Unit5: Chapter 13 (Karch 7th Ed) - Anthelmintic Agents 1.

Question 1

1. A public health nurse is speaking to parents of first graders. When discussing worm infection, the nurse
   will explain that the most common type found in U.S. school-aged children is what?
   A) Pinworms
   B) Roundworms
   C) Threadworms
   D) Whipworms

Answer 1

Ans: A
Feedback:
The most common worm infection encountered in U.S. school-aged children is pinworms. These
worms are endogenous to the area and easily spread. Roundworms, whipworms, and threadworms are
not as common.

Question 2

2. A mother of a 3-year-old child brings her child to the clinic. The child is diagnosed with pinworms.
   What drug would be the best choice for the patient?
   A) Pyrantel (Pin-Rid)
   B) Ivermectin (Stromectol)
   C) Mebendazole (Vermox)
   D) Albendazole (Albenza)

Answer 2

Ans: C
Feedback:
Mebendazole is the most commonly used anthelmintic for pinworms because it is available in a
chewable tablet. This is a good choice for the 3-year-old patient. Pyrantel is also prescribed for
pinworms but is not available in a chewable form. Ivermectin is prescribed for treatment of threadworm
disease and albendazole is given to treat active lesions caused by pork tapeworm and cystic disease of
the liver, lungs, and peritoneum caused by dog tapeworm.

Question 3

3. A nurse is teaching a young mother about administering pyrantel (Pin-Rid, others) to her 5-year-old
   child. What will the nurse emphasize about how the agent is given?
   A) In 3 doses as a 1-day treatment
   B) In a morning dose and an evening dose for 3 days
   C) B.I.D. for 10 days
   D) Give only once

Answer 3

Ans: D
Feedback:
Pyrantel is administered orally as a single dose. Albendazole is prescribed for hydatid disease and is
given twice a day for 8 to 30 days of treatment. Mebendazole is used in the treatment of diseases
caused by pinworms, roundworms, whipworms, and hookworms and is given in a morning and evening
dose for 3 days. Praziquantel is used to treat schistosomes and is taken in three doses as a 1-day
treatment.

Question 4

4. A patient has been diagnosed with roundworms and is to be treated with albendazole. A priority nursing
   assessment of this patient would be to determine if the patient is taking what?
   A) Cimetidine (Tagamet)
   B) Pioglitazone (Actos)
   C) Alprazolam (Xanax)
   D) Loperamide (Imodium

Answer 4

Ans: A
Feedback:
The adverse effects of albendazole, which are already severe, may increase if the drug is combined with
dexamethasone, praziquantel, or cimetidine. These combinations should be avoided if at all possible; if
they are necessary, patients should be monitored closely for the occurrence of adverse effects.
Pioglitazone is an oral antidiabetic agent that could be taken with albendazole. Loperamide is an
antidiarrheal drug that may be used for treatment of diarrhea as a result of the mebendazole and
pyrantel. Alprazolam should not be a concern.

Question 5

5. What would be a priority nursing action related to the care of a patient taking albendazole (Albenza)?
   A) Check blood pressure, pulse, and respirations
   B) Weigh the patient
   C) Monitor renal function
   D) Encourage small, frequent meals

Answer 5

Ans: C
Feedback:
It is important that the patient’s kidney function be monitored because a serious adverse effect of this
drug is renal failure. Even though vital signs, weight, and nutrition are important and should be
monitored, if the patient exhibits any signs of renal failure the drug should be stopped immediately.

Question 6

6. The nurse is caring for an adult patient receiving a prescription for an anthelmintic drug. What is a
   possible nursing diagnosis for this patient?
   A) Constipation
   B) Disturbed body image
   C) Acute confusion
   D) Imbalanced nutrition: More than body requirements

Answer 6

Ans: B
Feedback:
A potential nursing diagnosis for the patient would be disturbed body image related to diagnosis and
treatment. There is a stigma associated with having helminthic infections. Treatment can cause
diarrhea, loss of hair, and pruritus, which could be noticed by others and further impact the patient’s
body image. Usually these drugs do not cause constipation; they have not been linked to confusion

Question 7

7. A nurse is teaching a patient who has been diagnosed with trichinosis. The nurse will include in the
   discussion that trichinosis is caused by roundworms having what effect?
   A) Disruption of the host’s normal cellular functions causing cell death and resulting in disease
   B) Invasion of body tissues seriously damages lymphatic tissue, lungs, the central nervous system,
   heart, and liver
   C) Exposure to the delicate mucous membranes of the anus and colon producing local irritation
   D) Easily passed from one individual to another resulting in rapid spreading within a work place

Answer 7

Ans: B
Feedback:
Trichinosis is a disease caused by the ingestion of the encysted larvae of the roundworm from
undercooked pork. These worms exist outside the intestinal tract and can seriously damage the tissues
they invade. The worms do not spread rapidly through a large group of people unless they have all
eaten the undercooked pork. They do not enter cells to alter human cellular function.

Question 8

8. When instructing a patient about the therapeutic effectiveness of an anthelmintic drug, the nurse would
   be sure to include what?
   A) Any person exposed to the patient should also be treated.
   B) The drugs should never be taken with food.
   C) The infected person should be isolated.
   D) Strict hygiene measures are important in eradicating the worm.

Answer 8

Ans: D
Feedback:
When treating a patient with an anthelmintic drug, the patient should be instructed to follow strict hand
washing and hygiene measures as an adjunct in eradicating the worm. Isolation is not necessary and
prophylactic treatment is not effective with worms. Anthelmintics are often taken with food to decrease
the gastrointestinal (GI) adverse effects.

Question 9

9. The nurse is caring for a patient diagnosed with hookworms. The patient is receiving mebendazole
   (Vermox). What would the nurse expect to see in this patient?
   A) Increased bilirubin
   B) Decreased hematocrit and hemoglobin
   C) Increased aspartate transaminase levels
   D) Decreased blood sugar

Answer 9

Ans: B
Feedback:
Hookworms can cause anemia and fluid and electrolyte imbalances because of the amount of blood that
is sucked from the walls of the intestine. A decreased hematocrit and hemoglobin would indicate
anemia and is often found in patients with hookworm. Bilirubin and aspartate transaminase indicate
liver function. Because mebendazole is not absorbed systemically, adverse effects are limited to
abdominal effects such as discomfort, diarrhea, or pain so this drug would not impact bilirubin or
aspartate transaminase levels. Neither the disease nor drug should decrease blood sugar.

Question 10

10. A patient is taking an anthelmintic that is absorbed systemically. What adverse effect should the nurse
inform the patient might be experienced?
A) Abdominal discomfort
B) Diarrhea
C) Loss of hair
D) Pain

Answer 10

Ans: C
Feedback:
Anthelmintics that are absorbed systemically could cause headache, dizziness, fever, shaking, chills,
malaise, pruritus, and loss of hair. Mebendazole and pyrantel are anthelmintics that are not generally
absorbed systemically and may cause abdominal discomfort, diarrhea, and pain.

Question 11

11. A mother brings her child to the clinic where the child is diagnosed with hookworms. The mother asks
    how the child got hookworms. What would the nurse tell the mother is the route of entry for
    hookworm?
    A) Inhalation
    B) Contact with skin
    C) Ingestion of undercooked foods
    D) Blood-borne exposure

Answer 11

Ans: B
Feedback:
The larvae penetrate the skin and then enter the blood and within about a week, reach the intestine.
Inhalation, ingestion, and blood-borne exposure are incorrect.

Question 12

12. A patient is diagnosed with an ascaris infection. The patient asks what the best way is to prevent ascaris infections. What is the nurse’s best response?
    A) Wash hands before eating.
    B) Do not share hairbrushes or hats.
    C) Wash fresh fruits and vegetables before eating.
    D) Avoid heavily populated areas.

Answer 12

Ans: C
Feedback:
Ascaris infection occurs where sanitation is poor. Eggs in the soil are ingested with vegetables or other
improperly washed foods containing the worm. The patients may be unaware until a worm in their stool
is seen or the patient becomes quite ill. Teaching patients the importance of washing fresh fruit and
vegetables will help them reduce risk of infection. Washing hands, avoiding sharing hairbrushes or
hats, and being aware in populated areas will reduce the risk of other infections but do not relate to
ascaris.

Question 13

13. What is an appropriate nursing diagnosis for a patient with tapeworm?
    A) Imbalanced nutrition: less than body requirements
    B) Chronic pain
    C) Constipation
    D) Impaired mobility

Answer 13

Ans: A
Feedback:
Tapeworm affects the body’s ability to absorb food products and weight loss and malnutrition often
follow unless treatment is received promptly. As a result, the best nursing diagnosis is imbalanced
nutrition: less than body requirements. Patients with tapeworm are often symptom-free but may
experience some abdominal discomfort and distention as well as weight loss so they do not have
chronic pain, constipation, or impaired mobility.

Question 14

14. Why is it important for a nurse to inquire about any foreign travel of a patient with a suspected
    lymphatic or hematologic disorder?
    A) To determine the varied sexual history of the patient, if any
    B) To determine the potential exposure to infectious agents
    C) To determine whether the patient has had any blood transfusions
    D) To determine whether the patient adopted any specific dietary habits

Answer 14

Ans: B
Feedback:
Knowledge of recent travel can help the nurse to pinpoint potential exposure to helminths, parasites, or
other infection exposure common in the area visited. The nurse should specifically ask about foreign
travel to countries where malaria or parasitic roundworms are common. Sexual history, dietary habits,
or any blood transfusions that the patient may have had before would not be adequately explored by
questioning travel history.

Question 15

15. What helmintic infestation occurs in tropical areas and is carried by snails?
A) Schistosomiasis
B) Platyhelminths
C) Trichinosis
D) Filariasis

Answer 15

Ans: A
Feedback:
Schistosomiasis is a common problem in many tropical areas where the snail that is necessary in the life
cycle of the fluke lives. Trichinosis is caused by eating undercooked pork and can occur in any part of
the world. Filariasis and platyhelminths are not restricted to tropical areas.

Question 16

16. The nursing instructor is discussing helmintic infections with the nursing students. How would the
    instructor explain the action of anthelmintic drugs?
    A) Destroy the nervous system of the invading worm
    B) Act on metabolic pathways that are present in the invading worm
    C) Interfere in the reproductive cycle of the invading worm
    D) Cause fatal mutations in the deoxyribonucleic acid of the invading worm

Answer 16

Ans: B
Feedback:
The anthelmintic drugs act on metabolic pathways that are present in the invading worm, but that are
absent or significantly different in the human host. Other options are incorrect descriptions of how
anthelmintic drugs work.

Question 17

17. What anthelmintics would the nurse expect will be readily absorbed from the gastrointestinal (GI)
tract? (Select all that apply.)
A) Mebendazole
B) Pyrantel
C) Albendazole
D) Praziquantel
E) Ivermectin

Answer 17

Ans: D, E
Feedback:
Praziquantel and ivermectin are readily absorbed from the GI tract. Mebendazole, pyrantel, and
albendazole are not.

Question 18

18. A mother brings her 18-month-old son into the clinic. The child is diagnosed with pinworms. Which
    anthelmintic would the nurse expect to be prescribed?
    A) Pyrantel
    B) Mebendazole
    C) Ivermectin
    D) Praziquantel

Answer 18

Ans: B
Feedback:
Mebendazole is available in the form of a chewable tablet that would be preferable for a young child. Because little of the drug is absorbed systemically, it is safe for children and has few adverse effects,
thus making it safer to administer to a child. Pyrantel is not approved for children younger than 2 years
old. Ivermectin and praziquantel effects are systemic and would a greater number of adverse effects.

Question 19

19. The nurse is caring for a 26-year-old patient diagnosed with roundworms who is prescribed pyrantel.
    What adverse effect would the nurse teach the patient about?
    A) Vomiting
    B) Itching
    C) Diarrhea
    D) Constipation

Answer 19

Ans: C
Feedback:
Mebendazole and pyrantel, which are not absorbed systemically, may cause abdominal discomfort,
diarrhea, or pain, but have very few other effects and are well-tolerated. Therefore options A, B, and D
are incorrect.

Question 20

20. The nurse is caring for a patient taking albendazole. When reviewing the patient’s medication history
    what drug would cause the nurse to question administering albendazole?
    A) Propranolol
    B) Fexofenadine
    C) Furosemide
    D) Dexamethasone

Answer 20

Ans: D
Feedback:
The effects of albendazole, which are already severe, may increase if the drug is combined with
dexamethasone, praziquantel, or cimetidine. These combinations should be avoided if at all possible; if
they are necessary, patients should be monitored closely for occurrence of adverse effects. No
contraindications are noted for propranolol, fexofenadine, or furosemide.

Question 21

21. Why is a filariae infestation potentially fatal?
    A) Worm-like embryos overwhelm the lymphatic system
    B) Worm-like embryos invade the central nervous system (CNS)
    C) Worm-like embryos destroy the gastric mucosa
    D) Worm-like embryos hibernate in the brain

Answer 21

Ans: A
Feedback:
Filariasis refers to infection of the blood and tissues of healthy individuals by worm embryos, which
enter the body via insect bites. These thread-like embryos, or filariae, can overwhelm the lymphatic
system and cause massive inflammatory reactions. While any system can be impacted due to the effect
on the blood and lymphatic system, the filariae do not invade the CNS, gastric mucosa, or the brain
specifically.

Question 22

22. The nurse is caring for a patient diagnosed with threadworm infestation. What is the nurse’s priority
    assessment related to common manifestations of this infestation?
    A) Gastroenteritis
    B) Pneumonia
    C) Hematuria
    D) Tarry stools

Answer 22

Ans: B
Feedback:
Threadworm is a pervasive nematode that can send larvae into the lungs, liver, and central nervous
system and can cause severe pneumonia or liver abscess. Threadworms do not cause gastroenteritis,
hematuria, or tarry stools.

Question 23

23. What infestation would the nurse suspect when the patient manifests with intestinal obstruction caused
    by the adult worms clogging the lumen of the intestine?
    A) Platyhelminth
    B) Trichinosis
    C) Nematode
    D) Cestode

Answer 23

Ans: C
Feedback:
Nematode are roundworms such as the commonly encountered pinworm, whipworm, threadworm,
Ascaris, or hookworm that cause a common helminthic infection in humans and can cause intestinal
obstruction as the adult worms clog the intestinal lumen or severe pneumonia when the larvae migrate
to the lungs and form a pulmonary infiltrate. Options A, B, and D are incorrect.

Question 24

24. The nurse is caring for a 17-year-old girl who has just been diagnosed with a tapeworm. What is a
    priority nursing action for this patient?
    A) Monitor hepatic and renal function before and periodically during treatment.
    B) Provide small, frequent, nutritious meals if GI upset is severe.
    C) Instruct the patient about the appropriate dosage regimen.
    D) Offer support and encouragement.

Answer 24

Ans: D
Feedback:
Frequently, patients have a very difficult time dealing with a diagnosis of worm infestation. It is very
important for the nurse to understand the disease process and to explain the disease and treatment
carefully to help the patient to cope with both the diagnosis and the treatment. Options A, B, and C are
correct nursing interventions for this patient, but they are not the priority nursing intervention.

Question 25

25. The nurse is counseling a patient who has been prescribed mebendazole for a worm infestation. What adverse effects would the nurse caution this patient about? A) Fever B) Constipation C) Nausea D) Hematuria

Answer 25

Ans: A Feedback: Mebendazole is not absorbed systemically so it has few adverse effects. Adverse effects include transient abdominal pain, diarrhea, and fever. Adverse effects do not include constipation, nausea, or hematuria.

Question 26

``` 26. When teaching a class of her peers about use of the drug ivermectin, what would the nurse say is the primary route of excretion? A) Urine B) Feces C) Sweat D) Both urine and feces ```

Answer 26

Ans: B Feedback: Ivermectin is readily absorbed from the gastrointestinal (GI) tract and reaches peak plasma levels in 4 hours. It is completely metabolized in the liver with a half-life of 16 hours and excretion is fecal. Options A, C, and D are incorrect.

Question 27

``` 27. Which anthelmintic medication is poorly absorbed from the gastrointestinal (GI) tract and primarily excreted in the urine? A) Ivermectin B) Praziquantel C) Albendazole D) Mebendazole ```

Answer 27

Ans: C Feedback: Albendazole is poorly absorbed from the GI tract, reaching peak plasma levels in about 5 hours. It is metabolized in the liver and primarily excreted in urine. Although praziquantel is excreted in the urine, it is rapidly absorbed from the GI tract. Mebendazole and ivermectin are excreted in feces.

Question 28

28. The nurse is presenting at an educational event about pinworms at the local elementary school during an outbreak of the infestation. What suggestion would the nurse give the attendees to prevent a recurrence of the infestation? A) Tell the children not to share combs and brushes. B) Tell the children not to drink out of other peoples drinks. C) Avoid pajamas in favor of night gowns. D) Shower the children every morning

Answer 28

Ans: D Feedback: Some suggested hygiene measures that might help to control the infection include the following: Keep the child’s nails cut short and hands well scrubbed, because reinfection results from the worm’s eggs being carried back to the mouth after becoming lodged under the fingernails when the child scratches the pruritic perianal area. Give the child a shower in the morning to wash away any ova deposited in the anal area during the night. Change and launder undergarments, bed linens, and pajamas every day. Open gowns, rather than pajamas with pants, would not be the best choice because this would allow for greater perianal scratching.

Question 29

29. An adult presents at the clinic complaining of a cough, fever, abdominal distention, and pain. The patient is diagnosed with pneumonia and a helminth infection. What type of worm would the nurse suspect the patient has? A) Ascaris B) Platyhelminth C) Hookworm D) Schistosomiasis

Answer 29

Ans: A Feedback: Ascaris manifestations include cough, fever, pulmonary infiltrates, abdominal distention, and pain. Platyhelminth is a flatworm that can live in the human intestine or can invade other human tissues causing malnutrition as the worm competes for the food eaten by the human. Hookworms attach to the small intestine leading to severe anemia, lethargy, fatigue, and weakness. Schistosomiasis presents with a rash and then symptoms of diarrhea and liver and brain inflammation

Question 30

``` 30. A mother asks the nurse what to look for if her child has pinworms. What would be the nurse’s best response? A) Hard stools full of worms B) Perianal itching C) Upset stomach D) Bloody diarrhea ```

Answer 30

Ans: B Feedback: Pinworms manifestation includes perianal itching, and occasionally, vaginal itching particularly at night when the pinworms are most active around the anal opening. Pinworms do not usually present in any other manner so the other options are incorrect.

Question 31

31. A patient with hookworm infection states that he has a hard time following medication regimens. The nurse knows that what medication would be preferred for this patient? A) Pyrantel (Antiminth) B) Mebendazole (Vermox) C) Ivermectin (Stromectol) D) Albendazole (Albenza)

Answer 31

Ans: A Feedback: Pyrantel can be administered as a single dose, which makes it a good choice for patients who have trouble remembering to take their medications, or have trouble following medication regimens. Mebendazole requires twice-daily dosing, which makes it less optimal for a patient who has trouble with medication regimens. Ivermectin is used to treat threadworm disease (strongyloidiasis) and river blindness (onchocerciasis). Albendazole is used to treat active lesions caused by pork tapeworm and cystic disease of the liver, lungs, and peritoneum caused by dog tapeworm.

Question 32

32. What benefit would the nurse describe for treating pinworms and roundworms with a prescription for pyrantel instead of mebendazole? A) Pyrantel needs only be taken once. B) Mebendazole has many serious adverse effects. C) Pyrantel is excreted in the feces. D) Pyrantel is safer for children younger than 2 years.

Answer 32

Ans: A Feedback: Pyrantel’s big advantage is that it needs only be taken one time so it is a better choice for those who may not remember to take repeated doses. Mebendazole has very few side effects because very little of the medication is absorbed systemically so that is not a reason to prescribe pyrantel. Pyrantel is mostly excreted in the feces but some is also found in urine while mebendazole is only excreted in the feces so this does not benefit prescribing pyrantel. Pyrantel has not been established as safe for use in children under 2 years old.

Question 33

``` 33. What laboratory test will the nurse obtain to determine what type of helminth is infecting the patient? A) Stool culture B) Stool for ova and parasite C) Renal function studies D) Liver function studies ```

Answer 33

Ans: B Feedback: The only test to specifically determine what helminth is involved is a stool culture for ova and parasite. A simple stool culture would not be likely to identify the helminth. Renal and liver function studies would indicate the functioning of these organ systems but would not identify the helminth.

Question 34

``` 34. What assessment findings would raise the nurse’s level of suspicion that the patient may be infected with cestodes? (Select all that apply.) A) Abdominal discomfort and distention B) Weight loss without dieting C) Pneumonia D) Heart failure E) Encephalitis ```

Answer 34

Ans: A, B Feedback: Cestodes enter the body as larvae that are found in undercooked meat or fish; they sometimes form worms that are several yards long, people with a tapeworm may experience some abdominal discomfort and distention, as well as weight loss, because the worm eats ingested nutrients. Trichinosis can result in fatal pneumonia, heart failure, and encephalitis if not treated early, but these symptoms would not be expected with cestode infection.

Question 35

35. The nurse is caring for an 85-year-old woman diagnosed with a roundworm infection in addition to heart disease, chronic renal failure, and history of a stroke. The patient is prescribed mebendazole. What assessments will be of particular importance for this patient related to drug therapy? (Select all that apply.) A) Hydration B) Nutritional status C) Liver function D) Cognitive function E) Respiratory function

Answer 35

Ans: A, B, D Feedback: Mebendazole is a relatively safe drug with few adverse effects. However, infection by a helminth that impacts absorption of nutrients in a frail older woman could lead to significant dehydration and malnutrition so it would be of particular importance to assess this patient frequently and regularly. Respiratory function, liver function, and cognition would not be impacted by the helminth or the medication, but altered cognition could occur with malnutrition and/or dehydration.