c42 Fundamentals of Nursing

Chapter 42: Antifungal Drugs
Lilley: Pharmacology and the Nursing Process, 8th Edition
MULTIPLE CHOICE
1. During an intravenous (IV) infusion of amphotericin B, a patient develops tingling and

numbness in his toes and fingers. What will the nurse do first?
a. Discontinue the infusion immediately.
b. Reduce the infusion rate gradually until the adverse effects subside.
c. Administer the medication by rapid IV infusion to reduce these effects.
d. Nothing; these are expected side effects of this medication.
ANS: A
Once the intravenous infusion of amphotericin B has begun, vital signs must be monitored
frequently to assess for adverse reactions such as cardiac dysrhythmias, visual disturbances,
paresthesias (numbness or tingling of the hands or feet), respiratory difficulty, pain, fever,
chills, and nausea. If these adverse effects or a severe reaction occur, the infusion must be
discontinued (while the patient is closely monitored) and the prescriber contacted. The other
options are incorrect.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 676

TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. If a patient is taking fluconazole (Diflucan) with an oral anticoagulant, the nurse will monitor
for which possible interaction?
a. Reduced action of oral anticoagulants
b. Increased effects of oral anticoagulants
c. Hypokalemia
d. Decreased effectiveness of the antifungal drug
ANS: B
Azole antifungal drugs increase the effects of oral anticoagulants. As a result, increased
bleeding may occur. The other options are incorrect.

TOP: NURSING PROCESS: Assessment
3. The nurse is preparing an infusion of amphotericin B for a patient who has a severe fungal
infection. Which intervention is appropriate regarding the potential adverse effects of
amphotericin B?
a. Discontinuing the infusion immediately if fever, chills, or nausea occur
b. Gradually increasing the infusion rate until the expected adverse effects occur
c. If fever, chills, or nausea occur during the infusion, administering medications to
treat the symptoms
d. Before beginning the infusion, administering an antipyretic and an antiemetic drug
ANS: D
Almost all patients given the drug intravenously experience fever, chills, hypotension,
tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache. For
this reason, pretreatment with an antipyretic (acetaminophen), antihistamines, and antiemetics
may be conducted to decrease the severity of the infusion-related reaction. The other options
are incorrect.

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
4. The nurse is administering one of the lipid formulations of amphotericin B. When giving this
drug, which concept is important to remember?
a. The lipid formulations may be given in oral form.
b. The doses are much lower than the doses of the older drugs.
c. The lipid formulations are associated with fewer adverse effects than the older
drugs.
d. There is no difference in cost between the newer and older forms.
ANS: C
Newer lipid formulations of amphotericin B have been developed in an attempt to decrease
the incidence of its adverse effects and increase its efficacy. However, the lipid formulations
are more costly.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 673

5. The nurse is reviewing instructions for vaginal antifungal drugs with a patient. Which
statement by the nurse is an appropriate instruction regarding these drugs?
a. “The medication can be stopped when your symptoms are relieved.”
b. “Discontinue this medication if menstruation begins.”
c. “Daily douching is part of the treatment for vaginal fungal infections.”
d. “Abstain from sexual intercourse until the treatment has been completed and the
infection has resolved.”
ANS: D
Female patients taking antifungal medications for the treatment of vaginal infections need to
abstain from sexual intercourse until the treatment has been completed and the infection has
resolved. The medication needs to be taken for as long as prescribed. Instruct patients to
continue to take the medication even if they are actively menstruating. Douching is not an
appropriate intervention.

6. A patient is infected by invasive aspergillosis, and the medical history reveals that the patient
has not been able to tolerate several antifungal drugs. The nurse anticipates an order for which
medication to treat this infection?
a. Fluconazole (Diflucan)
b. Micafungin (Mycamine)
c. Caspofungin (Cancidas)
d. Nystatin (Mycostatin)
ANS: C
Caspofungin is used for treating severe infection by Aspergillus species (invasive
aspergillosis) in patients who are intolerant of or refractory to other drugs.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 674

TOP: NURSING PROCESS: Planning
7. A patient with a severe fungal infection has orders for voriconazole (Vfend). The nurse is
reviewing the patient’s medical record and would be concerned if which assessment finding is
noted?
a. Decreased breath sounds in the lower lobes
b. History of cardiac dysrhythmias
c. History of type 2 diabetes
d. Potassium level of 4.0 mEq/L
ANS: B
Voriconazole is contraindicated when co-administered with certain other drugs metabolized by
the cytochrome P-450 enzyme 3A4 (e.g., quinidine) because of the risk for inducing serious
cardiac dysrhythmias.

TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
8. During therapy with amphotericin B, the nurse will monitor the patient for known adverse
effects that would be reflected by which laboratory result?
a. Serum potassium level of 2.7 mEq/L
b. Serum potassium level of 5.8 mEq/L
c. White blood cell count of 7000 cells/mm3
d. Platelet count of 300,000/ microliter
ANS: A
The nurse needs to monitor for hypokalemia, a possible adverse effect of amphotericin B. The
other options are incorrect.
DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 673

9. A patient has received a prescription for a 2-week course of antifungal suppositories for a
vaginal yeast infection. She asks the nurse if there is an alternative to this medication, saying,
“I don’t want to do this for 2 weeks!” Which is a possibility in this situation?
a. A single dose of a vaginal antifungal cream.
b. A one-time infusion of amphotericin B.
c. A single dose of a fluconazole (Diflucan) oral tablet.
d. There is no better alternative to the suppositories.
ANS: C
A single oral dose of fluconazole may be used to treat vaginal candidiasis. The other options
are incorrect.

10. A patient is taking nystatin (Mycostatin) oral lozenges to treat an oral candidiasis infection
resulting from inhaled corticosteroid therapy for asthma. Which instruction by the nurse is
appropriate?
a. “Chew the lozenges until they are completely dissolved.”
b. “Let the lozenge dissolve slowly and completely in your mouth without chewing
it.”
c. “Rinse your mouth with water before taking the inhaler.”
d. “Rinse your mouth with mouthwash after taking the inhaler.”
ANS: B
Nystatin may be given orally in the form of lozenges, or troches, which need to be slowly and
completely dissolved in the mouth for optimal effects; tablets are not to be chewed or
swallowed whole. The other options are incorrect. Patients taking an inhaled corticosteroid
must rinse their mouths with water thoroughly after taking the inhaler.

MULTIPLE RESPONSE
1. The nurse is administering an amphotericin B infusion. Which actions by the nurse are
appropriate? (Select all that apply.)
a. Administering the medication by rapid IV infusion
b. Discontinuing the drug immediately if the patient develops tingling and numbness
in the extremities
c. If adverse effects occur, reducing the IV rate gradually until they subside
d. Using an infusion pump for IV therapy
e. Monitoring the IV site for signs of phlebitis and infiltration
f. Administering premedication for fever and nausea
g. Knowing that the intravenous solution for amphotericin B will be cloudy
h. Knowing that muscle twitching may indicate hypokalemia
ANS: B, D, E, F
If the patient develops tingling and numbness in the extremities (paresthesias), discontinue the
drug immediately. An infusion pump is necessary for the infusion, and the nurse will monitor
the IV site for signs of phlebitis and infiltration. Premedication to reduce the adverse effects of
fever, malaise, and nausea may be ordered. The IV solution must be clear and without
precipitates; and muscle weakness, not twitching, may indicate hypokalemia. The medication
must be administered at the rate recommended and stopped, not slowed, if adverse reactions
occur.

COMPLETION
1. A patient will be taking fluconazole (Diflucan) 100 mg/day PO for 2 weeks. The patient is
unable to swallow tablets, so an oral suspension that contains 10 mg/mL is available. Identify
how many milliliters will the nurse administer with each dose. _______
ANS:
DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A


c42 Fundamentals of Nursing

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

c42 Fundamentals of Nursing

Uploaded by

Copyright:

Available Formats

Chapter 42: Antifungal Drugs

Lilley: Pharmacology and the Nursing Process, 8th Edition

1. During an intravenous (IV) infusion of amphotericin B, a patient develops tingling and

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 676

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 675

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 672

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 673

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 677

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 674

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 675

DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 673

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 674

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 676

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 673

DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A

You might also like