Pharm quiz study guide - week 10

What is the MOST common drug used to treat oral candidiasis? Oseltamivir (Tamiflu) Griseofulvin (Fulvicin P/G) Amantadine (Symmetrel) Nystatin (Mycostatin

Nystatin (Mycostatin) Nystatin is an antifungal drug that is used for a variety of candidal infections. It is applied topically as a cream, ointment, or powder. It is also available as a troche and an oral liquid or tablet

The nurse is teaching a patient who is starting antitubercular therapy with rifampin. Which adverse effects would the nurse expect to see? a. Headache and neck pain b. Gynecomastia c. Reddish brown urine d. Numbness or tingling of extremities

Answer: C

Explain how to evaluate effectiveness of treatment regime.

By the decrease of symptoms, negative blood smears, and negative x-rays.

The nurse has provided education to a client about fungal skin infection. Further client teaching is necessary when the client includes which condition in the discussion of fungal skin infections? Impetigo Vaginal yeast infection Athlete's foot Thrush

Impetigo Impetigo is a bacterial skin infection and would not be classified as a fungal skin infection. If the client included this in the discussion, further teaching is needed. All other skin infections listed are fungal and would be treated with antifungal medications.

List common infection sites (note primary site).

Lungs primary, can then be passed to other locations such as GI, GU, etc.

Describe how the tubercle bacilli spread.

Passed to others via airborne through cough or breathing the same air.

When admitting a client to a medical-surgical unit with a diagnosis of Pneumocystis jirovecii pneumonia, the nurse will anticipate administering which medication? Pentamidine (Pentam) Paromomycin (Humatin) Iodoquinol (Yodoxin) Albendazole (Albenza)

Pentamidine (Pentam) Iodoquinol and paromomycin are used to treat intestinal amebiasis, and albendazole is used to treat helminthic infections.

The nurse is providing education to a client who is prescribed metronidazole (Flagyl) for trichomoniasis. What client statement indicates that the client understood the teaching? "I won't get this again because I have had it once." "I will have my partner evaluated and treated." "I will stop taking the medication when the discharge stops." "I can continue to have intercourse as long as we use condoms."

"I will have my partner evaluated and treated." Inform the client taking metronidazole for a sexually transmitted infection to avoid sexual intercourse until the prescriber states otherwise. The partner, and any sexual partners possibly exposed, need to be evaluated and treated if positive. All other statements would require further teaching by the nurse.

Which client statement indicates to the nurse that the client understands the discharge teaching for ethambutol (Myambutol)? "Constipation will be a problem, so I will increase the fiber in my diet." "This medication may cause my bodily secretions to turn red-orange-brown." "Dizziness and drowsiness are common adverse effects with this drug." "I will need to have my vision checked periodically while I am taking this drug.

"I will need to have my vision checked periodically while I am taking this drug." Ethambutol can cause optic neuritis. Ophthalmologic examinations should be performed periodically to assess visual acuity.

Discuss diagnostic tests.

*PPD - Mantoux skin test checked 48-72 hours later for induration generally over 10mm (sometimes under 5mm for people from out of the country) *X-ray of lungs looking for lesions in the lungs. *Acid fast bacilli smear (AFB) x3 - the need of a true specimen can be obtained through deep suction if can not cough up a specimen.

Discuss patient teaching for a patient being treated for TB.

-How transmission of TB occurs, how to prevent spreading it. -Difference between LTBI to active TB -Signs & symptoms to be aware of -Importance of respiratory isolation & use of masks -Infection period and how it starts 3 months prior to symptoms occurring. -medications used, side effects, testing, precautions, & toxicity

When assessing for adverse effects to Rifamate (combination isoniazid and rifampin), the nurse would monitor which laboratory values? (Select all that apply.) • Liver function tests • Complete blood cell count • Sputum cultures • Uric acid levels • Cholesterol

-Liver function tests -Complete blood cell count Rifamate can lead to impairment of liver function as well as hematologic disorders. Assessment of sputum cultures confirms the diagnosis but is not related to adverse effects. The drug does not affect uric acid levels or cholesterol.

When preparing to administer an intravenous (IV) infusion of metronidazole (Flagyl), the nurse will anticipate infusing the medication over how many minutes? 30 to 60 5 to 10 15 to 30 1 to 5

30 to 60 Infuse IV doses of metronidazole as prescribed and generally are to infuse over 30 to 60 minutes and never as an IV bolus.

.A patient will be taking fluconazole (Diflucan) 100 mg/day PO for 2 weeks. The patient is unable to swallow tablets, so an oral suspension that contains 10 mg/mL is available. Identify how many milliliters will the nurse administer with each dose.

ANS: (10 xx) = (1 x 100); 10x= 10mL.

1. During an intravenous (IV) infusion of amphotericin B, a patient develops tingling and numbness in his toes and fingers. What will the nurse do first? a. Discontinue the infusion immediately. b. Reduce the infusion rate gradually until the adverse effects subside. c. Administer the medication by rapid IV infusion to reduce these effects. d. Nothing; these are expected side effects of this medication.

ANS: A Once the intravenous infusion of amphotericin B has begun, vital signs must be monitored frequently to assess for adverse reactions such as cardiac dysrhythmias, visual disturbances, paresthesias (numbness or tingling of the hands or feet), respiratory difficulty, pain, fever, chills, and nausea. If these adverse effects or a severe reaction occur, the infusion must be discontinued (while the patient is closely monitored) and the prescriber contacted. The other options are incorrect.

treatment with which medication for this pneumonia? a. Ivermectin (Stromectol) b. Atovaquone (Mepron) c. Praziquantel (Biltricide) d. Metronidazole (Flagyl)

ANS: B Pentamidine and atovaquone are used for the treatment of pneumonia caused by P. jirovecii. The other options are not used for this pneumonia.

6. A patient with an intestinal infection that is positive for the Giardia lamblia organism will be taking an antiprotozoal drug. The nurse will include which information in the teaching plan for this patient? a. The urine may become dilute and pale during therapy. b. Taking the medications with food reduces gastrointestinal upset. c. The medications should be taken on an empty stomach. d. The drugs may be discontinued once the diarrhea subsides.

ANS: B Taking these drugs with food reduces gastrointestinal upset. Antiprotozoal drugs may cause the urine to turn dark. These drugs should be administered for the prescribed length of time to ensure complete eradication of the infection.

A patient has received a prescription for a 2-week course of antifungal suppositories for a vaginal yeast infection. She asks the nurse if there is an alternative to this medication, saying, 'I don't want to do this for 2 weeks!" Which is a possibility in this situation? A. A single dose of a vaginal antifungal cream. B. A one-time infusion of amphotericin B. C. A single dose of a fluconazole (Diflucan) oral tablet. D. There is no better alternative to the suppositories.

ANS: C A single oral dose of fluconazole may be used to treat vaginal candidiasis. The other options are incorrect.

A patient is infected by invasive aspergillosis, and the medical history reveals that the patient has not been able to tolerate several antifungal drugs. The nurse anticipates an order for which medication to treat this infection? A. Fluconazole (Diflucan) B. Micafungin (Mycamine) C. Caspofungin (Cancidas) D. Nystatin (Mycostatin)

ANS: C Caspofungin is used for treating severe infection by Aspergillus species (invasive aspergillosis) in patients who are intolerant of or refractory to other drugs.

5. A patient has been taking antitubercular therapy for 3 months. The nurse will assess for what findings that indicate a therapeutic response to the drug therapy? a. The chronic cough is gone. b. There are two consecutive negative purified protein derivative (PPD) results over 2 months. c. There is increased tolerance to the medication therapy, and there are fewer reports of adverse effects. d. There is a decrease in symptoms of tuberculosis along with improved chest x-rays and sputum cultures.

ANS: D A therapeutic response to antitubercular therapy is manifested by a decrease in the symptoms of tuberculosis, such as cough and fever, and by weight gain. The results of laboratory studies (culture and sensitivity tests) and the chest radiographic findings will be used to confirm the clinical findings of resolution of the infection.

8. A patient is experiencing the exoerythrocytic phase of malaria. The nurse expects which drug to be used for this patient? a. Quinine b. Chloroquine (Aralen) c. Mefloquine (Lariam) d. Primaquine

ANS: D Primaquine is one of the few antimalarial drugs that can destroy the malarial parasites while they are in their exoerythrocytic phase. The other drugs are effective during the erythrocytic, or blood, phase.

The nurse needs to know that major adverse effects are MOST common by which drug? Griseofulvin (Fulvicin P/G) Ketoconazole (Nizoral) Amphotericin B (Amphocin) Fluconazole (Diflucan)

Amphotericin B (Amphocin) The major adverse effects caused by antifungal drugs are encountered most commonly in conjunction with amphotericin B treatment. Drug interactions and hepatotoxicity are the primary concerns in clients receiving other antifungal drugs, but the IV administration of amphotericin B is associated with a multitude of adverse effects.

A client, who weighs 45.4 kg, is prescribed pyrantel (Pin-X) for a roundworm infection. The dosage is 11 mg/kg in one single dose to a maximum of 1 g. What is the appropriate dosage for this client?

Answer: 499 mg (45.4 kg × 11 mg/kg = 499.4 mg, which rounds to 499 mg)

During an infusion of amphotericin B, the nurse knows that which administration technique may be used to minimize infusion-related adverse effects? a. Forcing of fluids during the infusion b. Infusing the medication quickly c. Infusing the medication over a longer period of time d. Stopping the infusion for 2 hours after half of the bag has infused, and then resuming 1 hour later

Answer: C

When monitoring a patient who is receiving caspofungin, the nurse will look for which serious adverse effects? (Select all that apply.) a. Blood dyscrasias b. Hypotension c. Pulmonary infiltrates d. Tinnitus e. Hepatotoxicity

Answer: a, b, e,

The nurse would question a prescription for voriconazole (Vfend) if the client was taking which medication? Prednisone (Deltasone) Quinidine Clindamycin (Cleocin) Captopril (Capoten)

Quinidine The nurse would question a prescription for quinidine because both voriconazole and quinidine are metabolized by the cytochrome P-450 enzyme system. The drugs will compete for the limited number of enzymes, and one of the drugs will end up accumulating.

Explain how to read Mantoux test (PPD).

Read 48-72 hours after administered. Checked by induration of 10 mm or larger.

Explain multi-drug resistant tuberculosis.

Resistant to a majority of drugs. Generally, this occurs because patients do not finish antibiotic treatment and later comes back two-fold w/ resistance factors. So, it may take two synergetic drugs or broad spectrum strong medications.

A client visits the health care provider for treatment of tinea pedis (athlete's foot). Which medication would the nurse MOST likely instruct the client to take to treat this condition? Voriconazole (Vfend) Caspofungin (Cancidas) Amphotericin B (Amphocin) Terbinafine (Lamisil)

Terbinafine (Lamisil) Terbinafine (Lamisil) is classified as an allylamine antifungal drug and is currently the only drug in its class. It is available in a topical cream, gel, and spray for treating superficial dermatologic infections, including tinea pedis (athlete's foot), tinea cruris (jock itch), and tinea corporis (ringworm).

Discuss the characteristics of the tubercle bacilli:

The bacilli are 2-4 um in length and have a very slow generation time of between 15 and 20 hours. The cell wall of the mycobacterium is unique in that it is composed mainly of acidic waxes, specifically mycolic acids. They are a nonmotile, acid-fast, obligate aerobe. "the active lung infection"

The nurse would question a prescription for chloroquine (Aralen) in a client also prescribed which medication? Doxycycline (Doryx) Valproic acid (Depakote) Diazepam (Valium) Clindamycin (Cleocin)

Valproic acid (Depakote) Concurrent use of chloroquine with valproic acid may reduce serum drug levels of valproic acid and thus increase the risk of seizure activity. Chloroquine may be given concurrently with clindamycin or doxycycline for synergistic actions.

Explain use of BCG.

BCG, or bacille Calmette-Guerin, is a vaccine for tuberculosis (TB) disease. BCG is used in many countries with a high prevalence of TB to prevent childhood tuberculous meningitis and miliary disease. It will not prevent Tb but will help with the severity of the case. It will also cause a false positive with PPD, will need a chest x-ray.

The nurse anticipates a prescription for vitamin supplementation for a client who is receiving isoniazid (Nydrazid) therapy. What vitamin supplement is usually prescribed with isoniazid? Vitamin E Calcium Vitamin B6 Folate

Vitamin B6 Pyridoxine (vitamin B6) is often given concurrently with isoniazid to prevent the adverse effect of isoniazid induced peripheral neuropathy associated with neurotoxicity.

3. When monitoring patients on antitubercular drug therapy, the nurse knows that which drug may cause a decrease in visual acuity? a. Rifampin (Rifadin) b. Isoniazid (INH) c. Ethambutol (Myambutol) d. Streptomycin

C Ethambutol may cause a decrease in visual acuity or even blindness resulting from retrobulbar neuritis. The other options are incorrect.

What is the MOST important action for the nurse to complete before administration of intravenous (IV) amphotericin B? Monitor for cardiac dysrhythmias. Assess for nausea and vomiting. Monitor IV site for signs of phlebitis. Check for premedication prescriptions.

Check for premedication prescriptions. Almost all clients given IV amphotericin B experience fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache. Pretreatment with an antipyretic, antihistamine, and antiemetic can minimize or prevent these adverse reactions. The other choices are appropriate nursing actions after the IV infusion has begun.

A nurse is caring for a client diagnosed with malaria. What drug would the nurse expect to be prescribed? Pentamidine (Pentam) Penicillin Chloroquine (Aralen) Metronidazole (Flagyl)

Chloroquine (Aralen) Chloroquine is a standard drug used for the treatment of malaria in an acute stage.

When a client is receiving an IV infusion of metronidazole (Flagyl), what adverse effect would the nurse immediately report to the health care provider? Elevated blood pressure Dark colored urine Diminished breath sounds Dizziness or confusion

Dizziness or confusion During use of this drug, metronidazole administered intravenously, report to the health care provider any changes in neurologic status (e.g., dizziness, confusion).

What instruction should the nurse include for a client prescribed rifampin (Rifadin) and isoniazid (Nydrazid) prophylactically secondary to TB exposure? Remind that sunscreen is not needed during outdoor activities. Explain that isoniazid may decrease blood serum glucose in susceptible people. Emphasize that oral contraceptives become ineffective when given with rifampin. Advise that these drugs will only need to be taken for 7 to 10 days.

Emphasize that oral contraceptives become ineffective when given with rifampin.

Explain dormancy in mycobacterium tuberculosis.

latent tuberculosis infection, in which the bacteria exist in a non-replicative state, 2-5 years before presents symptoms.

2. A patient has an infestation with flukes. The nurse anticipates the use of which drug to treat this infestation? a. Praziquantel (Biltricide) b. Pyrantel (Pin-X) c. Metronidazole (Flagyl) d. Ivermectin (Stromectol)

ANS: A Praziquantel is an anthelmintic that is used to kill flukes. Metronidazole is used to treat protozoal infections. The other drugs listed are used for other helminthic infestations.

During therapy with amphotericin B, the nurse will monitor the patient for known adverse effects that would be reflected by which laboratory result? a. Serum potassium level of 2.7 mEq/L b. Serum potassium level of 5.8 mEq/L c. White blood cell count of 7000 cells/mm3 d. Platelet count of 300,000/ microliter

ANS: A The nurse needs to monitor for hypokalemia, a possible adverse effect of amphotericin B. The other options are incorrect.

Hydroxychloroquine (Plaquenil) is prescribed as part of malaria prophylaxis for a patient who will be traveling. The nurse will discuss which potential adverse effects with the patient? (Select all that apply.) a. Diarrhea b. Constipation c. Insomnia d. Dizziness e. Rash f. Headache

ANS: A, D, E, F Diarrhea, anorexia, nausea, vomiting, dizziness, rash, and headache are potential adverse effects of hydroxychloroquine. See Table 43-1 for other common adverse effects. The other options are not adverse effects of this drug.

A patient is being evaluated for a possible helminthic infection. The nurse knows that which statement about anthelmintic therapy is true? A. The drugs may cause severe drowsiness. B. Anthelmintics are very specific in their actions. C. Anthelmintics are effective against broad classes of infestations. D. The drugs are used to treat protozoal infections such as intestinal amebiasis.

ANS: B Anthelmintics are very specific in their actions, and it is important to identify the cause of the infestation before beginning treatment. They are not used to treat protozoal infections, and they do not cause severe drowsiness.

If a patient is taking fluconazole (Diflucan) with an oral anticoagulant, the nurse will monitor for which possible interaction? a. Reduced action of oral anticoagulants b. Increased effects of oral anticoagulants c. Hypokalemia d. Decreased effectiveness of the antifungal drug

ANS: B Azole antifungal drugs increase the effects of oral anticoagulants. As a result, increased bleeding may occur. The other options are incorrect.

A patient is taking nystatin (Mycostatin) oral lozenges to treat an oral candidiasis infection resulting from inhaled corticosteroid therapy for asthma. Which instruction by the nurse is appropriate? a. "Chew the lozenges until they are completely dissolved." b. "Let the lozenge dissolve slowly and completely in your mouth without chewing it. " c. "Rinse your mouth with water before taking the inhaler." d. "Rinse your mouth with mouthwash after taking the inhaler."

ANS: B Nystatin may be given orally in the form of lozenges, or troches, which need to be slowly and completely dissolved in the mouth for optimal effects; tablets are not to be chewed or swallowed whole. The other options are incorrect. Patients taking an inhaled corticosteroid must rinse their mouths with water thoroughly after taking the inhaler.

The nurse is preparing to administer morning medications to a patient who has been newly diagnosed with tuberculosis. The patient asks, "Why do I have to take so many different drugs?" Which response by the nurse is correct? e. "Your prescriber hopes that at least one of these drugs will work to fight the tuberculosis.' f. "Taking multiple drugs reduces the chance that the tuberculosis will become drug resistant. " g. "Using more than one drug can help to reduce side effects." h. "Using multiple drugs enhances the effect of each drug."

ANS: B The use of multiple medications reduces the possibility that the organism will become drug resistant. The other options are incorrect.

6. A patient with a severe fungal infection has orders for voriconazole (Vfend). The nurse is reviewing the patient's medical record and would be concerned if which assessment finding is noted? a. Decreased breath sounds in the lower lobes b. History of cardiac dysrhythmias c. History of type 2 diabetes d. Potassium level of 4.0 mEq/L

ANS: B Voriconazole is contraindicated when co-administered with certain other drugs metabolized by the cytochrome P-450 enzyme 3A4 (e.g., quinidine) because of the risk for inducing serious cardiac dysrhythmias.

The nurse is administering an amphotericin B infusion. Which actions by the nurse are appropriate? (Select all that apply.) a. Administering the medication by rapid IV infusion b. Discontinuing the drug immediately if the patient develops tingling and numbness in the extremities c. If adverse effects occur, reducing the IV rate gradually until they subside d. Using an infusion pump for IV therapy e. Monitoring the IV site for signs of phlebitis and infiltration f. Administering premedication for fever and nausea g. Knowing that the intravenous solution for amphotericin B will be cloudy h. Knowing that muscle twitching may indicate hypokalemia

ANS: B, D, E, F If the patient develops tingling and numbness in the extremities (paresthesias), discontinue the drug immediately. An infusion pump is necessary for the infusion, and the nurse will monitor the IV site for signs of phlebitis and infiltration. Premedication to reduce the adverse effects of fever, malaise, and nausea may be ordered. The IV solution must be clear and without precipitates; and muscle weakness, not twitching, may indicate hypokalemia. The medication must be administered at the rate recommended and stopped, not slowed, if adverse reactions occurs.

The nurse is providing patient teaching for a patient who is starting antitubercular drug therapy. Which of these statements should be included? (Select all that apply.) a. 'Take the medications until the symptoms disappear." b. 'Take the medications at the same time every day." c. "You will be considered contagious during most of the illness and must take precautions to avoid spreading the disease." d. "Stop taking the medications if you have severe adverse effects." e. "Avoid alcoholic beverages while on this therapy." "If you notice reddish-brown or reddish-orange urine, stop taking the drug and contact your doctor right away." g. "If you experience a burning or tingling in your fingers or toes, report it to your prescriber immediately." h. "Oral contraceptives may not work while you are taking these drugs, so you will have to use another form of birth control."

ANS: B, E, G, H Medications for tuberculosis must be taken on a consistent schedule to maintain blood levels. Medication therapy for tuberculosis may last up to 24 months, long after symptoms disappear, and patients are infectious during the early part of the treatment. Compliance with antitubercular drug therapy is key, so if symptoms become severe, the prescriber should be contacted for an adjustment of the drug therapy. The medication must not be stopped. Because of potential liver toxicity, patients on this drug therapy must not drink alcohol. Discoloration of the urine is an expected adverse effect, and patients need to be warned about it beforehand. Burning or tingling in the fingers or toes may indicate that peripheral neuropathy is developing, and the prescriber needs to be notified immediately. A second form of birth control must be used because antitubercular drug therapy makes oral contraceptives ineffective.

1. A patient who has a helminthic infection has a prescription for pyrantel (Antiminth). Which is one of the common adverse effects that the patient may experience while on this therapy? a. Vertigo b. Seizures c. Diarrhea d. Insomnia

ANS: C Diarrhea and abdominal pain are some of the possible gastrointestinal effects of pyrantel. See Table 43-11 for other adverse effects. The other options are incorrect.

7. A patient who has started drug therapy for tuberculosis wants to know how long he will be on the medications. Which response by the nurse is correct? a. "Drug therapy will last until the symptoms have stopped.' b. "Drug therapy will continue until the tuberculosis develops resistance." c. "You should expect to take these drugs for as long as 24 months." d. "You will be on this drug therapy for the rest of your life."

ANS: C Drug therapy commonly lasts for 24 months if consistent drug therapy has been maintained. The other options are incorrect.

7. The nurse is reviewing antimalarial drug therapy with a patient and instructs the patient to watch for and report which potential adverse reactions? a. Drowsiness b. Insomnia c. Visual disturbances d. Constipation

ANS: C Encourage the patient to contact the prescriber if there is unresolved nausea, vomiting, profuse diarrhea, or abdominal pain and to report immediately any visual disturbances, dizziness, or respiratory difficulties.

9. A patient is receiving hydroxychloroquine therapy but tells the nurse that she has never traveled out of her city. The nurse knows that a possible reason for this drug therapy is which condition? a. Lyme disease b. Toxoplasmosis c. Systemic lupus erythematosus d. Intestinal tapeworms

ANS: C Hydroxychloroquine, which is used for malaria, also possesses anti-inflammatory actions and has been used to treat rheumatoid arthritis and systemic lupus erythematosus. The other options are incorrect.

The nurse is administering one of the lipid formulations of amphotericin B. When giving this drug, which concept is important to remember? a. The lipid formulations may be given in oral form. b. The doses are much lower than the doses of the older drugs. c. The lipid formulations are associated with fewer adverse effects than the older drugs. d. There is no difference in cost between the newer and older forms.

ANS: C Newer lipid formulations of amphotericin B have been developed in an attempt to decrease the incidence of its adverse effects and increase its efficacy. However, the lipid formulations are more costly.

A patient who has been taking isoniazid (INH) has a new prescription for pyridoxine. She is wondering why she needs this medication. The nurse explains that pyridoxine is often given concurrently with the isoniazid to prevent which condition? a. Hair loss b. Renal failure c. Peripheral neuropathy d. Heart failure

ANS: C Pyridoxine (vitamin B6) may be beneficial for isoniazid-induced peripheral neuropathy. The other options are incorrect.

6. The nurse is reviewing the medication administration record of a patient who is taking isoniazid (INH). Which drug or drug class has a significant drug interaction with isoniazid? a. Pyridoxine (vitamin B6) b. Penicillins c. Phenytoin (Dilantin) d. Benzodiazepines

ANS: C Taking INH with phenytoin will cause decreased metabolism of the phenytoin, leading to increased drug effects. Pyridoxine is often given with isoniazid to prevent peripheral neuropathy. The other options are incorrect.

The nurse is counseling a woman who will be starting rifampin (Rifadin) as part of antitubercular therapy. The patient is currently taking oral contraceptives. Which statement is true regarding rifampin therapy for this patient? e. Women have a high risk for thrombophlebitis while on this drug. f. A higher dose of rifampin will be necessary because of the contraceptive. g. Oral contraceptives are less effective while the patient is taking rifampin. h. The incidence of adverse effects is greater if the two drugs are taken together.

ANS: C Women taking oral contraceptives and rifampin need to be counseled about other forms of birth control because of the impaired effectiveness of the oral contraceptives during concurrent use of rifampin.

The nurse is preparing an infusion of amphotericin B for a patient who has a severe fungal infection. Which intervention is appropriate regarding the potential adverse effects of amphotericin B? A. Discontinuing the infusion immediately if fever, chills, or nausea occur B. Gradually increasing the infusion rate until the expected adverse effects occur C. If fever, chills, or nausea occur during the infusion, administering medications to treat the symptoms D. Before beginning the infusion, administering an antipyretic and an antiemetic drug

ANS: D Almost all patients given the drug intravenously experience fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache. For this reason, pretreatment with an antipyretic (acetaminophen), antihistamines, and antiemetics may be conducted to decrease the severity of the infusion-related reaction. The other options are incorrect.

5. The nurse is reviewing instructions for vaginal antifungal drugs with a patient. Which statement by the nurse is an appropriate instruction regarding these drugs? a. "The medication can be stopped when your symptoms are relieved. " b. "Discontinue this medication if menstruation begins." c. "Daily douching is part of the treatment for vaginal fungal infections." d. "Abstain from sexual intercourse until the treatment has been completed and the infection has resolved.'

ANS: D Female patients taking antifungal medications for the treatment of vaginal infections need to abstain from sexual intercourse until the treatment has been completed and the infection has resolved. The medication needs to be taken for as long as prescribed. Instruct patients to continue to take the medication even if they are actively menstruating. Douching is not an appropriate intervention.

1. The nurse is discussing adverse effects of antitubercular drugs with a patient who has active tuberculosis. Which potential adverse effect of antitubercular drug therapy should the patient report to the prescriber? a. Gastrointestinal upset b. Headache and nervousness c. Reddish-orange urine and stool d. Numbness and tingling of extremities

ANS: D Patients on antitubercular therapy should report experiencing numbness and tingling of extremities, which may indicate peripheral neuropathy. Some drugs may color the urine, stool, and other body secretions reddish-orange, but this is not an effect that needs to be reported. Patients need to be informed of this expected effect. The other options are incorrect.

A woman is traveling to a country where she will be at high risk for malarial infection. What will the nurse teach her regarding prophylactic therapy with hydroxychloroquine (Plaquenil)? a. Hydroxychloroquine is better absorbed and has fewer adverse effects if taken on an empty stomach. b. The drug is started 3 weeks before exposure but can be discontinued once she leaves the area. c. The medication is taken only when she observes mosquito bites because it can have toxic effects if taken unnecessarily. d. The drug is usually started 1 to 2 weeks before traveling to endemic areas and is continued for 4 weeks after leaving the area

ANS: D Prophylaxis of malaria with hydroxychloroquine is usually started I to 2 weeks before exposure and continued for 4 weeks after the person has left the area. The medication should be taken with food to decrease gastrointestinal upset.

2. The nurse will assess the patient for which potential contraindication to antitubercular therapy? a. Glaucoma b. Anemia c. Heart failure d. Hepatic impairment

ANS: D Results of liver function studies (e.g., bilirubin level, liver enzyme levels) need to be assessed because isoniazid and rifampin may cause hepatic impairment; severe liver dysfunction is a contraindication to these drugs. In addition, the patient's history of alcohol use needs to be assessed.

A patient newly diagnosed with tuberculosis (TB) has been taking antitubercular drugs for 1 week calls the clinic and is very upset. He says, "My urine is dark orange! What's wrong with me?" Which response by the nurse is correct? a. "You will need to stop the medication, and it will go away." b. "It's possible that the TB is worse. Please come in to the clinic to be checked." c. "This is not what we usually see with these drugs. Please come in to the clinic to be checked.' d. "This is an expected side effect of the medicine. Let's review what to expect."

ANS: D Rifampin, one of the first-line drugs for TB, causes a red-orange-brown discoloration of urine, tears, sweat, and sputum. Patients need to be warned about this side effect. The other options are incorrect.

3. A patient who is being treated for malaria has started therapy with quinine and tetracycline. He asks the nurse why he is on an antibiotic when malaria is caused by a parasite. Which response by the nurse is correct? a. "The tetracycline prevents reinfection by the malarial parasite." b. "The antibiotic is combined with quinine to reduce the side effects of the quinine." c. "An antibacterial drug prevents the occurrence of superinfection during antimalarial therapy." d. "The two drugs are more effective against malaria when given together."

ANS: D The combination of quinine and tetracycline takes advantage of their synergistic protozoacidal effects. The other responses are incorrect.

The order reads, "Give nystatin (Mycostatin) suspension, 500,000 units by mouth (swish and swallow) 4 times a day for 1 week." The medication is available in a suspension of 100,000 units per mL. How many milliliters will the nurse give per dose?

Answer: 5 mL

A patient with Pneumocystis jirovecii pneumonia will be receiving pentamidine (Pentam 300) as an intravenous piggyback (IVPB) dose. The medication has been added to a 100-mL bag of D5W for the infusion, and it needs to infuse over 120 minutes. The nurse will set the infusion pump to infuse at what rate for this IVPB medication?

Answer: 50 mL/hr. First, convert 120 minutes to hours because the pump will infuse at milliliters per hour rate. 120 minutes x (1 hour/60minutes) = 2 hours. 100 mL / 2 hours = 50 mL/hr.

A 5-year-old patient has been diagnosed with malaria after returning from an overseas trip. The patient is to receive one dose of mefloquine (Lariam), 25 mg/kg PO. The child weighs 44 lb. How much mefloquine will this child receive?

Answer: 500 mg

The order for isoniazid (INH) reads: "Give 5 mg/kg PO daily." The patient weighs 275 pounds. What is the amount per dose? Is this a safe dose?

Answer: 625 mg/dose; no, maximum dose is 300 mg

The nurse is teaching a client who is preparing to travel to a malarious country about the prophylactic medication chloroquine (Aralen). The nurse would instruct the client to take this drug for how long after leaving the affected area? 12 weeks 8 weeks 4 weeks 2 weeks

Answer: 8 weeks Treatment for malaria prophylaxis is usually started 2 weeks before travel and continues for 8 weeks after travel is completed.

Bedaquiline (Sirturo) is prescribed for a patient, and the nurse is providing instructions to the patient about the medication. Which statement by the patient indicates a correct understanding of the instructions? a. "I will take this with food." b. "I need to take this 1 hour before breakfast." c. "I can stop this drug if the side effects bother me." d. "It's okay to have a glass of wine while taking this drug."

Answer: A

Before administering antiprotozoal drugs, the nurse will review which baseline assessment? a. Complete blood count b. Serum magnesium level c. Creatinine clearance d. Arterial blood gas concentrations

Answer: A

The nurse is counseling a woman who is beginning antitubercular therapy with rifampin. The patient also takes an oral contraceptive. Which statement by the nurse is most accurate regarding potential drug interactions? a. "You will need to switch to another form of birth control while you are taking the rifampin." b. "Your birth control pills will remain effective while you are taking the rifampin." c. "You will need to take a stronger dose of birth control pills while you are on the rifampin." d. "You will need to abstain from sexual intercourse while on the rifampin to avoid pregnancy."

Answer: A

The nurse knows that antimalarial drugs are used to treat patients with infections caused by which microorganism? a. Plasmodium spp. b. Candida albicans c. Pneumocystis jirovecii d. Mycobacterium

Answer: A

What information should the nurse provide to a client prescribed rifampin (Rifadin)? Peripheral neuropathy is an expected side effect, and the patient should report any numbness or tingling of the extremities. Oral contraception is the preferred method of birth control when using rifampin. A nonharmful adverse effect of this medication is red-orange discoloration of urine, sweat, tears, skin, salvia, and feces. The patient will only need to take this medication for the prescribed 14-day period.

Answer: A nonharmful adverse effect of this medication is red-orange discoloration of urine, sweat, tears, skin, salvia, and feces. Red-orange-brown discoloration of the skin, sweat, tears, urine, feces, sputum, saliva, and tongue as an adverse effect of the drug, but it is not harmful. Rifampin does not cause peripheral neuropathies (isoniazid does), but it does interfere with the effectiveness of oral contraceptives. All antitubercular drugs need to be taken long term to eradicate the slow-growing mycobacterium lying deep within the tissues

When giving metronidazole, the nurse implements appropriate administration techniques, including which of these? (Select all that apply.) a. Giving oral forms with food b. Giving oral forms on an empty stomach with a full glass of water c. Infusing intravenous doses over 30 to 60 minutes d. Administering intravenous doses by bolus over 5 minutes e. Obtaining ordered specimens before starting the medication

Answer: A, C, E

. Praziquantel (Biltricide) is prescribed for a patient with a tapeworm infection. The nurse prepares to administer the medication via which route? a. Rectal b. Oral c. Intravenous d. Inhalation

Answer: B

During antitubercular therapy with isoniazid, a patient received another prescription for pyridoxine. Which statement by the nurse best explains the rationale for this second medication? a. "This vitamin will help to improve your energy levels." b. "This vitamin helps to prevent neurologic adverse effects." c. "This vitamin works to protect your heart from toxic effects." d. "This vitamin helps to reduce gastrointestinal adverse effects."

Answer: B

The nurse is assessing a patient who is about to receive antifungal drug therapy. Which problem would be of most concern? a. Endocrine disease b. Hepatic disease c. Cardiac disease d. Pulmonary disease

Answer: B

When teaching a patient about the potential drug interactions with antiprotozoal drugs, the nurse will include information about: a. acetaminophen. b. warfarin. c. decongestants. d. antibiotics.

Answer: B

When teaching a patient who is taking nystatin lozenges for oral candidiasis, which instruction by the nurse is correct? a. "Chew the lozenge carefully before swallowing." b. "Dissolve the lozenge slowly and completely in your mouth." c. "Dissolve the lozenge until it is half the original size, and then swallow it." d. "These lozenges need to be swallowed whole with a glass of water."

Answer: B

Which teaching point would be appropriate to include when the nurse is informing a patient about the adverse effects of antimalarials? a. The skin may turn blotchy while these medications are taken. b. These medications may cause anorexia and abdominal distress. c. These medications may cause increased urinary output. d. The patient may experience periods of diaphoresis and chills.

Answer: B

While monitoring a patient who is receiving intravenous amphotericin B, the nurse expects to see which adverse effect(s)? a. Hypertension b. Bradycardia c. Fever and chills d. Diarrhea and stomach cramps

Answer: C

The nurse is reviewing the medication history of a patient who is taking hydroxychloroquine. However, the patient's chart does not reveal a history of malaria or travel out of the country. The patient is most likely taking this medication for: a. Plasmodium. b. thyroid disorders. c. roundworms. d. rheumatoid arthritis.

Answer: D

The nurse notes in a patient's medication history that the patient is taking terbinafine (Lamisil). Based on this finding, the nurse interprets that the patient has which disorder? a. Vaginal candidiasis b. Cryptococcal meningitis c. Invasive aspergillosis d. Onychomycosis

Answer: D

When administering antifungal drug therapy, the nurse knows that an issue that contributes to many of the drug interactions with antifungals is the patient's: a. history of cardiac disease. b. history of gallbladder surgery. c. ethnic background. d. cytochrome P-450 enzyme system.

Answer: D

When counseling a patient who has been newly diagnosed with TB, the nurse will make sure that the patient realizes that he or she is contagious? a. during all phases of the illness. b. any time up to 18 months after therapy begins. c. during the postictal phase of TB. d. during the initial period of the illness and its diagnosis.

Answer: D

While monitoring a patient, the nurse knows that a therapeutic response to antitubercular drugs would be: a. The patient states that he or she is feeling much better. b. The patient's laboratory test results show a lower white blood cell count. c. The patient reports a decrease in cough and night sweats. d. There is a decrease in symptoms, along with improved chest x-ray and sputum culture results.

Answer: D

. The nurse is monitoring for liver toxicity in a patient who has been receiving long-term isoniazid therapy. Manifestations of liver toxicity include: (Select all that apply.) a. Orange discoloration of sweat and tears b. Darkened urine c. Dizziness d. Fatigue e. Visual disturbances f. Jaundice

Answer: b, d, f,

What are important for the nurse to monitor in a client receiving an antifungal medication? (Select all that apply.) • Blood urea nitrogen • Daily weights • Creatinine • Mental status • Intake and output

Blood urea nitrogen Daily weights Creatinine Intake and output Nursing interventions appropriate to clients receiving antifungal drugs vary depending on the particular drug. However, it is important for the nurse to monitor all clients for indications of possible medication-induced renal damage so that prompt interventions can occur to prevent further dysfunction. Monitoring intake and output amounts, daily weights, and renal function tests will help prevent such damage.

What instruction should the nurse include for a client prescribed rifampin (Rifadin) and isoniazid (Nydrazid) prophylactically secondary to TB exposure? Remind that sunscreen is not needed during outdoor activities. Explain that isoniazid may decrease blood serum glucose in susceptible people. Emphasize that oral contraceptives become ineffective when given with rifampin Advise that these drugs will only need to be taken for 7 to 10 days.

Emphasize that oral contraceptives become ineffective when given with rifampin. Women taking oral contraceptives who are prescribed rifampin must be switched to another form of birth control because oral contraceptives become ineffective when given with rifampin. These medications must be taken long term because mycobacterium is slow growing. They can cause photosensitivity, necessitating the use of sunscreen. Finally, isoniazid may increase, not decrease, serum glucose levels.

Which antifungal drug can be given intravenously to treat severe yeast infections as well as a one-time oral dose to treat vaginal yeast infections? Nystatin (Mycostatin) Caspofungin (Cancidas) Fluconazole (Diflucan) Voriconazole (Vfend)

Fluconazole (Diflucan) Fluconazole is an antifungal drug that does not cause the major adverse effects of amphotericin when given intravenously. It is also very effective against vaginal yeast infections, and a single dose is often sufficient to treat vaginal infections.

Discuss drugs to treat multi drug resistant TB.

Multidrug-resistant TB (MDR TB) is caused by TB bacteria that is resistant to at least isoniazid and rifampin, the two most potent TB drugs. These drugs are used to treat all persons with TB disease. First line drugs: Rifampin, INH, Rifapentine, Ethambutol, Rifabutin, Pyrazinamide, and streptomycin.

What is the organism that causes tuberculosis?

Mycobacterium

What conditions are considered contradictions for use of antifungal medications? (Select all that apply.) • Heart failure • Respiratory failure • Pancreatic failure • Liver failure • Kidney failure

Pancreatic failure Liver failure Drug allergy, liver failure, kidney failure, and porphyria (for griseofulvin) are the most common contraindications for antifungal drugs.

Explain the concept of "slow acetylator".

The slow acetylator phenotype often experiences toxicity from drugs such as isoniazid, sulfonamides, procainamide, and hydralazine, whereas the fast acetylator phenotype may not respond to isoniazid and hydralazine in the management of tuberculosis and hypertension, respectively. Patients with the highest plasma isoniazid levels were generally slow acetylators and they suffered from peripheral nerve damage, while fast acetylators were not affected. Slow acetylators are also at risk for sulfonamide-induced toxicity and can suffer from idiopathic lupus erythematosus while taking procainamide. The slow acetylator phenotype is an autosomal recessive trait.