1
Q
If antivirals act inside host cells, what is one major risk when using them?
A
They may damage or kill the host cell because viruses use the host’s own cellular machinery to replicate.
2
Q
Why don’t antibiotics work on viruses even if both cause infection?
A
Viruses are not living cells and hide inside host cells to replicate; antibiotics target bacterial structures and metabolism, which viruses do not have.
3
Q
At which stage of the viral cycle would blocking viral entry prevent infection entirely?
A
Stage 1–2 (attachment and entry). If the virus cannot enter the host cell, it cannot replicate.
4
Q
A virus has entered the host cell and is using the cell’s ribosomes to make proteins. Which part of the viral life cycle is this, and why is it hard to treat?
A
This is the “hijacking” stage (control of DNA/RNA and protein production). Treatment is difficult because the virus is using the host’s own machinery, so drugs can unintentionally harm the host cell.
5
Q
Why does viral replication often kill or weaken host cells?
A
The host cell’s energy and machinery are redirected toward making viral DNA/RNA and proteins, leaving the cell unable to function normally; some viruses also cause the cell to burst during release.
6
Q
A toddler develops vomiting and diarrhea after attending daycare. What route of viral entry should the nurse suspect, and what nursing teaching is most important?
A
GI (ingestion) — likely rotavirus or Norovirus. Teaching: hand hygiene and proper cleaning of surfaces to prevent fecal–oral spread.
7
Q
A pregnant client is diagnosed with cytomegalovirus (CMV). What is the nurse’s priority concern?
A
CMV can cross the placenta → risk of fetal infection, developmental problems. Nursing priority: monitor fetal health, provide counselling, coordinate with OB team.
8
Q
A patient with hepatitis B asks why they needed post-exposure prophylaxis after a needlestick injury. What entry route is involved?
A
Inoculation through blood exposure. Hep B spreads through blood and body fluids; PEP reduces the chance of infection.
9
Q
During cold and flu season, a patient asks why wearing a mask helps prevent illness. What viral entry route is being blocked?
A
Respiratory tract (inhalation) → droplets from coughing or sneezing.
10
Q
A nurse is assessing a child with a rash and fever. The parent reports recent exposure to someone with chickenpox. Why could this child be infected even without direct skin contact?
A
Varicella (chickenpox) spreads through the respiratory route as well as skin lesions, so inhalation exposure is enough to cause infection.
11
Q
A patient exposed to hepatitis B through a needlestick asks why they received immunoglobulin instead of a vaccine alone. What is the nursing explanation?
A
Immunoglobulin provides immediate antibodies for fast protection, while vaccines take weeks to build immunity. Both are needed to prevent infection.
12
Q
A neutropenic patient (low WBC count) asks why they are at high risk for severe viral infections. What is the best nursing response?
A
Antiviral drugs help, but the immune system does most of the work. A weak immune system cannot stop viral replication effectively.
13
Q
A patient asks if they can take leftover antibiotics for the flu. What should the nurse teach?
A
Antibiotics only work on bacteria, not viruses. Using them unnecessarily increases resistance and provides no benefit for viral infections.
14
Q
A child is exposed to varicella (chickenpox). Which antiviral strategy depends on immune system strength, and why is this important for nursing assessment?
A
Vaccination relies on a functioning immune system to build memory cells. Nurses must assess for immunocompromised status, because vaccines may be contraindicated or ineffective.
15
Q
A patient on interferon therapy reports new symptoms of fatigue and flu-like effects. What should the nurse consider?
A
Interferon stimulates the immune system, often causing systemic inflammatory side effects. The nurse should monitor tolerance, hydration, and worsening symptoms.
16
Q
A patient starts antiviral therapy 5 days after flu symptoms began. Why may the medication be less effective, and what should the nurse teach?
A
Antivirals work best before the virus enters many host cells, typically within 48 hours. Late treatment means the virus has already replicated inside cells, making it harder to control.
17
Q
A patient asks why antivirals can’t “kill the virus” the way antibiotics kill bacteria. What is the best nursing explanation?
A
Viruses hide inside human cells. Antivirals can only slow replication, not destroy viruses already inside cells. The immune system must eliminate infected cells.
18
Q
A client with recurrent herpes outbreaks asks why they still get symptoms even while taking antiviral medication. What should the nurse explain?
A
Antivirals reduce viral load and slow replication, but they cannot eliminate the virus from nerve cells. The goal is fewer outbreaks and milder symptoms, not a cure.
19
Q
A patient on antiviral medications shows delayed symptom improvement. What should the nurse consider first before changing the treatment?
A
Assess whether the immune system is functioning effectively, because antivirals rely on the immune system to finish clearing the infection.
20
Q
A patient declines vaccination, saying they will “just take antivirals if they get sick.” What is the priority nursing response?
A
Prevention is far more effective. Antivirals cannot stop infection once viruses enter cells; vaccines prevent infection entirely by building immunity beforehand.
21
Q
Why is it important to start some antivirals (like acyclovir for shingles) early in the disease course?
A
Early treatment limits viral replication, reduces severity, prevents complications (e.g., nerve pain), and supports faster immune recovery.
22
Q
A pregnant client tests positive for active genital herpes (HSV-2). What is the nurse’s priority concern during delivery?
A
Risk of neonatal herpes, which can be life-threatening. A C-section may be required if active lesions are present.
23
Q
A patient with shingles reports severe pain and a rash following one nerve pathway (dermatome). What should the nurse assess next?
A
Whether the patient is immunocompromised, because shingles is a reactivation of HHV-3 and occurs more often when immunity is weakened.
24
Q
A young adult has fatigue, swollen lymph nodes, and sore throat. They recently had close contact with an infected partner. Which virus should the nurse suspect and why?
A
Epstein–Barr virus (HHV-4) → causes mononucleosis (“kissing disease”). Nurse should teach rest and avoid contact sports (risk of spleen rupture).
25
A transplant patient suddenly develops fever and organ dysfunction. Which herpesvirus is most concerning, and why?
**CMV (HHV-5)** → can cause severe infections in immunocompromised patients. Monitor labs, organ function, and start antivirals if ordered.
26
A patient with recurrent cold sores asks why they keep coming back even with antiviral treatment. What should the nurse explain?
HSV-1 remains dormant in nerve cells and can **reactivate with stress, illness, or fatigue**. Antivirals reduce outbreaks but cannot eliminate the virus.
27
A client with HIV develops purple skin lesions on the legs. What herpesvirus should the nurse suspect?
**HHV-8**, which is associated with **Kaposi’s sarcoma**—often seen in immunocompromised patients.
28
A patient with genital herpes reports tingling and burning but no blisters yet. What is the best nursing action regarding antiviral medication?
Encourage **immediate** antiviral use. Starting treatment during the **prodrome phase** (tingling) can reduce severity, shorten the outbreak, and limit viral shedding.
29
A patient with frequent HSV-2 outbreaks asks whether daily antivirals are necessary. What assessment should guide your answer?
Evaluate outbreak **frequency and severity**. Daily *suppressive therapy* is recommended if outbreaks are frequent (≥6/year), severe, or impact quality of life.
30
A patient believes their cold sore is “not contagious because it hasn’t opened yet.” What is the priority teaching?
**Even without open blisters**, the virus can still shed and spread. The **prodromal stage** (tingling/burning) is also contagious.
31
A patient with severe pain from genital ulcers says they cannot sit comfortably. What should the nurse consider besides antivirals?
Provide **pain management**, warm sitz baths, and assess for **secondary infection**. Pain can severely affect mobility and hydration.
32
A patient on suppressive therapy develops a new outbreak. What is the nurse’s next step?
Assess **medication adherence**, triggers (stress, illness, immune suppression), and timing of symptoms. Adjustments to dosing or frequency may be needed.
33
An older adult presents with burning pain on one side of the torso before a rash appears. What should the nurse anticipate and why is early action important?
Likely **shingles** (prodrome phase). Antivirals must be started **within 72 hours** to reduce severity and prevent long-term nerve pain.
34
A patient with shingles has open, oozing lesions. What teaching is most important to prevent transmission?
Rash fluid is contagious → can cause **chickenpox** in people who are not immune. Keep lesions covered and avoid contact with pregnant women, infants, and immunocompromised people.
35
A patient with shingles reports severe eye pain and a rash near the forehead. What is the nurse’s priority?
**Emergency referral** to ophthalmology. Shingles involving the cranial nerves can cause **permanent blindness**.
36
A 55-year-old asks whether they should get the Shingrix vaccine even though they had chickenpox as a child. What is the correct nursing response?
Yes. Prior chickenpox increases risk for shingles, and Shingrix greatly reduces both shingles and **postherpetic neuralgia**.
37
A parent of an unvaccinated toddler with chickenpox asks if their child needs antivirals. What factors should guide the nurse’s decision?
Antivirals are typically reserved for **high-risk** children (immunocompromised, severe disease). Most healthy children receive **supportive care only**.
38
A patient has had shingles pain for months after the rash healed. What complication should the nurse suspect?
**Postherpetic neuralgia**—chronic nerve pain caused by nerve damage from shingles.
39
What antiviral is used to treat Cytomegalovirus (CMV), especially in immunocompromised patients?
Ganciclovir — reduces CMV complications such as vision loss and organ damage.
40
Which medications treat Influenza A & B, and what is their main limitation?
Oseltamivir (Tamiflu) and Zanamivir. They do not eliminate the virus—they reduce symptom severity and duration when started within 48 hours.
41
Which hepatitis viruses have vaccines available?
Hepatitis A and Hepatitis B have vaccines. Hepatitis C has NO vaccine.
42
What is the treatment goal for Hepatitis C, and what affects drug choice?
Goal: Virological cure (virus becomes undetectable). Drug choice depends on liver status, including whether cirrhosis is present.
43
How are modern Hepatitis C antivirals typically taken, and what is their effectiveness?
Once-daily oral combination therapy, highly effective, with very high cure rates.
44
Cytomegalovirus (CMV)
A common herpes-family virus that is usually mild but can cause serious illness in immunocompromised patients (e.g., transplant, HIV).
45
Influenza A & B
Seasonal flu viruses that spread by droplets and cause fever, body aches, cough, and fatigue.
46
Hepatitis A
A liver infection spread through contaminated food/water; usually short-term and preventable with a vaccine.
47
Hepatitis B
A liver virus spread through blood and body fluids that can become chronic. Preventable with a vaccine.
48
Hepatitis C
A liver virus spread mainly through blood-to-blood contact. No vaccine, but very effective antiviral treatments can cure it.
49
Why is acyclovir used for herpes infections, and what benefit does it provide during outbreaks?
Acyclovir reduces **viral shedding**, **pain**, and **duration** of lesions. It helps control symptoms and makes the virus less contagious.
50
A patient has frequent genital herpes outbreaks. Which treatment strategy may be recommended, and why?
**Daily suppressive therapy** with acyclovir or valacyclovir. It keeps the virus “asleep” and reduces how often outbreaks occur.
51
Why might a provider choose valacyclovir over acyclovir for a patient?
Valacyclovir has **better absorption** and lasts longer in the body, so it requires **less frequent dosing** and is more convenient.
52
What is valacyclovir converted into after being absorbed by the body, and why is this important?
Valacyclovir converts into **acyclovir** (it is a prodrug). This allows higher drug levels with fewer doses.
53
What serious side effect must nurses monitor for in patients receiving high-dose or IV acyclovir?
**Nephrotoxicity** (kidney damage). Patients need good hydration and monitoring of kidney function.
54
A patient reports a burning sensation after applying topical acyclovir. What should the nurse recognize?
This is a **common side effect**, along with mild rash or skin irritation.
55
What virus is Ganciclovir primarily used to treat, and why is it dangerous?
**Cytomegalovirus (CMV)** — harmless in healthy people but can cause **life-threatening infections** and **blindness (retinitis)** in immunocompromised patients.
56
What is the major, dose-limiting toxicity of Ganciclovir?
**Bone marrow suppression**, leading to ↓ WBCs (infection risk), ↓ RBCs (anemia), and ↓ platelets (bleeding).
57
Why must blood counts (CBC) be closely monitored in patients taking Ganciclovir?
Because Ganciclovir suppresses bone marrow, weakening the immune system and increasing the risk of infection and bleeding.
58
What is Valganciclovir, and why is it preferred for many CMV patients?
Valganciclovir is the **prodrug of Ganciclovir** with **better oral absorption**, allowing effective CMV treatment by pill instead of IV.
59
Who is most at risk of severe CMV complications, and why is antiviral therapy essential for them?
**Immunocompromised patients** (HIV, transplant, chemo). Their weakened immune system allows CMV to cause **opportunistic infections**, retinitis, or even brain involvement.
60
Why must antiviral treatment for influenza begin within 48 hours of symptom onset?
Because antivirals only work while the virus is actively replicating. After 48 hours, the flu is already progressing, and the medication becomes much less effective.
61
What is the main mechanism of action for Oseltamivir and Zanamivir?
They prevent new flu virions from **budding and escaping infected cells**, reducing symptom severity and illness duration.
62
A patient with asthma is prescribed Zanamivir. What is the nurse’s priority action?
Question the order, because **Zanamivir can cause bronchospasm** and is not recommended for patients with asthma or COPD.
63
Which antiviral is taken orally, and what are its common side effects?
**Oseltamivir (Tamiflu)**; common side effects are **nausea and vomiting**, and rare CNS effects like confusion or insomnia.
64
A patient receiving Oseltamivir reports nausea. What nursing advice is most appropriate?
Take the medication **with food** to reduce GI side effects.
65
Before starting antiviral therapy, what key assessments must the nurse complete?
Review **medical history**, **underlying diseases**, **current medications**, and **allergies** to ensure the antiviral is safe and appropriate.
66
Why must baseline vital signs and nutritional status be assessed before giving antivirals?
Because dehydration, malnutrition, or unstable vitals can worsen antiviral side effects and increase the risk of toxicity.
67
What is a “dose-limiting toxicity,” and why is this important for antiviral therapy?
A serious side effect that limits how much of a drug can be safely given (e.g., **bone marrow suppression with ganciclovir**). Nurses must monitor closely and report changes.
68
Why must nurses monitor for signs of opportunistic infections in patients taking antivirals like ganciclovir?
Because some antivirals suppress the immune system, increasing the risk of infection. Watch for fever, cough, chills, or new symptoms.
69
Why is patient teaching about early symptom recognition essential for medications used to treat herpes or shingles?
Antivirals work **best at the earliest sign of outbreak** (tingling, burning, redness). Early treatment reduces severity and duration of symptoms.
70
Why is it important to assess for contraindications and drug interactions before giving antivirals?
Certain conditions (kidney disease, immune suppression) and interacting drugs can increase toxicity or make the antiviral unsafe.
71
A patient with HIV has a CD4 count of 180. What is the nurse’s priority concern?
CD4 < 200 indicates **AIDS**, meaning high risk for **opportunistic infections**. Priority: infection prevention, prophylaxis medications, and monitoring for early signs of illness.
72
A healthcare worker experienced a needlestick from a patient with known HIV. What is the most important immediate action?
**Start post-exposure prophylaxis (PEP) ASAP**, ideally within **1–2 hours**. The transmission risk is low (0.3%), but fast intervention is critical.
73
A patient with HIV has a rising viral load despite taking antiretroviral therapy (ART). What should the nurse assess first?
**Medication adherence**—missed doses allow the virus to replicate and develop resistance.
74
A newly diagnosed HIV patient believes they can stop medications once they “feel better.” What teaching is essential?
ART must be taken **every day for life**. Stopping therapy allows HIV to rebound, destroy CD4 cells, and accelerate progression to AIDS.
75
A pregnant patient with HIV asks how to prevent transmission to her baby. What should the nurse explain?
Strict adherence to ART, avoiding breastfeeding, and sometimes C-section delivery can **reduce transmission risk to <1%**.
76
Why do HIV medications target multiple steps of the viral life cycle instead of just one?
Targeting different steps prevents HIV from replicating and lowers viral load more effectively, reducing the chance of resistance and protecting CD4 cells.
77
A patient asks why their viral load must be “undetectable.” What is the most important nursing explanation?
An undetectable viral load: ✔ protects CD4 cells ✔ prevents progression to AIDS ✔ reduces risk of opportunistic infections ✔ prevents transmission to others (U = U)
78
A patient admits to frequently missing doses of their HIV medication. What is the nurse’s biggest concern?
Missed doses allow HIV to **replicate**, which can lead to **drug-resistant strains**, increased viral load, and falling CD4 levels.
79
Why are modern single-tablet HIV regimens clinically important compared to older multi-pill regimens?
Fewer pills → **better adherence**, fewer side effects, and improved viral suppression, reducing progression to AIDS.
80
A patient has a CD4 count that continues to drop despite treatment. What complications should the nurse monitor for?
Opportunistic infections such as pneumonia, TB, fungal infections, certain cancers (e.g., Kaposi sarcoma), and brain infections like toxoplasmosis.
81
Why is the concept “undetectable = untransmittable (U=U)” an important part of patient teaching?
It reinforces the importance of **strict adherence**, empowering patients by showing that consistent treatment prevents both disease progression and sexual transmission.
82
Why is HIV treatment individualized and typically managed by a specialist?
Because drug choice depends on factors like age, health status, other medications, and HIV genotype (drug resistance), requiring expert evaluation.
83
Why is ART started early in HIV treatment?
Early treatment helps suppress viral load, protects CD4 cells, prevents opportunistic infections, and improves long-term outcomes.
84
Why is combination therapy the standard of care for HIV?
Using multiple drugs prevents resistance and more effectively reduces viral load compared to single-drug therapy.
85
How often should viral load and CD4 counts be monitored after starting ART?
At least **twice in the first month**, then **every 3 months** afterward.
86
What is the primary goal of anti-retroviral therapy?
To suppress viral load to **undetectable levels**, protect CD4 cells, prevent AIDS, and reduce transmission (U = U).
87
A patient on antiretroviral therapy has a viral load of 45 copies/mL. What does this indicate, and what should you teach the patient?
The viral load is **undetectable**, meaning HIV is well controlled and cannot be sexually transmitted (U=U). Teach: continue strict adherence—missing doses can reverse this.
88
A healthcare worker experiences a needle-stick injury from an HIV-positive patient. What is the **priority nursing action**?
Initiate **post-exposure prophylaxis (PEP)** immediately—ideally within 1–2 hours (up to 72 hours max).
89
A patient refuses to use condoms because they are already on antiretroviral therapy. What is the most appropriate nursing response?
ART does **not replace other prevention methods**. Condoms are still needed to prevent STIs and protect partners if viral load becomes detectable.
90
A newborn was exposed to HIV during delivery. Why is it essential to begin antiretroviral prophylaxis immediately?
Early prophylaxis greatly reduces the risk of HIV transmission by suppressing viral replication before it can establish infection.
91
A patient’s CD4 count has dropped despite being on ART. What complications should the nurse anticipate and monitor for?
Opportunistic infections such as pneumonia, TB, fungal infections, or certain cancers—indicating immune weakening.
92
A patient asks, “Can I stop taking my HIV medication now that my viral load is undetectable?”
No—therapy is **lifelong**. Stopping medication allows the virus to rebound, increasing viral load and risking resistance.
93
A patient frequently forgets doses. What is the nurse’s biggest concern?
**Drug resistance**—missing doses allows HIV to replicate and mutate, making treatment less effective.
94
A patient wants to start taking St. John’s Wort for stress while on ART. What should the nurse do?
Advise against it—anti-retrovirals have **major drug interactions**, and St. John’s Wort can reduce drug levels and cause treatment failure.
95
A patient says, “This medication will cure my HIV eventually, right?” What is the correct teaching?
No—ART does **not cure HIV**. It only reduces symptoms, protects the immune system, and keeps viral load low.
96
A patient will be traveling for two weeks. What key teaching should the nurse provide?
Ensure they bring enough medication and **avoid therapy interruptions**—even a short gap can increase viral load and risk resistance.
97
Why does Mycobacterium tuberculosis primarily infect the lungs?
TB is **aerobic**, meaning it needs **high oxygen**, and the lungs provide the highest oxygen concentration.
98
A patient reports weight loss, night sweats, fever, and a chronic productive cough with blood-tinged sputum. What condition should you suspect first?
**Active tuberculosis**—classic symptoms include hemoptysis, night sweats, weight loss, and chronic cough.
99
Why is a TB skin test *not* recommended for someone who previously received the BCG vaccine?
The BCG vaccine can cause a **false positive** skin test, so chest X-ray or blood testing (IGRA) is preferred.
100
A homeless shelter resident tests positive on a TB skin test. What is the next step to determine if they have active TB?
A **chest X-ray** and **sputum culture** are needed to confirm active disease.
101
What groups are most at risk for developing active TB after exposure?
Individuals who are **immunosuppressed** (HIV, cancer), **malnourished**, living in **overcrowded conditions**, or using **misused drugs**.
102
A patient with TB frequently misses doses because they “feel better.” What is the nurse’s biggest concern?
Missed doses can cause **MDR-TB (multi-drug resistant TB)** by allowing bacteria to mutate and become resistant to first-line drugs.
103
A patient’s TB culture shows resistance to isoniazid only. What type of resistance is this, and how does it change treatment?
**Monoresistant TB** → resistant to ONE first-line drug; treatment becomes longer and requires alternative drug combinations.
104
A patient is diagnosed with MDR-TB. What public health action is required for their family members who live in the same home?
**Close contacts** must receive preventive treatment for **6–9 months**, even if their test is negative, to prevent latent TB from becoming active.
105
Why is Directly Observed Therapy (DOT) often used for patients at high risk of non-adherence?
DOT ensures **every dose is taken**, preventing drug resistance, treatment failure, and spread of MDR/XDR-TB in the community.
106
A patient tests negative for TB but lives in overcrowded housing with someone who has MDR-TB. What is the priority teaching?
They still need **prophylactic treatment for 6–9 months** because they are highly exposed, and latent infection may not show on early tests.
107
A patient on INH reports numbness and tingling in their hands and feet. What is the nurse’s priority intervention and why?
Suspect peripheral neuropathy caused by vitamin B6 (pyridoxine) deficiency. The nurse should notify the provider and ensure B6 supplementation is started or increased.
108
A patient taking INH drinks alcohol daily. Why is this concerning, and what teaching is essential?
Alcohol significantly increases the risk of hepatotoxicity. The patient must avoid alcohol and have liver function tests monitored closely.
109
A diabetic patient on INH experiences dizziness and sweating. What complication should the nurse suspect?
Hypoglycemia, because INH can alter glucose metabolism—important in diabetic patients.
110
Before administering INH, what patient history findings would make the nurse question the prescription?
Severe liver disease (hepatitis, cirrhosis) or known severe drug allergy, because INH is contraindicated in these cases.
111
A patient starting INH therapy asks why genetic factors matter. How should the nurse explain the relevance of 'slow acetylators'?
Slow acetylators metabolize INH more slowly, causing the drug to stay in the body longer → higher risk of toxicity, especially liver toxicity and neuropathy.
112
A patient on Rifampin reports new **right upper quadrant abdominal pain** and dark urine. What is your priority action, and why?
**Hold the medication and notify the provider.** These are signs of **hepatotoxicity**, a serious adverse effect that requires immediate evaluation.
113
A patient on Rifampin becomes alarmed because their urine and sweat are turning orange. What should the nurse do?
**Reassure the patient this is a harmless expected effect**, but teach them that it may stain clothing and contact lenses. No need to stop the medication.
114
A patient taking Rifampin for TB also uses **oral contraceptives**. What key teaching must the nurse include?
Rifampin decreases the effectiveness of oral contraceptives → **use a backup non-hormonal birth control method** to prevent pregnancy.
115
Why must Rifampin be given in **combination** with other TB drugs such as isoniazid (INH)?
To prevent **drug-resistant TB**, because the bacteria mutate quickly. Combination therapy improves effectiveness and reduces resistance.
116
A patient on Rifampin is also prescribed warfarin. What monitoring or intervention is most important?
Monitor **INR closely** because Rifampin **reduces warfarin effectiveness**, increasing the risk of inadequate anticoagulation or clot formation. Dose adjustments may be needed.
117
A patient taking pyrazinamide reports new severe joint pain in the big toe. What is your priority action?
Suspect **hyperuricemia/gout** → notify provider and check uric acid levels.
118
A patient on pyrazinamide and rifampin asks why they must avoid alcohol. What is the best nursing explanation?
Both medications are **hepatotoxic**, and alcohol further increases **liver damage risk**.
119
Before starting pyrazinamide, what part of the patient’s history is MOST important to assess?
History of **liver disease** or **gout**, since the drug is hepatotoxic and raises uric acid levels.
120
A patient’s lab results show elevated AST/ALT after starting pyrazinamide. What nursing action is appropriate?
Hold the medication and notify the provider → concerns for **hepatotoxicity**.
121
Why is pyrazinamide never used alone to treat TB?
Using a single drug increases risk of **drug-resistant TB**; combination therapy prevents mutation and improves effectiveness.
122
A patient taking ethambutol reports new difficulty distinguishing red from green. What is your *priority* nursing action?
**Stop the medication and notify the provider immediately.** 🧠 *Reason:* This is a sign of optic neuritis, which can cause **permanent blindness** if therapy continues.
123
A patient on ethambutol has a history of gout. What complication are they most at risk for, and what might the nurse monitor?
**Increased uric acid → gout flare.** 🧠 *Monitor:* Joint pain, swelling, uric acid levels.
124
Before starting ethambutol, what important baseline assessment must the nurse ensure is completed?
**Baseline eye exam (visual acuity and color discrimination).** 🧠 *Reason:* Early comparison is critical to detect optic neuritis.
125
Why is ethambutol NOT usually given to children under 13 years old?
**They cannot reliably report vision changes**, increasing the risk of permanent optic damage.
126
A patient taking multiple TB medications asks why ethambutol is necessary if it doesn’t kill bacteria. What is the correct teaching?
**Ethambutol prevents TB from multiplying and helps stop the development of drug-resistant TB.** 🧠 *Combination therapy prevents resistance.*
127
A patient receiving Amphotericin B suddenly develops chills, fever, tachycardia, and hypotension 1 hour into the infusion. What is the priority nursing action?
Slow or stop the infusion and notify the provider.
128
Before starting Amphotericin B, which lab values must the nurse check first, and why?
Creatinine and GFR — to evaluate baseline kidney function.
129
A patient on Amphotericin B develops muscle weakness and new arrhythmias. Which electrolyte imbalance do you suspect, and why is it dangerous?
Hypokalemia (low K⁺).
130
The provider orders pre-medications before each Amphotericin B dose. What is the purpose of these medications?
To reduce infusion-related reactions such as fever, chills, hypotension, and nausea.
131
A patient receiving Amphotericin B complains of burning and pain at the IV site. What should the nurse do first?
Stop the infusion and assess the IV site for extravasation.
132
Your patient begins an Amphotericin B infusion. After 10 minutes, their BP drops from 128/78 to 92/60 and HR increases to 118 bpm. What should your PRIORITY action be?
Stop the infusion immediately, assess airway/breathing/circulation, and notify the prescriber. This is a common severe infusion reaction and can become life-threatening.
133
A patient on Amphotericin B has rising creatinine levels and decreasing urine output over 24 hours. Should the next dose be given? Why or why not?
The dose should likely be held because Amphotericin B is nephrotoxic. Worsening kidney function indicates increasing toxicity → notify the prescriber before giving the next dose.
134
You are preparing to give Amphotericin B. Which baseline labs are MOST important to review before administration, and why?
Creatinine/GFR (nephrotoxicity risk), LFTs (hepatotoxicity), CBC (bone marrow suppression), electrolytes (K⁺ and Mg²⁺ often drop). These determine if the patient is safe to receive the medication.
135
Your patient asks why they received Tylenol, Benadryl, and hydrocortisone before the infusion. What is the best explanation?
These medications help prevent or reduce infusion reactions such as fever, chills, nausea, hypotension, and respiratory distress—common with Amphotericin B (“shake and bake”).
136
The prescriber orders Amphotericin B to be infused by gravity because there are no pumps available. What should you do?
Do NOT give the medication by gravity. Amphotericin B must be given via an IV pump to tightly control the rate and avoid toxicity and adverse reactions → escalate to charge nurse or pharmacy.
137
Your patient taking fluconazole reports new right-upper-quadrant abdominal pain and dark urine. What is your PRIORITY action and why?
**Stop the medication and notify the prescriber** → These are signs of **hepatotoxicity**, a serious adverse effect of azoles.
138
A patient on warfarin is starting fluconazole. What is your main concern, and what should you monitor?
Fluconazole **inhibits CYP450**, increasing warfarin levels → **risk of bleeding**. Monitor **INR** and watch for bleeding signs (bruising, gums, urine).
139
A patient with chronic liver failure is prescribed ketoconazole. What should the nurse do?
**Question the order** → Azoles are **contraindicated** in severe liver disease due to hepatotoxicity risk.
140
A bone marrow transplant patient is receiving fluconazole prophylactically. Why is this appropriate?
These patients are immunocompromised → fluconazole prevents **Candida infections**, which they are at high risk for.
141
A patient states, “I take atorvastatin (a statin). Can I still take itraconazole?” What should the nurse explain?
Itraconazole inhibits CYP450 → can **increase statin levels**, raising risk for **rhabdomyolysis**. The provider may need to **adjust or change the statin**.
142
If a patient on IV antifungals shows signs of liver dysfunction (e.g., jaundice, dark urine), what immediate steps should you take as a nurse?
Stop the medication and notify the provider. Then, monitor liver function tests closely and assess for other signs of hepatotoxicity.
143
A patient taking Amphotericin B reports fever and chills shortly after the infusion starts. What should you consider doing?
Recognize this as a common infusion reaction ('shake and bake' syndrome). Slow the infusion rate if needed and ensure premedications (like antipyretics) are given to minimize symptoms.
144
Why is it important to monitor a patient’s intake and output, urinalysis, and kidney function while on IV antifungals?
Because these medications can be nephrotoxic. Monitoring helps detect early signs of kidney damage and prevents further complications.
145
If a patient on fluconazole reports unusual bruising and is also taking warfarin, what might you suspect?
Suspect an increased risk of bleeding due to fluconazole’s interaction with warfarin. The nurse should check the patient’s INR and notify the prescriber for possible dose adjustments.
146
A patient using vaginal antifungal treatments asks if they can continue sexual intercourse during treatment. What should you advise?
Advise them to avoid sexual intercourse while treating a vaginal fungal infection to ensure proper healing and prevent irritation or reinfection.
Pharm Lecture
flashcards
Decks in class (17)
# Cards
-
Unit 1 (part 1)200
-
Unit 2: Drugs Affecting The Autonomic NS278
-
Unit 3: coagulation modifiers and anemia medications220
-
Unit 3: coagulation modifiers and anemia medications163
-
Unit 3: drugs for anemia75
-
Lecture 4231
-
Lecture 5: Drugs affecting the respiratory system245
-
Lecture 6: Drugs Affecting GI131
-
Lecture 7255
-
Lecture 8184
-
Lecture 9380
-
Lecture 9 (Pt. 2)122
-
Lecture 10225
-
Lecture 10 pt. 2121
-
Lecture 11168
-
Lecture 11 (part 2)132
-
Unit 12146
