Unit5: Chapter 12 (Karch 7th Ed) - Antiprotozoal Agents Flashcards
- The patient is having an acute malarial attack with chills and fever. The nurse knows chills and fever
are caused by what?
A) Formation of sporozoites into the system
B) Rupture of red blood cells due to invasion of merozoites
C) Invasion of the tsetse fly into the central nervous system
D) Release of amastigotes into the blood vessels
Ans: B
Feedback:
The chills and fever associated with an acute malarial attack are caused by the rupture of red blood
cells containing merozoites. These symptoms are related to the pyrogenic effects of the protozoa and
the toxic effects of the red blood cell components on the system. The formation of sporozoites occurs in
the stomach of the mosquito when the male and female gametocytes mate and produce a zygote.
Invasion of the tsetse fly causes trypanosomiasis, which affects the central nervous system. The release
of amastigotes occurs in leishmaniasis, which is caused by the sand fly and is part of a cyclic pattern
that causes serious skin lesions.
- The nurse is caring for a patient of Greek descent who plans to travel to an area of the world in which
malaria is endemic. What should this patient be tested for before administering antimalarial
medications?
A) Tay-Sachs disease
B) Glucose-6-phosphate dehydrogenase (G6PD) deficiency
C) Plasmodium
D) Penicillin allergy
Ans: B
Feedback:
Patients of Mediterranean descent, including Greeks, are more likely to have a G6PD deficiency. When
patients with this deficiency take primaquine, chloroquine, or quinine, an acute hemolytic crisis may
occur. Patients of Mediterranean descent should be tested for G6PD deficiency before any antimalarial drugs are prescribed. Tay-Sachs disease is a disorder seen in those of middle-eastern descent that
causes death of the child by age 5. Plasmodium is the genus strain that causes malaria. Penicillin allergy
has no connection to this situation.
- The nurse is caring for a patient who is being treated with quinine (Qualaquin) for drug-resistant
malaria. The nurse will monitor the patient for cinchonism that will present with what manifestations?
A) Diarrhea, nausea, and fever
B) Yellowing of the sclera and skin
C) Tremors and ataxia
D) Vomiting, tinnitus, and vertigo
Ans: D
Feedback:
Patients with cinchonism or quinine toxicity may complain of tinnitus, headache, dizziness, nausea,
fever, tremors, and visual disturbances. Diarrhea, yellowing of the sclera or skin, and ataxia are not
associated with cinchonism.
- Patients receiving chloroquine (Aralen Phosphate) for malaria prophylaxis should receive patient
teaching from the nurse, which includes instructions to receive what regularly?
A) Cardiovascular studies
B) Eye exams
C) Immunizations
D) Pulmonary studies
Ans: B
Feedback:
Chloroquine is associated with visual disturbances and a patient receiving this drug should receive
regular ophthalmic exams. Heart and lung toxicity is not associated with chloroquine use.
Immunizations are not associated with chloroquine use.
- A 28-year-old woman is planning to be part of a mission team going to Central Africa. She will take
mefloquine (Lariam) once a week, beginning 1 week before traveling to Africa until 4 weeks after
leaving Africa. What precaution will the nurse teach this patient is needed?
A) Avoid excessive weight gain.
B) Have regular cancer screening.
C) Use contraceptives to avoid pregnancy.
D) Stop the medication if diabetes is diagnosed.
Ans: C
Feedback:
Mefloquine is teratogenic and should be avoided during pregnancy. The nurse will want to determine
whether a possibility exists that the patient is pregnant and warn about the need to avoid pregnancy for
2 months after completing therapy. Avoiding weight gain and having regular cancer screenings are
good preventive care but not associated with mefloquine. This medication is not contraindicated in
patients with diabetes
- The nurse is writing a plan of care for a patient receiving antimalarial drug therapy. What nursing
diagnosis would be appropriate for this patient if common adverse effects were indicated?
A) Disturbed sensory perception (visual) related to central nervous system effects
B) Imbalanced nutrition: more than body requirements
C) Constipation
D) Ineffective breathing pattern
Ans: A
Feedback:
Visual disturbances, including blindness related to retinal damage from the drug, may occur. Patients
usually have gastrointestinal (GI) upset including diarrhea, not constipation, which could produce loss
of weight and not an increase. Respiratory disturbances are not associated with antimalarial agents.
- During a lecture on intestinal parasites, the students learn that what is the most commonly diagnosed
intestinal parasite infection in the United States?
A) Amebiasis
B) Giardiasis
C) Leishmaniasis
D) Trichomoniasis
Ans: B
Feedback:
The most commonly diagnosed intestinal parasite in the United States is Giardiasis. It is transmitted
through contaminated water or food. Amebiasis is found in the United States but is not the most
common. Leishmaniasis is transmitted through sand flies, which are not common in the United States.
Trichomoniasis is a flagellated protozoan and most often is seen in the vagina and is spread during
sexual intercourse by men who have no signs and symptoms of infection, it is not the most commonly
diagnosed.
- A patient has been diagnosed with trichomoniasis. Before beginning tinidazole (Tindamax) therapy,
what should the nurse question the patient about?
A) Working conditions
B) Use of alcohol
C) Recent visit to a beach or desert
D) Possibly having AIDS
Ans: B
Feedback:
Tinidazole is prescribed for trichomoniasis, which is transmitted during sexual intercourse. The drug
should not be used when there is a history of alcohol use. Alcohol use could interfere with the drug’s
metabolism in the liver and cause toxicity and patients should be warned to avoid consuming all
alcoholic beverages while taking this medication. There is no need to question about working
conditions unless transmission involved environmental contamination of food and water, which is not
indicated by the question. A recent visit to a beach or desert would be indicated if the patient was
diagnosed with leishmaniasis and questioning the patient concerning AIDS would be indicated if the
patient had a diagnosis of Pneumocystis carinii pneumonia and would not involve trichomonas.
- The nurse is caring for a patient with acquired immunodeficiency syndrome (AIDS) who has been
diagnosed with Pneumocystis jiroveci pneumonia. The patient is taking multiple oral agents to treat
AIDS. What would be the drug of choice for this patient?
A) Nitazoxanide (Alinia)
B) Chloroquine
C) Metronidazole
D) Pentamidine
Ans: D
Feedback:
Pentamidine is available as an inhalation product for the direct treatment of P. jiroveci in patients with
AIDS. Because the patient is already taking multiple oral drugs, inhaler administration would be the
best choice. Nitazoxanide, chloroquine, and metronidazole are not effective against P. jiroveci
pneumonia.
- A patient with giardiasis is being treated with metronidazole. What comment by the patient would
indicate that the nurse needs to provide further teaching?
A) I can continue to work delivering pizza because the disease is not contagious.
B) I will not lose my hair during drug therapy.
C) I know I will experience diarrhea during this time.
D) I shouldn’t experience irregular menstrual periods.
Ans: A
Feedback:
Although giardiasis is not contagious, the patient should be encouraged not to drive or operate heavy
equipment until the effects of the drug can be assessed because metronidazole can lead to central
nervous system adverse effects, including dizziness and lack of coordination. The drug may also cause
diarrhea. Loss of hair and irregular menstrual periods are not associated with this drug, so these
statements would be correct and would not indicate the need for further teaching.
11. During treatment of amebiasis with chloroquine (Aralen Phosphate), the nurse assesses the patient for what adverse effects? A) Diarrhea B) Weight gain C) Hypertension D) Seizures
Ans: A
Feedback:
With amebicides, observe for anorexia, nausea, vomiting, epigastric burning, and diarrhea that can lead
to malnutrition and significant weight loss, which the nurse assesses for with each visit to intervene
before significant malnutrition occurs. Weight gain, hypertension, or seizures are not associated
adverse effects
- The clinic nurse provides teaching for a patient prescribed pyrimethamine (Daraprim) to prevent
malaria and instructs on the need to notify the prescriber immediately if what signs and symptoms
occur?
A) Diarrhea, fatigue, weight loss, and anemia
B) Irritation, rash, or inflammation
C) Headache, nausea, or constipation
D) Anorexia, nausea, or vomiting
Ans: A
Feedback:
If signs of folate deficiency develop, pyrimethamine will need to be discontinued so the prescriber
needs to be notified immediately. Folate deficiency presents with diarrhea, fatigue, weight loss, and
anemia. The other signs and symptoms would need to be reported if significant and/or long-lasting.
- The mother of a 6-month-old infant comes to the clinic. The mother is diagnosed with a protozoal
infection. What would be a priority for the nurse to assess for?
A) Whether she is breast-feeding
B) Whether she has a support network
C) Whether she has money to pay for the medication
D) Whether she eats a protein-rich diet
Ans: A
Feedback:
Assess for lactation because antiprotozoal drugs could enter the breast milk and be toxic to the infant.
The other options are part of a complete nursing history but do not specifically relate to treatment for a
protozoal infection.
- A patient is prescribed mefloquine (Lariam) for malaria prophylaxis. When should the nurse instruct
mefloquine be started?
A) 1 week prior to entering an endemic area
B) 1 to 2 days prior to entering an endemic area
C) On arrival to an endemic area
D) When mosquitoes are present
Ans: A
Feedback:
Lariam should be taken 1 week prior to entering a malarial area. Therefore, options B, C, and D are
incorrect.
- What statements made by the 36-year-old patient leads the nurse to believe that he or she has
understood the teaching regarding metronidazole (Flagyl)?
A) I will refrain from operating heavy machinery while I am taking this medication.
B) I will avoid foods high in vitamin C.
C) I will not drink alcohol while I am taking this medication.
D) I will contact my physician if I have a cold.
Ans: C
Feedback:
Patients should avoid all forms of alcohol while taking metronidazole. Patients do not need to avoid
operating heavy machinery,and foods high in vitamin C, and will not contact the physician if they have
colds.
- The emergency room nurse admits a patient suspected of having giardiasis. What symptoms would the
nurse expect the patient to present with?
A) Voluminous soft unformed stool
B) Frothy voluminous pale stool
C) Pale and mucous-filled stool
D) Frothy tan stool
Ans: C
Feedback:
Diarrhea, rotten-egg-smelling stool, and pale and mucous-filled stool are commonly seen. Diarrhea is
often accompanied by epigastric distress, weight loss, and malnutrition as a result of the invasion of the
mucosa. Therefore, options A, B, and D are incorrect.
- A 91-year-old man is being treated for Pneumocystis carinii pneumonia with pentamidine (NebuPent).
What should the nurse measure when assessing this patient for adverse effects of the medication?
A) Liver function tests
B) Serum potassium
C) Daily blood pressure
D) Blood urea nitrogen (BUN) and creatinine
Ans: A
Feedback:
Patients receiving antiprotozoal agents should be monitored regularly to detect any serious adverse
effects. Liver function tests are of particular importance to determine the appropriateness of therapy
and to monitor for toxicity. Serum potassium, BUN, and creatinine would indicate kidney damage,
which is not normally a risk with this drug. Blood pressure is not indicated for this medication but is an
early indicator of health deterioration and is usually included in all provisions of care.
- What is the priority teaching point to be provided by the nurse to a patient being treated for
trichomoniasis to prevent reinfection?
A) Meats should be fully cooked before eaten.
B) Sexual partners should be treated.
C) Wash hands before eating.
D) Purify all drinking water when camping.
Ans: B
Feedback:
Trichomoniasis is usually spread during sexual intercourse and men often have no symptoms. Women
present with red, inflamed vaginal mucosa, itching, burning, and a yellowish green discharge. Women
should be taught the importance of having their partners tested and treated simultaneously to prevent
reinfection. The other options are healthy lifestyle choices but are not the primary means of preventing
reinfection.
- How does the nurse teach the patient to take chloroquine (Aralen Phosphate)?
A) On an empty stomach
B) With 8 ounces of water
C) With meals
D) With orange juice followed by 8 ounces of water
Ans: C
Feedback:
Chloroquine should be taken with meals to reduce gastrointestinal (GI) upset; small frequent meals may
also reduce negative GI effects. Taking medications, any medication, with adequate amounts of water is
always good practice but not specific to this medication. There is no indication that ingestion of orange
juice makes any practical difference.
- The nurse, learning about malaria, discovers that the transmission of malaria occurs when what is
injected into the human body by the infected mosquito?
A) Sporozoites
B) Gametocytes
C) Schizonts
D) Merozoites
Ans: A
Feedback:
Gametocytes are sucked with the blood from an infected person by the mosquito. The gametocytes
mate in the stomach of the mosquito and produce a zygote that goes through several phases before
forming sporozoites (spore animals) that make their way to the mosquito’s salivary glands. The next person who is bitten by that mosquito is injected with thousands of sporozoites. Schizonts are the
primary tissue organisms resulting from asexual cell division and reproduction after the sporozoites are
introduced into the body. Merozoites are then formed from the primary schizonts.
- The nurse is caring for a patient who is taking antimalarial medications. The nurse teaches the patient
about the medication and explains the need to report what signs and symptoms immediately because of
its association with a serious adverse effect?
A) Loss of appetite
B) Loss of hair
C) Loss of vision
D) Loss of sensation
Ans: C
Feedback:
Report blurring of vision, which could indicate retinal damage; loss of hearing or ringing in the ears,
which could indicate central nervous system toxicity; and fever or worsening of condition, which could
indicate a drug-resistant strain or noneffective therapy. Loss of appetite is such a common result of the
gastrointestinal (GI) effects of the drug that the nurse should provide anticipatory guidance to teach the
patient how to maintain adequate nutrition, but the patient does not need to report this unless it becomes
serious or unmanageable. Loss of sensation is not a typical adverse effect the nurse would anticipate
and teach about.
- The nurse is caring for a patient who just returned from a trip to South America and was infected by the
protozoan Trypanosoma cruzi. What will the nurse assess for in this patient?
A) Serious lesions in the skin
B) Sleeping sickness
C) Severe cardiomyopathy
D) Yellowish green vaginal discharge
Ans: C
Feedback:
Chagas’ disease, which is caused by T. cruzi, is passed to humans by the common house fly. This
protozoan results in a severe cardiomyopathy that accounts for numerous deaths and disabilities in
certain regions. Sleeping sickness results from T. brucei gambiense; leishmaniasis produces serious
lesions in the skin, and trichomoniasis produces a yellowish green discharge.
23. A patient with malaria is taking primaquine. What would indicate to the nurse caring for this patient that the patient has cinchonism? A) Diarrhea B) Abdominal cramping C) Tan, frothy stool D) Vertigo
Ans: D
Feedback:
Cinchonism (nausea, vomiting, tinnitus, and vertigo) may occur with high levels of primaquine.
Symptoms of cinchonism do not include diarrhea, abdominal cramping, or tan, frothy stool.
- A patient has been prescribed an antimalarial as prophylaxis for the disease. What assessment finding
would the nurse recognize as indicating the patient has a common adverse effect?
A) Dyspepsia
B) Hematemesis
C) Tarry stool
D) Tachycardia
Ans: A
Feedback:
Nausea, vomiting, dyspepsia, and anorexia are associated with direct effects of the antimalarial
medications on the GI tract and the effects on central nervous system control of vomiting caused by the
products of cell death and protein changes. Adverse effects from antimalarial drugs do not usually
include hematemesis, tarry stool, or tachycardia.
