A patient with HIV and mucocutaneous HSV is being treated with foscarnet after failing treatment with acyclovir. After 2 weeks, the patient’s dose is increased to 90 mg/kg over 2 hours from 40 mg/kg over 1 hour. The patient reports numbness in the extremities and perioral
tingling. What will the nurse do?
A.
A patient has a positive test for hepatitis C and is admitted to the hospital. The admission laboratory tests reveal a normal ALT, and a liver biopsy is negative for hepatic fibrosis and inflammation. The nurse will prepare this patient for:
B.
A patient with HIV contracts herpes simplex virus (HSV), and the prescriber orders acyclovir [Zovirax] 400 mg PO twice daily for 10 days. After 7 days of therapy, the patient reports having an increased number of lesions. The nurse will expect the provider to:
A.
A nursing student asks a nurse why pegylated interferon alpha is used instead of regular interferon for a patient with hepatitis C. The nurse will tell the student that pegylated interferon:
B.
A patient has a positive test for influenza type A and tells the nurse that symptoms began 5 days before being tested. The prescriber has ordered oseltamivir [Tamiflu]. The nurse will tell
the patient that oseltamivir:
A.
A patient who is pregnant has a history of recurrent genital herpesvirus (HSV). The patient asks the nurse what will be done to suppress an outbreak when she is near term. The nurse will tell the patient that:
B.
A nurse provides teaching for a patient with cytomegalovirus (CMV) retinitis who will receive the ganciclovir ocular implant [Vitrasert]. Which statement by the patient indicates a need for further teaching?
B.
A patient has lamivudine-resistant hepatitis B and has been taking entecavir [Baraclude] for 2 years. The patient asks the nurse why the provider has recommended taking the drug for another year. What will the nurse tell the patient?
B.
The nurse is caring for a patient receiving intravenous acyclovir [Zovirax]. To prevent nephrotoxicity associated with intravenous acyclovir, the nurse will:
C.
A patient comes to the clinic and receives valacyclovir [Valtrex] for a herpes-zoster virus.
The nurse instructs the patient to take the medication:
B.
An immunocompromised child is exposed to chickenpox and the provider orders valacyclovir
[Valtrex] to be given orally three times daily. The nurse will contact the provider to change this order for which reason?
D.
A male patient with hepatitis C will begin triple drug therapy with pegylated interferon alpha2a [Pegasys], ribavirin [Ribasphere], and boceprevir [Victrelis]. The patient tells the nurse that his wife is pregnant. What will the nurse tell him?
D.
A female patient who has hepatitis C is being treated with pegylated interferon alpha and ribavirin [Ribasphere]. It will be important for the nurse to teach this patient that:
B.
A patient with hepatitis B begins treatment with adefovir [Hepsera] and asks the nurse how long
the drug therapy will last. The nurse will tell the patient that the medication will need to be taken for:
C.
A patient is being treated for a systemic fungal infection with amphotericin B [Abelcet] and
will be discharged home from the hospital to complete every-other-day infusions of the medication for 6 to 8 weeks. The nurse provides discharge teaching before dismissal. Which statement by the patient indicates a need for further teaching?
D.
Headaches, lower back pain, leg pain, and abdominal pain occur with intrathecal administration of
amphotericin B.
Patients taking amphotericin may experience hypokalemia and may need potassium supplements.
Acetaminophen and diphenhydramine should be taken to minimize
infusion reaction effects.
Renal function should be monitored every 3 to 4 days during treatment
A child has ringworm of the scalp. A culture of the lesion reveals a dermatophytic infection. The nurse teaching the child’s parents about how to treat this infection will include which statement?
C.
Tinea capitis is a difficult to treat with topical medications; oral griseofulvin, taken for 6 to 8 weeks is standard therapy. Itching, burning, and erythema are side effects of topical agents.
The nurse is preparing to administer amphotericin B intravenously. The nurse will expect to pretreat the patient with which medications?
B.
A nurse is caring for a patient who has a superficial fungal infection and notes that the provider has ordered 200 mg of ketoconazole [Nizoral] 200 mg PO once daily. Which action by the nurse is correct?
C.
Because of the risk of serious and potentially fatal hepatic necrosis with oral ketoconazole, it is not recommended for use in treating superficial fungal infections. Another antifungal medication should be ordered.
A patient is being treated with amphotericin B [Abelcet] for a systemic fungal infection. After several weeks of therapy, the provider orders flucytosine [Ancobon] in addition to the amphotericin. The nurse understands that the rationale for this combination is that it:
B.
Amphotericin potentiates the antifungal actions of flucytosine, and combining flucytosine with low-dose amphotericin can produce antifungal effects equivalent to those of high-dose amphotericin.
A patient will begin taking an immunosuppressant medication. The nurse learns that the patient
has a history of frequent candidal infections. The nurse will expect the provider to order which drug as prophylaxis?
B.
Posaconazole is used as prophylaxis for invasive Aspergillus and Candida infections in immunocompromised patients. Fluconazole, ketoconazole, and voriconazole are not used prophylactically
A provider has ordered oral voriconazole [Vfend] for a patient who has a systemic fungal infection. The nurse obtains a medication history and learns that the patient takes phenobarbital for seizures. The nurse will contact the provider to discuss which possibility?
D.
Voriconazole can interact with many drugs. It should not be combined with drugs that are powerful P450 inhibitors, including phenobarbital, because these can reduce the levels of voriconazole.
Administering the voriconazole IV will not increase the serum level. It is not correct to reduce the dose of either drug
A nurse is discussing intravenous amphotericin B treatment with a nursing student who is about
to care for a patient with a systemic fungal infection. Which statement by the student indicates a need for further teaching?
A.
Infusions of amphotericin B should be given over 2 to 4 hours to minimize phlebitis and cardiovascular reactions
A patient has come to the clinic with tinea corporis, and the prescriber has ordered clotrimazole. When educating the patient about this medication, the nurse will include which statement?
C.
The nurse should advise the patient to continue therapy for at least 1 week after the symptoms have
cleared up. The medication should be applied only to the affected areas. Sun exposure will not delay the effects of clotrimazole. The drug must be applied twice daily for several weeks
A patient has an invasive aspergillosis infection. Which antifungal agent is the drug of choice for this infection?
A.
Voriconazole has replaced amphotericin B as the drug of choice for treating invasive aspergillosis.
Fluconazole, which is fungistatic, is not used to treat aspergillosis. Posaconazole is used for
prophylaxis of aspergillosis in immunocompromised patients
A patient who is taking ketoconazole tells the nurse that her periods have become irregular. What will the nurse tell her?
A.
Ketoconazole inhibits steroid synthesis in humans, and in females it reduces estradiol synthesis, causing menstrual irregularities. It is not an indication that oral contraceptive pills (OCPs) are
needed. Because it is reversible, there is no indication for withdrawing the drug until treatment is complete
A patient is receiving intravenous voriconazole [Vfend]. Shortly after the infusion starts, the patient tells the nurse, “Colors look different, and the light hurts my eyes.” What will the nurse do?
B.
Reduced visual acuity, increased brightness, altered color perception, and photophobia are
reversible visual disturbances that can occur in 30% of patients receiving voriconazole. These usually begin within 30 minutes of dosing and then diminish over the next 30 minutes.
A patient with a history of congestive heart failure and renal impairment has esophageal candidiasis. Which antifungal agent would the nurse anticipate giving to this patient?
D.
Fluconazole is a drug of choice for treating systemic candidal infections.
Amphotericin is nephrotoxic and should not be used in patients with existing renal disease.
Itraconazole is a possible
alternative agent for treating candidiasis but has serious cardiac side effects.
Voriconazole is a drug of first choice for treating aspergillosis but not for candidiasis.
A patient will begin treatment with posaconazole [Noxafil] to treat oropharyngeal candidiasis that has not responded to fluconazole. The provider has ordered 200 mg three times daily. Which action by the nurse is correct?
B.
When given for treatment of oropharyngeal candidiasis that is refractory to treatment with
itraconazole or fluconazole, the dose is 400 mg twice daily. A dosage regimen of 200 mg three times daily is used for prophylaxis of invasive fungal infections
A patient is taking oral ketoconazole [Nizoral] for a systemic fungal infection. The nurse reviews the medication administration record and notes that the patient is also taking omeprazole [Prilosec] for reflux disease. What action should the nurse take?
B.
The nurse should administer the omeprazole at least 2 hours after the ketoconazole to prevent a drug-to-drug interaction. Drugs that reduce gastric acidity should be administered no sooner than 2 hours after ingestion of ketoconazole, because they reduce absorption of the drug
A nurse is caring for a patient who is receiving amphotericin B [Abelcet] for a systemic fungal infection. In spite of receiving diphenhydramine and acetaminophen before initiation of treatment, the patient has fever and chills with rigors. The nurse will contact the provider to discuss the addition of which drug?
Pretreatment with diphenhydramine and acetaminophen can reduce mild
reactions.
If rigors occur, the patient should receive dantrolene or meperidine
A patient has a systemic candidal infection, and the provider has ordered oral fluconazole [Diflucan] 400 mg on day 1 and 200 mg once daily thereafter. What will the nurse do?
A.
The dosing for fluconazole for systemic candidal infections is 400 mg on the first day and 200 mg/day each day thereafter. Dosing for oral or esophageal candidal infections is half that for systemic infections.
A patient with histoplasmosis is being treated with itraconazole [Sporanox]. The nurse will teach this patient to report which symptoms?
B.
Itraconazole is associated with rare cases of liver failure, some of which were fatal. Patients should be instructed to report signs of liver toxicity, including nausea, vomiting, and anorexia.
Ketoconazole is associated with gynecomastia and libido changes. Headache and rash are
associated with fluconazole.
Visual disturbances may occur with voriconazole
Which superficial mycosis is generally treated with oral antifungal agents?
B.
Tinea capitis must be treated with oral agents for 6 to 8 weeks.
A nursing student asks a nurse about flucytosine [Ancobon]. Which statement by the nurse is correct?
B.
The development of resistance during flucytosine therapy is common and is a serious clinical problem. Flucytosine has a narrow antifungal spectrum.
Neutropenia and thrombocytopenia may occur but are reversible.
Severe hepatic injury is rare; mild and reversible hepatic dysfunction is
common
A nursing student asks a nurse to explain the differences between amphotericin B [Abelcet] and the azoles group of antifungal agents. Which statement by the nurse is correct?
C.
The azoles class of antifungals is less toxic than amphotericin B.
Amphotericin B may only be
given parenterally.
The azoles, not amphotericin B, inhibit hepatic P450 drug-metabolizing enzymes, so they increase the levels of many other drugs.
A female patient has come to the STD clinic and has been diagnosed with a Trichomonas vaginalis infection. What education should be provided to this patient?
A.
The most important information the nurse can provide is that male partners should always be treated, even if they are asymptomatic.
Gels are not indicated for T. vaginalis; oral medications are.
T. vaginalis infection can be easily treated with a single dose of metronidazole or tinidazole.
A newborn infant has been given erythromycin ophthalmic ointment as a routine postpartum medication. The infant’s mother learns that she has a C. trachomatis infection and asks the nurse if her baby will need to be treated. Which response by the nurse is correct?
A.
Infants born to women with cervical C. trachomatis are at risk for conjunctivitis and pneumonia
A nurse is teaching a group of adolescent students about sexually transmitted diseases. Which
statement by a student indicates understanding of infections caused by C. trachomatis?
A.
Chlamydial infections are frequently asymptomatic in women and may be asymptomatic in men; they can cause sterility in women.
A patient is admitted to the hospital with fever, headache, malaise, joint pain, and enlarged
lymph nodes. Blood cultures are positive for Treponema pallidum. The nurse recognizes this as which type of syphilis?
A.
Secondary syphilis occurs when the organism spreads to the bloodstream, causing systemic symptoms such as fever, headache, reduced appetite, and general malaise, along with enlarged lymph nodes and joint pain.
A patient is diagnosed with pelvic inflammatory disease (PID). Which treatment regimen is most appropriate for reducing the risk of sterility in this patient?
A.
Many experts recommend that all patients with PID receive IV antibiotics in the hospital to
minimize the risk of sterility and other complications.
Medications used intravenously can be cefoxitin or cefotetan combined with doxycycline;
when symptoms resolve, IV therapy may be discontinued but must be followed by PO doxycycline.
An adolescent patient with mild cervicitis is diagnosed with gonorrhea. The nurse will expect
the provider to order which drug(s)?
a. Azithromycin [Zithromax], 1 g PO once, and doxycycline [Vibramycin], 100 mg PO twice daily for 7 days
b. Ceftriaxone [Rocephin], 250 mg IM once, and azithromycin [Zithromax], 1 g PO once
c. Ceftriaxone [Rocephin], 125 mg IM once
d. Doxycycline [Vibramycin], 100 mg IV twice daily for 12 days
C.
The only options for treating cervical infection with gonorrhea are cefixime and ceftriaxone.
Ceftriaxone is recommended over cefixime because of antibiotic resistance to cefixime.
Because a high percentage of patients with gonorrhea also have chlamydial infections, they should be
treated with either doxycycline or azithromycin until a chlamydial infection has been ruled out.
A patient admitted to the hospital is using metronidazole [Flagyl] 0.75% gel. The nurse understands that this agent is used to treat which condition?
B.
G. vaginalis causes bacterial vaginosis and is treated with metronidazole gel. C. trachomatis is
treated with systemic antibiotics. H. ducreyi, which causes chancroid, is treated with systemic
antibiotics. T. vaginalis is treated with oral metronidazole.
During a routine screening, an asymptomatic, pregnant patient at 37 weeks’ gestation learns that she has an infection caused by Chlamydia trachomatis. The nurse will expect the provider to order which drug?
A.
The preferred treatment for C. trachomatis infection during pregnancy is either azithromycin or amoxicillin.
Doxycycline can be used for nonpregnant patients.
Erythromycin is used for infants.
Sulfisoxazole is not recommended for pregnant women near term, because it can cause kernicterus in the infant.
