Pharmacology Ch. 35 (Adams)

The nursing instructor teaches the student nurses about fungal infections. The nursing instructor evaluates that learning has occurred when the student nurses make which statements?

Standard Text: Select all that apply.

1. Superficial infections are more difficult to treat than systemic infections.

2. Newer medications can be used for superficial as well as systemic infections.

3. Systemic infections are much more common than superficial infections.

4. Superficial infections are considered more benign than systemic infections.

5. Systemic infections require oral medications that have serious adverse effects

Correct Answer: 2,4,5

Rationale 1: Superficial infections are less difficult, not more difficult, to treat than systemic infections.

Rationale 2: Some of the newer antifungal agents may be used for either superficial or systemic infections.

Rationale 3: Systemic infections are less, not more, common than superficial infections.

Rationale 4: Superficial infections are relatively benign; systemic infections can be life threatening.

Rationale 5: Systemic infections often require aggressive oral or parenteral medications that produce more adverse effects than the topical agents.

The client has had malaria for many years. He asks the nurse why medications might not cure his illness when there are several drugs available. What is the best response by the nurse?

1. When erythrocytes rupture, the parasites are too numerous for medications to be effective.

2. Late in the illness, the immune system is too overwhelmed for medications to be effective.

3. Once the parasite starts multiplying in your liver, medications are usually ineffective.

4. When cysts occur late in the disease, the parasite is too resistant for medications to be effective.

Correct Answer: 4

Rationale 1: Erythrocytes rupture early in the course of the illness, and medications are more effective at this stage.

Rationale 2: Late in the illness, medications are often ineffective because the parasites are in cysts, not because the immune system is overwhelmed.

Rationale 3: The parasites begin multiplying in the liver in the earliest stage of the illness when medications are most effective.

Rationale 4: When cysts occur inside the host, the parasite is often resistant to pharmacotherapy.

The nurse plans to provide health promotion to a group of business travelers who are going to travel to Africa. What will the best teaching plan by the nurse include?

1. Plan to take antibiotics prophylactically.

2. Plan to take protease inhibitors prophylactically.

3. Plan to receive immunizations for malaria.

4. Plan to take antimalarial drugs prophylactically.

Correct Answer: 4

Rationale 1: Antibiotics are not necessary for travel into many countries.

Rationale 2: Protease inhibitors for viral infections are not recommended.

Rationale 3: To date, there are no effective immunizations against malaria.

Rationale 4: Taking antimalarial drugs prophylactically is recommended when traveling to countries where malaria is found.

The nurse works in infection control at a large hospital. Which client does the nurse recognize as being at greatest risk for acquiring a fungal infection?

1. The client with severe burns over 20% of the body

2. The adolescent client with a fractured femur from an auto accident

3. The client with anemia who is pregnant with triplets

4. The client with malignant melanoma who is receiving chemotherapy

Correct Answer: 4

Rationale 1: The client with burns is at risk, but will not acquire the infection if infection control procedures are followed.

Rationale 2: The adolescent with a fractured femur is not at risk.

Rationale 3: The pregnant client with anemia is not at risk.

Rationale 4: Chemotherapy suppresses the immune system; clients with a suppressed immune system are at highest risk

The nurse does medication education for the client with histoplasmosis who receives ketoconazole (Nizoral). The nurse evaluates that learning has occurred when the client makes which statement?

1. I cannot take this medication longer than 10 days.

2. I could develop resistance to this medication if I take it too often.

3. I could develop nausea, vomiting, and abdominal pain with this medication.

4. I cant take my diabetes medicine with this drug.

Correct Answer: 3

Rationale 1: Ketoconazole (Nizoral) is often used for longer than 10 days.

Rationale 2: Organisms, not people, develop resistance; this is not a likely occurrence anyway.

Rationale 3: Nausea, vomiting, and abdominal pain are common side effects of ketoconazole (Nizoral).

Rationale 4: The azole antifungals may affect glycemic control in diabetic clients. There is no indication to stop medications.

The client has scalp ringworm and is being treated with econazole (Spectazole). What are the best discharge instructions by the nurse?

1. Weigh yourself daily while using this medication.

2. Avoid meat and high protein foods with this medication.

3. Do not share any towels with family members.

4. Wash your head at least three times a day for 2 weeks.

Correct Answer: 3

Rationale 1: There is no indication of need for daily weights with use of superficial antifungals.

Rationale 2: There is no reason to restrict protein.

Rationale 3: Ringworm can be spread by contact with articles such as towels that are used by the affected person.

Rationale 4: Washing the head three times a day is excessive and unnecessary while taking econazole (Spectazole).

The client receives nystatin (Nilstat) for a fungal infection in the mouth. The nurse plans to do medication education prior to discharge. What will the best plan by the nurse include?

1. Dissolve the oral tablet in your mouth and then swallow it.

2. Take the oral suspension with a straw to prevent tooth discoloration.

3. Crush the oral tablet, mix it with orange juice, and then swallow it.

4. Swallow the oral tablet whole without chewing or crushing it.

Correct Answer: 1

Rationale 1: Dissolving the tablet in the mouth allows contact of the medication with the organisms causing the infection.

Rationale 2: The medication does not cause tooth discoloration.

Rationale 3: The medication must remain in the mouth as long as possible, so it should not be crushed and mixed with liquids.

Rationale 4: The medication must remain in the mouth as long as possible, so it should not be swallowed whole.

The client receives amphotericin B (Fungizone) for histoplasmosis. What does the best assessment by the nurse include?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Serum amylase

2. Serum sodium

3. Blood urea nitrogen

4. Serum glucose

5. Serum creatinine

Correct Answer: 3,5

Rationale 1: Amphotericin B (Fungizone) does not affect serum amylase.

Rationale 2: Amphotericin B (Fungizone) does not affect serum sodium.

Rationale 3: Amphotericin B (Fungizone) is nephrotoxic, so serum creatinine and blood urea nitrogen should be monitored.

Rationale 4: Amphotericin B (Fungizone) does not affect serum glucose.

Rationale 5: Amphotericin B (Fungizone) is nephrotoxic, so serum creatinine and blood urea nitrogen should be monitored.

The client is being treated for pinworms with mebendazole (Vermox). The nurse has completed medication education and evaluates that learning has occurred when the client makes which statement?

1. I need high-fiber foods to help with passage of the worms.

2. I should chew this tablet.

3. I must avoid aspirin while I am on this medication.

4. I need to have three negative stool cultures before I am cured.

Correct Answer: 2

Rationale 1: Diet will not impact the passage of worms.

Rationale 2: The drug is most effective when chewed.

Rationale 3: There is no interaction between mebendazole (Vermox) and aspirin.

Rationale 4: Stool cultures are not necessary.

The female client has a fungal infection and will receive nystatin (Mycostatin). What assessment data is critical for the nurse to collect prior to administering this medication?

1. The type of diet the client is eating

2. The amount of fat in the clients diet

3. The type of birth control the client is using

4. The clients height and weight

Correct Answer: 3

Rationale 1: The type of diet the client consumes is not significant.

Rationale 2: The type of diet the client consumes is not significant.

Rationale 3: Nystatin (Mycostatin) is a Pregnancy Category C drug, which means there isnt any data to indicate it is safe to take during pregnancy.

Rationale 4: The clients height and weight are not significant.

The client is noncompliant with taking medications to prevent malaria prior to an overseas business trip. What will the best assessment by the nurse reveal?

1. The taste of the various tablets was really too offensive to the client.

2. The medication dosing was too frequent for the client to tolerate.

3. The cost of the medications was too high for the clients budget.

4. The side effects of vomiting and diarrhea were too uncomfortable.

Correct Answer: 4

Rationale 1: The medication is not coated, but the taste is not a significant factor.

Rationale 2: Usually the dosing is once weekly or once daily; it is not too frequent for a client to tolerate.

Rationale 3: The cost of the medication is not a factor; generic forms are available.

Rationale 4: Side effects, such as vomiting and diarrhea, can be severe after taking the medication.

The client has a fungal infection of the toenails and receives oral terbinafine (Lamisil). The client asks the nurse how a pill will heal his nail infection. What is the best response by the nurse?

1. The medication accumulates in your nail beds and is there for many months.

2. The medication should be combined with a topical agent to increase effectiveness.

3. The medication works by destroying toxins excreted by the fungi in your nails.

4. The medication works by destroying circulating fungi in your blood.

Correct Answer: 1

Rationale 1: Terbinafine (Lamisil) is an oral agent that has the advantage of accumulating in nail beds, allowing it to remain active many months after therapy is discontinued.

Rationale 2: Terbinafine (Lamisil) does not need to be combined with a topical agent.

Rationale 3: Terbinafine (Lamisil) does not destroy toxins excreted by fungi.

Rationale 4: Terbinafine (Lamisil) does not destroy circulating fungi in the blood.

The client receives oral nystatin (Mycostatin) suspension for an oral candidiasis infection. She tells the nurse she cannot continue to swish and swallow because her nausea is too great. What is the best response by the nurse?

1. I will ask your doctor if a pill form can be substituted.

2. Try drinking a 7-Up after you swallow the medication.

3. It is all right to swish the medication and then spit it out.

4. You can take a phenergan suppository before the nystatin (Mycostatin).

Correct Answer: 3

Rationale 1: If GI side effects are disturbing, the client may swish the medication and then spit it out. A phenergan suppository is not necessary. Drinking a 7-Up is not necessary. Substituting a tablet form is not necessary.

Rationale 2: If GI side effects are disturbing, the client may swish the medication and then spit it out. A phenergan suppository is not necessary. Drinking a 7-Up is not necessary. Substituting a tablet form is not necessary.

Rationale 3: If GI side effects are disturbing, the client may swish the medication and then spit it out. A phenergan suppository is not necessary. Drinking a 7-Up is not necessary. Substituting a tablet form is not necessary.

Rationale 4: If GI side effects are disturbing, the client may swish the medication and then spit it out. A phenergan suppository is not necessary. Drinking a 7-Up is not necessary. Substituting a tablet form is not necessary.

The client receives terbinafine (Lamisil) as treatment for a fungal infection of the toenails. What is an important assessment question for the nurse to ask?

1. Are you HIV-positive?

2. How do you clean and clip your toenails?

3. Do you have diabetes mellitus?

4. What analgesic do you take for headaches?

Correct Answer: 4

Rationale 1: Terbinafine (Lamisil) is not contraindicated for a client who is HIV-positive.

Rationale 2: How the client cleans and clips his toenails is not significant.

Rationale 3: Terbinafine (Lamisil) does not affect glucose levels.

Rationale 4: Clients must be instructed not to use acetaminophen (Tylenol) while receiving terbinafine (Lamisil), because terbinafine (Lamisil) is hepatotoxic and so is acetaminophen (Tylenol) in large enough quantities.

Superficial fungal infections differ from systemic fungal infections in that superficial fungal infections

1. can be fatal.

2. affect hair and skin.

3. are less common.

4. affect internal organs.

Correct Answer: 2

Rationale 1: Systemic fungal infections can be fatal.

Rationale 2: Superficial fungal infections affect hair, skin, nails, and mucous membranes.

Rationale 3: Systemic fungal infections are less common than are superficial ones.

Rationale 4: Systemic fungal infections affect internal organs.

Which client is at the greatest risk of acquiring a serious fungal infection?

1. A teenager with no health problems

2. A client with a history of heart problems

3. A client with diabetes mellitus

4. A client who is immunosuppressed

Correct Answer: 4

Rationale 1: A teenager with no health problems is most likely resistant to a serious fungal infection.

Rationale 2: A client with heart problems most likely is resistant to a serious fungal infection.

Rationale 3: A client with diabetes mellitus can acquire an infection, but most likely not a serious one.

Rationale 4: Clients who are immunosuppressed, such as HIV or organ transplant clients, are very non-resistant to serious infections.

Treatment for malaria involves

1. multi-drug therapy.

2. single-drug therapy.

3. dietary restrictions.

4. topical drug therapy.

Correct Answer: 1

Rationale 1: Multi-drug therapy is the treatment of choice due to the life cycle of the protozoan parasite.

Rationale 2: The treatment of choice is multi-drug therapy.

Rationale 3: Dietary restrictions are not treatment.

Rationale 4: Topical therapy would be ineffective due to the infestation of the parasite in the red blood cells.

The nurse is preparing to administer a topical, oral antifungal medication to an adult client. The nurse will administer the medication

1. alone, and will allow the client to swish and swallow the medication.

2. with other medications.

3. with milk.

4. with water.

Correct Answer: 1

Rationale 1: Medication should be swished and swallowed and swished and spit without anything else in the mouth.

Rationale 2: Other medications should be given before or after antifungal medications.

Rationale 3: The client should wait at least 10 minutes after antifungal treatment to put anything else in the mouth.

Rationale 4: The client should wait at least 10 minutes after antifungal treatment to put anything else in the mouth.

The drug that most likely will be used for treatment of Trichomonas vaginalis is

1. praziquantel (Biltricide).

2. pyrimethamine (Daraprim).

3. suramin (Germanin).

4. metronidazole (Flagyl).

Correct Answer: 4

Rationale 1: Praziquantel (Biltricide) is an anthelmintic effective against flatworms.

Rationale 2: Pyrimethamine (Daraprim) is an antimalarial drug.

Rationale 3: suramin (Germanin) is used for African sleeping sickness.

Rationale 4: Metronidazole is the drug of choice for both giardiasis and trichomoniasis due to Trichomonas vaginalis.

The mechanism of action of systemic antifungal agents is to

1. interfere with the synthesis of ergosterol in the fungal cell membrane.

2. bind to toxic levels of parasite in the red blood cells.

3. bind to steroids in the fungal cell membrane.

4. kill fungal growth.

Correct Answer: 1

Rationale 1: Systemic antifungal agents interfere with the synthesis of ergosterol in the fungal cell membrane, causing them to become permeable.

Rationale 2: Antiprotozoal drugs bind to toxic levels of parasite in the red blood cells.

Rationale 3: Superficial fungal agents bind to sterols in the fungal cell membrane, allowing leakage of contents.

Rationale 4: None of these agents will kill the fungal growth.

A client is receiving amphotericin B. The nurse will reinforce teaching by telling the client that he should report which symptoms?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Feeling hot

2. Hearing loss

3. Dizziness

4. Constipation

5. Heartburn

Correct Answer: 1,2,3

Rationale 1: Many clients develop fever and chills at the beginning of therapy.

Rationale 2: Amphotericin B can cause ototoxicity.

Rationale 3: Vertigo can occur due to ototoxicity which may occur with amphotericin B.

Rationale 4: Constipation is not associated with amphotericin B.

Rationale 5: Heartburn is not associated with amphotericin B.

A client receives metronidazole (Flagyl) for treatment of a vaginal yeast infection. What should the nurse include in medication education for this client?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Do not drink alcohol with this medication.

2. Do not take this medication with milk or milk products.

3. Drink at least 3,000 mL of fluid per day with this medication.

4. Do not become pregnant while taking this medication.

5. You may experience a metallic taste while on this medication.

Correct Answer: 1,4,5

Rationale 1: The interaction of metronidazole and alcohol causes severe nausea, vomiting, and abdominal pain.

Rationale 2: There is no interaction between this medication and milk or milk products.

Rationale 3: Increasing fluids is not necessary.

Rationale 4: This medication is contraindicated during the first trimester of pregnancy.

Rationale 5: Dryness of the mouth and an unpleasant metallic taste may be experienced.

An infant is prescribed fluconazole (Diflucan) for treatment of infant oral candidiasis or thrush. Which information should the nurse provide to the infants caregiver in regard to this medication?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Give the medication right before a feeding.

2. Give the infant a small amount of water prior to administering the medication.

3. Use a dosage syringe to place medication in several parts of the infants mouth.

4. The infant should not breastfeed until this infection is gone.

5. The breastfeeding mother may also require treatment.

Correct Answer: 2,3,5

Rationale 1: The medication should be given after feeding.

Rationale 2: The medication will be more effective if milk sugars and proteins in the mouth are rinsed away prior to administration.

Rationale 3: The infant cannot swish and swallow so a syringe is used to distribute the medication around the mouth.

Rationale 4: There is no prohibition against breastfeeding.

Rationale 5: This treatment may be necessary to prevent re-transmission

A mother calls the emergency department and says, My 5-year-old just took four chloroquine (Aralen) that my husband was prescribed because he is going to Africa. What should the nurse advise?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. There should be no adverse effects.

2. Watch your child for nausea or vomiting.

3. Bring your child to the emergency department immediately.

4. Call 911 and watch your child for seizure activity until they arrive.

5. There should be no problem unless your child has kidney disease.

Correct Answer: 3,4

Rationale 1: Overdose of chloroquine is serious.

Rationale 2: Nausea and vomiting is an adverse effect of this medication, but this is not the advice that should be given.

Rationale 3: Overdose of chloroquine may be fatal.

Rationale 4: Convulsions may occur with this drug. The child should be brought to the ED.

Rationale 5: Overdose of chloroquine can be fatal, especially in children.

A client has been prescribed a topical antifungal medication for treatment of ringworm. What teaching should the nurse provide?

Standard Text: Select all that apply.

1. Avoid alcohol while using this medication.

2. Scrub the area vigorously prior to applying the medication.

3. Cover the area with an occlusive dressing after applying the medication.

4. Apply a thin layer of the medication.

5. After applying the medication, let the area air-dry.

Correct Answer: 4,5

Rationale 1: Oral antifungal medications require avoidance of alcohol. The same is not true of topicals.

Rationale 2: Vigorous scrubbing should be avoided.

Rationale 3: Occlusive dressings should be avoided.

Rationale 4: Only a thin, even layer is necessary.

Rationale 5: The area should be allowed to air-dry and loose-fitting clothing should be worn.