Question 1

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:

A) broadens the antifungal spectrum.
B) improves the effectiveness of the amphotericin B.
C) lowers the dose of amphotericin B and reduces toxicity.
D) treats fungal central nervous system (CNS) infection.

Accepted Answer

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. By allowing a reduced dose of amphotericin, the combination also reduces the risk of amphotericin-induced toxicity. Flucytosine does not affect the effectiveness of amphotericin. The combination does not broaden the antifungal spectrum or alter the ability to treat CNS infections.

Question 2

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?

A) Administer the omeprazole 1 hour before the ketoconazole.
B) Administer the omeprazole at least 2 hours after the ketoconazole.
C) Confer with the prescriber about a potential hazardous interaction.
D) The nurse should not administer omeprazole to a patient receiving ketoconazole.

Accepted Answer

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. There is no need to confer with the prescriber or to refuse to administer the drugs, because ketoconazole and omeprazole do not have a potentially hazardous interaction.

Question 3

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?

A) Administering intravenous voriconazole
B) Reducing the dose of phenobarbital
C) Reducing the dose of voriconazole
D) Using a different antifungal agent

Accepted Answer

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.

Question 4

Ketoconazole is used as an alternative to amphotericin B for less severe systemic mycosis. Which are the primary reasons for choosing ketoconazole? (Select all that apply.)&#10;A) It can be given orally.&#10;B) It can be used safely in patients with hepatic dysfunction.&#10;C) It can be given once weekly rather than daily.&#10;D) It is effective for severe, acute infections.&#10;E) It is less toxic.

Accepted Answer

Ketoconazole is given instead of amphotericin B because it is less toxic and can be administered orally. Amphotericin B is administered intravenously. Ketoconazole is hepatotoxic; it is given daily. Ketoconazole is less useful for severe, acute infections.

Question 5

A patient who is taking ketoconazole tells the nurse that her periods have become irregular. What will the nurse tell her?&#10;A) This indicates that she should begin taking oral contraceptives.&#10;B) This is caused by a reversible effect on estradiol synthesis.&#10;C) This is a serious side effect that warrants discontinuation of the drug.&#10;D) This is a sign of hepatic toxicity, and the drug dose should be lowered.

Accepted Answer

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. Menstrual irregularities are not a sign associated with hepatotoxicity.

Question 6

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?&#10;A) &#34;Apply the medication over the entire body twice daily for 2 weeks.&#34;&#10;B) &#34;Sun exposure will minimize the drug's effects.&#34;&#10;C) &#34;This drug is effective after a single application.&#34;&#10;D) &#34;Use the medication for at least 1 week after the symptoms have cleared.&#34;

Accepted Answer

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 affected areas. Sun exposure will not delay the effects of clotrimazole. The drug must be applied twice daily for several weeks.

Question 7

A patient is receiving intravenous voriconazole (Vfend). Shortly after the infusion starts, the patient tells the nurse, &#34;Colors look different, and the light hurts my eyes.&#34; What will the nurse do?&#10;A) Observe the patient closely for the development of hallucinations.&#10;B) Reassure the patient that these effects will subside in about 30 minutes.&#10;C) Stop the infusion and notify the provider of CNS toxicity.&#10;D) Tell the patient that this is an irreversible effect of the drug.

Accepted Answer

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. They are not precursors to other effects, such as hallucinations. They do not indicate CNS toxicity. They are reversible.

Question 8

A patient has an invasive aspergillosis infection. Which antifungal agent is the drug of choice for this infection?&#10;A) Amphotericin B&#10;B) Fluconazole (Diflucan)&#10;C) Posaconazole (Noxafil)&#10;D) Voriconazole (Vfend)

Accepted Answer

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.

Question 9

A nursing student asks a nurse about flucytosine (Ancobon). Which statement by the nurse is correct?&#10;A) &#34;Flucytosine has a broad antifungal spectrum.&#34;&#10;B) &#34;Irreversible neutropenia and thrombocytopenia may occur with this drug.&#34;&#10;C) &#34;Resistance is common with this medication.&#34;&#10;D) &#34;Severe hepatic injury is common and limits this drug's use.&#34;

Accepted Answer

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.

Question 10

A patient with histoplasmosis is being treated with itraconazole (Sporanox). The nurse will teach this patient to report which symptoms?&#10;A) Gynecomastia and decreased libido&#10;B) Headache and rash&#10;C) Nausea, vomiting, and anorexia&#10;D) Visual disturbances

Accepted Answer

Itraconazole is associated with rare cases of liver failure, some of which were fatal. Patients should be instructed to reports 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.

Question 11

Which superficial mycosis is generally treated with oral antifungal agents?&#10;A) Tinea capitis&#10;B) Tinea corporis&#10;C) Tinea cruris&#10;D) Tinea pedis

Accepted Answer

The answer of Which superficial mycosis is generally treated with...

Question 12

The nurse is preparing to administer amphotericin B intravenously. The nurse will expect to pretreat the patient with which medications?&#10;A) Acetaminophen (Tylenol), diphenhydramine (Benadryl), and meperidine (Demerol)&#10;B) Aspirin, diphenhydramine (Benadryl), and meperidine (Demerol)&#10;C) Ibuprofen (Motrin), diphenhydramine (Benadryl), and meperidine (Demerol)&#10;D) Morphine sulphate (Morphine) and acetaminophen (Tylenol)

Accepted Answer

The answer of The nurse is preparing to administer amphotericin...

Question 13

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?&#10;A) Administer the drug as ordered.&#10;B) Contact the provider to discuss cutting the dosing in half.&#10;C) Contact the provider to discuss giving 400 mg on all days.&#10;D) Contact the provider to discuss giving the drug intravenously.

Accepted Answer

The answer of A patient has a systemic candidal infection,...

Question 14

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?

A) "I may experience headaches and pain in my lower back, legs, and abdomen."
B) "I may need to take potassium supplements while taking this drug."
C) "I should take acetaminophen and diphenhydramine before each infusion."
D) "I will need to have blood drawn for serum creatinine and BUN levels every 3 to 4 days."

Accepted Answer

The answer of A patient is being treated for a...

Question 15

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?

A) Fluconazole (Diflucan)
B) Ketoconazole
C) Posaconazole (Noxafil)
D) Voriconazole (Vfend)

Accepted Answer

The answer of A patient will begin taking an immunosuppressant...

Question 16

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?&#10;A) Amphotericin B (Abelcet)&#10;B) Fluconazole (Diflucan)&#10;C) Itraconazole (Sporanox)&#10;D) Voriconazole (Vfend)

Accepted Answer

The answer of A patient with a history of congestive...

Question 17

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?&#10;A) &#34;Amphotericin B can be given orally or intravenously .&#34;&#10;B) &#34;Amphotericin B increases the levels of many other drugs.&#34;&#10;C) &#34;Azoles have lower toxicity than amphotericin B.&#34;&#10;D) &#34;Only the azoles are broad-spectrum antifungal agents.&#34;

Accepted Answer

The answer of A nursing student asks a nurse to...

Question 18

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) "A test dose of amphotericin B may be given to assess the patient's reaction."
B) "If I see any precipitate in the IV solution, I should stop the infusion immediately."
C) "Infusions of amphotericin B should be administered over 1 to 2 hours."
D) "The IV site should be rotated frequently to reduce the risk of phlebitis."

Accepted Answer

The answer of A nurse is discussing intravenous amphotericin B...

Question 19

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?

A) Aspirin
B) Dantrolene
C) Hydrocortisone
D) Omeprazole

Accepted Answer

The answer of A nurse is caring for a patient...

Question 20

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?&#10;A) &#34;Adverse effects of the medication include itching, burning, and erythema.&#34;&#10;B) &#34;Apply the topical medication daily until at least 1 week after the rash is gone.&#34;&#10;C) &#34;Your child will need to take this oral medication for 6 to 8 weeks.&#34;&#10;D) &#34;You will use an antifungal shampoo to treat this infection.&#34;

Accepted Answer

The answer of A child has ringworm of the scalp....

Question 21

Amphotericin B is the drug of choice for which systemic mycosis? (Select all that apply.)&#10;A) Aspergillosis&#10;B) Candidiasis&#10;C) Dermatophytosis&#10;D) Histoplasmosis&#10;E) Mucormycosis

Accepted Answer

The answer of Amphotericin B is the drug of choice...

Deck 92: Antifungal Agents