Chapter 11 Antifungal Agents

A client is receiving gentian violet as topical treatment for a fungal infection. What instruction should the nurse include in the teaching plan? A. "This medication can stain your skin and clothing". B. "Apply a thin layer of the medicine to any open areas on your skin". C. "Cover the area with plastic wrap to seal it off". D. "Take this medication with good to minimize upset stomach".

A. "This medication can stain your skin and clothing". Rationale: Gentian violet stains the skin and clothing bright purple. Occlusive dressings should be avoided to prevent systemic absorption; gentian violet is very toxic when absorbed. Gentian violet should not be applied to open lesions. It is topical, not oral.

The nurse is teaching peers about fungal infections. How does the nurse best describe the cell membrane of a fungal cell? A. Contains ergosterol B. Contains mycosis C. Has a soft cell wall D. Contains monosachharides

A. Contains ergosterol Rationale: Ergosterol is a steroid-type protein found in the cell membrane of fungi, similar in configuration to adrenal hormones and testosterone. Fungi have a hard cell wall. The cell membrane contains polysaccharides. Mycosis is a disease caused by a fungus.

Select all that apply: When administering a systemic anti fungal, the nurse would include which of the following in the patient's plan of care? A. Ensuring that a culture of the affected area had been done B. Having the patient swallow the troche used for oral Candida infections C. Ensuring that the patient stays flat for at least 1 hour if receiving a vaginal suppository D. Monitoring the IV site to prevent phlebitis E. Keeping the patient NPO (nothing by mouth) if GI upset occurs to prevent vomiting F. Providing antipyretics if fever occurs with IV antifungals

A. Ensuring that a culture of the affected area had been done D. Monitoring the IV site to prevent phlebitis F. Providing antipyretics if fever occurs with IV antifungals

A client with recurrent vaginal yeast infections is to receive tioconazole. The nurse should instruct the client to do what? A. Insert a full applicator at bedtime only once. B. Insert the suppository for at least 3 consecutive days. C. Use the powder as needed. D. Apply the cream to the area twice daily.

A. Insert a full applicator at bedtime only once. Rationale: Tioconazole is supplied as a vaginal ointment meant for one dose treatment only. A full applicator of the ointment is inserted vaginally at bedtime.

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? A. Inspection of the client's mouth and throat B. Temperature monitoring C. Inspection of the client's scalp D. Assessment of the client's perineal skin

A. Inspection of the client's mouth and throat Rationale: Micafungin is used in the treatment of clients with esophageal candidiasis. Consequently, the nurse should assess the mucous membranes of the client's mouth and throat.

Select all that apply: The nurse would include which of the following in a teaching plan for a patient who is receiving an oral anti fungal drug? A. It is important that you complete the full course of your drug therapy. B. You can share this drug with other family members if they develop the same symptoms. C.If you feel drowsy or dizzy, you should avoid driving or operating dangerous machinery. D. If GI upset occurs, avoid eating and drinking so you don't vomit and lose the drug. E. Use over-the-counter drugs to counteract any adverse effects like headache, fever, or rash. F. Notify your health care provider if you experience yellowing of the skin or eyes, dark urine or light colored stools, or fever and chills.

A. It is important that you complete the full course of your drug therapy. C.If you feel drowsy or dizzy, you should avoid driving or operating dangerous machinery. F. Notify your health care provider if you experience yellowing of the skin or eyes, dark urine or light colored stools, or fever and chills.

When caring for a client receiving amphotericin B, the nurse includes what assessments in the plan of care? Select all that apply. A. Reflexes B. Liver function C. Orientation D. Renal function E. Oxygen saturation F. Vision

A. Reflexes B. Liver function C. Orientation D. Renal function Rationale: When administering amphotericin B, it is important to assess the client's liver and renal function and monitor orientation and reflexes because these are the most vulnerable areas for adverse effects of the drug. Vision and oxygen saturation monitoring may be indicated due to the source of the infection but are not associated with adverse effects from amphotericin B.

A nurse who provides care on a medical unit is reviewing the use of topical antifungal agents. The nurse should recognize what characteristic of these medications? A. The drugs are often too toxic for systemic administration. B. The drugs can be used for an indefinite period of time as long as the client is not allergic. C. These drugs are associated with signifiant drug-drug interactions. D. Application site reactions rarely occur with topical application

A. The drugs are often too toxic for systemic administration. Rationale: The antifungal agents reserved for topical use are often too toxic to be given systemically. Systemic antifungals are associated with numerous drug-drug interactions. Topical agents are not absorbed systemically, so they do not have drug-drug interactions. Most of the topical agents are used for a specific period of time, usually no longer than 4 to 6 weeks depending on the drug.

An adult client who is critically ill with histoplasmosis has been prescribed amphotericin B 60 mg PO daily. What aspect of this order should the nurse discuss with the healthcare provider? A. The route B. The drug C. The timing D. The dose

A. The route Rationale: Amphotericin B is only available for intravenous administration. The choice of drug, timing, and dose are appropriate.

A parent has informed the nurse that she has been applying an OTC antifungal to her infant's buttocks and perineal region. What question related to safety should the nurse ask the parent? A. "Did you take any antifungal medications while you were pregnant?" B. "Are there any open wounds on the areas where you're putting the ointment". C. "Did you explore any herbal or alternative remedies before starting to use this ointment?" D. "Does your infant have any food allergies that you're ware of yet?"

B. "Are there any open wounds on the areas where you're putting the ointment". Rationale: Topical agents should not be used over open or draining areas that would increase the risk of systemic absorption and toxicity. Allergy status is always important, but questions of applying the medication over open areas would be a safety priority; no aspect of the scenario suggests a hypersensitivity response. Previous use of herbal remedies may be relevant but is not a high priority. The mother's use of antifungals while pregnant is not relevant.

A client has been diagnosed with a fungal infection and been prescribed a topical antifungal medication. What assessment question should the nurse ask when addressing the possible etiology of the fungal infection? A. "When was the last time you visited a hospital or clinic?" B. "Have you prescribed any antibiotics in the recent past?" C. "Have you received any vaccinations in the past few weeks?" D. "Where you prone to acne when you were younger?"

B. "Have you prescribed any antibiotics in the recent past?" Rationale: A course of antibiotics can often precipitate a fungal infection. Hospital visits, immunizations, and a history of acne are not identified as risk factors or causes of fungal infections.

A client is prescribed terbinafine for treatment of onychomycosis of the toenail. What should the nurse teach the client about this treatment? A. "It's important that you avoid taking any over-the-counter antacids during treatment." B. "You'll likely have to take this medication for around 3 months." C. "This drug might make your urine pink-tinged, but that doesn't actually mean you're bleeding." D. "I'll have to start an IV line so that I can give you your new antifungal medication."

B. "You'll likely have to take this medication for around 3 months." Rationale: For onychomycosis of the toenail, terbinafine is used for 12 weeks. Treatment lasting less than 12 weeks is less likely to be effective. Administration is oral, not IV. Pink-tinged urine is not an identified adverse effect, and there is no particular reason to avoid OTC antacids.

The nurse is caring for a client diagnosed with a life-threatening systemic fungal infection that is not responding to treatment with an azole. What medication should the nurse anticipate the provider may order next? A. Butenafine B. Amphotericin B C. Terbinafine D. Nystatin

B. Amphotericin B Rationale: Amphotericin B is a potent drug with many serious adverse effects, so it is often used only when other medications are not effective. Nystatin and butenafine are topical agents and would not be used for a systemic infection. Terbinafine is an azole and would not be used if azoles do not work.

After teaching a group of students about topical fungal infections, the instructor determines that the students need additional instructions when they identify which of the following as an example? A. Athlete's foot B. Rocky mountain spotted fever C. Jock itch D. Vaginal yeast infections

B. Rocky mountain spotted fever

A 3-year-old child has signs and symptoms of a systemic fungal infection, and the healthcare provider intends to prescribe an oral antifungal. The nurse recognizes which medication has the option of being administered as a sprinkle formulation? A. Griseofulvin B. Terbinafine C. Nystatin D. Flucytosine

B. Terbinafine Rationale: Terbinafine is available in a sprinkle formation useful with children who cannot swallow pills. Nystatin is available in liquid formula for treating oral thrush in newborns but is not available in sprinkle formulation. Griseofulvin is safe to use in children, but it is not available in sprinkle formulation. Flucytosine is available in pill form.

A patient with a fungal infection asks the nurse why she cannot take antibiotics. The nurse explains that the reason for this is that a fungus is resistant to antibiotic because A. A fungal cell wall as fewer but more selective protective layers B. The composition of the fungal cell wall is highly rigid and protective C. A fungus does not produce by the usual methods of cell division D. Antibiotics are developed to affect only bacterial cell walls

B. The composition of the fungal cell wall is highly rigid and protective

The nurse instructs the patient to use care when applying topical anti fungal agents to prevent systemic absorption because A. The fungus is only on the surface B. These drugs are too toxic to be given systemically C. Absorption would prevent drug effectiveness D. These drugs can cause serious local burning and pain

B. These drugs are too toxic to be given systemically

A patient with a severe case of athlete's foot is seen with lesions between the toes, which are oozing blood and serum. After teaching the patient, the nurse determines that the instruction was effective if the patient states which of the following? A. "I have to wear black socks and must be careful not to change them very often because it could pull more skin off of my feet." B. "I need to apply a thick later of the anti fungal cream between my toes, making sure that all of the lesions are full of cream." C. "I should wear white socks and keep my feet clean and dry. I shouldn't use the anti fungal cream in areas where i have open lesions." D. "After I apply the cream to my feet, I should cover my feet in plastic wrap for several hours to make sure the drug is absorbed."

C. "I should wear white socks and keep my feet clean and dry. I shouldn't use the anti fungal cream in areas where i have open lesions."

The critical care nurse is administering intravenous anidulafungin to a client for the treatment of candidemia. The client's blood urea nitrogen and creatinine levels have been rising in recent days due to adverse effects of other medications. What is the nurse's best action? A. Confirm the route with the provider. B. Hold the medication pending the provider's reassessment of the client. C. Administer the medication as prescribed because it is not excreted renally. D. Confirm the drug with the provider.

C. Administer the medication as prescribed because it is not excreted renally. Rationale: Anidulafungin is excreted in the feces, so renal impairment should not have a significant impact on therapy.

When administering a systemic anti fungal agent, the nurse incorporates understanding that all systemic anti fungal drugs function to A. Break apart the fungus nucleus B. Interfere with fungus DNA production C. Alter cell permeability of the fungus, leading to cell death D. Prevent the fungus from absorbing needed nutrients

C. Alter cell permeability of the fungus, leading to cell death

Which of the following would the nurse recommend that a woman with repeated vaginal yeast infections keep on hand? A. Tolnaftate B. Butenafine C. Clotrimazole D Naftifine

C. Clotrimazole

The nurse is describing fungi that cause infections of the skin and mucous membranes, appropriately calling these which of the following? A. Mycoses B. Meningeal fungi C. Dermatophytes D. Worms

C. Dermatophytes

A client with a systemic fungal infection has been prescribed ketoconazole 350 mg PO daily. What assessment should the nurse prioritize before administration? A. Review of potassium, sodium and chloride levels B. Assessment of cranial nerve function C. Review of liver enzyme levels. D. Review of blood urea nitrogen and creatinine levels

C. Review of liver enzyme levels. Rationale:Ketoconazole has been associated with severe hepatic toxicity and should be avoided in clients with hepatic dysfunction to prevent serious hepatic toxicity. For this reason, liver function would likely be a priority over cranial nerve function and electrolytes. Excretion is renal, so kidney function should be confirmed, but the consequence of hepatic impairment is even more serious.

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? A. Kidney disease rules out the safe and effective use of clotrimazole. B. Hemodialysis will remove serum clotrimazole, so dosages must be adjusted accordingly. C. The presence of kidney disease has no significant effect on the use of clotrimazole. D. The client will require a reduced dose due to impaired excretion.

C. The presence of kidney disease has no significant effect on the use of clotrimazole. Rationale: Because clotrimazole is not absorbed systematically, there is no need to consider the client's renal function during treatment. Excretion does not occur.

The client is diagnosed with a Candida infection of the mouth, which the nurse documents as what? A. Dermatophytes B. Tinea cruris C. Thrush D. Ringworm

C. Thrush Rationale: Thrush is a Candida infection of the mouth, often identified by small white spots on the tongue most commonly seen in newborns or clients who are immunocompromised. Ringworm is caused by tinea infection, not Candida, and is usually found on the skin and not in the mouth. Fungi known as dermatophytes include tinea infections, of which Candida infections are only one small subgrouping. Tinea cruris is also called jock itch and occurs in the area of the genitalia, usually as the result of perspiration from athletic activities.

After assessing a patient, the nurse would question an order for amphotericin B to prevent the possibility of serious nephrotoxicity if the patient was also receiving which of the following? A. Digoxin B. Oral anticoagulants C. Phenytoin D Corticosteriods

D Corticosteriods

The nurse is working with a client who has a cutaneous fungal infection and who has been prescribed a topical antifungal ointment. The client tells the nurse, "I bought a steroid ointment at the drugstore because I read it might help with my skin infection." What is the nurse's best response? A. "You can't safely take any over-the- counter drugs while you're taking a prescription drug". B. "Any ointment that you're able to buy without a prescription likely isn't going to help much". C. "Actually, that ointment would probably make your infection worse, not better". D. "It's best to check with your healthcare provider before applying any of the steroid ointment".

D. "It's best to check with your healthcare provider before applying any of the steroid ointment". Rationale: The client should inform the provider before using any OTC medications. These are not always contraindicated or ineffective, but the client should confirm this with the provider.

A client with a cutaneous fungal infection has been prescribed naftifine. When reviewing the prescriber's instructions, what should the nurse explain to the client? A. "Make sure to avoid taking any corticosteroid medications while you're on this drug". B. "If your schedule allows it, apply the ointment four or five times a day". C. "It's important to stay out of the sun until you've finished treatment". D. "Make sure you don't use this for more than 1 month".

D. "Make sure you don't use this for more than 1 month". Rationale: Naftifine should be used twice a day for no longer than 4 weeks due to the risk of adverse effects and possible emergence of resistant strains of fungi. Corticosteroids are not necessarily contraindicated, and the drug does not cause photosensitivity.

The nurse is providing health education to a client with vaginal candidiasis. The client's healthcare provider has prescribed tioconazole. What should the nurse teach the client? A. The client should avoid sunlight during treatment. B. The client should apply the ointment twice daily until symptoms resolve. C. Follow-up culture samples will be taken at the completion of treatment. D. A one-time dose will likely cure the infection.

D. A one-time dose will likely cure the infection. Rationale: Tioconazole is a vaginal ointment meant for one-time dose treatment. There is no need to avoid sunlight. Cultures are not normally taken after treatment for uncomplicated vaginitis.

The nurse is caring for a client who has a fungal infection and who has been prescribed fluconazole. The nurse recognizes which mechanism as the reason the medication will eradicate the fungus? A. Inhibiting the synthesis of glucans B. Inhibiting the cytochrome P2D6 enzyme system. C. Inhibiting the synthesis of ergosterol to prevent cell wall formation. D. Blocking the activity of a sterol in the fungal wall.

D. Blocking the activity of a sterol in the fungal wall. Rationale: Fluconazole blocks the activity of a sterol in the fungal wall. Terbinafine inhibits the CYP2D6 enzyme system. Posaconazole and voriconazole inhibit the synthesis of ergosterol leading to an inability of the fungus to form a cell wall. The echinocandins work by inhibiting glucan synthesis.

A client has a cutaneous fungal infection. What antifungal medication is available for topical administration? A. Fluconazole B. Itraconazole C. Voriconazole D. Butoconazole

D. Butoconazole Rationale: Butoconazole is a topical antifungal agent. Fluconazole, itraconazole, and voriconazole are systemic antifungal agents.

A client's previous medical history includes mycosis. What conclusion should the nurse draw from this fact? A. The client has an underlying immune disorder that caused a fungal infection. B. The client had an infection involving an overgrowth of opportunistic organisms. C. The client had a superficial infection of the skin related to fungal invasion. D. The client has had a disease that was caused by a fungus.

D. The client has had a disease that was caused by a fungus. Rationale: Mycosis refers to a disease that is caused by a fungus. Mycosis is unrelated to immune disorders. A superinfection refers to an infection that involves an overgrowth of opportunistic organisms. In some cases, a superinfection can be due to a fungal infection. Mycosis refers to a fungal infection that can be localized, superficial, or systemic.

The client is receiving ketoconazole. The nurse should be concerned about a drug-drug interaction on the basis of what other comorbidity? A. Penicillin allergy B. Venous ulcers C. Chronic pain D. Type 2 diabetes

D. Type 2 diabetes Rationale: Ketoconazole interacts with hypoglycemics, which are given for the treatment of type 2 diabetes. There is no obvious reason why a client's pain, penicillin allergy, or venous ulcer would preclude the safe and effective use of ketoconazole.

True or false: Terbinafine is a better choice for clients who need to take medications that are metabolized by the CYP 2D6 enzyme system.

False Rationale: Terbinafine inhibits the CYP 2D6 enzyme system, so it may be a better choice for clients who require drugs that are metabolized by the CYP 450 system.

True or false: The incidence of fungal infections has recently dropped due to the advances in drug therapy.

False Rationale: The incidence of fungal infections has increased with the rising number of immunocompromised individuals.

True or false: Amphotericin B is contraindicated for use during pregnancy.

False Rationale:Amphotericin B has been used successfully during pregnancy, but it should be used cautiously and only if benefits outweigh risks.

True or false: A topical antifungal cream should be gently rubbed into the affected area that has been washed with soap and water and patted dry.

True Rationale: The area should be gently cleaned before applying the antifungal cream and then gently rubbed into the affected area. Avoid covering the area to reduce risk of systemic absorption. Clients should be taught to wash their hands after application (unless the cream was applied to the hands).