Antifungals (before midterm) Flashcards
A patient has been prescribed fluconazole. What should the nurse tell the patient to do in regard to this medication?
a. Have liver function tested.
b. Take antacids with the drug to minimize gastrointestinal upset.
c. Take the drug with a large glass of orange juice or water.
d. Take the drug 2 hours before a meal or 2 hours after a meal.
ANS: A
Patients receiving fluconazole requires close assessment of pre-existing GI problems and kidney and liver functioning due to drug-induced adverse effects impacting these systems.
Which is a contraindication to the use of griseofulvin?
a. Porphyria
b. Renal disease
c. Cardiac disease
d. Meningitis
ANS: A
Griseofulvin is contraindicated in patients with porphyria
The nurse is administering an antifungal medication. What assessment finding may indicate medication-induced renal damage?
a. Rash and chills
b. Increased urinary output
dc. Decreased levels of blood urea nit
ANS: D
A weight gain of more than 1 kg in in a 24-hour period or 2.3 kg or more in 1 week may indicate possible medication-induced kidney damage and the need for prompt medical attention. BUN and creatinine levels will increase, not decrease, if renal damage occurs. Urine output would decrease if renal damage were indicated. Rash and chills are not symptoms of renal damage.
Which antifungal drug causes increased effects of oral anticoagulants?
a. miconazole
b. fluconazole
c. ketoconazole
d. amphotericin B (Fungizone®)
ANS: B
Fluconazole causes increased effects of oral anticoagulants.
During administration of amphotericin B (Fungizone), the patient may experience severe adverse effects, such as fever, chills, hypotension, tachycardia, malaise, nausea, and headache. The correct action for the nurse to take is to
a. discontinue the infusion immediately.
b. reduce the infusion rate gradually until the adverse effects subside.
c. administer the medication by rapid intravenous (IV) infusion to reduce the potential adverse effects.
d. anticipating these effects, pretreat the patient with an antipyretic, such as acetaminophen, an antihistamine, and an antiemetic drug.
ANS: D
Pretreatment with an antipyretic (acetaminophen), an antihistamine, and an antiemetic drug is the appropriate action to reduce the adverse effects of amphotericin B therapy.
The nurse is administering Amphotec, one of the newer formulations of amphotericin B. When giving this drug, what important information does the nurse need to remember?
a. The new formulation may be given in an oral form.
b. The newer doses are much lower than the older doses.
c. The newer doses are much higher than the older doses.
ofd. The newer and older forms have no differences in their doses.
ANS: C
The newer forms of amphotericin B use much higher doses, ranging from IV: 3–4 mg/kg/day, infused at 1 mg/kg/ hr. Doses of older forms of amphotericin B range from 0.25 to 1.5 mg/kg per day.
A patient has been prescribed a vaginal antifungal drug. What important information should the nurse teach the patient about this drug?
0a. The medication is to be continued even if menstruation begins.
b. The health care provider should be contacted if symptoms are not gone in 48 hours.
c. Daily douching is part of the treatment for vaginal fungal infections.
d. Consumption of alcohol is to be avoided.
ANS: A
The nurse should advise the patient to continue to take the medication even if menstruation begins; the course of treatment must be completed. Daily douching is not part of the treatment for vaginal fungal infections, and the patient does not need to avoid consumption of alcohol. It may take up to 7 to 10 days for symptoms to disappear.
Which drug may be used for severe invasive aspergillosis in patients who cannot tolerate other antifungal drugs?
a. fluconazole (Diflucan®)
b. flucytosine (5-FC)
c. caspofungin (Cancidas®)
d. nystatin
ANS: C
Caspofungin is used for treating a severe Aspergillus infection (invasive aspergillosis) in patients who are intolerant of or refractory to other drugs.
The nurse is reviewing the history of a patient who will be taking an antifungal drug. Which condition is a contraindication to this treatment therapy?
a. Diabetes
b. Kidney failure
c. Hyperthyroidism
d. Meningitis
ANS: B
Liver failure and kidney failure are the most common contraindications to antifungal drugs. The other conditions listed are not contraindications to the use of antifungal drugs.
A patient with a severe fungal infection has been prescribed voriconazole (Vfend®). Which assessment finding should the nurse be concerned about before the medication is started?
a. Decreased breath sounds in the lower lobes
b. History of cardiac dysrhythmias
c. History of type 2 diabetes
d. Potassium level of 3.8 mmol/L
ANS: B
Voriconazole is contraindicated when coadministered with certain other drugs metabolized by the cytochrome P-450 enzyme CYP3A4 (e.g., quinidine) because of the risk for inducing serious cardiac dysrhythmias.
A patient is receiving therapy with amphotericin B (Fungizone). The nurse will monitor for known adverse effects that are reflected sboy which laboratory result?
a. A serum potassium level of 2.9 mmol/L
. A serum potassium level of 5.6 mmol/L c. A white blood cell count of 6 500 mm3
d. A platelet count of 300 000 per microlitre
ANS: A
The nurse should monitor for hypokalemia, a possible adverse effect of amphotericin B.
The nurse is administering amphotericin B (Fungizone). Which actions by the nurse are appropriate? (Select all that apply.)
a. Administering the medication by rapid IV infusion
b. Discontinuing the drug immediately if the patient develops tingling and numbness
in the extremities
c. If adverse effects occur, reducing the IV rate gradually until the adverse effects
subside
d. Using an infusion pump with IV therapy
e. Monitoring the IV site for signs of phlebitis and infiltration
f. Administering premedication for fever and nausea as ordered
g. Ensuring that the IV solution for amphotericin B is cloudy
h. Monitoring for muscle twitching, which may indicate hypokalemia
ANS: B, D, E, F
When administering amphotericin B, the nurse should discontinue the drug immediately if the patient develops tingling and numbness in the extremities An infusion pump should be used with IV therapy. The nurse should monitor the IV site for signs of phlebitis and infiltration and note that premedication for fever and nausea may be ordered. The medication should be administered at the recommended rate and stopped, not slowed, if adverse reactions occur. The IV solution should be clear and without precipitates, and muscle weakness, not twitching, may indicate hypokalemia.
