Week 9-Antimicrobial Drugs 2
Which statement should the nurse include when teaching a patient about rifampin [Rifadin]? A) "A harmless side effect will be a red-orange discoloration of body fluids." B) "Oral contraception is the preferred method of birth control when using rifampin." C) "Take vitamin B6 to relieve numbness and tingling in the fingers and toes." D) "Treatment length for the medication is 3 times/day for an 8-week period."
A) "A harmless side effect will be a red-orange discoloration of body fluids." Red-orange discoloration of body fluids is a common side effect of rifampin, but it is not harmful. Rifampin does not cause peripheral neuropathy. It does reduce the effectiveness of oral contraceptives, so a nonhormonal form of birth control should be considered. All antitubercular agents need to be taken at least 6 to 24 months to eradicate the slow-growing mycobacterium.
When teaching a patient about tuberculosis, the nurse will include which statements? (Select all that apply.) A) "Most people infected with M. tuberculosis are asymptomatic." B) "Most people infected with M. tuberculosis harbor dormant bacteria for life if they do not receive drug therapy." C) "Treatment of tuberculosis lasts 3 months." D) "Isoniazid can cause peripheral neuropathy by depleting vitamin B12." E) "Rifampin can cause optic neuritis."
A) "Most people infected with M. tuberculosis are asymptomatic." B) "Most people infected with M. tuberculosis harbor dormant bacteria for life if they do not receive drug therapy." Treatment for tuberculosis usually lasts 6 months to 2 years. Isoniazid can cause peripheral neuropathy by depleting vitamin B6. Ethambutol, not rifampin, can cause optic neuritis. The other two statements are true and can be included in patient teaching.
Which administration instruction should the nurse give a patient scheduled to start receiving the HIV fusion inhibitor enfuvirtide [Fuzeon]? A) "Rotate injection sites in the arm, thigh, and abdomen." B) "Take only when you consume low-fat meals." C) "Dosing is optimal 30 minutes before meals." D) "Injection-site reactions are usually uncommon."
A) "Rotate injection sites in the arm, thigh, and abdomen." The primary action of enfuvirtide is to block the entry of HIV into CD4 T cells. It is administered through subcutaneous injection, and the injections should be rotated in the upper arm, thigh, and abdominal areas of the body. Injection-site reactions of pain, tenderness, erythema, and induration occur in almost every patient. Enfuvirtide is not an oral medication; dosing before meals or with low-fat meals is not a relevant instruction.
Which statements will the nurse include when teaching a patient about isoniazid therapy for the treatment of tuberculosis? (Select all that apply.) A) "Take the isoniazid on an empty stomach." B) "Notify your healthcare provider if your skin starts to turn yellow." C) "Numbness or tingling in your extremities is a normal response when taking this drug." D) "Your urine will turn reddish orange because of the effects of this drug." E) "Use of this drug is associated with vision problems."
A) "Take the isoniazid on an empty stomach." B) "Notify your healthcare provider if your skin starts to turn yellow." Numbness and tingling in the extremities is associated with the development of peripheral neuropathy and should be reported to the healthcare provider. Rifampin, not isoniazid, causes discoloration of body fluids. Ethambutol, not isoniazid, is associated with optic neuritis. The other two statements are true and can be included in patient teaching.
A patient who has tuberculosis is treated with isoniazid. The nurse should monitor for which symptoms, which could indicate a vitamin B6 deficiency caused by the medication? A) Numbness and tingling in the fingers and toes B) Alopecia and flaking scalp C) Dry skin and brittle nails D) Oral ulcers and tongue fissures
A) Numbness and tingling in the fingers and toes Correct Dose-related peripheral neuropathy is the most common adverse effect of isoniazid. It results from a vitamin B6 deficiency, which is corrected by taking oral supplements. Symptoms include numbness and tingling in the fingers and toes. Alopecia and flaking scalp, oral ulcers and tongue fissures, and dry skin and brittle nails are not adverse effects of isoniazid-induced vitamin B6 deficiency.
The nurse identifies terbinafine [Lamisil] as useful for treating which conditions? (Select all that apply.) A) Onychomycosis B) Tinea corporis C) Oropharyngeal candidiasis D) Vulvovaginal candidiasis E) Tinea pedis
A) Onychomycosis B) Tinea corporis E) Tinea pedis Terbinafine [Lamisil] is highly active against dermatophytes and is used to eradicate fungal infection of the nails (onychomycosis) and as topical therapy for ringworm infections (tinea corporis, tinea pedis). It is not effective against oropharyngeal and vulvovaginal candidiasis.
What is the drug of choice for most infections caused by herpes simplex viruses and varicella-zoster virus?
Acyclovir
Which drug is the drug of choice for most systemic mycoses, despite its potential for serious harm?
Amphotericin B
A patient has been prescribed efavirenz [Sustiva]. The nurse should instruct the patient to use which administration approach to minimize central nervous system (CNS) adverse effects? A) The drug should be taken in divided doses throughout the day. B) Bedtime dosing is most effective. C) The drug should be mixed only with an acidic beverage. D) A steroid medication should be used concurrently.
B) Bedtime dosing is most effective. Efavirenz frequently causes CNS symptoms of dizziness, impaired consciousness, drowsiness, vivid dreams, and nightmares. Bedtime dosing can minimize CNS effects, which typically resolve in 2 to 4 weeks. Mixing with an acidic beverage, using a steroid medication concurrently, and taking efavirenz in divided doses throughout the day are not effective means of minimizing CNS effects.
A nurse obtains a specimen from which body fluid when performing the QuantiFERON-TB Gold (QFT-G) test for latent tuberculosis? A) Saliva B) Blood C) Urine D) Sputum
B) Blood The specimen for the QFT-G test is obtained from blood, not from saliva, urine, or sputum. It is a new test for latent TB and is as sensitive as the tuberculin skin test and more specific. The results are available within 24 hours, and unlike with the skin test, a follow-up visit to a healthcare provider's office is not required.
A nurse should recognize that which laboratory result is used as a major factor in deciding when antiretroviral therapy is indicated for a patient infected with HIV? A) Plasma HIV RNA assay B) CD4 T-lymphocyte count C) Western blot assay D) OraQuick Rapid HIV-1 Antibody Test
B) CD4 T-lymphocyte count The CD4 T-cell count is the principal indicator of how much immunocompetence remains when a patient is infected with HIV. It is used as a guide in the initiation, discontinuation, and resumption of medications for opportunistic infections. A plasma HIV RNA assay is a measure of viral load that indicates HIV replication and magnitude and accordingly is used to predict clinical outcomes. The Western blot assay and OraQuick Rapid HIV-1 Antibody Test, respectively, are used for initial screening and follow-up confirmation of HIV infection.
A nurse planning care for a patient who is receiving nystatin [Mycostatin] should establish which outcome on the care plan? A) Relief of nasal congestion B) Decrease in mouth pain C) Productive cough D) Absence of urticaria
B) Decrease in mouth pain Nystatin is an antifungal medication that is used for candidiasis of the skin, mouth, esophagus, intestine, and vagina. It can be administered orally and topically and will heal mouth lesions from oral candidiasis. Nystatin has no effect on nasal congestion and cough production. It does not cause urticaria.
A patient who takes multiple antibiotics starts to experience diarrheal stools. The nurse anticipates administration of which antibiotic if a stool sample tests positive for Clostridium difficile? A) Rifaximin [Xifaxan] B) Metronidazole [Flagyl] C) Daptomycin [Cubicin] D) Gemifloxacin [Factive]
B) Metronidazole [Flagyl] Metronidazole is the treatment of choice for antibiotic-associated colitis caused by C. difficile. Rifaximin, daptomycin, and gemifloxacin are not used in the treatment of C. difficile infection.
A patient is taking daptomycin [Cubicin]. The nurse should obtain a creatine phosphokinase (CPK) level when the patient shows what? A) Increased urination and urinary urgency B) Muscle pain and weakness C) Abdominal bloating and diarrhea D) Headache and visual disturbances
B) Muscle pain and weakness Daptomycin is one of the cyclic lipopeptides, a class of antibiotics that can kill gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). It may pose a small risk of myopathy (muscle injury). Patients should be warned about muscle injury and told to report any pain or weakness. In addition, CPK levels should be measured weekly. Increased urination and urinary urgency, abdominal bloating and diarrhea, and headache and visual disturbances are not associated with daptomycin.
To promote treatment adherence in a patient with tuberculosis, the nurse will include which interventions? (Select all that apply.) A) Use a single medication, to keep the treatment simple. B) Teach the patient about intermittent-dose therapy. C) Teach the patient about the need for long-term treatment. D) Use a signed consent form to enhance patient compliance. E) Directly watch the patient take the medication.
B) Teach the patient about intermittent-dose therapy. C) Teach the patient about the need for long-term treatment. E) Directly watch the patient take the medication. In patients with TB, nonadherence is the most common reason for treatment failure, relapse, and increased medication resistance. Because treatment is necessary for at least 6 months, directly observed therapy (DOT) is a standard of care, as is intermittent dosing. Multiple medication regimens are needed to prevent drug resistance. Education about the length of treatment and the regimen is essential to compliance. A signed consent form does not increase patient compliance.
Which statement by a patient taking ethambutol [Myambutol] indicates understanding of adverse effects of the drug? A) "I will get up slowly when sitting to prevent me from getting dizzy." B) "I'll increase the fiber and liquids in my diet to prevent constipation." C) "I'll report any problems with blurred vision or determining colors." D) "I'll immediately report any red-orange urine to my healthcare provider."
C) "I'll report any problems with blurred vision or determining colors." Ethambutol can cause optic neuritis, resulting in disturbance of color discrimination and blurred vision. Symptoms resolve when the medication is discontinued. Orthostatic hypotension, constipation, and discoloration of urine are not known adverse effects of ethambutol.
What is the priority instruction a nurse gives to a male patient who is scheduled to receive ribavirin [Rebetol] combined with peg-interferon-alfa-2a for treatment of hepatitis C? A) "Combining these two medications will greatly increase response rates." B) "An antidepressant can be prescribed to alleviate symptoms of depression." C) "If you are sexually active, use two reliable forms of birth control to prevent pregnancy." D) "It is very important that you have blood counts checked every 2 weeks."
C) "If you are sexually active, use two reliable forms of birth control to prevent pregnancy." Because ribavirin is embryo lethal when taken by female patients and causes sperm abnormalities when taken by males, it is a priority that pregnancy be avoided during its use. Pregnancy must be avoided by female patients and by female partners of men taking ribavirin. Couples should use two reliable forms of birth control during treatment and for 6 months afterward. It is less important that the patient know that ribavirin is not effective against hepatitis C unless it is combined with interferon alfa. Less important information to provide than avoiding pregnancy includes hemolytic anemia is an adverse effect; frequent blood checks are advised; and depression is an adverse effect of peg-interferon-alfa-2a for which antidepressants can be prescribed.
The nurse identifies which medication as the drug of choice for most infections caused by herpes simplex viruses and varicella-zoster virus? A) Ganciclovir B) Amantadine C) Acyclovir D) Oseltamivir
C) Acyclovir Acyclovir is the drug of choice for most infections caused by herpes simplex viruses and varicella-zoster virus. Ganciclovir is the drug of choice for prophylaxis and treatment of CMV infection in immunocompromised patients, including those with AIDS. Amantadine and oseltamivir are drugs of choice for the treatment and prophylaxis of influenza.
The nurse notices tan lines around the arms of a female patient who is taking levofloxacin [Levaquin]. Which action should the nurse take? A) No action is needed, because this is a temporary but expected side effect. B) Continue the antibiotic with an anti-inflammatory medication. C) Advise the patient to avoid sun exposure and wear sunscreen when outside. D) Discontinue the medication.
C) Advise the patient to avoid sun exposure and wear sunscreen when outside. Fluoroquinolones pose a risk of phototoxicity. Accordingly, patients should avoid sunlight and sunlamps, and should use protective clothing and a sunscreen if they must go outdoors.
A nurse is teaching a patient who is scheduled to start taking itraconazole [Sporanox]. Which statement by the patient would indicate understanding of the teaching? A) "I'll take diphenhydramine [Benadryl] before this medication so I don't have a reaction." B) "It's important to remember to wear sunscreen while taking this medicine." C) "I'll avoid citrus foods, such as oranges and grapefruits, while taking this medication." D) "If I notice my skin turning yellow or feel any nausea, I'll notify my healthcare provider."
D) "If I notice my skin turning yellow or feel any nausea, I'll notify my healthcare provider." Itraconazole may cause liver injury, and although a causal link has not been identified, patients need to be informed about symptoms to report. These include jaundice, nausea, and right upper abdominal pain. It is not necessary to take diphenhydramine, wear sunscreen, or avoid citrus products while taking itraconazole.
The healthcare provider orders levofloxacin [Levaquin] 500 mg PO every day for 7 days. The available medication is levofloxacin 250-mg tablets. How many tablets should the patient take each day? A) 0.5 tablet B) 1 tablet C) 1.5 tablets D) 2 tablets
D) 2 tablets Two tablets that are each 250 mg would equal the ordered 500 mg daily dose.
A patient who has human immunodeficiency virus (HIV) infection has a tuberculin skin test (TST) for latent tuberculosis. The nurse assesses the result 48 hours after the injection. An induration of what size indicates that the patient needs to be treated for latent tuberculosis? A) 1 mm B) 2 mm C) 3 mm D) 5 mm
D) 5 mm A positive reaction on the TST is indicated by an area of induration (hardness) around the injection site. The decision to treat latent tuberculosis is based on the risk category and size of the induration area. Treatment is recommended in high-risk individuals, such as those with HIV infection, for an induration of 5 mm. An induration of 10 mm is required to treat moderate-risk individuals. An induration of more than 15 mm is required to treat low-risk individuals.
What is a serious adverse effect of Amohotericin?
renal injury
A patient who takes ciprofloxacin [Cipro] and runs 6 miles daily tells a nurse about heel and calf tenderness. The nurse anticipates the healthcare provider to take which action? A) No action is needed, because this is a temporary but expected side effect. B) Continue the antibiotic with an anti-inflammatory medication. C) Slow the running pace and walk more. D) Discontinue the medication, because severe damage can result.
D) Discontinue the medication, because severe damage can result. Fluoroquinolones may result in tendinitis and rupture by disrupting the extracellular matrix of cartilage. Because tendon injury is reversible if diagnosed early, fluoroquinolones should be discontinued at the first sign of tendon pain or inflammation.
A patient taking gemifloxacin develops a rash. The nurse anticipates the healthcare provider to take which action? A) No action is needed, because this is a temporary but expected side effect. B) Continue the antibiotic with an anti-inflammatory medication. C) Cut the dose of medication in half. D) Discontinue the medication.
D) Discontinue the medication. The incidence of rash with gemifloxacin is much higher than with other fluoroquinolones. Women under 40 years of age are at greatest risk. Symptoms are severe in about 10% of patients who develop a rash; in the rest, symptoms are mild to moderate. As a rule, gemifloxacin-induced rash resolves spontaneously in 1 to 2 weeks, although some patients require treatment with systemic glucocorticoids. If rash develops, gemifloxacin should be discontinued.
A patient who has an infection with Mycobacterium leprae (leprosy) has been prescribed rifampin [Rifadin]. The nurse identifies which dosing schedule as most effective for this drug? A) Two times per day B) Every other day C) Once every 2 weeks D) Once per month
D) Once per month Rifampin is the most effective agent for treating leprosy. A single dose kills more than 99.9% of viable M. leprae. Monthly administration is effective, and this dosing schedule minimizes adverse effects.
How does M. tuberculosis affect most people?
They remain asymptomatic, although they will harbor dormant bacteria for life (in the absence of drug therapy).
what is the best way to prevent influenza.
Vaccination
How is Vulvovaginal candidiasis treated?
with a single oraldose of fluconazole or with short-term topical therapy (e.g.,one 1200-mg miconazole vaginal suppository).
How long does Therapy of TB prolong?
a minimum of6 months to 2 years and even longer.
How is Acyclovir excreted
eliminated by the kidneys.
The human immunodeficiency virus (HIV) uses which enzymes to replicate and infect a host cell? (Select all that apply.) A) Integrase B) Dihydrofolate reductase C) Reverse transcriptase D) Carbonic anhydrase E) Protease
A) Integrase C) Reverse transcriptase E) Protease HIV is a retrovirus that replicates itself in a host cell by transcribing RNA into DNA. The enzyme used for this process is viral RNA-dependent DNA polymerase, commonly known as reverse transcriptase. HIV DNA becomes integrated into the host's DNA under the influence of a viral enzyme called integrase. Final maturation of HIV depends on protease, which breaks large HIV polyproteins into smaller, functional forms. Dihydrofolate reductase and carbonic anhydrase are other enzymes used to catalyze chemical cellular reactions, but they are not participants in HIV replication.
A nurse administering flu vaccines at an annual clinic should recognize that which individuals should be vaccinated, as recommended by the Advisory Committee on Immunization Practices (ACIP)? (Select all that apply.) A) Women who will be pregnant during flu season B) All children 6 months and older and older adults C) Those who report severe allergy to chicken eggs D) Those who have a history of Guillain-Barré syndrome E) Those 6 months to 18 years old receiving aspirin therapy
A) Women who will be pregnant during flu season B) All children 6 months and older and older adults E) Those 6 months to 18 years old receiving aspirin therapy The ACIP recommends flu vaccination for all children 6 months and older and for older adults. Individuals at high risk of complications from the flu who also should be vaccinated include women who will be pregnant during flu season and children receiving long-term therapy with aspirin (to prevent Reye's syndrome). Influenza vaccines are produced from viruses grown in eggs and should be avoided in persons with allergies to chicken eggs. Influenza vaccine may carry a small risk of Guillain-Barré syndrome, a paralyzing neuromuscular disorder, and should be avoided in those who have experienced it.
A nurse develops a plan of care for a patient who has an outbreak of recurrent genital herpes and is taking oral acyclovir [Zovirax]. Which outcome should be included? A) Minimal scarring from lesions B) Less frequent eruption of lesions C) Prevention of transmission to contacts D) Complete eradication of the virus
B) Less frequent eruption of lesions Acyclovir is used to treat herpes simplex infections caused by type 2 herpes simplex virus (HSV-2). For patients with recurrent herpes genitalis, oral therapy reduces the frequency with which lesions appear. It does not eradicate the virus or produce cure. Acyclovir does not prevent transmission of the virus to sexual contacts. It does not affect scarring from lesions.
why does treatment of systemic mycoses requires intravenous administration?
Because absorption of oral amphotericin B is poor
A patient is receiving weekly subcutaneous injections of peg-interferon-alfa-2a [Pegasys] for chronic hepatitis C. A nurse teaches the patient that which adverse effect will diminish with continued therapy? A) Black, sticky, tarry stools B) Lower leg muscle weakness C) Dyspnea and wheezing D) Flulike symptoms
D) Flulike symptoms The most common adverse side effect of peg-interferon-alfa-2a, a long-acting interferon used to treat chronic hepatitis C, is flulike symptoms characterized by fever, fatigue, myalgia, headache, and chills. Symptoms are likely to diminish with continued therapy over time. Black, tarry stools; lower leg muscle weakness; dyspnea; and wheezing are not adverse effects of peg-interferon-alfa-2a.
A patient is receiving amphotericin B. The nurse identifies which medication as useful in preventing adverse effects of amphotericin B? A) Furosemide [Lasix] B) Insulin C) Vitamin K D) Potassium
D) Potassium Renal injury from amphotericin B may cause severe hypokalemia. Serum potassium levels should be monitored more frequently and potassium supplements given to correct low plasma levels. Furosemide, insulin, and vitamin K do not prevent any adverse effects of amphotericin B.
How can we prevent emergence of resistance TB drug therapy?
initial therapy of TB should consist of at least two drugs to which the infectionis sensitive, and preferably four.
What is the principal first-line drugs for TB?
isoniazid, rifampin, pyrazinamide, and ethambutol.
How many drugs is required for Initial therapy of MDR-TB and XDR-TB?
may require up to seven drugs
A nurse is administering an oral dose of itraconazole [Sporanox] to a patient at 10:00 AM. The nurse should administer a prescribed dose of famotidine [Pepcid] at which time? A) 9:00 AM B) 10:00 AM 10:30 AM 11:00 AM
A) 9:00 AM Medications that lower gastric acidity, such as famotidine [Pepcid], can reduce absorption of oral itraconazole [Sporanox]. Those agents should be given at least 1 hour before itraconazole or 2 hours after. The other time, administrations would interfere with absorption of itraconazole.
The nurse is aware that mother-to-child transmission of HIV occurs primarily during labor and delivery. Which of the following can reduce the risk of transmission? (Select all that apply.) A) ART during gestation to minimize maternal viral load B) IV zidovudine to the mother during labor and delivery C) Two forms of birth control, including barrier and hormonal D) Oral or IV zidovudine to the infant for 6 weeks following delivery E) Planned induction of labor
A) ART during gestation to minimize maternal viral load B) IV zidovudine to the mother during labor and delivery D) Oral or IV zidovudine to the infant for 6 weeks following delivery Mother-to-child transmission of HIV occurs primarily during labor and delivery. The risk of transmission can be greatly reduced by (1) using ART during gestation to minimize maternal viral load, (2) giving IV zidovudine to the mother during labor and delivery, and (3) giving oral or IV zidovudine to the infant for 6 weeks following delivery. Birth control may prevent pregnancy, but not transmission of HIV to the infant. Planned induction does not prevent virus transmission.
When teaching a patient about therapy with famciclovir, which statements does the nurse include? (Select all that apply.) A) Famciclovir is generally well tolerated. B) Famciclovir is safe to use during pregnancy. C) Famciclovir is administered intravenously. D) Famciclovir is used in the treatment of acute herpes zoster. E) Famciclovir is contraindicated in the treatment of herpes simplex genitalis.
A) Famciclovir is generally well tolerated. D) Famciclovir is used in the treatment of acute herpes zoster. Famciclovir is generally well tolerated and is used in the treatment of acute herpes zoster as well as herpes simplex genitalis. The safety of famciclovir during pregnancy and breast-feeding and in children younger than 18 years has not been established. Famciclovir is supplied in tablets for oral dosing.
Which approach should a nurse take when administering an oral dose of levofloxacin [Levaquin]? A) Give the medication with or without food. B) Administer the drug with an oral dose of a magnesium-based antacid. C) Premedicate the patient with diphenhydramine [Benadryl]. D) Administer the drug with milk products.
A) Give the medication with or without food. Levofloxacin should not be administered with milk products or antacids containing magnesium or aluminum, because this reduces absorption from the gastrointestinal (GI) tract. However, this does not happen with most foods. Premedicating with diphenhydramine is unnecessary.
Which approach should a nurse take to administer intravenous (IV) acyclovir [Zovirax] to an immunocompromised patient? B) Administer IV acyclovir diluted in 20 mL normal saline (NS) over 10 minutes. C) Only infuse the drug if the white blood cell (WBC) count is above 2500/mm3. D) Ask the provider to change the route to subcutaneous (subQ) injection.
A) Infuse IV fluids during administration of the dose and for 2 hours afterward. Acyclovir can cause renal damage, and hydration of the patient during the infusion and for 2 hours afterward minimizes this risk. Acyclovir is not given by IV bolus or by intramuscular (IM) or subQ injection. It is used to treat infections in immunocompromised patients, but the dose is not changed or affected by the WBC count.
A patient is taking rifampin [Rifadin] for active tuberculosis. Which assessment does the nurse identify as an adverse effect of the drug? A) Jaundice B) Blood glucose level of 60 mg/dL C) Absent deep tendon reflexes D) Moon face
A) Jaundice Rifampin is toxic to the liver, which increases the patient's risk of hepatitis. Jaundice is a sign of liver dysfunction and should be monitored. Rifampin has no effect on the blood glucose level or deep tendon reflexes, nor does it cause a moon face.
A nurse should recognize that a patient who is infected with HIV is at the highest risk to develop opportunistic infections during which clinical phase of HIV? A) Late B) Intermediate C) Initial D) Prodromal
A) Late During the late phase of HIV infection, CD4 T lymphocytes (CD4 T cells) are reduced below a critical level (200 cells/mL). This significantly increases the risk for opportunistic infections. During the initial phase of HIV infection, patients experience flulike symptoms of fever, pharyngitis, and myalgias. In the intermediate or middle phase of HIV infection, blood levels of HIV remain low and most patients are asymptomatic. There are no prodromal or premonitory clinical signs that indicate the onset of HIV infection.
A nurse is preparing to administer ganciclovir [Cytovene] to a patient for treatment of Cytomegalovirus (CMV) pneumonitis. Which laboratory result should the nurse recognize as a contraindication to use of this drug? A) Neutrophil count below 500/mm3 B) Platelet count of 350,000/mm3 C) Serum calcium level of 9.5 mg/dL D) Reduced forced vital capacity (FVC)
A) Neutrophil count below 500/mm3 Ganciclovir is used to treat and prevent CMV infection in immunocompromised patients. Bone marrow suppression is a dose-limiting toxicity of ganciclovir; therefore, the drug is contraindicated in patients with neutrophil counts below 500/mm3 or platelet counts below 25,000/mm3. It does not affect the serum calcium level or FVC, a measure of lung function in patients who have airflow-restrictive disorders.
A patient is receiving the protease inhibitor (PI) amprenavir [Agenerase]. Which laboratory results would the nurse evaluate as indicators of adverse effects of this medication? (Select all that apply.) A) Plasma cholesterol level B) Serum transaminases C) Cardiac enzymes D) Blood glucose level E) Creatinine level
A) Plasma cholesterol level B) Serum transaminases D) Blood glucose level All PIs cause hyperglycemia and diabetes, and patients should be instructed to report symptoms of polydipsia, polyphagia, and polyuria. In addition, PIs can increase serum levels of transaminases and should be used with caution in patients with chronic liver disease. Cholesterol should be measured for elevation caused by the use of PIs that results in a risk of cardiovascular events. Altered cardiac enzymes and serum creatinine levels are not associated with adverse effects of PIs.
After completing a course of ciprofloxacin [Cipro] for a skin infection, the patient says, "I took the whole bottle of pills, but my infection hasn't gotten any better." Which additional information should the nurse recognize as most significant? A) The patient takes antacids on a daily basis. B) The medication was stored in a cool, dry area. C) The patient did not use sunscreen while taking the ciprofloxacin [Cipro]. D) The patient took two doses of diphenhydramine [Benadryl] while on ciprofloxacin [Cipro] therapy.
A) The patient takes antacids on a daily basis. Antacids interfere with the absorption of quinolone antibiotics, such as ciprofloxacin [Cipro], and many other drugs; therefore, this patient has not received the full dosing regimen, which is required if ciprofloxacin is to be effective against the infection. Storing the drug in a cool, dry area and using sunscreen or diphenhydramine would not disrupt the effectiveness of ciprofloxacin.
A nurse should teach a patient who has Pneumocystis pneumonia (PCP) about the dosing and therapeutic effects of which medication? A) Trimethoprim/sulfamethoxazole [Bactrim] B) Azithromycin [Zithromax] C) Acyclovir [Zovirax] D) Ganciclovir [Cytovene]
A) Trimethoprim/sulfamethoxazole [Bactrim] PCP is a potentially fatal infection caused by Pneumocystis jiroveci. Among people with advanced HIV infection, it is the most common opportunistic infection. The preferred regimen for treatment and prophylaxis of PCP is trimethoprim/sulfamethoxazole. Azithromycin is used in the treatment of Mycobacterium avium infection. Cytomegalovirus (CMV) retinitis is treated with ganciclovir. Acyclovir is the preferred treatment of varicella-zoster virus, which causes chickenpox and herpes zoster.
The nurse identifies rifampin as useful in the treatment of which disorders? (Select all that apply.) A) Tuberculosis B) Active meningococcal infection C) Leprosy D) Prophylaxis of meningitis caused by Haemophilus influenzae E) C. difficile infection
A) Tuberculosis C) Leprosy D) Prophylaxis of meningitis caused by Haemophilus influenzae Rifampin is useful in the treatment of tuberculosis and can be used for prophylaxis of meningitis caused by H. influenzae. The treatment of leprosy is an unlabeled use. Rifampin is indicated for treatment of carriers of meningococcal infection, but not for active meningococcal infection. Rifampin is not indicated for the treatment of C. difficile infection.
The nurse develops a care plan for a patient in the continuation phase of treatment for active tuberculosis (TB). The care plan includes teaching about which medication regimen? A) Pyrazinamide and ethambutol B) Isoniazid and rifampin C) Ethambutol and isoniazid D) Rifampin and ethambutol
B) Isoniazid and rifampin If drug resistance is not a factor, then treatment for active TB consists of a four-drug induction phase and a two-drug continuation phase. The continuation phase lasts at least 4 months, and therapy consists of two drugs—isoniazid and rifampin. Pyrazinamide and ethambutol, ethambutol and isoniazid, and rifampin and ethambutol are not the preferred regimens for the continuation phase.
When providing teaching for a patient starting flucytosine [Ancobon] therapy, the nurse identifies what as the priority concern? A) "You will have weekly blood draws to monitor your liver function." B) "Another very strong medication may be needed in addition to this one." C) "You'll need to report any symptoms of bruising, fever, and fatigue." D) "The dose is 10 pills, so take a few at a time over a 15-minute interval."
C) "You'll need to report any symptoms of bruising, fever, and fatigue." Flucytosine [Ancobon] is used for serious infections caused by Candida and Cryptococcus neoformans. Bone marrow suppression may cause fatal agranulocytosis, so symptoms of bruising, fever, and fatigue could indicate life-threatening conditions. The other statements are true; however, they are not the priority concern. Flucytosine [Ancobon] is usually combined with amphotericin B. Treatment may require ingestion of 10 capsules 4 times per day. Taking these pills for a short time helps to reduce nausea. Hepatotoxicity is mild and reversible; liver function is monitored while the patient is receiving treatment.
A patient is scheduled to receive intravenous amphotericin B. Which medication should a nurse administer as pretreatment before the infusion? A) 10 units of regular insulin intravenously B) 20 mg famotidine [Pepcid] in 50 mL of 5% dextrose C) 50 mg of diphenhydramine [Benadryl] and 650 mg of acetaminophen D) 1 g of calcium gluconate in 100 mL of normal saline
C) 50 mg of diphenhydramine [Benadryl] and 650 mg of acetaminophen Almost all patients given intravenous amphotericin B develop fever, chills, and nausea. Pretreatment with diphenhydramine and an analgesic, such as acetaminophen, can minimize or prevent these adverse effects. It is not beneficial to administer calcium gluconate, insulin, or famotidine as pretreatment.
The nurse identifies which medication as posing a significant risk of causing confusion, somnolence, psychosis, and visual disturbances in elderly patients? A) Metronidazole [Flagyl] B) Rifampin [Rifadin] C) Ciprofloxacin [Cipro] D) Daptomycin [Cubicin]
C) Ciprofloxacin [Cipro] In elderly patients, ciprofloxacin [Cipro] poses a significant risk of confusion, somnolence, psychosis, and visual disturbances. Metronidazole, rifampin, and daptomycin are not associated with confusion in elderly patients.
A nurse is providing teaching to a group of patients regarding flu season in the United States. Which statement should the nurse include in the teaching? A) In the United States, flu season usually peaks in October or November. B) To ensure full protection, the best time to vaccinate is September. C) For people who missed the best time, vaccinating as late as April may be of help. D) The influenza vaccine may not be administered at the same time as the pneumococcal vaccine.
C) For people who missed the best time, vaccinating as late as April may be of help. Peak flu season in the United States is usually January or February. To ensure full protection, the best time to vaccinate is October or November. For people who missed the best time, vaccinating as late as April may be helpful. Influenza vaccine may be given at the same time as other vaccines, including pneumococcal vaccine.
The antiretroviral medication raltegravir [Isentress] achieves therapeutic effectiveness through which action when administered to a patient infected with HIV? A) It blocks the entry of HIV into CD4 T cells. B) It increases protease enzyme activity. C) It inhibits the enzyme integrase D) It destroys reverse transcriptase.
C) It inhibits the enzyme integrase Raltegravir is the first and only member of a new class of antiretroviral medications, the HIV integrase inhibitors. Integrase is one of three viral enzymes needed for HIV-derived DNA insertion into DNA of CD4 T cells. Raltegravir effectively blocks HIV replication. It does not increase protease enzyme activity or destroy reverse transcriptase. Blocking HIV entry into CD4 T cells is an action of other antiretroviral medications, not raltegravir.
It is most important for the nurse to assess a patient taking itraconazole [Sporanox] for the development of what? A) Hair loss B) Skin rash C) Pedal edema D) Joint pain
C) Pedal edema traconazole [Sporanox] has negative inotropic actions and may cause a transient decrease in the ventricular ejection fraction, thus precipitating heart failure. Pedal edema is a symptom of heart failure, and the nurse should assess for it. Skin rash, hair loss, and joint pain are unrelated to the use of itraconazole.
A patient has been diagnosed with respiratory syncytial virus. The nurse anticipates administration of which drugs? (Select all that apply.) A) Ganciclovir B) Oseltamivir C) Ribavirin (inhaled) D) Palivizumab E) Entecavir
C) Ribavirin (inhaled) D) Palivizumab Ribavirin (inhaled) and palivizumab are used for the treatment of RSV. Ganciclovir is useful in the treatment of cytomegalovirus. Oseltamivir is used for the treatment of influenza A and B. Entecavir is a nucleoside analog used in the treatment of HBV.
A nurse should recognize that for maximum therapeutic effects against the influenza virus, oseltamivir [Tamiflu] should be taken when? A) Two days or more after symptom onset B) When lung crackles are present C) Within 12 hours of symptom onset D) Only when fever is above 102°F
C) Within 12 hours of symptom onset Oseltamivir is a neuraminidase inhibitor that is effective against the influenza A and influenza B viruses. Its benefits decline greatly when treatment is delayed. Dosing must begin early—no later than 2 days after symptom onset. If treatment is started within 12 hours of symptom onset, symptom duration is reduced by more than 3 days. Specific symptoms, such as lung crackles and fever above 102°F, are not criteria for receiving oseltamivir.
A patient who has active TB is to start a medication regimen that includes pyrazinamide. The nurse identifies a risk for complications if the patient also has which medical condition? A) Parkinson disease B) Rheumatoid arthritis C) Glaucoma D) Alcoholism
D) Alcoholism Pyrazinamide is contraindicated in patients with both liver dysfunction and gout. It should be used with caution in patients who abuse alcohol, and liver function studies should be done every 2 weeks. It is not known to cause complications in patients who have Parkinson disease, rheumatoid arthritis, or glaucoma.
A patient who has HIV and is taking the nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) zidovudine [Retrovir] reports vomiting, abdominal pain, fatigue, and hyperventilation. Which laboratory result is the priority for the nurse to evaluate? A) Megakaryocytes B) Red blood cell (RBC) counts C) CD4 T-lymphocyte counts D) Arterial blood lactate
D) Arterial blood lactate Potentially fatal lactic acidosis and hepatic steatosis (fatty liver) can occur with all NRTIs. Measuring arterial blood lactate is a priority for the diagnosis of lactic acidosis. Associated symptoms of nausea, vomiting, abdominal pain, fever, and hyperventilation may occur. Megakaryocytes, RBC counts, and CD4 T-lymphocyte counts also may be measured with NRTI therapy, but alterations in these values are not associated with the complication of lactic acidosis.
Which antifungal agent is used as a one-time oral dose to treat vaginal yeast infections? A) Nystatin [Mycostatin] B) Caspofungin [Cancidas] C) Voriconazole [Vfend] D) Fluconazole [Diflucan]
D) Fluconazole [Diflucan] Fluconazole [Diflucan] has almost 100% bioavailability and therefore is often sufficient as a single dose to treat vaginal yeast infections. Caspofungin [Cancidas] cannot be administered orally. It is used in patients unresponsive to amphotericin B. Nystatin [Mycostatin] is administered as an oral or topical application for candidiasis. Voriconazole [Vfend] is used in the treatment of aspergillosis.
What is the drug of choice for prophylaxis andtreatment of CMV infection in immunocompromisedpatients, including those with AIDS.
Ganciclovir
