Deck 10: Anti-Infectives: Antitubercular and Antifungal Drugs

Question 1

Why is ethambutol always used in combination with other antitubercular drugs?

A) Its presence enhances or potentiates the other first-line antitubercular drugs.
B) Its side effects are more serious when taken alone.
C) It is only bacteriostatic and not bactericidal.
D) It is not a first-line antitubercular drug.

Answer 1

It is only bacteriostatic and not bactericidal.

Question 2

A patient who is prescribed pyrazinamide and ethambutol for active tuberculosis (TB)also has gout.What adjustments will this patient's condition require?

A) Gout is not affected by TB drug therapy,and no adjustments are needed.
B) The prescribed therapy will improve gout and reduce the need for drug therapy to treat gout.
C) The prescribed therapy increases the risk for gout attacks,and the patient should increase his or her intake of water.
D) The drugs for treatment of gout interact with the drugs for TB,and the patient must not take the gout drugs within 2 hours of taking the TB drugs.

Answer 2

The prescribed therapy increases the risk for gout attacks,and the patient should increase his or her intake of water.

Question 3

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

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."

Answer 3

"This is common with isoniazid and will disappear after you stop drug therapy."

Question 4

Which drug must a patient be taught to avoid during TB drug therapy?

A) Aspirin
B) Ibuprofen
C) Acetaminophen
D) Iron supplements

Question 5

Which statement about tuberculosis (TB)is true?

A) The lungs are the only organ ever affected by TB.
B) A positive TB test means the person has active tuberculosis.
C) Far more people are infected with TB than actually develop the disease.
D) Any redness in the area where the TB test was performed is considered positive.

Question 6

Which antifungal drug causes some degree of renal impairment in everyone who receives it?

A) Amphotericin (Amphocin)
B) Terbinafine (Lamisil)
C) Caspofungin (Cancidas)
D) Fluconazole (Diflucan)

Question 7

Which drug is NOT one of the "first-line" antitubercular drugs?

A) Isoniazid (INH)
B) Rifampin (RIF)
C) Pyrazinamide (PAS)
D) Amphotericin (AMT)

Question 8

What type of fungal infections can be treated with topical antifungal agents?

A) Those that are confined to the skin or mucous membranes
B) Those that are located under the toenails or fingernails
C) Those that are infected by only one specific type of fungus
D) The type that only infect humans and not animals

Question 9

Which antitubercular drug causes the urine to turn reddish orange?

A) Isoniazid (INH)
B) Rifampin (RIF)
C) Pyrazinamide (PAS)
D) Ethambutol (EMB)

Question 10

Which antifungal drug causes "red man syndrome?"

A) Amphotericin B
B) Ketoconazole
C) Caspofungin
D) Fluconazole

Question 11

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

A) "To prevent nausea/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."

Question 12

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

A) 7 to 10 days
B) 6 weeks
C) 6 months
D) 2 years

Question 13

Which antitubercular drug is avoided in the treatment of children who have tuberculosis?

A) Isoniazid (INH)
B) Rifampin (RIF)
C) Pyrazinamide (PAS)
D) Ethambutol (EMB)

Question 14

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

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

Question 15

Why are most standard antibacterial drugs ineffective against tuberculosis?

A) The TB organism is slow growing.
B) The TB organism is not really a type of bacteria.
C) The TB organism does not have a true cell wall.
D) The TB organism is usually located in the brain stem where antibacterial drugs cannot reach.

Question 16

Which antifungal drug to treat ringworm is given to children as granules that are sprinkled over soft,nonacidic foods?

A) Amphotericin B
B) Flucytosine
C) Terbinafine
D) Micafungin

Question 17

Which class of antifungal agents should never be given with grapefruit juice?

A) Echinocandins
B) Alyamines
C) Polyenes
D) Azoles

Question 18

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

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.

Question 19

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 your best action?

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.

Question 20

What is the major way in which tuberculosis is spread from one person to another?

A) By blood transfusions
B) By aerosol transmission
C) Through direct skin contact
D) From unprotected sexual intercourse

Question 21

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

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

Question 22

An older adult patient is prescribed systemic antifungal therapy for 1 month.Which precautions are important 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."

Question 23

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

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.

Question 24

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

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%

Question 25

Which teaching point should you stress when a patient is prescribed terbinafine (Lamisil)?

A) Avoid citrus fruits while taking this drug.
B) Do not drive until you know how the drug affects you.
C) Stay away from crowds or people who are ill.
D) Get lots of extra rest while you are taking this drug.

Question 26

A patient is prescribed amphotericin B (Fungizone)400 mg intravenously.How fast should you infuse this drug?

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

Question 27

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) Fluconazole (Diflucan)
B) Ketoconazole (Nizoral)
C) Micafungin (Mycamine)
D) Terbinafine (Lamisil)

Question 28

Which laboratory value in a 76-year-old woman on systemic fluconazole (Diflucan)therapy should you report immediately to the prescriber?

A) Hematocrit of 38%
B) Bilirubin of 0.4 mg/dL
C) Potassium of 2.2 mEq/L
D) Blood urea nitrogen (BUN)of 12.2 mg/dL

Question 29

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

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?"

Question 30

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 (mL)per minute should you set the pump to infuse?

A) 1.4 mL
B) 2.2 mL
C) 4.2 mL
D) 6.2 mL

Question 31

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

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."

Question 32

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

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

Question 33

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 should you add to the D₅W for the correct?

A) 0.16 mL
B) 5mL
C) 7mL
D) 8mL

Question 34

Which changes are intended responses of first-line antituberculosis drugs? (select all that apply)

A) Sputum is mobilized (increased).
B) Cough is decreased.
C) Fatigue is eliminated.
D) Weight is gained.
E) Sputum culture for TB is negative.

Question 35

Why are standard antibacterial drugs ineffective against fungal infections?

A) Funguses are slow growing.
B) Funguses have a thick cell wall.
C) Fungal infections usually occur in the brain stem where antibacterial drugs cannot reach.
D) Fungal infections have so few symptoms that most people are unaware of the problem until the infection is widespread.

Question 36

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

A) Having one family member responsible for giving the drugs and watching the patient swallow them
B) Setting up the patient's 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

Question 37

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

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.

Question 38

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.

Question 39

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

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.

Question 40

A patient who is very immunosuppressed is prescribed ketoconazole (Nizoral)for prevention of a fungal infection.Which statement made by this patient indicates the need for more teaching?

A) "I will stop taking the drug if I should become pregnant."
B) "I will stay in the sun as much as possible to avoid catching an infection."
C) "I will avoid drinking alcoholic beverages during the time I am on this therapy."
D) "If I miss a dose,I will take it as soon as I remember it and not wait until the next day."

Question 41

A patient is to receive 200 mg of fluconazole (Diflucan)by intravenous (IV)piggyback over the next hour.The piggyback bag containing the fluconazole has a total of 120 mL and the drop factor of the administration set is 15 gtt/mL.How many drops per minute are needed to administer the 200 mg of fluconazole in 1 hour?

Question 42

A patient who weighs 220 lb is prescribed 20 mg/kg of ethambutol (EMB).The ethambutol tablets available 400 mg/scored tablet.How many tablets will you give?