The nurse is administering an amphotericin B infusion. Which actions by the nurse are appropriate? (Select all that apply)
Using an infusion pump for IV therapy
Discontinuing the drug immediately if the patient develops tingling and numbness in the extremities
If adverse effects occur, reducing the IV rate gradually until they subside
Administering the medication by rapid IV infusion
Monitoring the IV site for signs of phlebitis and infiltration
Correct Answer : A,B,E
Choice A reason: Using an infusion pump ensures precise delivery of amphotericin B, which requires controlled infusion rates to minimize toxicity. Amphotericin B’s nephrotoxic and infusion-related reactions (e.g., fever, chills) necessitate accurate dosing, as rapid administration increases adverse effects, making pumps essential for safe administration.
Choice B reason: Discontinuing amphotericin B for tingling and numbness is appropriate, as these may indicate neurotoxicity or severe infusion reactions. Stopping the infusion prevents further exposure, allowing assessment of potential electrolyte imbalances or neurological damage, ensuring patient safety during this high-risk antifungal therapy.
Choice C reason: Reducing the IV rate for adverse effects like fever or chills may be appropriate, but tingling and numbness require immediate discontinuation, as they suggest serious toxicity. Rate reduction is insufficient for neurological symptoms, which demand urgent evaluation to prevent irreversible harm, making this action less prioritized.
Choice D reason: Rapid IV infusion of amphotericin B is inappropriate, as it increases the risk of nephrotoxicity and infusion reactions. Slow, controlled infusion over several hours minimizes toxicity, as amphotericin B’s binding to ergosterol causes systemic effects that worsen with faster administration, making this incorrect.
Choice E reason: Monitoring the IV site for phlebitis and infiltration is essential, as amphotericin B is irritating to veins. Phlebitis or extravasation can cause tissue damage, and regular site checks ensure proper drug delivery and prevent complications, supporting safe administration of this potent antifungal.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Valerian, used for sleep disorders, has no significant interaction with anticoagulants like warfarin. It may cause sedation but does not affect hepatic CYP450 enzymes or vitamin K-dependent clotting factors, making it safe for patients on anticoagulant therapy, with no impact on bleeding risk or drug metabolism.
Choice B reason: St. John’s wort induces hepatic CYP450 enzymes, particularly CYP3A4, accelerating warfarin metabolism. This reduces warfarin’s anticoagulant effect, decreasing INR and increasing thrombosis risk. Patients must avoid it to maintain therapeutic anticoagulation, making this a critical herbal interaction to report.
Choice C reason: Saw palmetto, used for prostate health, has minimal interaction with anticoagulants. It does not significantly affect CYP450 enzymes or clotting factor synthesis. While it may have mild antiplatelet effects, it is not a primary concern for warfarin therapy compared to St. John’s wort’s enzyme induction.
Choice D reason: Soy has no significant interaction with anticoagulants like warfarin. It does not affect hepatic metabolism or vitamin K-dependent clotting factors. While dietary vitamin K can influence warfarin, soy’s impact is minimal, making it less critical to avoid compared to enzyme inducers like St. John’s wort.
Correct Answer is A
Explanation
Choice A reason: Fluticasone/salmeterol is a combination of an inhaled corticosteroid and a long-acting beta-2 agonist used for maintenance therapy to prevent bronchospasms in asthma or COPD. Fluticasone reduces inflammation, while salmeterol provides sustained bronchodilation, making it effective for long-term control, not acute relief.
Choice B reason: Using a spacer with fluticasone/salmeterol is not mandatory, though it may improve drug delivery in some patients. Spacers enhance lung deposition for metered-dose inhalers, but this combination is often delivered via dry powder inhalers, which do not require spacers, making this statement inaccurate.
Choice C reason: Avoiding water for 1 hour after using fluticasone/salmeterol is unnecessary. Patients should rinse their mouth after inhalation to prevent oral thrush, but water restriction is not required. The drug’s local action in the lungs is unaffected by oral hydration, making this instruction incorrect.
Choice D reason: Fluticasone/salmeterol is not indicated for acute therapy. Its slow onset (salmeterol takes 20-30 minutes) makes it unsuitable for acute bronchospasm. It is used for maintenance to prevent symptoms, while short-acting beta-agonists like albuterol are used for acute asthma or COPD exacerbations.
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