Pharm Ch. 24

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

Alcohol is absolutely contraindicated during treatment with metronidazole. Grapefruit juice, cured meats and raw vegetables are acceptable and safe.

Chloroquine acts against erythrocytic forms of plasmodial parasites to prevent or treat what condition?

Malaria Chloroquine is a widely used antimalarial agent. It acts against erythrocytic forms of plasmodial parasites to prevent or treat malarial attacks.

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

Oral Primaquine, like all the antimalarial agents, is administered orally.

act against the red-blood-cell phase of the life cycle

schizonticidal

What signs and symptoms most likely prompted a client diagnosed with amebiasis to initially seek care?

severe diarrhea Trophozoites (active amebae) produce an enzyme that allows them to invade body tissues. They may form erosions and ulcerations in the intestinal wall with resultant diarrhea. This is a characteristic symptom of amebiasis. None of the other options are associated with symptoms of amebiasis.

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

"Did you drink any alcoholic beverages around the time of taking the drug?" Flushing, headache, nausea, sweating, and vomiting may occur if alcohol is ingested with metronidazole. This reaction is unlikely attributable to an allergy, since the client has been taking the drug for 4 days. Taking metronidazole on an empty stomach or with antihistamines would not likely have this effect.

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

"I can teach you some strategies for managing some of the adverse effects of the drug." Instead of just reiterating the orders for the medication or downplaying the client's concerns, the nurse should acknowledge the client's concerns and offer solutions. Adverse effects of prophylaxis are a realistic possibility.

A female client is receiving mefloquine as part of malarial prevention. After teaching about the drug, which statement by the client indicates successful teaching?

"I should avoid getting pregnant for at least 2 months after I finish the drug." Mefloquine is teratogenic in preclinical studies; pregnancy should be avoided during and for 2 months after completion of therapy. Typically prevention therapy would require the client to take the drug once a week starting 1 week before travel and continuing for 4 weeks after leaving the area. The drug can be taken with food or meals if GI upset occurs. Rash and headache are common adverse effects of the drug and do not need to be reported.

The client has just begun taking metronidazole and calls the clinic to report that her urine has turned very dark. What is the nurse's best response to this client?

"This is an expected side effect. Your urine color will return to normal after you stop taking this drug." Metronidazole commonly causes a client's urine to turn dark. It is a temporary side effect. The color of the urine goes back to normal after the medication has been completed.

A client is receiving mefloquine as part of a treatment for malaria asks the nurse about becoming pregnant. Which response by the nurse would be most appropriate?

"You need to avoid pregnancy during the therapy and for 2 months after completion." Pregnancy should be avoided during treatment with any of the antimalarial agents. For mefloquine, the client should avoid pregnancy during therapy and for 2 months after the completion of therapy. Antimalarial agents are contraindicated for use with lactating women, so another method of feeding should be chosen if treatment is absolutely necessary.

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

"You'll need to keep taking this for about one month after you return." Prophylaxis should continue for four weeks after leaving an endemic area. The drug is taken weekly, not "each day." It should begin one to two weeks before travelling. The client has no way of telling what the minimum dose for prevention is; it should be taken as prescribed.

A client has been admitted to the emergency department with signs, symptoms, and travel history that are consistent with malaria. When assessing the client for possible contraindications to treatment with antimalarials, what assessment should the nurse prioritize?

Assessing the client for any history of liver disease Liver disease contraindicates the use of antimalarials. The client's immunization status would not complicate the use of antimalarials, nor would deficits in mental status. Autoimmune diseases do not contraindicate antimalarial treatment.

quinidine toxicity or poisoning

cinchonism

A client has been diagnosed and hospitalized with malaria and has been prescribed chloroquine. What test or function should the nurse monitor frequently?

visual function The nurse should perform a frequent ophthalmic examination of the client who is receiving a high dose of chloroquine to check for visual disturbances. The nurse should examine the stool of the client for a helminth infection, not malaria. There is no need to perform blood or urine examinations while caring for a client with malaria unless specifically instructed by the primary care provider.

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

"Do not drink alcohol while taking this medication." Because of the capacity for a disulfiram-like interaction (i.e., nausea, vomiting, headache, and chest pain), ingestion of metronidazole and alcohol should be separated by at least 1 day. To minimize possible GI irritation, metronidazole may be administered with meals. Suggest to patients who experience dry mouth that they may use sugar-free hard candies or ice chips to moisten the mouth. Sugar-containing products tend to promote dental caries in dry mouth, an environment that is already friendly to decay-causing organisms. All of the answers are important aspects of teaching for a patient who is going to be prescribed metronidazole, but the most important is not to drink alcohol while taking the medication.

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

"Have you drunk any water that might have been contaminated?" Giardiasis is transmitted by the ingestion of contaminated water or food. Trichomoniasis typically is transmitted by sexual intercourse with men who have no signs and symptoms of the infection. Malaria is transmitted by a mosquito bite. Family history of illness is relevant, but the main variable is intake of contaminated water.

A client is leaving for Africa in two weeks and has been prescribed chloroquine because of the prevalence of malaria in the region. What should the nurse teach the client about the safe and effective use of this medication? (Select all that apply.)

"Keep taking chloroquine for four weeks after you arrive back home." "Take a weekly dose of the drug until you leave on your trip." Chloroquine should be taken weekly for one to two weeks before traveling and continued for four weeks after travel. It should not be reserved solely for illness.

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

"Make sure you take your pill on the same day each week." For malaria prophylaxis, chloroquine is taken weekly. It is administered orally and may be taken with food. A rash is not expected and would necessitate further follow-up.

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

"Take the drug as a single dose with food." For giardiasis, tinidazole is taken as a single dose with food. Taking the drug for 3 consecutive days would be appropriate for the client with amebiasis. Metronidazole would be used for 5 to 10 days. Twice-daily dosing for 12 days would be appropriate for atovaquone as treatment for PCP.

A client who is receiving metronidazole therapy for trichomoniasis asks the nurse how this infection occurred. Which response by the nurse would be most appropriate?

"The infection is spread during sexual intercourse." Trichomoniasis is usually spread during sexual intercourse by men who have no signs and symptoms of the infection. A mosquito bite can transmit malaria. The common housefly is responsible for transmitting Chagas disease. Drinking contaminated water is associated with giardiasis.

The nurse caring for a client with Entamoeba histolytica infection explains to the client and family the mode of transmission of this amoeba. Which statement by the client indicates that an understanding of the teaching that was provided?

"This disease is spread from ingesting contaminated food." Amebiasis is most frequently caused by the microorganism Entamoeba histolytica, which is passed from host to host by the ingestion of fecally contaminated food or water.

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

"You'll have to take this drug each day, starting before you leave on your trip." Malarone is taken PO daily starting one to two days before exposure. It is not taken weekly. Adverse effects must be addressed but they do not necessarily mean that the client must discontinue the drug. Malarone prevents malaria.

A client who is planning to travel to Africa is prescribed chloroquine to prevent malaria. The nurse would instruct the client to begin the therapy at approximately which time?

10 days before trip Chloroquine is usually started 1 to 2 weeks before exposure and then continues for 4 weeks after leaving the area.

Amebiasis, an intestinal infection caused by Entamoeba histolytica, is often known as amebic dysentery. How many life cycles does the E. histolytica have?

2 Amebiasis, an intestinal infection caused by Entamoeba histolytica, is often known as amebic dysentery. E. histolytica has a two-stage life cycle. The organism exists in two stages: (1) a cystic, dormant stage, in which the protozoan can live for long periods outside the body or in the human intestine, and (2) a trophozoite stage in the ideal environment—the human large intestine.

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

2 The client's weight in kilograms is 37.5 kg. The prescribed dose is 40 mg/kg and 40 mg x 37.5 kg = 1500 mg. This yields the daily dose, and dividing it by 3 yields each individual dose of 500 mg. Providing this dose requires two 250-mg tablets.

Two weeks after returning from an overseas backpacking trip, a 23-year-old woman developed severe malaise and a high fever, prompting her physician to diagnose her with malaria and prescribe chloroquine. What nursing diagnosis should the nurse identify in the planning of this patient's care?

Acute Pain related to headache resulting from drug therapy Chloroquine frequently results in debilitating headaches. The drug typically causes diarrhea, not constipation. Impaired skin integrity and urinary incontinence are not common adverse effects of chloroquine therapy.

A client has been diagnosed with malaria and will begin treatment promptly. How can the nurse best attack the Plasmodium protozoa at the different stages of its life cycle?

Administer combination therapy as prescribed Antimalarial drugs are usually given in combination form to attack the Plasmodium at various stages of its life cycle. Using this approach, it is possible to prevent the acute malarial reaction in individuals who have been infected by the parasite. Antifungal have not therapeutic effect. Varying the time and dosage does not vary the effect on the protozoa's life cycle.

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

Administer combination therapy as prescribed Antimalarial drugs are usually given in combination form to attack the Plasmodium at various stages of its life cycle. Using this approach, it is possible to prevent the acute malarial reaction in individuals who have been infected by the parasite. Antifungal have not therapeutic effect. Varying the time and dosage does not vary the effect on the protozoa's life cycle.

A nurse is reviewing the health record of a client for whom antimalarial therapy is being proposed. The nurse should identify what aspect of the client's history as contraindicating the use of antimalarials?

Alcoholic liver disease A history of liver disease is a contraindication because of the parasitic invasion of the liver causing damage and the metabolism of the drug, which could further contribute to hepatotoxicity. Diabetes, hearing loss and atherosclerosis do not contraindicate the safe and effective use of antimalarials.

A client has been taking chloroquine for the treatment of malaria for the past 7 days. The client's hemoglobin level has declined from a baseline of 14.3 g/dL (143 g/L) to 7.9 g/dL (79 g/L) this morning. In addition to informing the provider, what is the nurse's best action?

Assess the client for further indications of hemolytic crisis. Some clients have a predisposition to hemolytic crisis, which causes a precipitous drop in red cell indices. This is unrelated to liver function or allergies. Sickle cell anemia is not associated with this adverse effect of chloroquine.

Which agent would a nurse identify as being most schizonticidal?

Chloroquine Chloroquine is considered a potent schizonticidal agent. Primaquine is considered a portent gametocytocidal agent. Primaquine and pyrimethamine are considered important prophylactic agents. Quinine is rarely used today to treat malaria.

Which statement made by a nurse indicates a need for further teaching concerning the medication chloroquine?

Chloroquine is used to prevent a recurrence of malaria. Chloroquine is a widely used antimalarial agent. It acts against erythrocytic forms of plasmodial parasites to prevent or treat malarial attacks. When used for prophylaxis, it is given before, during, and after travel or residence in endemic areas. When used for treatment of malaria, chloroquine relieves symptoms of the acute attack. However, the drug does not prevent recurrence of malarial attacks because it does not act against the tissue forms of the parasite.

Based on the client's history, the nurse suspects a client with Plasmodium falciparum malaria will have difficulty complying with pharmacotherapy if he has to take several different pills per day. What approach has the best potential to improve compliance?

Combination therapy Combination therapy can be helpful in improving compliance because there are fewer pills to take and the medications are taken less frequently. Prophylactic therapy would not be helpful because prophylactic doses tend to be smaller and would not treat an existing condition. Outpatient treatment is likely, but this setting does not enhance compliance in most cases. Dosing must be regularly-scheduled in order to be effective.

Which statement best reflects the use of antimalarial agents for treatment of the protozoan?

Combination therapy is used to attack the parasite at various life cycle stages. Antimalarial drugs are usually given in combination form to attack the parasite at various stages of its life cycle, thereby preventing the acute malarial reaction in individuals who have been infected with the parasite. Currently, chloroquine is the mainstay of antimalarial treatment. Quinine was the first drug found to be effective against malaria, but it is no longer available. Combination therapy is recommended because many strains of the parasite are developing resistance to chloroquine.

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

Communicate these assessment findings to the provider promptly. The combination of dizziness, tinnitus and nausea during primaquine treatment suggests cinchonism, which should be reported to the provider. The presence of tinnitus suggests adverse effects rather than a relapse. Adverse effects are not necessary worst near the end of treatment.

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

Confirm the client's knowledge of the medication regimen. This prescription is within recommended norms, so there is no need to question the order. Instead, the nurse should confirm that the client's familiarity with the regimen in order to provide any needed education. There is no need to assess the client for signs of malaria before the client has been exposed.

Amebiasis, an intestinal infection caused by Entamoeba histolytica, has two life cycles. Which stage is one of the cycles?

Cystic, dormant stage Amebiasis, an intestinal infection caused by Entamoeba histolytica, is often known as amebic dysentery. E. histolytica has a two-stage life cycle. The organism exists in two stages: (1) a cystic, dormant stage, in which the protozoan can live for long periods outside the body or in the human intestine, and (2) a trophozoite stage in the ideal environment—the human large intestine.

What pathologic change occurs in the body as a result of Plasmodium falciparum malaria and leads to death?

Destruction of red blood cells Because P. falciparum can destroy up to 60% of circulating red blood cells (RBCs) and induce serious adverse complications such as toxic encephalopathy, it is fatal in about 1% of all cases. That 1% accounts for more than 95% of all malaria-caused deaths worldwide.

With the emergence of chloroquine-resistant strains of Plasmodium, the Centers for Disease Control and Prevention recommends the use of quinine with an antibiotic as a combination therapy for the treatment of uncomplicated or severe malaria. What are the correct antibiotics to use? (Select all that apply.)

Doxycycline, Tetracycline, Clindamycin Doxycycline, tetracycline, and clindamycin are used as a combination therapy for the treatment of uncomplicated or severe malaria caused by chloroquine-resistant strains or uncomplicated malaria caused by strains with unknown resistance.

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

Encourage the client to use reliable contraception Antimalarials should not be used during pregnancy, so reliable contraception is necessary. The client and her husband do not necessary have to take the same medication and there is no notable effect on menstruation or the risk of fungal infections.

A client who is working in an area where malaria is endemic has been taking Malarone one tablet daily for prophylaxis for several months. The client has called the clinic to report loss of visual acuity to the nurse. What is the nurse's best action?

Have the client assessed by the provider immediately. Adverse effects involving vision must be promptly addressed. However, there is no immediate threat to the client's safety that would warrant calling 911. Instead, the client should be assessed by the care provider and referrals made as soon as possible. This adverse effect can be permanent and is not self-limiting. OTC eye drops are an insufficient response.

A client has tested positive for amebiasis and has been prescribed a course of metronidazole 750 mg PO t.i.d. for ten days. When planning this client's care, the nurse should address the possibility of what nursing diagnosis?

Imbalanced nutrition: Less than body requirements related to GI effects Metronidazole often causes nausea, vomiting and cramping. The presence of these effects over a ten-day course could create a risk for malnutrition. Respiratory status, GU function and cognition are not normally affected by metronidazole.

A client has been diagnosed with an amebiasis infection, and the primary health care provider has prescribed metronidazole. The client is also taking warfarin for blood clotting. Which is a possible interaction associated with taking metronidazole with warfarin?

Increases the risk of bleeding Combining warfarin with metronidazole increases the risk of bleeding. There is no risk of increased absorption, increased metabolism, or an increased risk of heart attack associated with taking warfarin and metronidazole.

A client, diagnosed with Trichomonas vaginalis, is being treated with metronidazole orally. What instruction is most important for the nurse to provide this client to minimize the spread of this infection?

Instruct her to have her partner treated. The client should be instructed that her partner should also be treated. Because trichomoniasis is transmitted by sexual intercourse, partners should be treated simultaneously to prevent reinfection. Although instruction on safe sexual practices is always important, it will not prevent reinfection, and the partner is infected asymptomatically. While the client should not drink while taking metronidazole, it has nothing to do with interfering with the spread of the infection. The woman should not double the dose if it is missed; that is a dangerous and noneffective method of attempting to minimize the spread of the infection.

A client receiving which agent should be instructed to avoid alcohol consumption?

Metronidazole A client should not consume alcohol if he or she is taking metronidazole or tinidazole. Interaction with alcohol is not associated with pentamidine, atovaquone, or nitazoxanide use.

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

Metronidazole (Flagyl) Adults and children older than 8 years of age with symptomatic giardiasis are usually treated with oral metronidazole. The administration of sulfasalazine is used to treat ulcerative colitis. Trimethoprim-sulfamethoxazole is used to treat urinary tract infections. Doxycycline is a tetracycline agent. It is not used for giardiasis.

A client is receiving chloroquine for a diagnosis of extra-intestinal amebiasis. The nurse should provide information on which medication that is likely to be administered with chloroquine?

Metronidazole (Flagyl) Chloroquine is used mainly for its antimalarial effects. When used as an amebicide, the drug is effective in extraintestinal amebiasis, but usually ineffective in intestinal amebiasis. Treatment is usually combined with an intestinal amebicide. Metronidazole is an intestinal amebicide. Iodoquinol is an iodine compound that acts against amebae in the intestinal lumen. Metyrosine is an enzyme inhibitor. Carbamazepine is an antiseizure medication.

What is one method that the nurse can teach community members to prevent many parasitic infections?

Personal and public hygiene practices Personal and public health hygienic practices can prevent many parasitic infections and should be followed diligently.

A patient has been diagnosed with amebiasis. Which intervention should the nurse perform regularly while caring for the patient?

Provide the patient with small, frequent meals The nurse should ensure that the patient has small, frequent meals (five to six daily) because these may be more appealing than three large meals. The nurse should take vital signs every four hours, not eight. Stool samples for testing should be maintained at room temperature and not frozen. There is no need to avoid foods that acidify the urine.

The nurse sees a female client in the clinic who has been taking chloroquine for the treatment of malaria. While the nurse measures vital signs, the client repeatedly rubs her eyes. When the nurse questions why, the client says, "I guess it's time for a trip to the ophthalmologist. My glasses don't seem to work very well and I'm having trouble with my vision." What should the nurse suspect?

Retinal damage as an adverse effect of medication Adverse effects of chloroquine include visual disturbances and retinal changes, so this client should be encouraged to see an ophthalmologist immediately to prevent further damage. Visual changes are less likely to result from glaucoma, cranial nerve damage or macular degeneration.

A student has presented to the college campus medical clinic and has been diagnosed with a helminthic infection. When planning this client's care, the nurse should include interventions to address what psychosocial nursing diagnosis?

Situational low self-esteem Helminthic infections are often a source of distress and embarrassment for clients, and their is a realistic risk of low self-esteem regarding the infection. Sorrow is a less likely response because it is usually associated with loss. Decisional conflict and denial less likely than a temporary reduction in self-esteem.

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

Taking the medication for 2 weeks before the trip and for 4 to 6 weeks after the trip People who plan to visit a malaria-endemic region should take chloroquine for 2 weeks before departure and should continue taking the drug for 4 to 6 weeks after returning home. Any other drug regimen may not be effective against malaria.

A female patient with giardiasis is taking oral metronidazole. After 3 weeks of therapy, she comes to the clinic for a checkup. Which would be the most important nursing action?

Test a stool specimen It would be most important for the nurse to test three stool specimens several days apart. Stool test results are good indicators of the success of metronidazole therapy. Discolored urine is a common adverse effect; the patient should not stop taking the drug. The nurse should also monitor for thrombophlebitis when metronidazole is administered intravenously. When the patient is on prolonged metronidazole therapy, the nurse may need to test visual acuity and recommend dental checkups.

Infections caused by protozoa are relatively rare in the United States, but with people moving throughout the world in increasing numbers, it is not unusual to find a person who returns home from travel with a fully developed protozoal infection. Which of the following areas are where protozoa infections are most prevalent? Select all that apply.

Thailand, Egypt, Columbia These illnesses are relatively rare in the United States, but with people moving throughout the world in increasing numbers, it is not unusual to find a person who returns home from a trip to Africa, Asia, or South America with a fully developed protozoal infection.

A client has made an appointment at a travel clinic seeking antimalarial prophylaxis. What aspect of the client health is most likely to contraindicate the use of antimalarials?

The client drinks eight to ten alcoholic drinks per day. Alcoholism contraindicates the safe use of antimalarials, and this client's alcohol intake is suggestive of alcoholism. Obesity, diabetes and an allergy to contrast solutions do not contraindicate their use.

A client is taking antiprotozoal medications to prevent a relapse of Plasmodium vivax malaria. The nurse is assessing the client during a scheduled follow-up appointment. What assessment finding suggests an increased risk for hepatotoxicity during antimalarial therapy?

The client is taking acetaminophen 1000 mg PO every four hours Concurrent use of other potentially hepatotoxic drugs can compound the risk of liver damage with antiprotozoals. Decreased fluid intake does not increase the risk, though the nurse should encourage fluid intake. Vitamin C is not hepatotoxic. Noncompliance decreases the efficacy of the medication but does not lead to liver damage.

The nurse is caring for a client who has just returned from an overseas trip and been diagnosed with malaria. When updating the client's provider on the client's current health status, what assessment finding should the nurse prioritize?

The client's sclerae are yellowed and the client reports pruritis Yellowed sclerae suggest liver damage, which must be addressed as a priority. The nurse must address the client's nutritional status, nausea, and headache but these are less acute safety risks. The client's urine quantity and character are not problematic.

A client will soon be leaving on a business trip to an area where malaria is endemic. The client has been prescribed mefloquine 250 mg PO weekly. What component of this order should the nurse question the prescriber about?

This order is within reference ranges for drug, dose, frequency and route. There is no apparent need for the nurse to question the prescriber about the order.

A nurse is providing education about tinidazole (Tindamax) to a client. What is a possible adverse effect?

Tindamax can cause a metallic or bitter taste. Tindamax, a chemical relative of metronidazole, is approved for the treatment of amebiasis, giardiasis, and trichomoniasis. It is metabolized in the liver and should be used cautiously in people with impaired liver function. The most common adverse effects are a metallic/bitter taste and nausea.

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

Tinnitus Cinchonism, due to high levels of primaquine, is manifested by nausea, vomiting, vertigo, and tinnitus. Fever, dyspepsia, and rash are adverse effects associated with antimalarial therapy; they are not associated with cinchonism.

While taking chloroquine for malaria prophylaxis, the nurse should likely encourage the client to avoid ingesting which food/beverage?

alcohol When chloroquine is combined with alcohol, the risk of GI distress increases. There is no particular need for this client to avoid soy, dietary fat, or unpeeled vegetables.

Laboratory testing has confirmed that a patient has chloroquine-resistant malaria and the patient's physician has prescribed quinine along with an adjunctive drug. The nurse should question the physician's order if the patient has a history of:

cardiac arrhythmias Patients with cardiac arrhythmias may be at risk for developing quinine-induced dysrhythmias and patients treated with quinine have shown prolonged Q-T intervals. Low bone density, diabetes, and COPD are not health problems that preclude the use of quinine in the treatment of chloroquine-resistant malaria.

Which drug is currently the mainstay of antimalarial therapy and is directly toxic to parasites that absorb it?

chloroquine Chloroquine is currently the mainstay of antimalarial therapy. This drug enters human red blood cells and changes the metabolic pathways necessary for the reproduction of the Plasmodium. In addition, this agent is directly toxic to parasites that absorb it; it is acidic, and it decreases the ability of the parasite to synthesize DNA, leading to a blockage of reproduction.

A male client is traveling to a country where malaria is endemic. The nurse suggests that he visit his health care provider and receive a prescription for what medication?

chloroquine Travelers to malarious regions should generally receive chloroquine to prevent malaria and take precautions to avoid or minimize exposure to the causative mosquito.

A group of nursing students and their professor are engaged in a service learning project and will be caring for clients in Haiti. What medication should be administered to prevent the development of malaria?

chloroquine phospate Chloroquine phosphate is administered to prevent malaria when traveling to the countries where malaria is a risk because of infected mosquitoes. Metronidazole is not administered to prevent malaria. Oprelvekin is used in the prevention of severe thrombocytopenia with antineoplastic chemotherapy. Chloroprocaine hydrochloride is a local anesthetic agent.

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

hookworms Ancylostoma duodenale and Necator americanus are the two types of hookworms that affect humans. This information identifies the other options as incorrect.

A client with amebiasis is to receive metronidazole. The client also takes warfarin for atrial fibrillation. The nurse would instruct the client to immediately report which symptom?

increased bleeding Metronidazole combined with oral anticoagulants can lead to increased bleeding, necessitating dosage adjustments with the anticoagulant. Abdominal cramps, ataxia, and peripheral neuropathy (as manifested by paresthesias) are adverse effects that are associated with antiprotozoal agents and are unrelated to the use of the warfarin.

Antimalarials are contraindicated in the presence of

lactation, liver disease or alcoholism, retinal disease or damage Antimalarials are contraindicated in the presence of known patient allergy to any of these drugs; liver disease or alcoholism, both because of the parasitic invasion of the liver and because of the need for the hepatic metabolism to prevent toxicity; and lactation because the drugs can enter breast milk and could be toxic to the infant. Another method of feeding the baby should be used if treatment is necessary. These drugs should be avoided during pregnancy because they are associated with birth defects. With mefloquine, which is teratogenic in preclinical studies, pregnancy should be avoided during and for 2 months after completion of therapy.

Losartan focuses on what aspect of the cardiac process to address the pathophysiology of heart failure?

lowering blood pressure Losartan potassium selectively blocks the binding of angiotensin II to specific tissue receptors found in the vascular smooth muscle and adrenal glands. This, in turn, blocks the vasoconstrictive effect of the renin-angiotensin system and the release of aldosterone, leading to a decrease in the client's blood pressure. Losartan is not focused on reducing preload or increasing either stroke volume or heart rate.

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

monitor the client closely for signs of bleeding. The combination of tinidazole and warfarin creates a risk for bleeding. There is no reason to believe the client has an increased risk of hypoglycemia, hyperglycemia, hypokalemia or hypotension.

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

trichomoniasis Metronidazole (Flagyl) is the prototype antiprotozoan drug for treating amebiasis, giardiasis, and trichomoniasis; the drug is not used for the treatment of PCP, malaria, or pediculosis.