the nurse's best action upon receiving this prescription?

Administer the medication once it is received from the pharmacy.

The child client has been diagnosed with a pinworm infection. What is the best method to teach the parent how to obtain a specimen?

Demonstrate how to collect a specimen to the parent.

The critical care nurse is providing care for a client who is being treated with amphotericin B. When assessing for potential adverse effects, what assessments should the nurse perform? Select all that apply.

Assess for jaundice and monitor liver enzyme levels. Monitor urine output and BUN and creatinine levels. Assess for nausea and vomiting. Assess skin integrity at the client's IV site.

A client who takes a beta blocker and loop diuretic for hypertension has been diagnosed with candidiasis. The client's provider has prescribed fluconazole 400 mg PO. What is the nurse's best action?

Assess the client and administer the drug as prescribed

The nurse educates the client on which of the following to prevent recurrent vaginal yeast infections? Select all that apply.

Avoid tight-fitting garments. Use a condom during sexual activity.

Caspofungin has been prescribed for a client diagnosed with invasive aspergillosis. The nurse should teach the client to promptly report what symptom associated with an adverse reaction?

Cardiac distress

How should the nurse adapt the plan of care when caring for an older adult receiving an antiprotozoal agent?

Clients should be monitored more closely for toxic adverse effects.

A client's signs, symptoms, and recent travel history suggest a helminthic infection. What should the nurse do in order to most accurately determine what type of helminth is infecting the client?

Collect a stool sample for ova and parasite.

The nurse is assessing a client who is in the military and who will leave in two weeks for a tour in an area where malaria is endemic. The client has been given a prescription by the provider reading "Chloroquine 300 mg PO weekly starting now and until four weeks after returning home." What is the nurse's best action?

Confirm the client's knowledge of the medication regimen.

The nurse is educating an 82-year-old client regarding amphotericin B (Fungizone). The nurse knows the client understand when the client states that he could develop which adverse effect?

Damage to his kidneys

Two clients ages 3 and 4 are diagnosed with ringworms. The nurse is educating parents on the importance of preventing the spread of a ringworm infection. Which is the best method to teach parents?

Do not share towels and linens.

A client with a fungal infection has been prescribed ketoconazole 250 mg PO daily. The client reports nausea and anorexia the day after starting the medication. What is the nurse's best action?

Encourage the client to try eating small, frequent meals rather than three larger meals

A client in her twenties has told the nurse that she will be going on a safari trip for her honeymoon and that she has been prescribed antimalarial prophylaxis. The nurse should follow up with what education?

Encourage the client to use reliable contraception

The nurse is conducting a follow up assessment of a client who had a pinworm infection and who completed a course of mebendazole one week ago. The client states, "I followed the directions for taking the pills exactly, but the itching seems as bad as ever." What is the nurse's best action?

Ensure that the client follows up with the care provider promptly

The nurse is caring for a client who has been diagnosed with aspergillosis and has been prescribed amphotericin B. What action should the nurse perform before administering this medication?

Establish intravenous access

A client has been diagnosed with candidemia and has just been prescribed anidulafungin. What is the nurse's best action?

Establish reliable intravenous access

A client was diagnosed with a helminthic infection and prescribed mebendazole. The day after starting the medication, the client contacts the nurse to report two episodes of diarrhea over the past 24 hours. What is the nurse's best action?

Explain that this is likely due to the medication and instruct the client to seek care if the diarrhea worsens

A client has a history of deep vein thrombosis, for which warfarin has been prescribed. When providing education for this client, who is now also taking fluconazole to treat a localized candidal infection, the nurse should provide what instruction?

Have routine laboratory tests done to monitor the effects of warfarin.

Amphotericin B is given by which route?

IV

A 43-year-old client, who has tested positive for systemic candidiasis, has been prescribed IV fluconazole. The nurse should implement which intervention to ensure the safe administration of this medication?

Infuse the drug no faster than 200 mg/h.

The nurse at a long-term care facility is admitting a new resident who is an older adult. The resident's current medication regimen includes nystatin 1,000,000 units PO t.i.d. The nurse should recognize the need to prioritize what aspect of this resident's care?

Mouth care

A client is prescribed nystatin suspension for an oral fungal infection. The nurse should provide the client with information concerning which adverse effect associated with this form of nystatin?

Nausea

A 5 year-old child has been diagnosed with whipworms and is currently undergoing treatment with mebendazole. What assessments should the nurse prioritize? Select all that apply.

Nutritional status Fluid balance Bowel movements

A nurse is preparing to administer primaquine therapy to a client. The nurse should anticipate administering the drug by which route?

Oral

What helminths should the nurse classify as nematodes? Select all that apply.

Pinworm Whipworm Threadworm

An 80-year-old woman is receiving treatment with oral fluconazole for a fungal infection Following yesterday's and today's dose, she reports an upset stomach to the charge nurse. How should the nurse at the facility best respond to the woman's report?

Provide food along with the fluconazole when administering it in the future.

A client is prescribed metronidazole for the treatment of a protozoal infection. The nurse should instruct the client to eliminate what from the diet during treatment?

Red wine

The critical care nurse is caring for a client whose systemic fungal infection is being treated with amphotericin B. The nurse's review of the client's most recent laboratory results indicates a white cell count of 2050/µL (2.05 ×109/L). What is the nurse's best action?

Report the client's possible bone marrow suppression to the client's provider

When administering the azoles in the home setting, the home health nurse should prioritize educational interventions that address what nursing diagnosis?

Risk for infection related to antifungal therapy

A nurse is monitoring the fluid input and output of a 26-year-old woman who is on amphotericin B. Which would the nurse report immediately to the health care provider?

Serum creatinine level of 3.5 mg/dL

A client has been diagnosed with amebiasis. What signs and symptoms would the nurse most likely expect to assess?

Severe diarrhea

A nurse is preparing to administer a client's prescribed anthelmintic medication. What diagnostic results should provide the rationale for the team's choice of medication?

Stool for ova and parasites

A client who takes chloroquine for antimalarial prophylaxis has just learned that she is pregnant. What should the nurse advise the client to do?

Stop taking the antimalarial medication

A client has been diagnosed with a helminthic infection and has begun treatment with mebendazole. What should the nurse include in client education?

Strict hygiene measures are important in eradicating the infection.

A 43-year-old man is traveling to an area where malaria is endemic and is being treated prophylactically. The nurse will explain which regimens of chloroquine prescribed by the health care provider?

Taking the medication for 2 weeks before the trip and continue for 4 to 6 weeks after the trip.

An older adult client has been diagnosed with candidiasis and prescribed fluconazole. What aspect of the client's health status should warrant close monitoring by the nurse?

The client has atrial fibrillation and takes warfarin daily

A client tells the nurse that she has taken several doses of over-the-counter fluconazole to treat a "yeast infection." When assessing the client's risk for drug toxicity, what aspect of the client's health status should the nurse prioritize?

The client has decreased renal function following recent pyelonephritis

The nurse is collaborating closely with the provider of a client whose helminthic infection is being treated with albendazole. What aspect of the client's pre-illness health status creates a heightened risk for adverse effects of albendazole?

The client often takes cimetidine 200 mg PO to treat dyspepsia

What information should the nurse provide a client prescribed warfarin and fluconazole concurrently?

The client will require regular assessment of the fluconazole toxicity.

The nurse is caring for a client whose fungal infection is being treated with ketoconazole. What change in the client's health status should the nurse prioritize when updating the provider on the client's condition?

The client's aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels are elevated

An client has been diagnosed with a helminthic infection has been prescribed praziquantel. The nurse receives the prescription, which reads "praziquantel 1600 mg PO TID over the course of three days." What aspect of this prescription should the nurse question?

The course

A 9-year-old boy was diagnosed with hookworm infection and will be sent home with a prescription for mebendazole. When providing education, the nurse should teach the mother which measures to avoid reinfection following treatment?

The importance of vigilant hygiene for the client and the other members of the family

A 30-year-old missionary who works in a developing country has been diagnosed with a helminthic infection. This client will be prescribed an anthelmintic. and the nurse should consequently provide what education?

The need to use barrier contraception during treatment

An adult client who is critically ill with histoplasmosis has been prescribed amphotericin B 60 mg PO daily. What aspect of this order should the nurse discuss with the prescriber?

The route

A client who is receiving primaquine comes to the clinic with nausea, vomiting, and vertigo. What other finding would the nurse expect to assess if the client was experiencing cinchonism?

Tinnitus

The client is receiving ketoconazole. The nurse should be concerned about a drug-drug interaction on the basis of what other co-morbidity?

Type 2 diabetes

A 7-year-old is treated for oropharyngeal candidiasis. As the nurse preparing for discharge, you teach the mother about the proper administration of nystatin. Which instruction will you emphasize?

Using the "swish and swallow" drug method

The client has a helminth infection and must be taught about prevention of reinfestation. Which is the best method to prevent reinfection?

Washing hands

During treatment of amebiasis with chloroquine, the nurse should be assessing the client for which adverse effect?

diarrhea

The clinic nurse provides teaching for a client prescribed pyrimethamine to prevent malaria. The nurse should instruct the client to notify the healthcare provider immediately if which signs and symptoms occur?

diarrhea, fatigue and weight loss

A nurse is caring for a client who is receiving amphotericin B. Which medication could the nurse administer concomitantly to promote client comfort?

antipyretics

The nurse is providing client teaching for a client who is taking antimalarial medication. The nurse should explain the need to report which signs and symptoms immediately? Select all that apply.

blurry vision tinnitus

Anidulafungin is prescribed to treat what form of fungal infection?

candidiasis

A client with a tapeworm has been prescribed albendazole. What aspect of this client's health history would cause delayed excretion?

chronic renal failure

An older adult resident of a long-term care facility has been diagnosed with a fungal infection and has been prescribed fluconazole. What change in the client's laboratory values may necessitate a change in medication therapy?

decreased creatinine clearance

An adult client, recently diagnosed with a tinea infection, has begun treatment with griseofulvin. During a scheduled clinic visit, the client states to the nurse, "I'm pretty good at reading my body's signals, so I make sure to take a bit extra when I think my infection is getting worse." This client's statement is suggestive of what nursing diagnosis?

deficient knowledge related to correct use of griseofulvin

A client has presented with severe swelling of his scrotum. Initial assessment rules out cardiovascular or renal causes. The care team should suspect what diagnosis?

filariasis

The client is admitted for IV administration of antifungal medication with the plan to discharge the client on oral medication in a few days. What medication would be most appropriate if it must be available by both IV and PO routes?

fluconazole

A child who lives in a rural area has been diagnosed with a Necator americanus infection during a public health campaign. This child's health is affected by what parasites?

hookworms

A client asks the nurse if the client should use a topical antifungal. The nurse is aware that contraindications to topical antifungals are limited to clients with:

known allergy to any of the antifungal drugs.

An adult client has been diagnosed with giardiasis and been prescribed a single dose of tinidazole 2000 mg PO. The client has a complex health history and takes metformin, warfarin, furosemide and bisoprolol. The nurse should:

monitor the client closely for signs of bleeding.

A client is prescribed mefloquine for malaria prophylaxis prior to a trip to rural Southeast Asia. When should the nurse instruct the client to begin taking the prescribed mefloquine?

one week prior to traveling.

The primary health care provider prescribes flucytosine to treat a systemic fungal infection. The nurse would administer this drug by which route?

oral

A nurse expects to administer griseofulvin cautiously to a client who also has an allergy to which drug?

penicillin

An adult client who is homeless and has a history of poor adherence to prescribed medical treatment has been diagnosed with a helminthic infection. What drug would best meet this client's medical needs and psychosocial circumstances?

pyrantel

A client is receiving amphotericin B. The nurse would assess the client closely for which adverse reaction?

renal impairment

A 22-year-old female college student presented to the clinic and was given a prescription for metronidazole 250 mg PO tid for 7 days. The nurse at the clinic understands that metronidazole is used in the treatment of which?

trichomoniasis