8. A patient is prescribed zanamivir (Relenza) to treat influenza B.
The patient has a history of
asthma. For which of the following symptoms
should the nurse assess?
A) Bradycardia
B) Pneumonia
C) Bronchospasm
D) Pulmonary embolism
Ans: C
Feedback:
A patient is administered zanamivir for the treatment of influenza B. The patient has asthma and
should be observed or assessed for decreased respiratory function, including bronchospasm. Bradycardia,
pneumonia, and pulmonary embolism are not adverse effects
the nurse should expect.
9. A neonatal intensive care unit nurse is caring for an infant with RSV. What route of delivery will
the nurse use when ribavirin
(Virazole) is administered?
A) Oral suspension
B) Topical
C) Intravenous
D) Inhaled
Ans: D
Feedback
:
Ribavirin is inhaled systemically.
10. A young female is seen in the physician's office and wants to ensure that she is vaccinated against
hepatitis. Vaccines are available for which of the following types of
hepatitis? Select all that apply.
A) Hepatitis A virus
B) Hepatitis B virus
C) Hepatitis C virus
D) Hepatitis D virus
E) Hepatitis G virus
Ans: A, B
Feedback:
Vaccines are available for hepatitis A and B.
11. A patient is prescribed indinavir sulfate (Crixivan) for the treatment of HIV infection. What
patient teaching should be provided
regarding renal function?
A) Drink grape juice daily for antioxidants.
B) Drink grapefruit juice to enhance absorption.
C) Assess for pulmonary edema.
D) Consume at least 48 ounces of fluid per day.
Ans: D
Feedback
:
When taking indinavir, the patient should be instructed to consume 48 ounces of water or fluid per
day to prevent nephrolithiasis. The consumption of grape juice with antioxidants will assist in preventing
nephrolysis but must be in sufficient amounts. The consumption of grapefruit juice is usually
contraindicated.
The nurse would not need to assess for
pulmonary edema.
12. A patient has sought care from her primary care provider after feeling “under the weather”
for several days. The care provider suspects that the patient is suffering from a viral illness. What signs
andsymptoms typically accompany viral infections? Select
all that apply.
A) Increased white cell count
B) Idiopathic bleeding
C) Malaise
D) Fever
E) Headache
Ans: C, D, E
Feedback:
Symptoms usually associated with acute viral infections include fever, headache, cough, malaise,
muscle pain, nausea and vomiting, diarrhea, insomnia, and photophobia. White blood cell counts usually
remain normal, and
bleeding is uncharacteristic.
13. A young adult male who has had multiple sex partners in the preceding months has
beendiagnosed with hepatitis B virus (HBV) and begun treatment with lamivudine (Epivir).
Shortly after beginning treatment, the man complains of a 24-hour history of intense abdominal pain.
Thenurse should recognize the possibility of what adverse effect of
lamivudine therapy?
A) Gastroenteritis
B) Gastroesophageal reflux disease
C) Bowel obstruction
D) Pancreatitis
Ans: D
Feedback
:
A main adverse effect of lamivudine is pancreatitis. GERD, obstruction, and gastroenteritis do not
typically result from lamivudine therapy. As well, these problems do not typically manifest with intense
and
sudden abdominal pain.
14. An influenza outbreak has spread through a long-term care residence, affecting many of the
residents with severe malaise, fever, and nausea and vomiting. In an effort to curb the outbreak, the
nursehas liaised with a physician to see if residents may be
candidates for treatment with what drug?
A) Saquinavir mesylate
B) Oseltamivir phosphate
C) Lamivudine
D) Ribavirin
Ans: B
Feedback
:
Oseltamivir phosphate (Tamiflu) is used to treat active influenza. Saquinavir mesylate is a
protease inhibitor. Lamivudine is used to treat
hepatitis B. Ribavirin treats RSV.
15. A patient who is undergoing treatment for cytomegalovirus received his first dose of IV
ganciclovir 3 days ago. When reviewing this patient's most recent blood work, what abnormality should
the nurse most likely
attribute to the use of this drug?
A) Hemoglobin 17 g/dL (high normal)
B) INR 3.8 (high)
C) Platelet count 118,000/mm3 (low)
D)3
Leukocytes 11,900/mm (high)
Ans: C
Feedback:
Ganciclovir causes granulocytopenia and thrombocytopenia in 20% to 40% of recipients,
oftenduring the first 2 weeks of therapy. Leukocytosis, increased hemoglobin, and hypocoagulation are
not typical adverse
effects associated with ganciclovir.
16. A 42-year-old female patient with HIV has been receiving antiretroviral therapy for several
years,and her care team has recently added raltegravir (Isentress) to her drug regimen. When appraising
the success or failure of this change in treatment and the patient's ability to fight infection, the nurse
should prioritize which of the following
laboratory values?
A) The patient's C-reactive protein levels
B) The patient's erythrocyte sedimentation
rate(ESR)
C) The patient's viral load
D) The patient's CD4 count
Ans: D
Feedback:
The nurse assesses for an increase in T-helper CD4 cells. The CD4 count measures the ability
to fight against infections. CD4 count is more important than viral load in this regard. CRP levels and
ESRdo not reflect the
patient's immune function.
17. When administering the fusion protein inhibitor enfuvirtide (Fuzeon) to a
patientwith HIV, the nurse should
A) have the patient gargle with normal
salineimmediately after taking the drug.
B) flush the patient's central venous catheter
with100 Unit/mL heparin prior to administration.
C) inject the drug into the patient's
ventroglutealsite using the z-track method.
D) regularly rotate the subcutaneous
injectionsites that are used.
Ans: D
Feedback:
The nurse injects enfuvirtide subcutaneously into the upper arm, abdomen, or anterior thigh.
Injection of the drug into blood vessels, navel, moles, scars, or other areas of skin change should never
occur. Rotation of injection sites and assessment of the sites for
reactions are necessary.
18. A patient's antiretroviral therapy has not been as efficacious as her care team had predicted,
and maraviroc (Selzentry) has consequently been added to her drug regimen. The nurse should
recognize thisdrug as belonging to
what category of antiretroviral?
A) Fusion protein inhibitors
B) Protease inhibitors
C) CCR5 antagonists
D) Integrase strand transfer
inhibitorsAns: C
Feedback:
Currently, maraviroc is the only member of
the class of CCR5 antagonists.
19. A school nurse is meeting with a high school student who mentions that she is frustrated with her
repeated outbreaks of cold sores. The student states that she tried an over-the- counter topical cream but
that it failed to produce an appreciable improvement. The nurse should recognize that this student used
what drug?
A) Ganciclovir
B) Valacyclovir (Valtrex)
C) Famciclovir (Famvir)
D) Docosanol (Abreva)
Ans: D
Feedback:
Docosanol (Abreva) is an over-the-counter topical antiviral agent that works in the early stages
ofintracellular events of viral entry into the target cells. Famciclovir (Famvir) is an oral antiviral agent
administered for herpes zoster and recurrent genital herpes.
Valacyclovir (Valtrex) is not an over-the- counter medication. Cold sores are not
treatedwith ganciclovir.
20. A patient began antiretroviral therapy several weeks ago for the treatment of HIV, and he has
nowpresented to the clinic for a scheduled follow-up appointment. He states to the nurse, “I've been
pretty good about taking all my pills on time, though it was a bit hit and miss over the holiday weekend.”
How should the nurse best respond to this patient's
statement?
A) “Remember that if you miss a dose, you need
to take a double dose at the next scheduled time.”
B) “It's acceptable to miss an occasional dose as long as your symptoms don't get worse,
butit's not really recommended.”
C) “Remember that your antiretroviral drugs
willonly be effective if you take them very
consistently.”
D) “If you're not consistent with taking your medications, you're likely to develop more
side effects.”
Ans: C
Feedback
:
Effective treatment of HIV infection requires close adherence to drug therapy regimens involving
several drugs and daily doses.
Missing as few as one or two doses can decrease blood levels of antiretroviral drugs and result in
increased HIV replication and
development of drug-resistant viral strains.
Chapter 24 Drug Therapy for Fungal Infections
1. vaginal vault while taking an anti-infective to
treat strep throat. What fungal agent has most likely caused the burning and itching?
A) Cryptococcus neoformans
B) Candida albicans
C) Aspergillus
D) Dermatophytes
Ans: B
Feedback:
Growth of Candida organisms is normally restrained by intact immune mechanisms and bacterial
competition of nutrients. When these restraining forces are altered (antibacterial drug therapy), fungal
overgrowth and opportunistic infection can occur.
Cryptococcus neoformans organisms evade normal immune defense of phagocytosis.
Aspergillus organisms produce protease.
Dermatophytes grow on cool body surfaces.
2. A patient is being treated with amphotericin B for a fungal infection of the urinary
tract.What is the action of amphotericin B?
A) It binds to ergosterol and forms holes in
themembrane.
B) It binds to an enzyme required for synthesis
of ergosterol.
C) It disrupts the fungal cell walls rather than
thecell membrane.
D) It inhibits glucan synthetase required
forglucan synthesis.
Ans: A
Feedback
:
Amphotericin B binds to ergosterol and forms holes in the membrane, causing leakage of fungal
cell contents and lysis of the cell. The azole drugs bind to an enzyme that is required for synthesis of
ergosterol. This action causes production of a defective cell membrane, which allows leakage of
intracellular contents and destruction of the cell. Echinocandins disrupt fungal cell walls rather than
fungalcell membranes. They inhibit glycan synthetase, an enzyme required for synthesis
of glucan.
3. A patient is being treated for a severe fungal infection with amphotericin B. What is the
expected length of treatment for this patient?
A) 1 to 2 weeks
B) 3 to 6 weeks
C) 4 to 12 weeks
D) 15 to 18 weeks
Ans: C
Feedback
:
Because of the toxicity of amphotericin B, the drug is used only for serious infections. It is usually
given for 4 to 12 weeks. Amphotericin B is not given for 1 to 2 weeks, 3 to 6 weeks,
or 15 to 18 weeks.
4. A patient is given Abelcet instead of amphotericin B. What is the advantage of
Abelcet over amphotericin B?
A) It is a newer medication with a lower cost.
B) It is the same as amphotericin B
inhepatotoxicity.
C) It reaches higher concentration in
diseasedtissue.
D) It constricts afferent renal arterioles to
reduceblood flow.
Ans: C
Feedback
:
Lipid formulations, such as Abelcet, reach higher concentrations in diseased tissues than in normal
tissues, so larger doses can be given to increase therapeutic effects. Abelcet does not cost less than
amphotericin B. Abelcet has fewer side effects than amphotericin B. Amphotericin B constricts afferent
renal
arterioles to reduce blood flow.
5. A child with a serious fungal infection is receiving amphotericin B parenterally. Which of the
following minerals will the patient most
likely be required to receive?
A) Chloride
B) Magnesium
C) Glucose
D) Sodium
Ans: B
Feedback
:
Hypomagnesemia may occur, which will require the administration of magnesium. The patient is
less at risk for changes in chloride,
glucose, or sodium.
6. A patient is receiving oral nystatin suspension for a fungal infection of the mouth. Which of the
following adverse effects is most likely to
be experienced with this form of nystatin?
A) Local irritation
B) Burning
C) Nausea
D) Urinary urgency
Ans: C
Feedback
:
Oral use of nystatin produces the following adverse effects: nausea, vomiting, and diarrhea. The
vaginal application of nystatin produces the following adverse effects: local irritation and burning.
Urinaryurgency is not
an adverse effect associated with nystatin.
7. A female is seen in the clinic for vaginal itching and discharge. Which of the following
medications can be administered in a single dose to treat her discomfort and vaginal
discharge?
A) Caspofungin (Cancidas)
B) Terbinafine (Lamisil)
C) Ketoconazole (Nizoral)
D) Fluconazole
(Diflucan)Ans: D
Feedback:
Fluconazole (Diflucan) is used for vaginal candidiasis in a single oral dose of 150 mg.
Caspofungin is not used for vaginal candidiasis, but for invasive aspergillosis. Terbinafine is used for
interdigital tinea pedis. Ketoconazole is used for patients with organ
transplants.
8. A patient has been diagnosed with a fungal infection and is to be treated with itraconazole
(Sporanox). Prior to administration, the nurse notes that the patient is taking carbamazepine (Tegretol)
fora seizure disorder. Based on this medication regime, which of the following
will be true regarding the medications?
A) The serum level of carbamazepine will be
increased.
B) The patient's carbamazepine should
bediscontinued.
C) The patient's antiseizure medication should
bechanged.
D) The patient will require a higher dosage
ofitraconazole (Sporanox).
Ans: D
Feedback:
Drugs that induce drug-metabolizing enzymes (e.g., carbamazepine, phenytoin, rifampin)
decrease serum concentrations of itraconazole. The serum level of carbamazepine will not need to be
increased. Thecarbamazepine should not be
discontinued or changed.
9. A patient is being treated with caspofungin for a systemic fungal infection related to Aspergillus.
Prior to the administration of the first parenteral dose, the nurse notes that the patient's AST and ALT
levels are elevated.
How will these serum hepatic enzymes affect
the administration of caspofungin?
A) The dose will need to be increased.
B) The dose will need to be decreased.
C) The dose will require a serum trough.
D) The medication should not be given.
Ans: B
Feedback
:
The dose of caspofungin will need to be reduced due to the risk of hepatotoxicity. The dose of
caspofungin should not be increased. The peak and trough are not as vital as the reduction of the dose.
Themedication should
be administered at a lower dose.
10. A patient is being treated for a fungal infection with IV amphotericin B. In order to prevent
drugdiscomfort, the nurse should
consistently monitor the patient's levels of
A) sodium.
B) hemoglobin.
C) calcium.
D) leukocytes.
Ans: A
Feedback
:
It is essential to assess the sodium balance throughout the administration of amphotericin.
Bymaintaining the serum sodium level within normal range, the patient
has decreased symptoms of drug discomfort.
11. A patient is receiving intravenous amphotericin. Which of the following assessments warrants the
discontinuation of
the antifungal agent?
A) Sodium of 138 mEq/L
B) Hematocrit of 39%
C) Blood urea nitrogen of 60 mg/dL
D) AST 10 Unit/L
Ans: C
Feedback
:
If the patient's BUN exceeds 40 mg/dL or serum creatinine exceeds 3 mg/dL, the drug should be
stopped or dosage should be reduced until renal function recovers. The hematocrit is in normal range
andwill not affect the medication administration. The AST and sodium levels are within normal range
and will not affect the administration.
12. A patient is being treated with amphotericin
B. Which of the following statements indicates that the patient has understood the patient teaching?
A) “The medication may cause diabetes.”
B) “The medication will cause liver necrosis.”
C) “The medication may cause kidney damage.”
D) “The medication will cause
pancreatitis.”Ans: C
Feedback:
The main concern with the administration of amphotericin B is the risk of nephrotoxicity. Thus,
the statement that the medication may cause kidney damage is the most appropriate. The medication will
not cause diabetes, liver
necrosis, or pancreatitis.
13. Amphotericin B is being used in the treatment of cryptococcosis in a patient who has HIV. When
assessing for potential signs and symptoms of cryptococcosis, the nurse should
prioritize what assessment?
A) Neurological assessment
B) Functional assessment
