Anti-Infectives NCLEX Flashcards
Which antifungal drug is available in injectable, oral, and topical preparations?
- Nystatin
- Terbinafine
- Caspofungin
- Amphotericin B
Amphotericin B
Amphotericin B is available in injectable, oral, and topical preparations. Nystatin is not available in a parenteral form. Terbinafine is available as a topical cream, gel, and spray. Caspofungin is available only in an injectable form.
A nurse has a sample of the medicine nystatin. Which type of patient will receive this medication?
- Patients with aspergillosis infection
- Patients with cryptococcus infection
- Patients with histoplasmosis infection
- Patients with oral candidiasis infection
Patients with oral candidiasis infection
Nystatin is not available for parenteral administration; therefore, its use is restricted to managing oral and pharyngeal candidiasis. The excessively high dose of oral nystatin required to treat aspergillosis, cryptococcosis, and histoplasmosis, would result in unacceptable toxicity, making it inappropriate treatment for these fungal infections.
A child has contracted chickenpox and is treated successfully. Which infection is the child prone to develop as an adult?
- Shingles
- Retinitis
- Gastroenteritis
- Kaposi sarcoma
Shingles
Shingles, or herpes zoster, is caused by reactivation of varicella-zoster virus, which causes chickenpox. The virus that causes chickenpox may lie dormant in the nerve cells of the person for many years, only to be reactivated by any trigger. When reactivated, it causes shingles. Retinitis is usually caused by cytomegalovirus. Gastroenteritis is unrelated to a history of chickenpox. Kaposi’s sarcoma is a cancer associated with acquired immune deficiency syndrome and is caused by Kaposi’s sarcoma herpesvirus.
The nurse is caring for a patient taking foscarnet. What will the nurse monitor to identify potential side effects of this medication?
- Platelets
- Stool guaiac
- Hemoglobin and hematocrit
- Blood urea nitrogen and creatinine
Blood urea nitrogen and creatinine
Foscarnet can cause kidney damage. Blood urea nitrogen and creatinine should be closely monitored. Platelets, stool guaiac, and hemoglobin and hematocrit would not be monitored to identify potential side effects of this medication.
A primary health care provider prescribes an antacid to a patient who is taking ciprofloxacin. What information should the nurse mention while counseling the patient?
- “Take both drugs simultaneously.”
- “Take the drug on an empty stomach.”
- “Take the antacid every alternate day.”
- “Take the antacid 2 hours before the drug.”
“Take the antacid 2 hours before the drug.”
The nurse should instruct the patient to take the antacid 2 hours before taking ciprofloxacin to improve the drug’s absorption. Ciprofloxacin causes gastric irritation when administered on an empty stomach. The antacids should not be taken on alternate days, because this may not help prevent gastrointestinal problems. Ciprofloxacin interacts with antacids, and this decreases the absorption of the ciprofloxacin.
A patient is prescribed zidovudine. The nurse understands that the drug may cause esophageal ulceration if not taken properly. What instruction will the nurse give to the patient to prevent this adverse effect?
- “Lie down after taking the drug.”
- “Avoid taking the drug with milk.”
- “Avoid taking the drug with food.”
- “Sit upright when taking the drug.”
“Sit upright when taking the drug.”
Zidovudine is an antiviral drug that may cause esophageal ulceration if regurgitated. Therefore, the patient should be instructed to sit upright or keep the head elevated when taking the drug. The patient should be instructed not to lie down immediately after taking the drug; the patient should sit upright for at least 30 minutes after taking the drug to prevent regurgitation. The drug can be taken with milk or food, because these do not interfere with absorption of the drug.
Which antifungal drug is applied topically for the treatment of candidal diaper rash?
- Nystatin
- Terbinafine
- Caspofungin
- Voriconazole
Nystatin
Nystatin is a polyene antifungal drug that is often applied topically for the treatment of candidal diaper rash. Terbinafine is an allylamine antifungal drug and is used for the treatment of superficial dermatologic infections, including tinea pedis. Caspofungin is used for the treatment of severe Aspergillus infection. Voriconazole is used for the treatment of severe fungal infections caused by Aspergillus spp.
What possible effect will the nurse anticipate in a patient who has received amphotericin B along with thiazide diuretics?
- Severe hypokalemia
- Additive nephrotoxicity
- Increased adrenal cortex response to corticotrophin
- Prolongation of the QT interval on an electrocardiogram
Severe hypokalemia
Administration of amphotericin B along with thiazide diuretics causes severe hypokalemia, because both drugs may cause loss of fluids and electrolytes. Administration of amphotericin B along with nephrotoxic drugs causes additive nephrotoxicity. Administration of amphotericin B along with thiazide diuretics causes a decreased adrenal cortex response to corticotrophin. Administration of voriconazole along with quinidine causes prolongation of the QT interval on an electrocardiogram.
Which nurse should not be assigned to treat a patient who is receiving ribavirin in an aerosol formulation?
- A nurse who is pregnant
- A nurse who has a low-grade fever
- A nurse who has not had chickenpox
- A nurse on light duty because of a back injury
A nurse who is pregnant
Ribavirin is a teratogenic (category X) drug and should be avoided in those who are pregnant or trying to conceive. Nurses who have a low-grade fever, who haven’t had chickenpox or have a back injury are not susceptible to the teratogenic properties of ribavirin.
Which form of the antifungal drug terbinafine is used primarily to treat onychomycoses of the fingernails or toenails?
- Gel
- Spray
- Cream
- Tablet
Tablet
Terbinafine is an allylamine antifungal drug and is the only drug in its class. Onychomycoses of the fingernails or toenails are primarily treated using the oral form of terbinafine. Gel, spray, and cream forms are used for the treatment of superficial dermatologic infections.
A patient has been on sulfonamides for urinary tract infections. The nurse assesses the patient and finds bruises on the legs and arms. What is the nurse’s best action?
- Tell the patient to be more careful.
- Assess the patient’s platelet counts.
- Administer vitamin K to the patient.
- Ask the patient if someone is abusing her.
Assess the patient’s platelet counts.
Blood disorders such as hemolytic anemia, aplastic anemia, and low white blood cell and platelet counts could result from prolonged use and high dosages. The nurse should assess the patient before assuming frequent falls, vitamin K deficiency, or potential abuse.
A patient who is prescribed intravenous (IV) vancomycin reports frequent ringing in the ears. Which condition should the nurse suspect?
- Red man syndrome
- Probable convulsion
- Early vestibular damage
- Ineffective antibiotic therapy
Early vestibular damage
Frequent ringing in the ears, or tinnitus, is an adverse effect of vancomycin. Red man syndrome is more likely to occur when the drug is infused too rapidly. Convulsion is an adverse effect of quinolones. Secondary infection can be caused by ineffective antibiotic therapy, not vestibular damage.
The nurse advises a patient to use sunscreen and wear a hat to avoid the sun between 10:00 AM and 4.00 PM. Which group of antibiotics is the patient most likely using?
- Penicillins
- Sulfonamide
- First-generation cephalosporins
- Second-generation cephalosporins
Sulfonamide
Sulfonamides, including cotrimoxazole and tetracyclines (especially demeclocycline), are more likely than other antibiotics to cause photosensitivity during their use. Photosensitivity is induced by exposure to sunlight during sulfonamide drug therapy. So the nurse advises the patient to use sunscreen and wear a hat. Allergic reactions to penicillins occur in 0.7% to 4% of treatment courses. The most common reactions are urticaria, pruritus, and angioedema. The safety profiles, contraindications, and pregnancy ratings of cephalosporins are similar to those of penicillins. The most commonly reported adverse effects are mild diarrhea, abdominal cramps, rash, pruritus, redness, and edema. No photosensitivity is seen here.
Which instruction will the nurse include in the discharge teaching for a patient receiving tetracycline?
- “Take the medication until you feel better.”
- “Use sunscreen and protective clothing when outdoors.”
- “Keep the remainder of the medication in case of recurrence.”
- “Take the medication with food or milk to minimize gastrointestinal upset.”
“Use sunscreen and protective clothing when outdoors.”
Photosensitivity is a common side effect of tetracycline. Exposure to the sun can cause severe burns. The medication should not be taken with milk and should be completely finished.
Why is the lipid dosage form of amphotericin B used only when patients are intolerant to nonlipid amphotericin B?
- The lipid dosage form of amphotericin B is costly.
- The lipid dosage form of amphotericin B is less effective.
- The lipid dosage form of amphotericin B has a high incidence of adverse effects.
- The lipid dosage form of amphotericin B requires the preadministration of antihistamines and corticosteroids.
The lipid dosage form of amphotericin B is costly.
The lipid dosage form of amphotericin B is costlier than conventional amphotericin B, so it is used only when patients are intolerant to nonlipid amphotericin B. The lipid dosage form of amphotericin B is more effective and safe and shows fewer adverse drug interactions than conventional amphotericin B. Nonlipid amphotericin B requires preadministration of antihistamines and corticosteroids to decrease the severity of infusion-related reactions, but lipid formulations do not.