Question 1

A child is seen in the clinic after complaining of intense perianal itching. The provider diagnoses the child with pinworms and orders mebendazole [Vermox]. The nurse will expect to teach the child's parents to:

A) administer the drug with a high-fat meal to improve absorption.
B) avoid driving or other hazardous activities until the drug's effects wear off.
C) give each family member one dose of the drug now and another dose in 2 weeks.
D) report serious adverse effects that can occur with death of the causative parasite.

Accepted Answer

Mebendazole is administered as a single dose once and then again in 2 weeks when given to treat pinworms. It should be given to all household members when one person is infested. Albendazole is given with a high-fat meal. Praziquantel can cause drowsiness. Ivermectin causes a Mazotti reaction, which occurs in patients treated for onchocerciasis with symptoms resulting from death of the parasite.

Question 2

A patient is being treated for trichinosis. The patient asks the nurse why the provider has ordered prednisone in addition to the anthelmintic medication. The nurse will tell this patient that this is ordered to:

A) prevent swelling of the legs caused by larval infestation of lymphatics.
B) reduce the inflammation that occurs during larval migration.
C) suppress the patient's allergic response to the anthelmintic agent.
D) suppress dermatologic symptoms that occur with heavy infestation.

Accepted Answer

Trichinosis is acquired by eating undercooked pork containing encysted larvae, which migrate from the intestine to the skeletal muscle. Prednisone is given to reduce the inflammation that results from larval migration. This parasite does not affect lymphatics or cause elephantiasis. Prednisone is not given to counter allergic reactions to the drug. Dermatologic symptoms are not part of trichinosis infestations.

Question 3

A patient is being treated with albendazole [Albenza] for neurocysticercosis caused by larval forms of the pork tapeworm. Which statement by the patient indicates a need for further teaching about the drug regimen?

A) "I may need to take this medication for a month before the infestation is cleared."
B) "I should take this drug with a fatty meal to improve absorption."
C) "I will need to have liver function tests before and during treatment."
D) "I will take the drug in 3 consecutive cycles of 28 days, followed by 14 drug-free days."

"I will take the drug in 3 consecutive cycles of 28 days, followed by 14 drug-free days."

Accepted Answer

Albendazole is given in consecutive cycles when dosing is done for cystic hydatid disease, not neurocysticercosis. For treatment of neurocysticercosis, patients generally take albendazole for 8 to 30 days. Albendazole can cause mild to moderate liver impairment, so patients should have liver function testing before and during treatment. The drug should be taken with a high-fat meal to improve absorption.

Question 4

A patient tells the nurse that a close friend has ascariasis. The patient expresses worry about becoming infested. What will the nurse tell this patient?&#10;A) &#34;Ascariasis usually resolves without treatment, so you should not worry.&#34;&#10;B) &#34;Avoid going barefoot and practice good hygiene and you won't become infested.&#34;&#10;C) &#34;Treatment is always indicated if you are exposed, because ascariasis is contagious.&#34;&#10;D) &#34;You should be tested, because serious complications can occur without treatment.&#34;

Accepted Answer

Because this patient is worried about possible infestation, testing should be done so that treatment can be initiated if necessary. Because ascariasis can have serious complications, treatment is always indicated. Ascariasis infestations do not result from poor hygiene or from going barefoot. Ascariasis is not contagious, so treatment should begin only if the diagnosis is certain.

Question 5

A young female patient is seen in a rural clinic after complaining of abdominal pain. The patient is wearing dirty clothing and is barefoot. The provider orders a complete blood count, which shows that the patient is anemic. The nurse may suspect that this patient has which of the following infestations?

A) Ancylostomiasis (hookworm)
B) Ascariasis (giant roundworm)
C) Enterobiasis (pinworm)
D) Trichuriasis (whipworm)

Accepted Answer

Ancylostomiasis is most common when hygiene is poor and the patient habitually goes barefoot. Symptomatic anemia may occur in menstruating women or undernourished individuals. Ascariasis is usually asymptomatic. Enterobiasis is characterized by perianal itching. Trichuriasis is usually asymptomatic but may cause rectal prolapse if the worm burden is very large.

Question 6

A patient is taking diethylcarbamazine [Hetrazan] to treat a filarial infestation. The patient reports intense itching and a rash after several days of therapy. What will the nurse tell this patient?&#10;A) These symptoms are caused by death of the parasite.&#10;B) This is a minor, direct adverse effect of the drug.&#10;C) This is a sign the infestation is worsening.&#10;D) This warrants discontinuation of the drug.

Accepted Answer

Indirect effects of therapy with diethylcarbamazine, such as itching and a rash, are the result of death of the parasite. These effects are transient. They are not direct effects of the drug. They do not indicate worsening of the infestation. They do not warrant discontinuation of the drug.

Question 7

A patient with strongyloidiasis is being treated with ivermectin [Stromectol]. What will the nurse expect to teach this patient?&#10;A) A Mazotti-type reaction is likely.&#10;B) Hypotension is a common side effect of the drug.&#10;C) The drug should be taken every 6 to 12 months until symptoms have cleared.&#10;D) The drug should be taken with water for 1 to 2 days.

Accepted Answer

Ivermectin is given for 1 to 2 days to treat strongyloidiasis. A Mazotti-type reaction occurs when ivermectin is used to treat onchocerciasis. Hypotension is not a common side effect. Ivermectin is given every 6 to 12 months when treating onchocerciasis.

Question 8

A patient who is being treated for onchocerciasis with ivermectin [Stromectol] has a Mazotti reaction. Which assessment findings would the nurse expect?&#10;A) Fever&#10;B) Nausea and vomiting&#10;C) Rash with pruritus&#10;D) Blurred vision&#10;E) Bone and joint pain

Accepted Answer

Signs and symptoms associated with a Mazotti reaction are fever, rash with pruritus, and bone and joint pain. Nausea and vomiting and blurred vision are not signs and symptoms associated with a Mazotti reaction.

Question 9

A child has been diagnosed with enterobiasis, and the prescriber orders mebendazole [Vermox] to treat the infestation. When teaching this child's parents about the treatment, the nurse will include which statement?

A) "A single dose of mebendazole will eradicate the infestation."
B) "Everyone in the household should be treated with mebendazole."
C) "Serious complications of this type of infestation are common."
D) "Treatment should be limited to family members with symptoms."

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Accepted Answer

Everyone in the family should be treated simultaneously, because pinworms are easily spread. To treat pinworms, an initial dose of mebendazole 100 mg is given, and the dose is repeated in 2 weeks. The infestation rarely causes serious complications. Treatment is not limited to symptomatic infestations.

Deck 97: Anthelmintics