Question 1

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?

Accepted Answer

Want 420 mg/Have 60 mg in 1 mL.420/60 = 7 mL.

Question 2

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?

Accepted Answer

Successful drug therapy for TB requires that all first line drugs be taken correctly without missing doses.Patients who have memory problems usually need some form of directly observed therapy (DOT)to ensure absolute adherence to this important therapy.Having one family member responsible for giving the drugs fulfills the requirements of DOT and reduces the risk that the patient will receive either too many drug doses or too few doses to be effective.

Question 3

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

Accepted Answer

Breast enlargement in men (gynecomastia)is a common side effect of isoniazid.This physical change can be very distressing and embarrassing to men,and they should be reassured that the problem is temporary.Even though it is distressing,breast enlargement is not a reason to stop drug therapy.

Question 4

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?

Accepted Answer

The WBC count,lactate dehydrogenase,and hematocrit values are abnormal; however,only the lactate dehydrogenase level is very high (three to four times normal).This value indicates liver impairment,which can be caused by taking ketoconazole.This value must be reported immediately so that liver function can be explored and any needed changes in drug therapy made before irreversible liver damage occurs.

Question 5

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?

Accepted Answer

All of these values are abnormal; however,only the RBC count is seriously out of the normal range.One of the most serious adverse effects of rifampin (a major part of first-line drug therapy for TB)is suppression of RBC production,leading to anemia.This patient's RBC level is only about half of normal.

Question 6

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

Accepted Answer

Ethambutol at high doses can cause optic neuritis vision changes that include reduced color vision,blurred vision,and reduced visual fields.This problem can lead to blindness.When the problem is discovered early,the eye problems are usually reversed when the drug is stopped.

Question 7

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

Accepted Answer

Systemic antifungal drugs have many common side effects,including loss of taste or changes in how food tastes.Unless this problem interferes with the patient's nutritional status,it is of no consequence.The patient should be reassured that the taste changes are an expected side effect and that normal taste sensation will return after the drug has been stopped after several days or a week.

Question 8

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?

Accepted Answer

This WBC count is lower than normal.Terbinafine and flucytosine (Ancobon)can further reduce this patient's WBC count and greatly increase his or her risk for infection.

Question 9

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?

Accepted Answer

500 mL ÷ 6 = 83.3 mL/hr.Divide 83.3 mL by 60 minutes = 1.38 mL per minute.Round up to 1.4.

Question 10

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

Accepted Answer

Rapid administration of IV amphotericin B is associated with more severe rigors,hyperkalemia,and a more rapid onset of renal insufficiency.It is recommended that the drug be administered over a 6-hour time period regardless of the dose.

Question 11

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

Accepted Answer

Usually TB is no longer contagious and clinical improvement is seen after drugs have been taken for 2 to 3 consecutive weeks.However,the organism growth has only been suppressed and the immune system and drugs have not had sufficient time to eradicate it.Stopping treatment after only a month will allow the disease to again become active and the organisms can become resistant to these drugs.The patient must continue taking the drugs for 6 months or longer,exactly as prescribed.

Question 12

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?

Accepted Answer

Among its many adverse effects,amphotericin B is very irritating and causes phlebitis at the site of infusion.This can occur quickly,sometimes after only one drug dose.When it is present,the IV site needs to be changed to prevent more complications and patient discomfort.

Question 13

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

Accepted Answer

Isoniazid raises blood pressure.When this drug is taken in combination with other drugs or agents that also raise blood pressure,the patient can develop dangerous hypertension.Caffeine is a common food ingredient that greatly increases the risk for hypertension when taken in combination with isoniazid.

Question 14

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

Accepted Answer

The IV form of rifampin contains a sulfite preservative that can cause hypersensitivity reactions in patients allergic to sulfite preservatives such as sodium metabisulfite or potassium metabisulfite.This problem is not the same as an allergy to "sulfa" drugs.

Question 15

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

Accepted Answer

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.

Question 16

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

Accepted Answer

The genetic material of fungi is DNA.Its construction is very similar to human DNA,and drugs that affect fungal DNA are more likely also to affect human DNA.This is one reason that humans respond with more side effects to antifungal therapy than to many antibacterial or antiviral drugs.

Question 17

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

Accepted Answer

Peripheral neuropathy with loss of sensation in the extremities is a common and expected side effect of flucytosine therapy.Drug therapy is not stopped for this effect.The patient must implement precautions to prevent injury from not having full sensation for touch,temperature,and pressure.

Question 18

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 nurse's best action?

Accepted Answer

Rifampin normally turns urine an orange color.No intervention is needed; however,the color change can be very distressing to patients.The patient should be reassured that this color change is normal and be taught how to manage this change so that clothing does not become stained.

Question 19

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?

Accepted Answer

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.

Question 20

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

Accepted Answer

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.

Quiz 11: Anti-Infectives: Antitubercular and Antifungal Drugs

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?

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?

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

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?

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?

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

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

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?

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?

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

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

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?

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

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

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

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

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

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 nurse's best action?

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?

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

Quiz 11: Anti-Infectives: Antitubercular and Antifungal Drugs

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?

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?

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

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?

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?

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

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

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?

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?

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

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

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?

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

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

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

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

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

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 nurse's best action?

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?

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

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?

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?

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?