Test Bank - Focus on Nursing Pharmacology (8th Edition by Karch)
1. A 17-year-old male patient with athlete’s foot is extremely upset that he cannot get
rid of it. He calls the clinic and asks the nurse whether the doctor can give him an
antibiotic to cure the infection. What should the nurse include in the explanation of
treatment for fungal infections?
a. Fungi differ from bacteria in that the fungus has flexible cell walls that
allow for free transfer into and out of the cell.
b. Protective layers contain sterols, which change the membrane permeability.
c. The composition of the protective layers of the fungal cell makes the
organism resistant to antibiotics.
d. Fungi cell walls contain Candida, which makes the cells rigid.
Ans: C
Feedback:
The nurse should tell the patient that the composition of the protective layers of the
fungal cell makes the organism resistant to antibiotics so that antibiotics would not
have any positive effect. Fungi do differ from bacteria, but the fungus has rigid cell
walls that allow for free transfer in and out of the cell. The protective layers contain
ergosterol, not Candida, that helps keep the cell wall rigid, not permeable.
2. The nurse admits a 1-year-old child to the pediatric intensive care unit (ICU) with
cryptococcal meningitis. What drug will the nurse anticipate receiving an order for
to treat this child?
a. Amphotericin B (Fungizone)
b. Fluconazole (Diflucan)
c. Griseofulvin (Fulvicin)
d. Ketoconazole (Nizoral)
Ans: B
, Feedback:
Fluconazole is used in the treatment of cryptococcal meningitis and is safe to use in a
1-year-old child. Amphotericin B has many unpleasant adverse effects and is very
potent, so it would not be the first or best medication to administer initially but would
be reserved for use if fluconazole was not effective. Griseofulvin is given to treat
tinea pedis and tinea unguium in children. Ketoconazole is not given to children
younger than 2 years because safety has not been established.
3. The nurse is teaching the patient about a newly prescribed systemic antifungal
drug. What sign or symptom will the nurse instruct the patient to report to the
provider immediately?
a. Unusual bruising and bleeding
b. Constipation or diarrhea
c. Red and dry eyes
d. Increased appetite with weight gain
Ans: A
Feedback:
Unusual bruising and bleeding can be an indication of hepatic toxicity, which should
be reported immediately. Yellowing of the eyes, not redness, and tearing are also
indicative of hepatic toxicity. Usually GI symptoms include nausea and vomiting with
antiviral drugs, which could cause decreased appetite and weight loss. These
symptoms should be reported if they persist but are not emergency symptoms to
report immediately.
4. A patient who has a tinea infection calls the clinic and complains of intense local
burning and irritation with use of a topical antifungal drug. Even before asking the
patient, the nurse suspects he or she is applying what medication?
a. Butoconazole (Gynazole I)
b. Ciclopirox (Loprox)
c. Econazole (Spectazole)
d. Haloprogin (Halotex)
Ans: C
Feedback:
Econazole can cause intense local burning and irritation in treatment of tinea
infections. Butoconazole is used to treat vaginal Candida infections. Ciclopirox is
used to treat toenail and fingernail tinea infections and does not produce intense
burning and irritation. Haloprogin is used to treat athlete’s foot, jock itch, and
ringworm infections and is not associated with burning or irritation.
5. A patient asks the nurse if he or she should use a topical antifungal. The nurse is
aware that the most important contraindication to topical antifungals is what?
a. Hepatic impairment
, b. Renal impairment
c. Congestive heart failure
d. Known allergy to any of the antifungal drugs
Ans: D
Feedback:
Topical antifungals are not absorbed systemically so they are not metabolized and
excreted. As a result, the only contraindication would be an allergy to the drug.
Hepatic and renal impairment and congestive heart failure would not be a
contraindication because these drugs do not enter the bloodstream and impact these
organ systems.
6. A patient with high cholesterol is taking lovastatin (Mevacor). What drug would
the nurse question if it was ordered for this patient?
a. Nifedipine (Procardia)
b. Ciprofloxacin (Cipro)
c. Itraconazole (Sporanox)
d. Oxazepam (Serax)
Ans: C
Feedback:
Itraconazole is an azole antifungal drug that has been associated with severe
cardiovascular events when taken with lovastatin. Nifedipine, ciprofloxacin, and
oxazepam have no drug interactions with lovastatin. Nifedipine is an antihypertensive
drug whose effects can be increased when taken with cimetidine. The effects of
ciprofloxacin are altered when taken with antacids and theophyllines. Oxazepam is an
antianxiety drug that should not be taken with alcohol or theophyllines.
7. An 85-year-old man who is a resident in an extended-care facility has athlete’s
foot. After applying an antifungal cream, what is the nurse’s next action?
a. Wipe away excess medication from the affected area.
b. Wrap a sterile kling dressing around both feet.
c. Elevate the feet for 30 minutes.
d. Apply clean dry socks.
Ans: D
Feedback:
Clean dry socks should be applied when treating athlete’s foot to help eradicate the
infection because they will keep the feet dry as well as prevent the cream from being
wiped away. A kling dressing is not necessary as it would bind the feet and interfere
with mobility and increase the risk of systemic absorption. Medication should not be
removed once applied, and there is no need to elevate the feet unless another medical
condition warrants this action.
, 8. A patient comes to the clinic and is diagnosed with a vaginal fungal infection. The
nurse provides patient information for self-administration of a vaginal antifungal
medication. What will the nurse include in the instructions?
a. Insert low into the opening of the vagina.
b. Discontinue use during menstruation.
c. Remain recumbent for at least 15 minutes after insertion.
d. Rub the cream into the vaginal wall after insertion.
Ans: C
Feedback:
The patient should remain recumbent at least 10 to 15 minutes after the medication is
deposited high in the vagina so that leakage will not occur and absorption will take
place. The effectiveness of the medication is determined by the consistent application
for each specified dose for maximal results. The nurse would instruct the patient to
continue the medication during menstruation. Stopping the drug and restarting it later
can lead to the development of resistant strains of the drug. The cream need not be
rubbed into the vaginal wall as it will coat the wall naturally after insertion.
9. A patient who is using a topical antifungal agent to treat mycosis calls the clinic to
report a severe rash that is accompanied by blisters. What will the nurse instruct
the patient to do?
a. Continue the drug as the prescription indicates.
b. Scrub the rash with soap and water.
c. Stop using the drug immediately.
d. Decrease the amount of the medication used.
Ans: C
Feedback:
The patient should stop using the drug. The rash could indicate sensitivity to the drug
or worsening of the condition being treated. Scrubbing the rash could cause further
irritation and increase the risk for other infections. Continuing the drug could cause
further complications. Decreasing the medication would be ineffective in treating the
infection while continuing to risk further complications.
10. The nurse admitted a 25-year-old woman to the unit. What would be the most
important thing for the nurse to assess before administering ketoconazole?
a. Complete blood count (CBC) and blood glucose
b. Eating and sleeping habits
c. Height and weight
d. Renal and hepatic function
Ans: D
Feedback:
It would be important for the nurse to know the patient’s CBC, blood glucose level,
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