Anti-Infectives: Antitubercular and Antifungal Drugs

Understanding Pharmacology Essentials for Medication Safety

Nursing
25
Questions
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True/False
21
Choices
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Essay
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Questions

Q1
Free

A patient received a tuberculosis skin test injection of purified protein derivative (PPD) 72 hours ago. Which assessment finding of the test site does the nurse interpret as a positive reaction?

Multiple Choice
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A) The injected area has a blister-like swelling about 2 mm high and 2 mm in diameter.
B) The injection site is puffy and soft with pus oozing from the needle hole.
C) The skin is red and very hard for 12 mm around the injection site.
D) There is a large bruise surrounding the injection site.
Answer:
C) The skin is red and very hard for 12 mm around the injection site.

Explanation:
A positive reaction to a TB skin test requires that the skin around the injection site be indurated, not just red. Induration is caused by infiltration of the skin around the test site with many white blood cells, making the area red and swollen, and the tissue much harder than the surrounding normal skin. Bruising is a result of bleeding into the injection site, not infiltration and induration from white blood cells.
Q2
Free

A patient with which findings requires drug therapy for active tuberculosis (TB)?

Multiple Choice
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A) Negative TB skin test and chest x-ray but who has productive cough, fever, and shortness of breath
B) Positive TB skin test, productive cough, and a cavitation on chest x-ray
C) Positive TB skin test and a TB scar on chest x-ray
D) Positive TB skin test as the only symptom
Answer:
B) Positive TB skin test, productive cough, and a cavitation on chest x-ray

Explanation:
A positive skin test for TB only means that the patient was infected with TB at one time. A TB scar also only indicates old, inactive disease. Cavitation and productive cough along with a positive skin test are indicators of active disease that can be spread to others, and this person must be treated. The person with a negative skin test and chest x-ray but with other symptoms probably has another type of respiratory infection.
Q3
Free

How long is the minimum course of drug therapy for an immunocompetent patient with active tuberculosis?

Multiple Choice
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A) 7 to 10 days
B) 6 weeks
C) 6 months
D) 2 years
Answer:
C) 6 months

Explanation:
A patient who has nondrug-resistant tuberculosis must remain on the prescribed medications for at least 6 months. The organism is slow growing and is harder to control than other types of bacteria.
Q4

A patient with active tuberculosis who has been taking isoniazid (INH, Nydrazid) and rifampin (RIF, Rifadin) reports having urine that is an orange color. What is the nurses best action?

Multiple Choice
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A) Obtain a specimen for culture and test the urine for occult blood.
B) Reassure the patient that this is a normal drug side effect.
C) Hold the dose and contact the prescriber.
D) Document the report as the only action.
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Q5

A male patient who has been prescribed isoniazid (INH, Nydrazid) reports that his breasts have enlarged since starting therapy. What is the nurses best response?

Multiple Choice
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A) This is common with isoniazid and will disappear after you stop drug therapy.
B) Is the enlargement the same on both sides or is one breast larger than the other?
C) If you are not having difficulty getting an erection, do not worry about this change.
D) I will report this problem to your prescriber and see if it is possible for you to stop taking this drug.
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Q6

Which statement made by a patient indicates to the nurse the need for more teaching about first-line drug therapy for tuberculosis (TB)?

Multiple Choice
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A) To prevent nausea and vomiting, I have been taking my drugs at night with a small snack.
B) I have stopped taking all herbal supplements and stopped drinking beer until I finish this drug therapy.
C) Now that my symptoms have disappeared after a month of drug therapy, I can no longer infect my family.
D) Now that my symptoms have disappeared after a month of drug therapy, I can stop taking all of these drugs.
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Q7

What is the most important question the nurse must ask a patient before administering rifampin (RIF) intravenously?

Multiple Choice
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A) Have you ever had gout?
B) Are you allergic to sulfa drugs?
C) Are you allergic to sulfite preservatives?
D) Have you had any alcoholic beverages within the last month?
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Q8

A patient is prescribed 420 mg of rifampin to be added to 500 mL of dextrose 5% in water (D5W). The vial contains rifampin 60 mg/mL. How many milliliters does the nurse add to the D5W?

Multiple Choice
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A) 0.16
B) 5
C) 7
D) 8
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Q9

A patient has been prescribed all four first-line drugs for tuberculosis (TB). Which laboratory blood value is most important for the nurse to report to the prescriber first?

Multiple Choice
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A) Red blood cells (RBCs) 2.2 million/mm3
B) International normalized ratio 1.6
C) White blood cells 6000/mm3
D) Sodium 134 mEq/L
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Q10

Which administration technique does the nurse teach the family of a patient with memory problems for best adherence to first-line drug therapy for tuberculosis?

Multiple Choice
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A) Having one family member responsible for giving the drugs and watching the patient swallow them
B) Setting up the patients drugs using a daily pill dispenser that has separate slots for each individual drug
C) Asking the patient every night whether he or she has remembered to take all the drug doses that day
D) Administering all the drugs together at the same time every day and ensuring that the patient drinks plenty of water
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Q11

Which precaution is most important for the nurse to teach a patient who is prescribed isoniazid (INH, Nydrazid)?

Multiple Choice
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A) Use another form of birth control in addition to oral contraceptives to prevent an unplanned pregnancy.
B) Do not drive or operate dangerous equipment until you know how this drug affects you.
C) Wear glasses rather than contact lenses throughout this drug therapy.
D) Avoid coffee and any foods or beverages that contain caffeine.
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Q12

A patient who is prescribed ethambutol (EMB, Myambutol) reports trouble distinguishing colors. What is the nurses best action?

Multiple Choice
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A) Document the report as the only action.
B) Hold the dose and notify the prescriber immediately.
C) Caution the patient to wear sunglasses and a hat when outside.
D) Reassure the patient that this is a common side effect of the drug.
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Q13

Why are the side effects of antifungal therapy often more common and severe than for other types of anti-infective drugs?

Multiple Choice
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A) Fungal DNA closely resembles human DNA.
B) Fungi do not respond to antibacterial therapy.
C) Humans have no immunologic resistance to fungus.
D) Most fungal infections are considered pathologic rather than opportunistic.
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Q14

A patient prescribed a systemic antifungal drug reports a change in how food tastes. What is the nurses best action?

Multiple Choice
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A) Document the report as the only action.
B) Hold the dose and notify the prescriber immediately.
C) Caution the patient to wear sunglasses and a hat when outside.
D) Reassure the patient that this is a common side effect of the drug.
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Q15

A patient taking ketoconazole (Nizoral) for the last 2 weeks has all of the following blood laboratory test values. Which value does the nurse report to the prescriber immediately?

Multiple Choice
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A) White blood cell count (WBC) 10,500 cells/mm3
B) Lactate dehydrogenase 880 IU/L
C) Potassium 3.6 mEq/L
D) Hematocrit 32%
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Q16

A patient about to start systemic antifungal therapy has a white blood cell (WBC) count of 3200 cells/mm3. Which antifungal drug must be avoided for this patient?

Multiple Choice
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A) fluconazole (Diflucan)
B) ketoconazole (Nizoral)
C) micafungin (Mycamine)
D) terbinafine (Lamisil)
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Q17

A patient is prescribed 50 mg of amphotericin B (Fungizone) by intravenous infusion in 500 mL of dextrose 5% in water (D5W) over 6 hours. How many milliliters per minute does the nurse set the pump to infuse?

Multiple Choice
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A) 1.4
B) 2.2
C) 4.2
D) 6.2
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Q18

A patient is receiving IV amphotericin B (Fungizone) for a systemic fungal infection. Which assessment parameter does the nurse perform to determine whether the patient is having an adverse reaction to the therapy?

Multiple Choice
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A) Measure abdominal girth for presence of ascites
B) Assess mouth and oral cavity for candidiasis
C) Assess infusion site for phlebitis
D) Assess calves for pain
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Q19

A patient is prescribed amphotericin B (Fungizone) 400 mg intravenously. How fast does the nurse infuse this drug?

Multiple Choice
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A) Immediately by intravenous (IV) push
B) Over a period of 60 minutes
C) Over a period of 2 hours
D) Over a minimum of 6 hours
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Q20

A patient who has been prescribed flucytosine (Ancobon) reports reduced sensation in the fingers and toes. What is the nurses best action?

Multiple Choice
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A) Document the report as the only action.
B) Hold the dose and notify the prescriber.
C) Remind the patient to continue the drug as usual and to take a multiple vitamin daily.
D) Reassure the patient that this is an expected drug side effect and to use injury precautions.
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Q21

Which food, drink, or herbal supplement does the nurse warn a patient who is prescribed any of the azole class of antifungal drugs to avoid?

Multiple Choice
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A) Caffeinated beverages
B) Grapefruit juice
C) St. Johns wort
D) Dairy products
Answer:

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Q22

[Multiple Response] A pregnant patient is taking all four first-line drugs for tuberculosis (TB). Which additional health care actions are needed for this patient? (Select all that apply.)
a. Ensuring that no weight is gained
b. Checking liver function tests monthly
c. Checking vision and intraocular pressure monthly
d. Testing urine for the presence of the TB organism
e. Supplementing with B-complex vitamins
f. Avoiding alcoholic beverages

Essay
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Q23

[Multiple Response] Which precautions are important to teach a woman using a vaginal cream form of an antifungal drug? (Select all that apply.)
a. Wear gloves to insert the cream.
b. Wash the applicator with soap and water.
c. Do not tub bathe until treatment is completed.
d. Avoid sexual intercourse during the treatment period.
e. Remind the patient that the cream can make holes in a condom or diaphragm.
f. Stop the drug immediately if you think you are pregnant. g. Stop the drug when symptoms have disappeared to avoid unnecessary exposure to it.

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Q24

[Multiple Response] A patient is receiving IV caspofungin (Cancidas). Which assessments are most important for the nurse to perform daily? (Select all that apply.)
a. Assessing both calves for swelling, redness, and pain
b. Examining the skin for rash and blisters
c. Assessing capillary refill in fingers and toes
d. Assessing the injection site for irritation or phlebitis
e. Reviewing laboratory reports of white blood cell counts
f. Listening for bowel sounds in all four abdominal quadrants g. Reviewing laboratory reports for blood urea nitrogen (BUN) and creatinine

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Q25

[Multiple Response] An older adult patient is prescribed systemic antifungal therapy for 1 month. Which precautions are important for the nurse to teach this patient? (Select all that apply.)
a. Avoid drinking coffee or any other beverages or food that contain caffeine.
b. Check your pulse daily and report any new irregularities to your prescriber.
c. Examine all bowel movements and any vomit for the presence of pus and report it to your prescriber.
d. Look at the whites of your eyes daily and if a yellow color appears, report it to your prescriber.
e. If your daily urine output drops below a liter less than your daily fluid intake, notify your prescriber immediately.
f. If you should develop abdominal bloating and diarrhea, go to the nearest emergency department as soon as possible.

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