Anti-Infectives NCLEX

Question 1

Which antifungal drug is available in injectable, oral, and topical preparations?

1. Nystatin
2. Terbinafine
3. Caspofungin
4. Amphotericin B

Answer 1

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.

Question 2

A nurse has a sample of the medicine nystatin. Which type of patient will receive this medication?

1. Patients with aspergillosis infection
2. Patients with cryptococcus infection
3. Patients with histoplasmosis infection
4. Patients with oral candidiasis infection

Answer 2

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.

Question 3

A child has contracted chickenpox and is treated successfully. Which infection is the child prone to develop as an adult?

1. Shingles
2. Retinitis
3. Gastroenteritis
4. Kaposi sarcoma

Answer 3

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.

Question 4

The nurse is caring for a patient taking foscarnet. What will the nurse monitor to identify potential side effects of this medication?

1. Platelets
2. Stool guaiac
3. Hemoglobin and hematocrit
4. Blood urea nitrogen and creatinine

Answer 4

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.

Question 5

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?

1. “Take both drugs simultaneously.”
2. “Take the drug on an empty stomach.”
3. “Take the antacid every alternate day.”
4. “Take the antacid 2 hours before the drug.”

Answer 5

“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.

Question 6

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?

1. “Lie down after taking the drug.”
2. “Avoid taking the drug with milk.”
3. “Avoid taking the drug with food.”
4. “Sit upright when taking the drug.”

Answer 6

“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.

Question 7

Which antifungal drug is applied topically for the treatment of candidal diaper rash?

1. Nystatin
2. Terbinafine
3. Caspofungin
4. Voriconazole

Answer 7

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.

Question 8

What possible effect will the nurse anticipate in a patient who has received amphotericin B along with thiazide diuretics?

1. Severe hypokalemia
2. Additive nephrotoxicity
3. Increased adrenal cortex response to corticotrophin
4. Prolongation of the QT interval on an electrocardiogram

Answer 8

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.

Question 9

Which nurse should not be assigned to treat a patient who is receiving ribavirin in an aerosol formulation?

1. A nurse who is pregnant
2. A nurse who has a low-grade fever
3. A nurse who has not had chickenpox
4. A nurse on light duty because of a back injury

Answer 9

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.

Question 10

Which form of the antifungal drug terbinafine is used primarily to treat onychomycoses of the fingernails or toenails?

1. Gel
2. Spray
3. Cream
4. Tablet

Answer 10

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.

Question 11

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?

1. Tell the patient to be more careful.
2. Assess the patient’s platelet counts.
3. Administer vitamin K to the patient.
4. Ask the patient if someone is abusing her.

Answer 11

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.

Question 12

A patient who is prescribed intravenous (IV) vancomycin reports frequent ringing in the ears. Which condition should the nurse suspect?

1. Red man syndrome
2. Probable convulsion
3. Early vestibular damage
4. Ineffective antibiotic therapy

Answer 12

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.

Question 13

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?

1. Penicillins
2. Sulfonamide
3. First-generation cephalosporins
4. Second-generation cephalosporins

Answer 13

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.

Question 14

Which instruction will the nurse include in the discharge teaching for a patient receiving tetracycline?

1. “Take the medication until you feel better.”
2. “Use sunscreen and protective clothing when outdoors.”
3. “Keep the remainder of the medication in case of recurrence.”
4. “Take the medication with food or milk to minimize gastrointestinal upset.”

Answer 14

“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.

Question 15

Why is the lipid dosage form of amphotericin B used only when patients are intolerant to nonlipid amphotericin B?

1. The lipid dosage form of amphotericin B is costly.
2. The lipid dosage form of amphotericin B is less effective.
3. The lipid dosage form of amphotericin B has a high incidence of adverse effects.
4. The lipid dosage form of amphotericin B requires the preadministration of antihistamines and corticosteroids.

Answer 15

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.

Question 16

The nurse is assessing a patient with pneumonia who is prescribed amikacin. After reviewing the medication history, the nurse finds that the patient is taking anticoagulants. For what should the nurse primarily monitor in the patient?

1. Abnormal bleeding
2. Venous thrombosis
3. Impaired consciousness
4. Burning sensation of feet

Answer 16

Abnormal bleeding

Anticoagulants are given to prevent the formation of a clot or thrombus. When they are combined with an aminoglycoside they cause anticoagulant toxicity by inhibiting the action of vitamin K in the body. Therefore, the nurse should check for abnormal bleeding in a patient who is administered both amikacin and anticoagulants. Formation of a thrombus is prevented by anticoagulants, and their effects are not decreased by the concomitant administration of amikacin. Loss of consciousness is not caused by amikacin or by a drug interaction with anticoagulants. A burning sensation of the feet is a symptom of paresthesia, which is a rare side effect caused by prolonged use of amikacin but it is not related to anticoagulants.

Question 17

The nurse has administered the morning dose of tobramycin to a patient according to the prescription. In the evening, the nurse collects a blood sample from the patient and observes that the serum drug concentration is greater than 2 mcg/mL. What does the nurse infer from this?

1. The patient is at risk for heartburn.
2. The patient is at risk for nasal congestion.
3. The patient is at risk for renal dysfunction.
4. The patient is at risk for red man syndrome.

Answer 17

The patient is at risk for renal dysfunction.

The safe therapeutic serum concentration of tobramycin is less than or equal to 1 mcg/mL (which is undetectable in blood tests). Serum concentration of the drug greater than 2 mcg/mL is associated with greater risk for both ototoxicity and nephrotoxicity (renal dysfunction). Increased serum concentrations of this drug cause increased serum creatinine concentrations. This indicates declining renal function. Heartburn is an adverse effect of quinolones. The use of metronidazole is associated with nasal congestion and red man syndrome, which is characterized by flushing and/or itching of the head, face, neck, and upper trunk area and is an adverse effect of vancomycin.

Question 18

The patient has been started on a medication regimen that includes sulfamethoxazole/trimethoprim. The nurse notes that the source of the patient’s infection has been determined to be viral in origin. What is the nurse’s highest priority action?

1. Administer the medication as ordered by the provider.
2. Ensure that the information is documented in the chart.
3. Contact the health care provider to discuss the medication.
4. Ask the patient if he knows how he contracted the infection.

Answer 18

Contact the health care provider to discuss the medication.

The health care provider should be contacted regarding the ordering of sulfamethoxazole/trimethoprim for this patient because it has not been shown to be effective in treating viral infections.

Question 19

What is the common drug-induced adverse effect of caspofungin?

1. Leukopenia
2. Bradycardia
3. Hypertension
4. Nephrotoxicity

Answer 19

Leukopenia

Caspofungin has potential drug-induced adverse effects, such as leukopenia. It also causes tachycardia and hypotension, but not bradycardia or hypertension. Nephrotoxicity is an adverse effect of amphotericin B.

Question 20

A patient is prescribed azithromycin for the treatment of a respiratory tract infection. Which parameters need to be assessed in the patient to ensure safe drug administration? Select all that apply.

1. Skin turgor
2. Visual acuity
3. Liver function
4. Baseline hearing status
5. Baseline cardiac function

Answer 20

• Liver function
• Baseline hearing status
• Baseline cardiac function

Azithromycin is a macrolide antibiotic. Liver function is assessed in the patient because macrolide antibiotics may cause hepatotoxicity and jaundice. The patient’s baseline hearing status should be assessed because the treatment may induce hearing loss and tinnitus. The patient’s baseline cardiac function should be assessed because macrolide antibiotics may lead to palpitations, chest pain, and electrocardiogram changes in the patient. Macrolide antibiotics do not affect skin turgor or visual acuity; therefore these parameters need not be assessed.

Question 21

A 22-year-old female patient is prescribed amoxicillin. Which is the most important intervention for this patient?

1. Obtain a baseline complete blood count.
2. Assess if the patient is on oral contraceptives.
3. Inform the patient about possible superinfections.
4. Instruct the patient to not take the medication before meals.

Answer 21

Assess if the patient is on oral contraceptives.

This medication may decrease the effectiveness of oral contraceptives. The nurse needs to assess whether or not the patient is on oral contraceptives and whether or not the patient is sexually active. Long-term use of antibiotics can cause blood dyscrasias, but a baseline complete blood count is not indicated. Informing the patient about possible superinfections and not to take the medication before meals are not priorities.

Question 22

A patient has been diagnosed with genital herpes. What drug will be used to treat and manage this infection?

1. Ribavirin
2. Acyclovir
3. Zidovudine
4. Amantadine

Answer 22

Acyclovir

Acyclovir is indicated for the treatment of genital herpes. Ribavirin is used in the treatment of respiratory syncytial virus and in combination with simeprevir and interferon for the treatment of hepatitis C. Zidovudine is used to increase the life expectancy of patients suffering from acquired immune deficiency syndrome. Amantadine is used to prevent herpes simplex virus (HSV)-1 and HSV-2.

Question 23

When planning care for a patient receiving a sulfonamide antibiotic, which is a primary intervention?

1. Force fluids to at least 2000 mL/day.
2. Encourage liquids that produce acidic urine.
3. Encourage a diet that causes an alkaline ash.
4. Insert a Foley catheter for accurate input and output measurement.

Answer 23

Force fluids to at least 2000 mL/day.

Forcing fluids will help prevent crystallization in the urine and kidney stone formation associated with sulfonamide antibiotics, regardless of the type of fluid consumed. Consuming a specific type of diet will not decrease the risk of crystallization. It is outside the nurse’s scope of practice to decide to insert a Foley catheter.

Question 24

The nurse is caring for a patient who is being treated for acne. The nurse anticipates that the health care provider is most likely to treat the patient using which medication?

1. Polymyxin
2. Tobramycin
3. Tetracycline
4. Vancomycin

Answer 24

Tetracycline

Tetracycline is considered a drug of choice for the treatment of acne rather than vancomycin, tobramycin, and polymyxin, which are not used in the treatment of acne.

Question 25

**How does superinfection occur in a patient?** 1. When the serum level of an antibiotic is too high 2. When the patient has a gram-positive bacterial infection 3. When the patient has a gram-negative bacterial infection 4. When the antibiotic eliminates the normal bacterial flora

Answer 25

_When the antibiotic eliminates the normal bacterial flora_ The normal bacterial flora consists of certain bacteria and fungi that are needed to maintain normal function in various organs. Superinfection can occur when antibiotics completely eliminate the normal bacterial flora. When these bacteria or fungi are killed by antibiotics, then other bacteria or fungi cause infection, which is known as superinfection. When the serum level of the antibiotic is too high, it causes a toxic reaction. Gram-positive and gram-negative bacterial infections do not cause superinfection.

Question 26

**While reviewing the blood reports of a patient who is receiving amikacin therapy, the nurse finds that the serum drug concentration is 4 mcg/mL. What additional laboratory reports will the nurse check to ensure the patient’s safety?** 1. Blood platelet count 2. Blood glucose concentration 3. Serum thyroxine concentration 4. Serum creatinine concentration

Answer 26

_Serum creatinine concentration_ Amikacin is an aminoglycoside antibiotic. Aminoglycosides have the potential to cause nephrotoxicity, so the patient’s serum drug concentrations should be monitored regularly. The usual serum drug concentration of aminoglycosides is expected to be less than or equal to 1 mcg/mL (considered as the safe range). Concentrations higher than this may cause adverse effects. Therefore, the nurse should check the serum creatinine concentration to evaluate proper renal function. Aminoglycosides do not affect blood glucose concentration. This means that the nurse does not need to check the patient’s blood glucose concentration. Aminoglycosides do not affect platelet count. Therefore, the nurse need not check the patient’s platelet count. Aminoglycosides do not affect thyroxine hormone concentration. Therefore, the nurse need not check the patient’s serum thyroxine concentration.

Question 27

**What should the nurse instruct a patient about administering topical clindamycin?** 1. "Squeeze the tube of medication into the vagina." 2. "Refrigerate the reconstituted medication between uses." 3. "Cleanse the skin with an exfoliating agent before application." 4. "Apply a thin layer to the affected area after it has been cleansed."

Answer 27

_"Apply a thin layer to the affected area after it has been cleansed."_ The patient needs to apply a thin layer of the drug after gently cleansing the affected area. Patients are advised to avoid using abrasive or irritating products while using topical forms of clindamycin and to avoid refrigerating the reconstituted form, which causes thickening. Proper vaginal administration of clindamycin involves the use of gloves and insertion of the medication with an applicator to prevent hand contamination and cross-contamination of the medication tube.

Question 28

**A patient has been prescribed acyclovir. What precautionary measure should the nurse implement to minimize kidney damage associated with this drug?** 1. Use the solution within 24 hours 2. Infuse acyclovir over at least 1 hour 3. Provide ice chips during the infusion 4. Assess the intravenous site frequently for redness

Answer 28

_Infuse acyclovir over at least 1 hour_ As a means of reducing the risk of crystalluria and renal tubule damage, the nurse infuses acyclovir over at least 1 hour, because renal damage is associated with too rapid infusion of this drug. In addition, the nurse prehydrates the patient and maintains hydration during and for several hours after the infusion to induce hemodilution. Acyclovir infusions are stable for 12 hours at room temperature. Ice chips are inadequate to maintain. hydration; however, they are suitable for supplemental fluid and comfort. Assessing the intravenous site is an important nursing intervention during the infusion; however, looking for redness at the site is a means of detecting potential phlebitis, not a renal-protective measure

Question 29

**A patient is prescribed sulfadiazine. After checking the patient's history, the nurse finds that the patient has glucose-6-phosphate dehydrogenase (G6PD) deficiency. What will the nurse do in this situation?** 1. The nurse requests testing for Clostridium difficile. 2. The nurse requests culture and sensitivity testing for the patient. 3. The nurse anticipates administering sulfadiazine in a higher dose to the patient. 4. The nurse contacts the primary health care provider before administration of the drug.

Answer 29

_The nurse contacts the primary health care provider before administration of the drug._ Sulfadiazine belongs to the class of sulfonamides. The administration of sulfonamides to a patient with G6PD deficiency may result in hemolysis, or destruction of red blood cells. Therefore the nurse should inform the primary health care provider before administration of the drug. Culture and sensitivity testing is helpful to optimize drug selection in individual cases, but it does not help to reduce the risk of hemolysis. Clostridium difficile infection testing is required when the patient has symptoms such as watery diarrhea, abdominal pain, and fever. The nurse does not find these symptoms in this patient; therefore this test is not needed. The nurse should not administer sulfadiazine in higher doses to the patient because this may result in severe complications.

Question 30

**The patient has been ordered azithromycin and asks the nurse why the medication does not have to be taken as often as other antibiotics that have previously been ordered. What is the nurse's best response?** 1. "You'll need to ask your health care provider questions like that." 2. "I'll call the pharmacy and ask about the chemical makeup of the drug." 3. "This is a much more effective drug than what you received previously." 4. "This drug has a longer duration of action than some of the other antibiotics."

Answer 30

_"This drug has a longer duration of action than some of the other antibiotics."_ Azithromycin is one of the newer macrolide antibiotics. It has a longer duration of action, as well as fewer and less severe gastrointestinal side effects than erythromycin. The other responses do not address the patient’s question, which was why azithromycin does not have to be taken as often.

Question 31

**What are the common primary tissues that are affected by infection with the Trichophyton spp.? Select all that apply.** 1. Skin 2. Scalp 3. Brain 4. Lungs 5. Blood

Answer 31

_Skin_ _Scalp_ Trichophyton spp infections are superficial or topical infections that affect the skin and scalp. Cryptococcus neoformans infections affect the meninges of the brain. Infections by Aspergillus spp. affect the lungs. Severe infections caused by Candida albicans may affect the blood.

Question 32

**While assessing a patient who began treatment with an antifungal drug 1 week earlier, the nurse notes an interval weight gain of 6 pounds. Upon notifying the primary health care provider of this change, what diagnostic testing should the nurse anticipate?** 1. Pulmonary function tests 2. Cardiac enzyme and CRP levels 3. Liver enzyme and bilirubin levels 4. Serum blood urea nitrogen and creatinine levels

Answer 32

**Serum blood urea nitrogen and creatinine levels** A gain of 6 pounds in a week after the initiation of antifungal therapy indicates the possibility of medication-induced renal dysfunction. The patient should be assessed for renal function, and appropriate medical attention should be provided. Hepatic, cardiac, and pulmonary problems are uncommon causes of acute weight gain in patients receiving antifungal drug therapy.

Question 33

**A patient who is receiving an oral anticoagulant is started on fluconazole to treat a fungal infection. What possible drug interaction could occur in this patient?** 1. Risk of bleeding 2. Risk of thrombosis 3. No drug interaction 4. Fluconazole toxicity

Answer 33

_Risk of bleeding_ Fluconazole increases the effects of anticoagulants, and thus the patient is at risk of bleeding. Fluconazole does not increase the risk of thrombosis. The interaction of fluconazole and anticoagulants does not cause fluconazole toxicity.

Question 34

**Which agent is used to treat most infections caused by herpes simplex viruses and varicella-zoster virus?** 1. Acyclovir 2. Zanamivir 3. Ganciclovir 4. Amantadine

Answer 34

_Acyclovir_ Acyclovir, the drug of choice for most infections caused by herpes simplex viruses and varicella-zoster viruses, is used to suppress replication of the herpes virus. Zanamivir is used to treat influenza in adults. Ganciclovir is the drug used most commonly in the treatment of cytomegalovirus. Amantadine is used to prevent and treat influenza.

Question 35

**The primary health care provider prescribes vancomycin to a patient who has a streptococcal infection. What will the nurse assess in the patient to ensure safe administration of the drug?** 1. Skin integrity 2. Renal function 3. Red blood cell count 4. Blood glucose concentration

Answer 35

_Renal function_ Vancomycin is a tricyclic glycopeptide, which causes nephrotoxicity. Therefore, the nurse should check the patient’s renal function before administering vancomycin. Renal impairment may lead to severe toxicity. The dosing frequency of vancomycin is dependent on renal function. Therefore, it is important to check the patient’s renal function. Vancomycin does not affect skin integrity, red blood cell counts, or blood glucose concentration; therefore, the nurse need not check these in the patient.

Question 36

**Which microorganism is directly affected by acyclovir?** 1. Herpes zoster 2. Proteus vulgaris 3. Pneumocystis carinii 4. Staphylococcus aureus

Answer 36

_Herpes zoster_ Acyclovir in its oral form is used as prophylaxis for and in the treatment of Herpes zoster. Proteus vulgaris, Pneumocystis carinii, and Staphylococcus aureusare not cured with acyclovir. There are other antiviral remedies for P. vulgaris, P. carinii, and S. aureus. P. vulgaris is treated with antibiotics such as sulfonamides. P. carinii is treated with antiprotozoal drugs such as atovaquone. Ciprofloxacin is used to treat S. aureus.

Question 37

**The nurse should question the prescription of tetracycline for which patient?** 1. A 6-year old patient with Haemophilus influenza 2. A 40-year-old patient diagnosed with rickettsia 3. A 60-year-old patient with a history of hypertension 4. A 45-year-old patient with a history of diabetes mellitus

Answer 37

_A 6-year old patient with Haemophilus influenza_ Tetracycline is contraindicated in children younger than 8 years old because it can cause permanent discoloration of the teeth. Additionally, increasing tetracycline resistance to Haemophilus influenza is a concern. Tetracycline is used to treat rickettsia. Tetracycline is not contraindicated for patients diagnosed with diabetes mellitus or hypertension.

Question 38

**Which patients are susceptible to developing severe systemic fungal infections? Select all that apply.** 1. A patient with cancer who is receiving chemotherapy 2. A patient who is using opioids to manage cancer-related pain 3. A patient who is receiving immunosuppressive agents for lupus 4. A patient who has acquired immune deficiency syndrome (AIDS) 5. A patient who is using thrombolytic agents for myocardial infarction

Answer 38

* _A patient with cancer who is receiving chemotherapy_ * _A patient who has acquired immune deficiency syndrome (AIDS)_ * _A patient who is receiving immunosuppressive agents for lupus_ The risk factors for the development of severe systemic fungal infections are use of chemotherapy in cancer patients, the use of immunosuppressive agents, and having AIDS. The use of opioids and thrombolytic agents does not predispose a patient to severe systemic fungal infection, because they do not affect the body’s immune system.

Question 39

**A patient who is resistant to several antiretroviral therapies is prescribed maraviroc. What substance in the patient’s history would decrease the therapeutic effect of the drug?** 1. Ginger 2. St. John’s wort 3. Acetaminophen 4. Oral contraceptives

Answer 39

_St. John’s wort_ Maraviroc is a new class of antiviral drugs that is used to treat patients who have developed resistance to antiretroviral therapies. Maraviroc has a reduced effect when given in combination with St. John’s wort, which is an herbal medication that is used for depression. St. John’s wort quickly processes maraviroc, reducing its absorption time and thereby reducing its effect. The drug does not interact with ginger, acetaminophen, or oral contraceptives.