STUDY GUIDE 94-108

George, a 73-year-old retired plant foreman, has been diagnosed with tuberculosis. Nursing assessment reveals a history of gout and diabetes. He also has a history of heavy drinking. 1. What considerations will the physician keep in mind when deciding on a first-line drug for George? 2. George tells you that he has been told that he has a "liver problem." His medical record mentions that he is a slow acetylator. How does this affect his therapy? 3. How will his history of "heavy drinking" affect his therapy? 4. You instruct George about taking vitamin B6 along with the isoniazid (INH) therapy. When he asks you why this is necessary, what will you tell him?

1. George's gout is a consideration; pyrazinamide can cause hyperuricemia, so gout or flare-ups of gout can occur in susceptible patients. His diabetes is a concern, too; ethambutol should be used cautiously in patients with diabetes. A baseline hearing test should be per-formed if streptomycin is considered because this drug may cause ototoxicity. In addition, liver function studies are needed because his heavy alcohol use may have caused liver damage. 2. An individual with a genetic deficiency of the liver enzymes that metabolize drugs can be classified as a "slow acetylator." When isoniazid is taken by slow acetylators, the drug accumulates because there are not enough of the enzymes to break down the isoni-azid. As a result, the dosage of isoniazid may need to be reduced. 3. Results of liver function studies should be assessed carefully before therapy is initiated because some drugs (isoniazid, pyrazinamide) are hepatotoxic. Liver function test results should be monitored closely during therapy as well. 4. Isoniazid can cause a pyridoxine (vitamin B6) deficiency. Patients should take pyridoxine as prescribed by the physician to prevent some of the neurologic effects of vitamin B6 deficiency, such as numbness and tingling of the extremities (peripheral neuritis).

A 78-year-old patient admitted to the hospital with a stroke 2 days earlier has developed a urinary tract infection. His Foley catheter is draining urine that is cloudy and dark yellowish-orange with a strong odor. He is receiving an intravenous heparin infusion and has a history of type 2 diabetes. The physician orders co-trimoxazole (Bactrim). 1. What will the nurse assess before giving this medication? 2. Are there any potential drug interactions? 3. Why was this particular antibiotic chosen? 4. Is this antibiotic bactericidal or bacteriostatic? Explain

1. He needs to be assessed for renal problems and blood dyscrasias. Also, the use of co-trimoxazole is con-traindicated in cases of known drug allergy to sul-fonamides or chemically related drugs such as sulfonylureas (used for diabetes), thiazide and loop diuretics, and carbonic anhydrase inhibitors. 2. If he is taking a sulfonylurea for his type 2 diabetes, close monitoring is needed because sulfonamides can potentiate the hypoglycemic effects of sulfonylureas in patients with diabetes. In addition, although he is currently receiving intravenous heparin and not war-farin, he may be switched to oral anticoagulants soon, so keep in mind that sulfonamides can potentiate the anticoagulant effects of warfarin and lead to hemorrhage. 3. These antibiotics achieve very high concentrations in the kidneys, through which they are eliminated. Therefore they are primarily used in the treatment of urinary tract infections. 4. Sulfonamides do not actually destroy bacteria but inhibit their growth. For this reason, they are consid-ered bacteriostatic antibiotics. Bactericidal antibiotics kill bacteria.

infestation of intestinal roundworms, specifically asca-riasis, after a visit to another country. You are preparing to medicate her with pyrantel. 1. How is this infestation diagnosed? 2. What are the contraindications to therapy with pyrantel? 3. What is the method of action of pyrantel? 4. The recommended dosage for pyrantel is 11 mg/kg, up to a maximum of 1 g, in a one-time dose. If Sandra weighs 57 kg, what dose will she receive? 5. What are the expected adverse effects of this medication?

1. Intestinal roundworms are diagnosed based on symptoms and examination of stool specimens. 2. Contraindications include allergy to the medication and pregnancy. Even though she is only 15 years old, she will be assessed for possible pregnancy before this medication is given. In addition, her liver function test results will be assessed because use of pyrantel is contraindicated in patients with liver disease. 3. It paralyzes intestinal worms so that the body is able to remove them via the feces. 4. Based on her weight of 57 kg, the dose for her would be 627 mg (11 mg 57 kg). 5. Adverse effects of pyrantel therapy include headache, dizziness, insomnia, skin rashes, anorexia, cramps, diarrhea, nausea, and vomiting.

1. The classification for the drug erythromycin

1. Macrolide

Mr. C., a 30-year-old stockbroker, has been diagnosed with genital herpes simplex type 2 (HSV-2) infection. The health care provider has prescribed topical acyclovir (Zovirax). 1. What patient teaching do you provide to Mr. C. regarding administration of this drug? 2. Mr. C. asks you how long it will take for the acyclovir to cure his herpes. What is your reply? 3. What else will you discuss with Mr. C., who is sexually active? 4. HSV-2 is closely related to which other viruses?

1. Mr. C. needs to use a glove when applying topical acyclovir (Zovirax) to the affected area, which should be kept clean and dry. Also, he should not use any other creams or ointments on the area. 2. Mr. C.'s herpes infection cannot be "cured," although the acyclovir will help to manage the symptoms. 3. Stress the importance of treatment for Mr. C. and his sexual partner and discuss with him how to prevent transmission of the virus. 4. There are several viruses in the Herpesviridae family, including herpes simplex type 1, which causes mucocutaneous herpes—usually blisters around the mouth; varicella-zoster virus (herpes simplex type 3), which causes both chickenpox and shingles; herpes-virus type 4 (also called Epstein-Barr virus); and herpesvirus type 8, which is believed by some to cause Kaposi's sarcoma, a cancer associated with acquired immunodeficiency syndrome (AIDS).

Sadie has been taking indomethacin (Indocin) as part of therapy for osteoarthritis but lately has noticed that it has been less effective. Her provider has decided to try celecoxib (Celebrex). Sadie has a history of hepatitis (15 years earlier). 1. What advantages might there be to treatment with celecoxib rather than indomethacin? 2. What potential adverse effects will you warn Sadie about before she takes this medication? What should she report? 3. What allergies are important to assess before Sadie takes this medication? 4. She asks you if she can drink her usual glass of wine each evening while taking this medication. What will you tell her?

1. The specific cyclooxygenase-2 selectivity of these drugs allows them to control the inflammation and pain without producing some of the toxicity associated with NSAID therapy. 2. The most common adverse effects include fatigue, dizziness, lower extremity edema, hypertension, dyspepsia, nausea, heartburn, and epigastric discom-fort. Any stomach pain, unusual bleeding, or blood in vomit or stool must be reported to the physician immediately. Chest pain, palpitations, and any gas-trointestinal problems need to be reported as well. 3. Celecoxib is not used in patients with known sulfa allergy. 4. She needs to avoid alcohol and aspirin while taking this medication and check with her provider before taking any over-the-counter medications

Sally has pneumonia with invasive aspergillosis. She has been treated for 2 weeks without showing much improvement, and the physician is considering starting voriconazole (Vfend) therapy. Sally is also receiving a medication for treatment of a cardiac dysrhythmia. 1. What is the reason for starting voriconazole therapy now rather than earlier? 2. What consideration may arise depending on the cardiac medication she is taking? 3. What needs to be monitored while she is taking voriconazole?

1. Voriconazole is used to treat major fungal infections in patients who do not tolerate or respond to other antifungal drugs. The physician probably tried other drugs first. 2. Use of voriconazole is contraindicated in patients taking other drugs that are metabolized by cyto-chrome P-450 enzyme 3A4 (e.g., quinidine) because of the risk for inducing serious cardiac dysrhythmias. 3. Careful cardiac monitoring is needed if Sally is also taking quinidine while taking this antifungal drug.

Virgil has been admitted to your unit and prescribed aminoglycoside therapy as part of treatment for a uri-nary tract infection with Pseudomonas. He is 65 years old, awake, and alert, but he is anxious about his problem and wants to "hurry up and get better." 1. For which two serious toxicities will you monitor? What are their symptoms, and how can they be prevented? 2. The physician adds penicillin to Virgil's drug regimen. Explain the reason for this. 3. Virgil's "trough" aminoglycoside level is 3.0 mcg/ mL, and his serum creatinine level is increased from 2 days earlier. Are these results a concern? What will you do? Explain

1. You will monitor for ototoxicity and nephrotoxicity. Symptoms of ototoxicity include dizziness, tinnitus, and hearing loss. Symptoms of nephrotoxicity include urinary casts, proteinuria, and increased blood urea nitrogen and serum creatinine levels. Monitoring the drug's trough levels and renal function studies can help prevent those toxicities. 2. The aminoglycosides and penicillins are often used together because they have a synergistic effect; that is, the combined effect of the two drugs is greater than that of either drug alone. 3. Yes, there is a concern! The desired trough level is 1 mcg/mL, so a level of 3 mcg/mL could mean that he is receiving a dose that is too high. The increased serum creatinine level is also a concern because it could be an indication of impaired renal function. The physician must be notified immediately and doses of the ami-noglycoside withheld until the physician responds.

11. The order reads, "Give ketorolac 20 mg IV every 6 hours as needed for pain." The medication is available in a concentration of 15 mg/mL. How much will the nurse draw up for each dose? (Record answer using one decimal place.) ______________ Mark the syringe to indicate your answer.

1.3mL

10. The patient is to receive isoniazid (INH) 0.3 g daily. The medication is available as 100-mg tablets. How many tablets will the nurse administer per dose? ______________

10. 3 tablets (See Overview of Dosage Calculations, Sections I and I

10. A patient will be taking oral neomycin before having bowel surgery. The order reads, "Give 1 g per hour for 4 doses PO." The patient cannot swallow pills, so an oral solution has been ordered. The solution is 125 mg/5 mL. How many milliliters will the nurse give for each 1-g dose? _______________

10. 40 mL (See Overview of Dosage Calculations, Section II.)

10. A patient is to receive mefloquine 1250 mg in a single dose for treatment of malaria. The medication is available in 250-mg tablets. How many tablets will the patient receive? ______________

10. 5 tablets

10. A child is to receive celecoxib as part of treatment for juvenile rheumatoid arthritis. The dose ordered is 100 mg twice daily PO. The child weighs 33 lb. According to the text, the dosing chart for pediatric administration of celecoxib is as follows: Less than 25 kg --- 50 mg twice daily PO 1 More than 25 kg --- 100 mg twice daily PO Is the ordered dose appropriate for this child? Explain your answer

10. No. The child weighs 15 kg, and the appropriate dose for thatweight is 50 mg orally twice daily, not 100 mg.

11. A patient is to receive medication through a feeding tube. The order reads, "Give amoxicillin 250 mg per feeding tube every 8 hours." When reconstituted, the concentration of the medication is 125 mg/5 mL. How many milliliters will the nurse give per dose?

10mL

11. The patient has new orders for pyrazinamide, 30 mg/kg/day. The patient weighs 132 lb. How many milligrams will the patient receive per day? Is this dosage safe? ____________

11. 1800 mg; yes, the maximum dose is 2g (2000 mg)

11. The order reads, "Give colistimethate 2.5 mg/kg/day IVPB. Infuse over 5 minutes." The patient weighs 165 pounds. How many milligrams will the patient receive per dose? (Record answer using one decimal place.) _______________

11. 187.5 mg

11. Professor H. has just returned from a research sab-batical in Africa, where she did not adequately pro-tect herself from mosquito exposure; thus she has contracted malaria. What kind of parasite causes malaria? Which drug is recommended if the parasite is in the exoerythrocytic phase of development? What exactly is the exoerythrocytic phase?

11. Malaria is caused by Plasmodium organisms. During the asexual stage of the Plasmodium life cycle, which occurs in the human host, the parasite resides for a while outside the erythrocyte; this is called the exo-erythrocytic phase. The most effective drug for eradicating the parasite during this phase is primaquine.

12. Professor H.'s nurse practitioner would like to pre-scribe the drug identified in the answer to Question 11. The patient will be assessed for which contraindications?

12. Before primaquine is administered, Professor H. will be given a pregnancy test. This is a pregnancy category C drug, so the nurse will need to know if certain precautions are needed in Professor H.'s case. She will also be assessed for hypersensitivity and any disease states that cause granulocytopenia (rheumatoid arthritis, systemic lupus erythemato-sus). In addition, primaquine must be used with caution in patients with methemoglobinemia, por-phyria, methemoglobin reductase deficiency, and glucose-6-phosphate dehydrogenase (G6PD) deficiency.

12. Ms. B. is brought into the emergency department with severe tinnitus, hearing loss, and some confusion. On examination, the nurse discovers that the patient's blood glucose level is 52 mg/dL. Her husband tells you that she had been experiencing back pain and has been using "a lot of aspirin" over the past few weeks. What do her symptoms and history suggest? Explain your answer.

12. Chronic salicylate intoxication, which occurs as a result of either high dosages or prolonged therapy with high dosages of aspirin

12. Amy is 12 weeks into her pregnancy when she dis-covers that she is HIV positive. Amy is very upset and says, "I won't live long enough to have this baby. We're both going to die." Is it possible to treat Amy, the fetus, or both? Explain your answer.

12. It is possible to treat both Amy and the fetus. Zido-vudine, one of the few anti-human immunodefi-ciency virus (HIV) drugs known to prolong patient survival, can be used for maternal and fetal treat-ment. During the pregnancy, Amy can receive the oral form of the drug. During labor, she can receive the drug intravenously. Drug therapy for the infant can begin within 12 hours of delivery and continue for 6 weeks.

12. Angie has a severe infection and is receiving an aminoglycoside once a day. She says, "They tell me I have a terrible infection. Why am I not getting the antibiotic more than once a day? I don't understand!" What will the nurse tell her?

12. The current practice is once-a-day aminoglycoside dosing. The nurse can tell her that studies have shown that once-daily dosing provides a sufficient plasma drug concentration to kill bacteria and has either an equal or lower risk for toxicity compared with multiple daily dosing. Hopefully, this type of dosing will be safer and more effective for her.

12. Diane, a 33-year-old proofreader, has been pre-scribed prophylactic isoniazid (INH) treatment. a. What laboratory studies should be performed before the start of therapy? Why? b. After Diane has taken isoniazid (INH) for 2 months, the physician significantly reduces her dosage of the drug. Why might that be?

12. a. Liver function studies should be performed because isoniazid can cause hepatic impairment. In addition, an eye examination is important because the drug may cause visual disturbances. b. Diane may be a slow acetylator. Acetylation, the process by which isoniazid is metabolized in the liver, requires certain enzymes to break down the isoniazid. In slow acetylators, who have a genetic deficiency of these enzymes, isoniazid accumu-lates. The dosage of isoniazid may need to be adjusted downward in these patients.

13. Explain the concept of "trough" levels during aminoglycoside therapy and the way in which renal function is monitored.

13. A blood sample for measurement of "trough" level is drawn at least 8 to 12 hours after completion of dose administration. The therapeutic goal is a trough level at or below 1 mcg/mL. If the trough level is above 2 mcg/mL, then the patient is at greater risk for oto-toxicity and nephrotoxicity. Trough levels are nor-mally monitored initially and then once every 5 to 7 days until the drug therapy is discontinued. The patient's serum creatinine level will also be mea-sured at least every 3 days as an index of renal function, and drug dosages will be adjusted as needed for any changes in renal function.

13. Professor H.'s husband, who accompanied her on her trip, has even more recently begun to develop signs of malaria. He is given chloroquine, a 4-aminoquinoline derivative. Unlike his wife, how-ever, Mr. H. sees no diminishing of his symptoms. His strain of malaria appears to be chloroquine resistant. What alternative(s) will the nurse practi-tioner suggest for Mr. H.?

13. Mefloquine is indicated for the treatment of chloroquine-resistant malaria. Quinine, an older drug, may also be used. Quinine can be used alone but is more commonly given in combination with pyrimethamine, a sulfonamide, or a tetracycline (e.g., doxycycline).

13. Mr. C. was brought to the emergency department and on arrival states he is experiencing drowsiness, leth-argy, and disorientation and reports that he had a seizure while en route to the hospital. His girlfriend tells the nurse that she noticed an empty bottle of ibuprofen by his bed when she found him. What do his symptoms and history suggest? What would the nurse expect if the situation were allowed to progress?

13. Mr. C. has an acute overdose of a nonsalicylate nonsteroidal antiinflammatory drug (NSAID). If the condition progresses, symptoms can include intense headache, dizziness, cerebral edema, cardiac arrest, and even death in extreme cases.

13. Ms. I. is undergoing antitubercular therapy that includes streptomycin and rifampin. a. How is streptomycin administered? b. Ms. I. takes an oral contraceptive. Is that a con-cern given Ms. I.'s antitubercular therapy? Explain your answer.

13. a. Streptomycin isadministeredintramuscularly, deep into a large muscle mass, and the sites are rotated. b. Although it may not be a concern in terms of Ms. I.'s streptomycin therapy, oral contraceptives become ineffective when given with rifampin. If rifampin is part of her therapy, Ms. I. should switch to another form of birth control.

14. Why would an eye examination be performed before instituting antitubercular therapy?

14. A thorough eye examination may be called for before therapy is initiated because ethambutol can cause a decrease in visual acuity resulting from optic neuri-tis, which is also a contraindication to the use of ethambutol. In addition, isoniazid may cause optic neuritis and visual disturbances.

14. The medical clinic has a full waiting room this morning. Patient A is being seen for an intestinal disorder that he acquired after swimming in a local lake. Patient B has acquired immunodeficiency syndrome (AIDS) and is showing early signs of pneumonia. Patient C is being treated and evaluated on a regular basis for a sexually transmitted infec-tion. Here's your challenge: All three patients have something in common in terms of the causes of their disorders. Describe what that could be. Second, based on that commonality, predict what disorder, of those discussed in this chapter, each patient may have. (Hint: One patient has giardiasis.) Third, select the drugs you think the physician is likely to pre-scribe for each patient.

14. Each of these three patients has a protozoal infection. The patient with the intestinal disorder has giardiasis. The patient with acquired immunodeficiency syn-drome (AIDS) has pneumocystosis. The patient with the sexually transmitted infection has trichomonia-sis. See Table 43-3 for specific drugs used to treat these diseases

14. Mr. H. has come to the clinic complaining of a severe flare-up of his gout. He tells the nurse that he does not take his medicine on a regular basis because it "kills"his stomach. He also says that he hates to take medi-cine but hates the gout more. He has a prescription for allopurinol and a follow-up appointment for next month. What patient teaching does Mr. H. need?

14. Mr. H. needs to know that compliance with the entire medical regimen is important for the success of his treatment for gout. Allopurinol needs to be taken with meals tohelpprevent theoccurrenceofgastrointestinal symptoms such as nausea, vomiting, and anorexia. Fluids should be increased to 3 L/day, and hazardous activities must be avoided if dizziness or drowsiness occurs with the medication. Also, alcohol and caffeine need to be avoided because these drugs increase uric acid levels and decrease the levels of allopurinol.

14. Greg has been taking amiodarone for a heart rhythm problem. He has developed an infection from an open wound, and the sensitivity report indicates that levofloxacin (Levaquin) is the best

14. Yes. In patients who receive amiodarone therapy, dangerous cardiac dysrhythmias are more likely to occur when quinolones are taken. Hopefully, another drug besides levofloxacin has shown effectiveness against the bacteria that is causing his infection.

14. Brenda, age 2 years, has bronchopneumonia caused by respiratory syncytial virus (RSV). a. What antiviral drug is used to treat RSV? b. Brenda's mother wonders whether the treatment will be completed before Brenda's birthday, which is 2 weeks away. What will the nurse tell her

14. a. Ribavirin is used to treat infections caused by respiratory syncytial virus. b. Yes. Brenda's treatment will last at least 3 days but not longer than 7 days.

15. Nitrofurantoin has been ordered for a patient who has a severe urinary tract infection caused by Escheri-chia coli. Explain why this drug is used for this type of infection.

15. Nitrofurantoin is used primarily to treat urinary tract infections because it is renally excreted and con-centrates in the urine

15. Sandra has bronchitis and has been taking an anti-biotic for 1 week. She calls the nurse and complains of severe genital itching and a whitish discharge in her vaginal area. What has happened, and what caused it

15. She is experiencing a superinfection because the antibiotics she has been taking for bronchitis have reduced the normal vaginal bacterial flora, and the yeast that is usually kept in balance by this normal flora has an opportunity to grow and cause an infection

15. A 25-year-old man has acquired immunodeficiency syndrome (AIDS). He was treated with zidovudine for several months, but now the physician has switched him to didanosine powder. What frequently is the reason that patients are switched from zido-vudine to another anti-HIV drug?

15. The patient may be experiencing zidovudine's major dose-limiting adverse effect, which is bone marrow suppression.

15. Eileen has had arthritic joint pain for months, and her current pain management regimen has been less than successful. During a checkup today, she tells the nurse that she has heard of a drug, Toradol, that "works wonders." She wants to try it for "a couple of months" to see if it can help her. a. What will the nurse tell her? b. What could happen if Eileen takes the ketorolac (Toradol) on a long-term basis?

15. a. Ketorolac (Toradol) is indicated for the short-term management (up to 5 days) of moderate to severe acute pain that requires analgesia at the opioid level. It is not indicated for the treatment of minor or chronic painful conditions. b. The main adverse effects of ketorolac (Toradol) include renal impairment, gastrointestinal pain, dyspepsia, and nausea. These problems limit the length of time that the medication can be used.

15. Mr. F. is on antitubercular therapy. During his first follow-up visit, he is evasive when the nurse asks him about his compliance with his therapy regimen. He does tell the nurse that he has been very busy lately, entertaining various clients "at everything from cocktail parties to big sit-down dinners." a. What issues will the nurse discuss with Mr. F.? b. Several weeks later, Mr. F. returns for another follow-up visit. On examination, the nurse sees no apparent signs of tuberculosis. How can Mr. F.'s therapeutic response be confirmed?

15. a. Mr. F. needs to know that his compliance with therapy is essential for achieving a cure. Although he is keeping his follow-up appointments, Mr. F. also needs to take his medication as ordered. He should be warned not to consume alcohol because the antitubercular drugs may cause liver toxicity, andheshouldbe encouraged totake care ofhimself by ensuring adequate nutrition, rest, and relaxation. b. The therapeutic response can be confirmed by results of laboratory studies (sputum culture and sensitivity tests) and chest radiographic findings.

16. The nurse overhears a coworker explaining to a student nurse the procedure for administering acy-clovir intravenously. "After the acyclovir is diluted in sterile water," the coworker says, "we'll admin-ister this over at least an hour." Should the nurse intervene? Explain your answer.

16. No. The nurse's coworker is doing fine. Acyclovir administered by intravenous infusion is first diluted in the solution recommended by the manufacturer and is administered slowly over at least 1 hour to prevent renal damage.

16. Your neighbor calls you over to "check out this aspirin bottle" that she found in her medicine cabinet. It has a strong vinegary odor. She wants to know if she can still take it for her headaches. What will you tell her?

16. The vinegary odor means that the aspirin has expe-rienced some chemical breakdown, and she should not use it! She needs to discard it safely and purchase a new bottle.

16. Frannie is a homeless 68-year-old woman who lives in a shelter some of the time. She was diagnosed with tuberculosis at the community health clinic, and antitubercular therapy has been instituted. a. What patient education issues are of particular concern in Frannie's case? b. Frannie is staying at the shelter and seems to be handling her medication regimen well, but one day she comes by the clinic to tell the nurse that she is afraid the medication may be bad for her. "Whenever I go to the bathroom, everything is reddish-orange," she says. What do you suspect is going on, and what do you tell Frannie?

16. a. Frannie, similar to all patients taking antituber-cular drugs, needs to be compliant with the therapy regimen and keep her follow-up appointments. She should be reminded that she can spread the disease (during the initial period of the illness); she should wash her hands frequently and cover her mouth when coughing or sneezing. Frannie also needs adequate nutrition and rest. b. It is likely that Frannie is on rifampin therapy. She should be told that her urine, stool, saliva, sputum, sweat, and tears may become red-orange-brown in color and that this is an effect of rifampin therapy.

17. Randy has a history of hypertension and coronary artery disease. Today he is being evaluated for acute gout, and the prescriber is considering febuxostat (Uloric). Are there any concerns, based on Randy's history, if he takes this drug for gout? Explain your answer.

17. Febuxostat is indicated for the treatment of acute gout but may pose a risk for cardiovascular events. Randy's history of hypertension and coronary artery disease may be of concern

17. Stacy has had flu symptoms for 4 days and feels miserable. She calls the nurse practitioner in the clinic to ask for "that medicine, Tamiflu, that is supposed to make the flu symptoms better." Will Stacy receive this medication at this time? Explain your answer.

17. No. Therapy with oseltamivir (Tamiflu) needs to begin within 2 days of the onset of influenza. It is probably too late for this medication to be effective for Stacy.

18. Matt has had an organ transplant. What antiviral drug may be used, even though he does not have a viral infection at this time?

18. Ganciclovir may be administered to prevent cyto-megalovirus disease (generalized infection) in high-risk patients, such as those receiving organ transplants.

19. The order reads, "Give amphotericin B 20 mg in 300 mL D5W over 6 hours." The nurse will set the infusion pump to what rate? ______________

19. 50 mL/hr (See Overview of Dosage Calculations, Section V.)

2. This class of antibiotics is commonly used for urinary tract infections.

2. Sulfonamide

20. A patient is to receive voriconazole as follows: 6 mg/ kg q12h 2 doses, then change to 4 mg/kg q12h. The patient weighs 242 lb. How much will the patient receive for each 6-mg/kg dose? The 4-mg/kg dose? ______________

20. 660 mg; 440 mg

21. Mr. K. has cryptococcal meningitis, and the physi-cian has prescribed fluconazole (Diflucan). a. Why did the physician choose this drug rather than one of the other -azole antifungals? b. The results of Mr. K.'s cerebrospinal fluid culture eventually come back negative. When he hears the good news, he says, "Great! I'm tired of taking this medicine." What will be the nurse's response?

21. a. Fluconazole (Diflucan), unlike itraconazole and other -azoles, can pass into the cerebrospinal fluid (CSF), which makes it useful in the treatment of cryptococcal meningitis. b. Unfortunately, Mr. K. will need to remain on the medication (at a reduced dosage) for 10 to 12 weeks after the negative results on his CSF culture.

11. The order for a 1-year-old child reads, "Give amantadine 4.4 mg/kg/day in 2 divided doses." The child weighs 22 lb. How many milligrams will the child receive per dose? ______________

22mg

23. Chrissie has a prescription for nystatin oral troches to treat thrush. After a few days, she calls the nurse practitioner to report that her mouth is not better. "I've been chewing them slowly every time I take one. I don't understand why it's not working!" she says. What is the nurse's response?

23. Nystatin oral troches or lozenges are to be dissolved slowly and completely in the mouth for the best effects and should not be chewed or swallowed. Chrissie needs a review of how to use this medication.

24. David has a severe fungal infection, and the physi-cian has prescribed a lipid formulation of ampho-tericin B (Fungizone). Why was this formulation ordered, and what are the advantages and disadvantages?

24. Lipid formulations of amphotericin B have been developed in an attempt to decrease the incidence of its adverse effects and increase its efficacy. The disadvantage is that they are more expensive than conventional amphotericin B.

10. A patient is to receive 2 million units of penicillin G potassium per day, every 6 hours in IV piggyback doses. The medication is available in vials of 1 million units/50 mL, and each dose needs to be mixed in 50 mL of D5W. How many milliliters will the nurse draw up for each IV piggyback dose? _______________

25 mL per dose. Each dose will contain 500,000 units (every 6 hours will be 4 doses per day; divide 2 million units per day by 4 to get 500,000 units per dose). (See Overview of Dosage Calculations, Section III.)

3. Antibiotics taken before exposure to an infectious organism in an effort to prevent the development of infection

3. Prophylactic

4. Antibiotics that inhibit the growth of bacteria

4. Bacteriostatic

5. An infection that occurs during antimicrobial treat-ment for another infection and involves overgrowth of a nonsusceptible organism

5. Superinfection

10. The order reads, "Give acyclovir, 0.25 g IVPB now." The medication comes in a vial that contains 1000 mg. The label reads, "Add 20 mL of diluent for a solution that contains 50 mg/mL." The medication will be added to 100 mL D5W for IV piggyback infusion. How many milliliters of reconstituted medication will the nurse add to the 100-mL bag for infusion? ______________

5mL

6. This class of antibiotics may cause tooth discoloration in children younger than age 8 years.

6. Tetracycline

7. Anaphylactic reactions are common with this class of antibiotics.

7. Penicillin

8. Antibiotics that kill bacteria

8. Bactericidal

9. There is a chance of cross-reactivity between this class of antibiotics and the class in 7 Across

9. Cephalosporin

9. A patient with Pneumocystis jiroveci pneumonia will be receiving pentamidine intravenously. The order reads, "Give 4 mg/kg/day once daily." The medica-tion comes in a 300-mg vial and is to be reconstituted with 5 mL of sterile water, with a resulting concen-tration of60 mg/mL. The dose will then be added to a 100-mL bag of D5W for the infusion. The patient weighs 154 lb. What is the dose for this patient, and how many milliliters of medication will the nurse add to the infusion bag? (Record answer using one decimal place.) ______________

9. The dose is 280 mg (4 mg/kg 70 kg); the nurse will draw up 4.7 mL of the diluted solution for the infu-sion. (See Overview of Dosage Calculations, Section III.)

13. Mr. R., a 50-year-old banker, is scheduled for colon surgery tomorrow. The surgeon is planning to administer a prophylactic antibiotic. What drug is frequently used for this purpose? Why?

Cefoxitin (Mefoxin) is frequently used in patients undergoing abdominal surgeries because it can effectively kill intestinal bacteria, including anaer-obic bacteria.

12. A patient is receiving imipenem-cilastatin (Primaxin) and asks the nurse, "Why does that medicine bag have two names listed? Am I receiving two drugs?" What is the best explanation for the patient?

Imipenem-cilastatin (Primaxin) does contain two drugs, but one of the drugs (cilastatin) works to prevent the antibiotic (imipenem) from being destroyed by bacterial enzymes that can make the antibiotic ineffective.

3. A patient is receiving treatment with allopurinol for an acute flare-up of gout. Which statements will the nurse include during patient teaching? (Select all that apply.) a. "Be sure to avoid alcohol and caffeine." b. "Take the medication with meals to prevent stomach problems." c. "You need to take this medication on an empty stomach to improve absorption." d. "You need to increase fluid intake to up to 3 liters per day." e. "Call your provider immediately if you note any skin rashes or abnormalities."

a. "Be sure to avoid alcohol and caffeine." b. "Take the medication with meals to prevent stomach problems." d. "You need to increase fluid intake to up to 3 liters per day." e. "Call your provider immediately if you note any skin rashes or abnormalities."

5. The nurse is explaining antitubercular therapy to a patient. The patient asks, "Why do I have to take so many different medications?" What is the nurse's best response? a. "It helps prevent the tuberculosis from becoming resistant to the drugs." b. "It makes sure that the disease is cured." c. "These medications will reduce symptoms immediately." d. "You will have fewer side effects."

a. "It helps prevent the tuberculosis from becoming resistant to the drugs."

13. Bailey, a 53-year-old teacher, has shingles. a. What drug will the nurse expect the physician to prescribe? b. Several months later, Bailey calls the office to say that her symptoms have returned. What action will the nurse expect to be taken now?

a. Acyclovir (Zovirax) is indicated for herpes zoster (shingles). b. Bailey will be treated with acyclovir again; it is the drug of choice for treatment of both initial and recurrent episodes of shingles.

15. The nurse is administering an antifungal drug to a patient who has a severe systemic fungal infection. Which drug is most appropriate for this patient? a. Amphotericin B b. Fluconazole c. Griseofulvin d. Flucytosine

a. Amphotericin B

22. The physician is planning intravenous amphotericin B therapy for James. a. What guidelines will the nurse follow in admin-istering the drug? b. What adverse effects will the nurse expect James to experience? c. Should the nurse stop the infusion if those effects occur? Explain your answer.

a. Amphotericin B needs to be diluted according to the manufacturer's guidelines and administered using an infusion pump. The nurse must not use solutions that are cloudy or that have visible precipitates. Before administration, the nurse will check for an order to premedicate the patient with an antiemetic, antihistamine, antipyretic, or cor-ticosteroid to prevent or minimize infusion-related reactions. b. The nurse will monitor closely for expected adverse effects such as cardiac dysrhythmias, visual disturbances, paresthesias (numbness or tingling of the hands or feet), respiratory diffi-culty, pain, fever, chills, and nausea. c. No, unless a severe reaction occurs (e.g., exac-erbation of adverse effects or a decline in vital signs). To decrease the severity of expected adverse effects, the patient may be pretreated with an antipyretic (e.g., acetaminophen), antihista-mines, and antiemetics.

8. The nurse is reviewing the medication list of a patient with a new prescription for mefloquine. Which drugs may have an interaction with the mefloquine? (Select all that apply.) a. Beta blockers b. Antidiabetic drugs c. Calcium channel blockers d. Proton pump inhibitors e. Thiazide diuretics

a. Beta blockers c. Calcium channel blockers

8. The nurse is reviewing the medication list of a patient who has been newly diagnosed with tuberculosis and will be taking rifampin. Which classes of drugs, if taken with rifampin, may cause increased metabolism? (Select all that apply.) a. Beta blockers b. Proton pump inhibitors c. Selective serotonin reuptake inhibitors d. Oral anticoagulants e. Oral antidiabetic drugs

a. Beta blockers d. Oral anticoagulants e. Oral antidiabetic drugs

17. The nurse is administering a new order for ampho-tericin B and reviews the patient's current medica-tions. Which medications, if also ordered, may cause an interaction with the amphotericin B? (Select all that apply.) a. Digoxin, a cardiac glycoside b. Metoprolol, a beta blocker c. Warfarin, an oral anticoagulant d. Levothyroxine, a hormone replacement e. Hydrochlorothiazide, a thiazide diuretic

a. Digoxin, a cardiac glycoside e. Hydrochlorothiazide, a thiazide diuretic

9. Which patient teaching fact is the priority when the nurse is teaching the patient about lesinurad? a. Drink at least 2 liters of fluid per day. b. Take the medication on an empty stomach. c. Add a calcium supplement to the medication regimen. d. Use sunscreen or wear long sleeves when outdoors

a. Drink at least 2 liters of fluid per day.

9. The nurse would be correct in identifying which findings as possible side effects of bedaquiline? (Select all that apply.) a. Headache b. Chest pain c. Nausea d. QT prolongation e. Paresthesias

a. Headache b. Chest pain c. Nausea

6. The nurse would correctly identify the method of action of ethambutol as which of the following? a. Inhibiting protein synthesis b. Inhibiting mycobacterial ATP synthase c. Altering cell wall synthesis d. Unknown method of action

a. Inhibiting protein synthesis

7. The method of action of antiviral agents is identified by which statement? a. Inhibiting the virus's ability to replicate b. Interfering with receptor site activity c. Interrupting the viral cell wall membrane d. Destroying the nucleus of the cell

a. Inhibiting the virus's ability to replicate

6. The nurse would be correct in identifying which description as the method of action of febuxostat (Uloric) in the treatment of gout? a. Inhibits uric acid production b. Increase uric acid secretion c. Reduces inflammation d. Inhibits deposition of urate crystals

a. Inhibits uric acid production

1. A patient will be receiving long-term isoniazid (INH) therapy. What laboratory tests are most important for the nurse to monitor during therapy? a. Liver enzyme levels b. Hematocrit and hemoglobin level c. Creatinine level d. Platelet count

a. Liver enzyme levels

2. An 18-month-old toddler develops an abrupt onset of diarrhea. Results of the stool specimen suggest giardiasis as the cause. The nurse would anticipate the provider to write a prescription for which drug? a. Metronidazole b. Pentamidine c. Atovaquone d. Praziquantel

a. Metronidazole

12. During an infusion of amphotericin B, the nurse monitors for which adverse effects? (Select all that apply.) a. Nausea b. Fever c. Malaise d. Constipation e. Chills f. Hypertension

a. Nausea b. Fever c. Malaise e. Chills

7. After an infusion of colistimethate (Coly-Mycin), the nurse will report to the prescriber if the patient complains of which adverse effects? (Select all that apply.) a. Numbness b. Vertigo c. Upset stomach d. Insomnia e. Dizziness

a. Numbness b. Vertigo e. Dizziness

2. Which intervention is the priority for the nurse to perform before beginning antibiotic therapy? a. Obtain a specimen for culture and sensitivity. b. Give with an antacid to reduce gastrointestinal (GI) upset. c. Monitor for adverse effects. d. Restrict oral fluids.

a. Obtain a specimen for culture and sensitivity.

18. Amphotericin B would be contraindicated in which patients? (Select all that apply.) a. One with severe bone marrow suppression b. One with ulcer disease c. One with renal impairment d. One with hypertension e. One with asthma

a. One with severe bone marrow suppression c. One with renal impairment

5. The nurse is reviewing the use of the COX-2 inhib-itor celecoxib (Celebrex). Which conditions are indications for celecoxib? (Select all that apply.) a. Osteoarthritis b. Prevention of thrombotic events c. Rheumatoid arthritis d. Primary dysmenorrhea e. Fever reduction

a. Osteoarthritis c. Rheumatoid arthritis d. Primary dysmenorrhea

5. A patient calls the clinic nurse to ask for oseltamivir (Tamiflu) "because I was exposed to the flu over the weekend at a family reunion." The nurse knows that Tamiflu is indicated for which conditions? (Select all that apply.) a. Prevention of infection after exposure to influenza virus types A and B b. Reduction of the duration of influenza in adults c. Treatment of topical herpes simplex virus infections d. Reduction of the severity of shingles symptoms e. Treatment of lower respiratory tract infections caused by respiratory syncytial virus

a. Prevention of infection after exposure to influenza virus types A and B b. Reduction of the duration of influenza in adults

3. When reviewing the health history of a patient who is to receive foscarnet, the nurse knows that which condition would be a contraindication to its use? a. Renal failure b. CMV retinitis c. Asthma d. Immunosuppression

a. Renal failure

4. A patient who is receiving vancomycin therapy needs to notify the nurse immediately if which effects are noted? (Select all that apply.) a. Ringing in the ears b. Dizziness c. Hearing loss d. Flushing of the face e. Nausea

a. Ringing in the ears b. Dizziness c. Hearing loss

14. Sean is a 19-year-old college freshman who has been diagnosed with gonorrhea. The provider has pre-scribed doxycycline therapy. During the nursing assessment, Sean discusses his diet, which includes "lots of meat, milk, and veggies." Sean also tells the nurse that he jogs frequently and is a member of the tennis team. a. In addition to instruction about sexually trans-mitted infections, what patient teaching about the medication does Sean require? b. A few days later, Sean calls and complains of an upset stomach and diarrhea. What does the nurse suspect might be wrong with Sean?

a. Sean must not take doxycycline with milk because that can result in a significant reduction in the absorption of the drug. Also, Sean needs to be aware that tetracyclines can cause photosensitiv-ity; he needs to avoid direct exposure to sunlight and use sunscreen or protective clothing. b. The diarrhea is probably the result of alteration of the intestinal flora caused by the drug therapy.

8. Which of the following agents would the nurse expect to be used in the treatment of hepatitis C? (Select all that apply.) a. Sofosbuvir b. Daclatasvir c. Ribavirin d. Oseltamivir e. Zanamivir

a. Sofosbuvir b. Daclatasvir c. Ribavirin

3. Which teaching point is the priority when educating the patient beginning antitubercular therapy? (Select all that apply.) a. Take medications as ordered and at the same time every day. b. Take medications on an empty stomach. c. Monitor blood glucose daily. d. Increase intake of green leafy vegetables.

a. Take medications as ordered and at the same time every day. b. Take medications on an empty stomach. c. Monitor blood glucose daily.

5. _______ A term for fungal infection of the mouth

a. Thrush

1. Before beginning antiprotozoal therapy, the nurse will assess for which possible contraindications? a. Underlying renal or liver disease and pregnancy b. Porphyria and glucose-6-phosphate dehydroge-nase (G6PD) deficiency c. Glaucoma, cataracts, anemia, and petechiae d. Constipation, gastritis, and lactose intolerance

a. Underlying renal or liver disease and pregnancy

3. A patient has been admitted to the unit with a stage IV pressure ulcer. After 2 days, the wound culture results come back positive for methicillin-resistant Staphylococcus aureus (MRSA). The nurse knows that the drug of choice for the treatment of MRSA infection is which drug? a. Vancomycin b. Gentamicin c. Ciprofloxacin d. Colistimethate

a. Vancomycin

2. A patient is being prepared for colon surgery and will be receiving neomycin tablets during the day before surgery. He asks the nurse why he needs to take this medicine before he even has surgery. What is the nurse's best response? a. "This medicine helps clear out your bowels before surgery." b. "It helps reduce the number of bacteria in your intestines before surgery." c. "It is given to sterilize your bowel before surgery." d. "It is given to prevent an infection after surgery."

b. "It helps reduce the number of bacteria in your intestines before surgery."

2. A 13-year-old patient has the flu, and her mother is concerned about her fever of103° F (39.4° C). Which of these medications will the prescriber suggest to treat the teen's fever? a. Aspirin b. Acetaminophen (Tylenol) c. Indomethacin (Indocin) d. Ketorolac (Toradol)

b. Acetaminophen (Tylenol)

4. The nurse will warn the patient taking metronidazole about which possible adverse effects? (Select all that apply.) a. Reddish-orange urine b. Anorexia c. Cough d. Weakness e. Headache f. A metallic taste in the mouth

b. Anorexia c. Cough d. Weakness e. Headache

14. A patient will be receiving a one-dose treatment for vaginal candidiasis. The nurse expects to administer which drug? a. Ketoconazole b. Fluconazole c. Griseofulvin d. Terbinafine

b. Fluconazole

8. The nurse is reviewing the list of medications for a patient who will be starting antibiotic therapy with an aminoglycoside. Which medications, if present, may present a potential interaction with the aminoglycoside? (Select all that apply.) a. Metoprolol, a beta blocker b. Furosemide, a loop diuretic c. Warfarin, an oral anticoagulant d. Vancomycin, an antibiotic e. Levothyroxine, a thyroid hormone

b. Furosemide, a loop diuretic c. Warfarin, an oral anticoagulant d. Vancomycin, an antibiotic

1. When teaching a patient about the common adverse effects of therapy with nonsteroidal antiinflamma-tory drugs (NSAIDs), the nurse will mention which possible adverse effect? a. Dizziness b. Heartburn c. Palpitations d. Diarrhea

b. Heartburn

7. The nurse would be correct in identifying which description as the method of action of probenecid in the treatment of gout? a. Inhibits uric acid production b. Increase uric acid secretion c. Reduces inflammation d. Inhibits deposition of urate crystals

b. Increase uric acid secretion

8. Which statement accurately describes the method of action of penicillin? a. Interruption of bacterial protein synthesis b. Inhibition of bacterial cell wall synthesis c. Interruption of bacterial DNA replication d. Increased bacterial cell wall permeability

b. Inhibition of bacterial cell wall synthesis

3. The nurse will instruct a patient who is receiving a tetracycline antibiotic to take it using which guideline? a. It needs to be taken with milk. b. It needs to be taken with 8 oz of water. c. It needs to be taken 30 minutes before iron preparations are taken. d. An antacid should also be taken to decrease GI discomfort.

b. It needs to be taken with 8 oz of water.

10. _______ Multicellular fungi characterized by long, branching filaments called hyphae, which entwine to form a mycelium

b. Mold

1. The nurse is reviewing the drugs ordered for a patient. A drug interaction occurs between penicillins and which drugs? (Select all that apply.) a. Alcohol b. Oral contraceptives c. Digoxin d. Nonsteroidal antiinflammatory drugs e. Warfarin f. Anticonvulsants

b. Oral contraceptives d. Nonsteroidal antiinflammatory drugs e. Warfarin

6. Which drugs are used mainly for the management of Pneumocystis jiroveci (formerly Pneumocystis carinii) pneumonia? (Select all that apply.) a. Metronidazole b. Pentamidine c. Ivermectin d. Pyrantel e. Atovaquone

b. Pentamidine e. Atovaquone

6. The nurse is preparing to administer the aerosol form of ribavirin. Which condition is a contraindication to the drug? a. Asthma b. Pregnancy c. Hypertension d. Type 2 diabetes

b. Pregnancy

2. The nurse should include which information in the teaching plan for a patient who is taking isoniazid (INH)? a. Urine and saliva may be reddish-orange. b. Pyridoxine (vitamin B6) should be added to the regimen. c. Injection sites should be rotated daily. d. The medication should be taken with an antacid to reduce gastric distress.

b. Pyridoxine (vitamin B6) should be added to the regimen.

9. During a class on health care-associated infections, the nurse shares several facts about these infections. Which statements about health care-associated infections are true? (Select all that apply.) a. They are contracted in the home or community. b. They are contracted in a hospital or institution. c. They are more difficult to treat. d. The organisms that cause these infections are more virulent. e. The infection is incubating at the time of admission.

b. They are contracted in a hospital or institution. c. They are more difficult to treat. d. The organisms that cause these infections are more virulent.

5. A patient is taking quinine therapy for malaria. The prescriber has decided to add a sulfonamide or tet-racycline drug along with the quinine. When the nurse gives the patient the prescription for this new medication, the patient is upset about having to take "another pill." What is the nurse's best explanation for the second drug? a. "The antibiotic treats the bacterial infections that accompany malaria." b. "The antibiotic reduces the severe adverse effects of quinine." c. "The antibiotic will help the quinine to work more effectively against the malaria." d. "The antibiotic therapy is also needed to kill the parasite that causes malaria."

c. "The antibiotic will help the quinine to work more effectively against the malaria."

4. A patient newly diagnosed with tuberculosis asks the nurse how long he will need to take "all this medi-cine." The nurse replies that drug therapy for active tuberculosis may need to last how long? a. 6 months b. 12 months c. 24 months d. A lifetime

c. 24 months

4. When reviewing the use of amantadine, the nurse expects that the drug would be used most appropri-ately in which patient? a. A 29-year-old man who tests positive for HIV b. A 22-year-old woman who is in her eighth month of pregnancy and tests positive for HIV c. A heart transplant patient who has influenza A d. Older adult patients who require prophylaxis for influenza B

c. A heart transplant patient who has influenza A

7. The nurse would correctly identify the method of action of isoniazid (INH) as which of the following? a. Inhibiting protein synthesis b. Inhibiting mycobacterial ATP synthase c. Altering cell wall synthesis d. Unknown method of action

c. Altering cell wall synthesis

4. When reviewing the health history of a patient who is to receive NSAID therapy, the nurse keeps in mind that contraindications for the use of these drugs include which condition? a. Pericarditis b. Osteoarthritis c. Bleeding disorders d. Juvenile rheumatoid arthritis

c. Bleeding disorders

7. The nurse knows the use of tetracyclines is limited in children because of the occurrence of which side effect? a. Stunting of the growth plate b. Threat of sunburn c. Discoloration of teeth d. Pseudomembranous colitis

c. Discoloration of teeth

6. _______ One of the older antifungal drugs that acts by preventing susceptible fungi from reproducing

c. Griseofulvin

6. Which statement accurately describes the method of action of quinolones? a. Interruption of bacterial protein synthesis b. Inhibition of bacterial cell wall synthesis c. Interruption of bacterial DNA replication d. Increased bacterial cell wall permeability

c. Interruption of bacterial DNA replication

8. The nurse is reviewing a patient's medications and sees an order for ketorolac. This drug is ordered for which condition? a. Fever b. Mild pain c. Moderate to severe acute pain d. Long-term chronic pain conditions

c. Moderate to severe acute pain

3. The patient being treated with albendazole is experiencing infestations with which helminth? a. Flukes b. Tapeworms c. Nematodes d. Flatworms

c. Nematodes

11. An infant has thrush. The nurse expects to administer which drug for the treatment of thrush? a. Amphotericin B b. Fluconazole c. Nystatin d. Miconazole

c. Nystatin

1. When patients are receiving aminoglycosides, the nurse must monitor for tinnitus and dizziness, which may indicate which problem? a. Cardiotoxicity b. Hepatotoxicity c. Ototoxicity d. Nephrotoxicity

c. Ototoxicity

4. A patient is to receive antibiotic therapy with a cephalosporin. When assessing the patient's drug history, the nurse recognizes that an allergy to which drug class may be a possible contraindication to cephalosporin therapy? a. Cardiac glycosides b. Thiazide diuretics c. Penicillins d. Macrolides

c. Penicillins

5. Which is a common adverse effect that occurs when vancomycin (Vancocin) is infused too quickly? a. Bone marrow suppression b. Tubular necrosis c. Red man's syndrome d. Colitis

c. Red man's syndrome

13. A patient calls the gynecologic clinic because she has begun to menstruate while taking vaginal cream for a vaginal infection. She asks the nurse, "What should I do about taking this vaginal medicine right now?" Which is the nurse's best response? a. "You need to stop the medication until the menstrual flow has stopped." b. "Just take the medication at night only." c. "You should stop the medication for 3 days and then start it again." d. "It's okay to continue to take the medication."

d. "It's okay to continue to take the medication."

5. When asked about drug allergies, a patient says, "I can't take sulfa drugs because I'm allergic to them." Which question will the nurse ask next? a. "Do you have any other drug allergies?" b. "Who prescribed that drug for you?" c. "How long ago did this happen?" d. "What happened when you took the sulfa drug?"

d. "What happened when you took the sulfa drug?"

16. In an effort to prevent the complications associated with intravenous infusion of antifungal drugs such as amphotericin B, the nurse will administer them over which time frame? a. 30 minutes b. 60 minutes c. 1 to 2 hours d. 2 to 6 hours

d. 2 to 6 hours

2. When administering ganciclovir, the nurse keeps in mind that the main dose-limiting toxicity for this drug is which condition? a. Renal failure b. Gastrointestinal disturbances c. Peripheral neuropathy d. Bone marrow suppression

d. Bone marrow suppression

9. Which laboratory test will the nurse monitor in the patient taking daptomycin? a. Liver function studies b. Red blood cell counts c. Platelet levels d. Creatinine phosphokinase

d. Creatinine phosphokinase

9. _______ An infection caused by fungi

d. Mycosis

7. The nurse is reviewing anthelmintic therapy. Which statement is true regarding anthelmintic therapy? a. The medication can be stopped after symptoms disappear. b. Anthelmintics are more effective in their parenteral forms. c. Anthelmintics are broad in their actions and can be substituted easily for one another if a given medication is not well tolerated. d. Specific anthelmintic drugs are used to target specific organisms.

d. Specific anthelmintic drugs are used to target specific organisms.

6. Which statement accurately describes the action of antiseptics? a. They are used to kill organisms on nonliving objects. b. They are used to kill organisms on living tissue. c. They are used to sterilize equipment. d. They are used to inhibit the growth of organisms on living tissue.

d. They are used to inhibit the growth of organisms on living tissue.

1. The nurse is administering acyclovir and recalls that it is considered the drug of choice for treatment of which viral infection? a. Cytomegalovirus (CMV) b. Human immunodeficiency virus (HIV) c. Respiratory syncytial virus (RSV) d. Varicella-zoster virus (VZV)

d. Varicella-zoster virus (VZV)

9. Viral infections and viruses are more difficult to eradicate than bacteria for which reason? a. Viruses replicate at a faster rate. b. Viruses grow as an attachment to host cells and must first be removed from the cell wall. c. Viruses require folic acid synthesis. d. Viruses replicate only inside host cells, so medi-cations must enter the cell.

d. Viruses replicate only inside host cells, so medi-cations must enter the cell.

2. _______ One of the major chemical groups of antifungal drugs; includes amphotericin B and nystatin

e. Polyenes

3. _______ A very large, diverse group of eukaryotic, thallus-forming microorganisms that requires an external carbon source

f. Fungi

4. _______ Another of the major groups of antifungal drugs; includes ketoconazole

g. Imidazoles

7. _______ The drug of choice for many severe, sys-temic fungal infections; also, the oldest antifungal drug

h. Amphotericin B

8. _______ An antifungal drug commonly used to treat candidal diaper rash

i. Nystatin

1. _______ Single-celled fungi that reproduce by budding

j. Yeast