Pharm 11
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 with a fungal infection has been prescribed a miconazole vaginal suppository. What education should the nurse provide about safe and effective administration?
"If possible, lie down for 10 or 15 minutes after inserting the medication."
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?
"It's best to check with your health care provider before applying any of the steroid ointment."
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 with chronic renal failure has been prescribed clotrimazole for the treatment of a fungal infection. How should the client's health history affect the treatment plan?
The presence of kidney disease has no significant effect on the use of clotrimazole
Which statement best describes topical antifungal agents?
They are too toxic to be used systemically
The client is diagnosed with a Candida infection of the mouth. How will the nurse document this finding?
Thrush
Ketoconazole is available in oral form, a shampoo, and a cream.
True
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
The client is receiving ketoconazole. The nurse should be concerned about a drug-drug interaction on the basis of what other comorbidity?
Type 2 diabetes
Azole antifungals require caution under certain conditions. For which of the following patients would the nurse be most cautious when administering ketoconazole? Select all that apply.
a 78-year-old with cirrhosis a woman who is 4 weeks postpartum
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?
110 mcg/mL
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?
1300 hours
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?
"Are there any open wounds on the areas where you're putting the ointment?"
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 client is receiving gentian violet as topical treatment for a fungal infection. What instruction should the nurse include in the teaching plan?
"This medication can stain your skin and clothing."
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.)
-Clients with acquired immune deficiency syndrome (AIDS) and AIDS-related complex (ARC) -Clients taking immunosuppressant drugs -Clients who have undergone transplantation surgery or cancer treatment -The elderly
Fluconazole is the prototype for antifungals. Which are characteristics of fluconazole? (Select all that apply.)
-Treatment of oropharyngeal, esophageal, and vaginal candidiasis - Binds to sterols in the fungal cell membrane - Metabolized in the liver and excreted in the urine
The pediatric nurse is caring for a client with aspergillosis. The client weighs 66 pounds has been prescribed voriconazole 6 mg/kg IV q12h for two doses. How many mg of the medication should the nurse administer for each dose?
180
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?
The client's urine output is 75 mL over six hours
A nurse is caring for a client who is receiving fluconazole and amphotericin B. The prescriber has just added flucytosine to the treatment regime. Which information should be used in the teaching plan for the medication? Select all that apply.
The medication is for the treatment of chromomycosis and spergillosis. Reduce dosage for clients with impaired renal function.
The nurse is caring for several clients who have fungal infections. Which client should the nurse prioritize for informing the provider?
A client receiving amphotericin B whose torso appears jaundiced
The nurse is caring for a client receiving amphotericin B. Which condition should the nurse assess for in this client?
phlebitis
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
What medications are classified as echinocandin antifungals? (Select all that apply.)
Anidulafungin (Eraxis) Caspofungin (Cancidas) Micafungin (Mycamine)
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?
Tell the client not to administer the medication and to come be assessed by the provider
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?
Antifungal drugs that are effective for this disease without being excessively toxic to human cells are limited.
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:
Aspergillus infection.
A client is receiving amphotericin B. The nurse would assess the client closely for which adverse reaction?
renal impairment
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?
Candida albicans
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 client has decreased renal function following recent pyelonephritis
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's previous medical history includes mycosis. What conclusion should the nurse draw from this fact?
The client has had a disease that was caused by a fungus
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 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?
Hematologic status
A pharmacology student is learning about amphotericin B. This drug can be administered via which route?
IV
The azole antifungals are contraindicated in clients with what condition?
Increased liver enzymes
The nurse is caring for a client who has been prescribed micafungin, 150 mg IV daily. What assessment should the nurse prioritize in this client's care?
Inspection of the client's mouth and throat
Which statement would be correct for a client regarding the administration of an antifungal medication?
Instruct the client to complete the entire drug therapy even if a dose is missed.
Which antifungal agent is available for systemic and topical use?
Ketoconazole
Laboratory monitoring for clients on all systemic antifungal drugs should include what test?
LFTs (liver function tests)
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
What serious adverse effect is most associated with amphotericin B?
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?
Provide food along with the fluconazole when administering it in the future.
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
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?
Risk for impaired skin integrity related to local irritation
A client who is using a topical miconazole preparation calls the clinic to report a severe rash. What will the nurse instruct the client to do?
Stop using the drug.
A client is prescribed mebendazole. The nurse reviews the client's medication history for possible drug interactions. Which would the nurse identify as lowering the levels of mebendazole? Select all that apply.
carbamazepine phenytoin
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
A group of students are studying for a test on antifungal agents. The students demonstrate understanding of the material when they identify which as an example of an echinocandin antifungal?
caspofungin
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 been placed on amphotericin B. The nurse caring for this client should administer this medication:
intravenously
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?
jaundice
Prior to administering the doseinitial intravenous (IV) dose of caspofungin, the nurse should review the latest results of what diagnostic testing? Select all that apply.
liver function renal function complete blood count
A nurse is instructing a 19-year-old female patient on the use of fluconazole for candida vaginitis. A teaching priority will be to:
use an alternative form of birth control, if taking an oral contraceptive.
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:
wash and dry the affected area before applying the ointment.
