Pharm Ch 11: Antifungal Agents
A client is receiving flucytosine. The nurse is reviewing the client's serum drug level. Which serum drug level would lead the nurse to suspect that the client is developing toxicity? A. 22 mcg/mL B. 45 mcg/mL C. 88 mcg/mL D. 110 mcg/mL
D. 110 mcg/mL
The azole antifungals are contraindicated in clients with what condition? A. Hypovolemia B. Pancreatitis C. HIV D. Increased liver enzymes
D. Increased liver enzymes
A client with a fungal infection has been prescribed a miconazole vaginal suppository. What education should the nurse provide about safe and effective administration? A. "If possible, lie down for 10 or 15 minutes after inserting the medication." B. "Take showers rather than baths until you've finished the course of medication." C. "Insert the medication into your lower vagina so that it's distributed evenly." D. "You can douche up to once per day to help distribute the medication."
a
How will a client's newly prescribed fluconazole be affected by long-term prescribed calcium channel blocker therapy? A. It will increase the effect of the fluconazole. B. It will increase the chance of fluconazole-related adverse effects. C. It will increase the risk of blood dyscrasias. D. It will render the fluconazole ineffective.
a
What describes how amphotericin B harms host cells? A. The drug disrupts the sterols in the cell membrane. B. The mechanism of action is that the drug binds to the fungal cell. C. The drug increases cell permeability in the host cells. D. The drug leads to the destruction of target cells within the host.
a
Incidence of fungal infections has increased with the rising number of people who are immunocompromised. What groups are considered to have a compromised immune system? (Select all that apply.) A. Clients with acquired immune deficiency syndrome (AIDS) and AIDS-related complex (ARC) B. Clients taking immunosuppressant drugs C. Middle-class citizens D. The elderly E. Clients who have undergone transplantation surgery or cancer treatment
a,b,d,e
Fluconazole is the prototype for antifungals. Which are characteristics of fluconazole? (Select all that apply.) A. Binds to sterols in the fungal cell membrane B. Inhibits the growth of tumor cells and enhances the immune response C. Treatment of malignant melanoma D. Metabolized in the liver and excreted in the urine E. Treatment of oropharyngeal, esophageal, and vaginal candidiasis
a,d,e
The nurse is providing care for a diverse group of clients. Which client should the nurse monitor most closely for signs and symptoms of a fungal infection? A. An older adult client with osteoporosis who is taking a bispohosphonate B. A client who is receiving combination therapy for acquired immunodeficiency syndrome (AIDS) C. A client with chronic renal failure who has peritoneal dialysis three times per week D. A client with breast cancer who is post-operative day two following a mastectomy
b
What would be most important for the nurse to monitor in a client receiving amphotericin B? A. coagulation studies B. complete blood count C. bowel sounds D. respiratory status
b
Which antifungal agent is available for systemic and topical use? A. Voriconazole B. Ketoconazole C. Clotrimazole D. Butoconazole
b
When administering caspofungin intravenously (IV), the nurse should implement what intervention? Select all that apply. A. Administer it slowly, diluted in at least 250 mL of IV fluid. Administer it as a bolus over a 5-minute period. B. The medication should be allowed to warm to room temperature prior to administration. C. Prepare reconstituted medication in at least 250 mL of normal saline IV fluid. D. Dilute it in dextrose prior to administration. E. Administer it as a constant infusion over 60 minutes.
b,c
Antifungal drugs are available that do not fit into either the azole or echinocandin groups. Which fall into the other group? Select all that apply. A. terbinafine (Lamisil) B. griseofulvin (generic) C. flucytosine (Ancobon) D. nystatin (Mycostatin) E. amphotericin B (Abelcet)
b,c,d,e
What medications are classified as echinocandin antifungals? (Select all that apply.) A. Voriconazole (Vfend) B. Micafungin (Mycamine) C. Anidulafungin (Eraxis) D. Terbinafine (Lamisil) E. Caspofungin (Cancidas)
b,c,e
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? A. The client adheres strictly to a vegetarian diet B. The client has hypothyroidism and takes levothyroxine daily C. The client has a low body mass index D. The client has atrial fibrillation and takes warfarin daily
d
A client is being treated for a fungal infection with IV amphotericin B. In order to prevent drug discomfort, the nurse should consistently monitor the client's levels of which component? A. calcium B. leukocytes C. hemoglobin D. sodium
d
A client's fungal infection will be treated with amphotericin B. The nurse should question the prescription if what route of administration is specified? A. intravenous (IV) B. oral C. topical D. subcutaneous
d
A client, being treated for a fungal infection, reports being nauseating and requests that the dose be decreased or medication changed. Which statement should form the basis of the nurse's response to the client's request? A. Antifungal drugs are relatively inexpensive. B. There are several other drugs available that are just as effective. C. The drugs that are effective are given intravenously and generally cause medical complications. D. Antifungal drugs that are effective for this disease without being excessively toxic to human cells are limited.
d
A nurse is caring for a client who is receiving amphotericin B. Which medication could the nurse administer concomitantly to promote client comfort? A. sedatives B. diuretics C. beta-adrenergic blockers D. antipyretics
d
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? A. disturbed thought processes related to appropriate use of griseofulvin B. ineffective coping related to self-medication C. effective therapeutic regimen management related to symptom identification D. deficient knowledge related to correct use of griseofulvin
d
A client is receiving amphotericin B. The nurse would assess the client closely for which adverse reaction? A. renal impairment B. intensive weight loss C. skin discoloration D. CNS disorders
A. renal impairment
The primary health care provider prescribes flucytosine to treat a systemic fungal infection. The nurse would administer this drug by which route? A. oral B. IV C. IM D. topical
A. oral
A parent has informed the nurse that she has been applying an OTC antifungal to her infant's buttocks and perineal region for a rash. What question related to safety should the nurse ask the parent? A. "Are there any open wounds on the areas where you're putting the ointment?" B. "Did you take any antifungal medications while you were pregnant?" C. "Did you explore any herbal or alternative remedies before starting to use this ointment?" D. "Does your infant have any food allergies that you're aware of yet?"
A. "Are there any open wounds on the areas where you're putting the ointment?"
A parent has informed the nurse that she has been applying an OTC antifungal to her infant's buttocks and perineal region. What question related to safety should the nurse ask the parent? A. "Are there any open wounds on the areas where you're putting the ointment?" B. "Did you take any antifungal medications while you were pregnant?" C. "Did you explore any herbal or alternative remedies before starting to use this ointment?" D. "Does your infant have any food allergies that you're aware of yet?"
A. "Are there any open wounds on the areas where you're putting the ointment?"
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? A. "Have you been prescribed any antibiotics in the recent past?" B. "Have you received any vaccinations in the past few weeks?" C. "When was the last time you visited a hospital or clinic?" D. "Were you prone to acne when you were younger?"
A. "Have you been prescribed any antibiotics in the recent past?"
The nurse is working with a client with a cutaneous fungal infection. The client was prescribed a topical antifungal ointment. The client tells the nurse, "I went ahead and bought a steroid ointment at the drugstore because I read it might help with my skin infection." What is the nurse's best response? A. "It's best to check with your health care provider before applying any of the steroid ointment." B. "Actually, that ointment would probably make your infection worse, not better." C. "You can't safely take any over-the-counter drugs while you're taking a prescription drug." D. "Any ointment that you're able to buy without a prescription likely isn't going to help much."
A. "It's best to check with your health care provider before applying any of the steroid ointment."
A client is receiving gentian violet as topical treatment for a fungal infection. What instruction should the nurse include in the teaching plan? A. "This medication can stain your skin and clothing." B. "Take this medicine with good to minimize upset stomach." C. "Cover the area with plastic wrap to seal it off." D. "Apply a thin layer of the medicine to any open areas on your skin."
A. "This medication can stain your skin and clothing."
The nurse is caring for a client who has a systemic infection and who has been prescribed griseofulvin. After administering a dose at 0900, the nurse should expect the drug levels to peak at what time? A. 1300 hours B. 1000 hours C. 1500 hours D. 1700 hours
A. 1300 hours
The nurse is caring for several clients who have fungal infections. Which client should the nurse prioritize for informing the provider? A. A client receiving amphotericin B whose torso appears jaundiced B. A client with candidiasis who has been prescribed nystatin and who requires education C. A client who has a dose of miconazole vaginal suppository due in 15 minutes D. A client who reports the new onset of a rash where terbinafine is being applied
A. A client receiving amphotericin B whose torso appears jaundiced
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? A. Amphotericin B B. Nystatin C. Butenafine D. Terbinafine
A. Amphotericin B
A pharmacology student is learning about amphotericin B. This drug can be administered via which route? A. IV B. IM C. SQ D. IF
A. IV
Which statement would be correct for a client regarding the administration of an antifungal medication? A. Instruct the client to complete the entire drug therapy even if a dose is missed. B. Instruct the client to take frequent meals of fat and protein when GI distress occurs. C. Instruct the client to take a forgotten dose as soon as it is remembered, even if it is time for the next dose. D. Advise that for persistent headache, unrelieved by acetaminophen, the client should increase the dosage of acetaminophen.
A. Instruct the client to complete the entire drug therapy even if a dose is missed.
What is the action of amphotericin B when prescribed for a fungal infection of the urinary tract? A. It binds to ergosterol resulting in changes in the cell membrane. B. It binds to an enzyme required for synthesis of ergosterol. C. It disrupts the fungal cell walls rather than the cell membrane. D. It inhibits glucan synthetase required for glucan synthesis.
A. It binds to ergosterol resulting in changes in the cell membrane.
What serious adverse effect is most associated with amphotericin B? A. Nephrotoxicity B. Hypovolemia C. Cardiogenic shock D. Septic shock
A. Nephrotoxicity
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? A. Provide food along with the fluconazole when administering it in the future. B. Stop administering the fluconazole and inform the client's physician. C. Arrange for the client to receive intravenous fluconazole on an outpatient basis. D. Assess the client for signs and symptoms of an infusion reaction.
A. Provide food along with the fluconazole when administering it in the future.
A client with a systemic fungal infection has been prescribed ketoconazole 350 mg PO daily. What assessment should the nurse prioritize before administration? A. Review of liver enzyme levels B. Assessment of cranial nerve function C. Review of blood urea nitrogen and creatinine levels D. Review of potassium, sodium and chloride levels
A. Review of liver enzyme levels
A client has been prescribed sulconazole for the treatment of tinea pedis. When nursing diagnosis should the nurse identify when planning this client's care? A. Risk for impaired skin integrity related to local irritation B. Impaired urinary elimination related to nephrotoxicity C. Risk for injury related to central nervous system depression D. Imbalanced nutrition: Less than body requirements related to liver damage
A. Risk for impaired skin integrity related to local irritation
A client with topical mycosis was prescribed oxiconazole for topical administration and has been using the medication for 10 days. The client now reports an open wound on the same region. What is the nurse's best action? A. Tell the client not to administer the medication and to come be assessed by the provider B. Document the statement and ask the client to mention this in the next scheduled appointment with the provider C. Encourage the client to apply an over-the-counter barrier cream before the next application of the medication D. Tell the client to apply a bandage over the wound to prevent secondary infection
A. Tell the client not to administer the medication and to come be assessed by the provider
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? A. The client client has decreased renal function following recent pyelonephritis B. The client has type 2 diabetes and takes oral hypoglycemics C. The client has lost over 30 lbs. in the past four months through diet and exercise D. The client experienced a transfusion reaction to packed red blood cells several years ago
A. The client client has decreased renal function following recent pyelonephritis
A client is being treated for histoplasmosis with amphotericin B. The nurse has completed a comprehensive assessment of the client and should report what assessment finding? A. The client's urine output is 75 mL over six hours B. The client reports a frontal headache C. The client reports a lack of appetite and refused breakfast D. The client had an episode of diarrhea overnight
A. The client's urine output is 75 mL over six hours
The client is diagnosed with a Candida infection of the mouth. How will the nurse document this finding? A. Thrush B. Ringworm C. Dermatophytes D. Tinea cruris
A. Thrush
The client is receiving ketoconazole. The nurse should be concerned about a drug-drug interaction on the basis of what other co-morbidity? A. Type 2 diabetes B. Chronic pain C. Venous ulcers D. Pencillin allergy
A. Type 2 diabetes
The client is receiving ketoconazole. The nurse should be concerned about a drug-drug interaction on the basis of what other comorbidity? A. Type 2 diabetes B. Chronic pain C. Venous ulcers D. Pencillin allergy
A. Type 2 diabetes
The nurse is caring for a client who has a fungal infection and who has been prescribed fluconazole . The nurse should understand that the medication will eradicate the fungus by: A. blocking the activity of a sterol in the fungal wall. B. inhibiting the cytochrome P2D6 enzyme system. C. inhibiting the synthesis of ergosterol to prevent cell wall formation. D. inhibiting the synthesis of glucans.
A. blocking the activity of a sterol in the fungal wall.
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? A. cardiac distress B. diaphoresis C. dry mouth D. muscle pain
A. cardiac distress
Guidelines for the use of topical antifungals in children are frequently the same as those for adults. However, safety and dosage recommendations have not been established for most oral and IV antifungals in the pediatric population. Which antifungal drug is suitable for pediatric use? A. fluconazole B. caspofungin C. voriconazole D. metropolol
A. fluconazole
An adult client has begun treatment with fluconazole. The nurse should recognize the need to likely discontinue the drug if the client develops which sign or symptom? A. jaundice B. weight gain C. iron deficiency anemia D. hematuria
A. jaundice
What antifungal medication has the same mechanism of action as amphotericin B but is used only in the topical treatment of candidiasis? A. nystatin B. terbinafine C. fluconazole D. griseofulvin
A. nystatin
A client has been prescribed a topical antifungal ointment to treat a fungal infection between her breasts. When providing education about this medication, the nurse should encourage the client to: A. wash and dry the affected area before applying the ointment. B. ensure the affected area is not exposed to sunlight during treatment. C. avoid the use of soap on the affected area until treatment is complete. D. apply the ointment a maximum of every two hours.
A. wash and dry the affected area before applying the ointment.
A client develops itching and burning of the vaginal vault while taking an anti-infective to treat strep throat. What fungal agent has caused the burning and itching? A. Cryptococcus neoformans B. Candida albicans C. Aspergillus D. Dermatophytes
B. Candida albicans
A client is being treated with amphotericin B. Which statement indicates that the client has understood the client teaching? A. "The medication may cause diabetes." B. "The medication will cause liver necrosis." C. "The medication may cause kidney damage." D. "The medication will cause pancreatitis."
C. "The medication may cause kidney damage."
A client has been placed on amphotericin B. The nurse caring for this client should administer this medication: A. intramuscularly. B. orally. C. intravenously. D. subcutaneously.
C. intravenously.
Ketoconazole is available in oral form, a shampoo, and a cream. False True
True
A client is undergoing treatment with amphotericin B. The client feels like a medication reaction is taking place about 1 hour into the infusion and reports fevers and chills. The nurse should A. inform the client that the client is allergic to amphotericin B and stop the infusion. B. tell the client that this is a common reaction and the client does not need any treatment. C. inform the client that this is a common reaction. Obtain orders to treat the client's fever and provide comfort measures for the chills. D. speak with the health care provider, as the client should not take any more amphotericin B without provider approval.
c
A client's previous medical history includes mycosis. What conclusion should the nurse draw from this fact? A. The client had an infection involving an overgrowth of opportunistic organisms B. The client has an underlying immune disorder that caused a fungal infection C. The client has had a disease that was caused by a fungus D. The client had a superficial infection of the skin related to fungal invasion
c
A nurse is caring for a 29-year-old man who is being treated for meningitis. He is receiving flucytosine (5-FC). Which will the nurse monitor weekly? A. Blood glucose B. Visual acuity C. Hematologic status D. Blood pressure
c
A nurse is caring for a client who asks why she has been prescribed posaconazole following kidney transplantation. The nurse responds that posaconazole is used as prophylaxis to prevent A. blastomycosis. B. coccidioidomycosis. C. Aspergillus infection. D. mucormycosis.
c
Anidulafungin is prescribed to treat what form of fungal infection? A. aspergillosis B. histoplasmosis C. candidiasis D. tinea infection
c
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? A. The client vomited 30 minutes after the most recent scheduled dose of ketoconazole B. The client's temperature is 99.5°F (37.5°C) C. The client's aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels are elevated D. The client's sodium level is 136 mEq/L (136 mmol/L) and potassium is 5.0 mEq/L (5.0 mmol/L)
c
The nurse is caring for a client receiving amphotericin B. Which condition should the nurse assess for in this client? A. nausea 30 minutes after administered orally B. swelling at the subcutaneous injection site C. bruising at the intramuscular injection site D. phlebitis
d