Chapter 92: Antifungal Agents

Chapter 92: Antifungal Agents

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. 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.

 

 

ANS:  B

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.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 1098

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

2. 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

 

 

ANS:  B

Patients receiving amphotericin frequently experience infusion reactions, with fever, chills, rigors, nausea, and headache. Pretreatment with diphenhydramine and acetaminophen can reduce mild reactions. If rigors occur, the patient should receive dantrolene or meperidine. Aspirin would be effective for pretreatment but can increase kidney damage. Hydrocortisone is also effective, but it causes immune suppression. Omeprazole is not indicated.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 1094

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

3. 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.”

 

 

ANS:  A

Headaches, lower back pain, leg pain, and abdominal pain occur with intrathecal administration of amphotericin B. Patients taking amphotericin may experience hypokalemia and may need potassium supplements. Acetaminophen and diphenhydramine should be taken to minimize infusion reaction effects. Renal function should be monitored every 3 to 4 days during treatment.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 1094

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

4. 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.

 

 

ANS:  C

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.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 1095

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies