Nokea
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.
Correct Answer: D
Rationale: 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.
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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
Correct Answer: C
Rationale: A single oral dose of fluconazole may be used to treat vaginal candidiasis.
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.
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.
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.
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.