Anthelmintic Agents

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
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.

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)
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.

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
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.

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)
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.

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
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.

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
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.

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
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.

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.
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.

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
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.

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
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.

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
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.

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.”
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.

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
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.

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
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.

15.

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

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
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.

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
Ans:
D, E

Feedback:

Praziquantel and ivermectin are readily absorbed from the GI tract. Mebendazole, pyrantel, and albendazole are not.

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
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.

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
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.

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
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.

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
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.

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
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.

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
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.

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.
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.

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
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.

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
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.

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
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.

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.”
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.

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
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.

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
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.

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)
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.

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.”
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.

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
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.

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
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.

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
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.