Nokea
A patient with a severe fungal infection has orders for voriconazole. 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. Patient is also taking quinidine
- C. History of type 2 diabetes
- D. Potassium level of 4.0 mEq/L
Correct Answer: B
Rationale: 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.
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A patient will be taking fluconazole 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.
Correct Answer: 10 mL
Rationale: Calculate dose: 100 mg/day ?· 10 mg/mL = 10 mL/day. The nurse will administer 10 mL of the oral suspension per dose.
If a patient is taking fluconazole 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
Correct Answer: B
Rationale: Azole antifungal drugs increase the effects of oral anticoagulants. As a result, increased bleeding may occur.
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/mm?³
- D. Platelet count of 300,000/microliter
Correct Answer: A
Rationale: The nurse needs to monitor for hypokalemia, a possible adverse effect of amphotericin B. A serum potassium level of 2.7 mEq/L indicates hypokalemia, which requires attention.
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.
Correct Answer: C
Rationale: 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.
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
Correct Answer: B,D,E,F
Rationale: 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.