Unit5: Chapter 12 (Karch 7th Ed) - Antiprotozoal Agents

Question 1

1. 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

Answer 1

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.

Question 2

2. 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

Answer 2

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.

Question 3

3. 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

Answer 3

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.

Question 4

4. 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

Answer 4

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.

Question 5

5. 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.

Answer 5

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

Question 6

6. 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

Answer 6

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.

Question 7

7. 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

Answer 7

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.

Question 8

8. 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

Answer 8

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.

Question 9

9. 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

Answer 9

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.

Question 10

10. 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.

Answer 10

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.

Question 11

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

Answer 11

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

Question 12

12. 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

Answer 12

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.

Question 13

13. 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

Answer 13

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.

Question 14

14. 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

Answer 14

Ans: A
Feedback:
Lariam should be taken 1 week prior to entering a malarial area. Therefore, options B, C, and D are
incorrect.

Question 15

15. 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.

Answer 15

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.

Question 16

16. 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

Answer 16

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.

Question 17

17. 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

Answer 17

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.

Question 18

18. 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.

Answer 18

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.

Question 19

19. 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

Answer 19

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.

Question 20

20. 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

Answer 20

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.

Question 21

21. 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

Answer 21

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.

Question 22

22. 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

Answer 22

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.

Question 23

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

Answer 23

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.

Question 24

24. 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

Answer 24

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.

Question 25

25. A patient presents at the emergency department complaining of sudden onset of high fever and swelling
    and reddening of the limbs. Assessment shows severe hypotension. The nurse taking the patient’s
    history notes that the patient has recently returned to the United States from the African continent. The
    patient is admitted to the intensive care unit (ICU) suspected of having malaria caused by what
    protozoan?
    A) Plasmodium ovale
    B) Plasmodium falciparum
    C) Plasmodium vivax
    D) Plasmodium malariae

Answer 25

Ans: B
Feedback:
P. falciparum is considered to be the most dangerous type of protozoan. Infection with this protozoan
results in an acute, rapidly fulminating form of the disease with high fever, severe hypotension,
swelling and reddening of the limbs, loss of red blood cells, and even death. The other options are
pathogens that cause milder forms of the disease and P. ovale is rarely encountered.

Question 26

26. Pyrimethamine (Daraprim) has been ordered for the patient as prophylactic treatment of malaria. The
    nurse recognizes the action of this drug prevents relapse of the disease by acting on what?
    A) Changing the metabolic pathways for reproduction
    B) Disrupting the mitochondria of the plasmodium
    C) Blocking the use of folic acid
    D) Increasing the acidity of plasmodial food vacuoles

Answer 26

Ans: C
Feedback:
Pyrimethamine is used in combination with agents that act more rapidly to suppress malaria; it acts by
blockings the use of folic acid in protein synthesis by the plasmodium, eventually leading to inability to
reproduce and cell death. Chloroquine changes the metabolic pathways for reproduction of the
plasmodium and is toxic to parasites that absorb it. Primaquine disrupts the mitochondria of the
plasmodium. Mefloquine increases the acidity of plasmodial food vacuoles causing cell rupture and
death.

Question 27

27. A patient, recently returned from a vacation in the tropics, is diagnosed with leishmaniasis. The patient
    asks the nurse how he or shes got this disease. What is the nurse’s best response?
    A) You got this disease from a mosquito bite.
    B) You got this disease from unsanitary drinking water.
    C) You got this disease from eating unsanitary food.
    D) You got this disease from the bites of sand flies.

Answer 27

Ans: D
Feedback:
Leishmaniasis is a disease caused by a protozoan that is passed from sand flies to humans. Therefore,
options A, C, and D are incorrect.

Question 28

28. The patient, newly diagnosed with African sleeping sickness, asked what caused the disease. What is
the nurse’s best response?
A) Trypanosoma brucei gambiense
B) Giardia lamblia
C) Promastigote
D) Trypanosoma cruzi

Answer 28

Ans: A
Feedback:
African sleeping sickness, which is caused by Trypanosoma brucei gambiense, is transmitted by the
tsetse fly. After the pathogenic organism has lived and grown in human blood, it eventually invades the
central nervous system, leading to acute inflammation resulting in lethargy, prolonged sleep, and even
death. G. lamblia causes giardiasis; T. cruzi causes Chagas’ disease. A promastigote is a flagellated
protozoan that causes leishmaniasis.

Question 29

29. The patient, a physician returning from a trip to the tropics, is prescribed chloroquine and asks the
    nurse how it works. What is the nurse’s best response?
    A) Blocks the plasmodium’s ability to synthesize ribonucleic acid
    B) Changes the metabolic pathways necessary for the reproduction of the plasmodium
    C) Interrupts the cell wall preventing entry of nutrients into the plasmodium
    D) It is alkaline and decreases the ability of the parasite to synthesize deoxyribonucleic acid (DNA).

Answer 29

Ans: B
Feedback:
Chloroquine is currently the mainstay of antimalarial therapy. This drug enters human red blood cells
and changes the metabolic pathways necessary for the reproduction of the plasmodium (see Figure
12.1). In addition, this agent is directly toxic to parasites that absorb it, it is acidic, and it decreases the
ability of the parasite to synthesize DNA, leading to a blockage of reproduction.

Question 30

30. What antimalarial medication is used as a radical cure of Plasmodium vivax malaria?
A) Chloroquine
B) Mefloquine
C) Pyrimethamine
D) Primaquine

Answer 30

Ans: D
Feedback:
Primaquine (generic) is the only drug indicated for the prevention of relapses of P. vivax and P.
malariae infections and a radical cure of P. vivax malaria. It may be given in combination with other
drugs that interrupt the cell cycle at other stages. None of the other options are indicated for this use.

Question 31

31. The nurse, working in a pediatric clinic, admits a patient who will be traveling to a country where
    malaria is endemic. What is the safest treatment for this child?
    A) No prophylaxis is administered because of the severity of adverse effects.
    B) Call the Centers for Disease Control and Prevention (CDC) or local health department for the
    safest possible treatment.
    C) Administer extremely small doses of chloroquine.
    D) Any antimalarials in appropriate dosages can be administered.

Answer 31

Ans: B
Feedback:
Although dosages for prophylaxis have been calculated to treat malaria in children, many drugs have
not been proven to be safe and efficient in that population and extreme caution is needed .If a child
needs to travel to an area with endemic protozoal infections, the CDC or local health department should
be consulted about the safest possible preventive measures. As a result, the other options are incorrect.

Question 32

32. What statement, if made by the nurse, would be correct?
    A) Malaria can live without a host and be contracted from drinking standing water.
    B) Any mosquito can carry the plasmodium that transmits malaria.
    C) A major problem with controlling malaria is the mosquito that is resistant to insecticide.
    D) Widespread efforts at mosquito control have never been helpful.

Answer 32

Ans: C
Feedback: Widespread efforts at mosquito control have been successful, with fewer cases of malaria being
reported each year. However, the rise of insecticide-resistant mosquitoes has allowed malaria to
continue to flourish, increasing the incidence of the disease. Malaria requires a host to live, whether it is
human or mosquito. Only the female Anopheles mosquito harbors the protozoal parasite and carries it to
humans.

Question 33

33. The nurse is caring for a patient diagnosed with amebiasis caused by Entamoeba histolytica that
    resulted in the patient having amebic dysentery. What questions might the nurse ask in an attempt to
    discover how the patient came in contact with the organism? (Select all that apply.)
    A) Have you traveled outside the country recently?
    B) Have you been swimming in a lake or pond recently?
    C) Have you been eating fresh fruits or vegetables without washing them first?
    D) Have you been bitten by a mosquito?
    E) Have you had unprotected sex recently?

Answer 33

Ans: A, B, C
Feedback:
The disease is transmitted while the protozoan is in the cystic stage in fecal matter, from which it can
enter water and soil. It can be passed to other humans who drink this water or eat food that has been
grown in this ground. It is not passed by a mosquito or from sexual activity

Question 34

34. The nurse explains that the drugs metronidazole (Flagyl) or tinidazole (Tindamax) can be administered
    to treat what protozoan infections? (Select all that apply.)
    A) Trichomoniasis
    B) Giardiasis
    C) Amebiasis
    D) Pneumocystis carinii pneumonia
    E) Cryptosporidium parvum

Answer 34

Ans: A, B, C
Feedback:
Metronidazole or tinidazole are effective treatments for trichomoniasis, giardiasis, and amebiasis. They
are not effective for P carinii pneumonia or C. parvum.

Question 35

35. How does the nurse adapt the plan of care when caring for an older adult receiving an antiprotozoal
    agent?
    A) Patients should be monitored more closely for toxic adverse effects.
    B) The drug dosage should be lowered for all older adults.
    C) Antiprotozoal agents should not be administered to older adults.
    D) Female patients of appropriate age should be advised to use barrier contraceptives

Answer 35

Ans: A
Feedback:
Older patients may be more susceptible to the adverse effects associated with these drugs. They should
be monitored closely. Dosage should only be lowered if the patient has hepatic dysfunction or if hepatic
dysfunction is anticipated. Antiprotozoal agents can be administered to older adults with caution when
the benefit outweighs the risk. It is not necessary for older adult women to use barrier methods of
contraceptives because they are no longer of childbearing age.