Chapter 27

Question 1

The nurse is caring for a patient who is taking rifampin. The patient has a heart rate of 90 beats/min, blood pressure of 100/89 mm Hg, and red-orange urine. What is the nurse’s best action?

A) document the findings and teach the patient
B) call the health care provider
C) collect a urine culture
D) discard the first void and start a 24-hour urine collection

Answer 1

A) document the findings and teach the patient

Red-orange discoloration of body fluids is a common side effect of rifampin, but it is not harmful and does not indicate infection. There is no need to call the health care provider, collect a urine culture, or start 24-hour urine collection.

Question 2

A patient enters the emergency department with suspected influenza. Prior to starting the patient on the prescribed oseltamivir phosphate, what should the nurse determine?

A) allergies to antibiotics
B) over-the-counter medications taken in the last 48 hours
C) immunization history
D) length of time since onset of symptoms

Answer 2

D) length of time since onset of symptoms

Oseltamivir phosphate inhibits the replication and spread of influenza if given within 48 hours of symptoms.

Question 3

Before administration of intravenous amphotericin B, what will the nurse do?

A) set up an IV solution with potassium
B) premedicate the patient with an antipyretic, antihistamine, and antiemetic as prescribed
C) administer insulin as prescribed to prevent severe hyperglycemia
D) administer intravenous dextrose as prescribed to prevent severe hypoglycemia

Answer 3

B) premedicate the patient with an antipyretic, antihistamine, and antiemetic as prescribed

Almost all patients given intravenous amphotericin B develop fever, chills, nausea and vomiting, and hypotension. Pretreatment with an antipyretic, antihistamine, and antiemetic can minimize or prevent these adverse reactions. There is no need to treat with IV potassium or administer insulin or IV dextrose.

Question 4

The patient has been diagnosed with candidiasis. The nurse recognizes that the patient is most likely to be ordered which drug?

A) sulconazole
B) haloprogin
C) miconazole nitrate
D) tolnaftate

Answer 4

C) miconazole nitrate

Miconazole nitrate can be ordered to treat candidiasis. The other drugs listed can be used to treat tinea pedis, corporis, and cruris.

Question 5

A patient with Mycobacterium tuberculosis is prescribed ethambutol for long-term use. Which statement by the patient indicates understanding of the instructions?

A) “dizziness, drowsiness, and decreased urinary output are common with this drug, but they will subside over time”
B) “constipation will be a problem, so I will increase the fiber and fluids in my diet”
C) “I will need to have my eyes checked regularly while I am taking this drug”
D) “this medication may cause my bodily secretions to turn red-orange”

Answer 5

C) “I will need to have my eyes checked regularly while I am taking this drug)

Ethambutol can cause optic neuritis. Ophthalmologic examinations should be performed periodically to assess visual acuity.

Question 6

A patient is diagnosed with an oral candidal infection. Which intervention is best?

A) start an IV so the patient does not have to eat by mouth
B) instruct the patient to brush her teeth and gargle hourly
C) teach the patient how to take nystatin
D) administer valacyclovir hydrochloride and monitor lips and gums

Answer 6

C) teach the patient how to take nystatin

Nystatin is an antifungal ointment that is used for a variety of candidal infections. The patient needs to be taught how to “swish and swallow” to treat this infection. There is no need to brush the teeth hourly or administer Valtrex, and starting an IV is an extreme measure.

Question 7

Which statement indicates to the nurse that the patient understands the medication instructions regarding ketoconazole for treatment of candidiasis?

A) I will take this medication with orange juice for better absorption
B) I need to take this drug with food to minimize gastrointestinal distress
C) I can take this medication with antacids if it causes gastrointestinal discomfort
D) I can expect my skin to turn yellow from taking this drug

Answer 7

B) I need to take this drug with food to minimize gastrointestinal distress

Taking this medication with food will help minimize gastrointestinal upset. Ketoconazole should not be taken with coffee, tea, or acidic fruit juices. Additionally, it needs to be taken at least 2 hours before or after the ingestion of alkaline products or antacids.

Question 8

The patient has been diagnosed with tinea pedis. The nurse recognizes that the patient is most likely to be ordered which drug?

A) terconazole
B) miconazole nitrate
C) butoconazole nitrate
D) griseofulvin

Answer 8

D) griseofulvin

Of the drugs listed, the patient is most likely to be treated with griseofulvin. The other drugs treat candidiasis.

Question 9

What will the nurse teach a patient who is taking isoniazid (INH)?

A) you will need to take vitamin C to potentiate the action of INH
B) you should not be on that drug, I will check with the health care provider
C) pyridoxine (vitamin B6) will prevent numbness and tingling that can occur when taking isoniazid
D) multidrug therapy is necessary to prevent the occurrence of resistant bacteria

Answer 9

C) pyridoxine (vitamin B6) will prevent numbness and tingling that can occur when taking isoniazid

Isoniazid can cause neurotoxicity. Pyridoxine (vitamin B6) is the drug of choice to prevent this adverse reaction. It is not an anti-infective agent and thus will work to destroy the mycobacterium or prevent drug resistance. Vitamin C is not taken with this drug; the drug is appropriate for most patients, and INH with pyridoxine is not multidrug therapy.

Question 10

The health care provider has ordered amphotericin B for the patient. The nurse recognizes that which is the most effective way to administer this medication to the patient?

A) intravenously over 1 hour
B) orally at regular intervals
C) by subcutaneous injection
D) intravenously over 2 to 6 hours

Answer 10

D) intravenously over 2 to 6 hours

Amphotericin B should be administered by slow intravenous infusion.

Question 11

What is the primary assessment the nurse should make for a patient who is taking ganciclovir sodium?

A) blood urea nitrogen
B) bowel elimination
C) complete blood count
D) input and output

Answer 11

C) complete blood count

Bone marrow suppression is a dose-limiting toxicity of ganciclovir, and a complete blood count should be monitored.

Question 12

The nurse is caring for a patient who has been diagnosed with genital herpes. Which medication is the drug of choice for this patient?

A) acyclovir
B) amantadine
C) ribavirin
D) zidovudine

Answer 12

A) acyclovir

Acyclovir is the drug of choice to treat herpes simplex infections. Ribavirin is effective against respiratory syncytial virus (RSV); zidovudine is effective against HIV; amantadine is effective against influenza A.

Question 13

A patient taking amantadine complains of depression and dizziness. What intervention will the nurse perform first?

A) evaluate the patient for other central nervous system effects from the medication
B) order a consult for counseling
C) take the patient’s blood pressure sitting and standing
D) call the health care provider

Answer 13

C) take the patient’s blood pressure sitting and standing

The side effects and adverse reactions to amantadine include central nervous system effects, such as insomnia, depression, anxiety, confusion, and ataxia; orthostatic hypotension; neurologic problems, such as weakness, dizziness, and slurred speech; and gastrointestinal disturbances, such as anorexia, nausea, vomiting, and diarrhea. The nurse should evaluate the patient for orthostatic hypotension first to address safety issues.

Question 14

The patient is being treated with intravenous amphotericin B. What is the nurse’s primary intervention?

A) encourage the patient to drink at least a liter of fluid per shift
B) assess the IV site for infiltration
C) administer with dextrose
D) assess blood urea nitrogen and creatinine

Answer 14

D) assess blood urea nitrogen and creatinine

Nephrotoxicity can occur when taking amphotericin B so it is important to assess BUN and creatinine levels to determine how well the kidneys are functioning. Urinary output, electrolyte levels, and complete blood counts should also be monitored while taking amphotericin B.

Question 15

The health care provider has ordered ribavirin for the patient with respiratory syncytial virus (RSV). The nurse recognizes that which route is the most effective way to administer this medication to the patient?

A) intravenously over 1 hour
B) orally at regular intervals
C) by subcutaneous injection
D) aerosol inhalation

Answer 15

D) aerosol inhalation

Ribavirin should be administered by aerosol inhalation.

Question 16

What will the nurse monitor to evaluate the effectiveness of antiviral agents administered to treat human immunodeficiency virus infection?

A) megakaryocyte counts
B) lymphocyte counts
C) red blood cell counts
D) viral load

Answer 16

D) viral load

All antiretroviral agents work to reduce the viral load, which is the number of viral RNA copies per milliliter of blood.

Question 17

The patient states that she has been prescribed prophylactic medication for tuberculosis for a period of 4 weeks. What is the nurse’s best response?

A) “let me teach you about the medications”
B) “we do not use medications prophylactically for tuberculosis”
C) “you should be on the drugs for at least 6 months”
D) “you should be on the medications for only 2 weeks”

Answer 17

C) “you should be on the drugs for at least 6 months”

Between 6 months and 1 year is sufficient time for prevention of active tuberculosis. Because the tuberculosis mycobacterium is slow-growing, shorter lengths of time may not sufficiently eradicate the organism.

Question 18

Which teaching for the patient who is taking fluconazole is a priority for the nurse?

A) take concurrent vitamin B6 to prevent peripheral neuropathy
B) take 1 hour before or 2 hours after meals
C) advise that hypoglycemia may occur with concurrent oral sulfonylureas
D) warn that gingival hyperplasia may occur with prolonged use

Answer 18

C) advise that hypoglycemia may occur with concurrent oral sulfonylureas

According to the orange chart on pg. 382, there is an increased risk for hypoglycemia in a patient taking fluconazole with oral sulfonylureas. Answers A and B are teaching points for a patient taking isoniazid. Answer D is a potential adverse effect for a patient taking acyclovir.

Question 19

A patient has developed active tuberculosis and is prescribed isoniazid and rifampin. Which information will the nurse include in teaching the patient about taking this drug? (Select all that apply)

A) isoniazid should be given 1 hour before or 2 hours after meals
B) have periodic eye examinations as ordered by the health care provider
C) compliance with drug regimen is essential
D) report numbness, tingling, and burning of hands and feet
E) warn patient that rifampin may turn body fluids a harmless green color

Answer 19

A) isoniazid should be given 1 hour before or 2 hours after meals
B) have periodic eye examinations as ordered by the health care provider
C) compliance with drug regimen is essential
D) report numbness, tingling, and burning of hands and feet

Isoniazid should be given 1 hour before or 2 hours after meals because food decreases isoniazid absorption. The patient should have periodic eye exams because antitubercular drugs can cause ocular toxicity. The patient should take the drug regimen as prescribed to ensure the entire infection is treated and to prevent drug resistance. The patient should report numbness, tingling, and burning of hands and feet because these symptoms may indicate that peripheral neuropathy is developing. Rifampin may turn body fluids into a harmless reddish-orange color, not green.

Question 20

A middle-aged adult is diagnosed with tuberculosis. Which is true of treatment for this diagnosis?

A) treatment may take about 10 days to 2 weeks
B) usually two to three agents are needed
C) the bacteria is usually resistant to treatment therapy
D) treatment for tuberculosis is usually without side effects

Answer 20

B) usually two to three agents are needed

Single-drug therapy for the treatment of tuberculosis is usually not effective. Multi-drug therapy is typically used to decrease bacterial resistance to the drugs and to decrease the duration of treatment.

Question 21

When teaching a patient about isoniazid (INH) and rifampin drug therapy, which statement will the nurse include?

A) “take isoniazid with meals”
B) “double the amount of vitamin C in your diet to prevent the peripheral neuropathy associated with isoniazid therapy”
C) “notify the primary health care provider immediately if your urine turns a red-orange color”
D) “avoid exposure to direct sunlight”

Answer 21

D) “avoid exposure to direct sunlight”

The nurse should instruct the patient to avoid exposure to direct sunlight because isoniazid can cause photosensitivity. Isoniazid should be taken 1 hour before or 2 hours after meals. The patient should take vitamin B6, not vitamin C, to prevent peripheral neuropathy. Isoniazid may turn urine a red-orange color but this is harmless.

Question 22

A patient is diagnosed with a Candida infection in the mouth. The nurse anticipates that the patient will be treated with:

A) metronidazole
B) amphotericin B
C) isoniazid
D) nystatin

Answer 22

D) nystatin

Nystatin is most commonly used to treat Candida infection in the mouth.

Question 23

When caring for a patient receiving amphotericin B, it is most important for the nurse to assess the patient for the development of

A) hypokalemia
B) hypernatremia
C) hypocalcemia
D) hypermagnesemia

Answer 23

A) hypokalemia

Hypokalemia has the greatest potential to negatively affect the heart so it would be the most important to monitor.

Question 24

Which nursing intervention is the priority when a patient is receiving antiviral drugs?

A) promoting hydration
B) enhancing bowel function
C) increasing tidal volume
D) promoting circulation

Answer 24

A) promoting hydration

Antiviral drugs can affect renal function. Adequate hydration is needed for drug therapy to be beneficial and to increase urine output.

Question 25

A patient is beginning isoniazid and rifampin treatment for tuberculosis. The nurse gives the patient which instruction?

A) do not skip doses
B) take both drugs three times daily with food
C) take an antacid with the drugs to decrease GI distress
D) take rifampin initially, and begin isoniazid after 2 months

Answer 25

A) do not skip doses

The nurse should teach the patient to not skip doses because this can lead to bacterial drug resistance. Antitubercular drugs should be taken 1 hour before or 2 hours after meals for better absorption. Antitubercular drugs should not be taken with an antacid because this decreases their absorption. The health care provider will decide when the antitubercular drugs should be taken and for how long.

Question 26

The nurse teaches a patient taking amphotericin B to report which signs and symptoms to the health care provider?

A) change in sight
B) decrease in hearing
C) decrease in urine
D) painful red rash and blisters

Answer 26

C) decrease in urine

Amphotericin B can cause nephrotoxicity so it is very important for the nurse to monitor urine output and kidney function. A change in sight, a decrease in hearing, and a painful red rash and blisters are not side effects of taking amphotericin B.

Question 27

A patient has been diagnosed with tuberculosis and is to begin antitubercular therapy with isoniazid, rifampin, and ethambutol. What should the nurse do? (Select all that apply)

A) encourage periodic eye examinations
B) instruct the patient to take medications with meals
C) suggest that the patient take antacids with medications to prevent GI distress
D) advise the patient to report numbness and tingling of the hands or feet
E) alert the patient that body fluids may develop a red-orange color
F) teach the patient to avoid direct sunlight and to use sunblock

Answer 27

A) encourage periodic eye examinations
D) advise the patient to report numbness and tingling of the hands or feet
E) alert the patient that body fluids may develop a red-orange color
F) teach the patient to avoid direct sunlight and to use sunblock

Antitubercular drugs should not be taken with food or with antacids.

Question 28

Zanamivir is ordered for a patient. What does the nurse know about the use of this drug?

A) it is a treatment for herpes simplex virus type 2
B) oral administration is for treatment of herpes simplex virus type 1
C) it treats varicella-zoster virus
D) administration must be within 48 hours of onset of symptoms to be effective

Answer 28

D) administration must be within 48 hours of onset of symptoms to be effective

Zanamivir is used to treat influenzas A and B but it must begin within 48 hours of onset of flu symptoms to be effective.

Question 29

Acyclovir has been ordered for a patient with genital herpes. Which nursing interventions are appropriate for this patient? (Select all that apply)

A) monitor the patient’s blood urea nitrogen (BUN) and creatinine
B) monitor the patient’s blood pressure for hypertension
C) administer intravenous acyclovir over 30 minutes
D) advise maintenance of adequate fluid intake
E) monitor complete blood count (CBC) for blood dyscrasias

Answer 29

A) monitor the patient’s blood urea nitrogen (BUN) and creatinine
D) advise maintenance of adequate fluid intake
E) monitor complete blood count (CBC) for blood dyscrasias

The nurse would also need to monitor the patient for orthostatic hypotension, not hypertension and acyclovir should be administered intravenously over 60 minutes, not 30 minutes.

Question 30

A mother of two children was just diagnosed with hepatitis C virus. Which of the following is incorrect about hepatitis C virus?

A) a vaccine is available
B) hepatitis C virus can be transmitted by blood and body fluids
C) hepatitis C virus can cause hepatic carcinoma
D) persons with hepatitis C virus can become chronic carriers

Answer 30

A) a vaccine is available

Both hepatitis B virus and hepatitis C virus are spread via blood and body fluids. Hepatitis A virus is spread by eating contaminated food. There is a vaccine available for hepatitis A virus and hepatitis B virus, but no vaccine is currently available for the hepatitis C virus.