Chapter 10 Book Qs + Evolve Flashcards
- A patient has been admitted to the hospital with tuberculosis and is prescribed first-line drug therapy. Which drugs should you plan to teach the patient about before discharge? Select all that apply.
A. amoxicillin/clavulanate (Augmentin) B. bedaquiline (Sirturo) C. ethambutol (Myambutol) D. isoniazid (Nydrazid) E. posaconazole (Noxafil) F. pyrazinamide (PZA) G. raltegravir (Isentress) H. rifampin (Rifadin) I. vancomycin (Vancocin)
C D F H
- Which adverse effect is common to all the first-line antitubercular drugs?
A. Liver toxicity B. Blurred vision C. Reddish-orange urine D. Excessive daytime drowsiness
A
- Which precaution is most important to teach a patient who has been prescribed the four first-line anti-TB drugs?
A. “Do not drive or operate heavy machinery while taking these drugs.” B. “Take these drugs at night to prevent nausea and vomiting.” C. “Do not drink alcoholic beverages while on these drugs.” D. “Be sure to take these drugs with food.”
C
- Which systemic antifungal drug has the nickname “shake and bake”?
A. anidulafungin (Eraxis) B. amphotericin B (Amphocin) C. flucytosine (Ancobon) D. terbinafine (Apo-terbinafine)
B
- Which type of superficial fungal infection requires systemic antifungal drug therapy rather than topical antifungal drug therapy?
A. Oral thrush B. Vaginal candidiasis C. Infection of the toenail D. Infection of the skin and scalp
C
- Which antifungal drug is never prescribed for anyone who is pregnant because it causes birth defects?
A. anidulafungin (Eraxis) B. fluconazole (Diflucan) C. griseofulvin (Fulvicin) D. micafungin (Mycamine)
C
- Which precaution is important to teach a patient who is prescribed to use an antifungal cream?
A. Wash your hands after applying the drug. B. Hold your breath while applying this drug. C. Take your pulse daily and report any irregularities immediately to the prescriber. D. Use a reliable method of birth control while using the drug and for 1 month after completing the drug therapy.
A
- The patient taking first-line drug therapy for tuberculosis reports that his urine is now a bright reddish-orange color. What is your best response or action?
A. Assess his skin and eyes for other indications of jaundice. B. Remind him to drink at least 2 to 3L of water daily. C. Ask whether he has noticed any pain or burning on urination. D. Reassure him that this is an expected side effect of the drug therapy.
D
- Why is it important to teach a patient who is taking first-line drug therapy for tuberculosis to avoid any products containing acetaminophen or Tylenol for the entire therapy period?
A. Acetaminophen, like first-line drugs, is liver toxic and the combination worsens this adverse effect. B. Acetaminophen reduces the activity of first-line drugs and the dosages would need to be increased. C. Acetaminophen increases the activity of first-line drugs and the dosages would need to be reduced. D. Acetaminophen delays or inhibits the intestinal absorption of first-line drugs.
A
- Which patient is most at risk for developing peripheral neuropathy as a result of taking isoniazid (Nydrazid) for tuberculosis?
A. A 36-year-old woman who is 6 months pregnant B. A 45-year-old man who has gouty arthritis C. A 50-year-old woman who has type 1 diabetes mellitus D. A 65-year-old man who has a greatly enlarged prostate gland
C
- The patient with tuberculosis who is prescribed the four first-line antituberculosis drugs asks how long he will have to “take all these pills.” What is your best response?
A. “When your skin test results are negative, you can stop the drugs.” B. “You will be reevaluated to stop this therapy after 1 year.” C. “You must take these drugs until your cough goes away.” D. “Effective therapy requires a minimum of 6 months.”
D
- Why do systemic antifungal drugs used to treat deep fungal infections cause more side effects than almost any other type of anti-infective drug group?
A. They are mostly given intravenously, which increases the speed of side effects and adverse reactions. B. Fungal cells have many similarities to human cells so that these drugs also exert their effects on human cells. C. Many antifungal drugs are actually slightly weaker forms of powerful cancer chemotherapy agents. D. When fungal cells are killed with these drugs, a toxic by-product is released that can damage human cells.
B
- Which electrolyte value is most important to monitor for a patient who is taking a systemic antifungal drug?
A. Calcium B. Chloride C. Sodium D. Potassium
D
- Which precaution is most important to teach a patient who is prescribed to take an “azole” antifungal drug?
A. Drink no more than 24oz of grapefruit juice daily. B. Check your lower legs daily for the presence of swelling, pain, or tenderness. C. Do not drive or operate heavy equipment until you know how the drug affects you. D. Avoid crowds and people who are ill because you are at an increased risk for infection.
A
A patient is complaining of side effects of flushing and chills during the administration of amphotericin B. What is the nurse’s best reaction?
Stop the medication and notify the prescriber.
Slow the medication infusion.
Check to see if any symptom control medications were ordered.
Double check the dosage.
Check to see if any symptom control medications were ordered.
Many health care providers prescribe premedication with specific drugs to counteract the side effects of amphotericin B. These drugs may include acetaminophen or ibuprofen to prevent or reduce fever, antihistamines (e.g., diphenhydramine), IV corticosteroids (e.g., hydrocortisone) to reduce blood vessel dilation, and meperidine (Demerol) to reduce or prevent excessive chills and shaking (rigors).Check the order to determine whether these drugs should be given in advance and administer them at the appropriate time. Common adverse effects of systemic amphotericin B include fever and chills that are so severe that this drug has been nicknamed “shake and bake.” The drug dilates blood vessels, causing widespread skin flushing (known as red man syndrome). For amphotericin B, a test dose (1 mg IV over 20 to 30 minutes) is recommended because hypersensitivity is common. Check and recheck the exact dose to be administered each time the drug is given. Usually the first dose of amphotericin B is much smaller than the daily maintenance doses. The entire prescribed dose should be then given because the infection that the drug is treating is often life threatening. Stopping the medication and notifying the prescriber is not the best reaction. Unlike other parenteral drugs, further slowing the intravenous rate of amphotericin B does not prevent or reduce side effects. The dosage should have been double checked before administration.