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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.
Correct Answer: A
Rationale: 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.
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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.
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.
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
Correct Answer: D
Rationale: 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 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.
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
- B. Micafungin
- C. Caspofungin
- D. Nystatin
Correct Answer: C
Rationale: Caspofungin is used for treating severe infection by Aspergillus species (invasive aspergillosis) in patients who are intolerant of or refractory to other drugs.