● Correction: Hemophilia A on PPT , INCREASED bleeding time
Professor Review of Test:
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Ganciclovir - treats CMV, most often in immunosuppressed
Adverse effects: Bone marrow suppression - thrombocytopenia, neutropenia (monitor neutrophil, ANC
below 500, platelets below),
○ If neutrophenia, S&S -> infections, fever, headache, sore throat
○ Teratogenic , GI upsets
○ Another drug that requires slow infusion like acyclovir
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Causes of hepatitis C?
○ Viral → contracted via body fluids, sharing needles, healthcare environment
○ If patients shared needle and developed hepatitis, what type of infection? VIRAL
○ Hepatitis - elevated ALT, hepatomegaly (enlarged liver) , history of IV abuse risk -> reason is due
to viral
○ S&S: Fever, vomiting, jaundice, anorexia → CT scan → hepatomegaly, elevated ALT, LFT
○ Could be due to: autoimmune, antibiotics, acetaminophen, alcohol
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Hemophilia A
○ Due to Factor 8 deficiency
○ Inherited- autosomal recessive X condition, usually males get it, females not as much.
○ Treatments:
■ Advate - recombinant treatment
■ Desmopressin - release of platelets from endothelial lining. NOT for severe. Used for
MILD conditions. Sometimes doesn’t work.
■ thrombolytic: aminocaproic acid, tranexamanic acid
○ **Know S&S of hemophilia - easy bleeding, petechiae, nose bleeds.
○ Mostly increases in APTT.
○ If has pain → acetaminophen
**Know definition of DIC - lots of clots and then bleeding after platelets exhausted
** Know definition idiopathic purpura and thrombotic purpura
**Polycythemia vera - increase in anytime of cell , can be fatal
What type of nutritional supplement for pregnanacy? Folic acid to prevent spina filda
**Causes of anemia. Know ALL of them. VERY IMPORTANT.
○ Blood loss, increased demand, pregnancy, chronic kidney disease, celiac
○ Alcoholism can cause it too → folic acid deficiency
○ Gastrectomy —> B12 defiency
○ Peptic ulcer disease
Which one associated with intrinsic factor? Pernicious anemia.
Which anemia is normocytic, microcytic vs macrocytic?
What are common treatments of sickle cell? Hydroxyurea, opioids for pain, stem cell transplant
○ Would you use filgrastim? NO , it’s for WBC count
Ganciclovir monitoring parameters
○ Bone marrow suppression -> Look at CBC
■ Not looking at heart rate as much
**Know what’s used as thrombopoietic emetics to increase platelet counts- romiplastim (SQ) ,
eltromobobag (oral)
Know definition of ITP
**Clinical manifestation of anemia → tachycardia , tachypnea, cyanosis, pallor, dyspnea
Specific vaccines for certain Hep - available for A&B
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Can lupus cause hepatitis? Yes, bc it’s an autoimmune condition
Treating Hep B and C - 3 drug cocktails - PI, peginterferon, ribavirin
FORGET ABOUT THIS: **Some questions about flu prevention on exam- oseltamivir prophylaxis for flu 5
day treatment, must be given within 48 hrs-72 hrs
Know risk factors of developing tuberculosis- prisons, immigrants from other countries, IV drug users,
Know the tests administered for TB - interferon gamma gold test, PPD → hardened induration more than
10mm = positive test , immunosupprssed more than 5 mm= positive test) Another test is sputum test.
○ Go to Kaplan TB and antifungals vid. Content library , took 1-2 questions from there
Drugs: isoniazid, rifampin , ethambutol (used for active TB, not latent)
TB S&S: fatigue, anorexia, low grade fever, trouble breathing
How long to treat? Induction 2 months and after that 4-7 months.
When to stop treating it? Patient must have 3 negative sputum tests
Side effects of rifampin:
In-Class Questions
A patient is taking oral ketoconazole [Nizoral] for a systemic fungal infection. The nurse reviews the
medication administration record and notes that the patient is also taking omeprazole [Prilosec] for
reflux disease. Which action should the nurse take?
a. Administer the omeprazole 1 hour before the ketoconazole.
b. Administer the omeprazole at least 2 hours after the ketoconazole.
c. Confer with the prescriber about a potential hazardous interaction.
d. The nurse should not administer the omeprazole to a patient receiving ketoconazole.
● Answer B: In order for ketoconazole to be absorbed, must be acidic environment.
Omeprazole decreases stomach acidity , preventing absorption of ketoconazole. Allowed
to take together, just make sure to SPACE IT APART.
A patient with a history of congestive heart failure and renal impairment has esophageal candidiasis.
Which antifungal agent would the nurse anticipate giving to this patient?
a. Amphotericin B [Abelcet]
b. Fluconazole [Diflucan]
c. Itraconazole [Sporanox]
d. Voriconazole [Vfend]
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Not A - amphotericin B can cause nephrotoxicity
Answer B: Fluconazole used for systemic fungal infections
Not C - Itraconazole has cardiac side effects
Not D - Voriconazole not drug of choice for systemic fungal infections. Treats:
aspergillus. Second in line, reserved.
● Any of azoles can potentially cause hepatotoxicity - N/V, anorexia, malaise
A patient who is taking ketoconazole tells the nurse that her periods have become irregular. What will
the nurse tell her?
a. This indicates that she should begin taking oral contraceptives.
b. This is caused by a reversible effect on estradiol synthesis.
c. This is a serious side effect that warrants discontinuation of the drug.
d. This is a sign of hepatic toxicity, and the drug dose should be lowered.
● Answer B: MOA of ketoconazole inhibits ergosterol and inhibits formation of steroids,
esp sex steroids→ decrease in estrogen. Reversible so just tell them continue course of
treatment.
The nurse is preparing to administer amphotericin B intravenously. The nurse will expect to pretreat the
patient with which medications?
a. Acetaminophen [Tylenol], diphenhydramine [Benadryl], and meperidine [Demerol]
b. Aspirin, diphenhydramine [Benadryl], and meperidine [Demerol]
c. Ibuprofen [Motrin], diphenhydramine [Benadryl], and meperidine [Demerol]
d. Morphine sulfate [Morphine] and acetaminophen [Tylenol]
● Acetaminophen - fever. Diphenhydramine - allergies. Meperidine - rigors. Can also
use dantrolene. Can also use hydrocortisone (GC but it’s an immunosuppressant
so not first-line for that)
Which superficial mycosis is generally treated with oral antifungal agents?
a. Tinea capitis
b. Tinea corporis
c. Tinea cruris
d. Tinea pedis
● Answer A: Only ONE fungal infection to treat systemically - Tinea capitis. Treated 6-8
wks for terbinafine or griseofulvin. Griseofulvin more for peds and less expensive.
Terbinafine comes in tablet.
A child has ringworm on the scalp. A culture of the lesion reveals a dermatophytic infection. The nurse
teaching the child's parents about how to treat this infection will include which statement?
a. Adverse effects of the medication include itching, burning, and erythema.
b. Apply the topical medication daily until at least 1 week after the rash is gone.
c. Your child will need to take this oral medication for 6 to 8 weeks.
d. You will use an antifungal shampoo to treat this infection.
● A - side effects of topical treatment
● Answer C: tinea capitis (same explanation above). Only systemic , oral, NOT topical
treatment.
A nurse is caring for a patient who has a superficial fungal infection and notes that the provider has
ordered 200 mg of ketoconazole [Nizoral], 200 mg PO once daily. Which action by the nurse is correct?
a. Administer the drug as ordered.
b. Contact the provider to discuss twice daily dosing.
c. Discuss a 400-mg daily drug regimen with the provider.
d. Request an order for a different antifungal medication.
● Answer D: Don’t give oral ketoconazole for superficial fungal infections or else side
effects such as hepatotoxicity . If don’t have to give oral ketoconazole, DON’T give.
Superficial usually treated topically.
A patient who is pregnant has a history of recurrent genital herpesvirus (HSV). The patient asks the
nurse what will be done to suppress an outbreak when she is near term. The nurse will tell the patient
that:
a. antiviral medications are not safe during pregnancy.
b. intravenous antiviral agents will be used if an outbreak occurs.
c. oral acyclovir [Zovirax] may be used during pregnancy.
d. topical acyclovir [Zovirax] must be used to control outbreaks.
● Answer: C - perfectly safe for pregnancy and actually even more effective.
● Not D - not necessary since oral is safe. Not the best answer.
The nurse is caring for a patient receiving intravenous acyclovir [Zovirax]. To prevent nephrotoxicity
associated with intravenous acyclovir, the nurse will:
a. hydrate the patient during the infusion and for 2 hours after the infusion.
b. increase the patient's intake of foods rich in vitamin C.
c. monitor urinary output every 30 minutes.
d. provide a low-protein diet for 1 day before and 2 days after the acyclovir infusion.
● Answer A: when administering acyclovir, always remember hydrate patient during and
after infusion
A male patient with hepatitis C will begin triple drug therapy with pegylated interferon alfa 2a [Pegasys],
ribavirin [Ribasphere], and boceprevir [Victrelis]. The patient tells the nurse that his wife is pregnant.
What will the nurse tell him?
a. Boceprevir is contraindicated in males whose partners are pregnant.
b. He should use a barrier contraceptive when having sex.
c. He should use dual drug therapy with pegylated interferon alfa and ribavirin only.
d. This combination drug therapy is safe for him to use.
● Answer A: Boceprevir - very teratogenic. Can transfer semen to partner and it’s
teratogenic to fetus. Same thing applies to ribavirin (teratogenic). If partner pregnant,
must stop the drug or stop sexual intercourse.
A patient has a positive test for hepatitis C and is admitted to the hospital. The admission laboratory
tests reveal a normal ALT, and a liver biopsy is negative for hepatic fibrosis and inflammation. The nurse
will prepare this patient for:
a. dual therapy with pegylated interferon alfa and ribavirin.
b. no medication therapy at this time.
c. pegylated interferon alfa only until ALT levels are elevated.
d. triple drug therapy with pegylated interferon alfa, ribavirin, and boceprevir.
● If no symptoms with Hep C, then don’t need to give treatment
A nursing student asks a nurse why pegylated interferon alfa is used instead of regular interferon for a
patient with hepatitis C. The nurse will tell the student that pegylated interferon:
a.
b.
c.
d.
decreases the need for additional medications.
has fewer adverse effects than interferon.
is administered less frequently than interferon.
may be given orally to increase ease of use.
● Answer C: Pegylated interferon is long acting so patients wouldn’t have to take
additional doses.
After starting an antiviral protease inhibitor, a patient with HIV telephones the nurse, complaining, I'm
so hungry and thirsty all the time! I'm urinating 10 or 12 times a day. The nurse recognizes these
findings to be consistent with:
a. pancreatic infiltration by HIV.
b. allergic reaction.
c. nonadherence to the antiviral regimen.
d. hyperglycemia.
Antiviral Practice Quiz
A nursing student is presenting to the class on acyclovir [Zovirax] for treatment of HSV and VZV
Which of the following statements would require further teaching:
A. Acyclovir can be used to treat shingles, chickenpox, cold sores, and genital herpes.
B. Acyclovir is available in oral, topical, and IV dosage forms.
C. Acyclovir is safe for use during pregnancy and may be used to suppress recurrent genital herpes
near term.
D. Acyclovir should not be used in the immunocompromised patient
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**Acyclovir topically. Application is done 5 times daily for 4 days. Safe for pregnancy.
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Main use: herpes, varicella, shingles
Nephrotoxic - give fluids
Phlebitis risk - infused slowly . NEVER GIVEN BOLUS INJECTION
A patient with leukemia who has undergone bone marrow transplant was given acyclovir [Zovirax]
5mg/kg IV infusion three times daily to treat a mucocutaneous herpes simplex virus infection. Important
nursing implications regarding the administration of intravenous acyclovir in this patient include all the
following except:
A. Monitor for serum creatinine and
blood urea nitrogen
B. Administer intravenous acyclovir
via bolus injection.
C. Provide adequate IV fluids during the infusion and for 2 hours after.
D. Monitor the patient for signs and symptoms of neurologic toxicity such as agitation, tremors,
delirium, and/or hallucination.
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Neurotoxicity can occur with acyclovir especially if have renal impairment
Phlebitis risk - infused slowly . NEVER GIVEN BOLUS INJECTION
Correction: ANSWER IS B
1. A nurse is reviewing a patient's most recent blood count and notes that the patient has a
hemoglobin of 9.6 gm/dL and a hematocrit of 33%. The nurse will notify the provider and will
expect initial treatment to include:
a.
determining the cause of the anemia.
b.
giving intravenous iron dextran.
c.
giving oral carbonyl iron [Feosol].
d.
teaching about dietary iron.
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Answer A: Iron dextran - only reserved for patients troubled with absorption , associated with anaphylactic
reactions (make sure have epi pen)
1. A nurse is caring for a patient after hip replacement surgery. The patient has been receiving
iron replacement therapy for 2 days. The nurse notes that the patient's stools appear black.
The patient is pale and complains of feeling tired. The patient's heart rate is 98 beats/min,
respirations are 20 breaths per minute, and the blood pressure is 100/50 mm Hg. The nurse
will contact the provider to:
a.
report possible gastrointestinal
hemorrhage.
b.
request a hemoglobin and hematocrit
(H&H).
c.
request an order for a stool guaiac.
d.
suggest giving a hypertonic fluid bolus.
1. A 12-year-old female patient is admitted to the hospital before sinus surgery. The nurse
preparing to care for this patient notes that the admission hemoglobin is 10.2 gm/dL, and the
hematocrit is 32%. The nurse will ask the child's parents which question about their daughter?
a.
Does she eat green, leafy vegetables? 1d
b.
Has she begun menstruating? 1d
c.
d.
Is she a vegetarian? 1d
Is there a chance she might be pregnant?
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B - most common cause of iron deficiency in female adolescents is due to menstruation
1. The nurse is taking a medication history on a newly admitted patient. The patient reports
taking folic acid and vitamin B12. The nurse notifies the provider because of the concern that
folic acid can:
a.
cause fetal malformation.
b.
mask the signs of vitamin B12 deficiency.
c.
negatively affect potassium levels.
d.
worsen megaloblastic anemia.
● Important to determine degree of B12 deficiency before treating with folic acid
1. The parents of a boy with hemophilia A want to know why their son will receive factor
replacement on an ongoing basis rather than when needed for bleeding episodes. They tell the
nurse that the boy’s grandfather, who had the same disease, received the drug only when he
had bleeding. The nurse will give the parents which information about ongoing therapy?
a.
It can reverse progression of the disease.
b.
It is cheaper, because the amounts of the
drug used are less.
c.
It is used to minimize long-term damage to
the joints.
d.
It prevents the development of inhibitors.
1. A nursing student asks a nurse why patients with chronic renal failure (CRF) have low erythrocyte
counts. Which response by the nurse is correct?
a.
1cDamage to the renal tubules increases
serum blood loss. 1d
b.
1cDialysis accelerates the breakdown of
red blood cells. 1d
c.
1cErythropoietin is no longer produced by
cells in the kidneys. 1d
d.
1cPatients with CRF are deficient in iron,
folic acid, and vitamin B12. 1d
2. The nurse is caring for a patient who begins to complain of shortness of breath. The nurse assesses
the patient and notes 3+ pitting edema bilaterally in the lower extremities. Which medication
taken by the patient causes the most concern?
a.
Epoetin alfa
b.
Filgrastim (granulocyte colony-stimulating
factor)
Oprelvekin (interleukin-11)
Sargramostim (granulocyte-macrophage
colony-stimulating factor)
c.
d.
● Oprelvekin - side effect - retains sodium and water
3. A prescriber has ordered filgrastim (granulocyte colony-stimulating factor) for a patient undergoing
myelosuppressive chemotherapy. The nurse will prepare the patient for which potential side
effect?
a.
Bone pain
b.
Fatigue
c.
Headache
d.
Hemorrhage
● About 25% of patients get bone pain with filgrastim
4. The nurse is preparing to administer a dose of epoetin alfa to a patient and notes that the patient
has a hemoglobin level of 11.7 gm/dL. Which action by the nurse is correct?
a.
Administer the dose as ordered.
b.
Hold the dose and notify the provider.
c.
Request an order for a reduced dose.
d.
Suggest that the provider increase the
dose.
● Above 11 hemoglobin level -> risk of cardiac issues
Chapter 54 PLT
1. A patient with hemophilia is hospitalized for infusion of factor VIII replacement through a
venous port. While giving the drug, the nurse notes that the patient’s temperature is 101.5°F.
The nurse will contact the provider to report which possibility?
a.
Anaphylactic reaction
b.
Contamination of factor replacement
c.
Port infection
d.
Thrombolytic event
● Common side effect with factor VIII
● Not on the exam
2. A patient who is receiving a factor VIII concentrate to treat hemophilia A develops hives, a
low-grade temperature elevation, and a stuffy nose. The nurse will prepare to:
a.
b.
c.
d.
administer subcutaneous epinephrine.
give an antipyretic medication.
give oral diphenhydramine.
provide respiratory support.
● Factor VIII associated with mild allergy reactions → give diphenhydramine
3. A patient with epistaxis and a history of hemophilia A is admitted to the unit and is scheduled
for replacement therapy. The nurse should prepare to administer which medication?
a.
Tranexamic acid [Cyklokapron]
b.
Aminocaproic acid [Amicar]
c.
Desmopressin [Stimate]
d.
Factor VIII
● Factor VIII usually given as replacement therapy
● Desmopressin can be given before surgery
● Exam focus on: Hemophilia A
4. The nurse is conducting a nursing education class on hemophilia. The nurse correctly states
that which characteristics are most likely to be seen in a patient with hemophilia? (Select all
that apply.)
a.
Male gender
b.
Female gender
c.
Mother is a carrier.
d.
All races and ethnicities are susceptible.
e.
Both parents are carriers.