Anti-infectives Topic 10 Part 2-TOPIC 12

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Questions and Answers

Which side effect is associated with the use of testosterone? (Select all that apply)

Depression

Postural hypotension

Aggressive behavior (correct)

Insomnia (correct)

Gynecomastia (correct)

What is the likely cause of weight gain in a patient one week after starting fluoxymesterone to treat reduced testosterone levels?

Increased fluid retention (correct)

Impaired thyroid activity

Impaired lipid metabolism

Impaired liver function

What are the vital signs recorded for the patient?

Temperature 37.3°C, Apical pulse 86 bpm, Respirations 28 breaths per minute, Blood pressure 122/72 mm Hg

What comments did the patient make?

I am constipated. My mouth is dry. I urinate less often during the day. Signup and view all the answers

Dry mouth is more likely than dehydration considering the patient’s intake and output.

True Signup and view all the answers

By which method(s) of transmission is tuberculosis spread? (Select all that apply)

Talking Signup and view all the answers

Which side effect(s) may occur in a patient receiving isoniazid for tuberculosis? (Select all that apply)

Changes in vision Signup and view all the answers

Which patient(s) would require cautious use, if at all, of fluconazole? (Select all that apply)

A patient who is in the first trimester of pregnancy Signup and view all the answers

Which microorganism is directly affected by acyclovir?

Varicella-zoster virus Signup and view all the answers

Which herpesvirus is commonly known as chickenpox?

Varicella-zoster virus Signup and view all the answers

A patient is taking fluconazole with warfarin. Which laboratory finding describes the possible interaction with these two medications?

Increased prothrombin time Signup and view all the answers

Which type of drug is used to destroy worms?

Anthelmintics Signup and view all the answers

Which drug classification includes antivirals, antimicrobials, antiparasitics, and antifungals?

Peptides Signup and view all the answers

Which adverse reaction is common for ivermectin?

Nausea Signup and view all the answers

Which purpose does pyridoxine (vitamin B6) serve in a patient receiving isoniazid for tuberculosis?

To prevent peripheral nerve damage Signup and view all the answers

What intervention would the nurse expect to implement in the case of a patient newly diagnosed with oral candidiasis?

Teach the patient to swish and gargle with nystatin. Signup and view all the answers

Which is a first-line antitubercular drug?

Isoniazid Signup and view all the answers

Which laboratory value alteration may be observed in a patient receiving isoniazid?

Increase in the alanine aminotransferase serum level Signup and view all the answers

Which drug is used to treat the majority of infections caused by the herpes simplex viruses and the varicella-zoster virus?

Acyclovir Signup and view all the answers

Which infection is a child at risk for developing as an adult if the child had chickenpox?

Shingles Signup and view all the answers

Which patient would receive nystatin therapy?

A patient with oral candidiasis Signup and view all the answers

Which statement best describes how tuberculosis is spread?

Inhaling droplets dispersed in the air Signup and view all the answers

A patient with diabetes is being treated with isoniazid (INH) for tuberculosis. To prevent peripheral neuropathy, which drug or vitamin supplement would the nurse anticipate giving?

Vitamin B6 Signup and view all the answers

The nurse has educated a patient on adverse reactions of antitubercular drugs. Which adverse reaction would be reported to the health care provider?

Numbness and tingling of extremities Signup and view all the answers

Which physical finding may indicate a superinfection in a patient taking an antiinfective agent?

White patches on tongue Signup and view all the answers

Which is the most common site for helminthiasis?

Intestine Signup and view all the answers

Which statement would provide the best education to prevent the spread of the infection to the patient’s family?

Handwashing before meals and after toileting is important. Signup and view all the answers

Which is considered a cardinal sign of inflammation? Select all that apply.

Redness Signup and view all the answers

Which serious illness would the nurse suspect in a 6-year-old patient with influenza if the parents gave the child baby aspirin for fever and the patient is vomiting, delirious, lethargic, and has dermatologic symptoms?

Reye syndrome Signup and view all the answers

Which response would the nurse have if a family visits a patient in a long-term care facility and becomes alarmed after noticing several large bruises on the patient?

This is common with people taking aspirin. Signup and view all the answers

Which supporting evidence would the nurse provide to the patient regarding a proposed change in pain medication from over-the-counter aspirin to over-the-counter ibuprofen?

Aspirin is associated with more gastric bleeding than ibuprofen. Signup and view all the answers

Which phrase describes the mechanism of action of allopurinol?

Reduces uric acid biosynthesis Signup and view all the answers

Which statement made by the female patient, who is at risk for stroke and on aspirin therapy, indicates an understanding of the nurse’s instructions regarding the correct use of aspirin?

I should take aspirin at mealtime. Signup and view all the answers

Which action performed by a patient could cause complications if the patient is on ibuprofen therapy for arthritis?

Eating more ginger and garlic Signup and view all the answers

Which medication would the nurse anticipate the primary health care provider prescribing if a patient is determined to be at an increased risk for ischemic stroke?

Aspirin Signup and view all the answers

Which assessment finding indicates that the nonsteroidal anti-inflammatory drug (NSAID) has been effective?

Pain has decreased from a 6 to a 1 on a scale of 10. Signup and view all the answers

A patient with Crohn’s disease presents to the outpatient infusion clinic to receive their first dose of infliximab. Which action will the nurse take first?

Ensure the patient has a negative TB test Signup and view all the answers

Which patient(s) would be at high risk for respiratory depression with the use of intravenous morphine therapy? Select all that apply.

77-year-old patient with chronic renal failure (CRF) Signup and view all the answers

Which type of pain originates from the skin and mucous membranes?

Superficial pain Signup and view all the answers

Which statement about somatic pain is accurate?

It originates from skeletal muscles, ligaments, and joints. Signup and view all the answers

Which assessment finding indicates that a patient has overdosed on morphine sulfate?

Pinpoint pupils Signup and view all the answers

Which condition would the nurse expect to see in a patient who ingested 14 grams of acetaminophen?

Acute hepatotoxicity Signup and view all the answers

Which finding would the nurse expect when assessing a patient for adverse effects of morphine sulfate?

Drowsiness Signup and view all the answers

Which instruction would a nurse give to a patient who has been prescribed bisacodyl? (Select all that apply)

Eat high-fiber foods consistently. Signup and view all the answers

Which mechanism of action describes how diphenoxylate with atropine treats diarrhea due to chemotherapeutic agents?

Inhibits gastric motility Signup and view all the answers

Which outcome assessment is essential to monitor for in a patient taking diphenoxylate with atropine?

Decrease in gastric motility Signup and view all the answers

Which parameter would be monitored closely in a patient receiving narcotic analgesics for pain and diphenoxylate with atropine for diarrhea?

Respiratory rate Signup and view all the answers

Which factor contributes to diarrhea? (Select all that apply)

Spicy foods Signup and view all the answers

Which information would the nurse include in the teaching plan for a patient who has been prescribed sucralfate?

This medication will form a protective barrier over the gastric mucosa. Signup and view all the answers

Which statement by the patient indicates that the nurse’s teaching on the administration of a histamine-2 (H2) receptor antagonist was effective?

Smoking decreases the effects of this medication, so I should look into cessation programs. Signup and view all the answers

Which cells in the stomach secrete hydrochloric acid?

Parietal cells Signup and view all the answers

Which adverse reaction would the nurse monitor for in a patient taking an aluminum-containing antacid?

Constipation Signup and view all the answers

Which mode of action is associated with solifenacin succinate? (Select all that apply)

Exerts a selective muscarinic receptor antagonist effect Signup and view all the answers

Which statement describes the mechanism of action of clomiphene citrate?

Stimulates ovulation Signup and view all the answers

Which potential side effect would the nurse educate the patient about if the patient becomes pregnant after taking clomiphene citrate to increase ovulation?

Multiple gestation Signup and view all the answers

Which medication regimen would the nurse educate a patient about if the patient is a perimenopausal woman who is experiencing vaginal dryness and hot flashes?

Conjugated equine estrogens with synthetic progestin Signup and view all the answers

Which condition is a side effect associated with estrogen therapy?

Nausea Signup and view all the answers

Which anticonvulsant drug decreases the effectiveness of combined hormonal contraceptives?

Phenytoin Signup and view all the answers

Which condition would the nurse suspect if a patient reports gasping for air at night and a burning sensation in the middle of the chest?

Gastroesophageal reflux disease (GERD) Signup and view all the answers

Which finding related to diphenoxylate with atropine would the nurse report immediately?

Swelling of the lips Signup and view all the answers

Which phrase describes how histamine-2 (H2) receptor antagonists reduce the secretion of acids?

By blocking H2 receptors Signup and view all the answers

Which assessment finding indicates to the nurse that lansoprazole has had a therapeutic effect?

No esophageal pain Signup and view all the answers

Which condition would the nurse suspect that the patient is experiencing if, after administration of an initial dose of famotidine, the patient reports shortness of breath and develops a rash?

Allergic reaction to the medication Signup and view all the answers

A patient has been taking a prescription of solifenacin succinate 5 mg orally daily. What reaction to the medication is this patient most likely experiencing?

Urinary retention or dry mouth Signup and view all the answers

Which condition is a contraindication for the administration of acetaminophen?

Liver disease Signup and view all the answers

Which opioid is used in mild to moderate pain and as an antitussive?

Codeine sulfate Signup and view all the answers

Which substance do antiinflammatories inhibit?

Prostaglandin Signup and view all the answers

Which drug is considered a cyclooxygenase-2 (COX-2) inhibitor?

Celecoxib Signup and view all the answers

Which response by the nurse would be most appropriate if a patient with rheumatoid arthritis expresses concern about treatment with infliximab?

The medication suppresses your immune system. Signup and view all the answers

Which drug is most appropriate for a patient with back pain caused by inflammation?

Ibuprofen Signup and view all the answers

Which instruction given by the nurse would ensure effective treatment for a patient with gout about dietary management during the administration of allopurinol?

Take the medication with lots of fluids. Signup and view all the answers

Which assessment finding in a patient taking nonsteroidal antiinflammatory drugs (NSAIDs) requires intervention?

Black, tarry stools Signup and view all the answers

Which drug would the nurse expect to be added to a patient's regimen if they have hyperuricemia and deposition of sodium urate crystals in the synovial fluid?

Allopurinol Signup and view all the answers

Which antiinflammatory agent inhibits cyclooxygenase-2 (COX-2) but not cyclooxygenase-1 (COX-1)?

Celecoxib Signup and view all the answers

Which food(s) or dietary supplement(s) would the nurse identify as potentially causing increased sedation with opioid therapy? (Select all that apply)

St. John's wort Signup and view all the answers

Which test would the nurse anticipate the health care provider ordering for a patient who has been chronically taking high doses of acetaminophen?

Liver function test Signup and view all the answers

Which action would the nurse take if a patient receiving 1 to 2 mg of morphine sulfate intravenously every 2 hours PRN has a respiratory rate of 8 breaths/min?

Consult the primary health care provider and obtain another drug prescription. Signup and view all the answers

Which rationale describes why a nurse would record baseline vital signs before administering 5 mg of morphine sulfate intravenously?

Morphine sulfate depresses the respiratory center. Signup and view all the answers

Which drug may cause tinnitus as a side effect?

Aspirin Signup and view all the answers

Which medication is used to treat severe adverse effects of an opioid analgesic?

Naloxone Signup and view all the answers

Which medication would the nurse anticipate incorporating into the care plan for a postoperative patient who received fentanyl and subsequently developed respiratory depression?

Naloxone Signup and view all the answers

Which symptom is an adverse effect associated with excessive doses of acetaminophen? (Select all that apply)

Nausea Signup and view all the answers

Which lifestyle factors would the nurse question if a patient presents with frequent constipation? (Select all that apply)

Water intake Signup and view all the answers

Which nonpharmacologic intervention is beneficial to a patient experiencing nausea and vomiting? (Select all that apply)

Advise the patient to drink weak tea. Signup and view all the answers

Study Notes

Tuberculosis Transmission

Tuberculosis is primarily spread through inhalation of respiratory droplets from an infected person.
It spreads via talking, sneezing, and coughing, but not through sexual contact or sharing toilet seats.
No transmission occurs through contact with blood or stool.

Side Effects of Isoniazid

Common side effects of isoniazid include tremors, drowsiness, photosensitivity, and changes in vision such as blurry vision.
Does not cause changes in hearing or red-orange urine (associated with rifampin).

Cautious Use of Fluconazole

Cautious in pregnant patients (especially in the third trimester), those with kidney failure, and hepatic diseases.
Indicated for treating candidiasis and cryptococcal meningitis.

Acyclovir Usage

Directly affects varicella-zoster virus, used for treating herpes zoster.
Not effective against Proteus vulgaris, Pneumocystis jiroveci, or Staphylococcus aureus.

Varicella-Zoster Virus

Known as the cause of chickenpox, it’s categorized as herpes simplex virus type 3.
Reactivation can lead to shingles later in life.

Drug Interactions with Fluconazole

Fluconazole can increase prothrombin time in patients taking warfarin, risking excessive anticoagulant effect.
Regular monitoring for signs of bleeding is essential.

Classification of Anthelmintics

Anthelmintics are specifically used to destroy worms.
Distinct from antivirals, antibiotics, and antimalarials, which target other types of infections.

Antimicrobial Drug Classifications

A combination of antivirals, antimicrobials, antiparasitics, and antifungals falls under a broad spectrum classification.
Antimalarials and anthelmintics do not encompass this entire range.

Side Effects of Ivermectin

Common side effects include gastrointestinal distress; nausea, vomiting, and diarrhea may occur.
Other symptoms like anxiety and hypertension are not expected with anthelmintics.

Pyridoxine (Vitamin B6) Role

Administered with isoniazid to prevent peripheral nerve damage due to pyridoxine deficiency.

Treatment for Oral Candidiasis

Patients are instructed to use nystatin as an antifungal, swishing and gargling for effectiveness.
Not necessary to start IV lines or administer antiviral medications.

First-Line Antitubercular Drugs

Isoniazid is the most widely used first-line antitubercular drug.
Other first-line options include rifampin, pyrazinamide, and ethambutol.

Liver Enzyme Alterations with Isoniazid

Patients receiving isoniazid may show elevated alanine aminotransferase levels.
Can lead to agranulocytosis, which lowers neutrophil levels.

Treatment for Herpes Simplex Infections

Acyclovir is the drug of choice for herpes simplex virus and varicella-zoster virus infections.

Risk of Shingles from Chickenpox

Exposure to varicella-zoster virus during childhood can lead to shingles in adulthood due to virus dormancy.

Nystatin Therapy Usage

Effective treatment for oral candidiasis.
Not used for fungal infections like aspergillosis or cryptococcosis.

Superinfection Indicators

White patches on the tongue may indicate a superinfection in patients taking anti-infective agents.

Helminthiasis Site Locations

The intestine is the most common site for helminthiasis, while liver, blood vessels, and lymphatic system are less common.

Preventing Helminthiasis Spread

Education on hand hygiene is crucial for preventing infection spread within a household.
Daily showering, while important, is secondary to proper handwashing practices.### Inflammation and Cardinal Signs
Pain, swelling, and redness are three of the five cardinal signs of inflammation.
Patients experience a decrease in function, contradicting the notion of increased function.
Numbness is not typically a symptom associated with inflammation.

Reye Syndrome in Pediatric Patients

Reye syndrome is suspected in children given aspirin for fever who exhibit vomiting, delirium, lethargy, and dermatological symptoms like petechiae.
Aspirin administration in children can lead to this serious condition, characterized by vomiting and altered consciousness.
Symptoms can mimic increased intracranial pressure but should be evaluated based on prior head trauma.

Bruising and Aspirin Therapy

Patients on aspirin may have increased bruising from minor injuries due to the drug’s effect on platelet aggregation.
It is important for healthcare providers to explain to family members that bruising can be a common side effect of aspirin therapy.

Aspirin vs. Ibuprofen

Aspirin is associated with a higher risk of gastrointestinal bleeding compared to ibuprofen.
Both drugs can potentially cause liver and kidney damage but have the same duration of action (4-6 hours).
The rationale for switching from aspirin to ibuprofen includes considerations for gastric side effects.

Allopurinol Mechanism of Action

Allopurinol works by reducing uric acid biosynthesis, relevant for treating gout and hyperuricemia.
It is distinct from ibuprofen, which inhibits prostaglandin synthesis, and other medications that affect inflammatory cell infiltration.

Aspirin Administration Guidelines

Aspirin should be taken at mealtime to minimize gastrointestinal irritation.
It must not be combined with warfarin due to increased bleeding risk, and should be avoided during menstruation to prevent heavy bleeding episodes.

Complications with Ibuprofen Therapy

Increasing dietary ginger and garlic while on ibuprofen may heighten bleeding risk.
Vitamin C intake poses no complications during ibuprofen use.

Ischemic Stroke Prevention

Aspirin is prescribed to reduce the risk of ischemic stroke due to its blood-thinning properties.
Other supplements or medications do not provide direct benefits in stroke prevention.

Efficacy of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

A decrease in pain levels is a key indicator of NSAID effectiveness.
Notable physiological metrics such as bleeding time or circulation rate are not direct indicators of efficacy.

Infliximab and Pre-infusion Assessment

A negative tuberculosis (TB) test is required before administering infliximab.
Baseline tests for liver function, renal function, and complete blood counts should be completed prior to infusion.

Risks of Morphine Use

Patients with chronic renal failure or chronic obstructive pulmonary disease (COPD) are at increased risk for respiratory depression when using morphine.
Monitoring for signs of opioid overdose, such as pinpoint pupils, is crucial.

Acetaminophen Overdose Consequences

Ingesting excessive acetaminophen (e.g., 14 grams) can lead to acute hepatotoxicity.
Morphine sulfate can cause drowsiness and decreased gastrointestinal motility, which can lead to constipation.

Contraindications for Acetaminophen

Acetaminophen is contraindicated in patients with liver disease due to the risk of exacerbating hepatotoxicity.

Opioid Use in Pain Management

Codeine sulfate is used for mild to moderate pain and has antitussive properties, distinguishing it from stronger opioids.

Prostaglandin Inhibition by Anti-inflammatory Drugs

Antiinflammatory medications inhibit the biosynthesis of prostaglandins, impacting inflammatory responses.

COX-2 Inhibitors

Celecoxib is categorized as a COX-2 inhibitor, differing from other non-selective NSAIDs.

Patient Education on Infliximab

It is important for nursing staff to explain that infliximab suppresses the immune system and may increase the risk for infections, beyond just tuberculosis.### Pain Management Medications
Ibuprofen: Best choice for back pain due to its stronger effect and less gastric irritation compared to aspirin.
Aspirin: Less preferred for analgesic use due to significant gastric irritation.
Ketorolac & Diclofenac Sodium: Phenylacetic acid derivatives; similar side effects to aspirin, making them less favored options.

Gout Dietary Management

Allopurinol: Requires administration with plenty of fluids to prevent kidney stones.
Foods to Avoid: Meat and oranges can increase uric acid levels; vitamin C-rich foods like oranges can potentially lead to kidney stones.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Assessment of Side Effects: Black, tarry stools indicate gastrointestinal bleeding, a critical side effect requiring immediate intervention.

Gouty Arthritis Treatment

Indications for Allopurinol: Hyperuricemia and sodium urate crystal deposition confirm gout, warranting the addition of allopurinol to the treatment regimen.

COX Inhibitors

Celecoxib: Selective COX-2 inhibitor, does not affect COX-1; typically used to minimize gastrointestinal side effects.

Opioid Interaction with Sedation

Sedating Agents: Kava, valerian, and St. John's wort may potentiate sedation when combined with opioids.
Other Considerations: Grapefruit can interact with some medications, leading to adverse effects.

Acetaminophen Use and Risks

Monitoring for Hepatotoxicity: Chronic high doses necessitate liver function tests due to the risk of liver damage.
Adverse Effects: Nausea, vomiting, and hepatotoxicity may occur with overdose.

Management of Morphine Sulfate Administration

Respiratory Rate Monitoring: Essential following morphine administration, as respiratory depression poses a serious risk.
Initial Response to Low Respiratory Rate: Consult healthcare provider for alternative analgesics if respiratory depression occurs.

Tinnitus and Analgesics

Aspirin Related Side Effects: Associated with tinnitus as a common side effect when overdosed.

Naloxone as Opioid Antagonist

Treatment of Opioid Adverse Effects: Naloxone is critical for reversing both therapeutic and adverse effects of opioid medications.

Postoperative Care and Respiratory Depression

Naloxone Administration: Anticipated for patients who have developed respiratory depression after opioid use, improving respiratory status.

Side Effects from Acetaminophen Overdose

Common Symptoms: Nausea, vomiting, and potential hepatotoxicity signify excessive dosages, while polyuria is not a recognized symptom.

Constipation Contributing Factors

Evaluating Lifestyle: Insufficient water intake, poor dietary habits, lack of exercise, and certain medications can lead to constipation.

Nonpharmacologic Interventions for Nausea

Effective Remedies: Weak tea, flat soda, and dry toast or crackers can alleviate symptoms of nausea.

Bisacodyl Administration Instructions

Guidelines for Use: Avoid taking with milk, recommend high-fiber foods, and encourage adequate fluid intake. Do not chew the tablets.

Mechanism of Action for Diphenoxylate with Atropine

Inhibition of Gastric Motility: Reduces diarrhea by decreasing peristalsis in the gastrointestinal tract.

Monitoring Outcomes in Diarrhea Treatment

Expected Results: A decrease in gastrointestinal motility correlates with reduced bowel movements when treating diarrhea.

Respiratory Rate in Opioid and Diarrhea Management

Essential Monitoring Parameter: The respiratory rate must be closely observed due to the risk of respiratory depression from co-administered opioids and other medication interactions.

Causes of Diarrhea

Identifiable Factors: Include spicy foods, toxins, and malabsorption syndromes.

Teaching on Sucralfate Use

Mechanism of Action: Forms a protective barrier over the gastric mucosa, stimulating healing and not inhibiting gastric acid.

Effectiveness of H2 Receptor Antagonist Teaching

Patient Understanding: Essential to gauge if the patient correctly understands the administration and purpose of H2 receptor antagonists.

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Description

Test your knowledge on anti-infectives with this quiz focused on Topic 10 Part 2. You'll assess how well you understand the transmission methods of infectious diseases, including tuberculosis. Perfect for those studying microbiology and pharmacology.