Chapter 32: Antituberculars, Antifungals, Peptides, and Metronidazole Nursing School Test Banks

Chapter 32: Antituberculars, Antifungals, Peptides, and Metronidazole
Test Bank

MULTIPLE CHOICE

1. Which person should be treated with prophylactic antitubercular medication?
a. A child who attends the same school with a child who has tuberculosis
b. A nurse who is working in a hospital
c. An individual who is HIV-positive with a negative TB skin test
d. A patient who has close contact with someone who has tuberculosis
ANS: D
Personal contact with a person having a diagnosis of tuberculosis is required to indicate prophylactic treatment with antitubercular therapy. Attending the same school does not necessarily mean close contact occurs. Health care professionals do not need prophylactic treatment. HIV-positive individuals with negative TB skin tests do not need prophylaxis.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 437
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A patient who has chronic liver disease reports contact with a person who has tuberculosis (TB). The nurse will counsel this patient to contact the provider to discuss
a. a chest x-ray.
b. a TB skin test.
c. liver function tests (LFTs).
d. prophylactic antitubercular drugs.
ANS: B
Patients who have exposure to TB should have a TB skin test. A chest x-ray is performed if the skin test is positive. LFTs do not need to be done simply because of TB exposure. This patient is not a candidate for antitubercular drug prophylaxis.

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TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A patient who has tuberculosis asks the nurse why three drugs are used to treat this disease. The nurse will explain that multi-drug therapy is used to reduce the likelihood of
a. disease relapse.
b. drug hypersensitivity reactions.
c. drug resistance.
d. drug adverse effects.
ANS: C
Without multi-drug therapy, patients easily develop resistance to antitubercular drugs. Using more than one antitubercular drug does not prevent relapse, hypersensitivity reactions, or adverse effects.

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TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A patient is being treated with isoniazid (INH), rifampin, and pyrazinamide in phase I of treatment for tuberculosis. The organism develops resistance to isoniazid. Which drug will the nurse anticipate the provider will order to replace the isoniazid?
a. Ciprofloxacin (Cipro)
b. Ethambutol (Myambutol)
c. Kanamycin
d. Streptomycin sulfate
ANS: B
If there is bacterial resistance to isoniazid, the first phase may be changed to ethambutol, rifampin, and pyrazinamide. Ciprofloxacin, kanamycin, and streptomycin are not generally first-line antitubercular drugs.

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TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. The nurse is caring for a patient who is diagnosed with tuberculosis. The patient tells the nurse that the provider plans to order a prophylactic antitubercular drug for family members and asks which drug will be ordered. The nurse will expect the provider to order which drug?
a. Isoniazid (INH)
b. Pyrazinamide
c. Rifampin (Rifadin)
d. Streptomycin
ANS: A
INH is the drug of choice for prophylactic treatment of patients who have had close contact with a patient who has tuberculosis.

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TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. The nurse caring for a patient who has tuberculosis and who is taking isoniazid, rifampin, and streptomycin reviews the medical record and notes the patients sputum cultures reveal resistance to streptomycin. The nurse will anticipate that the provider will take which action?
a. Add ethambutol (Myambutol).
b. Change the streptomycin to clarithromycin.
c. Change the streptomycin to kanamycin.
d. Order renal function tests.
ANS: C
The patients current regimen is first-phase treatment. If resistance to streptomycin develops, the provider can change to kanamycin or to ciprofloxacin. Ethambutol is added if there is resistance to isoniazid. Clarithromycin is used during phase II. Renal function tests are not indicated.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 437
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. A patient who is taking isoniazid (INH) as part of a two-drug tuberculosis treatment regimen reports tingling of the fingers and toes. The nurse will recommend discussing which treatment with the provider?
a. Adding pyrazinamide
b. Changing to ethambutol
c. Increasing oral fluid intake
d. Taking pyridoxine (B6)
ANS: D
Peripheral neuropathy is an adverse reaction to INH, so pyridoxine is usually given to prevent this. It is not necessary to change medications. Increasing fluids will not help with this.

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TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. The nurse is teaching a patient about rifampin. Which statement by the patient indicates understanding of the teaching?
a. I should not wear soft contact lenses while taking rifampin.
b. I will need regular eye examinations while taking this drug.
c. I will report orange urine to my provider immediately.
d. I understand that renal toxicity is a common adverse effect.
ANS: A
Patients taking rifampin should be warned that urine, feces, saliva, sputum, sweat, and tears may turn a harmless red-orange color. Patients should not wear soft contact lenses to avoid permanent staining. Regular eye exams are necessary for patients who receive isoniazid and ethambutol. Orange urine is a harmless side effect and does not need to be reported. Renal toxicity is not common with rifampin.

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TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. A patient who has completed the first phase of a three-drug regimen for tuberculosis has a positive sputum acid-bacilli test. The nurse will tell the patient that
a. drug resistance has probably occurred.
b. it may be another month before this test is negative.
c. the provider will change the pyrazinamide to ethambutol.
d. there may be a need to remain in the first phase of therapy for several weeks.
ANS: B
The goal is for the patients sputum test to be negative 2 to 3 months after the therapy. The positive test does not indicate drug resistance. The provider will not change the drugs or keep the patient in the first phase longer than planned.

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TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. The nurse is teaching a nursing student about the antifungal drug amphotericin B. Which statement by the student indicates a need for further teaching?
a. Amphotericin B may be given intravenously or by mouth.
b. Patients who take this drug should have potassium and magnesium levels assessed.
c. Patients with renal disease should not take amphotericin B.
d. This drug is used for severe systemic infections.
ANS: A
Amphotericin B is not absorbed from the gastrointestinal tract, so is not given by mouth. It can cause nephrotoxicity and electrolyte imbalance. It is highly toxic and is reserved for severe, systemic infections.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 442
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. A patient who has oral candidiasis will begin using nystatin suspension to treat the infection. What information will the nurse include when teaching this patient?
a. Coat the buccal mucosa with the drug and then rinse your mouth.
b. Gargle with the nystatin and then spit it out without swallowing.
c. Mix the suspension with 4 ounces of water and then drink it.
d. Swish the liquid in your mouth and then swallow after a few minutes.
ANS: D
Patients should be taught to swish the suspension in the mouth to coat the tongue and buccal mucosa and then swallow the medication. It should not be spit out, diluted with water, or swallowed with water.

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TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. A patient will begin taking streptomycin as part of the medication regimen to treat tuberculosis. Before administering this medication, the nurse will review which laboratory values in the patients medical record?
a. Complete blood count (CBC) with differential white cell count
b. Blood urea nitrogen (BUN) and creatinine
c. Potassium and magnesium levels
d. Serum fasting glucose
ANS: B
Streptomycin can cause significant renal toxicity.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 444
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

13. The nurse is preparing to administer an intravenous polymyxin antibiotic. The patient reports dizziness along with numbness and tingling of the hands and feet. The nurse will perform which action?
a. Administer the drug since these are harmless side effects.
b. Hold the drug and notify the provider of these adverse reactions.
c. Obtain an order for an oral form of this medication.
d. Request an order for serum electrolytes.
ANS: B
Polymyxins can cause nephrotoxicity and neurotoxicity. This patient has signs of neurotoxicity, so the nurse should notify the provider. These effects are generally reversible when the drug is discontinued. It is not correct to administer the drug when these symptoms are present. Polymyxins are not absorbed orally. Serum electrolytes are not indicated.

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TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

14. A young adult female who is taking metronidazole (Flagyl) to treat trichomoniasis calls the nurse to report severe headache, flushing, palpitations, cramping, and nausea. What will the nurse do next?
a. Ask about alcohol consumption.
b. Reassure her that these are harmless side effects.
c. Tell her that this signals a worsening of her infection.
d. Tell her to go to the emergency department immediately.
ANS: A
Patients who are taking metronidazole can experience a disulfiram-like reaction when they drink alcohol. These are not harmless adverse effects or a sign of worsening of her infection.

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TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

15. A patient who is taking metronidazole (Flagyl) reports reddish-brown urine. Which action will the nurse take?
a. Obtain an order for BUN and creatinine levels.
b. Reassure the patient that this is a harmless effect.
c. Request an order for a urinalysis.
d. Test her urine for occult blood.
ANS: B
Reddish-brown urine is a harmless side effect of metronidazole and is not cause for concern.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 446
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

16. A patient is diagnosed with histoplasmosis and will begin taking ketoconazole. What information will the nurse include when teaching this patient about this medication?
a. Take the medicine twice daily.
b. Take the medication with food.
c. You may consume small amounts of alcohol.
d. You will not need lab tests while taking this drug.
ANS: B
Ketoconazole should be taken with food. It is administered once daily. Patients taking antifungals should not consume alcohol. Antifungals can cause liver and renal toxicity, so patients will need lab monitoring.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 441
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

17. A patient who has AIDS is at risk to contract aspergillosis. The nurse will anticipate that which antifungal medication will be ordered prophylactically for this patient?
a. Metronidazole (Flagyl)
b. Micafungin (Mycamine)
c. Posaconazole (Noxafil)
d. Voriconazole (Vfend)
ANS: C
Posaconazole is given for prophylactic treatment of Aspergillus and Candida infections.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 441
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

18. A patient is diagnosed with tinea capitis. The provider will order which systemic antifungal medication for this patient?
a. Anidulafungin (Eraxis)
b. Fluconazole (Diflucan)
c. Griseofulvin (Fulvicin)
d. Ketoconazole (Nizoral)
ANS: C
Griseofulvin is used to treat tinea capitis. Anidulafungin is used to treat esophageal candidiasis, candidemia, and other Candida infections. Fluconazole is used to treat Candida infections and cryptococcal meningitis. Ketoconazole is used to treat Candida infections, histoplasmosis, blastomycosis, and other infections.

DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: Page 442
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

19. Which topical antifungal medication is used to treat vaginal candidiasis?
a. Haloprogin (Halotex)
b. Miconazole (Monistat)
c. Oxiconazole (Oxistat)
d. Terbenafine HCl (Lamisil)
ANS: B
Topical miconazole is used to treat vaginal candidiasis.

DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: Page 444
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

20. A patient who takes an oral sulfonylurea medication will begin taking fluconazole (Diflucan). The nurse will expect to monitor which lab values in this patient?
a. Blood urea nitrogen (BUN) and creatinine
b. Electrolytes
c. Fluconazole levels
d. Glucose
ANS: D
Patients taking sulfonylurea drugs may have altered serum glucose when taking antifungal medications.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 444
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE

1. A client is being treated for tuberculosis. Which medications are used to treat this condition? (Select all that apply.)
a. Streptomycin sulfate
b. Amoxicillin (Amoxil)
c. Ethambutol (Myambutol)
d. Gentamicin (Garamycin)
e. Rifabutin (Mycobutin)
f. Ethionamide (Trecator-SC)
g. Pyrazinamide
ANS: A, C, E, F, G
Streptomycin sulfate, ethambutol (Myambutol), rifabutin (Mycobutin), ethionamide (Trecator-SC), and pyrazinamide are used to treat tuberculosis. The other medications are not used.

DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: Page 437
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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