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1. The patient is having an acute malarial attack with chills and fever. The nurse knows chills and fever are caused by what?
A) Formation of sporozoites into the system
B) Rupture of red blood cells due to invasion of merozoites
C) Invasion of the tsetse fly into the central nervous system
D) Release of amastigotes into the blood vessels
The chills and fever associated with an acute malarial attack are caused by the rupture of red blood cells containing merozoites. These symptoms are related to the pyrogenic effects of the protozoa and the toxic effects of the red blood cell components on the system. The formation of sporozoites occurs in the stomach of the mosquito when the male and female gametocytes mate and produce a zygote. Invasion of the tsetse fly causes trypanosomiasis, which affects the central nervous system. The release of amastigotes occurs in leishmaniasis, which is caused by the sand fly and is part of a cyclic pattern that causes serious skin lesions.
2. The nurse is caring for a patient of Greek descent who plans to travel to an area of the world in which malaria is endemic. What should this patient be tested for before administering antimalarial medications?
A) Tay-Sachs disease
B) Glucose-6-phosphate dehydrogenase (G6PD) deficiency
D) Penicillin allergy
Patients of Mediterranean descent, including Greeks, are more likely to have a G6PD deficiency. When patients with this deficiency take primaquine, chloroquine, or quinine, an acute hemolytic crisis may occur. Patients of Mediterranean descent should be tested for G6PD deficiency before any antimalarial drugs are prescribed. Tay-Sachs disease is a disorder seen in those of middle-eastern descent that causes death of the child by age 5. Plasmodium is the genus strain that causes malaria. Penicillin allergy has no connection to this situation.
3. The nurse is caring for a patient who is being treated with quinine (Qualaquin) for drug-resistant malaria. The nurse will monitor the patient for cinchonism that will present with what manifestations?
A) Diarrhea, nausea, and fever
B) Yellowing of the sclera and skin
C) Tremors and ataxia
D) Vomiting, tinnitus, and vertigo
Patients with cinchonism or quinine toxicity may complain of tinnitus, headache, dizziness, nausea, fever, tremors, and visual disturbances. Diarrhea, yellowing of the sclera or skin, and ataxia are not associated with cinchonism.
4. Patients receiving chloroquine (Aralen Phosphate) for malaria prophylaxis should receive patient teaching from the nurse, which includes instructions to receive what regularly?
A) Cardiovascular studies
B) Eye exams
D) Pulmonary studies
Chloroquine is associated with visual disturbances and a patient receiving this drug should receive regular ophthalmic exams. Heart and lung toxicity is not associated with chloroquine use. Immunizations are not associated with chloroquine use.
5. A 28-year-old woman is planning to be part of a mission team going to Central Africa. She will take mefloquine (Lariam) once a week, beginning 1 week before traveling to Africa until 4 weeks after leaving Africa. What precaution will the nurse teach this patient is needed?
A) Avoid excessive weight gain.
B) Have regular cancer screening.
C) Use contraceptives to avoid pregnancy.
D) Stop the medication if diabetes is diagnosed.
Mefloquine is teratogenic and should be avoided during pregnancy. The nurse will want to determine whether a possibility exists that the patient is pregnant and warn about the need to avoid pregnancy for 2 months after completing therapy. Avoiding weight gain and having regular cancer screenings are good preventive care but not associated with mefloquine. This medication is not contraindicated in patients with diabetes.
6. The nurse is writing a plan of care for a patient receiving antimalarial drug therapy. What nursing diagnosis would be appropriate for this patient if common adverse effects were indicated?
A) Disturbed sensory perception (visual) related to central nervous system effects
B) Imbalanced nutrition: more than body requirements
D) Ineffective breathing pattern
Visual disturbances, including blindness related to retinal damage from the drug, may occur. Patients usually have gastrointestinal (GI) upset including diarrhea, not constipation, which could produce loss of weight and not an increase. Respiratory disturbances are not associated with antimalarial agents.
7. During a lecture on intestinal parasites, the students learn that what is the most commonly diagnosed intestinal parasite infection in the United States?
The most commonly diagnosed intestinal parasite in the United States is Giardiasis. It is transmitted through contaminated water or food. Amebiasis is found in the United States but is not the most common. Leishmaniasis is transmitted through sand flies, which are not common in the United States. Trichomoniasis is a flagellated protozoan and most often is seen in the vagina and is spread during sexual intercourse by men who have no signs and symptoms of infection, it is not the most commonly diagnosed.
8. A patient has been diagnosed with trichomoniasis. Before beginning tinidazole (Tindamax) therapy, what should the nurse question the patient about?
A) Working conditions
B) Use of alcohol
C) Recent visit to a beach or desert
D) Possibly having AIDS
Tinidazole is prescribed for trichomoniasis, which is transmitted during sexual intercourse. The drug should not be used when there is a history of alcohol use. Alcohol use could interfere with the drugs metabolism in the liver and cause toxicity and patients should be warned to avoid consuming all alcoholic beverages while taking this medication. There is no need to question about working conditions unless transmission involved environmental contamination of food and water, which is not indicated by the question. A recent visit to a beach or desert would be indicated if the patient was diagnosed with leishmaniasis and questioning the patient concerning AIDS would be indicated if the patient had a diagnosis of Pneumocystis carinii pneumonia and would not involve trichomonas.
9. The nurse is caring for a patient with acquired immunodeficiency syndrome (AIDS) who has been diagnosed with Pneumocystis jiroveci pneumonia. The patient is taking multiple oral agents to treat AIDS. What would be the drug of choice for this patient?
A) Nitazoxanide (Alinia)
Pentamidine is available as an inhalation product for the direct treatment of P. jiroveci in patients with AIDS. Because the patient is already taking multiple oral drugs, inhaler administration would be the best choice. Nitazoxanide, chloroquine, and metronidazole are not effective against P. jiroveci pneumonia.
10. A patient with giardiasis is being treated with metronidazole. What comment by the patient would indicate that the nurse needs to provide further teaching?
A) I can continue to work delivering pizza because the disease is not contagious.
B) I will not lose my hair during drug therapy.
C) I know I will experience diarrhea during this time.
D) I shouldnt experience irregular menstrual periods.
Although giardiasis is not contagious, the patient should be encouraged not to drive or operate heavy equipment until the effects of the drug can be assessed because metronidazole can lead to central nervous system adverse effects, including dizziness and lack of coordination. The drug may also cause diarrhea. Loss of hair and irregular menstrual periods are not associated with this drug, so these statements would be correct and would not indicate the need for further teaching.
11. During treatment of amebiasis with chloroquine (Aralen Phosphate), the nurse assesses the patient for what adverse effects?
B) Weight gain
With amebicides, observe for anorexia, nausea, vomiting, epigastric burning, and diarrhea that can lead to malnutrition and significant weight loss, which the nurse assesses for with each visit to intervene before significant malnutrition occurs. Weight gain, hypertension, or seizures are not associated adverse effects.
12. The clinic nurse provides teaching for a patient prescribed pyrimethamine (Daraprim) to prevent malaria and instructs on the need to notify the prescriber immediately if what signs and symptoms occur?
A) Diarrhea, fatigue, weight loss, and anemia
B) Irritation, rash, or inflammation
C) Headache, nausea, or constipation
D) Anorexia, nausea, or vomiting
If signs of folate deficiency develop, pyrimethamine will need to be discontinued so the prescriber needs to be notified immediately. Folate deficiency presents with diarrhea, fatigue, weight loss, and anemia. The other signs and symptoms would need to be reported if significant and/or long-lasting.
13. The mother of a 6-month-old infant comes to the clinic. The mother is diagnosed with a protozoal infection. What would be a priority for the nurse to assess for?
A) Whether she is breast-feeding
B) Whether she has a support network
C) Whether she has money to pay for the medication
D) Whether she eats a protein-rich diet
Assess for lactation because antiprotozoal drugs could enter the breast milk and be toxic to the infant. The other options are part of a complete nursing history but do not specifically relate to treatment for a protozoal infection.
14. A patient is prescribed mefloquine (Lariam) for malaria prophylaxis. When should the nurse instruct mefloquine be started?
A) 1 week prior to entering an endemic area
B) 1 to 2 days prior to entering an endemic area
C) On arrival to an endemic area
D) When mosquitoes are present
Lariam should be taken 1 week prior to entering a malarial area. Therefore, options B, C, and D are incorrect.
15. What statements made by the 36-year-old patient leads the nurse to believe that he or she has understood the teaching regarding metronidazole (Flagyl)?
A) I will refrain from operating heavy machinery while I am taking this medication.
B) I will avoid foods high in vitamin C.
C) I will not drink alcohol while I am taking this medication.
D) I will contact my physician if I have a cold.
Patients should avoid all forms of alcohol while taking metronidazole. Patients do not need to avoid operating heavy machinery,and foods high in vitamin C, and will not contact the physician if they have colds.
16. The emergency room nurse admits a patient suspected of having giardiasis. What symptoms would the nurse expect the patient to present with?
A) Voluminous soft unformed stool
B) Frothy voluminous pale stool
C) Pale and mucous-filled stool
D) Frothy tan stool
Diarrhea, rotten-egg-smelling stool, and pale and mucous-filled stool are commonly seen. Diarrhea is often accompanied by epigastric distress, weight loss, and malnutrition as a result of the invasion of the mucosa. Therefore, options A, B, and D are incorrect.
17. A 91-year-old man is being treated for Pneumocystis carinii pneumonia with pentamidine (NebuPent). What should the nurse measure when assessing this patient for adverse effects of the medication?
A) Liver function tests
B) Serum potassium
C) Daily blood pressure
D) Blood urea nitrogen (BUN) and creatinine
Patients receiving antiprotozoal agents should be monitored regularly to detect any serious adverse effects. Liver function tests are of particular importance to determine the appropriateness of therapy and to monitor for toxicity. Serum potassium, BUN, and creatinine would indicate kidney damage, which is not normally a risk with this drug. Blood pressure is not indicated for this medication but is an early indicator of health deterioration and is usually included in all provisions of care.
18. What is the priority teaching point to be provided by the nurse to a patient being treated for trichomoniasis to prevent reinfection?
A) Meats should be fully cooked before eaten.
B) Sexual partners should be treated.
C) Wash hands before eating.
D) Purify all drinking water when camping.
Trichomoniasis is usually spread during sexual intercourse and men often have no symptoms. Women present with red, inflamed vaginal mucosa, itching, burning, and a yellowish green discharge. Women should be taught the importance of having their partners tested and treated simultaneously to prevent reinfection. The other options are healthy lifestyle choices but are not the primary means of preventing reinfection.
19. How does the nurse teach the patient to take chloroquine (Aralen Phosphate)?
A) On an empty stomach
B) With 8 ounces of water
C) With meals
D) With orange juice followed by 8 ounces of water
Chloroquine should be taken with meals to reduce gastrointestinal (GI) upset; small frequent meals may also reduce negative GI effects. Taking medications, any medication, with adequate amounts of water is always good practice but not specific to this medication. There is no indication that ingestion of orange juice makes any practical difference.
20. The nurse, learning about malaria, discovers that the transmission of malaria occurs when what is injected into the human body by the infected mosquito?
Gametocytes are sucked with the blood from an infected person by the mosquito. The gametocytes mate in the stomach of the mosquito and produce a zygote that goes through several phases before forming sporozoites (spore animals) that make their way to the mosquitos salivary glands. The next person who is bitten by that mosquito is injected with thousands of sporozoites. Schizonts are the primary tissue organisms resulting from asexual cell division and reproduction after the sporozoites are introduced into the body. Merozoites are then formed from the primary schizonts.
21. The nurse is caring for a patient who is taking antimalarial medications. The nurse teaches the patient about the medication and explains the need to report what signs and symptoms immediately because of its association with a serious adverse effect?
A) Loss of appetite
B) Loss of hair
C) Loss of vision
D) Loss of sensation
Report blurring of vision, which could indicate retinal damage; loss of hearing or ringing in the ears, which could indicate central nervous system toxicity; and fever or worsening of condition, which could indicate a drug-resistant strain or noneffective therapy. Loss of appetite is such a common result of the gastrointestinal (GI) effects of the drug that the nurse should provide anticipatory guidance to teach the patient how to maintain adequate nutrition, but the patient does not need to report this unless it becomes serious or unmanageable. Loss of sensation is not a typical adverse effect the nurse would anticipate and teach about.
22. The nurse is caring for a patient who just returned from a trip to South America and was infected by the protozoan Trypanosoma cruzi. What will the nurse assess for in this patient?
A) Serious lesions in the skin
B) Sleeping sickness
C) Severe cardiomyopathy
D) Yellowish green vaginal discharge
Chagas disease, which is caused by T. cruzi, is passed to humans by the common house fly. This protozoan results in a severe cardiomyopathy that accounts for numerous deaths and disabilities in certain regions. Sleeping sickness results from T. brucei gambiense; leishmaniasis produces serious lesions in the skin, and trichomoniasis produces a yellowish green discharge.
23. A patient with malaria is taking primaquine. What would indicate to the nurse caring for this patient that the patient has cinchonism?
B) Abdominal cramping
C) Tan, frothy stool
Cinchonism (nausea, vomiting, tinnitus, and vertigo) may occur with high levels of primaquine. Symptoms of cinchonism do not include diarrhea, abdominal cramping, or tan, frothy stool.
24. A patient has been prescribed an antimalarial as prophylaxis for the disease. What assessment finding would the nurse recognize as indicating the patient has a common adverse effect?
C) Tarry stool
Nausea, vomiting, dyspepsia, and anorexia are associated with direct effects of the antimalarial medications on the GI tract and the effects on central nervous system control of vomiting caused by the products of cell death and protein changes. Adverse effects from antimalarial drugs do not usually include hematemesis, tarry stool, or tachycardia.
25. A patient presents at the emergency department complaining of sudden onset of high fever and swelling and reddening of the limbs. Assessment shows severe hypotension. The nurse taking the patients history notes that the patient has recently returned to the United States from the African continent. The patient is admitted to the intensive care unit (ICU) suspected of having malaria caused by what protozoan?
A) Plasmodium ovale
B) Plasmodium falciparum
C) Plasmodium vivax
D) Plasmodium malariae
P. falciparum is considered to be the most dangerous type of protozoan. Infection with this protozoan results in an acute, rapidly fulminating form of the disease with high fever, severe hypotension, swelling and reddening of the limbs, loss of red blood cells, and even death. The other options are pathogens that cause milder forms of the disease and P. ovale is rarely encountered.
26. Pyrimethamine (Daraprim) has been ordered for the patient as prophylactic treatment of malaria. The nurse recognizes the action of this drug prevents relapse of the disease by acting on what?
A) Changing the metabolic pathways for reproduction
B) Disrupting the mitochondria of the plasmodium
C) Blocking the use of folic acid
D) Increasing the acidity of plasmodial food vacuoles
Pyrimethamine is used in combination with agents that act more rapidly to suppress malaria; it acts by blockings the use of folic acid in protein synthesis by the plasmodium, eventually leading to inability to reproduce and cell death. Chloroquine changes the metabolic pathways for reproduction of the plasmodium and is toxic to parasites that absorb it. Primaquine disrupts the mitochondria of the plasmodium. Mefloquine increases the acidity of plasmodial food vacuoles causing cell rupture and death.
27. A patient, recently returned from a vacation in the tropics, is diagnosed with leishmaniasis. The patient asks the nurse how he or shes got this disease. What is the nurses best response?
A) You got this disease from a mosquito bite.
B) You got this disease from unsanitary drinking water.
C) You got this disease from eating unsanitary food.
D) You got this disease from the bites of sand flies.
Leishmaniasis is a disease caused by a protozoan that is passed from sand flies to humans. Therefore, options A, C, and D are incorrect.
28. The patient, newly diagnosed with African sleeping sickness, asked what caused the disease. What is the nurses best response?
A) Trypanosoma brucei gambiense
B) Giardia lamblia
D) Trypanosoma cruzi
African sleeping sickness, which is caused by Trypanosoma brucei gambiense, is transmitted by the tsetse fly. After the pathogenic organism has lived and grown in human blood, it eventually invades the central nervous system, leading to acute inflammation resulting in lethargy, prolonged sleep, and even death. G. lamblia causes giardiasis; T. cruzi causes Chagas disease. A promastigote is a flagellated protozoan that causes leishmaniasis.
29. The patient, a physician returning from a trip to the tropics, is prescribed chloroquine and asks the nurse how it works. What is the nurses best response?
A) Blocks the plasmodiums ability to synthesize ribonucleic acid
B) Changes the metabolic pathways necessary for the reproduction of the plasmodium
C) Interrupts the cell wall preventing entry of nutrients into the plasmodium
D) It is alkaline and decreases the ability of the parasite to synthesize deoxyribonucleic acid (DNA).
Chloroquine is currently the mainstay of antimalarial therapy. This drug enters human red blood cells and changes the metabolic pathways necessary for the reproduction of the plasmodium (see Figure 12.1). In addition, this agent is directly toxic to parasites that absorb it, it is acidic, and it decreases the ability of the parasite to synthesize DNA, leading to a blockage of reproduction.
30. What antimalarial medication is used as a radical cure of Plasmodium vivax malaria?
Primaquine (generic) is the only drug indicated for the prevention of relapses of P. vivax and P. malariae infections and a radical cure of P. vivax malaria. It may be given in combination with other drugs that interrupt the cell cycle at other stages. None of the other options are indicated for this use.
31. The nurse, working in a pediatric clinic, admits a patient who will be traveling to a country where malaria is endemic. What is the safest treatment for this child?
A) No prophylaxis is administered because of the severity of adverse effects.
B) Call the Centers for Disease Control and Prevention (CDC) or local health department for the safest possible treatment.
C) Administer extremely small doses of chloroquine.
D) Any antimalarials in appropriate dosages can be administered.
Although dosages for prophylaxis have been calculated to treat malaria in children, many drugs have not been proven to be safe and efficient in that population and extreme caution is needed .If a child needs to travel to an area with endemic protozoal infections, the CDC or local health department should be consulted about the safest possible preventive measures. As a result, the other options are incorrect.
32. What statement, if made by the nurse, would be correct?
A) Malaria can live without a host and be contracted from drinking standing water.
B) Any mosquito can carry the plasmodium that transmits malaria.
C) A major problem with controlling malaria is the mosquito that is resistant to insecticide.
D) Widespread efforts at mosquito control have never been helpful.
Widespread efforts at mosquito control have been successful, with fewer cases of malaria being reported each year. However, the rise of insecticide-resistant mosquitoes has allowed malaria to continue to flourish, increasing the incidence of the disease. Malaria requires a host to live, whether it is human or mosquito. Only the female Anopheles mosquito harbors the protozoal parasite and carries it to humans.
33. The nurse is caring for a patient diagnosed with amebiasis caused by Entamoeba histolytica that resulted in the patient having amebic dysentery. What questions might the nurse ask in an attempt to discover how the patient came in contact with the organism? (Select all that apply.)
A) Have you traveled outside the country recently?
B) Have you been swimming in a lake or pond recently?
C) Have you been eating fresh fruits or vegetables without washing them first?
D) Have you been bitten by a mosquito?
E) Have you had unprotected sex recently?
Ans: A, B, C
The disease is transmitted while the protozoan is in the cystic stage in fecal matter, from which it can enter water and soil. It can be passed to other humans who drink this water or eat food that has been grown in this ground. It is not passed by a mosquito or from sexual activity.
34. The nurse explains that the drugs metronidazole (Flagyl) or tinidazole (Tindamax) can be administered to treat what protozoan infections? (Select all that apply.)
D) Pneumocystis carinii pneumonia
E) Cryptosporidium parvum
Ans: A, B, C
Metronidazole or tinidazole are effective treatments for trichomoniasis, giardiasis, and amebiasis. They are not effective for P carinii pneumonia or C. parvum.
35. How does the nurse adapt the plan of care when caring for an older adult receiving an antiprotozoal agent?
A) Patients should be monitored more closely for toxic adverse effects.
B) The drug dosage should be lowered for all older adults.
C) Antiprotozoal agents should not be administered to older adults.
D) Female patients of appropriate age should be advised to use barrier contraceptives.
Older patients may be more susceptible to the adverse effects associated with these drugs. They should be monitored closely. Dosage should only be lowered if the patient has hepatic dysfunction or if hepatic dysfunction is anticipated. Antiprotozoal agents can be administered to older adults with caution when the benefit outweighs the risk. It is not necessary for older adult women to use barrier methods of contraceptives because they are no longer of childbearing age.
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