A provider has ordered oral voriconazole [Vfend] which is an azole medication for a patient who has a systemic fungal infection. The nurse obtains a medication history and learns that the patient takes anticoagulant medication Warfarin. The nurse will contact the provider to discuss which possibility?

Choice A reason:
Hepatocellular jaundice occurs due to damage or dysfunction of the liver cells (hepatocytes). This type of jaundice is associated with liver diseases such as hepatitis or cirrhosis, where the liver cannot effectively process bilirubin. It is not directly related to increased red blood cell breakdown but rather to the liver’s inability to handle bilirubin.

Choice B reason:
Hemolytic jaundice results from an increased breakdown of red blood cells, leading to a higher production of bilirubin, which the liver cannot clear fast enough. This condition causes an overload of bilirubin in the blood, resulting in jaundice. Hemolytic jaundice is typically seen in conditions such as hemolytic anemia, where red blood cell destruction exceeds the liver's ability to process and excrete bilirubin.

Choice C reason:
Obstructive jaundice is caused by a blockage in the bile ducts, preventing bilirubin from being excreted into the digestive system. This blockage can result from gallstones, tumors, or strictures. It is not related to the increased breakdown of red blood cells but rather to the obstruction of bile flow, leading to bilirubin buildup in the liver and subsequently in the blood.

Choice D reason:
Metabolic jaundice results from metabolic disorders that affect bilirubin processing or liver function. These disorders can lead to abnormalities in bilirubin metabolism, but they are not directly caused by increased red blood cell breakdown. Metabolic jaundice is less common than other forms and typically involves inherited conditions affecting bilirubin conjugation and excretion.

Choice A reason:
As mentioned earlier, infusion reactions are common with Amphotericin B, including symptoms like fever and chills. Therefore, recognizing that these reactions occur is correct and indicates a proper understanding of the medication's effects.
Choice B reason:
Rapid administration of Amphotericin B is incorrect because it increases the risk of severe side effects. The infusion should be slow to ensure patient safety, indicating that the student needs further teaching on this point. Thus, this choice is incorrect and suggests a misunderstanding.
Choice C reason:
Frequent rotation of the IV site or the use of a central line is standard practice to minimize the risk of phlebitis. This practice is correct and shows that the student understands how to manage the complications associated with Amphotericin B infusion.
Choice D reason:
Amphotericin B's primary use is to treat systemic fungal infections. This is a correct statement, reflecting an accurate understanding of the drug's purpose and does not require further teaching.