Chapter 10 Book Qs + Evolve

Question 1

1. 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)

Answer 1

C D F H

Question 2

2. 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

Answer 2

A

Question 3

3. 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.”

Answer 3

C

Question 4

4. Which systemic antifungal drug has the nickname “shake and bake”?

A. anidulafungin (Eraxis) B. amphotericin B (Amphocin) C. flucytosine (Ancobon) D. terbinafine (Apo-terbinafine)

Answer 4

B

Question 5

5. 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

Answer 5

C

Question 6

6. 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)

Answer 6

C

Question 7

7. 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.

Answer 7

A

Question 8

8. 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.

Answer 8

D

Question 9

9. 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.

Answer 9

A

Question 10

10. 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

Answer 10

C

Question 11

11. 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.”

Answer 11

D

Question 12

12. 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.

Answer 12

B

Question 13

13. 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

Answer 13

D

Question 14

14. 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.

Answer 14

A

Question 15

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.

Answer 15

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.

Question 16

Before giving an antifungal drug, what should the nurse check? (select all that apply)

Vital signs
Laboratory values for anemia and liver problems
List of all drugs and supplements taken by the patient
Whether or not the patient has eaten
Laboratory values for kidney impairment

Answer 16

Laboratory values for anemia and liver problems

List of all drugs and supplements taken by the patient

Laboratory values for kidney impairment

Before giving an antifungal drug, ask the patient about all other drugs or supplements that he or she takes and check with the pharmacist to avoid a possible drug interaction. Because antifungal drugs may cause anemia and liver toxicity, check the patient’s most recent laboratory values for anemia (low RBC count, low hemoglobin level) and liver problems (elevated liver enzyme levels). Check the patient’s current laboratory work, especially blood urea nitrogen (BUN) and serum creatinine levels, because these drugs can cause kidney impairment. Use these values as a baseline to determine whether the patient develops any kidney problems while taking an antifungal drug. Taking vital signs is important, but not the most important thing to check before giving an antifungal drug. Only some antifungals should be taken on an empty stomach; this is not the most important thing to check before giving an antifungal drug.

Question 17

A patient is taking an antifungal drug. What drug does the nurse know requires grapefruit juice consumption to be limited to no more than 24 ounces per day?

Answer 17

Fluconazole (Diflucan)

Teach patients to limit intake of grapefruit juice to less than 24 oz daily while taking an azole and to not take the drug with grapefruit juice. Limiting grapefruit juice is not necessary for amphotericin B, terbinafine, or micafungin.

Question 18

The nurse is discharging a patient with a prescription for a first-line antitubercular drug. What is the most important information for the nurse to teach the patient?

“Take the medication exactly as prescribed.”

“You are no longer contagious about 3 weeks after treatment begins.”

“Increase fluid intake while taking these drugs.”

“Your urine may turn an orange color while taking these drugs.”

Answer 18

“Take the medication exactly as prescribed.”

Question 19

The nurse is teaching a patient about taking the antitubercular drug, ethambutol (EMB). What specific patient teaching point should the nurse include?

Notify the prescriber immediately for any changes in vision.

Do not take over-the-counter (OTC) supplements without notifying the prescriber.

Avoid alcohol while taking this medication.

Take this medication exactly as directed.

Answer 19

Notify the prescriber immediately for any changes in vision.

The most important teaching point for the patient taking ethambutol at high doses is that the drug can cause optic neuritis and vision changes that include reduced color vision, blurred vision, and reduced visual fields. This problem can lead to blindness.

Question 20

The nurse is caring for a clinic patient who has a positive tuberculosis (TB) skin test. What statement made by the patient indicates the need for further teaching?

“A positive result does not mean I have an active infection.”

“The test result will be negative after I start taking TB medication.”

“A positive result means I have had a TB infection.”

“A positive result means that I am not contagious with TB.”

Answer 20

“The test result will be negative after I start taking TB medication.”

A positive TB skin test never becomes negative again, even after treatment has successfully controlled or eradicated the TB organism.

Question 21

The nurse is instructing a patient taking isoniazid (INH). What patient teaching points are most important for people to know who are on this drug? (select all that apply)
Select all that apply.

Males should inform their prescriber if urinary retention occurs.

Avoid caffeine in all forms.

Notify the prescriber if yellowing of the skin or eyes occurs.

Notify the prescriber about the occurrence of orange-tinged urine.

Drink 3 L of water daily.

Answer 21

Males should inform their prescriber if urinary retention occurs.

Avoid caffeine in all forms.

Notify the prescriber if yellowing of the skin or eyes occurs.

Drink 3 L of water daily.

Isoniazid is a first-line anti-TB drug. Ask male patients before beginning these drugs if they have an enlarged prostate and ask all patients whether they have any problems with urinary retention. If so, report this problem to the prescriber before giving the TB drugs. Isoniazid can raise blood pressure to dangerous levels when taken with caffeine. Teach patients taking isoniazid to avoid coffee, tea (including green tea), chocolate, colas, and any other forms of caffeinated drinks or “stay-awake” pills. TB drugs can lead to liver toxicity, so make sure the patient has no liver problems before starting this therapy. Check the patient for any yellowing of the skin or eyes and the patient’s most recent laboratory values for evidence of liver problems (such as elevated liver enzymes). Teach patients to drink at least 8 oz of water when taking these drugs and increase fluid intake to at least 3 L of water daily. Rifampin (RIF) and not Isoniazid tints body fluids an orange color and would not be a reason to notify the prescriber.

Question 22

The nurse is caring for a patient diagnosed with active tuberculosis (TB). What is the best way for a person to minimize the spread of this disease?

Avoid contaminated needles.

Avoid unprotected sex.

Keep food refrigerated.

Wear a mask around a person with TB.

Answer 22

Wear a mask around a person with TB.

TB spreads by aerosol transmission, which transfers bacteria-filled droplets through the air when a person with active TB coughs, laughs, sneezes, whistles, or sings.

Question 23

The nurse is caring for a patient with a systemic antifungal medication. What fungal infection typically requires this type of drug?

Vaginal yeast infection

Toenail infection

Athlete’s foot

“Jock itch”

Answer 23

Toenail infection

^remember it’s a weird one = we use topicals for all other infections on the skin.

Question 24

A patient has a severe systemic fungal infection. The nurse knows that what antifungal medication is reserved for use only in patients with this condition?

Fluconazole (Diflucan)

Ketoconazole (Nizoral)

Terbinafine (Lamisil)

Amphotericin B (Amphocin)

Answer 24

Amphotericin B (Amphocin)

remember the monster

Question 25

The nurse is discharging a patient taking rifampin (RIF). What information is important for the nurse to teach this patient?
Select all that apply.

Take the medication exactly as prescribed.
Avoid all alcohol beverages.
Oral contraceptives must be supplemented.
Breast tenderness may occur.
Soft contact lenses may be stained.

Answer 25

Take the medication exactly as prescribed.

Avoid all alcohol beverages.

Oral contraceptives must be supplemented.

Soft contact lenses may be stained.

All antitubercular drugs should be taken exactly as prescribed, or they will not be effective. Teach patients taking rifampin to avoid alcoholic beverages for the entire therapy period due to the risk of liver damage. Rifampin prevents reproduction of the TB organism by binding to the enzyme that allows RNA to be transcribed from DNA. Without this enzyme, TB cannot make the proteins needed to reproduce, so women using oral contraceptives may be advised to use an additional method of contraception while taking this drug and for 1 month after stopping the drug. Rifampin stains the skin, urine, and all other secretions but will be clear to normal within a few weeks after the drug is discontinued. Soft contact lenses used at this time will become permanently stained. Breast tenderness is a side effect of isoniazid, not rifampin.

Question 26

The nurse is caring for a patient receiving ethambutol (EMB). The nurse knows why this drug must be used in combination with other antitubercular drugs?

Ethambutol only suppresses reproduction of the TB bacteria.

Ethambutol is only bactericidal.

Ethambutol is most effective when TB bacillus is dividing.

Ethambutol enhances the efficacy of other antitubercular drugs.

Answer 26

Ethambutol only suppresses reproduction of the TB bacteria.

^it’s the bacteriostatic one